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Article

Connectedness and Successful Aging of Older Adults in Croatia

by
Jadranka Plužarić
1,2,
Ivana Barać
1,*,
Vesna Ilakovac
2,
Robert Lovrić
1,
Nikolina Farčić
1,3,
Željko Mudri
1,
Marija Barišić
1 and
Ivana Pavlić
1
1
Nursing Institute “Professor Radivoje Radić”, Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
2
Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
3
Department of Surgery, University Hospital Centre Osijek, 31000 Osijek, Croatia
*
Author to whom correspondence should be addressed.
Sustainability 2023, 15(14), 10843; https://doi.org/10.3390/su151410843
Submission received: 29 May 2023 / Revised: 4 July 2023 / Accepted: 7 July 2023 / Published: 11 July 2023
(This article belongs to the Special Issue Enhancing the Sustainability of Healthy Ageing and Long-Term Care through Innovations)
Review Reports Versions Notes

Abstract

:
Connectedness is a multidimensional human experience that is essential to successful aging. The aims of this cross-sectional study were to assess connectedness and self-perception of successful aging in older people, to examine whether there are differences in relation to basic characteristics, and to examine whether there is a connection between connectedness and self-perception of successful aging. The respondents were elderly people in the Republic of Croatia. Data were collected using two validated scales: Croatian versions of the Register–Connectedness Scale for Older Adults and the Self-Assessment Scale of Successful Aging. The study included 824 respondents, of which 319 (38.7%) were men and 505 (61.3%) were women. The median age was 72 years. The median connectivity of the respondents was 8.9 (IQR= 7.6–10.2), and the median rating of successful aging was 3.25 (IQR = 1–5). Spearman’s correlation coefficient ρ (p value) was 0.585 (<0.001). Connectivity was rated better by respondents with a higher level of education, who were married, resided in their own homes, used modern technologies, and were active in the community. There is a significant positive association between connectedness and the self-perception of successful aging overall, as well as in all individual connectedness domains.

1. Introduction

New perspectives on aging attempt to shift the focus away from the negative aspects of aging, such as explaining aging as a time of weakness and decline. The aims of the new perspectives are to focus on the positive aspects of aging and to see older adults as an economic and social asset rather than as a burden on society [1]. The World Health Organization defines healthy aging as the process of developing and maintaining functional ability that enables well-being in old age. Well-being is based on an older person’s assessment of his or her ability to be and do what he or she wants and values most [2]. Healthy and successful aging is a critical component of sustainable aging [3]. Life satisfaction, good social relationships in the context of connectedness, and preserved psychological resources are increasing possibilities to maintain and improve the quality of life in old age, regardless of impaired health [4,5,6]. Research on the psychosocial factors of successful aging highlights the significant impact of a positive self-perception of aging on the quality of life of older adults [7].

1.1. Connectedness—Meaning and Theoretical Framework

Connectedness is a key component of successful aging and can affect mental, physical, and emotional health. Decreased connectedness can lead to a series of negative events, such as overuse of health services, pressure on families, and premature institutionalization. Better connectedness with people and systems can prevent unpleasant emotional experiences and physical deterioration that diminish the potential of older people to achieve and maintain successful aging [8]. Connectedness is a synchronous, harmonious, and interactive state of human presence that is released from temporal and spatial constraints, which produces and maintains the quality of life of older adults [8]. It is defined as an experienced connection with the forces and processes that constitute sustainable quality of life [9].
Connectedness is, as a conceptual model, incorporated into Register’s middle-range theory of Generative Quality of Life for the Elderly, which is grounded on the General System Theory [8]. The General System Theory propagates the continual importing, transforming, and exporting of energy in accordance with the environment, which maintains the sustainability of the system [8,10]. The focus of connectedness is on maintaining, sustaining, and restoring connections with the forces and processes that are preconditions for sustainable, healthy, and successful aging [8]. Register and Scharer contended defining connectedness as a concept of quality of life viewed from a generative perspective [11]. The bases of the connectedness phenomenon are prominent connections in the lives of older people, with the help of which they can live in a more meaningful, positive, and purposeful way and thus contribute to more successful aging. Older adults generate quality of life while experiencing connectedness through six intercorrelated concepts: metaphysically connected (being aware of oneself as part of a larger universe), spiritually connected (being aware of a higher power and seeking purpose and meaning in life), biologically connected (optimizing functional abilities and participating in health promotion and preservation activities), connected to others (includes interpersonal relationships that do not have spatial and temporal limitations), ecologically connected (connected to the environment that surrounds us), and socially connected (includes personal and global social systems) [8].
In the literature, there are studies focused on the individual dimensions of connectedness, such as social connectedness [12,13,14] or spiritual connectedness [15,16]. However, older adults do not experience connectedness one by one, as an individual area, but rather as a whole, shared experience. If multidimensionality is left out in research on connectedness, methodological doubts may arise.
Connectedness is an intrinsic construct that is not always visible to outside observers. Self-perceived connectedness can only be assessed by older adults, which requires individual assessment. Register, Herman, and Tavakoli developed an instrument for quantifying multidimensional connectedness that was used in this study [5,17,18,19,20].

1.2. Importance of Sustainability in Successful Aging

Older adults perceive successful aging as more complex than many researchers and express many other factors, such as a sense of purpose and meaning in life, spirituality, learning new things, financial security, productivity, achievement, contribution to life, physical appearance, and sense of humor [21]. A major implication for researching and promoting the quality of life of older adults and successful aging from a generative perspective is the existing need for a sustainable resolution for aging societies. A longer and healthier life is important, both for the individual and for society, because it opens up new opportunities for the participation and inclusion of older people in an economic and social life, which contributes to the health and well-being of the individual. It is predicted that the increasing number of older adults will not only increase economic demands within the health and social system but also affect the abilities of social structures to respond accordingly, which is a major sustainability challenge for society [9]. Ethical dilemmas that can arise during the allocation of resources in the community can increase the risk of losing services for older adults and endanger their health. A special challenge for the sustainability of successful aging is the inequality between life expectancy and years of healthy life remaining, which is a cause for concern that needs to be addressed urgently [22]. Relevant solutions for reducing the negative financial and ethical effects of demographic aging on society and improving health outcomes for older adults is the promotion of a model of successful aging [23].
According to the 2021 census, the population of the Republic of Croatia is 3,888,529 people. Of these, 868,638 (22.3%) are over 65 years old, with a proportion of 58.41% (361,518) women and 41.60% (507,721) men [24], making Croatia one of the countries with the oldest population in Europe. In the Republic of Croatia, encouraged by international initiatives, positive legal regulations related to the care of older adults have been adopted, but they have not yet been sufficiently implemented in practice. Additionally, this happens in other countries that have strong influences on traditional relations in society, where the care of disabled older adults is usually left to the family [25]. The modern concept of and way of life in a family, with the absence of adequate support from the social community, such as insufficiently developed, non-institutional care and the lack of accommodation capacity in institutions for permanent accommodation, makes this way of care unsustainable. Many older adults, especially those living in single households, face numerous obstacles and interruptions of connectedness, which limit their access to services and prevent them from participating in society and the community.
One of the priority areas of activity under the motto “Decade of Healthy Aging” is to help older people maintain relationships and activities that are important to them [2]. The applicability of research on successful aging and its dimensions is evident in the discovery of factors that contribute to longevity, better quality of life in older age, and the promotion of a healthy lifestyle [26]. Research on successful aging should consider the cultural, religious, and social contexts of the community [27]. Understanding various processes associated with connectedness can provide researchers and practitioners with information on how to strengthen connectedness and thereby promote successful aging and community sustainability.
In order to ensure the quality of life of older adults with social sustainability, the involvement of all stakeholders who care for older adults is necessary. Nurses who are on the front line, both in healthcare facilities and in the community, can greatly contribute to sustainable, successful aging by applying integrated, comprehensive, and cost-effective interventions. Healthcare professionals need to understand the key role of connectedness in the quality of life of older adults and develop care strategies and interventions that create opportunities for connectedness [11].
According to our knowledge, there has been insufficient research that examines multidimensional connectedness and its relation to other factors of successful aging in various groups of older adults and different ethnic and cultural environments.
That is why the aims of this study were to assess the level of connectedness and self-perception of successful aging in older adults, determine whether there are differences in relation to the basic characteristics of the respondents, and examine the association between the level of connectedness and self-perception of successful aging.

2. Materials and Methods

2.1. Study Design

This cross-sectional study was conducted between May and October 2022 in the Republic of Croatia. Respondents were interviewed in their own home or nursing home with privacy ensured. Before being enrolled in the study, respondents were given detailed information about the purpose of the study, ethical issues, and how to complete the questionnaire. Respondents had the right to withdraw before and during the filling out of the questionnaire. Each respondent signed the informed consent. The anonymity of the respondents was guaranteed. Data were collected individually (“face to face”), ensuring the privacy and anonymity of each respondent. The enumerator helped the older adults who had difficulties with reading or understanding certain items of the questionnaire but did not in any way suggest an answer or participate in its selection. The time for completing the questionnaire was not limited.

2.2. Respondents

The study included 824 older adults from Osijek-Baranja County who live either in their house or in a home for the elderly and disabled. In order to be included in the study, respondents had to meet all the criteria for the selection. The inclusion criteria were: (a) people aged 65 and over, (b) people who understand and speak the Croatian language, and (c) voluntary participation (signed informed consent). The exclusion criteria were: (a) people aged under 65, (b) people with whom it is not possible to establish contact, and (c) people who did not sign the informed consent.

2.3. Instruments

The research instrument was an anonymous three-part questionnaire. The first part of the questionnaire included information on the socio-demographic characteristics of the respondents, with 13 items of background information (gender, age, subjective age, level of education, occupation, place of residence and housing choice, marital status, parenthood, and social inclusion).

2.3.1. Register–Connectedness Scale for Older Adults

The second part of the questionnaire was a validated instrument, the Register—Connectedness Scale for Older Adults (R-CSOA). The construction of the R-SCOA was based on Register’s model of Generative Quality of Life for the Elderly. The instrument examines the frequency and relevance of different dimensions of connectedness from a multidimensional perspective. Relevance scores inform the salience of links in the environment of older adults, and frequency scores help to identify the types of links that an individual typically uses. The Register–Connectedness Scale for Older Adults (R-CSOA) has two parts. Each part contains 43 items distributed in five subscales: Self-Regulating, Facing Aging, Being Part of a Family, Having Friends, and Being Spiritual. In the first part, respondents rate their satisfaction with each item (1—not at all satisfied; 2—poorly satisfied; 3—mostly satisfied; 4—completely satisfied). In the second part, respondents rate the importance of the same items (1—not at all important to me; 2—mostly not important to me; 3—mostly important to me; 4—very important to me) [17].
The applied Croatian version of the instrument was psychometrically analyzed on 698 elderly people in the Republic of Croatia and showed good construct validity, sensitivity, and reliability. The internal reliability Cronbach’s alpha value was 0.968, which meant that the questionnaire was a suitable instrument for assessing connectedness in our sample. The scale consists of five domains of good internal reliability, from 0.912 to 0.933. It is currently in the publishing phase.

2.3.2. Self-Assessed Successful Aging Scale

The third part of the questionnaire included the Croatian version of the Self-Assessed Successful Aging Scale [28], the instrument that measures how respondents self-assess successful aging. The scale is based on the Croatian translation of the list of 20 characteristics of successful aging [19,20].
It included 20 items that respondents assessed on a 5-point scale (1—does not apply to me; 2—partially applies to me; 3—applies to me; 4—mostly applies to me; 5—totally applies to me). The statements cover most of the dimensions that belong to the construct of successful aging. This questionnaire is a reliable and applicable instrument in the research of older adults since it is methodologically valid, has a positive international rating, and has a validated version in the Croatian language. The internal reliability Cronbach’s alpha value was 0.893 for the overall scale.

2.4. Data Analysis

Categorical data are presented in absolute and relative frequencies. The normality of the distribution of numerical variables was tested by the Shapiro-Wilk test. Numerical data are described by the median and the interquartile range bounds. Differences in the numerical variables between two independent groups were tested by the Mann-Whitney U test, and differences between three or more independent groups were tested by the Kruskal Wallis test (post hoc Conover). We evaluated the internal reliability of the scales via the Cronbach alpha coefficient. All p values were two-sided. The significance level was set to alpha = 0.05. The statistical program Med Calc® Statistical Software, version 19.6, was used for the statistical analysis.

2.5. Ethical Considerations

The respondents were informed of all the details and ethical considerations regarding this study prior to filling in the questionnaire. They were guaranteed anonymity, both during filling in the questionnaire and after the research, and the data obtained during the research were available only to the researchers. Respondents, who were informed about the aim of the study in writing, signed the informed consent. The respondents had the right to withdraw at any moment. Only the researchers had access to research data.
The researchers obtained the author’s consent to use the original version of the Register-Connectedness Scale for Older Adults for translation and as a research instrument in this study. Consent was also obtained for the use of the Croatian version of the Self-Assessed Successful Aging Scale by Croatian authors. The study was conducted in accordance with the Declaration of Helsinki. The study was approved by the relevant Ethics Committee (class: 62-04/22-08/02, reg. number: 2158-61-46-22-81; date of approval 23/04/2022).

3. Results

The study included 824 respondents. There were 319 (38.7%) men and 505 (61.3%) women. The median age was 72 years (IQR = 68–79). According to the self-assessed age, the median was 68 years (IQR = 60–75). Further, 55% lived in an urban residence, and almost 79.2% lived in their own house. Of the total number of respondents, 47.8% were married, but 41.7% were widowed (Table 1).
The largest number of respondents lived with a spouse, 37.7%, but also 30.7% were single. Of the respondents, 60.3% used modern technology, mainly smartphones, but only 14.7% of them were involved in a form of association membership. Further, 37% of them had and took care of a pet (Table 2).
There were significant differences in the area of the Facing Aging Subscale between male and female respondents (p = 0.009). Male respondents better faced aging (M = 9.2). On the contrary, female respondents had higher values in the Being Spiritual Subscale (M = 10.4) (Table 3). Respondents who had a higher level of education had higher values in the Self-Regulating domain (M = 9.4, p = 0.03), while primary-educated respondents, in relation to highly-educated respondents, had a higher level of spirituality (M = 10.7, p < 0.001). (Table 3).
There were significant differences in all domains and total scale scores in relation to place of residence. It is evident that respondents who live in their own house have higher values in all areas of connectedness, as well as in total (p < 0.001) (Table 3).
There was a significant difference between respondents in almost all domains of connectedness, as well as overall, except in the area of having friends (p = 0.06), even though married respondents had the highest mean value (M = 8.5). In the area of spirituality, respondents who were widowed had the highest value (M = 9.8) (Table 3).
There was a significant difference between respondents in relation to the usage of modern technology in almost all domains of connectedness, as well as overall (p < 0.001), except in the area of spirituality (p = 0.49) (Table 3).
Although a smaller number of respondents were involved in some of the associations and/or clubs for older adults, there were significant differences in the overall assessment of connectedness (p = 0.001) (Table 3).
Self-Assessed Successful Aging Scale median was 3.25 (interquartile range from 2.8 to 3.75) in the range of 1 to 5. A higher score refers to the perception of one’s own aging as more successful by those who: use modern technologies (p < 0.001), are members of senior citizens associations (p < 0.001), live in their own house/apartment (p < 0.001), and are married (p < 0.001) (Table 4).
There was a significant correlation between the perception of successful aging and connectedness. If the perception of successful aging was better, the connectedness score was also better (Table 5).

4. Discussion

This study attempted to quantify connectedness as a key component of successful aging and examine its association with the perception of successful aging among older adults. The obtained results can help to identify factors that contribute to successful aging and consequently enable the development of strategies and planning of interventions that promote successful aging.
Based on data from the Organization for Economic Cooperation and Development (OECD), a multidimensional Aging Society Index was developed that assesses the status of the elderly population in five areas and allows comparison between countries. For 18 OECD countries, the results demonstrate substantial diversity in countries’ progress in adapting to aging. The countries of Central and Eastern Europe are at the bottom with a large untapped potential for successful aging, where Croatia is also located. Cohesion and connectedness are recognized as one of the important factors of successful aging in adapting to an aging society [29].
The study included 824 respondents. The gender distribution in this research was similar to the proportion of men and women in Osijek-Baranja County, where 40.86% of men and 59.14% of women are over 65 years old [24]. Results by gender, age, and level of education correspond to the distribution of the older population in relation to gender, age, and educational structure in the Osijek-Baranja County of the Republic of Croatia [24,30]. Recent research indicates that the increasing proportion of women in the population of older adults can lead to gender inequality in achieving sustainable aging. Older women are generally more likely than older men to face severe difficulties in accessing basic goods and services, such as health services, long-term care, and decent housing, owing to a range of factors, such as the gender pay gap, the pension gap, women’s greater longevity, and the greater proportion of older women living alone [22].
The median chronological age was 72 years, while the median subjective age (how old one feels) was 68 years. The results of several studies on older adults in the Republic of Croatia show that most older adults feel younger and perceive themselves as younger in relation to their chronological age [31,32]. The effort that a person makes to feel younger than they chronologically are is one of the ways of denying aging and raising self-confidence. Additionally, it is positive because it contributes to greater psychological well-being [33,34].
In most developed countries, older adults are considered to be people over 65 years of age, which often does not correspond to the actual economic and social activities of older adults. The age group over 65 is very heterogeneous, with significant differences in health, lifestyle, and living and social conditions, so focusing on the age of 65 as an upper age limit is no longer appropriate [35].

4.1. Assessment of Connectedness of Older Adults

The total score of connectedness in respondents was M = 8.9 in the range of 7.6 to 10.2, which represents 75% of the scale maximum. This result showed very good connectedness in older adults in the Republic of Croatia. The best-scored domain was Being Part of a Family (M = 9.5), and the lowest-scored domain was Having Friends (M = 8.1). A similar study conducted among a group of older adults in the USA had a better score of overall connectedness, which was 82% of the scale maximum. Additionally, the best-scored domain was Self-Regulating, and the lowest-scored domain was Being Spiritual [17,36]. These differences can be explained by the fact that the respondents in this study had a higher level of education, and previous studies have indicated that people with a higher level of education have better self-regulation, while spirituality is associated with a lower level of education. [37,38].
Furthermore, this research included older adults with reduced functional abilities who live in a nursing home or in their own home, in contrast to respondents in the USA who had good functional abilities and were actively involved in community life [37]. Respondents who lived in their own home or with their family had a higher level of overall connectedness in relation to those who lived in nursing homes. This result confirms the results of other research conducted in the Republic of Croatia, which state the benefits of living, aging, and connecting in one’s own home in relation to a nursing home [39].
Connectedness was better among respondents who were married and had children. Previous research clearly indicates that marriage and parental satisfaction in older adults have a positive effect and contribute to their successful aging [40,41]. Traditional family relationships, which are also present in the Republic of Croatia, still support the children’s responsibility to care for their parents, although this is becoming increasingly difficult to achieve due to changes in the structure and dynamics of the family [3]. This study found no difference in the overall connectedness in relation to gender and level of education. There was also no difference in relation to the place of residence, i.e., whether the respondents lived in urban or rural areas. This finding can be explained by industrialization, urbanization, and globalization processes that have led to changes and slight differences in the way of life between urban and rural areas [42,43,44].
There were differences in certain domains in relation to some characteristics of the respondents. The domain Self-Regulating was scored higher by respondents with a higher level of education, who lived in marriage, resided in their own home, used modern technologies, and who were members of senior citizen associations. Self-regulation was negatively related to age and positively related to self-assessment of mental and physical health, which is consistent with the study conducted in the USA, according to which the promotion of self-regulation has a positive effect on the health of older adults [37]. People who have a higher level of education and are actively involved in society have better self-regulation [45].
Female respondents and respondents with a lower level of education assessed the domain of Being Spiritual as significantly higher. This result is consistent with the study conducted in the Republic of Croatia, according to which women and people with a lower level of education tend to be more religious [38,46]. In relation to marital status, the domain Spirituality was rated higher by respondents who were married or widowed compared to unmarried and divorced respondents and those who lived in their own home and had children. The domain Spirituality was scored higher by respondents who were actively involved in various senior citizen associations, including religious associations. These results are in line with the results of research conducted in other cultural and ethnic settings [40,47].
The domain Being Part of a Family was assessed the highest in this study. Respondents who lived in marriage, owned their own home, had children, and used modern technologies assessed this domain significantly higher, which is in line with the results of several studies that emphasize the importance of maintaining family ties in old age and the positive role of modern technologies. The use of modern technologies enables communication and independence, especially for older adults who are separated from family members and friends or have mobility impairments. This was particularly noticeable during the COVID-19 pandemic when numerous restrictions were imposed preventing close contact with the family [48,49]. Although older adults are usually deprived of the burden of an active parental role, parenthood remains an important aspect of their life that strongly affects their well-being. The results of the study show that parents remained focused on their children and tried to maintain close contact with them even after their children had left their parental home. Their relationship with their children remained an important source of happiness and satisfaction in life. Therefore, it can be assumed that parental satisfaction in older adults also contributes to successful aging as a wider construct in relation to subjective well-being variables [41]. Some results show that older adults who take care of their grandchildren or live with their children can significantly reduce depression [50].
The lowest-rated domain was Having Friends. It was rated higher by respondents who were active members of various senior citizen associations and who lived in nursing homes. Research shows that friendship is strongly associated with well-being and better cognitive functioning in older adults [48]. Since meetings with less close people in senior citizens associations or in nursing homes are optional and include socializing and fun, they are associated with better mood [49]. Relationships with others, including family and friends, are key elements of older adults’ well-being [2]. Social support is one of the key measures of cohesion, and in 18 OECD countries, on average, 89% of older people said they have a friend or relative they can count on for help in case of need [29]. The United States is among the top, with 91.5% of respondents saying they have someone they can confide in, showing that older Americans are well-connected, contrary to the popular perception of social isolation in later life [51]. In contrast, a study conducted in Japan found that the prevalence of social isolation was 31.0% for older adults living alone and 24.1% for older adults living with family [52].
The Coping with Aging domain was evaluated by the respondents through ten items that describe their thoughts and activities while facing the normal aging process and their own mortality. Strategies for coping with aging include the individual’s self-regulation, with the aim of reducing the emotional consequences of stressful [53]. Respondents who use modern technologies assessed overall connectedness and all domains of connectedness as significantly high, except the domain Being Spiritual. Numerous studies highlight the positive impact of using modern technologies on coping with aging and connecting with family and friends. Older adults who use modern technologies find that they are more satisfied, more productive, and better socially included. Additionally, they cope better with the aging process and estimate that they age more successfully [36,54,55].

4.2. Self-Assessment of Successful Aging

Successful aging was assessed using the Self-Assessed Successful Aging Scale, where a higher score indicated a better perception of one’s own aging. The median of successful aging in this study was 3.25 in the range of 1–5. A slightly better result of M = 3.7 was obtained by research conducted in the Republic of Croatia [28]. Aging was self-assessed higher by respondents who used modern technologies, lived in their own home, were married, and were members of senior citizen associations. More than 50% of respondents answered the open question, “What else is important to you for successful aging?” stating that it is health, the ability to take care of themselves until death, and a good relationship with family and friends.
Although pensions in Croatia do not even meet the basic needs of a large number of older adults, people, money, pension, and finances were mentioned by less than 5% of respondents. This result corresponds to a survey conducted in Poland, according to which older people emphasize universal values such as family, honesty, happiness, and love as the most important in life, much more than work, career, or money [56]. On the contrary, another survey conducted in Southeast Europe shows that financial security was important for almost 30% of respondents [57]. In retirement, older people are at a greater risk of poverty, with financial worries and job withdrawal predicting post-retirement stress [58]. Poverty in older adults makes it difficult to participate in social activities, so social ties are reduced, and the probability of social isolation increases [59].
More than 10% of the respondents in this study, which was conducted in 2022, stated that peace in the world is important for successful aging. This statement is notable since it occurred very rarely in the research conducted in 2020 in the Republic of Croatia [57], which was prompted by current war events, i.e., the instability of peace in Europe. Older adults who follow daily events and share concerns about the future and sustainability of the community in which they live face the aging process more effectively [8].

4.3. Relationship between Connectedness and Successful Aging

There was a significant association between the self-perception of successful aging and overall connectedness, as well as among all individual domains. The strongest association was with the Self-Regulating domain. The Self-Regulating domain was significant in the self-perception of successful aging more than other domains, and it was scored higher by respondents with a higher level of education, who lived in marriage, resided in their own home, used modern technologies, and were members of senior citizen associations.
These results are in accordance with the adopted resolution of EU countries on sustainable aging [22], which recommends encouraging lifelong education, primarily training in the use of modern technologies [60]. Numerous studies indicate that the preservation of psychophysical health through the active use of modern technologies could be one of the important factors for encouraging connectedness and more successful aging [36,54,55].
It is especially important to achieve a successful and sustainable connection with the social systems with which older adults are often in contact. These are primarily health and social care systems. In this research, more than 60% of respondents used modern technologies, mostly smartphones. However, the health system still does not follow this fact to a sufficient extent, and older adult people often encounter “disconnections” in communication with the health system, which makes it difficult to access health services and negatively affects the quality of life. Innovative technological solutions, without great costs, can ensure better connectedness of older adults with the healthcare system, which enables better healthcare and a better quality of life [61].
Furthermore, it is necessary to develop sustainable social support for the dignified lives of older adults in their own home, which implies access to quality and comprehensive services adapted to their personal needs and prices. Care services must be designed to respect the differences among older adults with a wide range of preferences regarding the types of care services they need, thus enabling independent living for all categories of older people [22]. Given, in the Republic of Croatia, that older adult people with reduced functional capacity and increased care needs mainly rely on family, it is necessary to provide support to informal care providers in order to not only improve the quality of life of care recipients but also to quickly identify new needs in order to respond to them in a sustainable way [62].
It is important to promote programs, projects, and activities that encourage the participation of older people in social, cultural, and political life by organizing various activities in the community [22]. By participating in various activities, older people improve their well-being by building supportive relationships with other members involved in the activities and represent a valuable resource that increases the connection and sustainability of the local community in which they live [63,64].
Additional research is needed to advance understanding and identify innovative, evidence-based strategies that can be used to promote connectedness and quality of life in older adults. The identification of predictors of successful aging is important for public health policymakers who are interested in adapting health, social, pension, educational, and other social systems to the growing and changing needs of older adults. The results of such policies could, instead of a competition, become a gain for all generations [65,66,67]. Nurses and other healthcare professionals need to understand the critical role of connectivity in elder care and plan interventions that facilitate connectivity [11]. Strategies and interventions should be directed towards creating opportunities for connection, which can be implemented without significant financial and organizational requirements. These can be programs that include meaningful activities for older adults, such as education on the use of modern technologies, preserving health and functional ability, strengthening self-esteem and the process of self-regulation, and strategies for effectively coping with the aging process. It is also necessary to enable connections with family and friends in all places and conditions where older adults live.
As people live and work longer, investing in educational programs and skills development can extend the productive lives of older adults. If older people get involved in society through paid activities or volunteering, this can have a double benefit. Older people provide society with an economic benefit, as they directly participate in the workforce. At the same time, older adults improve their physical health and cognitive functioning through numerous activities and facilitate social cohesion and sustainability through a shared sense of purpose [68].
Older adults should be considered active participants in the community who can make a significant contribution to the development of society. With small changes in organization, without much investment, they can join society and use their knowledge and experience for mutual benefit.

4.4. Limitations of the Study

There are certain limitations of this study. To start with, the convenient sample of respondents in this study makes it impossible to generalize the results to all older adults in the Republic of Croatia. Furthermore, survey data collection allows respondents to give socially desirable answers, despite the fact that the questionnaire is completely anonymous. Finally, although the data were collected using standardized and validated instruments, certain limitations are possible in the comprehensiveness of the insight into the self-assessments of the respondents, which can otherwise be achieved by a combination of quantitative and qualitative research approaches.

4.5. Implications for the Future Research

In future research, it would be desirable to include assessments of objective indicators, such as health status and the assessments of close people, in addition to the self-assessments of respondents. Implications for future research state the use of OPV (Online Photovoice) as one of the effective and innovative qualitative research methods. OPV gives opportunities to the participants to express their own experiences. Future researchers can conduct qualitative or mixed-method research on the same or similar topics utilizing OPV to understand connectedness and successful aging among older adults and to examine the lives of older people and their experiential activity to increase group and organizational synergy [69,70].

5. Conclusions

The overall score of connectedness in respondents indicates a very good connectedness in older adults in the Republic of Croatia. The highest-scored domain was Being Part of a Family, and the lowest was Having Friends. Connectedness was assessed higher by respondents with a higher level of education, who lived in marriage, resided in their own home, used modern technologies, and were active in the community. There was a significant positive association between connectedness and self-perception of successful aging in total, as well as in all individual domains, which confirms the significant contribution of connectedness in the positive perception of aging as a prerequisite for successful, healthy, and sustainable aging. States must respond to the challenges brought by the growing number of older adults in society by adopting public policies that will develop strategies and adapt social systems to the growing and changing needs of older adults. As part of the sustainable development of the health system, health professionals, in their daily work with older adults, can carry out interventions aimed at facilitating and maintaining connectedness and strengthening the personal potential of older adults themselves to achieve well-being in accordance with their needs, wishes, and abilities.

Author Contributions

Conceptualization, J.P., I.B. and V.I.; methodology, J.P., I.B., V.I., R.L., M.B., Ž.M. and I.P; software, V.I.; validation, I.B., N.F., Ž.M. and M.B.; formal analysis, Ž.M., M.B. and I.P.; investigation, N.F. and I.P.; resources, J.P., I.B. and V.I.; data curation, I.B., R.L. and N.F.; writing—original draft preparation, J.P. and V.I.; writing—review and editing, I.B., R.L., N.F., Ž.M., M.B. and I.P; visualization, V.I. and R.L.; supervision, J.P., I.B., R.L., N.F. and Ž.M.; project administration, M.B. and I.P.; funding acquisition, J.P. and I.B. All authors have read and agreed to the published version of the manuscript.

Funding

This research was funded by the University of Osijek, Faculty of Dental Medicine and Health Osijek, grant number P9 (class: 602-01/22-12-01; order number 2158/97-97-10-22-05). The APC was funded by the Faculty of Dental Medicine and Health Osijek.

Institutional Review Board Statement

The study was conducted in accordance with the Declaration of Helsinki and approved by the Ethics Committee of the Faculty of Medicine, Osijek class: 62-04/22-08/02, reg. number: 2158-61-46-22-81; date of approval 23 April 2022.

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study. Written informed consent has been obtained from the patient(s)/client(s) to publish this paper.

Data Availability Statement

All authors agree that data can be shared upon request. The request must be addressed to either the first author or the corresponding author of the article.

Acknowledgments

We would like to thank the 3rd year nursing students for their administrative and technical support and the participants for their participation in the study.

Conflicts of Interest

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

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Table
Table 1. General characteristics of respondents.
Table 1. General characteristics of respondents.
Characteristics of RespondentsN (%)
Gender
Male319 (38.7)
Female505 (61.3)
Place of residence
Rural360 (43.7)
Urban453 (55)
Other11 (1.3)
Housing
Own house, apartment 653 (79.2)
With children63 (7.6)
With relatives, friends4 (0.5)
Foster family6 (0.7)
Nursing home96 (11.7)
Other2 (0.2)
Marital status
Married/Common-law394 (47.8)
Single26 (3.2)
Divorced60 (7.3)
Widowed344 (41.7)
Parenthood
With children744 (90.3)
Childless80 (9.7)
Median (IQR)
Number of children2 (2–3)
Table
Table 2. Respondents in relation to household, level of education, occupation, use of modern technologies, association membership, and assessment of physical and mental health.
Table 2. Respondents in relation to household, level of education, occupation, use of modern technologies, association membership, and assessment of physical and mental health.
Characteristics of RespondentsN (%)
Household
One-person253 (30.7)
With spouse/partner311 (37.7)
With spouse/partner and children79 (9.6)
With children131 (15.9)
With relatives9 (1.1)
With friends13 (1.6)
Other28 (3.4)
Level of education
Unfinished primary education50 (6.1)
Primary 264 (32)
Secondary429 (52.1)
Bachelor’s degree24 (2.9)
Master’s degree57 (6.9)
Modern technology usage497 (60.3)
Club/association membership121 (14.7)
Pet305 (37)
Median (IQR)
Physical health assessment3 (3–4)
Mental health assessment3 (3–4)
Table
Table 3. Differences in domains and total scale in relation to gender, level of education, place of residence, marital status, and use of modern technology.
Table 3. Differences in domains and total scale in relation to gender, level of education, place of residence, marital status, and use of modern technology.
Subscale
Characteristics		Self-RegulatingFacing
Aging		Being Part
of Family		Having
Friends		Being
Spiritual		Total
Scale		p-Value
(Total)
Median (Interquartile Range)
Gender
Men8.9 (7–11)9.2 (8–11)9.3 (8–11)8.1 (7–11)7.5 (6–11)8.8 (8–10)0.38 *
Woman8.9 (7–11)8.5 (7–10)9.6 (8–11)8.0 (7–11)10.4 (8–12)8.9 (8–10)
p (domain)0.650.0090.320.72<0.0010.38
Education
Primary8.7 (7–10)8.7 (7–10)9.4 (8–11)7.8 (6–11)10.7 (8–12)8.9 (8–10)0.48 **
Secondary8.9 (7–10)8.8 (7–10)9.5 (8–11)8.4 (7–11)8.4 (7–12)8.8 (8–10)
Tertiary9.4 (8–11)9.3 (8–11)9.6 (8–12)8.7 (7–11)8 (6–10)9.3 (8–10)
p (domain)0.030.320.770.31<0.0010.48
Place of Residence
Own house ap.9 (8–11)8.9 (7–10)9.8 (8–11)8.2 (7–11)9.4 (7–12)9 (8–10)<0.001 **
Nursing home8.6 (7–10)8.7 (7–10)8.4 (7–10)8.4 (7–11)8.3 (6–11)8.5 (8–10)
Other7.5 (6–10)8.1 (6–10)8.2 (7–10)7.5 (5–9)7.5 (6–12)8.1 (7–10)
p (domain)0.0020.03<0.0010.0050.005<0.001
Marital status
Married9 (8–11)9.2 (8–10)10.2 (8–11)8.5 (7–11)8.8 (7–12)9.2 (8–10)<0.001 **
Widowed8.5 (7–10)8.6 (7–10)8.9 (8–11)7.8 (6–11)9.8 (7–12)8.7 (8–10)
Other7.9 (7–10)8.3 (7–10)7.5 (6–9)7.7 (6–10)7.5 (6–11)8.4 (7–10)
p (domain)<0.0010.004<0.0010.060.002<0.001
Technology usage
Use9.3 (8–11)9.1 (8–11)10.1 (8–11)8.7 (7–11)9.3 (7–12)9.2 (8–10)<0.001 *
Do not use7.8 (7–10)8.3 (7–10)8.5 (7–11)7.5 (6–10)9.1 (7–12)8.3 (7–10)
p (domain)<0.001<0.001<0.001<0.0010.49<0.001
Membership association
Members9.8 (8–11)8.9 (8–10)9.8 (8–11)9.4 (8–11)10.4 (8–12)9.3 (8–11)0.001 *
Not members8.7 (7–10)8.7 (7–10)9.4 (8–11)7.9 (7–11)8.8 (7–12)8.8 (8–10)
p (domain)<0.0010.200.46<0.0010.0040.001
* Mann-Whitney U test. ** Kruskal-Wallis test (Post hoc Conover).
Table
Table 4. Differences in self-perception of successful aging in relation to characteristics of respondents.
Table 4. Differences in self-perception of successful aging in relation to characteristics of respondents.
CharacteristicsMedian (IQR)Difference95% CIp-Value
Gender
Male3.35 (2.85–3.80)−0.05−0.15 to 0.050.19 *
Female3.25 (2.80–3.70)
Parenthood
Yes3.30 (2.80–3.75)−0.10−0.25 to 0.100.34 *
No3.20 (2.73–3.70)
Technology
Yes3.45 (2.95–3.85)−0.35−0.45 to −0.25<0.001 *
No3.05 (2.65–3.55)
Association member
Yes3.50 (3.04–3.97)−0.25−0.35 to −0.10<0.001 *
No3.25 (2.80–3.70)
Level of Education
Primary3.20 (2.75–3.70) 0.07 †
Secondary3.30 (2.90–3.75)
Tertiary3.45 (2.85–3.91)
Housing
Own house/apartment3.35 (2.85–3.80) <0.001 †‡
Nursing home3.05 (2.73–3.58)
Other3.0 (2.41–3.49)
Marital status
Married3.40 (2.90–3.85) <0.001 †§
Widowed3.20 (2.70–3.65)
Other (single/divorced)3.03 (2.65–3.65)
* Mann-Whitney U test; † Kruskal-Wallis test (Post hoc Conover). ‡ at p < 0.05, respondents living in their own house or flat are significantly more satisfied in relation to all other groups. § at p < 0.05, married respondents are significantly more satisfied in relation to all other groups.
Table
Table 5. Association between perception of successful aging and connectedness.
Table 5. Association between perception of successful aging and connectedness.
Spearman’s Correlation Coefficient ρ (p-Value)
Scale of Perception of Successful Aging
Self-Regulating0.619 (<0.001)
Facing Aging Subscale0.420 (<0.001)
Being Part of a Family Subscale0.460 (<0.001)
Having Friends Subscale0.472 (<0.001)
Being Spiritual Subscale0.250 (<0.001)
Total Scale0.585 (<0.001)
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MDPI and ACS Style

Plužarić, J.; Barać, I.; Ilakovac, V.; Lovrić, R.; Farčić, N.; Mudri, Ž.; Barišić, M.; Pavlić, I. Connectedness and Successful Aging of Older Adults in Croatia. Sustainability 2023, 15, 10843. https://doi.org/10.3390/su151410843

AMA Style

Plužarić J, Barać I, Ilakovac V, Lovrić R, Farčić N, Mudri Ž, Barišić M, Pavlić I. Connectedness and Successful Aging of Older Adults in Croatia. Sustainability. 2023; 15(14):10843. https://doi.org/10.3390/su151410843

Chicago/Turabian Style

Plužarić, Jadranka, Ivana Barać, Vesna Ilakovac, Robert Lovrić, Nikolina Farčić, Željko Mudri, Marija Barišić, and Ivana Pavlić. 2023. "Connectedness and Successful Aging of Older Adults in Croatia" Sustainability 15, no. 14: 10843. https://doi.org/10.3390/su151410843

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