IJGG Journal

Introduction

Many countries acknowledged the aging of the population and its impact on long-term care expenditures are widely acknowledged, as they have started adopting policy reforms to address the consequences of population aging (AUTHORS). Relevant results might reveal more insights into constructive agendas to support policymakers in optimally allocating healthcare services to such a vulnerable group [1]. In addition, using broader outcome measures as results of such well-being surveys may provide additional information relevant to the decision to exhibit more focus on better care for older adults [2]. Multiple research studies focusing on the association of age and life satisfaction measures of older adults have found that health problems are the key determinants of life satisfaction [3]. Some studies have explicitly focused on the healthcare for elderlies with a disability as one [4]. Improving the well-being of elderly individuals with disabilities is high on the agenda of healthcare policymakers [5]. Despite acknowledging the relevance of well-being measures beyond health for older adults, scientific evidence remains sparse [6].

This study aims to increase our understanding of whether being with a disability is associated with the self-reported level of life satisfaction among older adults in Abu Dhabi. This association is fascinating to study since a disability could persist throughout a person’s lifetime. Given the increasing focus on subjective well-being as an outcome measure for elderlies with disabilities, examining what constitutes their life satisfaction and the determinants of their life satisfaction is essential. For Abu Dhabi, the third cycle of the Quality of Life (QoL-3) survey could serve as a valuable source of data to address the associations of well-being measures regarding the life satisfaction of older adults. We expect that the results of this study could boost our understanding of the well-being and life satisfaction of older adults in general and those with disabilities in particular to inform social policymaking.

Review of Literature

Life satisfaction is generally seen as a construct of subjective well-being related to how people evaluate the quality of their lives. However, some researchers attach more general aspects, such as happiness and morale, to the definition of life satisfaction; and desires concerning several essential domains of life [7]. In general, for older adults, life satisfaction is related to lifestyle behaviors [8], and both objective and subjective dimensions are used in the studies of life satisfaction of older adults [9]. Growing evidence reveals that disabilities and health conditions influence the life satisfaction of older adults [3]. They reported that life satisfaction was strongly and negatively related to the presence of some disability features.

Higher frequencies of social connection and emotional support from family and close friends can mitigate the negative influence on the overall life satisfaction of older adults [10]. Some studies refer to family relations as the most significant factor for disabled elderlies [11].  Moreover, the lack of social contact could significantly predict the quality of life for older disabled persons, especially older women [12]. Meanwhile, people with many social resources cope better when struggling with health issues than those with few social resources, and thus they may enjoy better life satisfaction [13,14]. Environmental factors could act as restrictions in the social environment and everyday activities for older people with disabilities [15]. Research on active aging has shown that physical activity and physical exercise have a positive effect on the quality of life of older people with disabilities [16]. The same study noted that physical activity prevents and slows the population’s aging process and improves their quality of life.

Several studies focus on the role of psychosocial factors in the life satisfaction of older adults with disabilities. For example, some suggest that older people who suffer from depressive feelings and loneliness might be more susceptible to the detrimental effects of disabilities, which lowers their life satisfaction [17]. On the other hand, they also elaborate that happier individuals live longer lives, enjoy better physical health, and possess greater psychological resilience. Thus, many researchers have paid increasing attention to maintaining happiness in older adults with disabilities [18]. Some studies pointed to the education level as a significant factor in the quality of life of older adults with disabilities [19]. Those disabled with a higher education tend to have a much better ability to function independently, which affects their quality of life [20].

Only a few studies look closely at the income and life satisfaction of older persons with disabilities [21]. In a sample from Siberia, [22], reported that factors such as income affect the life satisfaction of older adults. [23], Reported a significant relationship between life satisfaction and the source of income, as the mean score of life satisfaction of people who could buy and save was higher than that of others. A study [24] analyzed some income well-being determinants of life satisfaction of older adults with disabilities in Korea and confirmed a direct effect of income status on life satisfaction. In addition, the authors addressed the concept of a sense of coherence is discussed and seen as an essential personal factor in maintaining life satisfaction among older people with disabilities.

Several research publications are addressing the wellbeing of elderly adults in the context of Abu Dhabi (AUTHORS; AUTHORS). However, these studies approach the general population or older adults without focusing on the older adults with disabilities, called persons of determination (PoD) in Abu Dhabi.

Designs and Methods

The survey instrument and pre-analysis

The data used in this research were obtained from the QoL3, an alternative, multi-attribute instrument aiming to capture wellbeing outcomes for all Abu Dhabi community members, including older people with disabilities. The QoL-3 is comprehensive, with a total of fourteen modules (i. e., housing, household income, jobs and earnings, work-life balance, health, education, personal safety, social connection, civic engagement, environment quality, subjective well-being, social and cultural values, social and community services, and digital well-being. Based on the literature review, we focused mainly on the most significant predictors of life satisfaction of older disabled persons (60+ years).

A widely recognized methodology used to collect data on subjective well-being is to ask individuals to self-report their level of life satisfaction on an ordered scale [3]. Life satisfaction is usually seen as a relatively stable measure that is not dramatically affected by positive or negative life events. In this research, to be consistent with the OECD method, the self-reported level of life satisfaction, measured on a scale from 0 to 10, is used as the dependent outcome measure [25]. 

(Table 1) shows the associated well-being indicators initially considered significant to enter the analysis. We measured most indicators on a 1-5 scale and positively worded them. In addition, many attributes were selected to enter the analysis as control variables. They included gender, income category, education attainment, being the head of household or not, having a longstanding illness or not, being born with a disability or acquiring it later in life, and having someone to count on whenever needed. The QoL-3 was distributed online using more than 50 survey links created and distributed amongst the various community segments. As a result, more than 82 thousand respondents participated in the survey, of which 319 declared being older than 60 years with a disability.

Table 1: Selected well-being indicators and variables in QoL-3

Analysis methods

The primary purpose of the research is to provide a comprehensive view of the determinants of life satisfaction for Abu Dhabi’s older people with disabilities. After standardizing the data, we employed hierarchical multiple regression analysis using SPSS [26], where the levels corresponded to selected control variables. Hierarchical linear modeling has the advantage of modeling nested data more appropriately than regular multiple linear regression. Specifically, hierarchical regression refers to adding or removing predictor variables from the regression model in steps and blocks [27]. For example, the first block entered a hierarchical regression, including control variables. As a result, the current study aimed to account for the variability of the control variables by removing them before analyzing the relationship between the predictors and the outcome variable [28].

The pre-analysis examined the assumptions when applying hierarchical regression. First, we checked the distribution of the dependent variable. The Shapiro-Wilk significance test produced a value of 0.1698, and the Kolmogorov-Smirnov significance was 0.0803. Both were not statistically significant and indicated the normal distribution of the dependent variable. Concerning sample size, the number of 319 elderly PoDs in the analysis was deemed sufficient, given the explanatory variables in the model. It is worth noticing that some variables were eliminated from further analysis due to multicollinearity and other issues. Regarding the residual statistics, the standard residuals fell within a minimum of −2.021 and a maximum of 2.06. Both were within the range of −3 and +3. Finally, the values of Cook’s distance ranged from a minimum of zero to a maximum of 0.387. A few outliers were removed accordingly.

We started the process of hierarchical regression by selecting life satisfaction as the dependent variable. For the initial models, we examined the significance of many variables such as gender, being head of household or not, having a longstanding illness or not, being born with a disability or acquiring it later in life, being able to reach the level of education wanted or not, and have someone to count on whenever needed or not. Finally, the analysis used significance tests for change in R-square to assess how additional variables accounted for the variance in the ability to make ends meet. For better comprehension, additional insights into the descriptive nature of older adults with or without disabilities were sought.

Results

(Table 2) summarizes respondents who were 60 years or older with disabilities. About 60.5% were males, 58.0% were married, 80.9% were Emiratis, and 43.3% of the respondents resided in the Abu Dhabi region, and 55.8% could only read and write without qualifications.

Table 2: Profile of respondents (60+ with disabilities)

For the first block, we included gender (male or female), nationality (Emirati or else), type of housing (villa or else), marital status (married or else), long-standing illness (yes or no), and having relatives or friends who could support when needed (yes or no). The next step involved entering other independent variables in block 2 of the model. (Table 3) shows that ten variables are significant in two blocks of the hierarchical regression models. The first model with an R-square of 0.130 suggests that the two variables - having a college degree or higher and having someone to depend on when needed - account for 13% of the variance in the life satisfaction of older adults with disabilities. The second model accounts for 72.3% of the variance in the life satisfaction of older adults with disabilities. It provides evidence to suggest that nine variables significantly affect the life satisfaction of older adults with disabilities. The analysis of variance (ANOVA) results confirms the significance of both models, with the first model recording an F-value of 9.435 and the second recording an F-value of 23.474.

Table 3: Model summary

(Table 4) shows the coefficients of the significant variables considered in the models. The first model produced only two significant variables, education attainment and having relatives or friends to count on when they needed help and support—having relatives and friends that could be counted on produced a significant positive effect on the life satisfaction of the older adult with disabilities. On the other hand, education attainment produced a significant adverse effect. The negative t-value (-2.861) reflects that those older adults with disabilities (characterized mainly by reading and writing) had a significant role in the results.

Table 4: Final model coefficients

(Table 5) shows the correlations between the variables remaining in the final hierarchical model. All the correlation coefficients between the independent variables are below the 0.7 mark, suggesting a lack of multicollinearity between the independent variables. We further examined the differences between older adults with and without disabilities to obtain more insights. As shown in (Table 6), older adults with disabilities recorded lower means for most variables in the second hierarchical regression model. The highest differences in means between those with and those without disabilities are found on the two subjective mental health items (negatively worded), with a noticeable difference of 34.4% and 27.3%, respectively, followed by the variable of satisfaction with household income with a difference of 15.6%. The table also shows that the life satisfaction of older adults with disabilities is 7.2% lower than those without disabilities, and their happiness level is about 5.4%.

Table 5: Correlation between variables in the final model

Table 6: Descriptive of older adults (with or without disabilities)

Discussions

The study concentrated on the life satisfaction of older people with disabilities. By addressing the most significant determinants of life satisfaction, the current study fills the research gap to a great extent while examining the association between disability and life satisfaction among older adults. The two psychological feeling variables (frequency of feeling worried/anxious and depressed) negatively affected the life satisfaction of disabled older people in Abu Dhabi. In addition, both feelings were significantly higher among the disabled elderlies in Abu Dhabi compared to non-disabled elderlies. These findings corroborate similar studies in the UAE – mainly from the health sector – indicating rising psychological issues among elderly populations [29]. Other regional studies indicate that geriatric populations are vulnerable to psychological disorders [30]. However, these studies did not explore differences between disabled and non-disabled elderly populations. The findings in the current study suggest that disability adds a layer of complexity in investigating psychological variables among older adults and that it may have a moderating effect on psychological well-being and life satisfaction. On the global stage, such results are also consistent with other studies that revealed the negative impact of some psychosocial factors on the life satisfaction of older adults with disabilities [17].