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Hong Kong Journal of Occupational Therapy 71

2010 Elsevier. All rights reserved.

HKJOT 2010;20(2):7179

Department of Occupational Therapy and Art Therapy, School of Health Sciences, Queen Margaret University, Edinburgh, United Kingdom.

Reprint requests and correspondence to: Akehsan Dahlan, Department of Occupational Therapy and Art Therapy, School of Health

Sciences, Queen Margaret University, Edinburgh EH21 6UU, United Kingdom.

E-mail: [email protected]

ELEMENTS OFLIFESATISFACTION AMONGST

ELDERLY PEOPLELIVING ININSTITUTIONS IN

MALAYSIA: A MIXEDMETHODOLOGY APPROACH

Akehsan Dahlan, Margaret Nicol and Donald Maciver

Background: Changes in demographic characteristics, social structure and economic status have

shifted the direction of care of elderly people in Malaysia. Subsequently, nursing homes and institu-

tions for elderly people becoming a significant care option. The aim of this study is to identify the level

of life satisfaction and to examine the elements of life satisfaction amongst the elderly people living inthe institutions.

Methods: In this mixed methodology, a survey using translated version of Satisfaction with Life Scale

(SWLS) was conducted to 82 participants who conformed to the inclusion criteria. Twenty participants

who volunteered to discuss about their live experience regarding life satisfaction living in a public elderly

institution in Malaysia. The participants were stratified according to age group and gender. Four focus

groups were conducted and the Interpretative Phenomenological Analysis were used to identify the key

themes emerged from the focus groups.

Results: The level of life satisfaction is equivalent to the norms and there is no statistical significant

difference between the levels with the demographic variables. Two main themes were developed, con-

tentment and acceptance, reflecting the elements of life satisfaction of the participants in the institution.

Conclusion: The findings are inconsistent with previous findings. However, it identified new elements

of life satisfaction for elderly people in the institution.

KEY WORDS: Institutionalised elderly people Life satisfaction

Mixed methodology Occupational therapy

Introduction

It is anticipated that the elderly people population in Malaysia

will increase up to 9.9% by the year 2020 (Pala, 2005), whilst

life expectancy has increased from 66.4 to 70.2 years old in

males, and from 70.5 to 75.0 in females (Ministry of Health,

2008). These increased changes have implications for health

services, as people living longer will require more health care

and hospitalisation for chronic illness, functional dependence,

mental health, sensory deficiency and cognitive impairment,

thus increasing the government expenditure for health services.

(Chen, 1987; Jamaiyah & Hanafiah, 2006; Sherina, Lekhraj, &

Mustaqim, 2004; Yeoh, 1980).

The Malaysian family has long been regarded as a care insti-

tution, which bears the responsibility for looking after the elderly

people. This belief derived from the teaching of Islam and

Confucians ethics of filial piety that put a strong emphasis on

respect for the elderly people. Therefore, elderly people in

Malaysia are greatly respected and are usually cared for by their

family. In addition, Kim et al. (2005) indicated that 62% of adults

surveyed believe that they should support their elderly people

parents and they should not send their parents to nursing homes.

ORIGINALARTICLE


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A. Dahlan, et al HKJOT 2010;20(2)

The social characteristics of people in Malaysia are chang-

ing as a result of urbanisation and modernisation of the pop-

ulation, for example, the changing role of women and their

participation in the labour force, delay in marriage, smaller

family size, migration of the younger generation to urban areas

with more jobs and education opportunities (Aminah, 1996;

Arpita, 2000; Hew, 2007; Sim, 2002). These changes have

social implications for elderly people. The extended family

structure is being replaced by a nuclear family structure, con-

sequentially affecting and putting a strain on the family as the

role of the care giver for elderly people (Cheng, 2003; Hew,

2007; Martin, 1989; Mubarak, 1997; Ng, Lim, Jin, & Shinfuku,

2005; Selvaratnam & Tin, 2007). For example, the urban pop-

ulation has increased from 33.5% (as a percentage of total

populations) in 1970 to 65.1% in 2005, the elderly people who

lived in an extended family decreased from 57.8% in 1991 to

43.8% in 2000, whilst the average household size decreased

from 5.2 people in 1980 to 4.6 people in 2000 (Department of

Statistics Malaysia, 2008). In addition, the fertility rate has

continuously declined, for example the fertility for all races is

4.9 children born per women in 1970 to 2.95 in 2009. The

birth rate has also continuously declined from 23.7 birth to

22.24 per 1000 populations in 2009.

These changes have created a vacuum that has seen the

development of many private and public nursing homes and

other institutional care facilities which reflect the demand and

ability to purchase, and are perceived as a significant care

option. For example, the first nursing home was established in

1983, and by the year 2001, there were 50 moderate-sized nurs-

ing homes which contained 40 beds, but there are hundreds

more smaller homes in operation (fewer than 10 beds) which

are located in bungalows and private residences (Sim, 2002).

By the year 2007, there were 209 moderate size nursing homes

and 7 institutions for elderly people (Social Welfare Department

of Malaysia, 2009).

As the need and demand increases, placing elderly people in

institutions or nursing homes is becoming increasing common

practice in spite of the cultural expectation and assumption

that placing the elderly people in a nursing home is a violation

to tradition and personal beliefs.

Elderly people institutions have negative effect on health

and well-being as the institutional environment creates feelings

of dependency and reinforces a sick role amongst the residents

(Dommenwerth & Petersen, 1992). In addition, the institutions

and nursing homes are viewed as dumping place where one

would idle till death, close to death and possessing an un-

controlled future (Lee, 1997, p. 333). The elderly people also

feel dissatisfied with the quality of care, erosion of personal

autonomy, loss of meaning and sense of belonging in life as a

result of institutional policy, stiffness of general routine and

the hierarchical structure of the institution (Berglund, 2007;

Bowling & Formby, 2002; Brooker, 2008; Brown, 1995; Lee,

1997). As a result, elderly people feel isolated and lonely

(Fessman & Lester, 2000; Kim, Jeon, Sok, & Kim, 2006) and

depressed (Brooker, 2008; Sabariah & Hanafiah, 2006). A

study by Jones, Marcantonio and Rabinowitz (2003) indicated

that 20.3% of the elderly people who resided in the nursing

home or institutionalised type of care were depressed. Sherina,

Rampal, Hanim and Thong (2006) who conducted a study of

elderly people in an institution in Kuala Lumpur reported that

54% of the elderly people were depressed. In addition, Oksoo

et al. (2009) reported that 66.7% of Korean elderly people and

41.7% of Japanese elderly people who live in nursing homes

were depressed. Choi, Ransom, and Wyllie (2008) indicated

that depression amongst elderly people in the institutions and

nursing homes is due to loss of independence, inability to

continue previous occupations, feelings of isolation and lone-

liness, lack of privacy and meaningful occupations.

Depression causes the failure to thrive in the institution

(Bergland & Kikrevold, 2006), thus they are likely to comply

and participate in the programme, processes and routine occu-

pations run by the institution. As a result, the elderly people have

a low level of life satisfaction and quality of life (Hjaltadottir &

Gustafsdottie, 2007; Subasi & Hayran, 2005).

Research Aim

The aim of this research is to identify the level of satisfaction

with life and to examine the relationship between life satisfac-

tion and the sociodemographic characteristics of the elderly

people living in the institution. In addition, the study aims to

describe the elements which constitute to the life satisfaction

experience living in the institute.

Methodology

Overview of the Design

A mixed method of both quantitative and qualitative designs

was chosen to answer the research aims. The method will pro-

vide strong inference and complement the strength of each

methodology to provide more meaningful in-depth data

(Barbour, 1998; Brannen, 2005; Creswell, 2003; Morse, 2005;

Shin, 1998; Tashakkori & Teddlie, 1998). The simultaneous

strategy models were used to obtain the data, thus the data can

be collected and analysed concurrently in a short period of

time (Schulenberg, 2007; Tashakkori & Teddlie, 2003). Aligned

with this, a cross-sectional survey was conducted to identify

the level of life satisfaction followed by focus group interview

that aimed to understand the elements of lived satisfaction

72 Hong Kong Journal of Occupational Therapy


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LIFE SATISFACTION IN INSTITUTIONALISED ELDERLY PEOPLE

through the life experience of the participants who are living

in the institution.

Research Setting and Participants

The participants were located at the public funded elderly peo-

ples institution in Malaysia. The institution houses independent

elderly people, 60 years old and above. There are seven hostel

types of buildings, occupied by 3040 residents per house.

The institute could house about 250300 residents at one time

and is currently staffed by 64 people. Medical staff consisted

of two full time nurses and a physiotherapist. The institution

provides free basic amenities to the elderly people such as six

meals per day, clothes and items for personal hygiene. There

were no structured activity for the elderly people, and they

were free to move around the compound of the institution.

All of the residents were sampled and 82 participants were

found fit into the inclusion criteria which was elderly people

aged 60 and above, independent in basic self-care skills, able

to understand and or speak fluently in either in Bahasa or

English, scores of 22 and above in the Mini Mental State

Examination (MMSE; Folstein, Folstein, & McHugh, 1975)

and scores below 7 in the Geriatric Depression Scale (GDS;

Yesavage et al., 1983).

Survey and Focus Groups Interview

The survey was conducted through face to face interview

using Satisfaction with Life Scale (SWLS) (Diener, Emmonas,

Larsen, & Griffin, 1985). The scale was translated into Malay

language and the translated version has a good internal con-

sistency of 0.83 across demographic variables (Swami &

Chamorro-Premuzic, 2009). The scale consists of five items

intended to measure life satisfaction. Participants indicate their

agreement or disagreement with the statements on a 7-point

Likert type of scale and the scores range from 5 to 35 with

higher scores indicating a greater life satisfaction. The psy-

chometric properties were tested in numerous studies (Diener

et al., 1985; Hultell & Gustavsson, 2008) and the internal con-

sistency generally exceeds .80. Pavot, Diener, Colvin, and

Sandvik (1991) obtained an alpha coefficient of .83 and the

results were correlated with other types of life satisfaction

measurement such as the Life satisfaction Index-A (p< .01).

This measurement is considered suitable for the participants

in view of their education level. Assistance was given if the

participants needed further clarif ication about the scale.

The focus groups were conducted using semi-structured

interview to collect data regarding the life satisfaction experi-

ence of the elderly people living in the institute. Semistruc-

tured questionnaires were prepared. To ensure representation

and homogeneity, 20 participants who volunteered for focus

groups were stratified through stratified purposeful sampling

strategy. The participants were divided based on two age cate-

gories (6075 years old and above 76 years old) and gender

(male and female group). There were four focus groups in the

study and each group consist of 46 elderly people. The focus

groups will preserve the life experience of the participants and

provide rich data as a result of the opportunity for the partici-

pants to reflect, cross-check and clarify their shared experience

(Bradbury-Jones, Sambrook, & Irvine, 2009).

Data Analysis

The survey was analysed using the PASW v18. Spearmans rho,

one-way between groups analysis of variance (ANOVA) with

post hoc were conducted to determine whether there are any

differences between the life satisfactions with the subgroups

within the demographic variables. The critical value for sig-

nificant were set atp< .05 with 95% confidence interval and

Cohens (1988) guideline will be used to determine the strength

of the relationship.

The interview transcripts was analysed using four stages

of Interpretative Phenomenological Analysis (IPA) as outlined

by Smith, Flowers, and Larkin (2009). Initially the first transcript

from the first group was read over several times and the left

margin of the transcripts was used to annotate the key points

and provide comment on language, linguistic differences, con-

tradictions and what was considered important from the respon-

dents words, then the key points were compiled into the list.

The lists were reviewed and the points that had similar

characteristics were clustered together to form subsumma-

tions of themes. Further analyses were conducted to ensure all

of the important key points were compiled and clustered

accordingly. When all key points are included, masters of

theme were developed alongside with the participants details

and the quotes from the participants. This process was

repeated for the remainder of the focus groups transcripts.

After each transcript was analysed, a further analysis was con-

ducted to highlight disparities and resemblances within the

groups. Constant reflection and re-examination of the themes

was conducted throughout the analytical process to ensure

that the themes were interconnected. Subsequently, some

themes are expended or dropped from the master themes.

The quotes and themes developed were translated into

English using forward translation (Heij, Hooglander, Kerling,

& Velden, 2006; World Health Organisation, 2008). The

quotes were used to validate the research findings and to pro-

vide clear examples for the research report (Sandelowski

1994). Few measures were taken to ensure trustworthiness of

the themes developed as outlined by Curtin and Fossey

(2007). Detailed descriptions of the participantsbackgrounds



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and situation of the phenomena understudy are obtained, so

that the meaning and experience of the elderly participants

can be fully understood. In addition, the focus groups were

facilitated by three different individuals and an external

researcher was invited to validate the themes which emerge

from the focus groups. The quantitative and qualitative data

were integrated into a coherent whole and inference between

the data was made aligned with the principles of mixed meth-

ods data synthesis (Onwuegbuzie & Teddlie, 2003).

Ethical Consideration

The confidentiality and anonymity of the participant infor-

mation was obtained from the participants and the study was

approved by Research Ethic Committee of the Queen Margaret

University. In addition, the study was registered and approved by

the Ministry of Women, Family and Community Development

in Malaysia.

Results

Demographic Characteristics

The sample consists of 68.3% male (n=56), 31.7% female

(n= 26) and 68.3% (n=56) are Malay elderly people. There

are 43.3% (n= 36) of the participants who never attended

school, the mean age of the participants is 74.1 year old and

the duration of living in the institute is 42.2 months. There are

51.2% (n=42) did not have contact with their family members

and 45.1% (n=37) were referred by family members or friends.

Survey on Satisfaction With Life

The scores indicated that 59% (n=48) have an average life sat-

isfaction, 30.5% (n=25) are below average satisfaction with

life and 8.5% (n=7) are dissatisfied with their life. The mean

for life satisfaction is 20.2 (4.1).

In spite of 55% (n = 45) of the elderly people stating that

they did not have the opportunity to engage in important occu-

pations in life such as work and leisure, 66% (n = 54) state that

their life is in an excellent condition and 63% (n = 52) are sat-

isfied with their life condition.

The relationship between life satisfaction (as measured by

SWLS) and the demographic variables indicated that there was a

positive correlation between life satisfaction with duration of liv-

ing in the institute, rho=0.23, n=82,p< .05 as shown in Table 1.

The assumption for homogeneity using Levines test for

homogeneity of variance indicated that the assumption for one-

way between groups ANOVA is not violated (p> .05) in all the

groups in the socio-demographic variables. A one-way between-

group ANOVA was conducted to explore the impact of demo-

graphic variables such as age group, duration of staying in the

institute, number of friends outside the institute, number of

family members who keep in touch and reason for admission on

life satisfaction, as measured by SWLS. There was no statisti-

cal significant differences at thep< .05 level in SWLS scores for

the demographic variables. Demographic variables measured

did not influence SWLS as shown in Table 2.

Themes Generated From Focus Groups

Two key themes emerged from the analysis of the residents

experience in relation to their life satisfaction living in the insti-

tute: (a) Contentment (Syukoor) (b) Acceptance (Redha). The

themes and the subthemes are summarised in Table 3.

Theme 1: Contentment (Syukoor)

Three subthemes from contentment were identified from the

analysis, these included contentment to the benefits obtained,

hospitality from staff and the institute, and health and content-

ment with health and safety. These superordinate themes were

shared amongst six focus groups. The participants were con-

tented with the benefits. Thus this theme was closely related

to the living situations, facilities obtained and benefits

gained by the participants living in the institute.

Subtheme 1: Benefits

This subtheme was shared by many participants. One participant

said,

I feel happy with my life here, I feel happy to live here

[break] syukoor I have what I need, I am contented,

I am not worried about work and means to look for


Table 1. Spearmans Rho correlation between Satisfaction with Life Scale (SWLS) with demographic variables

Scale SWLS Age Duration Friend outside In-touch No. of health problems

1. SWLS .94 .02* .94 .69 .42

2. Age .43 .82 .72 .46

3. Duration .59 .58 .71

4. Friend outside the institute .02* .77

5. In-touch with family member .56

6. No. of health problems

*Correlation is significant at .05 (2-tailed).


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money to buy food, everything is prepared, I have six

meals a day, and then I relax all day I feel free from

the pressure to work, house maintenance and so on

I dont even have to clean my plates, I dont have to

worry about anything anymore (72-year-old male).

Another acclaimed, Nobody ask me to do anything or

forced me to do anything (69-year-old male).

Master Themes 2 and 3: Hospitality, Health and Safety

The staff hospitality and feeling safe living in the institute

were also indicated as a mean for contentment. One partici-

pant described,

I feel safe in here, nobody is teasing me because I am

old, I feel that I am respected... [The staff] call me Mak

Cik (Auntie). They really take care of me, I can go to

the clinic if I am not feeling well at anytime and I dont

have to worry about my children and my relatives and

they dont have to worry about me in here, they can

come and visit me anytime (78-year-old female).

Another explained that he was contented with the current

health status and the benefits of living in the institute and

described that,

Syukoor, I am still be able to walk although I am very old,

I can do my daily activities without any help from other

inmates, I can perform daily praying, go the mosque and

to the dining halls, not like other people here nobody

can force me to do anything (73-year-old female).

Superordinate Theme 2: Acceptance (Redha)

This superordinate theme coveyed a sense that the participants

were accepting of their current life conditions and this sense

was shared among almost all of the participants. One partici-

pant said that

It is ok, Redha with what happen in my life, what was

determine in my life, [break] left by my husband for

another women. I cant stand staying with my children,

they have a small house in the city, I felt that I lived in a

prison and I dont have friends there. I redha that I have

a place to stay, at least, I am not homeless. Even though

the food here sometime is not nice, thats ok [break],

at least I have food to eat (68-year-old female).

Discussion

There is substantial literature indicating the effect of health

status, demographic characteristics, social relationships and

occupations towards life satisfaction for elderly people in the

community (Chou & Chi, 1999; Depaola & Ebersole, 1995;

Iwatsubo, Derriennic, Cassou, & Poitrenaud, 1996; Melendez,

Tomas, Oliver, & Navarrow, 2009). However, there is a

scarcity of recent literature regarding the life satisfaction of

elderly people who lived in an institution or a long term type

of care, especially in the developed countries. The changes in

government policy of elderly peoples care which focus on


Table 2. Analysis of variance between demographic

variables and life satisfaction, as measured by Satisfaction

with Life Scale (SWLS)

VariablesSWLS

F pMean (SD)

Age group (yr)6069 (n=23) 20.7 (3.6) 4.60 .37

7079 (n=29) 21.7 (4.0)

80 (n=30) 20.2 (4.6)

Duration of stay in the

institution (mo)

1260 mo (n=65) 20.4 (4.0) 1.90 .16

61120mo (n=14) 22.8 (3.5)

120180mo (n=3) 21.0 (4.1)

Friends outside the institute

None (n=29) 20.8 (4.4) 0.15 .93

15 (n=34) 21.1 (4.3)

610 (n=17) 19.5 (3.5)

1134 (n=2) 20.9 (4.1)

In-touch with family members

None (n=42) 21.2 (4.0) 0.31 .74

15 (n=29) 20.5 (4.5)

612 (n=11) 20.5 (3.5)

School qualification

Never gone to school (n=36) 20.8 (4.4) 0.57 .63

Up to standard six 21.1 (3.8)

(612 yr) (n=37)

Lower certificate 18.6 (5.3)

(1315yr) (n=5)

Others/certificate (n=4) 21.5 (2.9)

Referral agencies

Self-referral (n=14) 20.1 (3.2) 0.57 .63

Referred by others (n=37) 20.1 (3.9)

Directly referred by the 20.6 (4.7)

Department of Social

Welfare (n=29)

Referred by the enforcement 23.5 (0.7)

agency (n=2)

Table 3. Overview of the themes and subthemes

1. Contentment (Syukoor)

Subtheme 1.1: Semua ada (everything available)

Subtheme 1.2: HospitalitySubtheme 1.3: Health and safety

2. Acceptance (Redha)

Subtheme 2.1: Personal changes

Subtheme 2.2: Adjustments and adaptations


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community orientation services and smaller size type of care

like nursing homes, dominated recent literature.

This study attempted to identify the level of satisfaction

and the relationship between life satisfaction with sociodemo-

graphic characteristics of the elderly people (60 years and

above) and the elements that constitute the level of life satis-

faction. The statistical analysis shows that the duration living

in the institute weakly influences the SWLS scores. However,

one way between groups ANOVA indicated that there are no

significant differences in the life satisfaction as measured

with SWLS with other socio-demographic variables.

The SWLS scores indicated that there are no significant

differences with the norms of elderly people living in the com-

munity (20.24.1 and 22.417.74 respectively). According

to Swami and Chamorro-Premuzic (2009), this value is com-

mon amongst elderly people in the developing countries. The

majority of the people are satisfied in most areas of their life,

but they need to see an improvement in other areas (Diener

et al., 1985). Another possible reason for the value could be

predicted by looking at the base line demographic characteris-

tic of the participants, for example the reasons for admissions

and education level. Many of the participants come from low

economic background status, thus the opportunity to live in a

modest environment (which is better than previous living envi-

ronment) could contribute to the current level of life satisfac-

tion. The qualitative findings indicated that they are happy with

their life which is free from pressure of life, expectations and

obtaining free amenities. Happiness and life satisfaction is a

synonymous term and one of the important predictor for life

satisfaction for people in Asian countries (Jagodzinski, 2005),

thus this provides an important finding. To ensure life satis-

faction is achieved for elderly people who lived in the institu-

tion, the living environment in the institution should surpass

the previous living environment in the terms of the physical

infrastructure, hospitality and social connection.

Although the participants are disconnected from main-

stream society and have limited social connections (as a result

of the institutes regulations) as indicated in quantitative f ind-

ings, they, on average found life to be satisfying. This was hy-

pothesized as an effect of the self adjustment and adaptation,

in addition to the level of hospitality and relationship that shows

counter dependency or interdependency amongst the residents

and the relationship with the staff. For example, the partici-

pants volunteered to help the disabled elderly people and the

way they are addressed by the staff, which indicates respect

and closeness in Asian context. The elderly people in the insti-

tute were addressed in personal way such as mother, father,

uncle or auntie as indicated in qualitative findings. Pre-

vious literature indicated that the need for social gratification,

intimate relationships which involved mutual disclosure and

continues ties with familiar people had a great impact on moral

and life satisfaction for individuals who live in the institution

(Harel, 1981).

The harmonious reciprocal relationship between the resi-

dents and the staff facilitate the elderly people to thrive in the

institute (Bergland & Kirkevold, 2008; Jacelon, 1995). Fur-

thermore, the institute adopted an open policy, thus there is an

encouragement for the public and any organisation to visit the

centre, providing social visits or donations especially during

the festive seasons. Although the opportunity to socialise with

the community outside the institute is limited, it was compen-

sated by the intensity of the relationship among inmates and

the staff. Intensity of relationships was determined as one of

the variables that improve satisfaction with life for the Chinese

elderly people who live in the community (Silverman, Hecht, &

McMillan, 2000). Other variables that contribute to the life

satisfaction are social supports, active socialisation and en-

gagement in meaningful occupational activities (McGuinn &

Mosher-Ashley, 2000; Nimroad, 2007; Parker, 1996; Subasi &

Hayran, 2005; Yeung & Fung, 2007). Qualitative findings in-

dicated that there is a lack of opportunity for the residents to

engage in meaningful occupational activities due to the lack of

resources, the custodial elements and authoritarian type of care

that were shown through the rules and regulations imposed

on the residents. However, the f indings from this study indicated

that although they lack occupational opportunity, the partici-

pants are satisfied with life. Life satisfaction can be obtained as

a result of acceptance and contentment with the unavoidable

social and psychological changes and withdrawn from others

in the social system (Madigan, Mise, & Maynard, 1999).

Contentment is defined as the feeling of happiness and ease

with ones life situations which is synonymous with good life

(Carson, 1981). A degree of contentment is required to adjust

and adapt to a new environment (Clare, Rowlands, Bruce,

Surr, & Downs, 2008). The respondents indicated their content-

ment with the benefits obtained through indigenous words,

such as alhamdullilah orsyukoor. Both words have a religious

connotation. Syukoor is an Arabic word frequently used by

Malay Muslims to show gratitude and gratefulness towards God

who is providing a fortune, whilst alhamdullilah literally means

thank you God or all praise to God and it is similar to the

Hebrew word of Halelu Yah. Both words are frequently used

by Malay to indicate thankfulness and contentment with what

was given regardless of what it was. This indicated that the par-

ticipants are grateful and contented with the experience of living

in the institute which is further exemplified with moderate

level of satisfaction as measured by SWLS in spite of the limita-

tions in the institute. Feeling of contentment with life conditions



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was identified as one of the factors to perceived health status

amongst elderly people in spite of problem associated with

hearing, mobility, sleep and fear of fall (Lindgren, Svardsudd,

& Tibblin, 1994). However, being contented is not compatible

with having no desire to change or improve the life situations

which facilitate the highest level of potentials (Carson). The

findings indicated that the participants are contented but

describe their expectations to have the opportunity to perform

various occupations, exercising autonomy, independence and

various physiological expectations thus changing life situations.

The findings provide ideographic explanations and patterns

amongst the themes, thus a life satisfaction model for institu-

tionalised elderly people was developed as shown in Figure 1.

The model shows that connection between contentment with the

benefits obtained, feeling of safe and good relationship with

the staff. In addition, the life satisfaction was also contributed

by acceptance with the changes in life and ability to adjust

and adapt with the institutional environment.

Conclusion

This study has indicated that the elderly people who lived in the

institution could have a satisfaction with life in spite of con-

strains, occupation and social deprivation and improvised living

situations as a result of adjustment, acceptance and contentment

with current life. Occupational therapy could facilitate adjust-

ment and integrate or encourage acceptance and contentment to

facilitate life satisfaction through engagement in meaningful

activities and traditional occupational therapy techniques such

as the Life Review or the reminiscence therapy.

Acknowledgements

This study was not supported by any research grant and is a

small part of a PhD thesis entitled The Development and

Testing of Lively Later Life Programme (3LP) for institution-

alised elderly people.

References

Aminah, A. (1996). Work-family conflict among married professionals

women in Malaysia.Journal of Social Psychology, 136, 663665.

Arpita, C. (2000). Gender differences in socioeconomic returns to family

migration in Malaysia. The role of family decision making versus labour

market stratification. Gender Issues, 18(2), 2948.

Barbour, R. S. (1998). Mixing qualitative methods: Quality assurance or

qualitative quagmire? Qualitative Health Research, 8, 352361.

Bergland, A., & Kirkevold, M. (2006). Thriving in nursing homes in

Norway: Contributing aspects described by resident.International Journal

of Nursing Studies, 43, 681691.

Bergland, A., & Kirkevold, M. (2008). The significant of peer relation-

ship to thriving in nursing homes. Journal of Clinical Nursing, 17,

12951302.

Berglund, A. L. (2007). Satisfaction with caring and living conditions in

nursing homes: Views of elderly people persons, next of kin and staff

members.International Journal of Nursing Practice, 13, 4651.


Theme 1:

CONTENTMENT

(Syukoor)

Subtheme 3:

Health & safety

Subtheme 1:

Personal

changes

Subtheme 2:

Adjustment &

adaptation

Subtheme 1:Benefits

LIFE

SATISFACTION

Phenomena & strategies Consequences

Theme 2:

ACCEPTANCE

(Redha)

Subtheme 2:

Hospitality

Figure 1.Life satisfaction model for the institutionalised elderly people.


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Bowling, A., & Formby, J. (2002). Hospital and nursing home care for the

elderly people in an inner city health district.Nursing Times, 88(13), 5154.

Bradbury-Jones, C., Sambrook, A., & Irvine, F. (2009). The phenomenologi-

cal focus group: An oxymoron?Journal of Advanced Nursing, 63, 663671.

Brannen, J. (2005). Mixing method: The entry of qualitative and quantitative

approaches into research process.International Journal of Social Research

Methodology, 8, 173184.

Brooker, D. (2008). Editorial. What makes life worth living? Aging &

Mental Health, 12, 525 527.

Brown, C. (1995). Handling back power to elderly people in residential

institutions. Social Alternatives, 14(2), 2223.

Carson, T. L. (1981). Happiness, contentment and the good life. Pacific

Philosophical Quarterly, 68, 378392.

Chen, P. C. (1987). Psychological factors and health of the elderly people

Malaysian [Electronic version]. Annals of the Academic of Medicine,

Singapore, 16, 110114.

Cheng, S. H. (2003). The impact of urbanization on family structure: The

experience of Sarawak, Malaysia. SOJOURN: Journal of Social Issues in

Southeast Asia, 18, 3442.

Choi, N. G., Ransom, S., & Wyllie, R. J. (2008). Depression in older nursing

home residents: the influence of nursing home environmental stressors,

coping, and acceptance of group and individual therapy. Aging & Mental

Health 12, 536547.

Chou, K. L., & Chi, I. (1999). Determinants of life satisfaction among

Chinese elderly: A longitudinal study.Aging & Mental Health, 3, 328335.

Clare, L., Rowlands, J., Bruce, E., Surr, C., & Downs, M. (2008). The

experience of living with dementia in residential care: An interpretative

phenomenological analysis. The Gerontologist, 48, 711720.

Cohen, J. (1988). Statistical power analysis for the behavioural sciences

(2nd ed.). Hillsdale, NJ: Erlbaum.

Cowgill, D. O., & Holmes, L. D. (1972). Aging and modernisation.New York: Appleton Century-Crofts.

Creswell, J. W. (2003). Research design. Qualitative, quantitative and

mixed method approaches (2nd ed.). Thousand Oaks, CA: Sage.

Curtin, M., & Fossey, E. (2007). Appraising the trustworthiness of qualitative

studies: Guidelines for occupational therapists.Australian Occupational

Therapy Journal, 54, 8894.

Depaola, S. J., & Ebersole, P. (1995). Meaning in life categories of elderly

nursing home residents. International Journal of Aging & Human

Development, 40, 227236.

Department of Statistics Malaysia. (2008). Vital statistics. Retrieved January

10, 2008, from http://www.statistics.gov.my/portal/index.php

Diener, E., Emmonas, R. A., Larsen, R. J., & Griffin, S. (1985). The satis-faction with life scale.Journal of personality assessment, 49, 7175.

Dommenwerth, G. V., & Petersen, L. R. (1992). Institutionalisation and

well-being among the elderly. Sociological Inquiry, 62, 437449.

Fessman, N., & Lester, D. (2000). Loneliness and depression among elderly

people nursing home patients.International Journal of Ageing & Human

Development, 51, 137141.

Folstein, M. F., Folstein, F. E., & McHugh, P. R. (1975). Minimental

state. A practical method for grading the cognitive state of patients for

the clinician.Journal of Psychiatric Research, 12, 189198.

Harel, Z. (1981). Quality of care, congruence and well-being of institu-

tionalise age. Gerontologist, 21, 523531.

Heij, D. L., Hooglander, A., Kerling, R., & Velden, E. V. (2006). Context

effects in forward and backward word translation: Evidence for concept

mediation.Journal of Memory & Language, 35, 648665.

Hew, C. S. (2007). Like a chicken standing on one leg. Urbanization and

single mother. In: Hew, C. S. (Ed.), Village mothers, city daughters:

Women and urbanization in Sarawa (pp. 104119). Singapore: Institute

of Southeast Asian Studies.

Hjaltadottir, I., & Gustafsdottie, G. (2007). Quality of life in nursing homes:

Perception of physically frail elderly residents. Scandinavian Journal of

Caring Science, 21, 4855.

Hultell, D., & Gustavsson, J. P. (2008). A psychometric evaluation of the

Satisfaction with Life Scale in a Swedish national wide sample of university

students. Personality & Individual Differences, 44, 10701079.

Iwatsubo, Y., Derriennic, F., Cassou, B., & Poitrenaud, J. (1996). Predictors

of life satisfaction amongst retired people in Paris.International Journal

of Epidemiology, 25, 160170.

Jacelon, C. S. (1995). The effect of living in a nursing home on socialization

in the elderly people.Journal of Advanced Nursing, 22, 539546.

Jagodzinski, W. (2005). Structure and measurement of life satisfaction in

Asian countries: An exploratory analysis. Japanese Journal of PoliticalScience, 6, 287312.

Jamaiyah, H. & Hanafiah, M. S. (2006). Cataract prevalence amongst the

elderly people community of Rumah Sri Kenangan, Cheras. Journal of

Community Health (Malaysia), 12, 2326.

Jones, R. N., Marcantonio, E. R., & Rabinowitz, T. (2003). Prevalence

and correlates of recognised depression in U.S. nursing homes.Journal of

the American Geriatric Society, 51, 14041409.

Kim, S. Y., Jeon, E. Y., Sok, S. R., & Kim, K. B. (2006). Comparison of

health promoting behaviours of noninstitutionalized and institutionalized

older adults in Korea.Journal of Nursing Scholarship, 38, 3135.

Kim, O. S., Kim, S. S., Kim, K. O., Kim, Y. A., Kim, H. S., & Park, J. S.

(2005). The need about paying nursing homes for elderly people parents.

Journal of Korean Gerontology Nursing, 7, 2027.

Lee, D. T. F. (1997). Chinese elderly peoples perceptions of nursing

homes in Hong Kong.Journal of Clinical Nursing, 6, 333334.

Lindgren, A. M., Svardsudd, K., & Tibblin, G. (1994). Factors related to

perceived health among elderly people: The Albertina Project. Age &

Ageing, 23, 328333.

Madigan, M. J., Mise, D. H., & Maynard, M. (1999). Life satisfaction and

level of activity of male elderly people in institutional and community

setting.Activities, Adaptation & Aging, 21, 2135.

Martin, L. G. (1989). Living arrangement of the elderly in Fiji, Korea,

Malaysia and the Philippines [Electronic version]. Demography, 26,

627643.

McGuinn, K. K., & Mosher-Ashley, P. M. (2000). Participation in recre-

ational activities and its effect on perception of life satisfaction in resi-

dential settings.Activities, Adaptation & Aging, 25, 7787.

Melendez, J. C., Tomas, J. M., Oliver, A., & Navarrow, E. (2009).

Psychological and physical dimensions explaining life satisfaction among

the elderly people: A structural model examination.Archives of Gerontology

& Geriatrics, 48, 291295.

Ministry of Health. (2008). Malaysian health facts 2006. Retrieved

February 19, 2008, from http://www.moh.gov.my/v/stats_si

Morse, J. M. (2005). Editorial. Evolving trends in qualitative research:

Advances in mixed-method design. Qualitative Health Research,

15, 583585.



9/9


Mubarak, A. R. (1997). A comparative study on family, social supports

and mental health of rural and urban women [Electronic version]. The

Medial Journal of Malaysia, 52, 274284.

Ng, T. P., Lim, L. C. C. , Jin, A., & Shinfuku, N. (2005). Ethnic differences

in quality of life in adolescence among Chinese, Malay and Indian in

Singapore [Electronic version]. Quality of Life Research: An Inter-

national Journal of Quality of Life Aspect of Treatment, Care &

Rehabilitation, 14, 17551768.

Nimroad, G. (2007). Retirees leisure: Activities, benefits, and their con-

tribution to life satisfaction.Leisure Studies, 26, 6580.

Oksoo, K., Byeon, Y. S., Kim, J. H., Endo, E., Akahoshi, M., &

Ogasawara, H. (2009). Loneliness, depression and health status of the

institutionalized elderly people in Korea and Japan. Asian Nursing

Research, 3, 6370.

Onwuegbuzie, A. J., & Teddlie, C. (2003). A framework for analysing

data in mixed methods research. In A. Tashakkori & C. Teddlie (Eds.),

Handbook of mixed methods in social and behavioral research (pp.

351383). Thousand Oaks, CA: Sage.

Pala, J. (2005).Aliran Penuaan Penduduk di Malaysia (Siri Monograph

No.1). Kuala Lumpur: Department of Statistic Malaysia.

Parker, M. D. (1996) The relationship between time spent by older adults

in leisure activities and life satisfaction. Physical & Occupational

Therapy in Geriatrics, 14(3), 6171.

Pavot, W. G., Diener, E., Colvin, C. R., & Sandvik, E. (1991). Further val-

idation of the Satisfaction with Life Scale: Evidence for the cross-method

convergence of well-being measures.Journal of Personality Assessment,

57, 149161.

Sabariah, A. H., & Hanafiah, M. S. (2006). Depression among elderly peo-

ple in Rumah Sri Kenangan Cheng and Rumah Sri Kenangan, Seremban.

Journal of Community Health (Malaysia), 12, 4548.

Sandelowski, M. (1994). The use of quotes in qualitative research.

Research in Nursing & Health, 17, 479482.

Schulenberg, J. L. (2007). Analysing police decision-making: Assessing the

application of a mixed-method/mixed-model research design.International

Journal of Social Research Methodology, 10, 99119.

Selvaratnam, D. P., & Tin, P. B. (2007). Lifestyle of the elderly in rural and

urban Malaysia [Electronic version].Annals of the New York Academy of

Sciences, 1114, 317325.

Serina, M. S., Lekhraj, R., & Mustaqim, A. (2004). Physical and mental

health problems of the elderly people in a rural community of Sepang,

Selangor [Electronic version]. Malaysian Journal of Medical Sciences,

11, 5259.

Serina, M. S., Rampal, L., & Mustaqim, A. (2004). Cognitive impairment

among the elderly people in rural community in Malaysia [Electronic ver-

sion]. The Medical Journal of Malaysia, 59, 252257.

Sherina, M. S., Rampal, L., Hanim, M. A., & Thong, P. L. (2006). The

prevalence of depression among elderly people warded in tertiary care

centre in Wilayah Persekutuan.Medical Journal of Malaysia, 61, 1521.

Shin, F. J. (1998). Triangulation in nursing research: Issues of conceptualclarity and purpose.Journal of Advanced Nursing, 28, 631641.

Silverman, P., Hecht, L., & McMillan, J. D. (2000). Modelling life satisfac-

tion among the aged: A comparison of Chinese and American.Journal of

Cross-Cultural Gerontology, 15, 289305.

Sim, O. F. (2002) Ageing in Malaysia. A review of national policy and

programmes. In D. R. Phillips & A. C. M. Chan (Eds.)Ageing and long-

term care. National policies in the Asia-Pacific (pp. 107149). Singapore:

Institute of South Asian Studies. Retrieved April 23, 2009, from http://

www.idrc.ca/en/ev-28476-201-1-DO_TOPIC.html

Smith, J. A., Flowers, P., & Larkin, M. (2009).Interpretative phenomeno-

logical analysis: Theory, method and research. London: Sage.

Social Welfare Department. (2009). Pusat Jagaan Jabatan Kebajikan

Masyrakat, Malaysia. Retrieved May 21, 2009 from http://www.jkm.gov.my/jkm

Subasi, F., & Hayran, O. (2005). Evaluation of life satisfaction index of

the elderly people living in nursing homes. Archives of Gerontology &

Geriatrics, 41, 2329.

Swami, V., & Chamorro-Premuzic, J. (2009). Psychometric evaluation of

the Malay satisfaction with life scale. Social Indication Research, 92, 2533.

Tashakkori, A., & Teddlie, C. (1998). Mixed methodology combining

qualitative and quantitative approach. London: Sage.

Tashakkori, A., & Teddlie, C. (2003).Handbook of mixed methods in social

behaviour science. London: Sage.

World Health Organization. (2008). Process of translation and adaptation

of instruments. Retrieved May 21, 2008, from http://www.who.int/

substance_abuse/research_tools/translation/en/index.html

Yeoh, O. H. (1980). Malay psychiatric patients and traditional healers

(bomohs) [Electronic version]. The Medical Journal of Malaysia, 34,

349357.

Yesavage, J. A., Brink, T. L., Rose, T. L., Lum, O., Huang, V., & Adey, M.

(1983). Development and validation of a geriatric depression screening

scale: A preliminary report.Journal of Psychiatric Research, 17, 3749.

Yeung, G. T. Y., & Fung, H. H. (2007). Social support and life satisfaction

among Hong Kong Chinese older adults: Family first?European Journal

of Aging, 4, 219227.


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