Envejecimiento saludable: un primer acercamiento a la revisión de indicadores subjetivos de salud en zonas urbanas y rurales en Costa Rica / Healthy aging: An initial review of subjective health indicators in urban and rural areas in Costa Rica

Resumen En este artículo se presentan los resultados de una primera aproximación al análisis del efecto moderador del contexto social, cultural y geográfico en indicadores subjetivos del envejecimiento saludable en personas mayores de 46 años residentes en territorios con características diferenciadas en Costa Rica. Se trabajó con una muestra de 305 personas residentes en tres áreas geográficas: una urbana, una semiurbana y una tercera principalmente rural. La diferenciación de las tres zonas se basó en criterios de densidad poblacional, infraestructura y acceso a bienes y servicios. Los indicadores subjetivos del envejecimiento saludable analizados fueron: participación social, apoyo social, salud percibida, espiritualidad, autoeficacia, comportamientos de autocuidado, bienestar subjetivo (satisfacción con la vida y bienestar psicológico) y estado de ánimo; todas las variables fueron condicionadas por zona de residencia, edad y sexo. Para analizar los indicadores subjetivos se estimó un análisis de covarianza (ANCOVA) o un análisis multivariado de covarianza (MANCOVA), dependiendo del número de variables dependientes analizadas. En general, se identificaron indicadores subjetivos de envejecimiento saludable altos en las personas participantes del estudio, quienes reportaron altos niveles de participación social, satisfacción con la vida y estados de salud y ánimo positivos. Se encontraron diferencias por edad entre los grupos. Sin embargo, no se evidenciaron diferencias estadísticamente significativas en los indicadores subjetivos analizados según la zona de residencia o el sexo. En síntesis, este estudio encontró que los indicadores subjetivos de envejecimiento saludable analizados eran muy similares en residentes de tres zonas geográficas con características distintas. Estos hallazgos iniciales se discuten desde una perspectiva cultural y geográfica y en relación con los modelos de envejecimiento saludable.

Abstract This review exposes the results of a first approximation to the analysis of the moderator effect of the geographical, social, and cultural context on subjective indicators of healthy aging in the Costa Rican context. Costa Rica is a middle-income democratic country that is in an advanced demographic changing process; this phenomenon makes it one of the aged countries in the Latin American region. Therefore, studying healthy aging becomes relevant in the context of population demographic change in the present and future aging societies. The study compared several subjective indicators of healthy aging among people older than 46 who resided in three different geographical areas in the country. Participants were 305 healthy people from three locations: one urban (Heredia Central City), one semi-urban (Santa Ana Central City), and one mainly rural (Nicoya). Participants completed standardized assessment scales to evaluate social participation, social support, perceived health, spirituality, self-efficacy, self-care behaviors, and subjective well-being (life satisfaction and psychological well-being). All variables were conditioned by geographical zone (urban, semi-urban, and mainly rural), age, and gender. Either Analysis of Covariance (ANCOVA) or Multivariate Analysis of Covariance (MANCOVA) were estimated depending on the number of dependent variables analyzed to test the effect of the zone of residence, gender, and age, over the subjective indicator of healthy aging studied. In general, participants evidenced high scores on subjective indicators such as self-care, social support, spirituality, life satisfaction, and psychological well-being, which have been associated with health and well-being during the aging process. Participants reported high levels of social participation and perceived that they received adequate support for their daily life needs. Likewise, participants evidenced a general state of well-being, a positive state of health, high levels of self-efficacy, and positive moods. Differences were found among the groups by comparing age. However, no significant differences were found in the variables studied related to geographical areas of residence and sex, suggesting invariant comparison evidence by zone of residence and sex. Nevertheless, the results indicate that the subjective indicators of healthy aging studied are key to promoting healthy aging at the national level. It is considered necessary to improve opportunities for social participation aimed at older adults, to strengthen community and family social networks, to promote socio-economic support such as financial and instrumental support for activities of daily living, and finally emotional support such as listening, empathy and advice. Although the differences among geographical areas of residence of the people studied were not statistically significant in this study, the evidence suggested a trend of high well-being indicators mainly in the rural areas studied, and particularly more in males than in females. As this study only reached preliminary data, further research must obtain conclusive evidence, as previous research had suggested older people living in rural areas with high longevity indicators in Costa Rica might enjoy unusual environmental characteristics and personal protective factors that could be absent in most of the urban areas in the country. On the other hand, it will be necessary to include the historical and socio-cultural determinants focusing on context-specific review analyses in the mainstream research on healthy aging, even more in aged countries like Costa Rica. The findings are discussed within the inter-cultural emphasis and healthy aging models in order to contribute to a better understanding of how the context (physical-constructed and social/cultural) influences the differences, although subtle, in the study´s variables and participants, and how the process of aging might be different according to the multiple contextual conditions in which people live and adapt their capacities and abilities for coping with daily life demands.

Aging in Place: Connections, Relationships, Social Participation and Social Support in the Face of Crisis Situations.

OBJECTIVES: We seek to identify active coping strategies used by older adults to face the pandemic and to deal with daily stressors, and to clarify which factors had an effect on stress, positive emotions and depression in active and healthy community-dwelling older adults in the first and second year of the pandemic in Costa Rica. METHODS: Participants were living in their own homes in Costa Rica (n = 218, mean age 69.96, 82.1% women). Participants were interviewed by phone and answered an online survey, which included socio-demographic information, mental health variables such as stressors (perceived health and fear of COVID-19, illness, perception of pandemic gravity), loneliness (whether they felt lonely and how often they felt lonely), access to Information and Communication Technologies, socio-emotional coping variables, social participation and physical activity level during the pandemic. RESULTS: Positive socio-emotional indicators related to well-being such as self-efficacy, social support, perceived health and proactive behavior were high. Negative well-being indicators such as perceived stress, emotional COVID-19 fear and loneliness showed low values in the sample studied during both years. We found significant relations across the dependent variables (perceived stress, positive emotions and depression) by studying the psychological well-being coping strategies. CONCLUSIONS: Findings highlight the importance of coping strategies and social participation in the capacity of older adults to mitigate the negative psychological consequences of crisis situations and provide evidence of "aging in place".

Testing a Proactive Model of Successful Aging Among Older Adults in Costa Rica and Spain.

The purpose of this study is to examine successful aging among Spanish-speaking older adults in Costa Rica and in Spain using the proactive framework proposed by Kahana et al. (2014). More specifically, we hypothesized that older adults' life satisfaction would be positively associated with the frequency and perceived level of social support, spirituality/having purpose in life, and the use of proactive physical, cognitive, and social self-care behaviors. Our results confirmed these hypotheses, not only for the overall group of participants, but also separately for older adults in Costa Rica and in Spain. The present study contributes to the literature of successful aging among older adults, by examining the protective factors associated with life satisfaction among Spanish speaking older adults in Costa Rica and in Spain. It identifies specific protective factors (spirituality/purpose in life, social support, and self-care) associated with the values and preferences held by participants in the study.

Subjective well-being key elements of Successful Aging: A study with Lifelong Learners older adults from Costa Rica and Spain.

Subjective well-being is a major psychological construct in the research tradition. Along with literature, authors have distinguished between hedonic and eudaimonic well-being. The aim of this study is to determine the role of some psychosocial variables plays in the perceived well-being is conceived from a hedonic or a eudaimonic perspective. The sample consisted of 1016 people of 55 years and older in a Spanish sample and 277 people of 55 years old or older from a Costa Rican sample. Both samples were part of the Longitudinal Older Learners (LOL) study. A structural model with latent variables was estimated with Mplus. The results point out that, the traditional variables included on successful aging models are relevant for explaining older adults' well-being in both countries with some differences on the hedonic and eudaimonic approach of successful aging on the Latin cultural context studied.

Cross-cultural consistency and relativity in the enjoyment of thinking versus doing.

Which is more enjoyable: trying to think enjoyable thoughts or doing everyday solitary activities? Wilson et al. (2014) found that American participants much preferred solitary everyday activities, such as reading or watching TV, to thinking for pleasure. To see whether this preference generalized outside of the United States, we replicated the study with 2,557 participants from 12 sites in 11 countries. The results were consistent in every country: Participants randomly assigned to do something reported significantly greater enjoyment than did participants randomly assigned to think for pleasure. Although we found systematic differences by country in how much participants enjoyed thinking for pleasure, we used a series of nested structural equation models to show that these differences were fully accounted for by country-level variation in 5 individual differences, 4 of which were positively correlated with thinking for pleasure (need for cognition, openness to experience, meditation experience, and initial positive affect) and 1 of which was negatively correlated (reported phone usage). (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Predictores socioemocionales y cognitivos: su papel en la comprensión del envejecimiento con éxito en el contexto costarricense / Socio-Emotional and Cognitive Predictors: Its Roll on the Comprehension of the Successful Aging in Costarica's Context

RESUMEN Tomando en cuenta las teorías del envejecimiento con éxito, este estudio se orientó hacia la identificación y el análisis de las características que presentan personas adultas mayores con altos niveles de actividad y participación social residentes en Costa Rica. El estudio contó con 191 participantes con edades entre 55 y 87 años (M = 68.5, DE = 6.9) que habitan en el área metropolitana y participan en programas dirigidos a personas mayores en cursos de computación, idiomas, actividad física, arte, entre otros. Mediante modelos lineales, se evidenció la importancia de las condiciones sociales, emocionales y cognitivas como las mejores variables predictoras del nivel de actividad en la muestra estudiada: a) variables emocionales como autoeficacia percibida, emociones positivas, satisfacción con la vida, control personal, adecuadas redes de apoyo; b) características cognitivas como funciones ejecutivas preservadas; c) percepción subjetiva de salud y d) características sociodemográficas como nivel educativo e ingresos. El estudio permite funcionar como línea base, a nivel teórico y metodológico, del envejecimiento con éxito en Costa Rica. Describe los estilos de vida activos en la vejez de los participantes costarricenses, caracterizados primordialmente por la participación en relaciones sociales y ocio, más que por actividades de tipo cognitivas y físicas o vinculadas al logro personal.

ABSTRACT The present study was aimed at identifying and analyzing the characteristics of older people with high levels of activity and social participation living in Costa Rica, from perspectives like the Successful Aging approach. It also addresses the classical criteria of successful aging theories and their scope in Costa Rican culture. 191 participants between the ages of 55 and 87 (M = 68.5, SD = 6.9) who live in the metropolitan area and participate in programs of the Costa Rican Gerontological Association and the Program for the older people at the University of Costa Rica (in computer courses, languages courses, physical activity, art, among others). Linear models analysis has shown that social, emotional and cognitive factors are the best predictors of the level of activity in the analyzed sample. The variables combined to better predict social participation in leisure activities, physical activities, cognitive activities, instrumental functionality and productivity in old age are: a.) Variables of emotional stability as self-efficacy, positive emotions, life satisfaction, personal control, adequate support networks b.) executive functions, c.) perceived subjective health and d.) sociodemographic characteristics such as level of education and income. The study can serve as a baseline for theoretical and methodical descriptions of successful aging in Costa Rica, characterized by a strong orientation to give more importance to social participation and leisure activities rather than cognitive and physical activity or personal achievement.