Archives of Gerontology and Geriatrics 41 (2005) 23–29

www.elsevier.com/locate/archger

Evaluation of life satisfaction index of the

Abstract

The aim of our study was to evaluate the quality of life of the elderly living in nursing homes. A
pool of 183 elderly people living in nursing homes were involved in the study. Data regarding the
socio-demographic characteristics and life satisfaction index-A (LSI-A) of the participants were
collected by means of a questionnaire during face-to-face interviews. The average LSI-A score of the
whole group of participants was 25.26  5.51. When the mean LSI-A score of participants in relation
to their independent variables was analyzed, no statistically significant differences were found for
gender, socio-economic status or body mass indexes (BMI). However, the mean LSI-A score of those
elderly people who spent some time in leisure activities was significantly higher than those who did
not (p = 0.03). In the stepwise linear regression analysis, the education level and place of residence
were found to be the statistically significant independent predictors of LSI-A scores in the study
group (p = 0.05, p = 0.001).
# 2004 Elsevier Ireland Ltd. All rights reserved.

Keywords: Life satisfaction index-A; Nursing homes; Leisure activities in older ages

1. Introduction

Although the elderly people still constitute a small portion of the total population, in the
coming decades Turkey is expected to experience rapid population aging as a result of
decreasing mortality and fertility rates (Unalan, 2000). In the year 2000, only 5.5% of the
population was aged 65 years or more. The population projections for the year 2025 show

* Corresponding author. Present address: Soyak Yenişehir Palmiye Evleri, C 5 Blok Daire 39, 81230
Ümraniye/Istanbul, Turkey. Tel.: +90 216 3999 384/371; fax: +90 216 3996 242.
E-mail address: feryalsubasi@superonline.com (F. Subaşı).

0167-4943/$ – see front matter # 2004 Elsevier Ireland Ltd. All rights reserved.
doi:10.1016/j.archger.2004.10.005
24 F. Subaşı, O. Hayran / Archives of Gerontology and Geriatrics 41 (2005) 23–29

that the percental share of the elderly and their implications for the country’s health and
social services will be significant issues in the near future. The findings of a recent study
by Unalan (2000) suggested that more than half of the elderly population live, with at
least one of their children in the same house. This proportion was higher for females, as
compared to males. Elderly population in Turkey still holds and needs to be around their
families. The residents who live in nursing homes in Turkey because of either a lack of
close relatives, widowhood, divorce, never having married, low income, or not having
children, prefer institutionalized care in Turkey. However, as Aytaç (1998) states,
changing family lifestyles and changing medical problems associated with older
populations mean that families will no longer be in a situation to care for the elderly,
neither psychologically nor economically. Therefore, the role of nursing homes and the
quality of social and health services for the elderly will gain importance. Today a small
minority of the elderly population in Turkey is institutionalized in nursing homes; only a
limited number of studies are available regarding the social and health problems they
face.
As Kottke (1982) has rightfully stated, we should not only be interested in living a long
life but we should also care for its quality and meaning. Likewise, many gerontologists
share the view that the degree of satisfaction the elderly gets from life should be considered
alongside the core issue of prolonging their lives (Ebersole, 1995). Low life-satisfaction
scores are indicators of a serious deficit in physical and mental health and in social relations
(Fred, 1984).
Evaluation of life satisfaction has presently become a reliable tool in investigations into
rehabilitation of the elderly and in determining the efficiency of the health care services
provided for them (Ebersole, 1995). The link between life satisfaction, cognitive functions
and regular physical activity has been investigated in various studies on geriatric
rehabilitation (Cress et al., 1995; Harris et al., 1995; Ruuskanen and Ruoppila, 1995;
Roomi et al., 1996; Somogyi-Zalud et al., 2000; Wu et al., 2000). It has been reported in
these studies that regular physical activity and exercise increase both the functional
capacity of the elderly and their life satisfaction, and that one of the most important factors
determining the life satisfaction of the elderly is their level of functional independence.
Life satisfaction is not only related to one’s functional independence level, but is also
connected to such socio-demographic characteristics as income, social life, education and
leisure activities (Tulsky and Rosenthal, 2003). However, little attention has been paid to
possible socio-demographic risk factors related to life satisfaction scores for elderly
people.
This study is therefore aimed at examining the link(s) between life satisfaction and the
socio-demographic characteristics of the elderly living in nursing homes.

2. Subjects and methods

This cross-sectional study was conducted on a group of elderly people (n = 183) living
in three different nursing homes in three provinces: Istanbul, Izmir and Bolu. All of these
nursing homes are maintained and managed by the Institution for the Protection of
Children and Social Services, a government organization, operating under the auspices of
 F. Subaşı, O. Hayran / Archives of Gerontology and Geriatrics 41 (2005) 23–29 25

the Prime Ministry, which owns 37% of all nursing homes in Turkey, 28% being owned by
the private sector and the rest owned by municipalities. The total bed capacity of these
nursing homes is approximately 16,000.
Two kinds of health care services are provided in nursing homes: primary health care
services for all residents and long-term care and rehabilitating services for the elderly with
chronic disabling conditions. Older people with functional disabilities are dependent on
others in their activities of daily living (ADL), such as bathing, dressing, transfer,
continence, ambulation or eating are accepted in the ‘‘Nursing home, elderly care and
rehabilitation centers’’. Those who do not have functional disabilities or are independent
for ADL and cognitive functions are accepted in common nursing homes. The physician,
nursing assistants and social workers and psychologists in the nursing homes for those who
require assistance and supervision but do not need intensive rehabilitation, provides
services. Our study group was comprised of pensioners who were independent in ADL and
had no significant functional disability. Because the study group was not randomly selected
using sampling methods, the result of the study cannot be applied to all nursing home
residents in Turkey.
Criteria for inclusion in the study were as follows: (1) Being in a stable medical
condition; (2) not being bedridden or in a wheelchair; (3) being independent of other
people in carrying out daily living activities; such as bathing, dressing, transfer, continence,
ambulation or eating; (4) having the mental capacity and sufficient cognitive functions to
learn and retain new information; (5) motivated and willing to participate in the study.
Subjects who had a history of significant cardiovascular, pulmonary, metabolic and/or
musculoskeletal diseases were excluded. The physician in the nursing home before the
study has verified these criteria. The response rate in the study was 92%.
The life satisfaction index-A (LSI-A) questionnaire was applied to all the subjects
during face-to-face interviews by trained interviewers (Neugarten et al., 1961; Adams,
1969; Iwatsubo et al., 1996; Franchignoni et al., 1999). Of the 20 items in the
questionnaire, 12 items were positively worded; 0, 1 and 2 points were assigned to
‘‘disagree’’, ‘‘don’t know’’ and ‘‘agree’’ answers, respectively. Eight items were negatively
worded. 0 assigned to the ‘‘agree’’ answer. This shows that the scores to be received from
LSI-A ranged between 0 and 40 points.
The socio-demographic characteristics of the subjects were scored as follows: gender
(female = 1, male = 2); marital status (1 = never married, divorced, widow/widower;
2 = married); level of education (1 = no education/illiterate, 2 = primary school, 3 = high
school, 4 = college/university); income (1 = yes, 2 = no); leisure activities (reading, going
out for a walk, doing exercise, gardening, doing handicrafts, etc.) (1 = yes, 2 = no).

2.1. Statistical analysis

The collected data were analyzed using the SPSS 10.0 statistical package program. The
Student’s t-test, x2 test and one-way ANOVA were used during analysis. We also have
constructed stepwise regression models to determine the predictors of LSI-A. Independent
variables were age, gender, education level, marital status, place of residence, involvement
in leisure time activities and regular income status. We set the critical value for significance
in all the analysis at p < 0.05.
26 F. Subaşı, O. Hayran / Archives of Gerontology and Geriatrics 41 (2005) 23–29

3. Results

The mean LSI-A scores of the study group with regard to socio-demographic
characteristics are given in Table 1 (n = 183, mean age = 73.0  7.9); 57.9% of the
participants were male, 59.6% had a primary school education, 88.0% were single
(divorced or never married, widow or widower), and 73.8% had a regular income.
Statistically significant differences were found between the mean LSI-A scores of the
participants in terms of marital status (p = 0.02), leisure time activity (p = 0.03), education
level (p = 0.03) and place of residence (p = 0.001). Table 2 presents the relationship
between the nursing homes and involvement in leisure activities, which reveals that 59% of
the subjects regularly occupied themselves with such activities as handicrafts, walking, and
reading, etc. When leisure activities performed by the study group were analyzed
according to the nursing homes they lived in, it was revealed that 92.5% of those living in
Istanbul were in the habit of occupying themselves with some kind of activity.
Furthermore, the subjects’ LSI-A scores in relation to the nursing home they resided in
were noted to vary to a significant degree (p = 0.001). In the stepwise linear regression,

Table 1
Mean LSI-A scores of the study group with regard to socio-demographic characteristics
Socio-demographic characteristics N (%) LSI-A score, mean (S.D.) Significance
Age groups (years)
60–69 61 (33.3) 25.9 (5.3) F = 0.56
70–79 76 (41.5) 25.1 (6.0) p > 0.05
>79 46 (25.2) 24.8 (5.0)
Gender
Male 106 (57.9) 25.2 (5.2) t = 0.20
Female 77 (42.1) 25.4 (5.9) p > 0.05
Education level
No education 38 (20.8) 23.3 (4.8)
Primary school 109 (59.6) 25.5 (5.7) F = 2.97
Secondary school 24 (13.1) 25.9 (4.6) p = 0.03
University 12 (6.5) 28.3 (6.1)
Marital status
Single 161 (88.0) 24.9 (5.5) t = 2.25
Married 22 (12.0) 27.7 (5.3) p = 0.02
Place of residence
Istanbul 53 (29.0) 28.4 (5.9)
Izmir 93 (50.8) 24.1 (4.9) F = 13.94
Bolu 37 (20.2) 23.7 (4.4) p = 0.001
Involvement in leisure time activities
Yes 108 (59.0) 26.0 (6.0) t = 2.14
No 75 (41.0) 24.2 (4.7) p = 0.03
Regular income
Yes 135 (73.8) 25.5 (5.5) t = 0.84
No 48 (26.2) 24.7 (5.5) p > 0.05
 F. Subaşı, O. Hayran / Archives of Gerontology and Geriatrics 41 (2005) 23–29 27

Table 2
The frequency of leisure activities in the different nursing homes, n and %
Location of the nursing homes Active Non-active Total (100.0%)
Istanbul 49 (92.5) 4 (7.5) 53
Izmir 48 (51.6) 45 (48.4) 93
Bolu 11 (29.7) 26 (70.3) 37
Total 108 (59.0) 75 (41.0) 183
x2 = 39.726, p = 0.001.

Table 3
Predictors of LSI-A in the study group
Predictor B S.E.M. Significance
Age 0.06 0.05 p = 0.22
Gender 0.02 0.79 p = 0.92
Education level 1.06 0.54 p < 0.05*
Marital status 1.57 1.21 p = 0.19
Place of residence 1.75 0.48 p < 0.001*
Involvement in leisure time activities 1.07 0.83 p = 0.20
Regular income 0.28 0.95 p = 0.76
*
= statistically significant; B = the mean partial regression coefficient in the regression equation; S.E.M. = the
standard error of the mean B; R2 = 0.15; R = 0.39.

statistically significant predictors of LSI-A scores were revealed to be place of residence

4. Discussion

Iwatsubo et al. (1996) state that general health status, personal characteristics, career
history, social relations and demographic characteristics are factors affecting life
satisfaction in the elderly. Likewise, Ebersole (1995) argues that in geriatric care, the life
satisfaction of the elderly basically reflects their functional status. In this study, we have
attempted to evaluate the link between the life satisfaction and socio-demographic
characteristics of the elderly (60 years of age and above) with the following characteristics:
being independent in performing such daily living activities as eating, dressing, bathing
and transfer; having sufficient mental and cognitive functions; being medically stable; and
living in a nursing home. The statistical analyses show that leisure activities, marital status
and levels of education significantly influence the LSI-A scores of the subjects (Table 1)
(p = 0.03, p = 0.02, p = 0.03, respectively). To illustrate, it was observed that a high level of
education (college/university) gives rise to a statistical increase in LSI-A scores (Table 1).
Using a stepwise regression analysis, education levels and the place of residence were
identified as the statistically significance independent predictors of LSI-A scores in the
study group (Table 3). It was also observed that the LSI-A scores of elderly people who
were involved in some kind of leisure activity (handicrafts, reading, walking, etc.) were
higher than the scores of those who were not involved in such activities (Table 2),
(p = 0.001). Thus, high levels of education along with the area one lives in may explain the
28 F. Subaşı, O. Hayran / Archives of Gerontology and Geriatrics 41 (2005) 23–29

higher LSI-A scores in the study group. In a study carried out in Paris on retired individuals
over a period of 60 years, Iwatsubo et al. (1996) examined the factors affecting LSI scores
by multivariety analysis, demonstrating that these factors were physical activity, state of
mental health, social activities and hobbies. Fuhrer et al. (1992), examining the life
satisfaction of a group of individuals with spinal cord injuries, between the ages of 19–77,
maintain that the LSI-A scores of this group were below those of the normal population,
and that the group’s LSI scores were not affected by disability or impairment, but by
handicap. In the elderly, there is a link between levels of physical activity and feeling
psychologically sound; this naturally affects their ability to perform daily living activities
(Strasser, 1992). Our study group consisted of subjects performing ADL activities
independently.
Total scores that can be received from this index range from 0 to 40, with higher scores
signifying greater life satisfaction (Adams, 1969; Franchignoni et al., 1999). Of note, the
mean LSI-A score of our cases was 25.2  5.5, similar to the 26.1  6.9 recorded by
Franchignoni et al. (1999) among healthy individuals. Although Iwatsubo et al. (1996)
found a mean LSI-A score among the retired elderly at 12.1  4.4, the index made use of in
their study was modified, and the highest score that could be received from the LSI-A was
reduced to 20.
It has been maintained in various studies that the mental, emotional or social status of
geriatric individuals is as important as their physical functionality (Guilmette et al., 1992;
Strasser, 1992; Rudman et al., 1993; Greendale et al., 2000). In our opinion, however, from
the point of view of geriatric rehabilitation it is not easy to determine which of these factors
is greater in importance, as the severity of the factors, the personal characteristics of the
individuals and the complexities of the social relations involved must all be taken into
account.
In summary, the data suggest that the life satisfaction of the study group was positively
affected by participation in leisure activities (handicrafts, reading, walking, etc.) in the
nursing homes they lived in. Further studies into how controlled leisure time activities in
the elderly can be promoted would be a welcome addition to the field.

References

Adams, D.L., 1969. Analysis of a life satisfaction index. J. Gerontol. 24, 470–474.
Aytaç, I.A., 1998. Intergenerational living arrangements in Turkey. J. Cross-Cult. Gerontol. 13, 241–264.
Cress, M.E., Schechtmann, K.B., Mulrow, C.D., Fiatarone, M.A., Gerety, M.B., Buchner, D.M., 1995. Relation-
ship between physical performance and self-perceived physical function. J. Am. Geriatr. Soc. 43, 93–101.
Ebersole, P., 1995. Quality life: what is it? Geriatr. Nurs. 16, 49–50, March–April.
Franchignoni, F., Tesio, L., Ottonello, M., Benevolo, E., 1999. Life satisfaction index: Italian version and
validation of short form. Am. J. Med. Rehabil. 78, 509–515.
Fred, M.M., 1984. Quality of life: physician’s dilemma. Arch. Phys. Med. Rehabil. 6, 100–102.
Fuhrer, M., Rintala, D.H., Hart, K.A., Clearman, R., Young, M.E., 1992. Relationship of life satisfaction to
impairment, disability and handicap among persons with spinal cord injury living in the community. Arch.
Phys. Med. Rehabil. 73, 552–557.
Greendale, G.A., Salem, G.J., Young, J.T., Damesyn, M., Marion, M., Wang, M.Y., Reuben, D.B., 2000. A
randomized trial of weighted vest use in ambulatory older adults: strength, performance and quality of life
outcomes. J. Am. Geriatr. Soc. 48, 305–311.
 F. Subaşı, O. Hayran / Archives of Gerontology and Geriatrics 41 (2005) 23–29 29

Guilmette, T.J., Snow, M.G., Grace, J., Giuliano, J., 1992. Emotional dysfunction in a geriatric population: staff
observations and patients reports. Arch. Phys. Med. Rehabil. 73, 587–593.
Harris, R.E., O’Hara, P.A., Harper, D.W., 1995. Functional status of geriatric rehabilitation patients: a one-year
follow-up study. J. Am. Geriatr. Soc. 43, 51–55.
Iwatsubo, Y., Derrıennıc, F., Cassou, B., Poıtrenaud, J., 1996. Predictors of life satisfaction amongst retired people
in Paris. Int. J. Epidemiol. 25, 160–170.
Kottke, F.J., 1982. Philosophic considerations of quality of life for disabled. Arch. Phys. Med. Rehabil. 63, 60–62.
Neugarten, B.L., Havighurst, R.J., Tobin, S.S., 1961. The measurement of life satisfaction. J. Gerontol. 16, 134–
143.
Roomi, J., Johnson, M.M., Waters, K., Yohannes, A., Helm, A., Connolly, M.J., 1996. Respiratory rehabilitation,
exercise capacity and quality of life in chronic airways disease in old age. Age Ageing 25, 12–16.
Rudman, D., McCormack, J., Cuisinier, M., Mattson, D.E., 1993. A simple method to quantify the changes in
activities of daily living of long-stay nursing home populations. Am. J. Phys. Med. Rehabil. 72, 276–280.
Ruuskanen, J.M., Ruoppila, I., 1995. Physical activity and psychological well-being among people aged 65 to 84
years. Age Ageing 24, 292–296.
Somogyi-Zalud, E., Zhong, Z., Lynn, J., Hamel, M.B., 2000. Elderly persons last six months of life: findings from
the hospitalized elderly longitudinal project. J. Am. Geriatr. Soc. 48, 131–139.
Strasser, D.C., 1992. Geriatric rehabilitation: perspectives from the United Kingdom. Am. J. Phys. Med. Rehabil.
73, 582–586.
Tulsky, D.S., Rosenthal, M., 2003. Measurement of quality of life in rehabilitation medicine: emerging issues.
Arch. Phys. Med. Rehabil. 84 (Suppl. 2), S1–S14.
Unalan, T., 2000. The status of old age population in Turkey. Turk. J. Popul. Stud. 22, 3–22.
Wu, A.W., Yasui, Y., Alzola, C., Galanos, A.N., Tsevat, J., Phillips, R.S., Connors, A.F., Teno, J.M., Wenger, N.S.,
Lynn, J., 2000. Predicting functional status outcomes in hospitalized patients aged 80 years and older. J. Am.
Geriatr. Soc. 48 (Suppl.), S6–S15.