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Brief Report

Negative perceptions of older adults and life satisfaction among community-dwelling older citizens in Japan

[version 1; peer review: 2 approved with reservations]
PUBLISHED 09 May 2024
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Abstract

Background

With the rapid aging of the population, increasing life satisfaction among older adults is essential. Negative perceptions of older adults are internalized, leading to poor mental health. This study hypothesized that participants with more negative perceptions of older adults would have lower life satisfaction.

Methods

A cross-sectional survey of older adults was conducted across five wards and four cities in Tokyo, Japan. Participants responded to questions regarding demographics, life satisfaction, and negative perceptions of older adults. Data from 285 participants (264 women, M = 71.97 years) were analyzed.

Results

The intraclass correlation coefficient for life satisfaction concerning residential areas was. 03 (95% confidence interval [CI] = [-.03, .10]). Instead of multilevel models, a multiple regression model with life satisfaction as the dependent variable and negative perceptions of older adults and demographics as the independent variables yielded the best fit. Results indicated that participants with more negative perceptions of older adults reported lower life satisfaction (β = -.16, 95% CI = [-.28, -.04], p = .008), supporting our hypothesis.

Conclusions

This study was constrained by limited variance in residential areas and a predominantly female participant pool. Previous studies have shown that higher life satisfaction is associated with increased social participation and extended life expectancy, and interventions aimed at enhancing life satisfaction in older adults are significant. Further exploration is warranted to ascertain whether a causal relationship exists, wherein more negative perceptions of older adults diminish life satisfaction.

Keywords

Psychological Well-Being, Quality of Life, Stereotyping, Life Satisfaction, Multilevel Models 

Introduction

Globally, the population is aging rapidly. This is especially evident in Japan, where 29.0% of the population will be 65 years or older by 2022.1 While social problems associated with aging have become more apparent, older adults generally have a higher level of life satisfaction than other generations.2,3 However, life satisfaction among older adults in Japan has declined in recent years.4 As life satisfaction among older people is closely associated with a higher level of physical health,5 increased social participation,6 and longer life expectancy,7,8 efforts to increase life satisfaction in this demographic are of great importance.

One variable that could be related to life satisfaction among them is negative perceptions of older adults, which is how older citizens perceive the social group of “older adults.” Stereotype embodiment theory (SET) assumes that older adults internalize negative old-age perceptions.9 Moreover, the SET argues that older adults who hold more negative perceptions are more likely to experience various negative effects. Previous studies have shown that older adults with more negative perceptions have poorer mental health,10,11 lower cognitive function,12 and slower recovery from illness.13 Similar to the SET, the risks of ageism model14 suggest that three factors broadly inhibit active aging: “stereotype embodiment,” “stereotype threat,” and “being a target of ageism.” Based on the above findings, negative perceptions of older adults among the older participants will be associated with lower life satisfaction.

We conducted a cross-sectional survey of community-dwelling older adults in Japan and examined the relationship between their negative perceptions and life satisfaction. Participants were enrolled in a health course conducted by local governments in Tokyo, Japan to train volunteers to read picture books to their children. In addition to population and economic size, each area had different main goals for the health course presented when recruiting participants (e.g., volunteer training and/or dementia prevention). Thus, an exploratory multilevel analysis was conducted to examine the relationship between the two variables, considering the effect of participants’ residential areas. We hypothesized that participants with more negative perceptions of older adults would have lower levels of life satisfaction.

Methods

Participants

A power analysis assuming a small to moderate effect size (ρ = .20, α = .05, 1–β = .80) yielded a required sample size of 193. Three hundred and two older Japanese individuals from Tokyo participated in this study. However, 17 participants were excluded from the analysis because they were < 65 years old. Thus, the data of 285 participants (aged 65–92, M = 71.97 years, SD = 5.16) were analyzed. The participants comprised 21 men and 264 women. They were older adults who voluntarily applied for a health course to train volunteers to read picture books to children, which was held in five wards and four cities in Tokyo from 2021–2022. A summary of the participants by residential area is available in the Open Science Framework (OSF) repository (https://doi.org/10.17605/OSF.IO/X6JSN).15 Participants were required to attend the health course venue independently. Note that the data for this study were collected before the implementation of the health course; therefore, our results do not include course effects. This study was approved by the first author’s institution for ethical review.

All procedures were in accordance with the ethical standards of Tokyo Metropolitan Institute for Geriatrics and Gerontology (approval number: 748; June 10, 2020) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all participants in written format.

Measurements

Negative perceptions of older adults were measured using the eight adjectives (five-point Likert scale).16 Participants were asked the following question: “To what extent do you think older adults fit each of the following adjectives?” Adjectives presented to participants included “depressed” and “passive.” The mean was taken as the score (α = .89), with higher scores indicating more negative perceptions of older adults.

Life satisfaction was measured using the five-items of the Satisfaction with Life Scale17 measured on a seven-point Likert scale. Examples of items include: “In most ways, my life is close to my ideal.” The mean was taken as the score (α = .86), with higher scores indicating a higher level of life satisfaction. Demographic variables included years of education, age, and sex.

Procedure and analysis

Participants received an explanation regarding the use of survey data for research purposes and agreed to participate in the study. Subsequently, they responded to demographic variables, life satisfaction, and negative perceptions of older adults. The statistical software R (ver.4.1.0) was used for all analyses. The list of questions, data used in the analysis, scripts for R, histograms for each variable, and summary statistics can be accessed through the OSF.

Results

The intraclass correlation coefficient (ICC) for life satisfaction concerning residential areas was.03 (95% CI = [-.03, .10]). Therefore, applying a multilevel analysis was not necessary. However, in this study, we conducted a simple multiple regression analysis (Model 1), a random effect with an analysis of covariance (RANCOVA) model, including the effect of residential area (Model 2), a random intercept and slope model with a group-level effect of negative perceptions of older adults (Model 3), and a random intercept and slope model with a cross-level interaction (Model 4). These models were compared in Table 1.

Table 1. Results for each model with life satisfaction as the dependent variable.

Model 1Model 2Model 3Model 4
β95%CIβ95%CIβ95%CIβ95%CI
NP-.16**[-.28, -.04]
NP (individual)-.18**[-.30, -.05]-.16[-.33, .02]-.15[-.33, .04]
NP (area)-.07[-.58, .42]-.08[-.66, .44]
NP (ind.×area).02[-.14, .18]
Education years.06[-.06, .18].06[-.06, .18].06[-.05, .19].06[-.05, .19]
Age-.07[-.19, .06]-.05[-.17, .08]-.03[-.16, .09]-.03[-.16, .09]
Sex-.09[-.20, .03]-.09[-.20, .03]-.09[-.20, .03]-.09[-.20, .03]
AIC808.53826.30831.20836.38
BIC830.44851.87867.72876.56

** p < .01.

Life satisfaction was used as the dependent variable in each analysis. In Model 1, a multiple regression analysis including the demographics (years of education, age, and sex) showed that participants with more negative perceptions of older adults had lower life satisfaction (β = -.16, 95% CI = [-.28, -.04], p = .008). In Model 2, we conducted a RANCOVA model with an individual-level effect (group-mean centering) of negative perceptions of older adults and found a similar effect to Model 1 (β = -.18, 95% CI = [-.30, -.05], p = .005). In Model 3, we employed a random intercept and slope model, including a group-level effect (deviating from regional means) of the negative perceptions of older adults. The results showed that the individual-level effect (β = -.16, 95% CI = [-.33, .02], p = .11) and the group-level effect (β = -.07, 95% CI = [-.58, .42], p = .80) were not significant. In Model 4, we employed a random intercept and slope model, including cross-level interaction. The results showed that the individual-level effect (β = -.15, 95% CI = [-.33, .04], p = .18), the group-level effect (β = -.08, 95% CI = [-.66, .44], p = .77), and the cross-level interaction (β = .02, 95% CI = [-.14, .18], p = .85) were not significant.

Model comparisons were conducted using the Akaike’s information criterion and the Bayesian information criterion, and Model 1 was determined to fit the data best. Note that when participants aged under 70 (n = 103) and 70 or over (n = 182) were analyzed separately; the results for both groups were similar to those in the main manuscript (see OSF). Similar results were obtained in a multiple regression analysis using a dummy variable for the residential area, with zero for the ward and one for the city (see OSF). Thus, our hypothesis that participants with more negative perceptions of older adults have lower levels of life satisfaction was supported.

Discussion

In this study, we conducted a cross-sectional survey of community-dwelling older adults in nine areas in Tokyo to examine the relationship between negative perceptions of older adults and life satisfaction. Each multilevel model fits the data worse than the simple multiple regression analysis. The results showed that participants with more negative perceptions of older adults had lower life satisfaction, thus supporting our hypothesis. Note that a reverse relationship could also be assumed: individuals with lower life satisfaction have more negative perceptions of older adults. The same association was found when this possibility was examined, as in the main manuscript (see OSF).

In this study, the ICC for life satisfaction in residential areas was small, and the fit of each multilevel model was relatively low. One reason for this may be that our participants were limited to those in a health course, training volunteers to read picture books. While detailed motivations for participating in the course varied from individual to individual, the attitude of “I am interested in picture books” and “I want to work as a volunteer” was probably shared by almost all participants. Thus, possibly, the group-level effect was relatively small due to the presence of factors common to participants across residential areas.

As this study is a cross-sectional survey, we should examine whether a causal relationship exists between more negative perceptions of older adults and decreased life satisfaction. Meanwhile, given that older adults with negative perceptions of themselves have poorer mental health,10,11 positively changing their perceptions of older adults is important. One way to achieve this is to present people with information that contradicts negative old-age stereotypes. For example, negative stereotypes exist that “older adults are prone to illness,” but it was shown that presenting people with the content that “many older adults are healthy enough and able to live on their own” decreased ageism toward older adults.18,19 Although these findings targeted younger people, a similar experimental manipulation for older adults may affirm their perceptions of older adults. Future empirical studies are required to positively change the perceptions of old age among older adults.

This study had two major limitations. First, the areas covered in this study were all located in Tokyo, Japan, and the regional differences were small. Compared with Japan’s underpopulated regions, all nine regions in this study share a high population density and a very small number of people engaged in agriculture, forestry, and fisheries. Therefore, follow-up studies are required to select regions with significantly different geopolitical characteristics from a wide range of prefectures. Second, the participation was skewed toward women. Since this study was conducted before a health course to train volunteers to read picture books to children, women comprised the majority of the participants. Note that results similar to those in the main manuscript were obtained when the analysis was limited to women’s data (see OSF); however, this study could not make adequate comparisons between men and women. Therefore, our findings should be re-examined with a sufficient number of male participants.

In this study, we found an association between negative perceptions of older adults and life satisfaction among community-dwelling older adults. Interventions that increase life satisfaction in older adults are meaningful because higher life satisfaction leads to increased social participation and longer life expectancies. Thus, it would be useful to focus on the negative perceptions of older adults. In addition, we conducted an exploratory multilevel analysis. Future studies on life satisfaction and negative perceptions of older adults in a broader geographic area should consider the effects of residential areas.

Ethical considerations

All procedures were in accordance with the ethical standards of the research committee of Tokyo Metropolitan Institute for Geriatrics and Gerontology, (approval number: 748; June 10, 2020 and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Written Informed consent was obtained from all individual participants included in the study.

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Shimizu Y, Sato K, Ogawa S et al. Negative perceptions of older adults and life satisfaction among community-dwelling older citizens in Japan [version 1; peer review: 2 approved with reservations]. F1000Research 2024, 13:467 (https://doi.org/10.12688/f1000research.149132.1)
NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article.
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ApprovedThe paper is scientifically sound in its current form and only minor, if any, improvements are suggested
Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.
Not approvedFundamental flaws in the paper seriously undermine the findings and conclusions
Version 1
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PUBLISHED 09 May 2024
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Reviewer Report 16 Jul 2024
Susiana Nugraha, Public Health Department, Faculty of Health Science, Universitas Indonesia, University of Respati Indonesia, Jakarta, Special Region of Jakarta, Indonesia 
Approved with Reservations
VIEWS 15
This paper discusses about the negative perception of being older adult is associated with life satisfaction. The title of this paper is little bit biased in wording. the term of "negative perception of older adult" tend to created ambiguous meaning ... Continue reading
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HOW TO CITE THIS REPORT
Nugraha S. Reviewer Report For: Negative perceptions of older adults and life satisfaction among community-dwelling older citizens in Japan [version 1; peer review: 2 approved with reservations]. F1000Research 2024, 13:467 (https://doi.org/10.5256/f1000research.163548.r297567)
NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article.
  • Author Response 23 Aug 2024
    Yuho Shimizu, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
    23 Aug 2024
    Author Response
    Reply to Reviewer 2

    We express our appreciation to the reviewer for their insightful comments on our manuscript, which have helped us significantly improve the paper. Additionally, we have ... Continue reading
COMMENTS ON THIS REPORT
  • Author Response 23 Aug 2024
    Yuho Shimizu, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
    23 Aug 2024
    Author Response
    Reply to Reviewer 2

    We express our appreciation to the reviewer for their insightful comments on our manuscript, which have helped us significantly improve the paper. Additionally, we have ... Continue reading
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20
Cite
Reviewer Report 05 Jul 2024
Anna Zalewska, Faculty of Health Sciences, University of Lomza, Lomza, Poland 
Approved with Reservations
VIEWS 20
Thank you for the opportunity to review this paper. This is a timely issue to explore. It is mostly clear paper, there is, however, issues that must be resolved before the study can be accepted for indexing. Several comments and ... Continue reading
CITE
CITE
HOW TO CITE THIS REPORT
Zalewska A. Reviewer Report For: Negative perceptions of older adults and life satisfaction among community-dwelling older citizens in Japan [version 1; peer review: 2 approved with reservations]. F1000Research 2024, 13:467 (https://doi.org/10.5256/f1000research.163548.r297565)
NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article.
  • Author Response 23 Aug 2024
    Yuho Shimizu, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
    23 Aug 2024
    Author Response
    Reply to Reviewer 1

    We express our appreciation to the reviewer for their insightful comments on our manuscript, which have helped us significantly improve the paper. Additionally, we have ... Continue reading
COMMENTS ON THIS REPORT
  • Author Response 23 Aug 2024
    Yuho Shimizu, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
    23 Aug 2024
    Author Response
    Reply to Reviewer 1

    We express our appreciation to the reviewer for their insightful comments on our manuscript, which have helped us significantly improve the paper. Additionally, we have ... Continue reading

Comments on this article Comments (0)

Version 4
VERSION 4 PUBLISHED 09 May 2024
Comment
Alongside their report, reviewers assign a status to the article:
Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested
Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.
Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions
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