Happiness in and out of nursing homes: The case of Cyprus

Abstract

This study measures the level of happiness among elderly Cypriots living in their own home environments and in nursing homes. We find that the elderly living in their own home are significantly happier than the elderly living in nursing homes. On the basis of these findings, we propose that the role of social workers could be valuable regarding happiness of older Cypriots. Within the frame of the current results, we have identified a lack of alternative housing options in Cyprus that would combine home environment with adequate health and social care for older people.

Keywords

Cypriot elderly people old age happiness home environment nursing homes social work

Introduction

The world ageing population is ageing fast with Europe to be probably the region with the most rapidly ageing population. On a global level, the number of people aged 60 and over is projected to increase dramatically between the years 2000 and 2050 (Bloom et al., 2009). The expected change in the age structure will eventually lead to ‘a substantially higher proportion of older people in the world’ (Börsch-Supan, 2004: 1). In particular, the 2009 Ageing Report indicates that demographic changes are transforming the European Union (EU) population through longer life expectancy, low fertility and inward migration (European Economy, 2008). The age structure of the European population is older than that of any other world region and is set to age further during the next few decades (Grundy, 2006; United Nations, 2002). The Cyprus Statistical Service predicts that by the year 2051 life expectancy for women will be 85 years compared to 81.8 years currently, and 79 years for men compared to 76.9 today; this represents an increase in the older population from the current figure of 13 percent to 28 percent (Statistical Service of Cyprus (CYSTAT), 2007). Yet, there is a lot to life after 60 – and society is coming increasingly to appreciate the contribution older people can make (Europa, 2012).

While ageing is a global phenomenon, Cyprus would not fall behind from such a trend. However, the difference between Cyprus and probably other European countries is the financial crisis that the country is currently facing. The financial recession appeared in the Cypriot economy in 2010. As a result of the severe economic crisis that affected the country, retirement pension payments were reduced, the budget of social services was also significantly reduced, while many nursing homes had to go through particular and often excruciating measures, such as redundancies and termination of services and programmes, in order to balance their budgets.

In a time in which Cyprus is facing such an unprecedented financial crisis, particular attention should be paid to the happiness of senior citizens who live in their own homes or in private or community nursing homes, as they constitute one of the more vulnerable population groups.

In order to understand happiness, it is important to provide the definition of the term. Some research has suggested that the meaning of happiness is similar across individuals (Layard, 2005; Myers and Diener, 1995); others have argued that its meaning is highly subjective and idiosyncratic (Gilbert, 2006). For the purpose of this article, we adopted the definition of Diener and Diener (2008): happiness is a combination of life satisfaction and having more positive emotions than negative emotions. Additionally, Seligman (2004) views happiness as composed of three parts: pleasure, engagement and meaning. Pleasure is the ‘feel good’ part of happiness. Engagement refers to living a ‘good life’ of work, family, friends and hobbies. Meaning refers to using our strengths to contribute to a larger purpose. Seligman says that all three are important, but that of the three, engagement and meaning make the most difference to living a happy life.

This study is the first of its kind in Cyprus, and it aims to examine whether the different living environments (home vs. nursing home) affect happiness in old age. Furthermore, the study examines the various activities in different living settings in order to explore any associations with the level of happiness among older people, especially in nursing homes which currently accommodate some 3000 elderly Cypriots.

Happiness in old age: In and out of nursing homes

An age of around 60 or 65, roughly equivalent to the retirement age in most developed countries, is considered to be the beginning of old age. In ‘entering’ old age, many people could move towards a feeling of powerlessness resulting in a significant barrier to happiness, which includes the achievement of life satisfaction, well-being and higher life expectancy, the capacity for self-care, autonomy, productivity and achievement, and a positive psychological outlook (Rowe and Kahn, 1998). More specifically, the concepts subjective well-being and life satisfaction are used interchangeably in the literature and are often likened to the concept of happiness (Sotgiu et al., 2010). In fact, all three of these concepts refer to an overall judgement about the quality of one’s own life, which encompasses both affective and cognitive aspects (Diener, 2000; Diener et al., 2003; Triandis, 2000; Uchida et al., 2004; Veenhoven, 2000).

Furthermore, there are several factors that may affect happiness of elderly people and which are likely to vary with the place of residence, that is, in or out of nursing homes. Research highlights that the factors associated with good quality of life and feelings of happiness in old age include positive social relationships and pleasurable activities (Cahill and Diaz-Ponce, 2011). The literature also suggests that the family, particularly quality social interaction with family members, has a very important positive impact on older people’s quality of living, as well as engaging in hobbies, provided that their physical and mental health allows such activities (Byrne-Davis et al., 2006; Drageset et al., 2009; Dröes et al., 2006; Jonas-Simpson and Mitchell, 2005).

In relation to the three universal basic psychological needs (competence, relatedness, autonomy) identified in self-determination theory (Ryan and Deci, 2001, 2002), human beings are seen as actively engaged, growth-oriented organisms in their social contexts (Custers et al., 2010). The fulfilment of the need for relatedness has come under strain due to changes in social situations: today, married people are often separated from their partners and visiting friends and family becomes more difficult (Custers et al., 2010; De Klerck, 2005). However, social networks, support and participation have been shown to be associated with happiness of nursing home residents (Hanestad, 1997).

In the last few decades, there has been growing interest in the role of the environment as a factor contributing to happiness among the elderly (Giles-Corti and Donovan, 2002). Interaction between individuals and the environment is a two-way process in which individuals’ happiness is affected by factors in the environment, but they also have the capacity to modify different aspects of the environment to make them better suited to their needs (King, 1981; Levine, 1967). Older people’s strengths and abilities are more likely to be evident in the context of their social and physical environment (Ranzijn, 2002). These abilities include memory, intelligence, feelings, motivation and other skills that foster and maintain self-esteem and personal control (Cavanaugh and Blanchard-Fields, 2002).

Menec’s (2003) longitudinal research in Manitoba, Canada, highlights the importance of social and physical activities for happiness in old age; greater happiness, better functioning and reduced mortality could be related to these activities. A follow-up study among older Royal Canadian Air Force individuals aged 65–84 found that factors such as interests, having goals, family and diet were related to happiness in old age (Tate et al., 2003). As long ago as 1989, Ryff (1989) discussed the same issue, stating that for people to age well, they need to develop and maintain self-acceptance, positive relations with others, autonomy, environmental mastery, purpose in life and personal growth. By maintaining the above six elements, it is possible to pass through old age successfully. Similarly, in a 5-year study undertaken by Crooks et al. (2008), the results indicated that among 2249 women aged 78 years or older, there were fewer cases of dementia among those who socialized with family and friends. Another study found that older people living in family settings score more highly on subjective well-being and level of happiness than older people living in nursing homes (Chakrabarti, 2009).

In addition, towards a process of happiness, it is important to oversee the sources of it, such as social policies, welfare and health programmes and services (Baltes and Mayer, 1999). However, the British Longitudinal Survey found that there is a need for further clarification on how successful ageing can be achieved in relation to assuring happiness (Bowling and Iliffe, 2006).

While in recent years there has been a shift in the focus of nursing homes with the introduction of various activities for their residents, the outcomes are largely still unknown as researchers have yet to evaluate the impact of activities in nursing homes on enhancing happiness of the nursing home residents (Anderson and Dabelko-Schoeny, 2010). Living in a nursing home can be a difficult experience for many people, leading to reduced socialization with family and community, a decrease in physical activity and an increased perception of loneliness; these issues result in many cases in a deterioration in mental health, especially for those with existing depressive symptoms or dementia (Custers et al., 2010; D’Amico-Panomeritakis and Sommer, 1999). For many older people residing in nursing homes, lack of control over their lives and loss of independence are the inevitable (or perceived) consequences of moving into an aged care facility (Brownie and Horstmanshof, 2012). Furthermore, some residents complain that their lives have no meaning, they have nothing to do and they are biding their time in a waiting room for the dying (Prince and Butler, 2007). They also express the need for interaction with each other, reciprocity in social support and the importance of maintaining continuity with their identity (Franklin et al., 2006).

As many nursing homes are based on the medical model, they have traditionally emphasized meeting residents’ physical needs while inadvertently overlooking their psychological and personal needs (Lundervold and Lewin, 1992). The literature has shown that daily life in an aged care facility is often characterized by boredom and loneliness, feelings of helplessness and few opportunities for residents to construct meaningful lives. Idleness and time spent in passive activities, such as doing nothing, sleeping and waiting, is commonplace among aged care residents (Brownie and Horstmanshof, 2012; Choi et al., 2008; Otsuka et al., 2010; Tuckett, 2007).

This study seeks to explore the connections between place of living and the activities of older Cypriots and their levels of happiness. It also aims to examine the factors that are associated with happiness in old age within the Cypriot frame, and to measure the levels of happiness among the ageing population in Cyprus who live in their own home environments and in nursing homes. This endeavour is growing even more important in the light of the recent economic crisis that has hit Cyprus and which is having an effect on housing options for the elderly. For instance, pension benefits are likely to be reduced, forcing many elderly people currently residing in nursing homes to return to their homes. Finally, it also provides suggestions that would help towards the improvement of happiness among older people and the role of social workers in moving into that direction.

Method

Materials

The survey comprised three parts. In the first part, demographic information was collected: sex, age, marital status, number of daughters, number of sons, income (i.e. pension) and place of living (own home, nursing home). Participants were also asked to indicate their health status using a 7-point Likert-type scale (1 = very bad, 7 = very good), and how frequently they were visited by their families. In the second part, participants had to indicate their level of happiness. To measure happiness, we employed a published instrument composed of three questions where participants had to indicate approximately the percentage of time during an average day that they feit happy, unhappy and neutral (Larsen and Diener, 1985). In the final part, participants were asked a number of questions related to their daily activities. In particular, participants were given several options to indicate how they usually spent their free time. Participants could choose more than one option at a time. In order to identify these activities, a small sample of senior citizens were asked to report some of their spare time activities and then the most frequently reported were chosen by the researchers to be included in the questionnaire. Finally, the order of presentation of Parts 2 and 3 was counterbalanced across participants.

Participants

Three research assistants were employed for the purposes of this study. In order to ensure the reliability of the data collection, the three research assistants were trained on understanding the philosophy of the study and the questions in particular, as well as how to administer the questionnaire. The research assistants administered the questionnaire to the total number of participants who were residents of nursing homes and to older people who lived on their own. To have a more representative sample, we listed all the public and private nursing homes in Nicosia district (N = 22) and we randomly chose 12. Letters were then sent to the administrator of each one of the 12 institutions, requesting permission to conduct the study in their agency. The research took place in six nursing homes which gave a positive response. All nursing homes participating in the survey allowed the researchers to invite any resident who was willing to take part. The only persons excluded from the study were those who were bedridden due to severe health problems and those whose medical condition did not allow them to communicate effectively with the research assistants. To recruit older people outside the nursing homes, the research assistants visited coffee shops and senior citizens’ centres in the city of Nicosia as well as villages in the district of Nicosia. All participants were able to read and write and were mentally healthy enough to manage the questionnaires by interpreting and answering all questionnaires by themselves. Participants’ capacity to take part in the study was verified by the nursing homes administration and by the research assistants regarding those living on their own. All participants were mentally healthy enough to manage the questionnaires by interpreting and answering all questionnaires by themselves and all of them were able to read and write.

Participants were briefly informed about the purposes of the research and then they were asked to sign a consent form. Following this, participants were given the questionnaire in paper format together with a pencil for its completion.

In this study, 285 Greek-Cypriots took part (131 women, 154 men). The mean age of participants in the sample was 75.2 (standard deviation (SD) = 7.4) years. Moreover, 47.3 percent of the participants were married, 38.6 percent were widowed, 7.6 percent were divorced and 6.5 percent were single. Participants had on average 1.9 male children (SD = 1.1) and 1.8 female children (SD = 1). Finally, 67 percent of the participants lived on their own and 33 percent in a nursing home.

Results

The causes of happiness

In order to examine the various factors that affect older people’s happiness, we employed multivariate analysis of covariance (MANCOVA). In the initial model, the three variables of happiness (percentage of time feeling happy, percentage of time feeling unhappy and percentage of time feeling neutral) were entered as dependent variables and the place of living, health, marital status, age, income, sex, number of sons, number of daughters and frequency of visits were entered as independent variables. We employed backward elimination, to reach a final model where only three independent variables became significant.

We have to stress that it is likely that people in and out of nursing homes differ in their health status. It may be for instance the case that because individuals’ health has deteriorated, their capacity to function on their own has deteriorated also and this forces them to move in a nursing home. In this respect then, the health status of those inside the nursing home is different from those outside the nursing home. Due to this, it may be the case that the elderly inside the nursing homes are less happy than the elderly outside the nursing homes. Therefore, the difference in happiness may not be due to whether one is in or out of a nursing home but due to the different health status of those in and out of the nursing homes which affects their happiness. To control for this possible bias in our statistical analysis, we have entered participants’ health status as a covariate, making in effect comparisons between individuals of the same health status.

The results indicate that there was a significant main effect of health on happiness (F(3, 140) = 7.14, p < .001, $η_{p}^{2}$ ), there was a significant main effect of place of living on happiness (F(3, 140) = 3.53, p = .017, $η_{p}^{2}$ ) and finally, there was a significant main effect of frequency of visits on happiness (F(12, 426) = 7.14, p = .007, $η_{p}^{2}$ ).

These represent overall effects, but to get a more detailed picture we examined how each factor affects each dependent variable. The results indicate that there was a significant main effect of health on feeling happy (F(1, 142) = 16.24, p < .001, $η_{p}^{2}$ ), with the percentage of time feeling happy increasing as participants become healthier. Moreover, there was a significant main effect of health on feeling unhappy (F(1, 142) = 13.4, p < .001, $η_{p}^{2}$ ) with percentage of time feeling unhappy increasing as participants become less healthy. No significant effect was found for the percentage of time feeling neutral.

Moving on, there was a significant main effect of place of residence on feeling happy (F(1, 142) = 4.45, p = .037, $η_{p}^{2}$ ), with participants living at home reporting a higher percentage of time feeling happier (M = 58.1, SD = 21.1) than those living in a nursing home (M = 42.9, SD = 23.3). In addition, there was a significant main effect of place of living on feeling unhappy (F(1,142) = 9.82, p = .002, $η_{p}^{2}$ ) with participants living in a nursing home reporting a higher percentage of time feeling unhappy (M = 32.3, SD = 22.9) than those living at home (M = 19.9, SD = 15.3).

Furthermore, there was a significant main effect of the frequency of visits on feeling unhappy (F(4, 142) = 3.5, p = .009, $η_{p}^{2}$ ). Post-hoc comparisons using the Bonferroni method indicate that those who were hardly ever visited by their children were more unhappy than those who received more frequent visits. There was no difference between the other frequencies, indicating that it is probably having someone to visit them rather than the frequency of visits that matters. Moreover, there was a significant main effect of visits on feeling neutral (F(4, 142) = 4.31, p = .003, $η_{p}^{2}$ ). Post-hoc comparisons using Bonferroni indicate that those who were rarely visited by their children were feeling less neutral than everybody else. No significant effects were found for the percentage of time feeling happy.

Finally, there was a significant interaction between place of residence and visits on feeling unhappy (F(4,142) = 2.93, p = .023, $η_{p}^{2}$ ), with those being in a nursing home reporting significantly more unhappiness than those who living on their own when their children visit them rarely. That is to say, if they live in a nursing home and their children never visit them, they will be much more unhappy than if they are living on their own and their children never visit them.

Why are those who live at home happier than those who live in a nursing home?

Our next task was to identify possible reasons that account for the finding that older people who live on their own are happier than those who live in a nursing home. One possible hypothesis is that the two groups differ in the frequency of activities, with those living on their own having access to more of these activities than the rest. To examine whether this is the case, a series of binary logistic regressions were applied to each activity. This statistical technique was chosen because our dependent variable (i.e. the activity) is binary (i.e. yes, no). Here, each activity was entered as the dependent variable and the place of living and health status were entered as the independent variables.

The results indicate a significant effect of looking after grandchildren (p < .001, odds ratio (OR) = 35.7), with those living on their own being 35 times more likely to spend their free time looking after their grandchildren than those in a nursing home. There was also a significant effect of cooking (p < .001, OR = 18), with those living on their own being 18 times more likely to cook in their free time than those in a nursing home. Furthermore, there was a significant effect of housekeeping activities (p < .001, OR = 36.2), with those living on their own being 36.2 times more likely to engage in this activity than those who live in a nursing home.

Similarly, there was a significant effect of gardening (p < .001, OR = 13.3), with those living on their own being 13.3 times more likely to engage in this activity than the rest. There was also a significant effect of reading (i.e. newspapers/magazines/books; p < .001, OR = 2.8), with those living on their own being 2.8 times more likely to engage in this activity than the rest. Walking in the park was also significant (p < .001, OR = 5.7), with those living on their own being 5.7 times more likely to engage in this activity than the rest. Moreover, there was a significant effect of trips and excursions (p < .001, OR = 8.3), with those living on their own being 8.3 times more likely to engage in this activity than the rest. Finally, there was a significant effect of church going (p < .001, OR = 3), with those living on their own being three times more likely to engage in this activity than the rest. No significant differences were found for watching TV, working, creative activities, games, music, dance, drawing and volunteering.

Do free-time activities contribute to happiness?

Participants who live on their own engage in more activities than those who reside in a nursing home and this can potentially account for the differences in happiness between the two groups. To see if this is actually the case, we needed to examine whether these activities actually contribute to people’s happiness.

To do so, a series of MANCOVAs was performed with the three variables measuring happiness entered as the dependent variables and the activity as the independent variable. The analysis was performed on the activities that participants living on their own performed more frequently than those living in a nursing home. In order to examine the effect of the activity on happiness keeping health constant, we also entered health status as an independent variable.

Significant results were produced only for reading, and for trips and excursions. In particular, there was a significant main effect of trips and excursions on happiness (F(3, 168) = 4.02, p = .009, $η_{p}^{2}$ ). More specifically, there was a significant main effect of trips and excursions on the percentage of time feeling happy (F(1, 170) = 12.16, p = .001, $η_{p}^{2}$ ), with participants engaging in this activity reporting more happiness than the rest. Moreover, there was a significant main effect of trips and excursions on the percentage of time feeling unhappy (F(1, 170) = 9.17, p = .003, $η_{p}^{2}$ ), with those engaging in this activity feeling less unhappy than the rest. No significant effect was found for feeling neutral.

Furthermore, there was an overall significant main effect of reading on happiness (F(3, 168) = 2.8, p = .044, $η_{p}^{2}$ ). In particular, there was a significant main effect of reading on the percentage of time feeling happy (F(1, 170) = 6, p = .015, $η_{p}^{2}$ ), with those engaging in this activity feeling happier than the rest. Finally, there was a significant main effect of reading on the percentage of time feeling unhappy (F(1, 170) = 6.8, p = .010, $η_{p}^{2}$ ), with those engaging in this activity feeling less unhappy than the rest.

Discussion

This study examined the effect of happiness on living in a nursing home and in one’s own home. A divergence in the level of happiness between those living at home and those living in nursing homes was found, with the former being happier than the latter, who reported a higher percentage of time feeling unhappy. Also, a significant role in diminishing happiness among older people is related to the lack of any visits from their families. Although engagement in various activities, as well as feeling healthy, can improve life happiness, the level of relations with family is a major factor and predictor of happiness in old age.

In addition, feelings of happiness seem to be related to the environment in which people live and not necessarily to the activities in which they engage. We also found that those living on their own have more opportunities to engage in activities than those who live in a nursing home. Still, only a few of these activities can contribute to increased happiness. Such activities include reading, trips and excursions; accordingly, nursing homes should be encouraged to offer more of these activities to their residents.

There is a possibility that an overall higher level of activity does increase happiness. For instance, those living in a nursing home do not have to cook for themselves or deal with household chores. This limitation considerably reduces their level of activity and may result in the deterioration of their level of happiness. If this is so, nursing homes in Cyprus should re-examine their approaches, offering their residents the opportunity to be more than a service user.

A more pessimistic, albeit evidence-based conclusion, is that nursing homes will never be a substitute for one’s own home and there will always be a gap in the happiness level between the two. However, living at home may not necessarily increase the welfare of an individual because he or she may not have prompt access to the facilities and services that are required in old age (e.g. healthcare centres).

Social work to enhance happiness among older people

In relation to the research findings, there are several implications for social workers who practise in the area of old age in Cyprus in terms of supporting, influencing and enabling structures and systems for the development of strong local communities that promote happiness of their members. Similarly, social workers could collaborate with older adults in creating and advocating for ageing-friendly policies, services and programmes that would be culturally competent to older adults. For example, social workers can encourage elderly people and nursing homes to engage in or establish a variety of activities, such as gardening, reading, taking care of grandchildren or cooking. Evidently, such activities could contribute to happiness in, as well as out of, nursing homes.

For instance, social workers could promote the strengthening of the bonds between the family and its older members. Social workers can mediate between families and their older members who reside in nursing homes in order to encourage more visits. Similarly, social workers could organize events focusing on family bond activities.

Additionally, in an environment such as Cyprus where there is nothing in between the nursing home and the older person’s own home, social workers could promote the introduction of policies for ageing at home through community-based interventions. Such practices could allow older people to remain in their home environments rather than moving to a nursing home. For example, a community social worker could check on a certain number of older people with regard to their activities of daily living (ADLs) on a daily or weekly basis. Also, they could facilitate friendly visiting or telephone reassurance teams of volunteers in the community. Arranging transport to services (i.e. healthcare, the supermarket) is also a useful tool that social workers could utilize in their community intervention.

Furthermore, in order for social workers to promote active ageing and happiness among the older population through a variety of programmes and services, their engagement in social policy is considered crucial. By networking and educating policy makers, or through their direct involvement in policy planning, social workers could function as a lever towards social planning that would enhance the quality of life of older people.

The responsibility of social workers in Cyprus is to promote the values of ageing, and especially active ageing, through participation in community social activities. Yet the promotion of such values should be the outcome of specifically designed social policies towards those interventions that would assure happiness of older people within an environment that would allow them to live with dignity and autonomy.

Further to social policies, it is vital that social workers promote active, and happiness in the Cypriot society towards the establishment of solidarity among the various generations. The key to a successful campaign for active ageing is through education. The Cypriot society is not well informed about ageing and it has not, as yet, been proved that it fully acknowledges the consequences of not ageing well. Ageing stereotypes are a part of everyday life in Cyprus in both personal and institutional settings. Myths regarding the relation between senility and old age should be removed and substituted by the reality that ageing can and should be a happy and active process.

The critical role of social workers seems to play a vital part in the process of enhancing the level of happiness among older people. Their involvement in assisting older people, as the fastest growing age group on the planet, is more crucial than ever. Social work is the profession that should be at the frontline of human services in dealing with the social needs of older people. Through continuing education, social workers can maintain competency towards the specific needs, prevention and intervention methods in order to improve the existing programmes and services or to develop new ones with one goal; the advancement of the quality of life of the older population.

Conclusive remarks

The current study has extracted important elements regarding the quality of living of older Cypriots, whether they live in their own home environments or in a nursing home. Furthermore, knowledge about the extent of intervention through programmes and services for older people has been gained. As a result, the researchers have identified certain areas that need to be improved in order to allow older people to maintain their happiness. These areas should be seen as an opportunity to promote the appropriate social policies.

The lack of alternative housing options in addition to the limited programmes that are offered to nursing home residents, especially to the frail older people, should be evaluated by the policy makers in the country. The strengthening of family bonds with their older family members is another issue that should be promoted.

The aforementioned findings should be examined within the context of the Cypriot welfare system. The recent economic crisis in Cyprus has affected the country’s older population through social insurance and other retirement benefit cuts or reductions, with many elderly people moving out of nursing homes and return to their homes seeking. There is currently a lack of alternatives to either living in one’s own home environment and/or a nursing home, such as senior living communities. The establishment of independent living facilities or older living communities could be a significant option for older people in Cyprus. While in many countries a variety of social and medical services allow older people to age at home and improve the quality of their lives, Cyprus has a long way to go in introducing services specifically tailored to the needs of older people.

Social policies in Cyprus should focus on new approaches to improving happiness among older people. At a time in which the globe is facing unprecedented demographic ageing, Cypriot social policy should not ignore the fact that without the design and implementation of specific strategies to support the thousands of older Cypriots, happiness in old age could be at risk. It is therefore very important for policy makers and social welfare professionals to take into serious consideration research on ageing and the various suggestions for an improvement in the happiness of older people.

Furthermore, with respect to organized communities, especially in the middle of a financial recession in Cyprus, pension cuts and pressures on pension funds, specifically designed interventions within the community could allow older people to remain in their own home environments but with additional social support from professionals with training in old age. Such interventions could include a variety of activities designed to cover the needs of the heterogeneous older population. At the same time, families should be encouraged to increase their visits and strengthen their bonds with their older relatives.

In conclusion, there are several implications for old age in Cyprus and ageing well. Questions arise in relation to the different approaches to care provision for elderly people, an issue that needs to be examined further with a view to making radical decisions and changes in the field of old age and improving happiness among elderly Cypriots.

Footnotes

Funding

The author(s) received no financial support for the research, authorship and/or publication of this article.

Author biographies

Gregory Neocleous is a faculty member at the Social Work Programme of School of Humanities, Social Sciences, and Law at the University of Nicosia. His research interests include old age, social insurance and elderly people, social policy, and migration.

Menelaos Apostolou is an assistant professor for the School of Humanities, Social Sciences, and Law at the University of Nicosia. His research is focused on understanding interfamily conflict and family dynamics.

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