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PLACE IN RETURN Box to remove this checkout from your record.
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'0

EXPRESSED LIFE SATISFACTION IN OLDER ADULTS
LIVING IN A RETIREMENT HOME

BY

Glenes Jean Boerema

A SCEOLARLY PROJECT

Submitted to
Michigan State University
in partial fulfillment of the requirements
for the degree of
MASTER OF SCIENCE IN NURSING

College of Nursing

1989

 

 

 

 

LIBRARY
Michigan State
University

 

 

 

 

ABSTRACT

EXPRESSED LIFE SATISFACTION IN OLDER ADULTS
LIVING IN A RETIREMENT HOME

BY

Glenes Jean Boerema

With the increasing number of American's entering the age
group categorized as elderly, concern arises regarding living
arrangements for this segment of the population. The retirement
home setting is one housing alternative available for older
adults who are able to maintain some degree of self-care but who
are unable or do not wish to remain in their own personal homes
or condominiums. However, little is known concerning the
perceived levels of life satisfaction among those who live in the
retirement home setting. The purpose of this study was to
examine the expressed life satisfaction levels of adults 65 years
of age or older six months or more after entry into a retirement
home, utilizing the Adams (1969) revision of the Life
Satisfaction Index-A and three open ended questions. The
instrument was administered to a sample of eleven retirement home
residents and results of this pilot project indicate that there
was a high degree of life satisfaction present among this sample

of generally healthy middle class retirement home residents.

DEDICATION

This project is dedicated with love to my Grandparents:
Simon & Carrie Boerema
Arthur & Hazel Maricle

From them I learned to love, respect and admire the elderly.

iii

ACKNOWLEDGEMENTS

I would like to warmly thank Dr. Sharon King, Committee
Chairperson, for her constant encouragement and support
throughout this project. I greatly appreciate all of her
time and efforts spent in facilitating and guiding this
project to completion. Special thanks alSo to Carol
Garlinghouse for helping me get this project "underway“ and
for being an excellent role model and mentor. Joanne Pohl's
clinical expertise and knowledge of nursing theory has been
particularly helpful and much appreciated.

I want to thank my parents John and Betty Boerema for
their unfailing patience, understanding, and support
throughout this endeavor.

A special appreciation is extended to my dear friends
Mary Sue Van Dyke, Renee Rasikas, and Marcy Schueler for
always being there to listen, encourage and understand. I
am also grateful to my friend Therese Rasch for her ongoing
encouragement, support, and often empathy as we concurrently
pursued MSN's in Gerontological Nursing on opposite sides of

the country.

iv

TABLE OF CONTENTS

LIST OF TABLES . . . . . . .

LIST OF FIGURES . O O O C O 0

CHAPTER ONE

INTRODUCTION . . . . .
DEFINITION OF CONCEPTS . . .
ASSUMPTIONS. . . . . . .
LIMITATIONS. . . . .
IMPORTANCE AND SIGNIFICANCE OF

CHAPTER TWO
THEORETICAL FRAMEWORK . . .

Overview . . . . .
DEFINITION OF CONCEPTS . . .

RELATIONSHIP OF THEORY TO STUDY

PROJECT.

CONCEPT DEVELOPMENT FROM LITERATURE.

CHAPTER THREE

REVIEW OF THE LITERATURE . .
Overview . . .

External Environmental Change

Life Satisfaction . . .

Relationship Between External

Environmenta3

Change and Life Satisfaction.

SUMMERY O O O O O O O 0
CHAPTER FOUR
METHODOLOGY AND PROCEDURES. .

Overview . . . . . .
Research Question . .

Sample . . . .
Operational Definitions .
Procedure . . . . .

V

Page

vi

ommbI—a

12
12
14
22
24

29
29
30
41

54
57

INSTRUMENT DEVELOPMENT . . . . .
RELIABILITY. . . . . . . . .
VALIDITY. . . . . . .
PROPOSED SCORING AND ANALYSIS. . .

CHAPTER FIVE
OVERVIEW. 0 O O O I O O O O
PARTICIPANTS . . . . . .
LIFE SATISFACTION INDEX A . . . .
DIS CLISSION O O C C O O C O .
ADDITIONAL FINDINGS . . . . . .
CHAPTER SIX
OVERVIEW. . . . . . .
RECOMMENDATIONS FOR FUTURE RESEARCH.
RELATIONSHIP TO CONCEPTUAL FRAMEWORK
IMPLICATIONS FOR NURSING PRACTICE .
APPENDIX A. O O O O O O O O O 0
APPENDIX B. O O O O O O O O O 0
APPENDIX C. . . . . . . . . . .

REFERENCES 0 O O O O O O O O O 0

vi

64
67
68
70

73
73
76
83
84

90
91
94
97
101
104
105

106

Table

LIST OF TABLES

Sample Characteristics. .

Score Distribution of the LSIA
Life Satisfaction Index

Summary of Responses to LSIA.

Responses
Responses
Responses

Responses

to

to Zest vs. Apathy.

to

to

Mood Tone. .

A and Scores

Congruence between Goals.

Resolution and Fortitude.

Summary of Additional Findings .

vii

Page

75
76
77
78
80
81
82
83

86

LIST OF FIGURES

 

Figure Page
1 The Interacting Systems of King's Model. . . . 19
2 Representation of King's Model. . . . . . . 21

viii

CHAPTER ONE

Introduction

 

With the increasing number of Americans entering the
age group categorized as older adult or elderly, there
arises concern as to living arrangements for this segment
of the population. Prior to WOrld War II, older people
were generally taken into the homes of their children and
cared for there (O'Neill & Boosinger, 1981). However,
with the increasingly mobile and fast paced society of
today's culture this is not always appropriate. Only a

small segment (approximately five percent) of the

population over 65 years of age is institutionalized at
any one time. The U.S. Senate Special Committee on Aging
states that at any given time, two percent (295,000) of
those age 65 to 74 years will be in a nursing home
compared to about seven percent (627,000) of persons age
75 to 84 years, and about 16 percent (489,000) of those
persons over 85 years of age (1986, p. 97). Therefore, in
consideration of the distribution of the elderly residing
in long term care facilities especially since this
percentage so dramatically increases with age, various
housing options must be considered for these older adults
(O'Neill & Boosinger, 1981, p.99). Potential housing
options for these individuals include retirement
condominiums, senior citizen apartment highrise
structures, retirement communities, and retirement homes.
Many older adults are in a unique situation in which they
are no longer able to or do not wish to remain in their
own home, but are not at a point where nursing home or
skilled care is required. The retirement home provides
congregate living, private living quarters, and group
meals. Twenty-four hour security and planned social
activities are also incorporated, and in many cases,
accessible skilled nursing care is available within the

same institution. However, for the older adult relocation

into any type of housing option presents a major
"upheaval involving loss and requiring a redefinition of
self," and this upheaval must be taken into consideration
when examining relocation and the older adult (Gubrium,
1974, p.221).

Rosswurm (1983) describes the transition from a
residence to an institution for the first time as a
"drastic environmental change” (p.634). Individuals are
often forced to give up a degree of autonomy and
independence upon relocation into a retirement home and
this loss may lead to a diminished sense of life
satisfaction and feelings of depression. Diamond, King,
and Burt (1979) state that literature concerning
relocation of the elderly, and our knowledge of the
phenomena related to relocation are ”sketchy and
incomplete" (p.135). People bring with them into the new
setting enduring psychosocial and biological
characteristics which influence the degree of satisfaction
experienced in the new environment (Lawton & Cohen, 1974).
Residing in a retirement home necessitates potential
changes in life style and daily living. A question arises
relating to the perceived feelings of life satisfaction
of those living in retirement homes; therefore, the

research question for this study is:

What is the expressed level of life satisfaction of
adults over 65 years of age six months or more after entry

into a retirement home?

This scholarly project will take the format of a pilot
project in an effort to examine the single variable life
satisfaction. In addition, this project will not make an
intentional attempt to measure or control for extraneous
variables. The pilot study can provide valuable data to
guide further research, as well as provide information for
improvements in future research (Polit & Hungler, 1983).
The pilot study approach may be particularly beneficial
with this sample since little research on the perceived
levels of life satisfaction among retirement home

residents has been completed at the present.

DEFINITIONS OF CONCEPTS

 

A. Elderlinndividual:

 

The elderly individual is one who is experiencing the
aging process. Aging is "healthy, inevitable, and
irreversible" (Boettcher, 1985, p.27). It is not an

illness; rather it is a developmental stage (Boettcher,

1985). Atchley (1983) further describes the older person
as "an individual in the later maturity or old age stages
of the life cycle. Socially, people are usually
classified as older if they are chronologically sixty—five
or older” (p.294). Therefore for the purposes of this
study "elderly individual" will be defined as one who is

chronologically age sixty-five or older.

B. Retirement Home:

 

The retirement home is a specific alternative form of
housing for older adults. Beland (1984) describes senior
housing in general as "a place where some protection is
available, while enabling them (the resident) to preserve
personal autonomy" (p.184). Beland (1984) further
characterizes senior housing as including a congenial
environment and opportunities for friendship. Maves
(1983) depicts retirement homes as congregate living in
which an emphasis is placed ”on providing convenient
access to social activities, on companionship, on
security, and on the availability of a continuum of care
in meeting changing needs all in one location" (p. 82).
For the purposes of this study a retirement home will be

defined as congregate living with private sleeping and

dwelling quarters, group meals and opportunities for

social activities and security.

C. Life Satisfaction:

 

Life satisfaction is defined as "a global assessment
of life quality, derived from comparison of one's
aspirations to the actual conditions of life" (George,
1986, p.5). Life satisfaction differs from the concepts
of happiness and mood. Happiness and mood tend to be
related to emotional judgments, while life satisfaction
may be viewed as being on a continuum with evaluation
based on the perception of the differences between
achievements and aspirations (George, 1986). Happiness
and mood are fluctuating states, however life satisfaction
is more stable and since it is more cognitively based than
other subjective indicators of well-being, it has been a
"more attractive candidate for the study of the quality of
life in old age" (George, 1986, p.5).

Borup (1981) discusses the negative attitudes older
adults often have towards relocation, and how these
attitudes tend to become more positive with time after
relocation. Dissatisfaction may be viewed as "a
discrepancy between aspirations and achievements“ (George,

1986, p.6).

Diamond et a1. (1979) cite life satisfaction as being
a coping resource influencing relocation. Life
satisfaction is a measurement of perceived well-being
which includes five components: ”zest for life as opposed
to apathy; resolution and fortitude as opposed to
resignation; congruence between desired and achieved
goals; high physical, psychological and social self-
concept; and a happy, optimistic mood tone" (Adams, 1969,
p. 470).

For the purposes of this study, life satisfaction will
be defined as a subjective personal judgement of life
quality arising from a comparison between individuals'
aspirations and the actual situation in which they find

themselves.

D. Relocation:

 

Although relocation is not a focus of this project,
it is a concept which must be examined because the body of
literature connecting life satisfaction with retirement
home residency is closely related. In review of the
literature, relocation is a frequently used term, but
specific definition of the term appears to be inadequate.
Rosswurm (1983) describes relocation as a transfer from a

residence to an institution. She further states that

”older persons relocating from a residence to an
institution for the first time will probably experience
the most drastic environmental change" (Rosswurm, 1983,
p.634). Because relocation is such a radical change for
an individual, it poses great risk for coping and
adaptation as well as health status and requires
adaptation and new learning (Gubrium, 1984). It appears
that the prior characteristics of an individual may
determine to a great extent his/her reaction to
relocation, especially physical condition, cognitive
ability, and personality characteristics (Gubrium, 1974).
When addressed in this study, relocation will be
defined as the transfer of residence from an independent
situation such as a private home, condominium, or
apartment to a residential institution (retirement home)

for the first time.

Assumptions

 

This will be a descriptive study dealing with a
specific segment of the older adult population. Levels of
perceived life satisfaction will be assessed in
individuals who have moved into a retirement home at least

six months prior to measurement. 1) It will be assumed

that life satisfaction is measurable, and that 2)
individuals will understand the questions and give

truthful answers.

Limitations

 

l) Volunteers will be used in this study and may be
systematically different than nonvolunteers; therefore,
generalizations should not be made beyond this group. 2)
The small number of subjects due to the pilot nature of
the project limits forms of analysis and generalizability
of the results. 3) In addition, other intervening and
influencing variables affecting the older adult's
perceptions related to life satisfaction such as enduring
personality characteristics, declining health or mental
status, and/or financial insecurity may be present and are
not measured as a part of this study. 4) All subjects are

from the same retirement facility.

IMPORTANCE AND SIGNIFICANCE OF THIS PROJECT

Borup (1981) and Rosswurm (1983) both state that

relocation is potentially a very stressful life event for

the older adult and that "a change in residence can result

10

in a major disruption of a person's activities, regardless
of his/her age" (Borup, 1981, p.501). Lawton & Cohen
(1974) found that individuals who make voluntary changes
of residence tend to show more positive outcomes. Ferraro
(1982) also states that it would be expected that
relocation would have fewer negative effects when the move
is a voluntary choice. However, in his study it was found
that regardless as to whether or not the move was a
voluntary choice, relocation does adversely effect
physical health as determined by physical disability,
ability to perform own activities of daily living, and
number of days spent ill at home or in the hospital
(Ferraro, 1982).

Gubrium (1974) states that "it seems eminently clear
that the characteristics of persons prior to relocation,
particularly their functional adequacy in terms of
physical condition and cognitive ability, play a crucial
role in accounting for those who react negatively to
relocation" (p.221). Bourestrom & Pastalan (1981) also
point out that readjustment to change in residence is also
influenced by such characteristics as age, physical
health, psychiatric disturbance, and cognitive
functioning. Also, preparation for relocation may

influence the effects of relocation. All of these are

11

variables which may influence to some degree levels of
life satisfaction found in persons who reside in
retirement homes. Relocation may result in radical
changes in the life style of a person in an age group
which is characteristically reluctant to venture into new
and unexplored areas.

Therefore, in light of the lack of documentation
related to the elderly in retirement home settings and
their perceived levels of life satisfaction, assessment in
this area is indicated. Information collected from this
investigation will provide background for those working
with the elderly in the retirement home setting as well as
provide an area for further research.

Chapter one has provided an introduction to the
concepts of life satisfaction among retirement home
residents. Chapter two will introduce the theoretical
framework which will provide a foundation for this
project. A review of the relevant literature will be
presented in chapter three. Chapter four will include a
description and discussion of the methodology used for the
project. Discussion of the project results will be
addressed in chapter five. Chapter six will present areas
for future research and implications for advanced nursing

practice.

CHAPTER TWO

Theoretical Framework

Overview

In this study of perceived life satisfaction of
retirement home residents, King's theory of goal
attainment serves as a model. Analysis will be made of
perceived life satisfaction in older adults utilizing
King's model. Observations can be made as to whether or
not residing in a retirement home is accompanied by a
sense of life satisfaction by applying the concepts of

goal attainment. In addition, objectives for nursing

12

13

interventions may be made by utilizing the model. Nursing
actions for those living in the retirement home setting
may be directed towards interventions in which the
client's perceived life satisfaction levels might be
maintained or improved.

Iomogene M. King was one of the pioneers of nursing
theory. She presented her conceptual model in her first

book Toward a Theory in Nursing (1971). Since its

 

publication she has updated and revised her theory in

another publication, Theory for Nursing (1981). In her

 

revised theory, she addresses the systematic and
theoretical approach to professional nursing. The
theory's conceptual framework links concepts relating
nursing to the health care system and provides a method to
develop concepts to apply knowledge in nursing in practice
(King, 1981). Assumptions of King's model include:
-Individuals are social, sentient, rational
reacting, perceiving, controlling, purposeful,
action orientated, and time-orientated beings
(King, 1981, p. 143).
-The interaction process is influenced by
perceptions, goals, needs, and values of both the

client and the nurse (King, 1981).

14

-Individuals have the right to obtain information
and to participate in decisions that influence
their life, health, and community services, as well
as to accept or reject care (King, 1981).

-Hea1th care members have a responsibility to
inform individuals of their health care and to
assist them in making "informed" decisions (King,
1981).

-There may be incongruence between the goals of
the health care providers and the client (King,
1981).

-Clients want to be active participants in the

health care process.

Definition of Concepts

 

Nursing helps "individuals maintain their health so
they can function in their roles” (King, 1981, p. 4). In
acting as a helping profession which meets a social need,
Fawcett (1984) describes the service of nursing as
including "care of individuals and groups who are ill and
hospitalized, those who have chronic diseases and require
rehabilitation, and those who require guidance for the

maintenance of health" (p. 96). Situations in which

15

nursing care is given may be influenced by various factors
including the geographical setting, the perceptions of the
nurse and patient, communication patterns, expectations,
mutual goals, and nurse and patient interdependent roles
(King, 1981).

Three other key concepts of domain defined by King
include person, environment, and health. King describes
Person as a "rational, sentient, social being, perceiving,
thinking, able to choose between alternative actions, able
to set goals, to select means toward goals, to make
decisions, and have a symbolic way of communicating
thoughts, actions, customs, and beliefs (p. 19).

Environment is comprised of internal and external

 

components. The internal environment enables individuals
to adjust to a constantly changing external environment.
The external environment is the boundary system which
includes "social roles, behaviors, and practices developed
to maintain values and the mechanisms to regulate practice
and rules" (King, 1981, p. 115). King (1981) defines
Health as "the dynamic life experiences of a human being,
involving growth and development, and which implies
continuous adjustment to stressors in the internal and

external environment through optimum use of one's

16

resources to achieve maximum potential for daily living"
(p. 5,143).

There is an interrelationship between the environment,
health, and nursing in King's model. King differentiates
the environment into the concepts of internal and external
environment. She states that the "internal environment of
human beings transforms energy to enable them to adjust to
continuous external environmental changes" (1981, p. 5).
In this interaction model, the nurse is included as part
of the external environment. The focus of nursing is to
enable the patient to function in a social role
interacting with their environment. "Adjustments to life
and health are influenced by individual's interactions
with environment" (King, 1981, p. 141).

Within the concept of the person, King identifies
three interacting systems; individuals (personal systems),
groups (interpersonal systems), and society (social
systems) (See Figure 1). An individual is characterized
as being rational and one who "perceives, thinks, desires,
imagines, decides, identifies goals, and selects means to
achieve them" (Fawcett, 1984, p. 90). Persons are
described as the sum of their parts, and the self is
described as the sum of ones parts. Body image, another

component of the person, includes behavioral changes and

17

those things which take place to help an individual move
toward maturity. Body image is the combination of
self-perception and others' reactions to self. Time is
defined as "the duration between the occurrence of one
event and the occurrence of another event" (King, 1981,
p.45). Space, the final dimension of the individual,
"exists in all directions and is the same everywhere." It
is the "physical area called territory and by the behavior
of individuals occupying space" (King, 1981, p.37-38).
King linked the above concepts together by stating that
"an individuals perception of self, of body image, of time
and space influence the way he or she responds to persons,
objects, and events in his or her life" (King, 1981,
p.19).

The interpersonal system is comprised of two or more
individuals interacting within a particular situation. In
this situation goals are set and achieved and
communication takes place. Concepts relevant to the
interpersonal system include interaction, communication,
transaction, role, and stress (George, 1985). Interaction
is a dynamic process involving communication, values,
perceptions, and transactions. It includes the thoughts,
feelings, perceptions, expectations, and reactions of the

other person and what that person does to the individual.

18

Communication is "a process whereby information is given
from one person to another either directly or ...
indirectly" (King, 1981, p.74). Transactions are
interaction process between the environment and the person
to achieve goals. Roles involve "a relationship between
two or more individuals who are functioning in two or more
roles; learned; social; complex; and situational" and
includes reciprocity (George, 1985, p. 240). Stress is a
process of interaction with the "environment to maintain
balance for growth, development, and performance" (King,
1981, p. 98) An exchange of energy and information is
involved to regulate and control the stressors between the
person and the environment. Although life satisfaction
might be considered to be a personal perception of well-
being, the components of the interpersonal system
influence the individual's life satisfaction levels.
Interaction with others, communication, and the other
interpersonal system concepts all greatly contribute to
feelings of satisfaction with self and the environment.
Within the unit of the social system, individuals
carry on the activities of daily living. This social
system is the broader aspect of society and includes the
social roles, behaviors, and practices which help to

maintain the order of society (King, 1981).

19

Characteristic concepts of the social system which King
(1981) states relate to nursing include organization,

authority, power, status, and decision making.

 

SOCIAL SYSTEMS
(Society)

 

INTERPERSONAL SYSTEMS
(Groups)

 

PERSONAL SYSTEMS
(Individuals)

 

 

 

 

 

 

 

 

Figure l. The interacting systems of King's model

 

The model of goal attainment which is a major focus of
King's framework evolves from the interpersonal system.

Goal attainment is achieved through a process of

 

interaction between the nurse and the client which
includes perception, judgement, action, reaction,
interaction, and transaction (Figure 1). This process is
congruent with the goals of nursing to facilitate role

achievement, and demonstrates how the nurse-client

20

relationship is an interactive process in which the
communications, expectations, and mutual goals of
the client and nurse are shared and actions taken to
achieved these goals.

Perception is "each person's representation of

 

reality" (King, 1981, p. 146). The awareness of persons,
objects, events, and self gives meaning to a person's

subjective world of experience. Judgement is the value

 

placed on the perceived event; and an action may be a set
of behaviors, either verbal or nonverbal, which lead to
the acknowledgement of efforts to control the events or
situations which are occurring (George, 1985).

Reaction includes demonstration of what the perception
of reality is in an action or activity component.
Interaction is an exchange process of
communication either between persons or person and
environment and is goal directed. In person to person
interactions, individuals bring knowledge, past
experiences, and perceptions to the situation which then
influence present interactions. During this phase
inferences are made about what the other person is

perceiving and feeling (King, 1981).

21

Feedback

I\

I

v .
Perceptlon
4
Judgment
.4 i
GCNS Act1on :
T i i

i i
I . .
ea Reaction~—>Interact1on-——9Transact1one+fl

r 3'
! i

!
\l

Client Action
Judgment

Perception
’l‘

 

Feedback

Figure 2. Representation of King's Model

 

Transaction involves observable human behavior. It

 

can consist of the client and the nurse communicating in
an effort to achieve mutual goals. It is in this phase
that goals are achieved. Since transaction is an action

phase it may not always be achievable because both parties

22

must take part (George, 1985). Transactions lead to

changes in behavior through active participation in

working toward a desired goal.

Relationship of King's Theory to this Study

 

In light of King's model, clients entering the
retirement home are complex beings and bring with them in
this move their own expectations and perceptions of what
is expected from the new situation (a change in their

external environment). One's perception would be their

 

view themselves, others and their environment (the
retirement home). Life satisfaction is a subjective
experience, and the level of life satisfaction of persons
who reside in retirement homes is of interest. The
personal determination of life satisfaction may be

considered the client's judgement when viewing life

 

satisfaction as the internal environment as defined by
King (1981). These judgement concerning both the internal
and external environment will be reflected through scores
on the LSIA and the three open ended questions which
specifically address the decision to live in the
retirement home setting. Action may be the behavior

displayed in response to feelings of satisfaction or

23

dissatisfaction with both the internal and external
environment.

Reaction, as defined by King (1981), of the client who
has changed residence will exhibit a positive or negative
attitude. The assessment phase of the nursing process
directs the nurse to observe for such behaviors.

Depending on the individual, a positive attitude may be
demonstrated by active participation and involvement in
the activities of the retirement home. In contrast,
negative behavior may be evidenced by a pattern of
withdrawal and isolation. Care must be taken to assess
whether attitudes reflect levels of life satisfaction or
long term personality traits such as those individuals who
have always been withdrawn and isolated. For the purposes
of this project, evidence of these tendencies may be
reflected through the results of the Life Satisfaction
Index and the other questions used in this project.

The relationship of goal attainment to nursing can be
examined utilizing the King model. Life Satisfaction, or
the internal environment, of the older adult will be
influenced by past methods of coping, previous life-style,
health status, and other stressors which may be occurring.
The GCNS is prepared with skills to assess reactions to

the relocation experience, the aging process, and the

24

significance of perceived levels of life satisfaction. In
addition, the nurse's perceptions are influenced by
previous personal and professional experiences related to
relocation. Judgments by the nurse, based on
documentation from literature concerning older adults,
lead to action directed towards efforts to enable the
relocation to be a positive experience with high levels of
perceived life satisfaction (King, 1981).

This study will focus on the perceptions, judgement,
and reactions of the older adult who is living in a
retirement home setting. How individuals perceive their
present status (six months or more after relocating)
influences the judgement made regarding this perception
(generally positive or negative) to determine level of
life satisfaction. The LSIA is an appropriate tool to
measure life satisfaction within the framework of King's

interactive model.

Concept Development from the Literature

 

Goal attainment is the desired outcome in the King
model. This is achieved through nurse-client interaction
which focuses upon perceptions of the client related to

goal attainment. King (1981) states that "goal setting

25

depends upon the client population to be served and the
specific events that bring individuals to health care
systems in which nurses function" (p.3). Communication
between nurse and client is an essential element in mutual
goal setting and is necessary in order to make decisions
related to the perceived problem. This decision-making
process is a collaborative effort on the part of the
patient, nurse, family, and other health professionals.

George & Bearon (1980) state that "perhaps the most
crucial subjective assessment of life quality that
individuals can report is their relative satisfaction with
life in general" (p.7). The issue of life satisfaction
has played a major role in the development of the
psychosocial theories of aging. Both activity and
continuity theory discuss life satisfaction as an outcome
(George & Bearon, 1980). The following social
characteristics have been found to be important in regards
to high levels of life satisfaction in adults of all ages;
l)relationship to the social structure, 2)achievements
both occupationally and economically, 3) physical health,
4) active support system, and 5) meaningful social and
leisure activities (George, 1986).

The four subscales of the LSIA (Adams version, 1969)

fit well theoretically with King's interaction model. The

26

questions addressing Mood Tone interface with the concepts
of human interaction and transactions. Interactions with
others and communication contribute to feelings of Zest
vs. Apathy. Scores on the Congruence subscale may reflect
transactions and roles. Finally, the Resolution and
Fortitude subscale examines stress and roles.

In the older adult who has relocated to the retirement
home, those concepts which are a part of the interpersonal
system may greatly influence the degree of life
satisfaction experienced. Zest versus Apathy may indicate
a degree of involvement with other people or with new
ideas. Those adjusting positively to relocation might be
expected to maintain a high level of involvement, while
negative adjustment may be evidenced by withdrawal and
isolation. Resolution and Fortitude includes the extent
that persons take responsibility for their own lives. In
a retirement home setting this may be evidenced by what
part the individuals took in planning the move and future
plans for activities within the new environment.
Congruence is the extent to which life goals are achieved.
The extent to which individuals feel their goals have been
achieved is significant and may influence perceived life
satisfaction. In retirement home residents, consequences

might be evidenced by whether or not individuals feel they

27

have been able to attain their desired goals. Mood tone
is indicated by whether the person holds optimistic
attitudes and happy feelings. These individuals are
spontaneous, positive in outlook, and express and take
pleasure from life (Neugarten, Havinghurst, & Tobin,
1961).

Living in a retirement home could potentially have
negative effects on perceived levels of life satisfaction
if individuals living in such a setting would become
increasingly isolated, relinquish responsibility for
themselves and their activities, and no longer have any
goals to be achieved. Other signs of low levels of life
satisfaction might be evidenced by depression, bitterness,
and anger as well as complaints of being "a burden" and
speaking negatively of self and older people in general
(Neugarten, Havinghurst, & Tobin, 1961).

George (1986) points out that examining life
satisfaction is necessary to facilitate adaptation in
aging because "we should be interested in enhancement as
well as rehabilitation, in the good life as well as the
bad times" (p.8). Also life satisfaction illustrates that
''social and psychological factors are as important for
understanding life's triumphs as well as life's problems"

(George, 1986, p.8). At the personal level, life

28

satisfaction is important because people care about the
quality of life for their loved ones. George (1986)
concludes that "it reminds us to strive for health as well
as the absence of disease and to invest in mental health
as well as the amelioration of mental illness" (p.8).

This chapter has presented King's Theory of Goal
Attainment and the theory has been utilized to provide a
framework for this project examining life satisfaction
among retirement home residents. Chapter three will
review the relevant literature concerning life

satisfaction of older adults.

CHAPTER THREE

REVIEW OF THE LITERATURE

Overview

In this chapter the literature relevant to the concepts
of relocation (external environmental change) and perceived
life satisfaction (internal environment) of adults in later
life will be examined. Little research to date has
specifically explored levels of life satisfaction in persons
who live in retirement homes. However, documentation is
present within the literature exploring the effects of
relocation on the older adult (Borup, 1981; Borup, 1982;

Wolanin, 1978; Lawton & Cohen, 1974), and characteristics of

29

30

perceived life satisfaction over the later years of life
(Diamond, King, & Burt, 1979; Carp, 1975; Morris, 1975;
Brand & Smith, 1974; Neugarten, Havinghurst, & Tobin, 1961).
Both of the above concepts are influential in the lives of
those older adults residing in a retirement home setting.
The concepts discussed in this chapter will be divided

between relocation and life satisfaction.

External Environmental Change

 

Relocation literature is being considered because of the
fact that it is a large body of literature that does deal
with life satisfaction of those who have changed residence.
The focus of study concerning relocation of older adults has
changed significantly over the past twenty years.

Relocation studies began in the 1950's when concern had
arisen over the potential harm caused by governmental
imposed relocation (Coffman, 1981). During the 1960's
studies focused on exploration of the emotional trauma and
negative effects of relocation; specifically, examining
those effects in relation to mortality rates following
relocation (Coffman, 1981). Researchers in the next decade
placed an emphasis multidimensional factors affecting

relocation (Borup, 1981). Research trends of this present

31

decade have focused on identifying the effects of relocation
into long-term care settings on older adults and determining
methods which would best diminish negative effect of
relocation (Burnette, 1986; Coffman, 1981; Lawton & Cohen,
1974). However, the emphasis throughout the relocation
literature has been on interinstitutional (transfer from one
institution to another) (Liebowitz, 1974; WOlanin, 1978;
Eckert & Haug, 1984) and intrainstitutional (transfer within
an institution) (Borup, 1981; Lawton & Cohen, 1976; Beland,
1984; Carp, 1975) rather than transfer from home to an
institution.

Aleksandrowicx (1961) and Lieberman (1961) suggested
that a "pure relocation effect" influenced the survival
rates of relocated older adults. Aleksandrowicx (1961)
studied patients after being transferred to other hospitals
several weeks following a fire, and Lieberman (1961)
investigated nursing home applicants from time spent in a
waiting period until one year after relocation. Both
researchers cited higher mortality rates following
relocation and attributed the increased death rates more or
less to the relocation experience.

In research on low and middle income older people
(N=2908) using multiple linear regression to determine if

the effects of relocation from one noninstituational

32

residence to another led to decreased health status, Ferraro
(1982) found that movers were more likely than nonmovers to
experience health status declines such as increased amount
of time spent ill in bed. Four variables were used to
assess health status: physical disability, ability to
perform self-care activities, number of days spent ill in
bed, or number of days spent ill in a hospital or
institution per year. Ferraro hypothesizes that the possible
relationship of stress, decrements in health status prior
to relocation, and the influence of level of volunteerism
associated with the move may be related utilizing multiple
linear regression to compare movers with the community at
large. However, he concludes that neither the house type or
satisfaction with the housing significantly affected the
health status of those who moved (p>.05), and that when the
decline in health status was more pronounced in those who
moved, it may have been a result of stress related to
moving.

Brand and Smith (1974) studied 68 subjects to determine
the effects of forced relocation to another community as
measured by the life satisfaction index in relationship to
the control group of 69 nonrelocated subjects. Utilizing
the Chi square measure of association, the life satisfaction

index measuring personal and social adjustment of the two

33

groups revealed that the relocation group had more negative
effects for females than males as evidenced by greater
verbalized dissatisfaction, and that blacks appeared to
adjust more positively than whites. Brand and Smith (1974)
found that these negative effects for females may be related
to the loss of their household and its' accompanying roles.
Additionally, poor health was correlated with lower levels
of life satisfaction. The relocated individuals had less
frequent social interaction with friends and family members
than did the nonrelocated individual. Brand and Smith
(1974) concluded that involuntary relocation may have
significant negative consequences on the life adjustment of
older adults due to changes in social networks, and that
social interaction with the environment is imperative for a
positive adjustment in the relocation experience.

Borup, Gallego and Heffernan (1979) examined mortality
rates among 529 patients experiencing forced relocation
because of nursing home regulations within the state of Utah
and 453 patients residing in 19 randomly selected nursing
homes who did not move. In contrast to previous research
findings, no increase in mortality among patients was found
among the nursing home residents who had relocated. The
study sought to examine the effects of relocation on

mortality rates to determine if specific groups of

34

individuals such as the handicapped might be at greater risk
in relocation. Mortality rates between the groups were not
found to be significantly different (p=.05). Borup, et a1
(1979) also addressed methodological limitations of previous
relocation research including types of experimental designs
and methodology used. In addition, Lieberman (1974)
indicates that the emphasis on mortality rates fails to
address broader questions related to well-being of older
adults who are relocating.

Further studies by Borup (1981) investigated results of
a statewide study involving nursing home patients (N=326)
who relocated because their current nursing home residence
did not meet national safety standards. Results gathered
based on a longitudinal impact design (time l= 2-3 weeks
prior to relocation, time 2= 2-3 weeks after relocation, and
time 3= 3-6 months after relocation) indicated that
attitudes of residents toward relocation became more
positive following the move, including the large percentage
of females (44%) who viewed the relocation with more stress
than did the males. After an initial settling-in phase,
these females expressed more positive attitudes (Borup,
1981, p.509). Those who did not want to move initially did
develop negative attitudes, but after moving and adjusting

the majority verbalized positive attitudes. In further

35

study, examining the effects of degrees of residential
change experienced on the areas of mortality, health and
functioning, Borup (1982) noted that mortality rates were
not affected by radical or moderate environmental change
using the analysis of variance for selected variables. He
concluded that the "degree of environmental change does not
affect mortality, self-evaluated health, stamina,
hypochondria, daily functioning, responsiveness, life
satisfaction, alienation, or self concept" (Borup, 1982, p.
414).

Borup (1983) indicated that there is a changing
perspective taking place among researchers in the 1980's as
evidenced by the statement "we need to direct our attention
to possible adverse conditions that are causal to an
individual's vulnerability to mortality when relocating" (p.
241). This statement demonstrates a change in focus from
mortality to factors which improve or impede older adult
adaptation to the relocation process.

In a longitudinal comparison group design Lawton and
Cohen (1974) compare senior housing residents (N=574) and
elderly community residents (N=324) on measures of state of
well being, demographic characteristics, and initial state
of health using multiple regression analysis. In follow up

interviews one year later, the residents who had relocated

36

to the senior housing project demonstrated significantly
(p=.05) higher morale and housing satisfaction. A relative
decline in health status was noted by the researchers and
the precise reasons for this remain unclear. It is
hypothesized that this decline may have been related to an
increased vulnerability of the relocated and that these
individuals may have perceived themselves as more
vulnerable. Also, the environment itself may have decreased
the functional capacity (ie. less need to leave
neighborhood, climb stairs, etc.) and this was reflected
through the tool used. "The mechanism associated with the
direct negative effect of rehousing is unclear" (Lawton &
Cohen, 1974. p. 202). Conclusions of Lawton and Cohen
(1974), based on the findings of this study, were that
relocation can be a positive experience particularly if the
elderly individual judges it based on current conditions
which have changed over the past year. Increased
involvement in activities was observed, and self perceived
changes for the better was the most marked indicator of a
positive housing effect.

Eckert and Haug (1984) investigated the effects of
forced relocation on the health status on a group of older
hotel dwellers (N=38) who were forced to relocate due to an

urban renewal project. This population was compared to a

37

randomly selected comparison group (N=32) living in similar
conditions. Individuals were interviewed at 3-6 months pre—
relocation and then again at 3-6 months post-relocation
utilizing a quasi experimental design. Unexpectedly, the
results found that emotional health (measured by using the
Affect Balance Scale) actually improved among the movers.
Movers showed no significant declines in the two physical
health indicators used. Eckert and Haug (1984) conclude
that perhaps because of the similarity between the living
situations in this study, the "transfer trauma" referred to
in literature did not exist in this population.

Wolanin (1978), a gerontological nurse researcher, in
looking retrospectively at studies completed on relocated
older adults validated the hypothesis that mental status
changes measured by urinary incontinence, wandering,
nocturnal wakefulness, and disorientation can be avoided
through careful orientation and planning for the move.
Wolanin (1978) arrived at these conclusions based on a study
of nursing home residents moved from a hospital type of
nursing facility to an attractive extended care unit. In
addition, Wolanin (1978) reported that no increases in
mortality occurred and that improvement in socialization was
noted. Neither the instruments, or the data analysis

methods used in the study are described, but she states that

38

"the relocation did not cause more problems to the elderly"
(Wolanin, 1978, p. 49).

Rosswurm (1983), a gerontological nurse clinician, in
synthesizing recent relocation literature including a crisis
intervention paradigm, cites three factors which influence a
positive adaptation to the stress of relocation. These are
a realistic perception of the event, adequate situational
support, and adequate coping mechanisms. According to
Rosswurm (1983) these factors enable the older adult to
adapt to the stress and maintain equilibrium and thus avoid
crises which may result from a disequilibrium and inability
to cope with the stressors of reaction. She states that if
these factors are absent, the results may include increased
anxiety and depression, helplessness and disorganization,
and/or rapid deterioration/crisis. She also states that it
is imperative that the process by which the elderly are
relocated needs to be examined in order to determine the
factors that are present to enable a positive relocation
process.

Beland (1984) studied results of data gathered on three
random samples of urban elderly in Quebec concerning ten
broad observational categories related to the decision to
leave their homes and move into an institutional setting.

Beland (1984) concluded that physical and mental impairments

39

and functional capacities as measured by an AOL scale were
not related to indicators of desire to leave home. Many
social interrelations such as cohabitation with children and
health status appear to be associated with increased desire
to leave home. Frequent visits to professionals led to
wishes to leave home associated with increased use of health
services and poorer health status. In addition, assistance
of volunteers, friends and/or relatives does not seem to
affect the desire to leave home. It was noted however, that
demographic and housing variables were important in
indicating which factors influenced decisions by these older
adults to leave their homes.

Diamond, King, and Burt (1979) conducted a longitudinal
study in which a sample (N=37) of elderly individuals
experienced forced relocation to another community because
of a major industrial expansion project. Objectives of the
study were aimed at determining factors which served to
facilitate and/or hinder adjustment to relocation as well as
to identify those elderly at highest risk for difficulty in
adjusting to the change and what times were most significant
for nursing intervention. A model was utilized to examine
individual, social, and cultural characteristics in the pre-
move, the moving transition itself, and post relocation

outcomes. Eight measures and indicators of well-being were

40

utilized including areas of perceived health, symptoms,
affect balance, general happiness, subjective stress index,
self esteem, depression, and life satisfaction index.
Utilizing descriptive analysis, a pattern of factors which
appeared to be related to well-being in relocation emerged.
Marital status, high self rated health, social
participation, support systems, and greater numbers of
resources appear to influence a more positive relocation
experience based on the results of this study.

In summary, the literature supports the premise that
relocation can be a stressful life change occurring in the
later years of adulthood (Borup, 1981). Brody, Kleban, and
Moss (1974) found that a positive change in attitude among
relocated individuals occurred two weeks after the move, and
that these attitudes gradually became more positive as time
progressed. However, although an adjustment phase to
relocation may take place, relocation in general does not
lead to increased mortality rates, and indeed, may lead to
more positive feelings of life satisfaction, personal
security, and happiness in some studies and some settings
(Carp, 1975; Lawton & Cohen, 1974; Borup et a1, 1979).

Few studies examine life satisfaction in individuals who had
moved from the community to a retirement home setting. Only

Beland (1984) has reported on this group of individuals, and

41

his study was concerned with the decision-making processes

involved in the move rather than life satisfaction.

Life Satisfaction

 

Life satisfaction has been defined as "a global
assessment of life quality, derived from comparison of one's
aspirations to the actual conditions of life" (George, 1986,
p.5). George (1986) distinguishes life satisfaction from
happiness and mood, stating that life satisfaction is unique
in that greater amounts of cognitive judgement are present
and that life satisfaction is more of a long term judgement
concerning state of life. George (1986) also states that an
important issue is understanding the antecedents and
consequences of life satisfaction.

Neugarten, Havinghurst, and Tobin (1961) were among the
first researchers to attempt to operationally define and
develop a tool to measure life satisfaction. In research as
part of a larger examination of the Kansas City Study of
Adult Life, Neugarten, et a1 (1961) developed a measure that
utilized the individual's perceptions of state of well-being
independent of activity level or social interaction. This
would therefore provide a measure of well-being against

which other social and psychological variables could be

42

evaluated. Data for the development of the tool was derived
from information from in depth interviews of 177 men and
women ages 50-90, and validated by the judgement of a
clinical psychologist who rated and reinterviewed 50
subjects.

A method of rating life satisfaction was devised which
incorporated five areas including 1) Zest vs. Apathy, 2)
Resolution and Fortitude, 3) Congruence between desired and
achieved goals, 4) Self Concept, and 5) Mood Tone (Neugarten
et a1, 1961). Areas under each of these categories were
then rated on a five point scale (with 5 being high) and an
overall rating score ranging from 5 to 25 was obtained.
Intercorrelations of the components were calculated (ranging
between .48-.84) and it was determined that there was a
degree of interrelationship present as well as a degree of
independence which might indicate that more than one
dimension may be present in the scales (Neugarten, et a1,
1961). With the 177 subjects studied by Neugarten et a1
(1961), no correlation between life satisfaction and age
(r=.07) was found. A correlation of .39 was found between
the index of social characteristics (level of education,
area of residence, and occupation) and life satisfaction
ratings. No significant sex differences were found (17.9

mean for women and 17.5 mean for men). Ratings were

43

validated by a clinical psychologist who re-interviewed 80
subjects using the same instrument in an effort to establish
validity. In relation to marital status, nonmarried
individuals had significantly lower life satisfaction
ratings among both sexes and all age groups of the study. A
limitation of this study was that the majority of the
participants tended to have a middle class background.

From the information obtained using the Life
Satisfaction index with the Kansas City study, it was
decided that the Life Satisfaction Ratings (LSR) may prove
to be too lengthy and detailed for practical use and so a
sample of 60 subjects was selected representative of age,
sex, and social class to develop two short self report
indexes of life satisfaction Life Satisfaction Index A
(LSIA); a 25 item attitude questionnaire with answers of
agree, disagree, or "?", and Life Satisfaction Index B
(LSIB); a 17 item open ended questionnaire and checklist
which was then measured based on a three point scale. The
same five concepts were included in both the LSIA and the
LSIB. These concepts included: Zest, Resolution and
Fortitude, Congruence, Self-Concept, and Mood Tone
(Neugarten, et al 1961). Scores of the 60 cases correlated
LSIA .52 with the LSR, and LSIB correlated .59 with LSR. As

a result of this data, five items of the LSIA and seven

44

items of the LSIB were eliminated. The strength of the
correlation of scores on the two indexes was the 0.61 level.
To aid in validity, the scores of the clinical psychologist
were also compared. The researchers concluded that "if used
with caution, the Indexes will perhaps be useful for certain
group measurements of persons over 65" (Neugarten et a1,
1961, p.143).

In an effort to further analyze the Life Satisfaction
Index A, Adams (1969) studied results of the LSI
administered to a sample of 508 noninstitutionalized persons
residing in towns in Missouri from 1,000-2,500 in size.
Results indicated a mean score of 12.5 with a standard
deviation of 3.6 which compares with a score of 12.4 and
standard deviation of 4.4 for the Kansas City sample of
Neugarten et a1 (1961). Results were then further studied
to determine the reliability in the areas of test items,
number of items which the question measured, and the number
of characteristics which the index represented. Analysis
methods which were then implemented included a calculation
of discrimination value based on the percentage of positive
answers to items of the high and low total score groups.
Reliability was established by use of a biserial correlation
between the mean of the affirmative response group of each

item and the LSIA mean score for the whole sample. The

45

biserial correlations ranged from .16-.55. Ideally, items
have a score greater than .30. Based on data analysis,
Adams (1969) concluded that the LSIA provides "a fair
estimate of life satisfaction for a small town elderly
sample as it does for the urban and rural samples on which
it had been previously tested" (p.473). He further
recommended that two items be deleted from the index based
on their low scores on the biserial correlation. The two
items deleted were those which addressed the concept of
Self-Concept.

Bull and Aucoin (1975) carried out a replication study
comparing results from Oberlin, Ohio in 1970 with those of
Kansas City in 1973. Using the LSIA, results indicated that
among the elderly, socioeconomic status and health are
closely related and that those who tend to be "participants"
generally describe better levels of health and socioeconomic
status than "nonparticipants." ”With respect to the net
effect of subjective health, controlling for voluntary
association participation and socio-economic status, the
same level of net significance was reached in both studies
(p (.05)" (Bull & Aucoin, 1975). Further evidence of the
noteworthy relationship among self—reported health,
activity, and life satisfaction was cited by Markides &

Martin (1979).

46

Lohmann (1977) used the Pearson Product Moment to
determine the correlation among seven measures of life
satisfaction, adjustment, and morale on a sample of 259
older adults in Knoxville, Tennessee. The measures examined
were the Cavan Adjustment Scale, the Kutner Morale Scale,
the Dean Scale, the Life Satisfaction Indexes A and B (LSIA
and LSIB), the Philadelphia Geriatric Center Morale Scale,
and a global question ("How satisfied are you with you
life?"). Three modified scales including the Adams
modification of the LSIA and the LSIZ (a scale which is very
similar to the Adams version of the LSIA), and the Morris-
Sherwood modification of the Philadelphia Geriatric Center
Morale Scale were also used (Lohman, 1977, p.73). The
cluster samples were from institutionalized, housebound, and
community elderly. The Adams version of the LSIA was most
closely correlated with modifications of the scale including
the LSIZ (.952) and the original LSIA of Neugarten et al
(.989), and fairly highly correlated with the Cavan (.799)
and Philadelphia Geriatric Center Morale Scale Morris-
Sherwood modification (.779). Results indicated that there
was a common construct present among the seven different
scales which indicated that the scales were all directed
towards examining some aspect of satisfaction or morale with

life thus supporting the validity of the LSIA.

47

Carstenensen and Cone (1983) examined the discriminant
validity of the Life Satisfaction Index-B and the
Philadelphia Geriatric Center Morale Scale, two commonly
used measures of evaluating perceived well—being among the
elderly. A sample (N=55) of alumni of the West Virginia
University who graduated between 1917-1936 completed
questionnaires and correlations between the Philadelphia
Geriatric Center Morale Scale and the LSIB were significant
(r=.64, p <.0001). Because both of these measures are
commonly cited in the gerontology literature, it is helpful
to know that the convergent validity of both is supported as
an outcome of this study.

In research on a modified random probability sample of
325 older persons who were self—ascribed handicapped or
nonhandicaped from the metropolitan Phoenix area, Stock and
Okun (1982) found that internal consistency reliability
estimates for the LSI were high with reliability estimates
of approximately .80. Hoyt and Creech (1983) provided
evidence to further support the methodological structure of
the LSIA when they analyzed data from the 1974 Myth and
Reality of Aging Survey. Utilizing exploratory factor
analysis they found that modification of the LSIA to a four
factor, 11 item model, and a three factor, 8 item model were

more useful in calculating life satisfaction. Both of these

48

models represented the revisions of the LSIA by Adams'
(1969) and Wood, Wylie, and Sheafor (1969) respectively.
Hoyt and Creech (1983) conclude that the three factor, 8
item model which includes measuring satisfaction with the
past, satisfaction with the present, and future
orientation/optimism was best suited for a more
heterogeneous population than the population that comprised
Neugarten et al's (1961) study. Wilson, Elias, and Brownlee
(1985) concluded, based on a study of 791 University of
Missouri retirees and the effects of a preretirement
counseling program, that the 8 item, three factor instrument
was the most useful form of the LSI for their study. In
addition, they "suggest caution when using the LSI with
younger low-income retired groups, because they appear to
attach different meanings to the items than other groups.
Baur and Okun (1983) reported that the life satisfaction
scores of members of their longitudinal analysis of retired
individuals residing in a retirement community did
demonstrate some changes in variances over a three year
period but not in the mean scores of life satisfaction using
Neugarten, et al's (1961) LSIB and Adams (1969) revision of
the LSIA. Factors which were significantly related to
higher levels of life satisfaction (utilizing correlation

coefficients) included higher levels of self-perceived

49

health, and not being neglected by friends. However, these
factors did not allow for explanation of significant changes
in life satisfaction levels. Baur and Okun (1983) also
state that "despite the relative stability of the life
satisfaction variable, it can be affected by life events"
(p. 265). Changes of at least four points occurred in 33%
of the sample of this particular study (Baur & Okun, 1983,
p. 265).

McClelland (1982) utilized data drawn from a national
survey by the Louis Harris organization for the National
Council on Aging. Sample A (N=1324) consisted of those who
preferred social interaction with people of all ages and
sample B (N=439) consisted of older adults over age sixty-
five who preferred social interaction only with those of a
similar age group. McClelland (1982) proposed a model
including four central variables: social activity, social
adequacy, self-conception, and life satisfaction. Self-
conception was shown to be strongly dependent on social
activity and in effect have a significant impact on the
level of life satisfaction. The model applies analysis of
covariance to data from two subsets of the sample to arrive
at these conclusions.

Herzog and Rodgers (1981), in analyzing data from

several large surveys of American adults, examined

50

relationships between increased age and specific areas of
life satisfaction. Bivariate standardized regression
coefficients and beta values were applied to indicate
strengths of relationships. Herzog and Rodgers (1981)
concluded that older adults tended to show progressively
increased satisfaction in regards to finances/income,
standard of living, and leisure/sparetime. However, such
positive results were less clearly documented for family,
marriage, friends, and global well-being. Areas which
appear to facilitate higher satisfaction levels included
increased sense of religiosity, greater desire to behave in
a socially acceptable manner, and fewer changes in life
conditions. Satisfaction with health showed a significant
decrease with age. In addition, lower educational levels
and lower family incomes appeared to be related to decreased
life satisfaction levels.

Duff and Hong (1982) in examining a subsample (N=335) of
adults over 60 years from the 1974 Spring General Social
Survey conducted by the National Opinion Research Center
measured life satisfaction utilizing two questions and then
analyzed these with other demographic and social interaction
information. Five variables were found to be significantly
related to life satisfaction (p=.01). These included

income, health, frequency of attending religious services,

51

satisfaction with friendships, and satisfaction with family
life. The beta weight of these variables ranged between
.13-.21 compared with the highest value of .08 for the
remaining variables. Further data analysis demonstrated
that the greatest degrees of life satisfaction were observed
among those who got a great deal of satisfaction from
relationships without spending a lot of time in these
relationships; thus hypothesizing that "it is not how often
one interacts with friends and relatives, but how much
satisfaction one derives from such interactions that is
important in whether the older persons are happy and view
life as exciting" (Duff & Hong, 1982, p. 429). Data from
this study indicates that interaction with and satisfaction
with relationships with friends and relatives is very
important in the life satisfaction and happiness of older
adults.

Romsa, Bondy, and Blenman (1985) studied a sample of 300
retirees to examine the relationship between Maslow's
hierarchy of needs and recreational activities and perceived
feelings of life satisfaction. Utilizing multiple
regression analysis, recreational dimensions which had been
identified as meeting Maslow's hierarchy of needs were
assessed for their impact on life satisfaction. Maslow

specifies a hierarchy of basic needs common to human beings

52

consisting of physiological needs, safety and security
needs, love and belonging needs, self-esteem needs, and
self-actualization (Hunter, 1983). Romsa et a1 (1985) found
all the dimensions being examined to be statistically
significant (at the .05 level). This data provides
information concerning the relationship between recreational
patterns and life satisfaction of older adults. Related to
Maslow's hierarchy, a greater need for love and association
seems to take place within the retirement stage for some
older adults.

In another study concerning life satisfaction and
adjustment to retirement, Beck (1982) analyzed data gathered
from the National Longitudinal Surveys of Mature Men
(N=3,348) to examine levels of life satisfaction in older
men following retirement. Beck (1982) indicates that those
men who retired earlier than expected were significantly
less happy with their lives than those men who continued to
work (p<.05). Men who retired closer to the expected time
of retirement were not significantly different in regards to
life satisfaction than other retirees (p>.35). It was felt
that unexpected retirement, along with the variables of
health and income, played an important role in the levels of
personal happiness and life satisfaction expressed by older

men.

53

Utilizing data from the 1975 Harris survey of the myths
and reality of aging, subjective well-being was measured
using the 18 item LSIA of Neugarten, et a1 (1961). George,
Okun, and Landerman (1975) examined life satisfaction using
multiple regression and found that age was an important
moderator on the life satisfaction levels of older adults in
relation to marital status, income, health, and social
support (p <.05).

In a longitudinal study of retirement home residents
(N=91) in Phoenix, Arizona, Bauer and Okun (1983) concluded
that life satisfaction was fairly stable over time. Self-
perceived health, contact with friends, and the availability
of transportation were examined in relation to life
satisfaction initially and then controlled by means of a
regression equation to determine changes in level of life
satisfaction. Contact with friends was noted as an

important indicator of life satisfaction.

The relationship between external

 

environmental change and life satisfaction

Little research has been completed examining older adults
who have relocated into retirement homes and their perceived

levels of life satisfaction. Brand and Smith (1974) and

54

Lemon, Bengtson, and Peterson (1972) cite the importance of
social interaction and informal activity with friends as
being associated with positive levels of life satisfaction
among older adults who had relocated into a congregate
living setting. Using the LSIB Lemon, Bentson, and Peterson
(1972) assessed a sample (N=4ll) of retirement community
residents in southern California, and the relationship
between social activity and life satisfaction was examined.
Results using coefficient of ordinal association indicated
that among this highly homogenous sample positive life
satisfaction was significantly (p (.05) related to informal
activities with friends. Formal and solitary activities
were not found to be significantly related, and therefore,
the conclusion was reached that these factors may not be
"important sources of role support for subjects in this
sample" (Lemon, Bentson, & Peterson, 1972, p. 518).

It appears that relocation may be perceived as a
positive experience for certain groups of individuals such
as those for whom the new residence will enhance their
health status or represent an improved living environment
(Morris, 1975; Carp, 1975). Utilizing analysis of variance
on a sample (N= 269) of applicants for the Hebrew
Rehabilitation Center for the Aged in Boston, a portion of

the Philadelphia Geriatric Center Morale Scale was

55

administered to determine whether the relocation experience
was perceived with greater levels of satisfaction when it
was considered to be an "appropriate" move. Findings
indicated that for those whom residency changes were
considered to be appropriate in relation to their need,
reaction was viewed as positive, and that an increase rather
than decrease in morale was evident.

Carp (1975), in follow-up studies of residents of a
public housing project eight years after moving compared to
a control sample of nonmovers, reports that movers were
happier in their new residence and verbalized increased
satisfaction with life (p <.05). Other positive factors
included increased feelings of security with both the
physical structure and in a sense of having somewhere nice
to live. Carp (1975)conc1udes that "these results indicate
the importance of the living environment upon morale and
life satisfaction during the later years. The residents...
were also happier in their new environment than their peers
who remained elsewhere in the community and for the most
part in unsatisfactory living arrangements" (p. 515).

Golant (1982) examined a random sample (N=400) of
elderly community residents to identify the relationship
between dwelling satisfaction as a subjective indicator of

perceived quality of life and of possible residential

56

relocation plans and preferences. Multiple regression
revealed that only four variables were significant
(p < .05). The elderly persons who were more satisfied with
their home environment displayed the following
characteristics: comfort with familiar surroundings, fairly
high levels of satisfaction with life at the present, little
travel beyond their own dwelling, and considerable length of
time at their present residence. Golant (1982) states that
"an older person's level of happiness serves as a summary
indicator of this complex past" (p. 127). In addition, low
or high psychological well-being will be transferred into
all environmental transactions and these good or bad
feelings will dominate the lives of individuals. This study
does not specifically relate to the retirement home
resident; however, it does illustrate the significance of
dwelling satisfaction on perceived life satisfaction.
Diamond, King, and Burt (1979) state that general life
satisfaction is one of several factors which must be
considered regarding adaptation of the elderly to
relocation. In their sample (N=37) of rural Utah residents
forced to relocate, individuals with fewer informal supports
were more likely to describe lower levels of general
'happiness, self-esteem, and general satisfaction along with

higher levels of depression. The number of physical

57

symptoms and the level of depression were found to be
indicators of post-relocation well-being. Life satisfaction
was described in this study as a coping resource. Other
coping measures included in this study were self-reported
health, social support, happiness, affect balance, self-

esteem, and perceived stress of the move.

Summary

In summary, life satisfaction levels can be measured
utilizing instruments which have been developed and
administered by many researchers within the field of
gerontology, taking into account that these tools are not
without limitations, but do allow for some objective measure
to be used to assess life quality of groups of elderly
individuals. Life satisfaction is a significant determinant
of the perceived feelings of general well being and
happiness of the elderly (Bauer & Okun, 1983; Markides &
Martin, 1979; George, Okun, & Landerman, 1985; Duff & Hong
1982). In addition, George (1986) notes that "there is
almost no knowledge about the distribution of life
satisfaction among institutionalized older adults", and that
although the institutionalized elderly are in the minority

"from a policy perspective, institutionalized older adults

58

are a group whose life satisfaction is of particular
importance" (p.6). Further research is indicated on the
order of that done by Bauer & Okun (1983) to examine the
effects living in a retirement home setting has on the life
satisfaction of the elderly.

This chapter has been a review of the literature
relevant to the concepts of life satisfaction among
retirement home residents who have relocated. Chapter four
will describe the instrument, the sample, the protection of
human rights, and the proposed methodology for the project.
Chapter five will present the results of the pilot project,
and chapter six will address areas of future research,
implications for advanced nursing practice, and the

relevance to the conceptual framework.

CHAPTER FOUR

METHODOLOGY AND PROCEDURES

Overview

The purpose of this project is to examine the levels of
perceived life satisfaction among retirement home residents
and factors which may influence the level of satisfaction or
dissatisfaction in this population. The Life Satisfaction
Index A (LSIA), (Adams, 1969 version) was the tool chosen as
most appropriate for this project. The methods and
procedures to be used in this pilot project will be examined

in this chapter.

59

60

Research Question

 

The instrument used in this project was selected to
provide information concerning the following research
question:

What is the expressed level of life satisfaction of
adults over 65 years of age six months or more after entry

into a retirement home?

Sample

The sample for this project consisted of eleven
individuals selected randomly from the 152 residents of a
"church affiliated" retirement home for the aged in Grand
Rapids, Michigan. The roster of residents, which listed
residents by room number, was used to obtain the names of
those living in the retirement home. The investigator and
the Retirement Home Manager then selected each fourth name
from the roster of residents, for a total of forty potential
subjects. All residents selected met the criteria for this
project. Using a table of random numbers, the list of forty
residents was randomized into a list with each resident
receiving a number from one to forty. From this list of

forty, the first fifteen names were initially used. Eleven

61

of the fifteen residents agreed to participate in the
project, and four individuals chose not to participate.
Criteria specified for those individuals to be included
in the sample were: 1) age 65 or older, 2) able to read and
write in English, 3) no known terminal illness, 4) resident

of the retirement home for longer than six months.

Operational Definitions

 

For the purposes of this study, residents were
considered to be those persons who had moved their place of
residence from an independent situation such as a private
home, condominium or apartment to a retirement home for the
first time. For the purposes of this study, length of
retirement home residence was determined by asking residents
how long they had lived within the retirement home and where
they had resided prior to their relocation.

Elderly individual was defined as one who is
chronologically age sixty five or older. This was
determined by asking participants of the study to state
their date of birth.

Life satisfaction was defined as a subjective personal
judgement of life quality arising from a comparison between

individual's aspirations and the actual situation in which

62

they find themselves. Life satisfaction was measured using
the Life Satisfaction Index A (Adams, 1969) (see Appendix
A). In addition, in an effort to gain a more thorough
understanding of life satisfaction specifically among
retirement home residents, the following additional

questions were asked:

1. Overall what makes you the most satisfied/dissatisfied
with life?

2. How happy are you with your decision to relocate to the
retirement home setting?

3. What have you been going through the past two months?
(ie. death, change in financial status, serious illness,

etc.).

Procedure

 

Participants for the pilot study were comprised of
eleven individuals selected randomly from the retirement
home roster of residents. A total of forty individuals were
first obtained by selecting every fourth name, and after
eliminating those who did not meet the study criteria, a
final sample of fifteen subjects was be reached. The

fifteen potential subjects were then mailed a letter

63

explaining the purpose of the project (see Appendix B), the
support of the retirement home director, and that
information given in the questionnaire would remain
confidential. After receiving the letter in the mail the
potential subjects were reached by phone to arrange an
appointment time for the administration of the
questionnaire. From the initial mailing of fifteen letters,
eleven residents agreed to participate in the project.
Participants were informed that they could discontinue their
involvement in this project any time without consequences,
and a written form of consent was signed by each participant
(see Appendix C).

After the consent form was signed, the LSIA was
administered to the participant by the researcher who asked
the questions and recorded the participant's responses
categorically according to agree, disagree, or uncertain.
Following the LSIA, the three open ended questions were
asked and the answers recorded by the researcher (see
Appendix C). Confidentiality was assured and neither name

or code number was assigned to the questionnaire form.

64

Instrument Development

 

The LSIA was utilized to operationalize life
satisfaction in this study. In an effort to develop a tool
to measure psychological well-being using individuals' own
perceptions of life in a focus independent of activity and
social participation levels, Neugarten, Havinghurst, and
Tobin (1961) developed the Life Satisfaction Rating.
Utilizing data from the Kansas City Study, five components
were examined and then questions developed to address these
areas. The term life satisfaction was chosen because it
appeared to most closely describe the following five
components: Mood Tone, Zest vs. Apathy, Congruence between
Desired and Achieved Goals, Resolution and Fortitude, and
Positive Self-Concept (Neugarten et a1, 1961, p. 137). The
instrument was comprised of open ended questions which could
potentially be too time consuming; therefore, revisions on
the instrument were carried out to develop two separate
scales. The Life Satisfaction Index A (LSIA) consisted of
25 items requiring agree, disagree, or uncertain responses;
and the Life Satisfaction Index B (LSIB) was comprised of 17
opened questions and check list items, with responses scored

on a three point scale (Neugarten et a1, 1961, p. 141).

65

In an effort to further analyze the Life Satisfaction
Index A, Adams (1969) studied results of the LSIA
administered to a sample of 508 noninstitutionalized persons
residing in towns in Missouri from l,000-2,500 in size.
Results indicated a mean score of 12.5 with a standard
deviation of 3.6 which compares with a score of 12.4 and
standard deviation of 4.4 for the Kansas City sample of
Neugarten et a1 (1961) Results were then further studied to
determine the reliability in the areas of test items, number
of items which the question measured, and the number of
characteristics which the index represented. Analysis
methods which were then implemented included a
discrimination value based on the percentage of positive
answers to items of the high and low total score groups.
Reliability was established by use of a biserial correlation
between the mean of the affirmative response group of each
item and the LSIA mean score for the whole sample. The
biserial correlations ranged from .16-.55. Ideally, items
have a score greater than .30. Based on data analysis,
Adams (1969) concluded that the LSIA provides "a fair
estimate of life satisfaction for a small town elderly
sample as it does for the urban and rural samples on which
it had been previously tested" (p.473). He further

recommended that two items, which were the two questions

66

under the category entitled Self-Concept, be deleted from
the index based on their low scores on the biserial
correlation thus making the total number of items on the
questionnaire 18.

The LSIA (Adams, 1969 version) was chosen for this
project because the tool is well suited for a relatively
well educated, middle class, small sample such as those
individuals who reside at the retirement home selected for
this project. The responses were recorded on a three point
Likert Type scale. Responses were categorized as agree,
disagree, or uncertain. For questions A, B, G, H, I, J, K,
M, N, O, and R positive responses reflect higher levels of
life satisfaction, and in questions C, D, E, F, L, P, and Q,
negative responses are indicative of high life satisfaction.
For each item, responses are scored 1 or 0. For those
questions in which the positive response indicates the
higher level of life satisfaction a score of l was given and
a score of 0 for a negative response. Uncertain responses
were also scored as 0. In the remaining questions in which
a negative response indicates higher life satisfaction
levels, a score of l was given, and a score of 0 for a
positive response in these questions. The maximum score on

the scale is 18 points.

67

The three open ended questions at the conclusion of the
LSIA allowed participants to further verbalize their
feelings and elaborate on their perceptions of the
retirement home residency experience. The data from these
questions was examined for any tendencies which seem to

appear consistently among participants.

Reliability

 

Polit and Hungler (1983) define reliability as "the
degree of consistency or dependability with which an
instrument measures the attribute it is designed to measure"
(p. 621). Use of the instrument in this project was for the
purpose of measuring the perceived life satisfaction levels
of retirement home residents. Three aspects of reliability
warrant closer examination. These areas include stability,
internal consistency, and equivalence. Stability "refers to
the extent to which the same results are obtained on
repeated administrations of the instrument" (Polit &
Hungler, 1983, p. 387). Life satisfaction is considered to
be fairly stable over time and therefore, repeated
administrations of the tool would most likely yield
consistent responses. Stability may be computed by

determining the correlation coefficient which can range from

68

-1.00 to +1.00. A higher coefficient reflects a more stable
instrument. If an instrument is internally consistent, it
measures the same characteristic throughout. Within each
subgroup of the instrument (ie. Zest vs. Apathy and
Resolution and Fortitude), the items of the LSIA measure a
different component of life satisfaction.

Adams (1969) examined the reliability and
multidimensionality of the LSIA. Reliability was examined
using discrimination values and biserial correlations and
reliability was established except on two items which were
then deleted in his version of the scale.

Stock and Okun (1982) report a reliability estimate of
approximately .80 for the LSIZ which is very similar to the
Adams version of the LSIA. The LSIZ is a shortened 13 item
scale. Stock and Okun (1982) state that "the results
presented here offer substantial evidence for the construct
validity of life satisfaction. The multi-item scales

exhibited relatively high reliability" (p. 627).

Validity

Validity "refers to the degree to which an instrument

measures what it is supposed to be measuring“ (Polit &

Hungler, 1983, p. 384). An instrument must be reliable in

69

order to be valid, and yet validity itself is very difficult
to establish. Content validity looks at the ability of an
instrument to cover the amount of information being
considered. For the purposes of this project, the Adams
(1969) version of the LSIA covers the four broad categories
most frequently referred to when examining general well-
being of the elderly.

Construct validity attempts to determine what the
instrument is really measuring and is difficult to
establish. Construct validity of the LSIA has come under
some criticism (Hoyt & Creech, 1983; Wilson, et a1, 1985).
Wilson, et a1 (1985) stated that care must be taken with the
items since some of the items have different meanings to
differing groups of people, particularly with low income
retired groups. However in light of the homogeneity and
higher income level among retirement home residents, the
LSIA would be appropriate and useful in assessing life
satisfaction. For the purposes of this project, it is
important that the instrument measures the concept of
interest, ie. life satisfaction.

Lohman (1977) indicates that construct validity of the
Adams version of the LSIA is present. "Data indicate that
there is a high level of correlation among several measures

of life satisfaction, adjustment, and morale" (Lohman,

70

1977). In comparing several measures of well-being
significant intercorrelations of the LSIA Adams were .989
with the Neugarten et a1 LSIA version, .952 with the LSIZ,
.799 with the Cavan Adjustment Scale, and .779 with the

Philadelphia Geriatric Center Morale Scale.

Proposed Scoring and Statistical Analysis

 

The data obtained from the administration of the
questionnaire was analyzed in an attempt to describe life
satisfaction present among the residents concerning their
perceived levels of life satisfaction.

Data obtained from the demographic section including
age, marital status, and number of years of residency at the
retirement home was summarized using percentages and means.
The results of the Life Satisfaction Index A were scored
using the guidelines of the Adams (1969) version and
similarities among respondents would be noted.

The LSIA was used in this project with responses
recorded on a two point Likert Type scale as described in
detail earlier in this paper. Responses were categorized as
agree, disagree, or uncertain. The minimum possible score
is zero (if the subject would respond "uncertain to all the

questions), and the maximum score on the scale is 18 points.

71

The four subscales were computed separately with scores
recorded for each of the categories (Table 4). In addition,
a total mean score for the entire instrument will also be
presented in Chapter Five. This allows the researcher to
examine which areas tend to represent the highest and lowest
levels of life satisfaction. The three open ended questions
were analyzed in a qualitative manner and efforts were made
to describe these additional findings (Table 9).

In this project general trends and tendencies were
recorded using frequency tables, means, and percentages.
However, with a larger sample, detailed statistical analysis
would take place. The Pearson Product Moment could be
utilized to determine the degree of correlation between
those who have high LSIA scores and those who verbalize
positive responses to the general question of whether or not
they were glad they made the move.

This chapter has discussed the methods and procedures
to be used in addressing the research question: What is the
expressed level of life satisfaction of adults over 65 years
of age six months of more after entry into a retirement
home? The sample has been described as well as the
procedures for administering the research questionnaire.
Types of potential data analysis were also presented.

Chapter five will discuss the data obtained in the pilot

72

study. The implications of this pilot study on both advanced
nursing practice and areas for future research will be

examined in chapter six.

CHAPTE R F IVE

Overview

In chapter five, the results of the pilot testing will be
presented including a discussion of the characteristics of the
participants, and the summary of the responses to the Life
Satisfaction Index A (LSIA) and the additional open ended
questions. The sample was comprised of eleven retirement home
residents selected at random from the roster of residents of a

church affiliated retirement home in Grand Rapids, Michigan.

Pre-test Participants

Eleven residents of the retirement home completed the

questionnaire. Subjects ranged in age from 71 to 92 years of age

with an average age of 84 years.

73

74

The length of time residing in the retirement home ranged
from six months to twelve years with a mean length of residency
of 4.6 years.

The sample was comprised of four males and seven females,
36.3% and 63.6% respectively. Three of the residents were
married and eight were widowed. None of the subjects had never
been married. The sample was comprised of a majority of widowed
females who had moved from a private home or condominium setting
to the retirement home.

Prior to moving into the retirement home, five subjects
lived in their own private home, three were condominium dwellers,
and three lived in apartments. In Table l a portion of the
demographic data is summarized.

The subjects were similar to those of Neugarten,
Havinghurst, and Tobin (1961); Brand and Smith (1983); Baur and
Okun (1983); and Lemon, Bengtson, and Peterson (1972) in which
residents of the those particular studies were primarily
protestant, white, and middle class. In contrast, the studies of
Carp (1975; 1977) were comprised of low income housing residents,
and Lawton and Cohen (1974) examined residents of five high rise
subsidized housing units.

The subjects of this pre-test were similar in age and
marital status to those of Baur and Okun (1983) in which 80% of

the sample were female and 25% married (p. 261-2). Carp's (1977)

75

sample was comprised of 21% men and 79% women with a mean sample
age of 72.24 years (p. 243). These characteristics resemble
those of this project (See table 1). However, 81% of the
participants of Lemon, Bengtson, and Peterson's study (1972) were
married, and 85% of that sample were less than 75 years of age

(p. 516).

Table 1

Sample Characteristics

 

 

 

 

(N=11) (Percent)
Sex: Males 4 36.3%
Females 7 63.6%
Marital Status:
Married 3 27.3%
Widowed 8 72.7%
Single 0 00.0%

Previous Type of Residence:

 

Private Home 5 45.5%
Condominium 3 27.3%

Apartment 3 27.3%

 

76

Life Satisfaction Index A

 

Life satisfaction is a subjective personal judgement of life
quality arising from a comparison between individual's
aspirations and the actual situation in which they find
themselves. In this project life satisfaction was measured using
the 18 item version of the Life Satisfaction Index A (Adams,
1969). The four subscales of the LSIA include Mood Tone, Zest
vs. Apathy, Congruence, and Resolution and Fortitude. Table 2
delineates the items of the LSIA as well as the number of

subjects who responded to each statement.

Table 2

Score Distribution of the LSIA

 

 

LSIA total score Number of Subjects (N=ll) %
9 l 9.1

10 0 0.0

11 0 0.0

12 0 0.0

13 5 45.5

14 0 0.0

15 2 18.2

16 3 27.3

 

'T-a-t e—q—gn—Zl

_ L:

77

Table 3

Life Satisfaction Index A and Scores of Residents

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Agree Disagree Uncertain Statement

8 3 0 A. I am just as happy as when I was
younger.

I 10 0 B. These are the best years of my life.

4 7 0 C. My life could be happier than it
is now.

1 10 O D. This is the dreariest time of my
life.

0 ll 0 E. Most of the things I do are boring
or monotonous.

0 11 0 F. Compared to other people, I get down
in the dumps too often.

9 2 0 G. The things I do are as interesting
as they ever were.

7 4 0 H. I have made plans for things I'll be
doing a month or a year from now.

10 l 0 I. Compared to other people my age, I
make a good appearance.

8 3 0 J. As I grow older, things seem better
than I thought they would be.

5 6 0 K. I expect some interesting and
pleasant things to happen to me in
the future.

11 0 O L. I feel old and somewhat tired.

10 l 0 M. As I look back on my life, I am
fairly well satisfied.

11 0 0 N. I would not change my past life

 

 

even if I could.

 

78

ll 0 0 0. I've gotten pretty much what I
expected out of life.

 

 

 

0 ll 0 P. When I think back over my life, I
didn't get most of the important
things that I wanted.

 

4 l 6 Q. In spite of what people say, the
lot of the average man is getting
worse not better.

 

10 l O R. I have gotten more of the breaks in
life than most of the people I know.

 

 

 

Table 4 presents a summary of responses among the four
subscales of the LSIA. The maximum score on the scale is 18
points and responses of the subjects ranged from a low of 8

points to a high of 17 points with a mean score of 13.8.

Table 4

Summary of Responses to LSIA

 

 

LSIA Category Low Score High Score Mean
Mood Tone 2 5 4.36
Zest vs. Apathy 2 6 4.54
Congruence Between Goals 2 3 2.9
Resolution and Fortitude 2 3 2.0

 

Overall LSIA Mean Score 13.8

79

A description of responses within the specific subscales of
the LSIA is depicted in Table 5. In the subscale Mood Tone, one
subject scored two (9%), four subjects scored four (45.5%), and
six subjects scored five (54.5%) out of a possible six points.
Ten of the eleven subjects commented that these were not the best
years of their lives, and yet the same number also responded that
this was not the dreariest time of their lives. All of the
participants disagreed with "most of the things I do are boring
or monotonous" and "I get down in the dumps too often". Nearly
all of the residents were noted to have projects such as
needlework and reading sitting nearby. Eight of the eleven
agreed that they were ”just as happy" as when they were younger,
and four individuals agreed that "my life could be happier than
it is now." Generally these subjects went on to state that they
missed the companionship of their spouse. The participants
overall scored very high in the Mood Tone subscale with 90.9% of
the subjects scoring four or higher out of a possible total six

points.

80

Table 5

Responses to Mood Tone

 

 

Score Number (N=1l) %
6 Questions 2 1 9.1%
(Maximum score=6) 4 4 36.4%
5 , 6 54.5%

 

In the Zest vs. Apathy subscale, scores ranged from two to
six; with six being the maximum number of possible points (Table
6). One subject scored two (9.0%), one scored three (9.0%), and
there were three respondents in each of the levels four, five,
and six (27.2% respectively). Nine participants agreed that
things were "as interesting to me as they ever were." Four
subjects disagreed with making future plans stating that they
tended to "take one day at a time" and often also stated that it
"all depended on God's will." Ten subjects felt they "made a
good appearance," and that "things seemed better than expected."
Eight expect "interesting and pleasant things to happen" in the
future, and five individuals stated that they did indeed feel
"old and somewhat tired." The greatest diversity among the
participants was noted in this subscale particularly in items "H"
and "K". Subjects often appeared to be hesitant to plan and

anticipate the future as is reflected by their scores on these

81

items. Several subjects stated that they were leaving their

future plans "up to God."

Table 6

Responses to Zest vs. Apathy

 

Score Number (N=11) %
6 Questions 2 l 9.1%
(Maximum Score=6) 3 l 9.1%
4 3 27.2%
5 3 27.2%
6 3 27.2%

 

Congruence between Desired and Achieved Goals was
surprisingly consistent. One subject (9%) scored two, and ten
subjects (90.9%) scored three out of a total of three points
(Table 7). A great deal of stability of responses was noted in
this particular subscale. All eleven subjects responded that the
"felt fairly well satisfied with their lives" and that they "had
gotten pretty much what they expected out of life". Ten of the
eleven subjects stated that they would not change their past life

even if they could.

82

Table 7

Responses to Congruence between Goals

 

 

Score Number %
3 Questions 2 l 9.1%
(Maximum Score 3) 3 10 90.9%

 

Resolution and Fortitude responses included one subject
(9.0%) who scored one, nine subjects (81.8%) who scored two, and
one subject (9.0%) who scored three out of a possible total of
three points (Table 8). These scores reflect moderately high
feelings of resolution and fortitude. In verbalizing their
responses in this category, all eleven subjects were noted to
respond that they did get most of the "important things they
wanted in life," and ten out of eleven stated that they had
"received more of the breaks in life than many other individuals
they knew." However, nearly all respondents hesitated in their
answers regarding "the lot of the average man" stating that this
depended on whether one was discussing moral and religious
values, societal status, and/or material goods and possessions.
Four subjects agreed with the statement, one disagreed, and six
responded that they were "uncertain" about their response. It is

of interest that this was the only question on the entire

83

instrument in which any of the participants answered with the

"uncertain" response.

Table 8

Responses to Resolution and Fortitude

 

 

Score Number (N=1l) %
3 Questions 1 l 9.1%
(Maximum score=3) 2 9 81.8%
3 1 9.1%
Discussion

 

It is difficult to make generalizations based on the LSIA
beyond this pilot project because little research was found
describing results in other samples in the four subscales. Brand
and Smith (1974) selected 12 items from the Life Satisfaction
Index (Neugarten, et a1, 1961) and scores from 0-5 were
considered "low" and scores of 6-12 were considered to be "high."
If Neugarten, et a1 (1961) scoring scale were to be used for this
sample, ten of the eleven subjects would be considered to have
”high" levels of life satisfaction.

Baur and Okun (9183) utilized the LSIB to examine predictors

of change in life satisfaction in residents of a retirement

84

community complex. Scoring on the individual subscales or of the
scale in general was not described in detail. In an effort to
develop a causal model of life satisfaction, Markides and Martin
(1979) used a 13 item version of the LSI in which 2 points were
assigned to responses of high satisfaction, zero to low
satisfaction, and 1 point to "uncertain” responses. They
concluded that activity and self-reported health were strong

indicators of life satisfaction residents in the sample.

Additional Findings

Responses to the three Open ended questions which were asked
at the completion of the LSIA are summarized in Table 9.
Residents listed a variety of factors which they felt contributed
to their overall feelings of satisfaction with life. These
responses centered primarily around their faith, family, health,
professional satisfaction or former occupations, and present
hobbies and interests. Several residents also mentioned that the
safety of the physical environment and being able to live in a
setting in which other residents had similar ethnic heritage and
fundamental religious beliefs also contributed to a general
feeling of satisfaction.

All of the subjects (100%) responded positively to the

question "How happy are you with your decision to relocate to the

85

retirement home setting?" Several residents commented that the
primary reason they relocated was because of their own or their
spouses health status requiring assistance and/or monitoring.
Others mentioned that they moved because they were no longer able
to maintain their own homes. Several residents mentioned that
although they may not have been initially happy with their
decision to relocate because of their children's insistence that
they make the move, they were more than satisfied once they had
settled into the new environment and that they were happy with
the decision at the time of the interview.

In response to the question "What else have you been going
through the past two months?", three subjects cited problems with
their own health or the health of a family member or spouse.
Three subjects had experienced recent loss through the death of
friends or relatives (none had recently lost a spouse). Three
subjects had plans to visit family out of town over the upcoming
holiday season, and one subject discussed recent changes in the
seating arrangements in the dining room which had caused some

disruption and unhappiness among residents.

86

Table 9

Summary of Additional Findings

 

QUESTION: N=11 %

 

Factors contributing to overall satisfaction with life

 

Religious Faith 9 81.8%
Family (spouse and/or children) 9 81.8%
Health Status 2 18.2%
Profession/Hobbies 5 45.5%
Safety of the physical setting 2 18.2%
Common interests with others 3 27.3%
Satisfaction with decision to relocate 11 100.0%

 

Recent events taking place

 

Health related 1 5 45.5%
Deaths of friends or relatives 3 27.3%
Visits to out of town 3 27.3%
Environment (dining room) 1 9.1%

 

The results of this pilot study indicate that residents of
this retirement home verbalize high levels of life satisfaction.
This is reflected by scores achieved on the LSIA (see Table 2).
In addition, the residents verbalize satisfaction with their

decision to live in a retirement home setting. Generalizations

87

based on this pilot study are limited by the small sample size
and the homogenicity of the sample itself. However, it is
interesting to note that these subjects did achieve such high
scores on the LSIA.

Adams (1969) calculated LSIA scores based on the 20 item
scale prior to his recommendations to delete items S and T. A
mean LSIA score of 12.5 was obtained by Adams (1969). This
compared with a mean of 12.4 for the Kansas City sample
(Neugarten, et a1 1961), and 11.6 for the rural Kansas sample
(Wood, et al 1966). The mean LSIA score for this sample of
retirement home residents was 13.8 using the 18 item scale. If
the 20 item scale were to be administered to this sample the mean
scores would be expected to be even higher.

Carp (1977) discusses the long term effects of residents who
moved into subsidized senior housing vs. individuals who did not
move 8 years after the initial study. Residents of the senior
high rise, Victoria Plaza, were found to have less decline of
health over the years, less time spent in health care, and
experienced fewer numbers of health problems. It appeared that
the new environment was supportive of self—esteem, facilitated
self—actualization, and that "at all levels of human need... the
new living environment facilitated satisfaction and reduced

stress” (Carp, 1977, p. 248).

88

Palmore and Kivett (1977) report that self rated health is
the strongest factor related to life satisfaction among a sample
of members of a health insurance association (46-70 years of age)
followed longitudinally over four years. Levels of social
activity and reported sexual enjoyment also significantly
contributed to levels of life satisfaction. In addition, the
"best predictor of future life satisfaction appears to be the
person's life satisfaction in the past" (Palmore & Kivett, 1977,
p. 311). George, et a1 (1985) also found health to be an
important factor in levels of life satisfaction of elderly
adults.

Subjects from the Philadelphia Geriatric Center's Community
Housing project were compared with subjects from two control
groups six months after moving. Those living in the Community
Housing "liked their living arrangements, had attained freedom
from fear and crime, were more satisfied with their housing, had
more close friends, and perceived themselves as in better health"
than those who had not moved into the congregate housing setting
(Klevan & Turner-Massey, 1978, p. 1311). Subjects from this
piltnzprojects also noted freedom from fear of crime, the
:hnportance of friends and health as significantly contributing to
'their overall level of life satisfaction.

Cohen, Tell, Batten, and Larson (1988) cite access to

services and protection for a spouse as the most frequently

89

stated reasons for entering Continuing Care Retirement
Communities. Other frequently stated reasons for entry included
"access to services to maintain independence" and "access to
nursing home" (Cohen et al., 1988, p. 639). The subjects of this
project also cited these same factors as influencing their
decision to enter the retirement home. The residents were also
noted to describe some of these same reasons when stating why
they were glad they had made the decision to live in this
particular retirement home (skilled and basic nursing care is
available within this same complex).

The subjects in this project were in generally good health
and of middle socioeconomic status. Gubrium (1970) notes that
good health and solvency made it possible for older adults to be
less dependent on their environment to fulfill their needs, and
therefore, these individuals may have more flexible behavior
which in turn may contribute to greater levels of satisfaction
with life in general.

In chapter five, the results of the pilot project using the
LSIA and three open ended questions were summarized. Chapter six
will address areas of future research, implications for advanced
nursing practice, and relevance to the conceptual framework

presented in chapter two.

CHAPTER S IX

Overview

Chapter six will explore areas for future research, discuss
the relationship to the conceptual model, and examine
implications for advanced nursing practice and education.

The purpose of this project was to examine the expressed
levels of life satisfaction of adults over 65 years of age six
months or more after entry into a retirement home using the Life
Satisfaction Index A (Adams, 1969 version) and three open ended
questions. This tool could potentially be used by nurses in
advanced practice to plan, develop, and implement health care
among retirement home residents to optimize levels of life
satisfaction.

The sample was comprised of eleven subjects who completed
the LSIA in an interview format. As discussed in chapter five,

the subjects of this pilot study verbalized high scores on the

90

91

LSIA and the three open ended questions. Limitations of this
study were that the residents were from the same facility, and
that the sample itself was small in in size and fairly

homogeneous.

Recommendations for Future Research

 

Life satisfaction of the elderly is a concept frequently
mentioned in gerontological literature; however, there is a lack
of consensus as to definition and measurement of the concept.
Various forms of the Life Satisfaction Index (Neugarten,
Havinghurst, & Tobin, 1961) have been used to examine well-being
among the elderly (George, Okun, Landerman, 1975; Lemon,
Bengtson, & Peterson, 1972; Baur & Okun, 1983; Brand & Smith,
1974; Stock, Okun, & Benin, 1986; Liang, 1985). Because the Life
Satisfaction Index has been used with little to no consistency in
regards to the questions and form of the tool used by
researchers, it has little practical value to the clinician for
comparison use. Therefore, the following recommendations for
future research are presented in an effort to make the Life
Satisfaction Index a tool useful for the Gerontological Clinical
Nurse Specialist (GCNS) in clinical practice and for use with
retirement home residents.

1. One form of the tool should be utilized in a variety of

92

samples of elderly both in the community and in retirement
home settings so that comparisons may be made regarding
life satisfaction among the elderly residing in a variety
of living situations.

2. A consistent form of coding should be used in research
studies using the LSIA and categories indicating degrees of
life satisfaction established (ie. score of 0-6 = low life
satisfaction, 7-12 = moderate life satisfaction, and 13-18 =
high life satisfaction). This would be helpful in
identifying individuals at risk and possibly indicate areas
in which nursing interventions should be directed.

3. Scores on the four subscales of the LSIA should be
reported in the literature to provide a means of comparing
subjects in the specific areas of Mood Tone, Zest vs.
Apathy, Congruence, and Resolution and Fortitude.

4. The tool should be administered to a larger randomly
selected sample of retirement home residents including
subjects who had never married as well as those who were
married, widowed, or divorced. In addition, the sample
should include subjects from a variety of economic and
cultural backgrounds.

5. Longitudinal studies are indicated using the tool as a
screening measure prior to moving into the retirement home

setting. The tool could also be administered upon admission

93

and then at six month intervals for three years to assess
changes in satisfaction levels. This would provide data
indicating areas of need for education and support of
residents undergoing a relocation experience specifically
into this type of setting.

6. Study could be directed towards examination of the
relocation experience and what measures could be carried out
by the GCNS to facilitate this move to be a positive
experience.

7. A comparative study of healthy community residents and
retirement home residents could be carried out to assess for
differences in life satisfaction related to place of
residence.

8. Comparative studies examining the relationship between
health status and scores on the LSIA especially in the Mood
Tone subscale would be helpful to determine interventions
best suited to facilitate and promote higher levels of life
satisfaction.

9. Modifying variables such as age at time of moving into
the retirement home, sex, marital status, health status,
support system, and importance of religious beliefs should
be evaluated to determine the extent of influence of these

variables on participant's LSIA scores.

94

10. The relationship of the reasons for relocating (ie.
changes in health status of participant or spouse) to scores
on the LSIA warrants further investigation.

11. Correlations of the degree of perceived support from
family, friends, and religious faith and scores on the LSIA
would further indicate just how important these factors are
for the retirement home residents and how satisfied they are

with their lives.

In summary, although little research to date has been done
on life satisfaction in retirement home residents, this is an
area amenable to nursing research. The GCNS is in a unique
position to assess the needs of this segment of the population
and then to formulate strategies and interventions to meet these
needs. Actions on the part of the GCNS could be directed towards
assisting the client with exploring the decision whether or not
to relocate, and in assisting those already residing in the
retirement home setting to explore their feelings and concerns in

an effort to maintain or improve levels of life satisfaction.

Relationship to Conceptual Framework

 

King's theory of goal attainment addresses the

interrelationship between the environment, health, and nursing.

95

King provides a framework from which life satisfaction among
retirement home residents can be examined and provides a
theoretical basis for intervention by the GCNS.

The purpose of this project was not to measure interventions
of the GCNS, but rather to examine the perceived life
satisfaction levels of elderly individuals residing in a
retirement home. Often, long term care for the aged has very
negative connotations; however, participants of this project
verbalized very high levels of life satisfaction. The retirement
home is a form of institutional living which can allow for a
great deal of freedom and autonomy. In addition, residents of
this sample tended to be in fairly good physical health. King
(1981) describes health as a "continuous adjustment to stressors
in the internal and external environment through optimum use of
one's resources to achieve maximum potential for daily living"
(p. 5). It would appear that participants of this project had
successfully adapted to the change in their external environment
(relocation to the retirement home) and maintained a positive
internal environment (satisfaction with life).

The majority of these retirement home residents had a very
high level of perceived life satisfaction and probably for the
most part these residents had high levels of life satisfaction
prior to moving into the retirement home setting. These feelings

of satisfaction then persisted as the individuals adapted to

96

their new external environment. The judgments and actions of the
residents in this project demonstrated that they had reacted in a
surprisingly positive manner as evidenced by the scores on the
LSIA.

The LSIA is helpful in order to more closely examine the
relationship between the internal and external environment, and
the reactions and perceptions of those living in the retirement
home setting. Utilizing the LSIA, the GCNS can obtain objective
data on the resident's perceived level of life satisfaction and
from this data mutually determine goals which can be directed
towards optimizing levels of life satisfaction. Intervention on
the part of the GCNS may allow the client to verbalize feelings
and concerns related to present levels of life satisfaction (ie
his/her reactions) and thus through interaction with the GCNS,
the client might be able to achieve a more positive feeling of
life satisfaction. It is imperative that throughout this process
of goal attainment that the GCNS assess and obtain feedback as to
the client's feelings of satisfaction with life. The GCNS may
not be able to facilitate all clients to high levels of life
satisfaction, but efforts to optimize the level they can
personally achieve will benefit the client. The GCNS's role is
to assess on an ongoing basis the influence of the external
environment on the clients internal environment (level of life

satisfaction).

 

97

Implications for Nursing Practice

 

Although this project did not measure interventions of the
GCNS, several implications for advanced nursing practice may be
noted as an outcome of this project. The GCNS can use advanced
counselling and listening skills with retirement home residents
to assess their present levels of life satisfaction and to
determine areas of nursing intervention which may facilitate
residents to achieve higher feelings of satisfaction with their
lives. The GCNS may serve as an advocate by facilitating
resident's to develop a personal awareness of their life
satisfaction levels in an effort to promote self-care activities
which would encourage optimum feelings of well-being and
satisfaction in individual circumstances.

Counselling may take place with clients and families prior
to relocating to a retirement home. The GCNS may be able to help
the client with the relocation experience by providing
information and anticipatory guidance. The LSIA would provide an
objective measure of the client's general level of life
satisfaction and indicate areas in which information and guidance

is needed. Individualized anticipatory guidance on the part of

98

the GCNS may help the client to maintain feelings of life
satisfaction through the relocation process, including adaptation
to the congregate living environment which is present within the
retirement home setting.

Education at all levels is an essential role of the GCNS.
At both the graduate and undergraduate levels, nurses must be
given a realistic perspective of both the aging process and long
term care facilities, such as retirement homes. This is
necessary because a negative stereotype of long term care
facilities exists both among health care professionals and the
public. However, the results of this pilot project indicate that
retirement home residency can be a very positive and personally
satisfying experience. In many instances nurses are not aware of
the variety of housing options for the elderly and the various
health care services available to residents within these
institutions. Settings such as retirement homes are ideal
because the older adult can maintain a great deal of independence
and autonomy, yet care is readily available if needed. Families
of older adults need to be informed that they are not
"neglecting" their family member by encouraging retirement home
residency. Some children state that they have feelings of guilt
concerning relocation of their parents. However, in many
instances these older adults are much happier to be among their

peers and cohorts than to be living with their children. Dealing

99

with these types of issues and feelings is an imperative role of
the GCNS. The GCNS needs to have clinical experience within the
graduate education process to gain knowledge of the
physiological, psychological, and social needs of this
population.

The results of this project indicate that some residents
were reluctant to make long term plans for the future and some
residents stated that they did not expect some interesting and
pleasant things to happen to them in the future. The GCNS should
make efforts to assist these residents to make short term goals
to anticipate in the future, thereby giving them "something to
look forward to." This would hopefully facilitate feelings of
life satisfaction and optimism. Readily achievable, short term
goals would be most appropriate.

It is also important for the GCNS in carrying out the role
of the clinician to closely examine the client's health status.
Given the relationship between health and satisfaction, persons
experiencing health status changes would need to be considered to
be at risk for satisfaction levels declines. The spouse or
significant other of the ill individual would also be at risk for
changes in life satisfaction levels. The retirement home
provides the GCNS an ideal opportunity to implement primary care

which is comprehensive, coordinated, and continuous.

100

Although to date there has been little research addressing
life satisfaction among retirement home residents, this is an
opportune area for intervention on the part of the GCNS. The
GCNS may be able to function in a variety of roles in both the
pre-move and post-move phases, as well as a facilitator to
residents to determine their various needs and the best ways in

which these needs might be met.

APPENDIX A

101

Appendix A

Retirement Home Life Satisfaction Index A Questionnaire

 

DATE:

 

DATE OF BIRTH:

 

MARITAL STATUS:

 

NUMBER OF YEARS RESIDING AT RAYBROOK:

 

PREVIOUS TYPE OF RESIDENCE:

 

LIFE SATISFACTION INDEX A

AGREE DISAGREE UNCERTAIN

A. I am just as happy as when I

 

was younger

B. These are the best years of my life

 

C. My life could be happier than it is now

 

D. This is the dreariest time of my life

 

E. Most of the things I do are boring or

 

monotonous

F. Compared to other people, I get down in

 

the dumps too often

 

G. The things I do are as interesting to me

 

as they ever were

 

 

 

 

 

 

102
H. I have made plans for things I'll be

doing a month or a year from now
I. Compared to other people my age, I
make a good appearance
J. As I grow older, things seem better than
I thought they would be
K. I expect some interesting and pleasant
things to happen to me in the future

L. I feel old and somewhat tired

 

 

 

 

M. As I look back on my life, I am fairly
well satisfied

N. I would not change my past life even if
I could.

0. I've gotten pretty much what I

expected out of life

 

 

 

 

P. When I think back over my life, I didn't

get most of the important things I wanted

Q. In spite of what people say, the lot of

the average man is getting worse, not better
R. I have gotten more of the breaks in life

than most of the people I know

103

1. Overall what makes you feel the most satisfied/dissatisfied

with life?

2. How happy are you with your decision to relocate to the

retirement home setting?

3. What have you been going through the past two months?
(ie. death, change in financial status, serious illness,

etc.)

APPENDIX B

104

Appendix B

Letter to Participants Explaining Purpose of Project

 

October 31, 1988

Retirement Home Resident
2121 Raybrook Dr. S.E.
Grand Rapids, MI 49506

Dear Retirement Home Resident,

I am a Graduate Student in Nursing at Michigan State University
and am interested in people living in retirement homes and in
their opinions. I am working on a research project which
addresses older adults feelings concerning satisfaction or
happiness with life while living in a setting such as Raybrook.
Participation in my project will take approximately one hour of
your time and will simply consist of answering a few brief
questions. I will give you the questions in person so there will
be no forms that you have to complete or fill out.

Your answers will be held in complete confidentiality and
no attempt will be made to identify you in any manner. You may
choose to discontinue answering the questions at any time if you
desire without penalty.

This project has been reviewed with the administration and
Gary Ellens, and meets with their approval.

I will be contacting you in the near future to arrange a time at
your convenience when I can give you the questionnaire. Thank
you for your time and willingness to participate.

Sincerely,

Glenes J. Boerema RN, BSN
Gerontological Clinical Nurse Specialist candidate
Michigan State University College of Nursing

APPENDIX C

105

Appendix C

Consent Form

I state that I

 

understand the study that has been explained to me and agree to

participate. I understand that results are confidential and I am

free to withdraw from the study at any time without consequence.

Participant's signature

 

Sincerely,

Glenes J. Boerema RN, BSN

(Rerontological Clinical Nurse Specialist Candidate

Iflichigan State University College of Nursing

REFERENCES

106

References
Adams, D.L. (1969). Analysis of a life satisfaction index.

Journal of Gerontology, 23(4), 470-474.

 

Aleksandrowicz, D. R. (1961). Fire and its aftermath on a

geriatric ward. Bulletin of the Menninger Clinic,

 

1531) , 25, 28-37.

Atchley, R. (1983). Aging: Continuity and change.

 

Belmont, CA: Wadsworth.
Bauer, P.A. & Okun, M.A. (1983). Stability of life

satisfaction in late life. The Gerontologist, 22(3),

 

261—265.
Beck, S.H. (1982). Adjustment to and satisfaction with

retirement. Journal of Gerontology, 21(5), 616-624.

 

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