Domains and determinants of a person-centered index of aging well in Canada: a mixed-methods study

摘要

ObjectivesThe objectives of this study were to explore the perspectives of older adults about the most important domains of aging well and to identify the social determinants of a person-centered index capturing these domains.MethodsWe conducted a mixed-methods study of 40 semi-structured interviews and epidemiological data from 670 older adults participating in the International Mobility in Aging Study (IMIAS) in Saint-Hyacinthe and Kingston. A composite index capturing the domains of aging well was constructed on the basis of findings from qualitative content analysis. Bivariate and multivariate regressions were carried out to examine the determinants of aging well, including economic determinants, health behaviours, health services, and the social environment.ResultsThe qualitative results confirm the importance of symptomatic health conditions and psychosocial components. The index was computed as a continuous score (0 to 100) containing health components (ADL disability, mobility disability, pain, self-rated health, and cognitive function), and psychosocial components (mood, productive activities, social relations, life satisfaction, and self-mastery). Mean scores were 81 among Canadian older adults, and 83 and 79 for men and women respectively. Being male, having sufficient income, doing leisure physical activity, and feeling safe in one's neighbourhood were all significantly associated with a higher score on the aging well index.ConclusionThe composite index highlights important aspects of health and psychosocial well-being that could be augmented according to older adults themselves. Modifiable social determinants of aging well could guide social and health policies to maximize well-being in this population. ResumeObjectifsLes objectifs de cette etude etaient d'explorer la perspective de personnes agees a propos des plus importants domaines de ce que signifie bien vieillir, ainsi que d'identifier les determinants sociaux d'un index de bien vieillir centre sur la personne incluant ces domaines.MethodesNous avons effectue une etude a methodes mixtes utilisant 40 entretiens semi-diriges et des donnees epidemiologiques provenant de 670 personnes agees ayant participe a l'etude internationale sur la mobilite au cours du vieillissement (IMIAS) au Canada, a Saint-Hyacinthe et a Kingston. Un index comprenant les domaines mentionnes par les participants au devis qualitatif a ete construit a partir de mesures existantes. Des regressions bivariee et multivariee ont ensuite ete estimees afin d'examiner les determinants sociaux de l'index de bien vieillir, notamment les determinants economiques, les comportements de sante, l'acces aux services de sante, et l'environnement social.ResultatsLes resultats du devis qualitatif confirment l'importance de conditions de sante symptomatiques et de composantes psychosociales. Un index continu (0 a 100) a ete developpe, comprenant des domaines de la sante (incapacite dans les activites de la vie quotidienne, incapacite de mobilite, douleur, sante percue et fonction cognitive) et psychosociaux (humeur, activites productives, relations sociales, satisfaction dans la vie et maitrise de soi). Les scores moyens etaient de 81 pour l'ensemble des repondants canadiens, ainsi que de 83 et 79 pour les hommes et les femmes, respectivement. Etre un homme, avoir un revenu suffisant, faire des activites physiques comme loisir et se sentir en securite dans son quartier etaient des determinants associes de maniere statistiquement significative a un score plus eleve sur l'index de bien vieillir.