Health,social support,resilience and successful ageing among older Chilean adults

Abstract

The promotion of successful ageing (SA) has become a strategy. But there has been little examination of the dimensions that are associated with SA from an integrative perspective that takes into account potential particularities among indigenous older adults. This study explores the predictors of SA for a sample of 800 older Chilean adults. The results show that demographic, health and psychosocial variables are associated with SA, with resilience being of particular note. The findings of this study underline the importance of assessing SA, using multidimensional approaches and emphasising heterogeneity and the particularities of indigenous cultural contexts.

Keywords

Ethnicity health predictors of successful ageing resilience social support

Introduction

Ageing populations are a widespread phenomenon (United Nations, 2017), for which reason working with older adults is a growing concern for social work. Gerontology offers various theoretical models to understand this trend, and in recent decades the concept of successful ageing (SA) has gained influence. This is a multidimensional and strategic model aimed at promoting health, well-being, resources and the strengths that older adults have at their disposal (Araújo et al., 2016). The empirical evidence shows that SA has been most widely applied in developed countries (Cosco et al., 2014; Kim and Park, 2017). However, the approach is also being used in developing countries (Arias-Merino et al., 2012; Gallardo-Peralta et al., 2016; Hamid et al., 2012; Olivera and Tournier, 2015). This study analyses SA for a sample of older Chilean adults, taking into account the scant examination of this paradigm in Latin American contexts.

Literature review

There is no unanimous understanding of SA (Cosco et al., 2013; Pruchno et al., 2010a) and no consensus regarding the dimensions that should be included in its evaluation (Martin et al., 2015; Nimrod and Ben-Shem, 2015). These difficulties are probably due to the heterogeneity of facets that are included in its measurement (Kleineidam et al., 2018; Kok et al., 2017), in addition to its emphasis on highlighting the positive characteristics of ageing as opposed to its disadvantages (Jopp et al., 2015). These difficulties afflicting SA can undoubtedly also prove to be its strengths, reflecting a multidimensional and holistic approach that seeks to assess a positive process involving the acquisition of resources and investment of effort over the course of a lifetime (Nimrod and Ben-Shem, 2015). Since its creation by Rowe and Kahn (1987, 1997) as a concept focused on physical, cognitive and social functionality, SA has become a model that transcends good health and is made up of a wide range of bio-psychosocial factors (Fernández-Ballesteros García et al., 2010).

Bowling and Iliffe (2006) argue that the psychosocial competencies developed by older adults enable them to age successfully despite deterioration in health and functioning. These competencies include sense of control over life, or self-efficacy; effective strategies for coping, adaptation and self-worth; and goals. Kim and Park (2017) have subsequently maintained that if older individuals are socially active and psychologically well adapted, they can achieve SA in later life. In other words, the social gerontology perspective emphasises the personal and social resources that can help in successfully facing, coping with and adapting to old age. This approach facilitates an enriched perspective of gerontological social work, which emphasises psychosocial resources (e.g. self-determination, confidence, self-esteem and social networks) that help to design suitable social interventions (Ray et al., 2015). It is also a model that allows diversity to be incorporated into the analysis and intervention perspective (Kok et al., 2017). Specifically, the SA model permits an analysis of the various ways of ageing successfully that depend on ethnic-cultural context (Pace and Grenier, 2017), respecting the values and knowledge of indigenous communities, making their life pathways visible, bringing about social justice for these groups and, particularly, making them participants in the models of positive ageing.

In this context, the present study is based on the theoretical proposal of Troutman (formerly Flood), who defines SA as satisfactory adaptation to the physical and functional changes inherent to ageing, expressly incorporating the experience of a spiritual connection and/or sense of life purpose (Troutman et al., 2011). This model assumes that SA is achieved by having the ability to adapt mechanisms of functional performance, intrapsychic factors, spirituality, gerotranscendence and life purpose/satisfaction. Mechanisms may or may not be adapted in a synchronised fashion; this will determine whether the person ages successfully in the physical, cognitive and social domains. The present study applies this integrated model, made up of five dimensions, in order to assess SA. It also incorporates other variables, such as demographics, health, social support and resilience, that could have practical implications in social gerontology.

Demographic variables

The most analysed demographic variables in relation to SA tend to be age, gender, marital status and race/ethnicity (Bowling and Iliffe, 2006; Kim and Park, 2017; Strawbridge et al., 1996). Age is negatively related to SA (Depp and Jeste, 2006; McLaughlin et al., 2010). In contrast, there are discordant results relating to sex. A meta-analysis conducted by Depp and Jeste (2006) showed that 50 percent of the longitudinal studies reviewed reported women experiencing higher levels of SA. On the other hand, Bowling and Iliffe (2006) reported higher average SA scores for men than for women. With respect to marital status, research suggests that having a partner or being married is positively associated with SA (Pruchno et al., 2010a). Finally, as regards race/ethnicity, studies show that more adverse life pathways mean that minority ethnic groups have lower SA scores. This is particularly true in the case of indigenous older adults (Pace and Grenier, 2017).

Physical and mental health

Health is undoubtedly the most commonly used indicator of SA (Cosco et al., 2014). The objective criteria of lack of disability and health are commonly used (Jopp et al., 2015). However, there is also a tendency to evaluate the subjective aspects of health (Kleineidam et al., 2018). Mental health also appears as a significant indicator of SA (Parslow et al., 2011). Specifically, depression is associated with unsuccessful ageing (Dahany et al., 2014).

Social support from family networks, friends and social groups

Social integration, or access to support networks, is one of the most researched social aspects in relation to SA (Kim and Park, 2017; Li et al., 2014; Parslow et al., 2011). In general, the results show a direct and positive relationship between availability of social support networks and SA (Cho et al., 2015). Support from family and friends is a significant element in the well-being of older adults (Tkatch et al., 2017), but mainly when sources of social support tend to be heterogeneous in composition. This refers to the possibility of these networks not being purely family-focused and hence of older adults also interacting with non-family networks such as friends, neighbours or peers in social groups (Gallardo-Peralta et al., 2018a).

Resilience

Gerontology has recently incorporated the applicability of SA among older adults in adverse situations. The question is how SA can be achieved despite physical limitations or other kinds of structural hindrances, and this leads to consideration of the process of resilience. Studies suggest that resilience has a positive impact on SA (Jeste et al., 2013; Pruchno and Carr, 2017; Stewart et al., 2019). The premise is that ‘the resilience process consists of the activation and interaction of protective and vulnerability factors after encountering adversity’ (Bolton et al., 2016: 171). Along these lines, a study by Tkatch et al. (2017) confirms that older adults report that it is necessary to ‘bounce back’ from difficulties and not allow problems to get the better of them. Achieving SA therefore entails confronting problems and overcoming adversity.

Present study

This study is focused on analysing SA based on an integrative theoretical proposal, revolving around the capacity of older adults to adapt to the new material, physical, psychological and social conditions of old age. Specifically, it examines the SA process and its five dimensions (mechanisms of functional performance, intrapsychic factors, spirituality, gerotranscendence and life purpose/satisfaction) in terms of their relationships with the variables of physical and mental health (health problems, Activities of Daily Living [ADL], dependency and depression) and psychosocial resources (social support and resilience). The main theoretical and empirical contributions of this proposal – its specific aims – are hence (1) to analyse the relationship between SA and each of its dimensions with health (understood as a multidimensional construct) and the psychosocial resources that older adults use in order to age successfully; (2) to identify the dimensions of health (mental, general, dependence) that are related to SA and each of its dimensions, as defined in the model produced by Troutman et al. (2011); (3) to identify the psychosocial resources, such as support networks and resilience, that are associated with SA and each of its dimensions; (4) to explore the specific role played by the psychosocial resources taken into account (social support and resilience) – that is, to analyse the association between psychosocial resources and SA and its dimensions, including within the same model the dimensions of health that are significantly related to SA; and (5) to analyse the established aims for a multicultural and multi-ethnic sample. Two models are compared to achieve these aims. The first includes demographic (control) variables and health, and the second incorporates psychosocial resources such as social support from families, friends and groups, in addition to resilience. Both models were used to analyse the data obtained for all dimensions of SA in a sample made up of non-indigenous and indigenous older adults, as described in the following section.

Method

Participants

The sample is made up of 800 older adults living in the north and south of Chile. A sample stratified by sex, ethnicity and place of residence (municipal or rural areas) was used to ensure representativeness in each of these territories. The fundamental features of the sample are set forth in Table 1. It is appropriate to highlight average age (72.07 years; standard deviation [SD] = 7.81) and the fact that 71 percent of the sample stated that they were indigenous (35% Aymara and 65% Mapuche). The sample was therefore multi-ethnic and made up of two indigenous communities (369 Mapuche and 201 Aymara), in addition to participants who were not members of any indigenous ethnic group.

Table 1.

Participants’ characteristics.

Variable	Categories	Non-indigenous (n = 231)	Aymara (n = 201)	Mapuche (n = 368)	Total
Gender	Women	107 (46%)	106 (53%)	180 (49%)	393 (49%)
Gender	Men	124 (54%)	95 (47%)	188 (51%)	407 (51%)
Age groups (years)	60–69	82 (35%)	97 (48%)	162 (44%)	341 (43%)
	70–79	102 (44%)	75 (37%)	134 (36%)	311 (39%)
	80+	47 (21%)	29 (15%)	72 (20%)	148 (18%)
Marital status	Married or cohabiting	112 (48%)	120 (60%)	202 (55%)	434 (54%)
	Single	47 (20%)	23 (11%)	54 (15%)	124 (15%)
	Widow	49 (21%)	45 (22%)	96 (26%)	190 (24%)
	Divorced, separated	23 (11%)	13 (7%)	16 (4%)	52 (7%)
Residence	North (region of Arica y Parinacota)	110 (48%)	201 (100%)	0	311 (39%)
Residence	South (region of The Araucanía)	121 (52%)	0	368 (100%)	489 (61%)
Education	Primary school incomplete	56 (24%)	127 (63%)	250 (68%)	433 (54%)
	Primary school	120 (52%)	49 (24%)	76 (21%)	245 (31%)
	High school or vocational education	48 (21%)	21 (10%)	39 (10%)	108 (13%)
	Higher education	7 (3%)	4 (3%)	3 (1%)	14 (2%)

Values represent n (%).

Recruitment

Participants were contacted via two procedures. Where possible, the research team made first contact directly and arranged an appointment to perform the interview. The rural enclaves have low population density, meaning that contact with the older adult population was relatively straightforward. Some members of the research team (especially social workers) had enjoyed previous access to some communities from which participants were recruited, which enabled the technical team to obtain access without difficulty. Where first contact entailed greater difficulty, it was made via key social agents, including council personnel (mainly social workers) and the most important neighbourhood and local leaders. These agents carried out an initial selection of participants based on the inclusion criteria. The experience and knowledge of the community of social agents contributed to a recruitment process that enabled the identification of persons with dementia (excluded from eligibility), for example. The interviewer attended the place indicated for the interview in both cases.

Procedure

A face-to-face interview method was used to collect the data, taking an approximate time of 45 minutes. The questionnaire – comprising various scales as described in the following section – was read out loud to interviewees. Qualified social work and psychology professionals administered the questionnaire. Interviewers learned to administer the questionnaire in a short training workshop; specifically, they received instructions on how to address potential difficulties with understanding questions, for which purpose examples and even the linguistic meaning of some terms were provided. The main language used for the scales was Spanish.

The Ethics Committee of Tarapacá University and the National Council for Science and Technology of Chile approved and monitored the ethical aspects of the study. All procedures performed in studies involving human participants were in accordance with the 1964 Helsinki declaration and its amendments or comparable ethical standards. Having first obtained the informed consent of participants, the data were processed confidentially and anonymously.

Measures

SA. The Successful Aging Inventory (SAI) devised by Troutman et al. (2011) was used. This is made up of 20 items, divided into five dimensions: (1) mechanisms of functional performance: the older persons’ capacity to be aware and make choices as an adaptive response to the physiological and physical losses resulting from ageing were evaluated, via statements such as ‘I manage to do the things that I need to do to take care of my home and to take care of myself (eating, bathing, dressing)’; (2) intrapsychic factors: the older persons’ capacity to adapt to change and to resolve the problems inherent in old age were evaluated, through statements such as ‘I am good at thinking of new ways to solve problems’; (3) gerotranscendence: the change in the older persons’ metaperspective – that is, whether they have moved from a materialist and rational perspective to a more cosmic and existential or transcendental one – was evaluated, via declarations such as ‘I feel interest in/concern for the next generation’; (4) spirituality: religious behaviour that the older persons may display was analysed, via statements such as ‘I spend time in prayer or doing some kind of religious activity’; (5) life purpose/satisfaction: areas of well-being for older persons, such as having a purpose in life and having life satisfaction, were evaluated via affirmations such as ‘Overall, I am satisfied with my life right now’. A Likert-type scale was used, ranging from (0) totally disagree to (4) totally agree. The values for the different dimensions were added together and a score was obtained that varies from 0 to 80. Higher scores indicate SA. In specific terms, scores from 0 to 25 indicate unsuccessful ageing, scores from 26 to 53 suggest moderately SA and scores from 54 to 80 indicate SA. This inventory has been validated in Chilean, indigenous and non-indigenous elderly people, proving to be a reliable and adequate instrument for this population (Gallardo-Peralta et al., 2017). The internal consistency index (Cronbach’s alpha) for the general inventory was .90.

Main health problems were assessed using the Health Problems Questionnaire produced by Herrera et al. (2007). This instrument was specifically developed to measure the most recurrent illnesses in the population of older persons in Chile, within the framework of the ‘Chilean National Survey of Quality of Life in Old Age’. It constitutes an inventory/checklist made up of 14 pathologies: tension or hypertension; arthritis; high cholesterol; diabetes or elevated blood sugar levels; cataracts; osteoporosis; heart problems; chronic lung disorders; stomach ulcers; asthma; fractured hip or femur; cancer; stroke or vascular disorders; and Parkinson’s disease. The internal consistency index (Cronbach’s alpha) for the general questionnaire was .71.

Dependency. The Barthel ADL Index, developed by Mahoney and Barthel (1965), was applied. This is a scale assessing the capacity of a person to carry out 10 basic daily activities involving feeding, bathing, dressing, grooming, bowels, bladder, toilet use, transfer, mobility and use of stairs. Each activity was assigned a score (5, 10, 15) based on the time spent carrying it out and the need for assistance in doing so, resulting in a final score ranging from 0 to 100. This geriatric index is currently applied in Family Health Centres in Chile. The internal consistency index (Cronbach’s alpha) for the general questionnaire was .86.

Depression. The existence of depressive symptoms was evaluated using the Geriatric Depression Scale (GDS) developed by Brink et al. (1982). The original version consisted of 30 items, but the abbreviated 15-item version was used. This version maintains the effectiveness of the original scale, while improving ease of administration. The instrument records the presence of 15 symptoms of depression, with a resulting score of 0 to 15. It is a scale widely used to evaluate depression in Chilean elderly (Hoyl et al., 2000). The internal consistency index (Cronbach’s alpha) for the general questionnaire was .85.

Social support. Two instruments were used for the assessment of social support. One was focused on local social support networks – those offering help in everyday situations (The Perceived Social Support Questionnaire [PSSQ]) – and the second assessed community social support, specifically support from some kind of social group (The Perceived Social Community Support Questionnaire [PCSQ]).

The PSSQ by Gracia et al. (2002) is a scale made up of nine items evaluating the functional dimensions of support (emotional, advice and assistance) and reciprocity of support with respect to each source. It also offers a total score for functional support and reciprocity of support, as well as the number of components of the network, and separate scores for the different sources of social support. The present study took into account perceived social support from spouse/partner, children, other family members (grandchildren, siblings, nephews, in-laws, etc.) and friends. This instrument is widely used for the Spanish-speaking population, having been validated in various contexts (residential, general, hospital) (Herrero and Gracia, 2005). It has also been successfully used with elderly Chilean people (Gallardo-Peralta et al., 2015). The internal consistency index (Cronbach’s alpha) for the general questionnaire was .85.

The PCSQ devised by Gracia et al. (2002) is made up of four sub-scales. The Social Support in Informal Systems sub-scale was applied in this study. It contains 10 items evaluating the perception of social support in different informal community systems, such as groups of older adults, indigenous groups, religious groups, sports groups and other kinds of social groups. Statements included ‘I could find people who would help me to resolve my problems’, ‘I could find people who would listen to me when I am down’ and ‘I could easily relax and forget my problems’. The categories for responding to all of these questions followed a Likert-type-style design where 1 means strongly disagree and 5 means strongly agree. This questionnaire has been validated in the Chilean population, including indigenous elderly people (Gallardo-Peralta and Gálvez-Nieto, 2018). The internal consistency index (Cronbach’s alpha) for the general inventory was .92.

Resilience. The Brief Resilient Coping Scale (BRCS) developed by Sinclair and Wallston (2004) was used. The BRCS is composed of four items with 5 Likert-type-scale response categories. The questions were phrased as statements such as ‘I believe that I can grow in positive ways by dealing with difficult situations’. Total scores range between 4 and 20. A total score equal to or lower than 13 indicate low resilience, while scores equal to or higher than 17 result in a classification of high resilience. The BRCS has not been validated for indigenous populations. However, the available evidence has found the BRCS to be valid and reliable for Latin American older people (Caycho-Rodríguez et al., 2018). Its brevity and the ease with which it can be administered to older persons were the reasons for its use in this research. The internal consistency index (Cronbach’s alpha) for the general questionnaire was .87.

Control variables. Indicators of the respondent’s age, sex (1 = female), marital status (1 = with partner) and ethnicity (1 = indigenous) were included as controls in all models.

Analysis

Data analysis was conducted in two stages to fulfil the study aims. The first stage involved bivariate descriptive analyses for the main study variables. Specifically, the Student’s t-test for independent samples (man/woman, with/without partner, indigenous/non-indigenous, with/without health problems, independent/dependent ADL, depressed/not depressed, resilient/not resilient, with/without support) was applied for the SA variable. The second stage consisted of a hierarchical regression analysis (ordinary least squares regression models) for the mechanisms of functional performance, intrapsychic factors, spirituality, gerotranscendence and life purpose/satisfaction variables, and the general construct of SA that tested both models. Model 1 incorporates the control variables of age, sex, marital status and ethnicity and those relating to health: health problems, ADL independence and depression. Model 2 adds psychosocial social support resources (partner, children, other family members, friends and social groups) and resilience. Version 23 of the IBM-SPSS programme was used for the analyses.

Results

Bivariate descriptive statistics

The descriptive results showed that there are statistically significant differences among the independent variables in the SA process. Specifically, the results showed that women (t = 3.175; p < .002), participants with partners (t = 2.679; p < .007) and indigenous people (t = 3.091; p < .003) age more successfully. In terms of the health-related variables, the results showed that people with independence in ADL (t = –5.736; p < .001) and without symptoms of depression (t = –9.246; p < .001) age successfully. The results with regard to the analysis of social support by source showed that those with support from their partner (t = 1.974; p < .05), their children (t = 9.947; p < .001), other family members (t = 3.035; p < .002) and community groups (t = 6.280; p < .001) age more successfully. Finally, resilient people also age more successfully (t = 11.917; p < .001) (Table 2).

Table 2.

Descriptives and comparison of SA across study variables.

	Mean	T (df)	p value
Sex
Woman	65.39	3.175 (798)	.002**
Man	63.01
Marital status
With partner	65.11	2.679 (798)	.007**
Without partner	63.07
Ethnicity
Indigenous	64.90	3.091 (798)	.003**
Non-indigenous	62.40
Health problems
Without problems	65.32	–1.662 (798)	.097
With problems	63.83
Dependence ADL
Independent	65.37	–5.736 (798)	.001***
Dependent	59.15
Depression
Not depressed	66.25	–9.246 (798)	.001***
Depressed	57.59
Social support from partner
With support	65.57	1.974 (724)	.050*
Without support	63.98
Social support from children
With support	66.30	9.947 (646)	.001***
Without support	63.00
Social support from other family member
With support	66.30	3.035 (700)	.002**
Without support	63.59
Social support from friends
With support	64.39	–.664 (734)	.507
Without support	63.70
Social support from social groups
With support	66.10	6.280 (798)	.001***
Without support	61.19
Resilience
Resilient	67.13	11.917 (798)	.001***
Not resilient	57.65

ADL: activities of daily living; df: degrees of freedom.

p < .05; **p < .01; ***p < .001.

Mechanisms of functional performance

These were negatively associated with age, ethnicity (being indigenous), ADL dependence and depression. However, there was a positive association with resilience. The variables analysed explained 30 percent of variance and the two models were statistically significant.

Intrapsychic factors

These were negatively associated with age, health problems, ADL dependence and depression. Meanwhile, there was a positive association with social support from friends, social support from social groups and resilience. The variables analysed explained 40 percent of variance and the two models were statistically significant.

Gerotranscendence

This was positively associated with gender (women), social support from children, social support from groups and resilience. In contrast, there was a negative association with health problems and depression. The variables analysed explained 21 percent of variance and the two models are statistically significant.

Spirituality

This was positively associated with gender (women), social support from children, social support from groups and resilience. However, there was a negative relationship with health problems and ADL dependence. Although both models were statistically significant, they only explained 8 percent of variance.

Life purpose/satisfaction

This was positively associated with gender (women), marital status (having a partner), ethnicity (indigenous), social support from children, social support from other family members, social support from social groups and resilience. However, there was a negative relationship with ADL dependence and depression. The variables analysed explained 30 percent of variance and the two models were statistically significant.

General model of SA

This was negatively associated with age, health problems, ADL dependence and depression. SA was positively associated with gender (women), marital status (having a partner), social support from social groups and resilience. The variables analysed explained 38 percent of variance and the two models were statistically significant (Table 3).

Table 3.

Summary of hierarchical multiple regression analyses to predict SA (dimensions and total construct).

	Mechanisms of functional performanceB (SE)β		Intrapsychic factorsB (SE)β		GerotranscendenceB (SE)β		SpiritualityB (SE)β		Life purpose/satisfactionB (SE)β		Successful ageingB (SE)β
Variables	1	2	1	2	1	2	1	2	1	2	1	2
Model 1. Physical and mental health
Age	–.026 (.006)–.150***	–.023 (.006)–.133***	–.056 (.021)–.093**	–.031 (.019)–.051	–.021 (.016)–.049	–.007 (.016)–.016	.015 (.010).060	.019 (.010).074	–.004 (.009)–.014	–.005 (.009)–.020	–.092 (.048)–.067*	–.037 (.044)–.027
Gender (1 = female)	.120 (.082).044	.094 (.082).035	.087 (.291).009	–.132 (.267)–.014	.673 (.227).100**	.513 (.220).076*	.495 (.142).123**	.407 (.141).101**	.447 (.128).111**	.360 (.123).089**	1.822 (.665).085**	1.242 (.620).058*
Marital status (1 = with partner)	.057 (.082).021	.001 (.101).000	.281 (.293).030	.121 (.329).013	.404 (.228).060	.272 (.271).040	.179 (.143).044	.157 (.174).039	.494 (.129).122***	.277 (.152).068	1.415 (.670).066*	.827 (.765).039
Ethnicity (1 = indigenous)	–.207 (.091)–.069*	–.222 (.094)–.074**	.337 (.324).032	.302 (.307).029	.154 (.253).021	.012 (.252).002	.196 (.159).044	.037 (.162).008	.301 (.143).067*	.180 (.141).040	.782 (.742).033	.309 (.712).013
Health problems	–.019 (.032)–.019	–.030 (.032)–.030	–.281 (.113)–.079**	–.171 (.104)–.048	–.289 (.088)–.114***	–.210 (.085)–.083**	–.127 (.055)–.084*	–.092 (.055)–.061	–.079 (.050)–.052	–.023 (.048)–.015	–.758 (.258)–.094**	–.465 (.240)–.058*
Dependence ADL	–.053 (.005)–.339***	–.051 (.005)–.329***	–.112 (.019)–.206***	–.098 (.017)–.181***	–.028 (.015)–.071	–.021 (.014)–.053	–.029 (.009)–.125**	–.025 (.009)–.108**	–.020 (.008)–.086**	–.016 (.008)–.069*	–.242 (.043)–.196***	–.212 (.040)–.172***
Depression	–.094 (.012)–.258***	–.064 (.013)–.174***	–.531 (.041)–.416***	–.279 (.043)–.219***	–.275 (.032)–.303***	–.135 (.035)–.149***	–.028 .020–.052	.017 (.023).032	–.221 (.018)–.405***	–.137 (.020)–.251***	–1.149 (.094)–.398***	–.597 (.099)–.207***
Model 2. Psychosocial resources
Social support from partner		.003 (.014).007		–.018 (.047)–.013		.020 (.039).021		–.014 (.025)–.024		.049 (.022).085		.041 (.110).013
Social support from children		.019 (.013).047		–.008 (.043)–.006		.067 (.035).066*		.043 (.023).071*		.049 (.020).080**		.171 (.099).053
Social support from family member		–.011 (.013)–.025		.041 (.044).028		.075 (.036).071*		–.007 (.023)–.011		.057 (.020).090**		.155 (.102).046
Social support from friends		.017 (.016).035		.093 (.053).054*		.077 (.043).063		–.021 (.028)–.028		.036 (.024).049		.203 (.122).052
Social support from social groups		.004 (.002).054		.014 (.007).060*		.013 (.006).081**		.017 (.004).178***		.012 (.003).122***		.060 (.016).115***
Resilience		.067 (.015).154***		.618 (.049).407***		.303 (.040).280***		.059 (.026).091**		.163 (.023).250***		1.210 (.114).352***
R ²	.30	.32	.27	.40	.13	.21	.04	.08	.22	.30	.26	.38
F change	48.916***	4.718***	42.612***	29.593***	16.578***	13.689***	4.511***	6.169***	33.297***	16.405***	39.079***	25.164***

SA: successful ageing; ADL: activities of daily living; SE: standard error.

p < .05. **p < .01. ***p < .001.

Discussion

The results of this study have significant implications for the analysis of relationships between health, psychosocial resources and SA. There has been extensive debate regarding the importance for understanding SA of comparing multidimensional models (Cosco et al., 2017). Nonetheless, there continues to be a biomedical emphasis in the approach to the issue, with a gradual addition of psychosocial perspectives (Cheng, 2014). We sought to incorporate both approaches into this study, as well as capturing the diversity of the SA process by including objective indicators, such as health problems, and subjective ones, such as perceived social support (Pruchno et al., 2010a).

SA is a multidimensional and heterogeneous process. The results suggest that the various domains of SA are subject to different procedures; that is, health and psychosocial variables have specific relationships for mechanisms of functional performance, intrapsychic factors, spirituality, gerotranscendence and life purpose/satisfaction. SA is characterised specifically by its manifestation as a variable process (Mendoza et al., 2017). Although many older adults may age successfully, the nature of successful functioning over time varies in terms of indicators, and the combinations of successful indicators vary according to the individual. One may argue in this context that if a person is living in circumstances where they do not exhibit all the indicators or elements of SA, this is not synonymous with ageing ‘unsuccessfully’. In other words, an ageing process can be successful even if subject to limitations in certain domains of ageing (Kok et al., 2017).

Further evidence of the heterogeneity of SA was found in the results observed for the demographic variables. Age is negatively associated with mechanisms of functional performance, intrapsychic factors and the general construct of SA. In other words, the results confirmed that adaptation to physical and cognitive changes would decline as a person ages (Dahany et al., 2014; Li et al., 2014). But this relationship was not found for gerotranscendence, spirituality and life purpose/satisfaction, showing that aspects of SA can be maintained and even offer increased support at advanced ages (Jeste et al., 2013), such as having the desire to transcend one’s age, maintaining a spiritual connection and giving meaning to life. Being a woman was positively associated with gerotranscendence, spirituality, life purpose/satisfaction and the general construct of SA. Although the empirical evidence is inconsistent in terms of affirming the role of gender in SA (Pruchno et al., 2010b), in the present study we observed that women adapt with greater ease in the domains of transcendence and standard of living. With respect to marital status, having a partner is positively associated with life purpose/satisfaction and the general construct of SA. However, having a partner was not associated with the other domains of SA and this again confirms the complexity of a process that is individual yet at the same time social. In this regard, though the study conducted by Pruchno et al. (2010b) shows that having a partner has a positive impact on SA, the company of a partner may play different roles in other facets of SA.

This study confirms that the SA process is strongly related to health, which is consistent with the empirical evidence (Cosco et al., 2014; Kim and Park, 2017). The three health measures also appear as predictors of SA. In particular, health problems were negatively related to intrapsychic factors, gerotranscendence, spirituality and the general construct of SA; that is, having chronic illnesses such as diabetes, hypertension or high cholesterol would affect a person’s ability to satisfactorily adapt to the changes of old age (Li et al., 2014; Pruchno et al., 2010a). A similar argument can be used for ADL dependence, which was negatively related to mechanisms of functional performance, intrapsychic factors, spirituality, life purpose/satisfaction and the general construct of SA. These results are consistent with the model initially proposed by Rowe and Kahn (1987, 1997), in which physical functionality – a low probability of illness and related disorders – plays a central role in understanding SA.

Depression also appears as a significant predictive variable in understanding SA according to the present study. Specifically, depression was negatively associated with mechanisms of functional performance, intrapsychic factors, gerotranscendence, life purpose/satisfaction and the general construct of SA. This is supported by the empirical evidence (Jeste et al., 2013). This variable merits specific analysis in the Chilean case since depression is the most frequently occurring mental health disorder among older Chilean adults (Sandoval et al., 2016).

Psychosocial resources are also significant predictive variables for SA. Taking into account that SA is a process of adaptation that mobilises individuals’ resources, their support networks have to change in order to meet the specific needs or circumstances of old age. In this sense, the results showed how family and non-family networks are specifically associated with the domains of SA. Social support from children was positively related to gerotranscendence, spirituality and life purpose/satisfaction. Meanwhile, social support from other family members was positively associated with gerotranscendence, and social support from friends is positively associated with intrapsychic factors. This shows that family networks continue to occupy an important role as a source of support at advanced ages (Chappell and Funk, 2011), but when family support networks are insufficient or ineffective, friends fulfil a significant role in the promotion of well-being (Faquinello and Marcon, 2011). Finally, the role of social support from members of social groups is notable as a predictive variable for almost all assessed dimensions of SA, with the exception of mechanisms of functional performance. This confirms that social participation at advanced ages gives rise to various benefits that increase well-being (Kleineidam et al., 2018). All these findings invite us to reconsider the role of family in the promotion of positive ageing and the importance of progressing towards other systems of social integration with a focus on heterogeneous and complementary social networks (Gallardo-Peralta et al., 2018a).

Resilience represents one of the most significant psychosocial resources in this research. The results showed its positive association with all the domains and the general construct of SA. It is not unreasonable to state that resilience is the leading predictive variable. It has been defined as the ability to achieve, retain or regain a level of physical or emotional health after devastating illness or loss (Felten and Hall, 2001), which would position it as an ability that must be developed in order to satisfactorily adapt to the changes and new conditions of old age. Although resilience may appear to be an individual ability, it is a phenomenon that emerges in social and environmental interactions (Kok et al., 2018). It is therefore strongly related to social support networks (Hayman et al., 2017). Cultural aspects can also have an influence on the construction of resilience. In this respect, the empirical evidence affirms that Latin Americans understand SA from the perspective of seeking happiness in one’s daily life; they hence perceive ageing as a stage for enjoying life and coping with the changes that it entails based on a position of acceptance: ‘don’t think about it much, age with dignity, have realistic expectations’ (Hilton et al., 2012).

Finally, this study shows that SA is determined by cultural context and indigenous people age with particular features. The results showed that being indigenous is negatively associated with mechanisms of functional performance, but positively with life purpose/satisfaction. Therefore, the indigenous group – Aymara and Mapuche people – face difficulties in physical adaptation, but do not have adaptation difficulties with respect to well-being indicators (life satisfaction). These findings are consistent with the empirical evidence, which confirms that indigenous Chilean ethnic minorities tend to experience deficient health conditions – such as higher comorbidity and morality – compared with the general population (Vega et al., 2018), although paradoxically these indigenous communities report a higher quality of life measured in terms of physical pain and use of medical treatment when they maintain the cultural practices associated with a healthy and natural lifestyle, such as eating a traditional Andean diet based on quinoa and camelid meat (Gallardo-Peralta et al., 2018b). This paradox has been the subject of extensive research (Pace and Grenier, 2017). Its origins lie in the conflict between risk factors and various structural barriers as against protective factors, such as the upholding of cultural traditions that promote a healthy and natural lifestyle (Hilton et al., 2012; Lewis, 2011). Examples of structural barriers that ethnic minorities face include lower quality education, lower or unskilled jobs with more physically demanding tasks, lower pay at equivalent levels of education, lower incomes at retirement, higher exposure to toxic or unsafe working and living conditions, less access to health insurance or higher co-pays and deductibles even when insured, less access to or lower quality health care, greater receipt of health care in suboptimal settings, and less continuity of care (Cené et al., 2016: s97).

In conclusion, SA is a theoretical model that emphasises the potential of older adults, offers an integrative perspective of aspects that promote a positive old age and is also applicable in diverse cultural contexts, such as that of older Chilean adults.

Implications for social work practice with older persons and indigenous ethnic minorities

Old age is a stage of life marked by negative and stressful life events and situations, including physical and social losses. In this light, the SA approach proposes a positive outlook (Nimrod and Ben-Shem, 2015) and offers the possibility of offsetting the negative changes of old age by superimposing the psychosocial resources available to older adults (Cho et al., 2015).

The aim of this approach is to empower people to achieve SA (Pruchno and Carr, 2017), in line with the outlook of gerontological social work. Our research confirms that psychosocial resources can serve as promoters of positive ageing. These resources include social support networks and resilience, both extensively incorporated into professional work. There is a need to develop intervention protocols that promote protective factors that will act as buffers against the various difficulties inherent to old age (Bolton et al., 2016) and thereby to shift the focus of interventions away from an approach focused solely on the problems, needs and losses of older adults.

Another contribution of this work is the understanding that SA should be an ongoing process from the initial stages of old age, and hence capable of being modified and promoted over the course of a lifetime. As stated by Pruchno and Carr (2017), it is necessary to identify individual, sociocultural and environmental characteristics from the perspective of a life pathway in order to be able to promote SA.

With respect to the implications of this study for gerontological interventions with indigenous ethnic minorities, in the context of Latin American social work and particularly in Chile, there has been little progress made on theoretical models focused on the social reality of native indigenous ethnic minorities (Gallardo-Peralta et al., 2019) and the tendency is normally to apply Anglophone models for the management of cultural diversity (Guzmán, 2011). While recognising that this remains a pending challenge for Latin America, we cannot disregard the findings of social work on an international scale and their possible practice and research implications in terms of improving the social conditions of the indigenous communities that we have researched. A brief reference should be made to the practical implications of the ethnically sensitive approach, based on an anti-racist, anti-oppressive and anti-discriminatory perspective of social work. This is rooted in the idea that a ‘recognition of the cultural values, cultural needs and differences of local ethnic groups, includes social work practice focused on developing positive minority identities, taking affirmative action and empowering social service users’ (Urh, 2008: 121–2). This approach can guide social work practice with indigenous Chilean communities that are seeking to maintain their cultural customs (e.g. respecting their family and community values, which differ from the rest of the Chilean population). This tends to be a recurring theme in the design of participatory spaces for indigenous older adults when they interact with social workers. Moreover, our results suggest the utility of an Indigenous research paradigm, involving indigenous knowledge, cultures and protocols in relation to the place and nation within whose territory the research is undertaken (Pidgeon, 2019: 1).

Future research

The continuing lack of clarity over the dimensions that comprise SA (Pruchno et al., 2010a) raises a need for further studies that seek to compare the different variables affecting this process. In this regard, it is also important to extend the approach of SA to diverse cultural contexts (Stewart et al., 2019), such as the indigenous ethnic communities of Latin America – specifically, ethnicities live in their natural physical context and maintain ancestral cultural practices that can guide us towards more contextualised social interventions that are more respectful of diversity. As Torres (2006) argues, we must advance towards an understanding of the impact of culture on how ageing is understood and expressed; this would enable us to develop the SA paradigm in a culturally informed manner.

This understanding represents a challenge both for future research and for social work practice. It implies incorporating the ancestral knowledge of indigenous communities into theoretical and gerontological intervention models. Studies conducted with and for indigenous communities are subject to the basic principles of social work, which include respect for diversity, defence of human rights and social justice. The International Federation of Social Workers (IFSW) currently states that indigenous knowledge should underpin the discipline. More specifically, future research should offer useful knowledge so that social work interventions constitute anti-oppressive practices that facilitate the struggle of indigenous peoples against social exclusion.

The focal point of this study is that of two indigenous groups that have become ethnic minorities in a situation of social work in their own territorial location and natural geography. The impact and influences of social processes relating to ethnic diversity are hence not the product of an internal or external migratory process. However, the Aymara and Mapuche populations have not remained removed or isolated from colonial and post-colonial cultural influences. On the contrary, they have suffered a process of ‘Chileanisation’ that has been driven to a large extent by state institutions, and that has endangered central aspects of these groups’ way of life and the intergenerational transfer of their cultural content. In this regard, the findings of our study may prove useful in interpreting the role played by resilience and social support in the SA process in the case of indigenous peoples in societies different from the Chilean one, and particularly in the case of Latin America.

The main limitation of this research is its cross-sectional design. This means that the data must be interpreted with caution and it is not possible to establish causal interpretations of SA. We can only propose predictive variables that are associated with SA. The study is also limited by its quantitative character, which prevents access to the personal views of subjects with regard to the dimensions that promote SA. It is therefore necessary to develop the findings of this study with qualitative research and even mixed methodologies, which would provide us with a more complete overview of this process.

Footnotes

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship and/or publication of this article: This work was supported by the Government of Chile (‘Proyecto FONDECYT 1170493’) and University of Tarapacá (‘Proyecto UTA MAYOR 3766-19’).

ORCID iD

Lorena P Gallardo-Peralta

Author biographies

Lorena P Gallardo-Peralta (PhD. in Social Work) is associated lecturer and researcher at Social Work School, University of Tarapaca (Chile) and visiting scholar at the Faculty of Social Work, Complutense University of Madrid (Spain).

Abel Soto Higuera (Master in Applied Social Sciences) is lecturer and researcher at the Department of Social Work, University of La Frontera (Chile), currently a PhD in Social Work at the Complutense University of Madrid (Spain).

Cecilia Mayorga Muñoz (PhD. In Study and Treatment of Family Relationships) is assistant lecturer and researcher in the Department of Social Work, University of La Frontera (Chile).

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