The Psychological and Demographic Factors of Quality of Life in Older Adults

This research aims to determine the relationship between psychological and demographic factors, which are dispositional optimism, and self-efficacy are the psychological factors, meanwhile home, sex and ethnicity as the demographic factors of quality of life in the older adults. The major hypothesis of this research proposed that there are positive relationship from both psychological factors and demographic factors to the quality of life in older adults. This study involved 53 older adult peoples. The result of multiple regression analysis shows that there is a positive relationship from all five variables to the quality of life in older adults as big as 76,5% (Adjusted R2= 0,765). This result means that both the psychological and demographic factors do have effective contributions to the quality of life in older adult people. The results of t-tests are also discussed.


Introduction
The older adults segment has the quickest increase in number in the population, and until today the factors of quality of life in older adults still haven't gotten one universal conclusion (Ma, 2014;Bond & Corner, 2004). Psychological factors as the internal factors of human have been shown to determine the quality of life in aging individuals (Steptoe, Wright, Ebrecht, & Iliffe, 2006;Barlow, Williams, & Wright, 1996;Stretton, Latham, Carter, Lee, & Anderson, 2006), even when physical health becomes poor (Layte, Sexton & Savva, 2013). Dispositional optimism together with self-efficacy are deemed as some of key psychological factors in the older adults. (Kostka & Jachimowicz, 2010).
The relationship's value between these psychological measures and quality of life might be different in varied older adults community, affected by various external factors like behaviors related to health promotion, functional status, concomitant illness, and sociodemographic factors (Stretton et al., 2006). It is important to involve both psychological and demographic factors to determine the predictor of quality of life in aging individuals, and home, ethnicity and sex are some of the sociodemographic factors that considered key factors to be included as the predictors of quality of life in older adults (Kostka & Jachimowicz, 2010).
Dispositional optimism is an expectation for positive results in life.
Optimism scores significantly decrease with advancing age (Giltay, Zitman, & Kromhout, 2006). Evidence including results from a systematic review shows that high dispositional optimism will increase psychological well-being of someone (Huang et al., 2017;Cohen, Daniela & Lorber, 2010), but will not affect physical health component of quality of life (Weng et al., 2013). Optimism also proven to influences physical and mental quality of life via different pathways (Ramsay et al., 2015). It maintains higher quality of life in older adults compared with pessimists when trajectories related to death were considered (Zaslavsky et al., 2015;Zenger et al., 2010).
Self-efficacy has proven to be a functional measure of broad adaptational outcomes (Barlow, Williams, & Wright, 1996). A systematic review of 76 studies shows that self-efficacy positively associated with quality of life (Huang et al., 2017).
Another systematic review of found that self-efficacy has positive association with quality of life in some studies, while some other studies showed weak or no association (Crellin et al., 2014). Further, a more recent study found that self-efficacy was not associated with either psychological quality of life or social relationship quality of life (Perry, Casey & Cotton, 2015). Self-efficacy does have a favorable influence to the quality of life of person with diabetes mellitus disease (Asri, 2006), as well as hear failure patients (Buck et al., 2015). Similar results proven that selfefficacy influence the quality of life in person with lung tuberculosis disease (Sulaiman, 2009) and other chronic conditions (Cramm et al., 2013). It could be utilised as well in interventions to improve well-being of an individual (Guillamon et al., 2013;Kim et al., 2013). Self-efficacy was proven important in clinical settings especially in terms of improving self-care maintenance of older adults with various physical diseases (Buck et al., 2015).
The environment and conditions of someone's home will affect that individual ability to become his or her own self and to be able to perform his or her daily task effectively, then affect his or her own quality of life (Vaarama, Pieper, & Sixsmith, 2008). Some studies shown that older age people who lives at nursing home have a higher quality of life than older age people who lives at his or her own house (Brajkovic, Garden, Godan, & Godan, 2009;Jayanegara, 2007). Another study found almost no differences in quality of life of older people in nursing home and own home (Bleijlevens et al., 2014). Further a study found that older adults in nursing homes suffered from poor quality of life compared to living in home (Xiao, Yoon, & Bowers., 2016).
Ethnicity will determine quality of life by the traditions belong to a particular ethnic, particular tradition such as the habit to accept the conditions and situations happening in life will give influence to the increasing of quality of life (Bond & Corner, 2004). A study shown that members of an ethnic minority group in Netherlands have lower quality of life compared to native Dutch persons (Flink et al., 2013). Individual with Java ethnicity have the basic principle of 'nerimo', which means accepting situations happening in their own life, this basic principle combined with their life-goals to behave goodly and nicely will help increase their quality of life (Sutarto, 2006). Different with the Java ethnicity, the quality of life from individual with Tionghoa ethnicity can be predicted with their economical activities and conditions (Zhang, 2010;Turner & Allen, 2007).
The sex differences will diverse the way of achieving quality of life in someone (Forshee, 2006). A recent study found that sex differences was a significant predictor of mental health-related quality of life, with women reported poorer mental health-related quality of life compared to men (Wagner et al., 2016). Further, female stroke patients were signicantly more negatively affected in their quality of life than male stroke patients (Franzen-Dahlin & Laska, 2012). There's a difference between the results of previous studies that proves there's a relationship between sex differences and quality of life (Sutikno, 2011) and there's no relationship between them (Mandagi, 2010).
Interestingly, studies in Indonesia describing the relationship between both psychological and demographic factors to the quality of life in older adults were scarce in available literature. Therefore, the objective of this study was to describe the association of dispositional optimism, self-efficacy, as the psychological factors

Method
The study was done involving populations of older age individuals who take residence in Middle Java. The subjects are older age individuals aged 60 years old or more, male or female, belong to Java or Tionghoa ethnicity, and reside in either his or her own house or in a nursing home. Sampling technique used is the purposive sampling. 30 subjects participated in try-out phase, and 53 subjects agreed to participate in the study. Regression model was used to analyze the data.
Dispositional optimism and self-efficacy were treated as continuous variables while home, ethnicity and sex categories were treated as dummy variables. Age and education will be provided as socio-demographics data to help understand the research's context. Carver (Geers et al., 2008) was employed to measure dispositional optimism. This tool consists of 10 items, including six diagnostic ones that passed the try-out phase.
The last scale that used in this study is an Indonesian adaptation version of the General Self-Efficacy Scale (GSES) that comprises 9 items after validated in the try-out phase. This scale was used to measure self-efficacy withour particular reference to specific situation or behaviour (Oei et al., 2007).   (-8,549) is higher than the table t value (-1,645) with significance value 0,000 in home variable, which shows that there is a difference in quality of life between older age people who lives in their own house and those who lives in nursing home.
Mean value of quality of life in older adults who lives at their own house (69,57) is higher than those lives at nursing home (58,41) indicates that quality of life in older adults who lives at their own house are higher than the ones who lives at nursing home.
The count t value (-5,581) is also higher than the

Discussion
This is one of the early study to inspect the effective contributions of key psychological factors such as dispositional optimism, self-efficacy, and demographic factors such as home, sex categories and ethnicity to the quality of life in Indonesian This result strengthen the result of previous studies which mentioned that the quality of life in older adults was predicted by psychological factors such as dispositional optimism (Huang et al., 2017;Heo, 2010), and self-efficacy (Bandura, 1995;Huang et al., 2017;Kostka & Jachimowicz, 2010), and also demographic factors such as home (Xiao, Yoon, & Bowers., 2016;Jayanegara, 2007), sex categories (Wagner et al., 2016;Dewi, 2008;Heikkinen, Jallinoja, Saarni, & Patja, 2008), and ethnic (Turner & Allen, 2007;Jayanegara, 2007). The differences in quality of life differed by all three nominal variables are also strengthen the previous research conclusions (Turner & Allen, 2007).
The results show that dispositional optimism and home are two variables that greatly alter elder's quality of life. Proven before by existing studies before (Huang et al., 2017;Cohen, Daniela & Lorber, 2010), this study further the knowledge by confirming in Indonesian older adults population. It is evident now in Indonesia that increasing the tendency to positively view life events could greatly boost older adults' quality of life.
Providing a proper place to stay would also help to enhance older people's quality of life. Elder people in Indonesia prefer to live at their own house rather than staying in nursing house, rejecting the findings from Jayagenara's (2007) research.
This might be the results of various factors, such as quality of nursing house, quality of social support obtained in own house, and other related elements. The close-knit family relationships which is common in Indonesia may also be important factors determining older adults' choice to live at their own house.
Even though some evidences proved that self-efficacy was not associated with quality of life in several different populations (Crellin et al., 2014;Perry, Casey & Cotton, 2015), this study confirms otherwise, that self-efficacy predicts quality of life, especially in older individuals. We argue that this finding need to be further explored through qualitative analysis in order to explain deeper the dynamics of association between self-efficacy and quality of life.
It was also proven that Javanese elders are more likely to have a high quality of life compared to the Tionghoa elders, considering their ability to accept situations happening in their life (Sutarto, 2006 This study adds more knowledge in terms of psychological and demographic factors' contribution to quality of knowledge, especially in the context of older adults and Indonesia. As such, it addresses a gap in the evidence base which to date has been limited to studies in developed countries. It is hoped that this study will inform researchers and policy makers responsible for service aimed to older adults population in Indonesia.

Conclusion
We conclude that psychological and demographic factors like dispositional optimism, self-efficacy, home, ethnic and sexes are associated with quality of life, and the effective contributions from all six variables to quality of life are 76,5%.
Interestingly, when analysed separately with Pearson correlation analysis, sex categories shows negative relationship with quality of life, compared with other variables who have positive relationships.

Suggestion
This older adults group should be provided with preventive psychosocial programs. Educational interventions, and such program that intervenes with the psychological profiles to enhance the positive quality such as optimism and selfefficacy might be most effective while considering the conditions of their home, the value of elder's ethnicity, and their sex categories to determine the best appropriate of programs. To further corroborate these findings, potential well-designed researches are of the utmost importance.