Causal Model of the Anticipation of Quality of Life Based on Activity of Daily Living and Social Capital in the Elderly: The Mediating Role of Self-Care

According to population aging phenomenon all around the world, taking care of the older population is an important mission of the community health system to maintain their quality of life. Thus, it seems important that the experience of a long life is accompanied by desirable quality of life. Therefore, this study aimed to provide a quality of life model based on activity of daily living and social capital with the mediating role of self-care in the elderly. The population of the study included all the elderly aged over 60 living in Tehran in 2020, among whom 243 were selected through convenience sampling. Data were collected using the World Health Organization Short-Form Quality of Life (World Health Organization), Self-Care (Soderhamn), Social capital (Onyx and Bullen) and Activity of daily living (Mahoney and Barthel) questionnaires. Path analysis was used to analyze the causal model in AMOS-24. The results demonstrated that activity of daily living (β=0.547, p>0.01), social capital (β=0.178, p>0.01) and selfe-care (β=0.420, p>0.01) can predict quality of life in the elderly. Moreover, the mediating role of self-care in the relationship between activity of daily living and social capital with quality of life in the elderly was confirmed. According to the results of the present study, it can be said that the promotion of self-care through the health-related training programmes, appears to be an effective step in order to improve the quality of life in the elderly.
References
Ahmadi, F., Salar, A., & Faghihzadeh, S. (2004). Quality of life in Zahedan elderly population. Hayat, 10 (3), 61-67. [Persian]
Alimohamad, F., Setode Asl, N., & Karami, A. (2020). Developing a quality of life model based on metacognitive beliefs mediated with perceived stress in the elderly. Journal of Aging Psychology, 6(4), 341-355. [Persian]
 Alimohammadi, F., Setodeh-asl, N., & Karami, A. (2019). Designing a model of quality of life in elderly based on perceived stress and tolerance of distress. Journal of Health and Care, 21 (1), 53-65. [Persian] https://hcjournal.arums.ac.ir/article-1-1001-fa.html
Alizadeh-Aghdam, M. B., & Soltani-Bahram, S., & Alizadeh-Aghdam, R. (2013). Relationship between social capital and the quality of life in university of Tabriz retirees. Journal for Management and Development Process, 26(3), 63-78. [Persian]
 Andalib Kourayem, M., & Mahmoodinia, S. (2021). The Quality of life in the elderly: The Role of resiliency and mindfulness. Aging Psychology, 7(2), 167-179. [Persian]
 Asgari, S., & Shafiee, H. (2017). Prediction of elderly quality of life based on internal coherence, mindfulness and spiritual intelligence. Positive Psychology Research, 3(3), 61-74. [Persian]
 Ashoori, J. (2016). Investigation the role of social capital, social support and psychological hardiness in predicting life quality of elderly women. Journal of Geriatric Nursing, 2 (4),70-81. [Persian]
Barry, P. P. (2000). An Overview of special considerations in the evaluation and management of the geriatric patient. The American Journal of Gastroenteroly, 95(1), 8-10. https://doi.org/10.1016/S0002-9270(99)00756-X
Bonomi, P., Kim, K., Fairclough, D., Cella, D., Kugler, J., Rowinsky, E., & Johnson, D. (2000). Comparison of survival and quality of life in advanced non-small-cell lung cancer patients treated with two dose levels of paclitaxel combined with cisplatin versus etoposide with cisplatin: results of an Eastern Cooperative Oncology Group trial. Journal of Clinical Oncology, 18(3), 623-631. https://doi.org/10.1200/JCO.2000.18.3.623
Christiansen, L., Sanmartin Berglund, J., Lindberg, C., Anderberg, P., & Skär, L. (2019). Health‐related quality of life and related factors among a sample of older people with cognitive impairment. Nursing Open, 6, 849–859. https:// doi.org/10.1002/nop2.265
Demura, S., & Sato, S. (2003). Relationships between depression, lifestyle and quality of life in the community dwelling elderly: A com-parison between gender and age groups. Journal of Physiological Anthropology and Applied Human Science, 22(3), 159-66.  https://doi.org/10.2114/jpa.22.159
Eftekharian, R., Kaldi, A., Sum, S., Sahaf, R., & Fadaye Vatan, R. (2016). Validity and reliability of Persian version of Onyx social capital scale in elderly people. Salmand: Iranian Journal of Ageing, 11 (1), 174-189. [Persian] https://salmandj.uswr.ac.ir/article-1-746-fa.html
Firouzjah, B. (2016). Study of elder’s life quality living in homes and nursery home (Unpublished Master thesis). Allame Tabatabai University, Teharn. [Persian]
Glaeser, E. Laibson, D., & Sacerdote, B. (2000). The economic approach to social capital. National Bureau of Economic Research. Working paper. N. 7728 (Cambridge, AM. National Bureau of economic research).  https://doi.org/10.3386/w7728
Grady, K. L. (2008). Self-care and quality of life outcomes in heart failure patients. Journal of Cardiovascular Nursing Lippincott, 23(3), 285-292. https://doi.org/10.1097/01.JCN.0000305092. 42882
Habibi-Sola, A., Nikpour, S., Seyedshohadiei, M., Haghani, H. (2008). Health promotion behaviours and quality of life among elderly people: A crosssectional survey. Iran Journal of Nursing, 21(53), 29-39. [Persian]
Hashemlo, L., Hemmati Maslakpak, M., & Khalkhali, H. (2013). The Effect of Orem self-care program performance on the self- care ability in elderly. Nursing and Midwifery Journal, 11 (2), 119-126. [Persian]
He, Q. Y., Hu, H., Gao, B., Yang, S. J., & Li, N. X. (2010). [The Study of the relationship between community social capital and quality of life among the middle-aged and elderly rural-to-urban residents]. Sichuan Da Xue Xue Bao Yi Xue Ban, 51(2), 225-230. https://doi.org/10.12182/20200360502.
Himanshu, H., Arokiasamy, P., & Talukdar, B. (2019). Illustrative effects of social on health and quality of life among older adult in India: Results from WHO-SAGE India. Archives of Gerontology and Geriatrica, 82, 15-21.  https://doi.org/10.1016/j.archger.2019.01.005
 Kassani, A., Menati, R., Menati, W., Shoja, M., & Mirbalouch, A. (2014). Investigation of the Effective factors in social capital and its relationship with quality of life in elders of Ilam, Iran. Sadra Medical Sciences Journal, 2(3), 235-244. [Persian]
Kazemi, N., Sajjadi, H., & Bahrami, G. (2019). Quality of life in Iranian elderly. Salmand: Iranian Journal of Ageing, 13 (5), 518-533. [Persian]
Kim, D. & Kawachi, I. (2007). U.S. state level social capital and health related quality of life. Annals of Epidemiology, 17 (4), 258-269. https://doi.org/10.1016/j.annepidem.2006.10.002
Kline, R. B. (2005). Principles and practice of structural equation modeling, edition 2, Guilford press, New York & London.   
  Kowalski, C. H., Ommen, O., Driller, E., Ernstmann, N., Wirtz, M. A., Kohler, T., & Pfaff H. (2010). Burnout in nurses - the relationship between social capital in hospitals and emotional exhaustion. Journal of Clinical Nursing, 19, 1654-1663.  https://doi.org/10.1111/j.1365-2702.2009.02989.x.
Landi, F., Abbatecola, A. M., Provinciali, M., Corsonello, A., Bustacchini, S., Manigrasso, L., & Lattanzio, F. (2010). Moving against frailty: does physical activity matter? Biogerontology, 11(5), 537-545. https://doi.org/10.1007/s10522-010-9296-1
Lane, A. P., Wong, C. H., Močnik, Š., Song, S., & Yuen, B. (2020). Association of neighborhood social capital with quality of life among older people in Singapore. Journal of Aging and Health, 32(7-8), 841-850. https://doi.org/10.1177/0898264319857990
Levin, L. S., Katz, A. H. & Holst, E. (1977). Self care: Lay initiatives in health. Croom Helm: London.
Lorig, K. R., Sobel, D. S., Stewart, A. L., Brown, J. R., Bandura, A., Ritter, P., Gonzalez, V. M., Laurent, D. D., & Holman, H. R. (1999). Evidence suggesting that a chronic disease self-manage-ment program can improve health status while reducing hos-pitalization: A randomized trial. Journal of the Medical Care, 37(1),5-14. https://doi.org/10.1097/00005650-199901000-00003
Mackenbach, J.P., Hu, Y., & Looman, C.W.N. (2013). Democratization and life expectancy in Europe, 1960–2008. Social Science & Medicine, 93, 166-75. https://doi.org/10.1016/j.socscimed.2013.05.010
Mahoney, F. I., & Barthel, D. W. (1965). Functional evaluation: barthel Index. Maryland State Medical Journal, 14(2), 61-65.
Medhi, G.K., Sarma, J., Pala, S., Bhattacharya, H., Bora, P. J., & Visi, V. (2019). Association between health related quality of life (HRQOL) and activity of daily living (ADL) among elderly in an urban setting of Assam, India. Jouran of Family Medicine and Primary Care, 8(5),1760-1764. https://doi.org/10.4103/jfmpc.jfmpc_270_19
Mellor, D., Russo, S., McCabe, M. P., Davison, T. E., & George, K. (2008). De-pression training program for caregivers of elderly care re-cipients: Implementation and qualitative evaluation. Journal of Gerontological Nursing, 34(9),8-15.  https://doi.org/10.3928/00989134-20080901-09
Mesgar, S., Amini Nasab, Z., Nakhaei, M. H., Sharifzade, G., Seyyed Alira Javadinia, S.A. (2015). Study of quality of life, depression, and daily routines in rural elders in Birjand city, Iran, in 2013A. Iranian Journal of Ageing, 10(3), 143-147. [Persian]
Mirsaeedi, Z. S., Eftekhar ardebili, H., Nouri jalyani, & K. A. (2013). Effect of a self care program on quality of life of the elderly clients covered by health centers of Southern of Tehran. Journal of School of Public Health and Institute of Public Health Research, 10 (4),17-32. [Persian]
Mueller, R. O. (1996). Basic Principles Modeling, NY: Springer.
Nejat, S., Montazeri, A., Holakouie Naieni,. K, Mohammad, K., & Majdzadeh, S. (2006). The World Health Organization quality of Life (WHOQOL-BREF) questionnaire: Translation and validation study of the Iranian version. Journal of School of Public Health and Institute of Public Health Research, 4 (4),1-12. [Persian]
Onyx, J. & Bullen, P. (2000). Measuring social capital in five communities. Journal of Applied Behavioral Science, 36(1), 23-42. https://doi.org/10.1177/0021886300361002
Oraki, M., Mahdizadeh, A., & Dortaj, A. (2019). The Effectiveness of self-care empowerment training on life expectancy, happiness and quality of life of the elderly in Iranian elderly care Centers in Dubai. Salmand: Iranian Journal of Ageing, 14(3), 320-331. [Persian] https://doi.org/10.32598/sija.13.10.670
Payahoo, L., Khaje-bishak, Y., Pourghasem, B., Asghari jafarabadi, M., Kabir-alavi, M. B. (2013). The survey of the relationship between quality of life of elderly with depression and physical activity in Tabriz, Iran. Journal of Rehabilitation Medicine, 2(2), 39-46. [Persian] https://www.sid.ir/fa/journal/ViewPaper.aspx?id=232256
Prachuntasen, K., Laohasiriwong, W., & Luenam, A. (2018). Social capital associated with quality of life among late adults and elderly population in the Northeast of Thailand. https://doi.org/10.12688/f1000research.13954.1
Sattari, B. (2006). Studying the social status and health concerningrural elderly using the plan for rural empowering. Iranian Journal of Ageing, 1(2), 132-139.
Sherwood, S., Morris, J., Mor, V., & Gutkin, C. (1977). Compendium of measures for describing and assessing long-term care populations. Boston: Hebrew Rehabilitation Center for the Aged.
Skevington, S. M., Lotfy, M, & O'Connell K. A. (2004). The World Health Organization's WHOQOL-BREF quality of life assessment: psychometric properties and results of the international field trial. A report from the WHOQOL group. Quality of Life Research, 13(2), 299-310. https://doi.org/10.1023/B:QURE.0000018486.91360.00.
Smeltzer, S.C. & Bare, B.G. (2008). Brunner & Suddarths Textbook of Medical –Surgical Nursing (11th Eds.). Lippincott Co.
Soderhamn, O., Bachrach-Lindstorm, M. & EK, A. C. (2008). Self-care ability and sense of coherence in older nutritional at-risk patients. European Journal of Clinical Nutrition, 62 (1), 96-103. https://doi. Org. 10.1038/sj.ejcn.1602691
Soderhamn, O., EK, A. C., & Porn I. (1996). The self-care ability scale for the elderly. Scandinavian Journal of Occupational Therapy, 3 (2), 69-78.
Soosova,  M. S.   (2016).   Determinations   of  quality of life in the elderly. Central European Journal of Nurings and Midwifery, 7(3), 484-493.  https://doi.org/10.15452/CEJNM.2016.07.0019
Soury, A., Shabani Moghadam, K., & Soury, R. (2016). The effect of physical activity on quality of life in elder women in Kermanshah Province. Applied Research of Sport Management, 4(4), 75-84. [Persian]
Taheri Tanjani, P., & Azadbakht, M. (2016). Psychometric Properties of the Persian Version of the Activities of Daily Living Scale and Instrumental Activities of Daily Living Scale in elderly. Journal of Mazandaran University Medical Sciences, 25 (132), 103-112. [Persian]
Talarska, D., Tobis, S., Kotkowiak, M., Strugala, M., Stanislawska, J., & Wieczorowska, K. (2018). Determinants of Quality of Life and the Need for Support for the Elderly with Good Physical and Mental Functioning. Medical Science Monitor, 24, 1604-1613. https://doi.org/10.12659/MSM.907032
Tannenbaum, C. & Shatenstein, B. (2007). Exercise and nutrition in older Canadian women: opportunities forcommunity intervention. Canadian Journal of Public Health, 98(3), 187-193.  https://doi.org/10.1007/BF03403710
 
Tavakolizadeh, J., Jamali, Z., & Safarzade, S. (2015). Role of depression, anxiety and demographical factors in predicting the quality of life of retired elderly of Gonabad city. Horizon Medical Sciences, 21(4), 129-135. [Persian] https://hms.gmu.ac.ir/article-1-2418-fa.html
Unsar, S., Dindar, I., & Kurt, S. (2015). Activities of daily living, quality of life social support and depression levels of elderly individuals in Turkish society. Journal of Pakistan Medical Association, 65(6), 642-646.
 
Vafaei, Z., Haghdoost, A. A., Alizadeh, M., & Dortaj, E. (2014). Prevalence of disability and relevant risk factors in elderly dwellers in Isfahan province-2012. Salmand: Iranian Journal of Ageing, 8 (4), 32-40. [Persian]
Veenstra,   G.   (2005).    Location,    location, location: contextual and compositional health effects of social capital in British Columbia, Canada. Social Scienceand Medicine, 60(9), 2059-2071.
Wade, D., & Hewer, R. (1987). Functional abilities after stroke: Measurment, natural history and prognosis. Journal of Neurological Neurosurgery and Osychitry, 50, 177-182. https://doi.org/10.1136/jnnp.50.2.177
Xiao, H., Yoon, J. Y., & Bowers, B. (2017). Quality of life of nursing home residents in China: A mediation analysis. Nursing & Health Sciences, 19(2),149-56.  https://doi.org/10.1111/nhs.12288
 Zahedi Asl, M., & Farokhi, J. (2010). Studying the relation of life quality and social capital. Quarterly Journal of Social Sciences, 1(49), 1-29. [Persian]
Zahmatkeshan, N., Bagherzadeh, R., Akaberian, S. H., Yazdankhah Fard, M., Mirzaei, K., Yazdanpanah, S., Khorram Roudi, R., Gharibi, T., Kamali Dasharzhani, F., & Vajmand, T. (2012). Study of quality of life and related aspects of it in the elderly in Boushehr. Journal of Fasa University of Medical Sciences, 2(1), 53-58. [Persian]