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Domains and determinants of a person-centered index of aging well in Canada: a mixed-methods study

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Abstract

Objectives

The objectives of this study were to explore the perspectives of older adults about the most important domains of aging well and to identify the social determinants of a person-centered index capturing these domains.

Methods

We conducted a mixed-methods study of 40 semi-structured interviews and epidemiological data from 670 older adults participating in the International Mobility in Aging Study (IMIAS) in Saint-Hyacinthe and Kingston. A composite index capturing the domains of aging well was constructed on the basis of findings from qualitative content analysis. Bivariate and multivariate regressions were carried out to examine the determinants of aging well, including economic determinants, health behaviours, health services, and the social environment.

Results

The qualitative results confirm the importance of symptomatic health conditions and psychosocial components. The index was computed as a continuous score (0 to 100) containing health components (ADL disability, mobility disability, pain, self-rated health, and cognitive function), and psychosocial components (mood, productive activities, social relations, life satisfaction, and self-mastery). Mean scores were 81 among Canadian older adults, and 83 and 79 for men and women respectively. Being male, having sufficient income, doing leisure physical activity, and feeling safe in one’s neighbourhood were all significantly associated with a higher score on the aging well index.

Conclusion

The composite index highlights important aspects of health and psychosocial well-being that could be augmented according to older adults themselves. Modifiable social determinants of aging well could guide social and health policies to maximize well-being in this population.

Résumé

Objectifs

Les objectifs de cette étude étaient d’explorer la perspective de personnes âgées à propos des plus importants domaines de ce que signifie bien vieillir, ainsi que d’identifier les déterminants sociaux d’un index de bien vieillir centré sur la personne incluant ces domaines.

Méthodes

Nous avons effectué une étude à méthodes mixtes utilisant 40 entretiens semi-dirigés et des données épidémiologiques provenant de 670 personnes âgées ayant participé à l’étude internationale sur la mobilité au cours du vieillissement (IMIAS) au Canada, à Saint-Hyacinthe et à Kingston. Un index comprenant les domaines mentionnés par les participants au devis qualitatif a été construit à partir de mesures existantes. Des régressions bivariée et multivariée ont ensuite été estimées afin d’examiner les déterminants sociaux de l’index de bien vieillir, notamment les déterminants économiques, les comportements de santé, l’accès aux services de santé, et l’environnement social.

Résultats

Les résultats du devis qualitatif confirment l’importance de conditions de santé symptomatiques et de composantes psychosociales. Un index continu (0 à 100) a été développé, comprenant des domaines de la santé (incapacité dans les activités de la vie quotidienne, incapacité de mobilité, douleur, santé perçue et fonction cognitive) et psychosociaux (humeur, activités productives, relations sociales, satisfaction dans la vie et maitrise de soi). Les scores moyens étaient de 81 pour l’ensemble des répondants canadiens, ainsi que de 83 et 79 pour les hommes et les femmes, respectivement. Être un homme, avoir un revenu suffisant, faire des activités physiques comme loisir et se sentir en sécurité dans son quartier étaient des déterminants associés de manière statistiquement significative à un score plus élevé sur l’index de bien vieillir.

Conclusion

L’index proposé dans cette étude met en lumière des aspects importants de la santé et des domaines psychosociaux qui pourraient être améliorés selon la perspective de personnes âgées canadiennes. Les déterminants sociaux modifiables qui ont été identifiés pourraient guider des politiques sociales et de santé afin de maximiser le bien-être de cette population.

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Acknowledgements

The authors would like to thank the research participants. The first author received a postdoctoral fellowship from the Quebec Research Fund- Health (FRQ-S) to conduct this work. The qualitative study expenses were supported by a new initiative grant from the Public Health Research Institute of University of Montreal (IRSPUM). The IMIAS study was supported by an emerging team grant from the Canadian Institutes of Health Research (AAM-108751).

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Authors and Affiliations

  1. Center for Gerontology and Healthcare Research, Department of Health Services, Policy and Practice, School of Public Health, Brown University, 121 South Main Street, Providence, RI, 02903, USA

    Emmanuelle Bélanger

  2. Instituto Nacional de Geriatria, Mexico City, Mexico

    Mario Ulises Pérez-Zepeda & Roberto Carlos Castrejón-Pérez

  3. School of Rehabilitation Therapy, Queen’s University, Kingston, Canada

    Tamer Ahmed

  4. Sacré-Coeur Hospital Research Centre, Department of Social and Preventive Medicine, University of Montreal, Montreal, Canada

    Grégory Moullec

  5. Department of Family Medicine, Queen’s University, Kingston, Canada

    Susan P. Phillips

  6. Department of Social and Preventive Medicine, University of Montreal, Montreal, Canada

    Maria Victoria Zunzunegui

Authors
  1. Emmanuelle Bélanger
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  2. Mario Ulises Pérez-Zepeda
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  3. Roberto Carlos Castrejón-Pérez
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  4. Tamer Ahmed
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  5. Grégory Moullec
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  6. Susan P. Phillips
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  7. Maria Victoria Zunzunegui
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Correspondence to Emmanuelle Bélanger.

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Bélanger, E., Pérez-Zepeda, M.U., Castrejón-Pérez, R.C. et al. Domains and determinants of a person-centered index of aging well in Canada: a mixed-methods study. Can J Public Health 109, 855–865 (2018). https://doi.org/10.17269/s41997-018-0114-x

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  • DOI: https://doi.org/10.17269/s41997-018-0114-x

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