Research in Gerontological Nursing

Empirical Research 

Happiness Strategies for Older Adults: A Qualitative Study

Mansoureh Ashghali Farahani, PhD, MSN; Safoura Dorri, PhD, MSN; Naiemeh Seyedfatemi, PhD, MSN

Abstract

Ensuring happiness in older adults is critical for their mental health. The purpose of the current study was to identify strategies for creating happiness in Iranian older adults. A qualitative study was performed through content analysis and deep semi-structured interviews with 18 adults age 60 and older and one family member. Participants were selected through purposeful sampling, and data were encoded using MAXQDA. Data analyses revealed 187 codes, 23 subcategories, and four main categories: (a) self-centered strategies, (b) inductive strategies, (c) passive strategies, and (d) unselfish strategies. Following the four categories of strategies may lead to happiness in Iranian older adults. Self-centered strategies seemed to achieve better results given that such strategies can be learned and require involvement of older adults themselves. [Research in Gerontological Nursing, 13(5), 254–263.]

Abstract

Ensuring happiness in older adults is critical for their mental health. The purpose of the current study was to identify strategies for creating happiness in Iranian older adults. A qualitative study was performed through content analysis and deep semi-structured interviews with 18 adults age 60 and older and one family member. Participants were selected through purposeful sampling, and data were encoded using MAXQDA. Data analyses revealed 187 codes, 23 subcategories, and four main categories: (a) self-centered strategies, (b) inductive strategies, (c) passive strategies, and (d) unselfish strategies. Following the four categories of strategies may lead to happiness in Iranian older adults. Self-centered strategies seemed to achieve better results given that such strategies can be learned and require involvement of older adults themselves. [Research in Gerontological Nursing, 13(5), 254–263.]

Happiness is one variable of subjective well-being, which is a set of factors including satisfaction with life, positive emotion, and lack of negative emotion (Helliwell et al., 2013). Happiness has substantial effects on psychological and physical health. According to studies, happiness leads to more life satisfaction and less rumination (Eldeleklioglu, 2015), less anxiety and depression (Khayeri et al., 2016), and can protect against the effects of stress (Manderscheid & Kobau, 2017). Happiness improves sleep habits and practices that are important for concentration, performance, and productivity (Ong et al., 2017). Other studies have suggested that happiness may reduce the risk of stroke and frailty in older adults (Ostir et al., 2001; Ostir et al., 2004). In addition, happiness can reduce pain and knee stiffness and improve arthritis (White et al., 2012). A study comprising 4,478 older adults in Singapore has shown that happiness is associated with increased life expectancy—with each unit increase in happiness score, the mortality rate was reduced by 9% (Chei et al., 2018). Another study of Chilean older adults found that happiness was associated with life satisfaction, nutrition, and health (Lobos et al., 2016). Therefore, happiness is important in aging.

According to the World Happiness Report (Helliwell et al., 2018), Iran ranked 106 of 156, which is lower than some of the less secure countries in the region, such as Palestine and Pakistan. The reasons for this situation in terms of the indicators under consideration are that Iran is not in a good position in regard to social support, freedom to make life choices, and corruption, and these factors have caused Iran to be ranked lower in terms of happiness (Helliwell et al., 2018). Happiness, on the other hand, has a direct relationship with Gross Domestic Product and economic growth and an inverse relationship with poverty and economic inflation rate (Helliwell et al., 2018; Strotmann & Volkert, 2018). Over the past 1 year, Iran has faced international sanctions and a sharp decline in revenue due to the breakthrough nuclear deal; therefore, the economic pressure on the people and the increase in poverty have made happiness ranking worse. Thus, it is imperative to delve deeper into the concept of happiness in Iranians given the unique demographic and cultural specifications of the country.

An increase in the aged population in Iran is a recent demographic change in this country. Between 1967 and 2011 (45 years), the population of older adults in Iran increased four-fold. Official estimates show that at this rate, the population of older adults will increase three-fold between 2007 and 2027 and reach 15.5 million (Afshar et al., 2016). In light of this increase, it is important for Iran's health sector to consider happiness as a variable of subjective well-being for the growing population of older adults.

According to Montazeri et al. (2012), happiness score decreases by 1% with each year increase in age in Iran. Therefore, happiness in Iranian older adults seems to be lower than that in other age groups. A study on Iranian older adults by Molashahri et al. (2015) reported a low level of happiness. Other studies in different cities of Iran reported happiness, based on the Oxford Happiness Questionnaire, in older adults ranged from 32 to 39.9 (Javadi et al., 2018; Parvaneh et al., 2015), which is considered low. A study in Korea reported a moderate level of happiness among older adults (Jeon et al., 2016). In Thailand, the level of happiness among older adults was moderate, and social support and family relationships were directly associated with happiness (Nanthamongkolchai et al., 2009). The results of another study in Uruguay showed that happiness is higher in healthy, married, and high-income older adults (Cid et al., 2018).

Old age is accompanied by development of chronic disease, degenerative conditions, depression, and diseases that need health services and care (Volkert et al., 2013). These conditions affect happiness in older adults. For example, depression can affect happiness, and a higher depression score negatively impacts happiness among older adults (Jeon et al., 2016). To address these issues, older adults need community support in addition to personal resources (Iranian National Council of Elderly, 2017).

Factors such as child marriage or the need for parental care can affect family structure and complicate family relationships (Centre for Policy on Ageing [CPA], 2014). Economy is another important factor throughout the life course that can affect older adults' lives. These factors can lead to greater diversity in well-being and lower average well-being among older adults (Uhlenberg, 2007). The impact of these factors on well-being in different societies, however, varies due to cultural differences and the challenges facing rich and poor governments (Institute for Futures Studies in Health, 2018).

In Iran, it is essential to ensure happiness and a pleasant senescence period for the growing older adult population who are considered an important national asset given their valuable experiences. Thus, the following study question was posed: What strategies can make Iranian older adults happy from their own perspective? To answer this question, the current study was conducted using a qualitative approach, as qualitative research is best for determining relationships and perspectives and leads to discovery (Hammarberg et al., 2016). No previous research has been conducted in this area in Iran previously.

Method

Study Design

A qualitative study was performed, and data were gathered using deep semi-structured interviews and field notes. Data were analyzed using conventional content analysis (Hsieh & Shannon, 2005).

Participants were 18 community-dwelling older adults and one family member. Participants were selected through purposeful sampling, which is the best method to comprehend deep concepts and experiences in a qualitative study (Streubert & Carpenter, 2011). Participants were urban community-dwelling adults older than 60 who were capable of listening and speaking Farsi, had experienced no recent sad events (e.g., death of a parent or spouse, diseases [e.g., cancer], disability, or accidents over the past 3 months), had no cognitive impairment, and were capable of performing activities independently. Participant demographic characteristics are presented in Table 1.

Participant Demographics (N = 19)

Table 1:

Participant Demographics (N = 19)

Data Collection and Analysis

The current study is part of a larger study aimed at designing a model of developing happiness in Iranian older adults approved by Iran University of Medical Sciences. Data were collected using semi-structured deep interviews, observation, and field notes from October 2017 to April 2019. Interviews were started with three prompts/questions: “Please describe a normal day in your life”; “Describe a memory that makes you happy”; and “What would you do to make people, things, or events give you a good feeling?” Follow-up questions were asked, and at the end of the interview, participants were asked to score their happiness from 0 to 10, where 0 = completely unhappy and 10 = completely happy, and explain the reason for the given score. Interview questions were based on the Snaith–Hamilton Pleasure Scale (Snaith et al., 1995), Positive Psychotherapy Inventory (Seligman et al., 2006), Geriatric Depression Scale (Sheikh & Yesavage, 1986), and Fordyce Happiness Scale (Fordyce, 1988). These questions were corrected and approved by an expert panel (five faculty members specialized in geriatric and psychiatric nursing from three universities of Iran).

All interviews were recorded with participants' permission and transcribed verbatim. Interviews were private and took place at the date and time of the participant's choice. The interviews lasted between 45 and 110 minutes and continued until data saturation was ensured.

Interview analysis was performed after each new interview to extract codes. Analyses were done using conventional content analysis based on Hsieh and Shannon's (2005) method. In this nursing study, three initial interviews were conducted by the first and second authors (M.A.F., S.D.). The first author has experience in qualitative study and is skilled in interviewing. From the fourth interview onward, interviews were conducted by the second author and supervised by the first author. Analysis was conducted by the second author (who was a PhD Candidate in nursing at the time of the study), under the supervision and correction of the first and third (N.S.) authors, who are faculty members of the School of Nursing and Midwifery and have experience in qualitative study.

Data were managed in MAXQDA software 10.0. To evaluate trustworthiness of the study, Lincoln and Guba's (1985) criteria, including credibility, transferability, dependability, and confirmability, were used (Streubert & Carpenter, 2011). To improve credibility, the authors tried to maintain contact with participants and the study environment, record and transcribe the interviews, analyze the collected data immediately after each interview, review participants' answers, and examine the data continuously. Transferability was ensured through logging the study background, decisions, and results accurately so that other researchers would find it easy to compare the data. For dependability, member check (by three participants) and expert review (by four faculty members) were used. Finally, to ensure confirmability, data triangulation methods and review by experts were conducted.

Ethical Concerns

The current study was performed as part of a PhD thesis for Iran University of Medical Sciencesand approved by the Ethics Committee of Iran University of Medical Sciences. All participants were informed of the aim and design of the study and the voluntary nature of their participation. Written consents were obtained from all participants. The principles of anonymity and confidentiality were explained to participants, who gave written consent to allow tape recording of the interviews. Researchers assured participants that the interviews would only be heard by the interviewer and after being transcribed they would be archived and removed upon request by the participant.

Results

After combining similar codes and continuous comparisons, 23 subcategories and four main categories were found (Table 2). Based on findings, older adults use four categories of strategies to create happiness. Self-centered strategies (17 subcategories) comprise strategies in which the older adult is the beneficiary. Inductive strategies (two subcategories) are those in which the older adult is the key player and others are the beneficiaries. Passive strategies (two subcategories) represent strategies in which others play the key role and the older adult is the beneficiary. Unselfish strategies (two subcategories) represent strategies in which others are the main players and beneficiaries. Table 2 provides examples of these strategies.

Categories and Subcategories of Happiness Strategies for Older AdultsCategories and Subcategories of Happiness Strategies for Older AdultsCategories and Subcategories of Happiness Strategies for Older AdultsCategories and Subcategories of Happiness Strategies for Older Adults

Table 2:

Categories and Subcategories of Happiness Strategies for Older Adults

Discussion

Based on the findings of the current study, older adults use self-centered, inductive, passive, and unselfish strategies to create happiness. A notable finding was that older adults who used self-centered strategies enjoyed more happiness than those who used other strategies. Moreover, those who used passive strategies felt less happiness. These participants were waiting for others to make them happy and had lower skills in creating happiness. The codes under unselfish strategies were less frequent compared to other strategies. These codes were mostly mentioned by older adults with higher educational degrees. One explanation may be the ideologies that people develop during formal education.

Tkach and Lyubomirsky (2006) mentioned eight general strategies for creating happiness, including dependence, attending parties, mental control, setting goals, inactive hobbies, active hobbies, religion, and intentional attempt to achieve happiness. Their study was not limited to older adults and included all age groups. However, most of these strategies were supported by the current study. A qualitative study by Kim et al. (2007) aimed to extract what made Korean individuals happy, extracting 152 codes and 18 categories. Although Kim et al.'s (2007) study focused on factors that lead to happiness and the current study sought to develop strategies for happiness, five categories of Kim et al.'s findings were confirmed in the current study, including spending time with family, relationships with friends, helping others, effectiveness, and having a positive outlook. A point that should not be missed is that the strategies used by older adults in the current study to create happiness were affected by Iranian culture and religion. For instance, in the case of providing care, which was a subcategory of self-centered strategies, participants believed that it is the right thing to do and God will reward them in the next life. Moreover, some participants found that providing care was a way to ease their conscience. They believed once they were a burden on their parents and now it is their turn to provide and care for their parents. Such beliefs can have religious roots, as Muslims believe that serving one's parents is a responsibility and failure to fulfill such responsibility troubles one's conscience.

Culture and religion have effects on the types of hobbies participants in the current study enjoyed. In other cultures, older adults enjoy recreational activities such as exercising, traveling, reading, watching television, gambling, keeping pets, and participating in senior clubs (Onishi et al., 2006). However, in Iran, older adults enjoy different activities that are more consistent with their cultural, religious, and value systems. For instance, in Iran, gambling is against the law, and in public and religious culture it is a shameful act. Pets, such as dogs or cats, are prohibited in many places. In addition, bringing pets into the bedroom, home, and many other places is considered unpleasant, as most Iranians are Muslim, and their place of residence must be purified for them to pray.

Unlike today's Americans, whose happiness is less related to cultural ideology (Oishi et al., 2013), Iranian individuals' happiness is closely linked to cultural and religious ideologies. Iranian older adults seek happiness in volunteering; socializing with relatives, friends, children, and grandchildren; and praying (Khodaei et al., 2012), which is consistent with the current findings. Therefore, culture and religion should be considered when creating happiness strategies. These issues have been explicitly stated in qualitative research conducted in the United Arab Emirates in which culture and religion were noted as contributing factors to happiness (D'raven & Pasha-Zaidi, 2014). In another qualitative study in Iran, cultural beliefs have been listed as important contextual factors for happiness (Azadeh & Tafteh, 2016). Happiness has favorable effects on one's mental and physical conditions, and the impact of happiness on longevity in healthy populations is significant (Veenhoven, 2008).

Conclusion

Ensuring happiness in older adults who are growing in number in Iranian society should not be treated as a trivial issue. To this end, strategies for creating happiness in this population need to be recognized and developed to ensure good mental health. Among the four highlighted strategies, investment in self-centered strategies is more beneficial given that the older adult plays the main role in such strategies. Society will benefit from older adults who are more active and have better mental health. Investments in inductive and unselfish strategies are next in terms of priority.

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Participant Demographics (N = 19)

Variablen (%)
Age (years)
  <60a1 (5.4)
  60 to 707 (36.8)
  70 to 807 (36.8)
  ≥804 (21)
Sex
  Female10 (52.6)
  Male9 (47.4)
Income
  Enough2 (10.5)
  Relatively enough13 (68.4)
  Not enough4 (21.1)
Education level
  Illiterate4 (21.1)
  Less than high school5 (26.3)
  High school and beyond10 (52.6)
Job
  Employed8 (42)
  Housewife5 (26.3)
  Retired5 (26.3)
  Unemployed1 (5.4)
Marital status
  Married11 (58)
  Widowed/divorced5 (26.3)
  Single3 (15.7)
Health condition
  Healthy5 (26.3)
  Has one chronic disease6 (31.6)
  Has more than one chronic disease8 (42.1)

Categories and Subcategories of Happiness Strategies for Older Adults

CategoriesSubcategoriesCodesExample Quotes (Participant)
Self-centered strategiesBeing activePlanning for daily activities Physical capability to work independently Motivation to be active“I have plans for my every day.” (P3) “It makes me happy to be able to do my work and not need anyone.” (P13) “The days when my kids are in the house, I get more active, I clean the house, I go shopping, I feel happier...” (P1)
Self-knowledgeKnowing one's own interests Knowing one's own physical conditions Knowing one's own physiological conditions“The best activity for me is fishing. Takes the fatigue out of my body…” (P9) “I have urinary frequency. I have to go to the bathroom several times at night. For that reason, I feel more comfortable staying at [my] home than my child's.” (P16) “It bothers me being alone. I go to the park to talk to [some]one. Good for my mental health. “ (P6)
Providing careServing one's mother is a source of happiness Committed to look after children's health Looking after others Interested in looking after others“Taking care of my mom makes me very relaxed. When I see that she needs me and I arrive on time ...” (P9) “All my life, I was very careful about the health of my children. I'm fine when they're fine.” (P1) “I have looked after my husband in my life, because I feel I need to do so.” (P4)
Loving yourselfSelf-importance Self-interest“I consider myself important.” (P5) “...When I don't love myself, how can I expect others to love me?!” (P17)
Networking and developing relationshipsInterested in communicating with children Visiting relatives Attending scheduled visits Connecting with friends Creating relationships to satisfy one's needs Maintaining online relationships“Being in touch with my children makes me very happy.” (P1) “When we get together with relatives, we laugh and laugh and have a great time.” (P2) “Most of the time I would sit in a chair by the street. There are two or three old ladies in the neighborhood talking to each other there.” (P11) “I have a telegram channel with 2,000 members; I post every 2 days on the channel. It makes me very happy.” (P5)
Hobby and recreationSpending time with family Studying Spending time at parks Traveling Watching television Shopping Enjoying nature Attending art exhibitions Listening to music“I spend nights with my family.” (P3) “I usually study for an hour a day.” (P5) “I go to the park in the evening with my neighbors, if the weather is good.” (P2) “Traveling makes me feel good.” (P3) “Because I'm alone, the TV is always on at my house, and I spend most of my hours watching TV.” (P13) “I enjoy flowers, trees, and nature.” (P4) “I feel better when I read Hafez's poems or listen to music.”(P5)
Mental practicePaying attention to the environment Doing mental workout“When I get invited somewhere, I look around me very quickly, I look at things, I look at their arrangement…” (P4) “I remember and review all the events of my life with their date and time, I write and review what I've seen on my travels…“ (P10)
Spiritual/religious happinessParticipating in religious rituals Taking a pilgrimage Praying Talking to God Spending time at the mosque“The journey to Mecca [sacred place for Muslims] was the best moment of my life.” (P11) “When I pray, I feel at ease even if it is not fulfilled.” (P13) “I wake up half an hour before the Morning Prayer and prepare to attend the mosque next to my house.”(P10)
Preparing for the futureAvoiding things with unwanted outcomes Prudence Analyzing the outcomes of different behaviors“I usually think of the end of the works and it makes me feel comfortable later that I didn't do the wrong thing.” (P4) “One should see the outcome of what they/he/she does.” (P6)
Recalling happy timesRemembering good memories instead of bad memories Remembering memories of professional life Enjoying reviewing memories“I review the good memories in my mind instead of bringing the bad memories.” (P3) “Sometimes I see my old colleagues or visit my old work place. These remind me of old days. This is how I live and try to remain happy.” (P14) “I go with my brother and sister to our parents' grave and we remember and say our memories from them. We enjoy reviewing these memories.”(P4).
Willingness to learnEagerness to learn Eagerness to teach Trying to stay up-to-date“I recently learned search and typing...” (P15) “...Is it better for me to know and die or to not know and die? I must keep my knowledge up to date while I'm alive.” (P5)
OptimismNot too much emphasis on unwanted issues Seeing positive points Avoiding rumination Avoiding negative forecasts“I always try to look at someone's strengths instead someone's weaknesses.”(P8) “I'm a positive thinker.” (P12) “My daughter emigrated out of Iran, so sometimes bad thoughts come to my mind, so I find myself doing something to free my mind from that thought and I imagine their smiling faces.” (P4)
Contentment and self-respectEnjoyment and satisfaction with one's belongings Humbleness and modesty Enjoying small successes Minimum expectation from the joys of life“I am satisfied with what I have.” (P7) “One should not be proud, this land belongs to God, one must always remember God and be content with what he has given. This brings happiness.” (P7) “I enjoy small successes.”(P4)
Pursuing interestsWatching and following sports Interest in political affairs Returning to desired work Trade union activities after retirement“I love sports and follow sports news.”(P8) “I was a fan of Mr. Khatami, one of the best days of my life when he was elected president.” (P5) “After retirement, I joined the Neighborhood Association...” (P17)
Feeling self-efficientSense of being useful Avoiding being useless and ineffective Feeling competent to accept new job opportunities Trying to prove one's capability to others Remaining productive as an older adult“It has been 12 years since the 23rd of June, the day of my compulsory retirement. I do not remember a single day during this period that has been wasted.” (P6) “I am used to writing down the things I did throughout the day in my notebook. I feel like I've done some useful things that day.” (P10) “I still have the ability and I can work.” (P5)
Fulfilling tasks and assignmentsDoing tasks properly Avoiding laziness Ensuring a peaceful life for the family“I feel happier and more satisfied when I think that I have used my time in a better way and fulfilled the tasks assigned to me...” (P10) “When my family is at ease, I'm happy.” (P16)
MotivatedFeeling motivated in the morning to start a new day Having a plan for most days“The days I get motivated in the morning are also happier during the day.”(P1) “From the start of the week, my schedule is clear, I know what I'm doing and planning.” (P3)
Inductive strategiesEffectivenessMaking decisions with training effects Taking part in others' success Leaving good things behind after death Guiding others Taking part in national successes“...I have managed to convince three of X's children to quit [using] drug[s]. These things will be a source of bless[ing] for me in the other life.” (P13) “When I see that I have contributed to the success of others, I am happy.” (P3) “I'm the person who likes to guide others. I go ahead and say 'Can I help you?' It makes me happy.” (P10)
Social participationVolunteering Participating in society Membership in associations and unions“...a region was struck by earthquake, when [I] heard about it, I packed my small backpack and headed toward the region....” (P10) “I participate in the community.” (P3) “I am a member of the Tehran teachers' union.” (P3)
Passive strategiesInactive joyfulnessBeing taken on a trip Being taken to a party Being visited by children Receiving gifts“Last year, my son took me on a trip, which made me very happy.” (P13) “My daughter took me to a tribal wedding, talked to others, and had happy moments”. (P2) “When the children come to my house, the world is mine.” (P15)
Being assigned responsibilityLooking after grandchildren Being in charge of purchasing groceries for a child's family Being in charge of grocery shopping“I send my daughter to her house every Thursday to keep her company. When I go there to take my daughter home I clearly see that her mood is changed for better…” (P17) “Sometimes my daughter tells me to pick a vegetable to put in her freezer. I get up early in the morning and tell myself I have a job today and I have to be energetic.” (P15)
Unselfish strategiesAltruismEnjoying watching friends' happiness Children's health and well-being Enjoying others' happiness Solving hardships of fellow countrymen“My friends' happiness makes me happy.” (P4) “The health and well-being of my children is what makes me happy.” (P6) “…I am happy when others are happy.” (P15)
PatriotismLoving one's own country Feeling empathy toward motherland Feeling proud by seeing outstanding countrymen Feeling euphoria for national progress“Witnessing success of my country in different fields makes me happy.” (P11) “I feel proud by seeing outstanding countrymen.” (P5) “I love my country and the pride of my country is important to me.” (P3)
Authors

Dr. Farahani is Professor, Dr. Dorri is Graduate, Student Research Committee, and Dr. Seyedfatemi is Professor, Nursing Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran.

The authors have disclosed no potential conflicts of interest, financial or otherwise. This research was supported by a grant (96-04-28-32774) from Iran University of Medical Sciences, Tehran, Iran.

The authors thank the participants who contributed to this study.

Address correspondence to Safoura Dorri, PhD, MSN, Graduate, Student Research Committee, Nursing Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran, Rashid Yasemi Street, Valiasr Avenue, Tehran, 1996713883, Iran; e-mail: dorrisede.s@tak.iums.ac.ir.

Received: June 23, 2019
Accepted: October 28, 2019
Posted Online: February 27, 2020

10.3928/19404921-20200220-02

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