Sapporo City Public Health Center, Sapporo, Hokkaido, Japan.
Faculty of Medicine/Graduate School of Health Sciences, Department of Community and Public Health Nursing, Hokkaido University, Sapporo, Hokkaido, Japan.
PLoS One. 2023 Aug 22;18(8):e0289571. doi: 10.1371/journal.pone.0289571. eCollection 2023.
Previous cross-sectional studies suggest that negative health outcomes such as mortality, social isolation, loneliness, and depression among older adults living alone vary by sex and marital status, with men often worse off than women and unmarried people worse off than married people. However, limited evidence exists from longitudinal studies regarding whether positive health outcomes such as subjective well-being (SWB) also vary by sex and marital status. The focus by sex and marital status on the positive health outcomes and diverse profiles of older adults living alone is important for public health in the near future. Therefore, the purpose of this study was to identify changes in SWB over time and its associated factors by sex and marital status among older adults living alone in the community using a longitudinal study in a representative population.
This was a longitudinal study using data from the Japan Gerontological Evaluation Study. This study is the first to reveal differences in SWB and related factors over 3 years among older adults living alone in the community (n = 8,579) who were stratified by sex and marital status (married men, non-married men, married women, and non-married women).
Women moved to higher levels of SWB than did men, and married individuals moved to higher levels of SWB than did unmarried individuals. Independent functioning factors and interpersonal factors were significantly associated with SWB for married men and married women, but for unmarried women, the association by interpersonal factors was more pronounced, and for unmarried men, only limited emotional support and health promotion activities were significant among the interpersonal factors.
This study revealed that among older adults living alone, changes in SWB over time and the independent functioning factors and interpersonal factors associated with this change varied by sex and marital status among older people living alone. These findings are useful for policy-making and guiding intervention activities to promote SWB in a society in which the environment for older adults living alone is changing dramatically.
先前的横断面研究表明，独居老年人的健康结局（如死亡率、社会隔离、孤独和抑郁）存在性别和婚姻状况差异，男性的情况通常比女性差，未婚者比已婚者差。然而，关于积极健康结局（如主观幸福感[SWB]）是否也存在性别和婚姻状况差异，纵向研究的证据有限。从性别和婚姻状况出发，关注独居老年人的积极健康结局和不同特征，对于未来的公共健康至关重要。因此，本研究的目的是使用代表性人群的纵向研究，确定独居老年人的 SWB 是否随时间变化，以及其变化与性别和婚姻状况的关联。
这是一项使用日本老年评估研究数据的纵向研究。本研究首次揭示了社区独居老年人（n=8579）在 3 年内的 SWB 及相关因素差异，这些老年人按性别和婚姻状况分层（已婚男性、未婚男性、已婚女性和未婚女性）。
女性的 SWB 水平比男性高，已婚者的 SWB 水平比未婚者高。对于已婚男性和已婚女性，独立功能因素和人际关系因素与 SWB 显著相关，而对于未婚女性，人际关系因素的关联更为显著，对于未婚男性，人际关系因素中只有有限的情感支持和健康促进活动具有显著意义。
本研究表明，在独居老年人中，随着时间的推移，SWB 的变化以及与之相关的独立功能因素和人际关系因素因性别和婚姻状况而异。这些发现对于制定政策和指导干预活动以促进独居老年人所处环境发生巨大变化的社会中的 SWB 具有重要意义。
