Development And Application Of The Sources Of Meaning Scale For The Elderly

1 BackgroundData from the National Bureau of Statistics and the government work report in 2019 show that China's aging population has reached 250 million,accounting for 17.9%of the country's total population.The elderly were incapacitated due to weakness and disease,and are prone to negative emotions such as loneliness and depression,and even suicide.According to the blue book of aging:survey report on the living conditions of China's urban and rural older persons(2018),4.2%of China's urban and rural elderly were disabled and 6.3%often feel lonely.The study showed that the frailty rate of elderly in China ranges from 10.3%to 17.2%,and the depression rate ranges from 10.8%to 36.8%.The elderly account for 36%of the annual suicide population in China.More than 100,000 elderly died of suicide every year,and most of them are secondary to depression.Finding the meaning in life is one of the important research contents of positive psychology,which is helpful to relieve negative emotions and improve individual subjective well-being.Meaning of life has been extensively studied since its first proposed by professor Frankl,an Austrian-American psychiatrist.Research indicated meaning in life is a multidimensional concept with specific sources.Some scholars have developed the sources of meaning in life scale.But mostly used for college students and the general population.Most of the researches on the meaning in life in China focused on college students.Some scholars have also conducted researches on the meaning in life of elderly.Most of them are baseline surveys of the sense of meaning in life.The researches showed that sense of meaning in life of elderly in China is low and the sense of meaning in life has direct and indirect influence on successful aging.According to professor Frankl's meaning therapy,identifying the sources of an individual's meaning is crucial to improving their meaning in life.But there was no sources of meaning in life scale for the elderly according to literature review.Therefore,it is necessary to develop a scale suitable for community medical staff to quickly judge the level and sources of meaning in life of the elderly,and preliminarily explore the sources,level and influencing factors of meaning of life of the elderly in Guangzhou.2 ObjectiveTo explore the structure of the sources of meaning of the elderly,and based on literature research and qualitative interviews,we developed the Sources of Meaning Scale for the Elderly(SMSE)with good reliability and validity.This scale was used to explore the sources,levels and influencing factors of the meaning in life of the elderly,and constructed a structural equation model.3 Methods3.1 Qualitative researchA total of 21 elderly were investigated by using the phenomenological research method in the outpatient department of a community health service center in Yuexiu district and a nursing home in Baiyun district in Guangzhou,China.Semi-structured in-depth interviews were conducted,and the interview data were analyzed with Nvivo 11 to explore the sources and experiences of meaning in life of the elderly and analyze the relevant factors affecting life meaning.3.2 Cross-sectional surveyAn items pool of sources of meaning scale for the elderly was formed by combining the preliminary qualitative interview and literature research,and experts were invited to evaluate the items pool.A cross-sectional survey of 627 elderly people was conducted in 2 community health service centers,2 hospitals and 2 nursing homes in Guangzhou by convenient sampling method.Inclusion criteria:permanent residents in Guangzhou;Age 60.Exclusion criteria:a clearly diagnosed mental illness;Severe physical diseases(including advanced cancer,decompensation of cardiac,hepatic and renal functions)with definite diagnosis;Questionnaire respondents were rejected.Through retest reliability,internal consistency reliability,Combination reliability,structure validity,discriminant validity and acceptability evaluation scale of the elderly,the sources of meaning scale for elderls with 6 dimensions and 28 items was finally formed.After that,the convenience sampling method was used to investigate the status quo of the life meaning source of the elderly in Guangzhou,and the structural equation model was established to explore the relationship and action path among the life meaning source,family care,depression and quality of life.4 Results4.1 Qualitative research on the sources and experience of meaning in life of the elderlyThe Chinese elderly in the community were less concerned about meaning in life.The sense of meaning in the elderly's life is meaningful,meaningless and unexplored,with the level ranged from null to extremely high.The sources of meaning included suffering,autonomy,family,sense of value and faith.4.2 Reliability and validity of the sources of meaning scale for elderly among the elderly in Guangzhou,ChinaCombined with qualitative interview results and literature research,a 43-item item pool of the sources of meaning scale for the elderly was formed,including eight dimensions which were health autonomy,family,personal experience,personal development,social support,sense of value,leisure activities and life security.After project analysis and factor analysis,the SMSE scale with six dimensions and 28 items was finally formed.Likert 7 score was used in the scale,with a total score of 28 to 196.The higher the score,the higher the sense of meaning in life experienced from the source.Six dimensions respectively containing family(4 items,reflected the satisfaction of family life and dreams of the future development for future generations of the elderly),social support(4 items,reflected the support from family and friends,which can make the elderly experience love and care from others),value(7 items,reflected the sense of being respected,needed and meaningful in contribute to family,society or country,or found the value and meaning of their own existence from their existing contributions),life safeguard(4 items,reflected the material,medical and other aspects of security,so that the elderly can spend their twilight years,so as to experience the sense of meaning),and personal development(4 items,reflected that the elderly in their leisure time to participate in a series of activities for the purpose of improving their level of knowledge,cultural accomplishment and so on,these activities give the elderly a certain sense of achievement,allowing them to experience meaning),the leisure activity(5 items,reflected the activities that the elderly participate in in their daily life to enrich their leisure life,and these activities bring the elderly a sense of fulfillment,so that they can experience the meaning),explaining 62.16%variance variation in total.Confirmatory factor analysis model fitting index were x2= 694.652,df= 330,X2/df= 2.105,SRMR = 0.0695,GFI = 0.853,IFI = 0.905,TLI = 0.889,CFI=0.903,RMSEA = 0.062.The Cronbach's a coefficient of the scale was 0.924,and the Cronbach's a coefficient of each dimension was between 0.727 and 0.870.The ICC of the scale was 0.856.4.3 Investigation on the score of sources of meaning scale and related influencing factors among the elderly in Guangzhou,ChinaThe score of the sources of meaning scale for elderly in Guangzhou was 166(147,179),which was at a high level.And the scores of each dimension were life security 26(24,28),family 25(22,28),sense of value 43(38,47),social support 24(19,26),leisure activity 29(24,32),personal development 22(17,26).The scores of all dimensions of the scale are consistent with Maslow's hierarchy of basic needs,indicating that the meaning in life of the elderly first comes from the satisfaction of physiological needs and security guarantee.Under this premise,the elderly will gradually seek higher life meaning such as love,belonging and self-realization.The health score was 70(60,80),the quality of life index was 0.796(0.691?1.000),the family care index was 9(7,10),and the depression scale score was 4(1,8).The results of the regression analysis showed that there were statistically significant differences in the elderly's depression,monthly income,religious belief or not,degree of optimism,and degree of family care index on the sources of ieaning(R2=0.325).4.4 The interaction path among sources of meaning,family care index,depression and quality of life of the elderlyThe results of structural equation model showed that family care index affected the health score and depression score through affecting the meaning of life,and the depression score also has a significant negative impact on the health score(P<0.05).The structural equation model fitted well(X2/df=3.300,SRMR=0.0291,GFI=0.975,IFI=0.971,TLI=0.952,CFI=0.971,RMSEA=0.062).5 Conclusions5.1 The experience of meaning in life of the elderly is complex,which included positive experience brought by health,family harmony and growth after suffering,as well as negative experience caused by disease,loneliness and powerlessness towards aging.The intensity of meaning in life for the elderly ranged from null to high.5.2 SMSE scale has good reliability and validity,which can be used to evaluate the sources of meaning and meaning in life of the elderly.5.3 The influence factors of meaning in life for the elderly were relatively much more.The sense of meaning in life was higher in the elderly,and the influencing factors included depression level,monthly income,personality of the elderly,family care index,and religious belief.The elderly with low depression,high monthly income,optimistic personality,high level of family care index and religious belief were more likely to experience meaning of life.5.4 Meaning in life affected depression and life quality as an intermediate in the elderly.We can use the SMSE to clarify the sources of meaning and measure the levels of meaning in life quickly.The sense of meaning of the elderly can be promoted from the individuals,families and society by identifying the sources in the future to promote mental health in the elderly,help them to achieve successful aging.