The findings from this study have provided some unexpected, sometimes difficult to explain and potentially useful information for researchers, policy makers and health professionals who work with older people, an increasing segment of New Zealand’s population. Berg, Haffman, Hassing, McClearn and Johansson (2009) suggest that because of age-related deterioration in physical and psychological health at the oldest ages, generalisations of findings of life satisfaction from un-stratified samples of young-old through to oldest-old may not be appropriate. It was therefore important for this study to consider differences across older age which highlighted the
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heterogeneity of older people, an important consideration for research, clinical and policy-making endeavours.
The dramatic marked and sustained increase in satisfaction with life observed at age 85, clearly suggests that this cohort has a different perception of life satisfaction than the younger cohort. Chronological age and cohort more closely followed the trajectory of satisfaction with life, than did the physical, psychological or demographic factors assessed that are generally assumed to be important to the wellbeing of older people and act as indicators of successful ageing. Older people need to be considered not as a homogeneous group, but to have the differences between cohort groups factored in to the writing of national and local body policies related to ‘Ageing’ and ‘OIder People’ and to the development of health-promoting initiatives that are nurse- led or multi-disciplinary in nature. Health professionals may assume that health and functional maintenance is a dominant aspect of life satisfaction and wellbeing in the lives of older people and act as indicators of successful ageing. This Hypothesis could lead to frustration if clinicians find it difficult to engage older clients in health
promotion or rehabilitative initiatives, and the labelling of older clients as ‘non-
compliant’ when faced with health promoting or rehabilitative activities. On reflection of the findings of this study, health professionals may find that the oldest group have different priorities for the use of their time and energy to achieve a sense of
satisfaction with life. Individual assessment and understanding of older client’s priorities will help to establish what is important to their perception of satisfaction with life and so worth putting their time and energy into.
The steady decline observed in physical health and functional ability, with no sharp decline at any stage, might suggest that the health of the increasing number of older adults in New Zealand is generally good. The expected serious health decline among the older population may not occur and create the economic burden anticipated on the health dollar, as self-rated health has been found to predict mortality independently of objective health conditions (Cheng, Fung & Chan, 2007; Idler, Russel & Davis, 2000; Spiers, Jagger, Clark & Arthur, 2003). It must be
remembered however, that this study and the studies reviewed included only older people living in the community; the majority of the oldest people who experience the
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poorest health and functional ability frequently are institutionalised. It is possible that results are an indication of selective survivorship (Idler, 1993). It is also possible that potential community-dwelling participants with very poor health did not choose to participate in the studies.
The finding that the younger groups were the least satisfied with life while reporting the highest levels of physical health, functional ability and mental health is difficult to explain. The younger participants did not tend to make downward social comparisons as did the oldest group and this may provide some explanation. The major financial crisis in New Zealand, previously mentioned, may also have affected their perception of life satisfaction at the time of the survey. However, as no financial information was gathered, this can only be an Hypothesis. Targeted qualitative research would be needed to investigate this unusual and unexpected phenomenon.
Recalling that the purpose of social comparison is self-esteem, self-enhancement and self-evaluation, the findings relating to social comparison orientation and direction were noteworthy and highlight the heterogeneity that exists across old age. The
overall directional pattern of social comparisons suggests that respondents aged 65-77 used the range of three comparison directions indicating that they may view their target ‘other’ from a strengths-based position; it is possible that this may be related to their own character traits (e.g. of optimism or pessimism) (Dumtrache, Windle &Rubio, 2005). Those aged 78-87 no longer made upward comparisons but were still happy to compare equally with ‘same’ and ‘worse’ others. This group is more distant from working life, and closer to a developmental stage where less time is left to achieve large and hitherto unreached goals. Only at age 88 (with the poorest health and functional ability) was the target ‘other’ always ‘doing worse’ than the comparer. It is possible that this represents a survivorship bias (Heiss, 2011; Horner, 2014), as at this age, many peers may have died or been admitted to residential care.
The information related to social comparison provided in this study is potentially useful for health professionals aiming to motivate older clients towards positive health outcomes and functional improvements. Provision of information about a target other in the appropriate direction will allow older clients to compare themselves favourably
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and to be positively motivated or challenged. It is suggested that health professionals utilise a tailored-intervention approach and create appropriate opportunities for older people to engage in social comparisons that match the content of physical intervention to specific client comparison orientation and ability. When a health professional takes the time to understand the client’s directional preference, intervention outcomes may be enhanced. Similarly, being aware of comparison orientation/frequency may provide an indication of the likelihood of social comparison being an appropriate tool.
Comparison orientation (frequency) was found to be stronger in the oldest group and may be best encouraged with clients in this age group. Making effective social comparisons can help increase self-esteem ( Helgeson & Michkelson, 2000) and facilitate effective coping with inevitable age-related losses. Interventions targeting internal communications may help clients clarify thoughts, and what they tell themselves about these thoughts, while not exaggerating differences or
catastrophising about comparison gaps. Judicious use of social comparison as a potential cognitive intervention might help older people obtain a sense of optimism based on how comparisons are interpreted (Bailis et al., 2005). Many age-related health promotion and rehabilitative programmes are geared toward adverse outcomes of increasing frailty, such as reducing falls-risk. Including comparison information in such programmes may help to influence the way older people evaluate these outcomes, so that despite inevitable losses they may be able to maintain a level of satisfaction by adjusting their subjectively determined criteria of satisfaction and successful ageing.