Living arrangements and life satisfaction: mediation by social support and meaning in life

This was a cross-sectional survey. A total of 215 older adults were conveniently recruited between May 2016 and April 2017. The inclusive criteria were: (a) nursing home residents who had been living in a nursing home for more than 6 months or community-dwelling older adults who were permanent local residents; (b) aged 60 years or older; (c) ability to communicate. The exclusion criteria were as follows: (a) older adults with cognitive impairment, as measured by the Short Portable Mental Status Questionnaire (cut off ≥2) [27], and (b) critically ill or in the terminal stage of illness.

The ethic approval of this study was obtained from the co-responding author’s university. Then, our study proposal was sent to the available community committees and nursing homes in Fuzhou to invite them to participate in this study. Nine nursing homes and three communities agreed to be recruited for this study. After the informed consent was obtained, the individual face-to-face interviews were conducted by senior undergraduate nursing students with experience in conducting surveys. The data collectors read each question aloud and objectively marked the participants’ answers in the questionnaire. Each interview last about 20 min .

Descriptive statistics were calculated for all of the targeted variables. Categorical variables were described by frequencies and percentage, and continuous variables, by mean and standard deviation. A chi-square test was used to examine the differences in demographic characteristics between community-dwelling older adults and nursing home residents. An independent-sample t-test was used to compare life satisfaction, presence of meaning, search for meaning and social support between the two groups. Additionally, correlational analyses were calculated for life satisfaction, presence of meaning, search for meaning, and social support.

Hayes’s bias-corrected bootstrapping method [38] was employed to examine the multiple mediation effects of presence of meaning, search for meaning, and social support. The reason is that although a causal steps approach and the Sobel test enjoy some application in test mediation effects, they have a major flaw [39, 40]. They require the assumption that the sampling distribution of the indirect effect is normal. But the sampling distribution of indirect effect tends to be asymmetric, with nonzero skewness and kurtosis [41]. Indeed, bootstrapping has more power and better Type I error control than the Sobel test and the causal steps approach [38]. We used 5000 bootstrap samples, and bias was corrected at 95% confidence intervals (CI) to calculate the indirect effect of each variable. If the CI of the indirect effect did not include zero, it indicated that the indirect effect was significant.

Table 1 presented the sample characteristics by comparing the frequencies or means between the two settings. There were 101 respondents from long-term nursing homes, and 114 from communities. The mean age of all participants was 75.81 (SD = 9.42). The proportion of nursing home residents aged 75 or above was significantly larger than that of community residents (p<0.001). Nearly half of the respondents were married (45.6%), however, the proportion of married elderly living in the community (64.9%) was significantly larger than that of those living in nursing homes (23.8%). A total of 71.2% of respondents were living on a pension, while the rest were living on savings, public assistance or financial support from their children. There was a slightly lower proportion of nursing home residents living on a pension, compared with their counterparts (61.4% vs 79.8%). A χ² test indicated that no significant differences between the two groups were found in terms of gender, occupation, education level, religion or chronic disease.

Table 2 showed that social support, presence of meaning, search for meaning, and life satisfaction was different between nursing home residents and community-dwelling older adults(p<0.001). The nursing home residents reported lower levels of social support, presence of meaning, search for meaning and life satisfaction, compared with the community-dwelling older adults (p<0.001). All three variables were significantly correlated with one another. Social support was positively related to presence of meaning (r = 0.261, p<0.001), search for meaning (r = 0.160, p<0.05) and life satisfaction (r = 0.359, p<0.001). Higher level of presence of meaning and search for meaning were all significantly associated with a higher level of life satisfaction (r = 0.450, p<0.001; r = 0.397, p<0.001).

The findings about the mediation effects of presence of meaning, search for meaning, and social support on the relationship between living arrangements (nursing home vs. community) and life satisfaction were presented in Table 3, and the final path model was presented in Fig. 2. The total effect of living arrangements on life satisfaction was significant (b = 2.460, SE = 0.528, p<0.001, bias-corrected and percentile 95% CI = [1.419, 3.501]). The direct effect of living arrangements on life satisfaction was statistically non-significant (p>0.05, bias-corrected and percentile 95% CI = [− 0.210,1.899]). Both presence of meaning and social support were significant in mediating the relationship between living arrangements and life satisfaction (b = 0.531, SE = 0.219, p<0.05, bias-corrected 95% CI = [0.182, 1.054], percentile 95% CI = [0.163, 1.010]; b = 0.794, SE = 0.274, p<0.01, bias-corrected 95% CI = [0.306, 1.398], percentile 95% CI = [0.311, 1.290], respectively). Recording to the result of percentile, that showed the statistical analysis of interval contained 0, search for meaning was not significant in mediating the relationship between living arrangements and life satisfaction(b = 0.281, SE = 0.166, p<0.05, bias-corrected 95% CI = [0.027, 0.694], percentile 95% CI = [− 0.008, 0.647]).

The present study indicated that the relationship between living arrangements and life satisfaction was mediated by presence of meaning in life. Specifically, the community-dwelling older adults reported higher levels of meaning in life, which was associated with better life satisfaction, compared with nursing home residents. This is supported by Glaw et al., who identified a positive association between meaning in life and life satisfaction [20]. Presence of meaning in life refers to the extent to which people comprehend, make sense of, or perceive significance in their lives, as well as the degree to which they view themselves as having a purpose or mission [29]. It may be that presence of meaning in life was related to higher levels of well-being and mental health throughout the human life span [44]. It may also be possible that presence of meaning in life can protect individuals from negative outcomes [45], and make them less vulnerable to psychopathology [46]. Another explanation could be that individuals with higher levels of meaning in life can cope more effectively with physical health challenges and overcome obstacles more easily [47].

This study further revealed that a positive relationship between living arrangements and life satisfaction was mediated by social support. It suggested that compared to nursing home residents, community-dwelling older adults enjoy higher levels of social support, which was associated with better life satisfaction. Cumulative evidence showed that social support contributed to improved psychological well-being [48]. In this study, it may be that community-dwelling older adults receive more support than older adults living in nursing homes, particularly physical, psychological, emotional, and financial support from their family and children [49‐51]. Being deeply engaged with family members contributes to higher levels of life satisfaction. It may also be possible that social support can alleviate the negative effects of stressful events, contributing to greater life satisfaction [52]. Older adults face negative events, such as a reduction in physical functioning and cognition, an increase in dependency and the death of loved ones. Social support was found to be a protector from the negative effects of age-related challenges in older adults [53, 54]. Thus, older adults who are more engaged in social support networks are more likely to be satisfied with their lives.

These study findings are particularly important, which open a new nursing perspective, because the mediating effects on the relationship between living arrangements and life satisfaction provide evidence for improving nursing home residents’ life satisfaction. Given the importance of meaning in life, logotherapy could be a likely contributor to stimulating nursing home residents’ will to find meaning in life through three different ways including“creative values,” “experiential values,” and “attitudinal values” [55, 56]. Nursing staff could also guide older adults to set small goals, and help them fulfill these goals in their daily lives. They could facilitate residents to offer reminiscence activities and contributions, and help them clarify their values and what brings them meaning in life. Maximizing the social integration of the residents are also necessary. Nursing home staff could hold a variety of activities to increase residents’ opportunities to interact with one another and encourage them to engage in more social activities. In particular, for those who are less mobile, nursing home staff could offer opportunities for interaction by escorting them to other residents’ rooms, and maximize the opportunities for meeting other residents during activities, not by solely sitting them next to each other. Ensuring good relationships between nursing home staff and residents would be another effective approach to improve social support for nursing home residents. Maintaining close ties with family and friends, are also good options for enhancing their life satisfaction. Following this, researchers might explore how older adults place attachment-related resilience and/or belonging in relation to life satisfaction.

The results and implications of this study should be considered in light of several limitations. First, the data were collected at one point in time, and this study did not examine the modeled relationships longitudinally or test the models’ predictive power over time. Second, this study only 215 older adults from nine nursing homes and three communities in southeastern China. The findings’ generalizability is limited. Finally, the sole use of self-reported measures and a convenience sampling procedure are also methodological limitations, it could have been strengthened to use a mixed methods involving interviews with participants would provide more context to complement the quantitative findings.