Proposition no. 6 which states that A person who experienced negative life events can still be able to attain mental wellbeing relates to axiom 2 Positive and negative life events affect mental wellbeing and axiom 3 (A mentally healthy person functions effectively thus feels happy and satisfied) since it implies that using appropriate coping and adaptation skills against the many negative life events, minor, major or extreme life events, the older person still has a great chance attaining mental wellbeing, to be able to function normally despite physical and cognitive decline therefore making the older person happy and satisfied.
During the normal process of aging, the older people encounter stressors or negative life events that may trigger both appropriate and distorted emotional responses. Two of the most stressful unplanned life events include declines in health and loss of loved ones. It may result to distress and a sense of helplessness due to physical deterioration in function, such as blurred vision and hearing difficulty; adjustment and difficulty after retirement, resulting to loss of financial independence, feeling of emptiness for lack of life goal, etc.; social isolation, and feelings of out of touch with the world owing to the rapid changing environment; loss of confidence and self worth; misconception that family members and society no longer respect them; and a sense of loneliness as adult children leave the family. In addition, chronic strains may also impact the older adult; for example, strains within the community, in relationships, or in the older person’s immediate environment are all stressors. Most older people are able to adapt to these changes and maintain their well-being by utilizing and organizing their personal and environmental resources. These include coping skills, social support, and maintaining a sense of control.
A mentally healthy older adult has the ability to interact positively with internal and external environment, can adapt and cope up from the negative life events. As the World Health Organization (2001) defines mental health as the state of well-being in which the individual realizes his or her own abilities. He can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community” (Tameside and Glossop, 2011).
According to Ebersole, et.al (2004), it is difficult to define mental health of an elderly because the differentiation of personality throughout the life span is escalating which may have resulted to idiosyncratic and sometimes eccentric adaptation in late life. As the person grows older, faced with particular situations, it accentuates a certain aspect of personality and appearance which make the person uniquely himself because he is strengthened with the accumulation of life experiences. Such personality characteristics maybe negative like being crusty, disagreeable, grouchy or grumpy which is however considered adaptive. A good example would be a cantankerous old man who utilizes his coping skills against with his severe illness and stoically protecting others from awareness of his pain might be manifesting a mentally healthy person. Therefore, Ebersole, et.al (2004) best described mental health in elderly as being measured by the capacity to cope effectively with relationships and environment and by the satisfaction experience in doing so. If the environment provides the potential for mental health, then the only criterion for mental health is the person’s response to the environment.
The same connotation given by Zanden, et.al (2000) as he identified two (2) elements of mental health namely: (1) From a social perspective, mental health involves people’s ability to function effectively in their social roles and to carry out the requirements of group living; (2) From a psychological perspective, mental health involves a subjective sense of well being such as happiness, contentment and satisfaction.
Moreover, the qualitative study of Moyle, et.al (2010) about “Older people maintaining mental well-being through resilience” is a good example of a mentally healthy older adult who is able to manage and cope well with the adversities. The older people in the study identified their negative life changes categorized by the following four themes: 1) Social Isolation and Loneliness, 2) Social worth, 3) Self-determination, and 4) Security. When the researchers asked the older-participants to discuss strategies that they used to maintain well-being through resilience, their responses were categorized under six themes. These are: 1)Keeping active; 2)Relationships; 3)Community connections; 4)Practical coping; 5)Emotional coping; and 6) Spiritual coping.
Physical activities, mentally stimulating activities and meaningful activities are the identified activities of the participants inorder to be always active which enhance mental health and well-being. They reported keeping mentally active through continued learning, new interests or novel activities, as well as mentally stimulating games and through volunteering. Older people also identified that the more challenging activities can enhance well-being by giving a sense of accomplishment and achievement. Another approach which the participants expressed is being involved and maintaining healthy family contacts because this relationships could enhance well-being in older people just like the active and frequent presence of grandchildren. In addition, when participants felt able, taking on a caregiving role was another way maintaining well-being through relationships. The other strategy reveals the strength of community connections for maintaining well-being. Older people report that their health is maintained through continued and constant contact with all age groups and members of the community. For many participants, the key is to interact as part of the wider community and not isolating oneself according to age group. Another category of approaches used by older people in order to maintain well-being were those which used practical based coping strategies to minimize the effects of aging on well-being. The participants reported using practical focused coping strategies such as setting goals or planning for the future. This also includes financial planning and creating budgets to maintain financial security. While for other participants, actively minimizing responsibilities is one way to maintain well-being.
Utilizing emotional coping strategies is another approach to enhance mental wellbeing. While distraction and occupation were considered to be important ways of maintaining wellbeing others reported altering goals or standards according to ones age as a way to maintain well-being. Comments frequently centered on being realistic and reasonable when considering the limitations and expectations of later life. For others not focusing on age and acceptance of older age were key approaches to assist in sustained well-being. However an important aspect of acceptance was not to give up on doing things that are enjoyable because of aging such as to think positively or maintain a sense of humor. The final approach highlights spiritual strategies used by some older people in order to maintain well-being. In a study of quality of life and Jewish older people in South Africa, over half of the participants felt that as they grew older, religion played an increasingly important role in their lives.
Self-concept as mentioned in proposition no. 4 is an important factor that would help view the negative life events positively resulting to better coping skills. Self-concept is also evident when older person comments on major events in his life, he was engaging in a special form of reminiscence called life review – calling up past experiences with the goal of achieving greater self-understanding. Older adults who participate in counselor-led life review report increased self-esteem, greater sense of purpose in life, and reduced depression. At the same time, when they relate about themselves, elders have accumulated a lifetime of self-knowledge, leading to more secure and complex conceptions of themselves. Their autobiographical selves emphasized coherence and consistency, despite physical, cognitive, and occupational changes. So when an older adult who shows firm and multifaceted self-concept which allowed for self acceptance is a key feature of integrity.
Moreover, a flexible, optimistic approach to life, which fosters resilience in the face of adversity, is common in old age. Being resilient, the elderly gain in agreeableness, becoming increasingly generous, acquiescent, and good-natured well into late life. Agreeableness seem to characterize people who have come to terms with life despite its imperfections- greater acceptance of change – an attribute the elderly frequently mention as important to psychological well being. When asked about dissatisfactions in their lives, many older adults respond that they are not unhappy about anything.
Acceptance of change is also evident in most elders’ effective coping with the loss of loved ones, including death of a spouse. The capacity to accept life’s twists and turns, many of which are beyond one’s control, is vital for adaptive functioning in late adulthood. Most older adults are resilient, bouncing back in the face of adversity – especially if they did so earlier in their lives. And older persons’ heightened capacity for positive emotion contributes greatly to their resilience (Zanden, 2000).
Therefore, if the older adults are recalling past positively revealing a lifetime of self-knowledge, leading to more secure and complex conceptions of themselves and is resilient have arrived at a sense of integrity and they would feel whole, complete, and satisfied with their achievements. They have adapted to inevitable triumphs and disappointments and realize that the paths they followed, abandoned, and never selected were necessary for fashioning a meaningful life course.
Another measure for the older adult to consider inorder to successfully adapt and manage negative life events is for him to take initiatives in doing activities. This relates from the study of Steverink, Lindenberg and Slaets (2005) who define taking the initiative as the ability to take initiatives or to be agentic (self-organizing, proactive, self-reflecting and self-regulating). This ability, although closely related to self-efficacy, Deci and Ryan (1995) considered taking the initiative to be a separate ability, because the belief in one’s competence is not automatically linked to the motivation to use one’s competence. Thus it is hypothesized that taking the initiative with regard to important resources, as opposed to being or feeling passive, dependent or fatalistic, is necessary for the achievement and maintenance of wellbeing. With aging, as a consequence of losses in resources, together with decreasing opportunities and challenges, there may be a decline in the rate and range of self initiated behavior and an increase in dependency (Baltes 1996). The general construct that has been the focus of most research on this aspect of adaptive behavior is autonomy vs dependency. For example, it was found that nursing home residents who experienced greater autonomy reported less depression and higher self-esteem, life satisfaction, meaning in life, general health and psychological adjustment (Vallerand and O’Connor 1989). Similarly, in nursing home residents, Kasser and Ryan (1999) found out that greater autonomy in daily activities predicted decreased mortality over a 1-year period.
The initiative of the elderly to be always active and involved in social activities prevent mental depression. This way, it avoids the elderly population from thinking negatively and becoming pessimistic which contributes to health problems especially mental illness. However, the elderly should not limit itself to social activities, but he should be involved in variety of resources called multifunctionality.
Well-being is about being emotionally healthy, feeling able to cope with normal stresses, and living a fulfilled life. It can be affected by things like worries about money, work, your home, the people around, and the environment. Well-being is also affected by a feeling of having control of your life, feeling involved with people and communities, and feelings of anxiety and isolation (Coggins & Cooke, 2004). Axiom number 2 stresses then that there are multifunctional resources/factors, internal or external that would influence the person to reach and attain mental wellbeing.
Nieboer, A. & Lindenberg, S. (n.d.) described multifunctional resources as the resources or activities or factors that serve multiple aspects of wellbeing (e.g. social and physical wellbeing) simultaneously and in a mutually reinforcing way. Because of this mutual reinforcement, multifunctional resources are of special importance for the realization of wellbeing. Therefore, the ability to maintain or regain multifunctional resources is important for wellbeing in ageing. A spouse, for instance, is often a multifunctional “resource”. Interacting with a spouse fulfills the need for affection, and at the same time fulfills the need for activation. Another example of multifunctionality is having dinner (fulfilling the need for food) with friends (fulfilling the need for affection). With aging added by Riley and Riley (1994), there may be a decline in multifunctional resources and activities, due to the loss of a partner or close friend, and also because of a decrease in opportunities to participate in occupational and other formal settings. Such settings often offer opportunities for multifunctionality through interaction with colleagues and by performing tasks that yield reinforcing physical and social rewards. Because multifunctional resources or activities are hypothesized to yield more overall wellbeing than unifunctional activities or resources, the loss of these opportunities is therefore expected to have a particularly negative impact on wellbeing. Moreover, it is often hard to substitute or compensate the loss of a multifunctional resource. For instance, the loss of a spouse and subsequent widowhood, which is a common experience in later life especially for women, often has a broad impact on different aspects of wellbeing, because the loss of the spouse often involves the loss of other relationships as well. Other empirical evidence for the importance of multifunctional resources or activities for overall wellbeing is found in studies that show both higher levels of wellbeing and increased longevity in older people who remain socially active and productive (Nieboer & Lindenberg, n.d.). However, it is believed that if these multifunctional resources and strategies have been taught and develop at an early stage then obtaining mental wellbeing would not be difficult to attain. An elderly who has a loving, close family relationship and full support from them from childhood to adulthood, the elderly will have a positive outlook in life thus living a fulfilled, happy and contented and complete life will eventually reach the stage of integrity hence attain mental wellbeing.
Investment of behavior is another factor inorder to attain mental wellbeing. This relates to the famous adage which states “continue doing good because in the end you will reap a harvest full of blessings” would also mean doing something good in your life even in the earlier stage of life is an investment behavior which resulted to increase longevity. The investigation made by Steverink, Lindenberg and Slaets (2005), found that the investment of behavior is important for achieving stability in resources and the maintenance of wellbeing in the longer term. Therefore, it is hypothesized that a certain amount of investment behavior is important for the realization and maintenance of wellbeing, even with increasing age and a declining time-horizon. Without investment behavior there will be a decline in resources and wellbeing. With aging, this ability may decline as a consequence of a decreasing time-horizon and the loss of external resources and opportunities. It has, indeed, been found that older individuals become ever more present-oriented, and have a less extended future perspective than younger people in general. Yet, when older individuals are able to maintain a certain amount of investment behavior, this clearly will have a positive effect on their overall wellbeing. For example, proactive prevention activities in older people have positive consequences for longevity, as well as for indicators of subjective wellbeing. Although there are only a few studies that have investigated investment behavior in aging individuals, other studies have closely examined related aspects of future orientation and planning in older people. It has been found that older people who maintain a future orientation, and also plan for the future, report higher levels of life satisfaction (Prenda and Lachman 2001). Moreover, Isaacowitz and Seligman (2002) supported that a positive future orientation was found to predict affective adaptation (Nieboer & Lindenberg, n.d.).
Furthermore, there are more coping and adaptation strategies that can be used inorder to attack negative life events as reflected in axiom 2.
The measures/strategies discussed previously were indeed a good tips inorder to maintain mental health more especially if the older adult is optimistic, with positive self-concept and self-esteem, he can easily face the negative life events with confidence, happy and contentment. Axiom no. 3 (A mentally healthy person functions effectively thus feels happy and satisfied) will never be difficult to attain if the elderly views aging positively despites its cognitive and physical decline, this will never be a hindrance inorder to attain happiness and life satisfaction as measurements of mental wellbeing. It was never true that attaining mental wellbeing means having no diagnosed illness nor physical disabilities, what is important is the development of ones potential, work productively and creatively, how strong and positive relationships are built with others, and how to contribute something to the economy. As Baltes & Baltes (1990) accentuates that successful aging, is not based on denial of real losses in functioning in the last stage of life but rather it encourages older people to optimize the capacities that remain while compensating for inevitable losses. A report of Mroczek & Kolarz (1998), documented that older adults do not appear unhappier compared to middle-aged or younger persons even though they experienced declines in physical health, deaths of peers and spouses, and other objective rigors that accompany aging (Baltes & Baltes, 1990; Brandtstadter & Greve, 1994; Filipp, 1996; Staudinger, Fleeson, & Baltes, 1998). As a result of hardships in life, it was expected that they would have lower levels of happiness but it was not so. Their well-being seems to be unaffected by the adverse contexts brought on by the aging process (Borgatta & Fbss, 1979; Cameron, 1975; Haug, Belkgrave, & Gratton, 1984; Herzog, Rodgers, & Woodworth, 1982; Larson, 1978; Schulz, 1985). Also, Zanden, et.al (2000) cited that Erikson during his late adulthood, demonstrated a life of ego integrity. At age 87, he continued to publish books relating to old age, his last work found out that some older adults live hopeful, productive lives, despite failing health and alertness; while others were relatively robust, although sometimes giving in to loneliness, narcissism, and despair (Woodward, 1994). The Social Production Function (SPF) Theory explains the two (2) types of older adults. According to the theory, success in obtaining the goals of affection, behavioral confirmation and status for social well-being, and comfort and stimulation for physical well-being resulted to subjective wellbeing. People have their own multiple means for achieving these goals by using a variety of means or resources simultaneously, should there be a case in which their goals cannot be achieved, they will build buffers against the loss of subjective wellbeing, although people have differences in buffer formation but people are resourceful in substituting across different life-domains and different forms of well-being. This is confirmed from the study of Steverink (2001) among older adults (Nieboer & Lindenberg, n.d.). Relating it to the observation of Erikson some older adults though relatively robust but still give in to loneliness, narcissism and despair, this maybe due to how they deal with their negative life events, how they make use of their coping and adaptation skills, or their buffer system or multifunctionality resources.
The implication of the above scenarios portray that the negative life events were never considered as obstacles in attaining mental wellbeing. When appropriate skills are used in attacking adversities in life, there is a great chance of achieving happiness and life satisfaction. As Field (2009) expresses in his words “mental wellbeing is not simply as having absence of diagnosed illness, disability or dissatisfaction but the individual must acquire social qualities of confidence, optimism about the future, a sense of influence over one’s own destiny, and the social competences that promote satisfying and supportive relationships with other people. It also critically involve the resilience needed to deal with hard times whenever they occur inorder to function effectively so that by then happiness and life satisfaction are possible to reach. Therefore, mental wellbeing involve happiness or contentment, caring for and about others, and the capacity for creative and productive work”.
As the individuals grow old, people encounter challenges, stresses or adversities in life such as negative life events, it maybe in the form of major, minor or extreme life events. These life events have great impact to the lives of every individual especially on the desire of achieving functioning effectively, happiness and satisfaction or otherwise known as Mental Well being during the late stage of the people’s lives. The theory on Attainment of Mental Wellbeing is being developed because of the belief that despite those negative life events, the individual still manages to adapt and cope from those stressful events thus function effectively and shall have satisfied and happy lives. However, there is no best formula in attaining mental well being because it is believed that there are factors that will act as a barrier in attaining mental wellbeing and at the same time there are also factors that would help mold the individual to have good mental health in order for the person to be fully develop in combating against those negative life events.
The study is anchored on the Social Production Function (SPF) Theory which will explain “why people is still fairly satisfied with their lives even when they lack important resources such as a paid job or a spouse” (Nieboer & Lindenberg, n.d.). The same observations made by Erikson when he interviewed older Americans because he found out that some older adults opted to be lonely, narcissistic and desperate though they are relatively in good health. SPF theory asserts subjective wellbeing is ordered hierarchically. The general universal goals which are at the top: Overall subjective wellbeing consists of physical and social wellbeing; then followed by universal instrumental goals (for social well-being, three universal instrumental goals are specified: status, behavioral confirmation, and affection and for the production of physical well-being, two universal instrumental goals have been distinguished: comfort and stimulation (Wippler 1990)) and the lowest level is the layers of means called resources. In achieving the overall subjective being, one has to work on it, starting from the lowest level inorder to attain the universal goal. If an older person lacks the necessary resources like work, due to retirement, this doesn’t mean it’s the end of the world. The theory suggests that the older person should make use of a buffer system or multifunctionality resources as their coping and adaptation skills. There is still a big chance to achieve the higher goal which is the attainment of mental wellbeing, hence the theory on Attainment of Mental Wellbeing is being developed.
The proposed theory on Attainment of Mental Wellbeing is applicable to all individuals across several lifespan, specifically, among the institutionalized older adults in Por Cristo and in the city and provincial jails (elderly inmates) of Butuan City. The theory suggests basing on the SPF theory, that inorder to battle against their negative life events will make use first of the lowest level of resources before going up to the next level until they will be able to attain mental wellbeing. The theory further suggests that these resources are factors that would affect or influence the person on the extent of his effort, belief, perceptions, coping and adaptation skills towards the attainment of his mental wellbeing.
This theory will be tested to determine if the following propositions are true among the institutionalized older adults in Por Cristo and in the city and provincial jails (elderly inmates) of Butuan City:
Proposition 1: Mental wellbeing is an optimistic person.
Proposition 2: Parents and families have important role in the early initiation of secure attachment to the life of a child influences in the attainment of mental wellbeing across life span.
Proposition 3: Several factors and/or resources that work collaboratively inorder to help promote in the attainment of mental well being.
Proposition 4: A person with healthy self-concept and positive self-esteem towards life events can attain mental wellbeing.
Proposition 5: A person who fully understands the meaning of life with strong sense of spirituality has attained mental wellbeing.
Proposition 6: A person experienced negative life events can still be able to attain mental wellbeing using better coping skills and adaptation
The proposed theory on attainment of mental wellbeing is taken from the idea related to the effect of life events towards the attainment of mental wellbeing and in which there are several factors that will influence the process in the attainment of the goal.
Figure 1 illustrates the schematic diagram on the proposed theory called “the theory of attainment of mental wellbeing”. It shows the independent and dependent variables. Life events surrounded with the influencing factors signify the independent variables, while the effect called the dependent variable is the attainment of mental wellbeing.
Mental wellbeing or wellbeing is defined as a dynamic state, in which the individual is able to develop their potential, work productively and creatively, build strong and positive relationships with others, and contribute to their economy (Foresight Report, 2008) while mental health is a state of wellbeing in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work
ATTAINMENT OF MENTAL WELLBEING
productively and fruitfully, and is able to make a contribution to his or her community (Word Health Organization, 2007). Both mental health and wellbeing is the core elements of the over-all health which means if his health condition is marked with alteration in thinking, mood or behavior resulting to either distress, impairs ability to function or both (U.S. Department of Health and Human Services) is a manifestation that the older person has not attained mental wellbeing which might result to mental health problems such as depression, suicide, etcaˆ¦
There are two (2) elements of mental health namely: (1) From a social perspective, mental health involves people’s ability to function effectively in their social roles and to carry out the requirements of group living; (2) From a psychological perspective, mental health involves a subjective sense of well being such as happiness, contentment and satisfaction. Therefore, mental wellbeing is measured in terms of functioning effectively, happiness and contentment or life satisfaction.
However, attaining mental wellbeing is not an easy journey because all of us will always encounter different life events. Life events are described as a significant occurrence involving a relatively abrupt change that may produce serious and long-lasting effects. It is considered as stressor in the life of a person because the demands on the person exceed the resources available to meet those demands (Schwarzer, Schulz & Berlin, 2001). For older adults, it will be in a form of retirement, death of a spouse or children or friends, lost of income, change of living environment, etcaˆ¦ These life events can threaten the wellbeing of an individual that’s why life events are most often considered as obstacles in reaching the goals. However, depends on the person’s capability to face the different life events.
The influencing factors that will help attain mental wellbeing can be in form of intrinsic and extrinsic or promotive and preventive factors. Intrinsic factors are the core characteristics needed inorder to easily attain mental wellbeing, such as optimism, self-concept, self-esteem, meaning of life and spirituality. These core characteristics help the individual views the life events positively and produce a direct effect on the attainment of mental wellbeing such as optimism, self-concept, self-esteem, meaning in life & spirituality. While the promotive and preventive factors refer to the environmental factors which has indirect effect in the attainment of mental wellbeing, this includes: parental care, like exercise, healthy lifestyle, proper nutrition, etcaˆ¦ These factors influenced the individual on the proper choice of coping and adaptation skills when faced with life events especially the negative ones. Older adults must continue to engage in activities, socialize, etcaˆ¦ despite their health condition right now.
The study aimed to determine the life stories of institutionalized older adults relating to the essence of mental well being in relation to the different life events they encountered. Specifically, it sought answers from the following problems:
To identify the significant life events they encountered from childhood up to the present and how they cope up and adapt with that experiences.
To determine the different factors that influence their mental wellbeing causing them to be able to surpassed their negative life events.
To explore “the essence of mental well being” and if they have attained it despite the condition/situation of their life right now.