| Background:The topic of population aging has gradually become the global attention with the increase of human life span and the decrease of birth rate.As the key policy to deal with population aging and the main global strategy,active aging has stepped into a new phase in terms of the worldwide studies and applications.However,the researches had some limitations like the lack of unanimous conceptual definition and assessment.Besides,the current studies mainly focused on urban seniors but barely on rural seniors.Accordingly,under the framework of WHO model,each country has the priority to clarify the active aging concept and model based on the individually unique culture and value,and pay attention to the social vulnerable groups such as countryside elderly.Objectives:Based on the three pillars-health,participation and security of WHO's active aging policy framework,from the perspective of whole-person health and whole-life care,using the methodology combined concept analysis and empirical research,this study aimed to develop China's active aging model to reveal the problems associated with health,participation and security of elderly people in China,to compare the differences between Chinese urban and rural areas to give constructive suggestion for the improvement of the senior people's quality of life.Methods:Using Walker and Avant's theory of concept analysis,we defined the concept and feature of active aging,built model case,critical case and opposite case,analyzed the cause and effect of active aging,and discussed evaluation tool.Then,using systematic review of active aging,social survey,focus group discussion,and Delphi method,we developed the evaluation index of active aging.According to the evaluation index of active aging,we carried on the empirical study.The data for this cross-sectional study were collected in 3 urban community health clinics and 7 rural clinics.A total of 1100 senior people aged 60 years and above including 550 each in urban and rural areas were asked to answer a series of questionnaires on sociodemographic informations,health,participation,and security status.SPSS 17.0 and Mplus7.0 were used to analyze the data.Descriptive analysis was applied to describe the status of elderly people with the respect of health,participation and security in active aging.Confirmatory factor analysis was applied to develop active aging model.T-test,rank sum test,and chi square test were applied to compare the differences in terms of the factors in 'health,particioation and security' of active aging model between senior people in urban and rural areas.Results:1.After documents analysis,social survey,focus group discussion and Delphi inquiry,we developed the evaluation indexes of active aging consisted of 3 first-level indices-health,participation,and security,ten second-level indices,and 45 third-level indices.Health included 3 second-level indices such as physical health,mental health and social adaption,and 17 third-level indices such as ability of daily life,sensory function,chronic pain,chronic disease,sleep,diet,excretion,coping ability,self-esteem,positive emotion,cognition,sense of security,subjective well-being,social support,self-management,interpersonal relationship,and role adaption.Participation included 4 second-level indices such as productive activity,spiritual cultural activity,physical activity,and social activity,and 16 third-level indices such as paid work,volunteering,care for family,watching TV,listening to radio,reading,shopping,traveling,using the Internet,walking,dancing fitness,housework,visiting friends,joining elderly club,senior college,playing chess or cards.Security included 3 second-level indices such as economic security,policy and regulation security and community environment,and 12 third-level indices such as social pension insurance,medical insurance,housing security,personal income,children support,policy guarantee,regulation guarantee,public transportation,community safety,community health service,community public service,and training and education.The scores of health,participation,and security were high(4.85±0.36,4.78±0.50,4.89±0.31).The scores of psychological health(4.85±0.45)were more important than physical health(4.81±0.39)and social adaption(4.70±0.46).Productive activity(3.67±0.77)had the lowest score compared with spiritual cultural activity(4.70±0.46),social activity(4.56±0.63)and physical activity(4.07±0.77)with the highest variable coefficient(20.99).The score of paid work(3.59±0.73)was lower than caring for family(4.11±0.74)and volunteering(3.93±0.77)with the highest variable coefficient(20.41).The scores of economic security(4.89±0.31),policy and regulation guarantee(4.67±0.54),social security(4.52±0.51)all had the scores more than 4.50.Specialists highly agreed with security indices.2.1022 senior people were included in the empirical study,474 people from city and 548 from rural with the average age of 71.07±7.22,573 females and 449 males,and 78.9%of samples had spouses,65%were living with spouses.The education level of samples was low,81.9%of them equal to or under the primary school.53.1%of the samples were farmers,and 31.1%were factory workers.Most of the samples did not smoke and drink with the body mass index at 23.86±3.60.3.Active aging model showed a fine model fitting(x2/df=2.888,CFI=0.888,RMSEA=0.043,SRMR-0.076),including 3 second-level factors covered health,participation,and security,and 19 first-level factors covered 7 factors of health(cognition,coping ability,sense of security,social support,self-management,social relationship,role adaption),4 factors of participation(paid work,watching TV,walking,visiting friends)and 8 factors of security(housing security,income,policy guarantee,regulation guarantee,public transportation,community security,community health service,community public service).4.In the three second-level factors of active aging,security and health had the highest factor loading(0.783,0.642),and participation had a negative correlation with active aging(-0.207).In the 19 first-level factors,role adaption(0.833),self-management(0.819),community health service(0.761),coping ability(0.700),community security(0.631)had the highest factor loading.5.The differences existed between urban and rural elderly in active aging model.As for health factor,urban seniors had higher cognition,coping ability,social support,self-management,and role adaption than rural seniors,but had fewer frequency of social interaction.In the participation factors,urban seniors spent more time watching TV and walking than rural seniors,but they spent less time on paid work.In security factors,urban seniors had a better housing security and a higher income.Besides,they had a better perception of the economy and better services of public transportation,community security,and community public infrastructure than rural seniors.The satisfaction of income,policy and regulation guarantee,and community public service was less than rural seniors.Conclusions:1.Active aging model based on the WHO active aging policy framework had a fine model fitting,including three second-level factors-health,participation,and security,and 19 first-level factors.Security was more relevant to active aging than health and participation.The participation had the negative correlation with active aging,maybe related to the type and intensity of the activities involved.2.Health factors of active aging included seven factors,such as cognition,coping ability,sense of security,social support,self-management,social relationship,role adaption.Psychological health and social adaptation were the essential components of health factors in active aging.Physical health was not an imperative factor in active aging.All senior people have a chance to realize active aging.3.Participation factors of active aging included four factors,such as paid work,watching TV,walking,visiting friends.Paid work had the biggest correlation coefficient.Caring family and ICT were not formed into the active aging model.Senior people should be encouraged to participate in multiple activities.The value of seniors caring family should be recognized,and training and support should be offered to seniors.4.Security factors which were the foundation and prerequisite of active aging included eight factors,such as housing security,income,policy guarantee,regulation guarantee,public transportation,community safety,community health service,and community public service.Community safety and community health service were the most critical security factors in active aging.5.Psychological health and social adaptation of rural seniors were lower than urban seniors,which affects the active aging of rural seniors.Rural seniors spent more time on paid work than urban seniors and had fewer social activities and spiritual cultural activities,which were associated with the dual social and economic structure between urban and rural.Rural seniors had lower security level than urban seniors.They were more satisfied with the national policies,regulation of strengthening rural construction and community public service. |
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