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The mediating effect of expectations regarding aging between psychological resilience and quality of life in rural elderly

Archives of Public Health volume 82, Article number: 239 (2024) Cite this article

Abstract

Background

At present, China’s elderly population is facing several difficulties. The implementation of active aging is an important initiative in the face of the rapidly developing situation of population aging, among which improving elderly expectations regarding the aging level is the key link to achieving active aging. Improving the quality of life of the majority of elderly individuals is the main goal of active aging. Moreover, increasing the level of expectations regarding the aging of the elderly depends to a large extent on psychological resilience. However, most of the current research related to expectations regarding aging focuses on urban elderly individuals and pays less attention to the expectations regarding the aging level of rural elderly individuals. It is not yet known how quality of life, psychological resilience, and expectations regarding aging are related among rural elderly individuals. This study focused on the state of expectations regarding aging, psychological resilience, and quality of life among senior citizens living in rural areas, as well as the relationships among these three factors. The goal is to provide a theoretical basis for further targeted interventions and promote active aging in China.

Methods

A cross-sectional descriptive design was conducted via convenience sampling of 320 elderly individuals living in four rural areas of Panzhihua, China, from January to May 2024. Questionnaires were used to collect data on the participants’ demographic information, the aging expectancy scale (ERA-21), the 10-item Connor-Davidson Resilience Scale (CD-RISC-10), and a 12-item short-form health survey (SF-12). The data were analysed via SPSS version 26.0 software for descriptive statistics, one-way ANOVA, and Pearson’s correlation coefficient. In addition, AMOS version 24.0 software was employed for path analysis.

Results

The results revealed that Chinese rural elderly individuals have low expectations regarding aging, moderate levels of psychological resilience, and moderate levels of quality of life. There were positive relationships between expectations regarding aging and quality of life (r = 0.631, p < 0.01), positive relationships between expectations regarding aging and psychological resilience (r = 0.261, p < 0.01), and psychological resilience in terms of quality of life (r = 0.334, p < 0.01). Expectations regarding aging play a partial mediating role between psychological resilience and quality of life (β = 0.273, 95% CI, 0.185 ~ 0.381), with an indirect effect accounting for 45.81% of the total effect.

Conclusions

Expectations regarding aging play a partial mediating role in the relationship between psychological resilience and quality of life. These findings suggest that grassroots health workers should take an active role in providing health education and psychological counselling, as well as actively working to improve the psychological resilience and health of elderly individuals. They should also be encouraged to actively approach aging and to raise expectations regarding aging. Finally, they should help elderly people maintain a healthy lifestyle and improve their quality of life.

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Text box 1. Contributions to the literature

• Expectations regarding aging is the tangible manifestation of health beliefs around the issue of aging. The majority of China’s expectations regarding aging related research places less emphasis on the ERA level among the rural elderly.

• Strong psychological resilience positively impacts the quality of life of elderly individuals, as do their expectations of aging. Improving the majority of elderly individuals’ quality of life is the main goal of healthy aging.

• This study hypothesises that expectations regarding aging has a mediating role in the association between psychological resilience and quality of life among the rural elderly. Find ways to alleviate the aging problem.

Introduction

The number of elderly individuals is steadily increasing as the global population ages. China’s elderly population is currently facing several difficulties. By the end of 2020, there were 260 million senior citizens over the age of 60, or 18.7% of the total population. By 2050, China’s elderly population is expected to peak at 487 million, accounting for 34.9% of the country’s total population [1]. As life expectancy increases, elderly individuals strive for higher levels of mental health. However, as individuals age, their range of social relationships narrows, leading to the emergence of negative emotions through active or passive withdrawal from social groups, with adverse effects on physical and mental health. In the context of an aging population, encouraging the active participation of elderly individuals is necessary. China is at a critical stage of this demographic transition. In the face of the serious aging situation, the realisation and promotion of active aging has become a necessary way for China to cope with the rapid development of aging [2]. A key concept emerging from these efforts is active aging, which emphasises that elderly individuals should have the right to participate fully in society [3]. This includes providing them with equal and accessible opportunities to engage in various activities that improve their quality of life and emotional well-being.

As medical research teams have made progress in helping elderly individuals achieve healthy aging, it is important to understand the extent to which elderly individuals themselves expect to achieve and maintain high levels of physical and mental functioning, i.e., high aging expectancy. Expectations regarding aging (ERA) refer to the expected level of physical and mental functioning that elderly individuals should be able to maintain. In other words, it is the expected level of healthy aging and the tangible manifestation of health beliefs about aging [4]. Research has shown that ERA has a significant effect on elderly individual’s health promotion behaviours, beliefs about health service use and health prevention behaviours and is one of the key factors in enabling active and healthy aging in elderly individuals [5, 6]. The level of ERA reflects, to a large extent, the degree to which elderly individuals are active in their lives, particularly in terms of their participation in the life course [7]. Studies have shown that ERA levels are highly malleable, that elderly individuals with positive expectations of aging are more likely to participate in social activities, and that early intervention is beneficial in helping people view aging correctly and optimistically and ultimately experience the aging process successfully [8]. Research has confirmed that interventions to promote healthy behaviours in elderly individuals with low expectations of aging are not effective in improving their health and that only positive expectations of aging motivate them to actively adapt to aging to maximise the positive effects of healthy behaviours [9].

Compared with young people, elderly individuals are more likely to experience the impact of life events such as retirement, empty nesters, the death of family or friends, disability and illness, leading to emotional isolation and a decline in their social relationships. In positive psychology, resilience reflects an individual’s ability to recover from stress or challenges and adapt to changing environments [10, 11]. Improving the aging expectancy of elderly individuals is largely dependent on psychological resilience. An elderly individual’s ability to maintain mental health, cope with adversity and promote good aging is supported by their level of psychological resilience [12, 13]. According to the theoretical framework of resilience, an individual’s inability to cope with pressures or challenges in their environment can lead to negative consequences and maladjustment [14]. If stressors or life challenges are not balanced by protective processes from the external social environment or biopsychospiritual resilience factors within an individual, imbalances or disturbances in homeostasis may occur, resulting in reduced ERA levels.

Nearly two-thirds of Chinese elderly individuals live in rural areas [15]. In recent years, the health status of elderly individuals in rural China has received increasing attention because they face more serious health problems than their urban counterparts do. Previous studies have shown that elderly individuals in rural areas are more likely to be disabled, to have poorer self-rated health and to underuse health services than their urban counterparts are [16]. The disproportionately higher the prevalence of poverty is, the greater the degree of health deterioration [17]. Quality of life reflects the combined satisfaction of individuals across cultures and value systems with their own expectations, standards and related living conditions, and maintaining and improving quality of life is the ultimate goal of both individuals and societies [18]. Owing to uncomfortable living conditions and outdated attitudes, elderly people living in rural areas often experience mental and financial strain, which reduces their quality of life [19].

Research has shown that high levels of psychological resilience have a positive effect on elderly people’s quality of life [20], increasing their aspirations for old age and promoting healthy aging [21]. Improving the quality of life of most elderly individuals is the main goal of healthy aging [22]. At present, most ERA-related studies in China have focused on urban elderly individuals, and little attention has been given to the ERA levels of rural elderly individuals. Therefore, the present study investigated the ERA levels, psychological resilience levels, and quality of life status of rural older adults. Previous studies have suggested that ERA mediates the relationship between psychological resilience and quality of life in rural elderly individuals.

As a cross-sectional study, the primary goal of this research is to analyse the relationship between psychological resilience and rural elderly people’s quality of life, demonstrating the mediating role of this relationship in the association between psychological resilience and quality of life among rural elderly individuals. Therefore, this study introduces ERA into the analytical framework, aiming to comprehensively understand the path between psychological resilience and the quality of life of rural elderly people, focusing on the following questions: (1) Does psychological resilience positively affect the quality of life of rural elderly people? (2) Does ERA mediate this relationship? (3) If there is a mediating effect, how does ERA function in this relationship? To answer these research questions, this study employs structural equation models (SEM) and bootstrap mediation analysis, selecting Panzhihua districts in Sichuan as survey areas and analysing the questionnaire results of rural residents aged 60 and above. The aim of this study is to provide a reference for improving psychological resilience, increasing the level of ERA and improving the quality of life of rural elderly individuals.

Methods

Design and participants

This was a survey-based cross-sectional study that was conducted between January and May 2024. Eligible participants were aged 60 years or older and were selected via convenience sampling from four rural areas in Panzhihua city, China. The inclusion criteria were as follows: (1) age ≥ 60 years; (2) rural household registration, with ≥ 1 year of local residence; (3) informed consent and voluntary participation. The exclusion criteria were as follows: (1) severe mental illness and cognitive impairment; (2) severe visual and hearing impairment; (3) extreme weakness and severe physical illness.

Minimal sample size calculation

The sample size was calculated according to the formula for estimating the overall mean, N = (µ1−ɑ/2 σ/δ)2, where µ1−ɑ/2 is the µ value corresponding to the test level α, σ is the standard deviation, and δ is the allowable error. Taking α=0.05 and δ =0.15σ, the results of the pretest revealed that the standard deviation δ of the total score of the ERA scale was 5.26. According to this calculation, N = (1.96 * 5.26/0.61)2 =171; considering 20% invalid questionnaires, the sample size was estimated to be at least 205. A total of 320 participants were included in this study.

Procedure

The investigators will explain the importance and purpose of the survey to the rural elderly individuals who meet the inclusion criteria after comprehensive training that clarifies the content of the survey and the issues that need attention. Only after their consent is obtained will the questionnaire be distributed. The survey will be completed by the elderly themselves, with the help of a standardised guide that explains the procedures for completing the questionnaire and the issues that need to be addressed. The investigator reads the questionnaire and completes it at his or her discretion if the elderly person has difficulty answering the questions. The questionnaire must be distributed and collected immediately. The investigator must check the questionnaire thoroughly to ensure that all the correct and missing information is included. Respondents should be updated or amended as soon as possible if any information is incorrect or missing.

Ethical considerations

The present study complied with the Declaration of Helsinki. All the participants fully understood the study and voluntarily signed an informed consent form.

Measurements

Demographic characteristics

Demographic and medical characteristics Designed by the researcher himself after reviewing the relevant literature and consulting experts, the content included gender, age, education level, availability of a spouse, status of the child, residence situation, socioeconomic status, type of medical insurance, and history of chronic diseases and number of chronic diseases (the presence or absence of a chronic disease is based on the doctor’s diagnosis).

Expectations regarding the aging Scale-21 (ERA-21)

This scale was created by Sarkisian in 2002 [23] and has been Chineseised and validated for reliability by Cheng [24]. It consists of twenty-one items covering four subscales: physical health (7 items), mental health (6 items), cognitive function (4 items), and functional independence (4 items).

Items 9 and 18 are reverse scored. Each item was rated on a 4-point Likert-type scale with scores ranging from 1 to 4 for each question and an overall score ranging from 21 to 84. The higher the score is, the higher the individual’s level of ERA. The Cronbach’s alpha coefficient for this scale (Chinese version) was 0.944, the folded half reliability was 0.952, and the retest reliability was 0.936. In the present study, the Cronbach’s alpha was 0.884.

10-item Connor‒Davidson Resilience Scale (CD-RISC-10)

This scale was created by Connor in 2003 [25]. Campbell-Cells used a systematic technique to reanalyse the component structure of the scale in 2007 and created a simplified version with 10 entries [26]. The Wang Chinese version was used in this research [27]. The 10-item version is unidimensional and assesses similar components of resilience as the original scale, such as an individual’s ability to tolerate change, personal problems, illness, pressure, failure and painful feelings. Each item was rated on a 5-point Likert-type scale with scores ranging from 0 to 4 for each question and an overall score ranging from 0 to 40. The higher the score is, the greater the individual’s level of psychological resilience. The Cronbach’s alpha coefficient for this scale (Chinese version) was 0.91, and the retest reliability was 0.90. In the present study, the Cronbach’s alpha was 0.920.

Medical outcomes study 12-item short-form health survey (SF-12)

The SF-12 scale is a simplified version of the SF-36, a universal brief health-related quality of life scale developed by the Institute for Health Education in Boston, USA [28]. The Wang Chinese version was used in this research [29]. It consists of twelve items covering two subscales: the Mental Component Scale (MCS) and the Physical Component Scale (PCS), with 8 items per subscale. The scale was scored on a percentage basis, i.e., raw total scores were obtained for each dimension and then transformed to obtain standardised scores for each dimension via a standardised scoring method [30]. Each subscale had standardised scores ranging from 0 to 100 points. The higher the score is, the greater the individual’s level of quality of life. The Cronbach’s alpha coefficient for this scale (Chinese version) was 0.828, and the folded half reliability was 0.797. In the present study, the Cronbach’s alpha was 0.839.

Statistical analysis

This study was assessed for internal consistency, and Cronbach’s alpha values were recorded. Missing values represented less than 5% of the total data and were therefore not replaced. The data were double checked and entered into an Excel spreadsheet and statistically analysed via SPSS version 26.0 and AMOS version 24.0 software. The data were analysed in SPSS version 26.0 via parametric or nonparametric equivalent tests on the basis of the study variables and the normality of the data distribution. Descriptive and inferential statistics, including frequency, mean, independent samples t test, Pearson and Spearman correlation, and one-way analysis of variance (ANOVA), were used to test each research hypothesis. In addition, SEM were constructed for path analysis via AMOS version 24.0 software. The p value is two-tailed and is less than 0.05, indicating statistical significance.

The test shows that the data collected in this study are normally distributed and that the variables are linearly correlated. First, descriptive statistics such as frequencies, percentages, means and standard deviations were used to describe demographics and ERA, psychological resilience and quality of life. Second, one-way ANOVA was used to assess whether different categories differed in terms of ERA, psychological resilience and quality of life. Moreover, the relationships among ERA, psychological resilience and quality of life were examined via Pearson’s correlation.

AMOS 24.0 was used to map the model and explore the relationships and parameters between the variables of ERA, psychological resilience and quality of life. Maximum likelihood (ML) was used for parameter estimation, and the model was corrected and fitted via methods such as the correction index and the goodness-of-fit index to finally reach the fit criterion. In this study, a chi-square test and degrees of freedom (χ2/df), comparative fit index (CFI), adjusted goodness-of-fit index (AGFI), root mean square error of approximation (RMSEA), goodness-of-fit index (GFI), incremental fit index (IFI) and Tucker‒Lewis index (TLI) were used to measure the overall fit of the hypothetical model. The smaller the value of χ2/df is, the better the model fit; the smaller the RMSEA is, the better the model fit; and the GFI, TLI, CFI, and AGFI range from 0 to 1; the closer the values are to 1, the better the fit. Finally, this study calculated a 95% confidence interval (CI) for bias-corrected percentile bootstrapping across 5000 bootstrapped samples [31].

Results

Common method bias test

As this study used self-report scales, to address the issue of possible common method bias in the data, Harman’s one-way test was used to further improve the rigour of this study. The results revealed a total of eight factors with eigenvalues greater than 1. The amount of variance explained by the first factor was 25.120%, which is less than the critical criterion of 40%; therefore, there is no serious common method bias in the data in this study.

Demographic characteristics

Among the 325 questionnaires distributed, 320 were returned for data entry, resulting in a response rate of 98.46%. Table 1 summarises the sociodemographic characteristics of the participants. Among the 320 respondents in this study, the mean age of the patients was 68.62 (SD = 7.26) years. There were 42.50% males and 57.50% females, 63.44% had a primary school education or less, 75.00% had spouses, 35.31% had 3 or more children, 67.19% lived alone, 41.25% felt their economic situation was somewhat difficult, 75.63% were covered by urban and rural residents’ health insurance, and 69.69% had a history of 1 or more chronic diseases.

The results of the one-way ANOVA revealed statistically significant differences in the ERA scores of rural elderly individuals compared by gender, educational level, socioeconomic status, and type of medical insurance (p < 0.05). Statistically significant differences in the psychological resilience scores of rural elderly individuals were found according to the availability of a spouse, socioeconomic status, type of medical insurance, and number of chronic diseases. Statistically significant differences in the quality-of-life scores of rural elderly people compared by the availability of a spouse, one’s own socioeconomic status, type of medical insurance, and number of chronic diseases were detected.

Table 1 The participants’ general demographics and characteristics (n = 320)
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ERA, psychological resilience and quality of life scores in the rural elderly

The total and mean scores for each variable are shown in Table 2. The mean ERA score of the rural elderly was 45.96 (SD = 9.11), and the highest subdomain score for mental health was 14.80 (SD = 3.09). The mean psychological resilience score was 22.67 (SD = 7.20). The mean quality of life score was 50.96 (SD = 9.56), and the highest subdomain score for the MCS was 51.95 (SD = 8.21).

Table 2 Score of ERA, psychological resilience and quality of life (\(\bar x\) n = 320)
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Correlation analysis of ERA, psychological resilience and quality of life in the rural elderly

The results of the correlation analysis between the variables are presented in Table 3. Correlation analysis revealed positive relationships between ERA and quality of life (r = 0.631, p < 0.01), positive relationships between ERA and psychological resilience (r = 0.261, p < 0.01), and positive relationships between ERA and psychological resilience and quality of life (r = 0.334, p < 0.01).

Table 3 Correlation Analysis of ERA, psychological resilience and quality of life in Rural Elderly (r, n = 320)
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The mediating effect of ERA on the relationship between psychological resilience and quality of life in the rural elderly

On the basis of the research hypotheses, an initial model was developed via AMOS version software with quality of life as the dependent variable, psychological resilience as the independent variable and ERA as the mediating variable. The model was parsimonious, and the variables followed a normal distribution. To make the model more reflective of the actual situation, ML correction was used to adjust and improve the model.

The model is corrected according to the correction index, if a covariance relationship is established between the incremental error values e4 and e5, i.e., if the relationship between these two variables is released and the covariance parameter is set as a free parameter, the chi-square value can be reduced by 20.021. On the basis of the correlation analyses of the previous studies and the present study [32], both the phrases “I am stronger because of the trials I have gone through” and “I recovered easily after illness, injury or suffering” fall into the category of people who are stronger after going through trials and tribulations, and there is a correlation between the two, hence the addition of the path. The optimised model is shown in Fig. 1. The model fit indices were χ2 = 210.302, χ2/df = 2.013, CFI = 0.959, GFI = 0.927, AGFI = 0.900, TLI = 0.950, IFI = 0.959, and RMSEA = 0.056, which indicated that the model could be successfully established.

All direct effects in Fig. 1 were significant. From the perspective of direct impact, psychological resilience positively predicts quality of life (β = 0.323, P < 0.01), psychological resilience positively predicts ERA (β = 0.424, P < 0.01), and ERA positively predicts quality of life (β = 0.644, P < 0.01).

The bootstrap mediation effect analysis method was used to test whether there was a mediating effect, as shown in Fig. 1. The direct effect (psychological resilience - quality of life) (β = 0.323, P < 0.01, 95% CI [0.179, 0.473], 54.19%), indirect effect (psychological resilience - ERA - quality of life) (β = 0.273, P < 0.01, 95% CI [0.185, 0.381], 45.81%), and total effect (β = 0.596, P < 0.01, 95% CI [0.472, 0.709]) indicated that ERA has a significant partial mediating effect between psychological resilience and quality of life (Table 4).

Table 4 Bootstrap mediation effect test (standardised)
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Fig. 1
figure 1

Model of the mediating effect of ERA on the relationship between psychological resilience and quality of life in the rural elderly

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Discussion

ERA reflects older people’s expectations of how much they will decline as they age [33]. In this study, the ERA score for rural older adults was 45.96 (SD = 9.11), which was lower than the mean total scale score of 52.5. The results of this study were lower than those of the Chen study [34], which may be due to the different sources of the study subjects. The subjects in this study were from rural areas, where the living environment, medical services and social security are quite different from those in the community, and 61.25% of the elderly in this study were not in a favourable financial situation and had a more difficult life, all of which affected the level of ERA of the rural elderly to some extent. Yang [35] studied rural empty elderly individuals, who have lower expectations of aging than those in this study do because they do not live with their relatives and have lower levels of family and social care than the average elderly person does. For the elderly themselves, the most intuitive sense of aging is a decline in physical health, including slowness of movement, memory loss and physical discomfort. Rural elderly people tend to have a stereotypical view of aging, seeing declining health and illness as inevitable phenomena of aging [36] and feeling powerless in the face of aging, so their level of expectation of aging is lower than that of this study. Among the four dimensions of ERA, the mental health dimension scored the highest, and the physical health dimension scored the lowest, which is consistent with the findings of Zhao [37]. Mental health refers to the extent to which elderly individuals are expected to have reduced levels of psychosocial and socialisation that reflect psychosocial well-being. In this study, 32.81% of the rural elderly lived with their relatives, had better relationships with their children, and interacted closely with their neighbours, and their social level tended to be stable, with less loneliness and depression among elderly individuals, which may explain the higher scores on this dimension. Physical health refers to the extent to which elderly individuals are expected to lose physical function as they age. Because medical conditions in rural areas are poorer than those in urban areas and because most rural elderly individuals are less aware of health management, most rural elderly individuals suffer from a decline in physical function, multiple chronic diseases and lower scores on the physical health dimension. The results of one-way ANOVA revealed that rural elderly individuals who were female and had low education levels, financial difficulties and self-funded medical care had low levels of ERA. Therefore, healthcare professionals should pay more attention to rural elderly individuals who are female, have low education, financial difficulties and self-funded medical care, provide them with more social security, improve their sense of well-being, advocate the concepts of active aging and proactive health seeking, and help rural elderly individuals establish a scientific concept of aging to further improve the level of ERA.

The psychological resilience of elderly individuals is a stable and positive psychological quality that enables them to actively use internal and external resources to adapt to the environment under adverse conditions such as stress or hardship [32]. This study revealed that the psychological resilience score of the rural elderly individuals was 22.67 (SD = 7.20), which was at a medium level compared with the middle range of the total score of the scale of 20. Chen’s [38] study subjects were COPD elderly individuals in Jiangsu Province, China, which has a more advanced geriatric security system, a greater evaluation of their own physiology and spirituality, and much help from the outside world in the face of adversity; thus, the level of psychological resilience of the elderly population was greater than that in this study. The level of psychological resilience of the elderly was greater than that in the present study. The results of one-way ANOVA revealed statistically significant differences in the psychological resilience scores of the rural elderly compared with those of the control group in terms of the availability of a spouse, their own socioeconomic status, type of medical insurance, number of chronic diseases, and degree of psychological resilience among the rural elderly who have a spouse, are financially well off, are insured by urban workers and are not chronically ill. Compared with those without a spouse, those with a spouse receive more external emotional support, have more channels for spiritual comfort and have their mental health needs met, so they have higher levels of psychological resilience. In addition, financial income positively predicts the psychological resilience of elderly individuals [39]. Elderly people with financial difficulties whose livelihoods are provided mainly by their children or who rely solely on their own labour often worry about their own retirement security, have lower levels of satisfaction with life and are prone to negative emotions, such as anxiety and depression, which have a significant impact on the physical and mental health of the individual. In addition, a number of diseases are associated with a lower quality of life, which can lead to a loss of independence, social isolation and greater demands on family members as caregivers [40]. Therefore, the government should vigorously improve the rural elderly security mechanism and maximise the provision of basic economic security for the rural elderly. Healthcare personnel can focus on elderly individuals without spouses, those with financial difficulties and suffering from chronic diseases and, by encouraging the expression of emotions and improving interpersonal and group interactions [41], can enable elderly individuals to actively mobilise their psychological resources; reduce their level of depression, anxiety and loneliness; and promote the psychological health of elderly individuals, thereby improving their psychological resilience.

As the world’s population ages, the health of elderly individuals has become a common concern of the global community. Quality of life is an important indicator of the physical and mental health of elderly individuals and is influenced by multiple dimensions [42]. The quality of life score of the rural elderly individuals in this study was 50.96 (SD = 9.56), which was at a medium level compared with the midpoint of the scale total score of 50, lower than the results of Wang’s [43] survey on the quality of life of the elderly population in townships of three different cities and lower than the results of Xie’s [44] survey in the elderly service centre of Anhui Province, which may be related to the fact that the pension security in the survey area of this study was lower than that of the other studies. This may be related to the fact that the pension security in the region surveyed in this study is lower than that in other studies.

In this study, the MSC dimension scores were higher than the PSC dimension scores, i.e., mental functioning was greater than physical functioning in rural elderly individuals, which is consistent with the results of the Chengdu norm in China [45] and is related to the fact that most of the rural elderly individuals in this study were farmers who had more physical illnesses due to long hours of work and low attention to their own health. Consistent with the results of the one-way analysis of psychological resilience, differences in quality of life scores for rural elderly individuals by marital status, socioeconomic status, type of medical insurance, and number of chronic diseases were statistically significant. The quality of life of the rural elderly is greater among those who are accompanied by their spouses, are financially well off and have health insurance for urban workers. This may be related to the fact that elderly individuals with one chronic condition are more focused on healthy living and physical and mental health than those with no conditions are and that elderly individuals with multiple chronic conditions are at increased risk of adverse health outcomes, including reduced physical and cognitive function, poor quality of life, and poorer quality of life [46], due to increased health care use. Therefore, the government should improve the grassroots health care system to provide adequate medical and health care for the elderly in rural areas. Grassroots health care personnel should make full use of pictures, models, slides, videos and other intuitive ways of communicating about health and combine them with a variety of forms to carry out health education activities, expand the content and scope of health education, improve the health management model of the elderly in rural areas, and improve the quality of life of the elderly in rural areas.

The results of the correlation analysis revealed that psychological elasticity and quality of life were positively correlated (r = 0.323, P < 0.01), indicating that the higher the level of psychological elasticity of the rural elderly is, the greater the quality of life is, which is similar to the results of the study by Lima [47]. The results of the path analysis revealed that psychological elasticity has a direct positive effect on the quality of life of the rural elderly, and the effect value is the largest, which is an important factor affecting the quality of life of the rural elderly. In essence, even if elderly individuals remain physically healthy as they age, there is always the possibility that they may experience a period of functional decline that affects their quality of life to some extent [48]. A high level of psychological resilience is a protective factor in elderly people’s quality of life. Psychological resilience has a stress-buffering effect and can improve quality of life by reducing the physical and psychological stress caused by life events and increasing confidence in managing health [49]. Some studies have shown that laughter therapy can effectively reduce levels of depression, anxiety and loneliness in elderly individuals, promote their mental health, improve their interpersonal and group interactions, and ultimately improve their quality of life [50].

The results of the correlation analysis revealed that ERA was positively correlated with quality of life in rural elderly individuals (r = 0.553, P < 0.01), i.e., the higher the level of ERA was, the better the quality of life was, which is consistent with the results of the Breda [51] study. The results of the path analysis revealed that ERA had a direct positive effect on the quality of life of the rural elderly. The reasons for this can be that the living conditions in rural areas are different from those in urban areas, where social resources and social support, etc., are insufficient or not fully used. Most rural elderly people have lower incomes, and some still face basic survival problems, which, together with the financial burden of chronic diseases, increase the physical and mental stress of the rural elderly and consequently reduce the ERA of the rural elderly. As they grow older and their physical functions deteriorate, elderly people’s attitudes towards aging become particularly important. The greater the expectation of active aging is, the more likely it will encourage elderly people to maintain a healthy lifestyle, remain active in their daily lives in old age, pay close attention to their physical and mental health, maintain good social and emotional function, and ultimately improve their overall quality of life.

The results of the path analysis revealed that ERA partially mediated the relationship between psychological resilience and quality of life among rural elderly individuals (β = 0.273, P < 0.001), and the mediating effect accounted for 45.81% of the total effect, suggesting that elderly individuals with higher levels of psychological resilience also tend to have better quality of life conditions when faced with negative events in their lives. The direct effect of ERA on the quality of life of rural elderly individuals is to reinforce the concept of positive aging among elderly individuals, thereby promoting the practice of proactive health-seeking behavior among elderly individuals. The mediating effect of ERA on psychological resilience and quality of life among rural elderly individuals may be that elderly individuals with higher levels of psychological resilience tend to be full of expectations for life, actively pay attention to their own health, and are more independent, which leads to higher levels of ERA and that elderly individuals with high levels of ERA have better psychological regulation, can actively face difficulties in life, pay attention to their own development, and have higher levels of life satisfaction. Their life satisfaction is also high, so they can take the initiative to improve their quality of life. In view of this, medical personnel should organise and establish volunteer teams to establish health records for rural elderly individuals, conduct regular screenings of their psychological conditions, and provide targeted interventions for elderly individuals with low psychological resilience. Moreover, publicity and education on active aging should be strengthened to proactively understand the unmet needs of elderly individuals, help them establish a correct perception of aging, eliminate negative psychology, improve their quality of life, and ultimately achieve active aging.

Limitations

This study has several limitations. First, owing to time and condition constraints, in this study, only elderly individuals in four rural areas of a town in Panzhihua, Sichuan Province, China, were selected for the study; thus, the sample was limited in its representativeness. Second, this was a cross-sectional study and did not provide a good understanding of the dynamic changes in the variables related to ERA, psychological resilience, and quality of life among the rural elderly. In the future, the scope of the study can be expanded, and a longitudinal study can be conducted to improve the reliability of the findings.

Conclusions

The results show that Chinese rural elderly individuals have low levels of expectations regarding aging, medium levels of psychological resilience, and medium levels of quality of life. Psychological resilience positively affects rural elderly people’s quality of life. ERA mediates this relationship. Expectations regarding aging play a partial mediating role in the relationship between psychological resilience and quality of life. These findings suggest that grassroots health workers should take an active role in providing health education and psychological counselling, as well as actively working to improve the psychological resilience and health of elderly individuals. They should also be encouraged to actively approach aging and to raise expectations regarding aging. Finally, they should help elderly people maintain a healthy lifestyle and improve their quality of life.

Data availability

No datasets were generated or analysed during the current study.

Abbreviations

ERA:

Expectations Regarding Aging

SEM:

Structural Equation Models

MCS:

Mental Component Scale

PCS:

Physical Component Scale

ERA-21:

Expectations Regarding Aging Scale-21

CD-RISC-10:

10 item Connor-Davidson psychological resilience Scale

SF-12:

Medical outcomes study 12-item short-form health survey

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Acknowledgements

The authors would like to thank all participants and those who helped in this Project.

Funding

This study was supported by the 2024 Gerontological Society Project of Sichuan (NO.24SCLN0149).

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Authors and Affiliations

  1. Panzhihua Central Hospital, Panzhihua, China

    Haojie Zeng, Chen Zhang, Meiying Shen & Zeyu Zhang

  2. North Sichuan Medical College, Nanchong, China

    Yunfan Liu

  3. Panzhihua Steel Group General Hospital, Panzhihua, China

    Xia Zhang

Authors
  1. Haojie Zeng
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  4. Xia Zhang
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Contributions

HJZ and CZ designed the study; YFL, ZYZ, and XZ collected the data; HJZ and XZ drafted the manuscript; HJZ and YFL performed the analysis and interpreted the results; CZ and MYS assisted in drafting and revising the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Chen Zhang.

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Ethics approval and consent to participate

Ethics approval and consent to participate the proposal of this research was approved by the Ethics Committee of Panzhihua Central of Hospital in China with the code IR.2024-043. Written informed consent was obtained from all participants after the objectives of the study were explained by the first author. Informed consent procedures were approved by the above institutional ethics committees. All procedures were performed in accordance with the relevant guidelines and regulations (Declaration of Helsinki). Not applicable. This study adhered to the Declaration of Helsinki. The purpose of the study was explained to all participants before the survey was conducted, and informed consent was obtained.

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Not applicable.

Competing interests

The authors declare no competing interests.

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Zeng, H., Liu, Y., Zhang, C. et al. The mediating effect of expectations regarding aging between psychological resilience and quality of life in rural elderly. Arch Public Health 82, 239 (2024). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s13690-024-01470-7

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Keywords

Archives of Public Health

ISSN: 2049-3258