So far, a review of the literature has shown some of the ways in which shopping may be different for those in later life. In order to show how shopping activity might relate to healthy ageing, first a general introduction to health in later life will be presented.
2.5.1 Definitions of health. Health is a multi-dimensional concept, which captures how people function as well as how they feel (Kuh, Karunananthan, Bergman, & Cooper, 2014). As with theories of ageing, definitions of health have changed throughout history and, consequently, there have been several approaches. These include the pathogenic approach, which views health as the absence of
disability, disease, and premature death. In addition, there is the salutogenic approach, which views health as the presence of positive states and functioning in cognition, affect, and behaviour (Keyes, 2014). Furthermore, there is the approach used in the World Health Organization’s (WHO) definition of health as a complete state. According to the WHO, health is: “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (WHO, 1948). Although these approaches do not use the same criteria, it is clear that health is considered to be a multidimensional concept and one that encompasses aspects of both physical functioning and psychological wellbeing.
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2.5.2 Social model of health. Traditionally, health and health variations have been understood through the social model of health (Dahlgren & Whitehead, 1991), which stresses the influence of social and community networks (including family, friends and wider social circles) on the health of individuals. Thus, improved health and wellbeing can be achieved by focusing on social and environmental
determinants of health along with biological and medical factors (Dahlgren & Whitehead, 1991). However, although the model accommodates variations in behaviours, shopping activities often are overlooked in terms of their potentially positive aspects and implications for health. As will be discussed, shopping as an everyday activity is included as a measure of functional ability but is not regarded as a factor that in itself contributes to health.
2.5.3 Measuring physical health in later life. There is a vast literature
spanning health psychology, social epidemiology, medical sociology and gerontology that has looked at the factors that impact on the health of older people. For the most part these studies rely on a number of well-established measures of health, which typically are self-rated general health (usually measured by a single item), presence of chronic illness, or functional limitation (often measured by activities of daily living (ADL) and/or instrumental activities of daily living (IADL) batteries). Furthermore, as disability and physical functioning are closely related, they are often grouped into one dimension and discussed together (Depp & Jeste, 2006). Having difficulty shopping is one of the items included in IADL scales, which assess an individual’s ability to live independently. Difficulty with tasks such as food preparation, finances and housekeeping are assessed and it has been argued that such tasks can be separated into cognitive and physical domains, though all may require some degree of both (Seidel et al., 2010). Having difficulty shopping may include difficulties relating to body posture (standing, reaching, bending), actions (lifting, holding) and hand function (gripping); however, shopping seems to be dependent on factors other than functional ability (Seidel et al., 2010).
2.5.4 Psychological health. Positive mental health, or wellbeing, describes a condition in which individuals are fulfilling their potential and enjoying their life. From the perspective of positive psychologists, there are three constituents of happiness or wellbeing, which are pleasure (a hedonic route to happiness in which positive emotion is increased), engagement (or gratification through being fully engaged) and
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41 meaning (or purpose in life) (Seligman, Parks, & Steen, 2005). Positive views of mental health have further challenged traditional models in which ageing was marked as a period of decline. There is some evidence from psychosocial studies that with age individuals tend to become happier, have better mental health, are better at managing interpersonal relationships, and that they present fewer negative emotions (Helmuth, 2003).
2.5.4.1 Subjective wellbeing. Subjective wellbeing refers to the evaluations people make of their lives that are made up of both affective reactions and cognitive judgements (Diener, 2000). It is concerned with how and why people experience their lives in positive ways and thus, encompasses happiness, satisfaction, morale and positive affect (Diener, 1984). As a subjective measure it necessarily resides within the individual and does not include objective measures (such as health or wealth) that are potential influences on wellbeing (Diener, 1984). Subjective wellbeing consists of a number of components, which include quality of life, life satisfaction (global judgments of one's life), satisfaction with important domains (e.g., work satisfaction), positive affect (experiencing many pleasant emotions and
moods), and low levels of negative affect (experiencing few unpleasant emotions and moods) (Diener, 2000). Diener et al.’s satisfaction with life scale (Diener, Emmons, Larsen & Griffin, 1985) is a commonly used measure of wellbeing at any age but there are other approaches to consider.
2.5.4.2 Six-factor model of wellbeing. A multidimensional model of wellbeing has been proposed in response to criticism that existing approaches were
‘atheoretical’ (Ryff & Keyes, 1995) and have ignored factors such as purpose in life. In this model, positive psychological functioning is determined by six components. These include: positive evaluations of oneself and one's past life (self-acceptance), a sense of continued growth and development as a person (personal growth), the belief that one's life is purposeful and meaningful (purpose in life), the possession of quality relations with others (positive relations with others), the capacity to manage effectively one's life and surrounding world (environmental mastery), and a sense of self-determination (autonomy) (Ryff & Keyes, 1995).
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