asia-pacific journal of public healthrepository.um.edu.my/7513/1/1010539510374751.full_perceived...

http://aph.sagepub.com/Public Health

Asia-Pacific Journal of

http://aph.sagepub.com/content/early/2010/07/20/1010539510374751The online version of this article can be found at:

DOI: 10.1177/1010539510374751

published online 3 August 2010Asia Pac J Public HealthSor Tho Ng, Hamid Tengku-Aizan and Nai Peng Tey

Perceived Health Status and Daily Activity Participation of Older Malaysians

Published by:

http://www.sagepublications.com

On behalf of:

Asia-Pacific Academic Consortium for Public Health

can be found at:Asia-Pacific Journal of Public HealthAdditional services and information for

http://aph.sagepub.com/cgi/alertsEmail Alerts:

http://aph.sagepub.com/subscriptionsSubscriptions:

http://www.sagepub.com/journalsReprints.navReprints:

http://www.sagepub.com/journalsPermissions.navPermissions:

at Universiti Malaya (S141/J/2004) on December 26, 2010aph.sagepub.comDownloaded from

http://aph.sagepub.com/

http://aph.sagepub.com/content/early/2010/07/20/1010539510374751

http://www.sagepublications.com

http://www.apacph.org/site/index.php

http://aph.sagepub.com/cgi/alerts

http://aph.sagepub.com/subscriptions

http://www.sagepub.com/journalsReprints.nav

http://www.sagepub.com/journalsPermissions.nav


Asia-Pacific Journal of Public HealthXX(X) 1 –15

© 2010 APJPHReprints and permission: http://www. sagepub.com/journalsPermissions.nav

DOI: 10.1177/1010539510374751http://aph.sagepub.com

Perceived Health Status and Daily Activity Participation of Older Malaysians

Sor Tho Ng, MEc1, Hamid Tengku-Aizan, PhD2, and Nai Peng Tey, MSc1

Abstract

This article investigates the influence of perceived health status on the daily activity participation of older Malaysians. Data from the Survey on Perceptions of Needs and Problems of the Elderly, which was conducted in 1999, were used. The negative binomial regression results show that older persons with good perceived health status reported more varieties of daily activity participation, especially among the uneducated and those with below-average self-esteem. The multinomial logistic regression model suggests that older persons with good perceived health status tended to engage daily in paid work only or with leisure activities, whereas those perceived to have poor health were more likely to engage in leisure activities only or leisure and family role activities. Promotion of a healthy lifestyle at a younger age encourages every person to monitor and take responsibility for their own health, which is a necessary strategy to ensure active participation at an older age, and thus improve their well-being.

Keywords

activity, aging, health, older persons, Malaysia

IntroductionThe number of older persons aged 60+ in Malaysia has increased from 1 million in 1991 to 1.4 million in 2000.1 It is projected to reach 4.4 million in 2025.2 In terms of percentage, it was 5.9% in 1991 and 6.3% in 2000, and it is projected to increase to 13.3% in 2025.2 The expected increase in the number and percentage of older persons aged 60+ is a significant challenge to the Malaysian government in planning and preparing programs for an aging nation to achieve a better quality of life.

The significance of activity in the lives of older persons was addressed in Aging and Leisure, edited by Robert Kleemeier in 1961.3 Engaging in activity that enables them to communicate, share, and socialize with others is an important element in their quality of life.4 The activity

1University of Malaya, Kuala Lumpur, Malaysia2University Putra Malaysia, Selangor, Malaysia

Corresponding Author:Ng Sor Tho, Faculty of Economics & Administration, University of Malaya, 50603 Kuala Lumpur, MalaysiaEmail: [email protected]

Asia Pac J Public Health OnlineFirst, published on August 3, 2010 as doi:10.1177/1010539510374751



2 Asia-Pacific Journal of Public Health XX(X)

theory developed by Robert Havighurst in the 1960s postulates that older persons who are active will be more satisfied and better adjusted than less-active older persons. The importance of activ-ities in later life is emphasized by the World Health Organization, which defines active aging as the process of optimizing opportunities for health, participation, and security to enhance quality of life as people age.5 Many studies have found that participation in activities in later years is associated with higher levels of satisfaction with life.6-9

The activities of older persons are related to social characteristics, population characteristics and policies, and personal characteristics and conditions.10 These sociodemographic factors and health factors modify the choices and opportunities of older persons and, thus, influence their daily activities.

The relationship between the health status of older persons and participation in activities has been documented in many studies. Good health enables an older person to engage in more hours of paid work,6,11-13 volunteer activities,6,12,14,15 physical exercise,13,16 and leisure activities.16,17 The perceived health status of older persons was also found to affect physical activity participa-tion of aged people with asthma in Canada.18

Past studies on the relationship between the health of older persons and participation in activi-ties were mainly focused on specific activities listed and rarely on daily activities. This study aims to investigate the influence of perceived health status on both the varieties and categories of daily activity participation of older Malaysians in the community. The hypothesis is that per-ceived health status has a significant influence on the varieties and categories of daily activities in which older persons participate. It is hoped that the outcome of this study could contribute toward a better understanding of the perceived health status of older Malaysians and their partici-pation in daily activities as well as the relationship between the two.

MethodsData were obtained from the Survey on Perceptions of Needs and Problems of the Elderly, which was conducted in 1999 on older persons aged 60 and above living in the community. The research project was funded by the Ministry of Science and Technology, Malaysia, under the Intensified Research Priority Area grant.

Respondents were selected using stratified random sampling of districts by stratum in 4 ran-domly selected states (representing different geographical zones) of Peninsular Malaysia: Kelantan, Kedah, Perak, and Johor. The total sample was proportionately allocated to reflect the population distribution of older persons in the 4 states. The ethnic distribution was calculated as a basis for a quota sample to ensure minority representation.19

The proposed sample size was 2000. However, a total of 1776 completed and usable data were eventually obtained. Face-to-face interviews were conducted with the use of a detailed questionnaire written in Malay and in English. The survey questionnaire was also translated into the main local dialects to enable the interviewing of the respondents who do not speak and write both Malay and English. The questionnaire consisted of the following modules:

Module A: respondent’s backgroundModule B: health status assessmentModule C: social and learning activities of respondentsModule D: aspect of lifeModule E: aspect of work and income

The daily activity participation comprises 2 constructs: (1) varieties of daily activity participa-tion and (2) categories of daily activity participation. The varieties of daily activity participation



Ng et al 3

are computed by counting the number of activities in which a person participates in a typical day. The categories of daily activity participation refers to the types of activities in which a person participates in a day. The daily activities reported by the respondents are divided into 4 main groups as follows:

1. Leisure activities include visiting friends/neighbors/relatives, chatting, singing at karaoke sessions, dancing, playing mahjong, gambling, physical exercise, fishing, feeding pets, playing a musical instrument, hunting, reading, praying, study of the Quran, watching television, and listening to radio.

2. Family role activities refer to activities that enhance their role in the family. It includes grandparenting, taking care of family members, sending grandchildren to school, doing housework, going to the market/shop, tidying/cleaning the house, sewing/knitting/handicraft.

3. Paid work refers to activities that generate income for the respondents. It includes farming, rubber tapping, and operating a sundry shop.

4. Social role activities refer to services that the respondents provide to their communities. In this study, social role activities include attending meetings, tidying or cleaning the community hall, volunteering, and doing social work.

Older persons who did not participate in any of the 4 main categories of activities were con-sidered as not participating in any activities.

The categories of daily activity participation is created by combining these 4 main groups of activities participated in in a day. They are as follows:

1. leisure activities only (L)2. family role activities only (F)3. paid work only (W)4. leisure and family role activities (L & F)5. leisure activities and paid work (L & W)6. family role activities and paid work (F & W)7. leisure, family role activities, and paid work (L, F & W)8. social role and other activities (S)

The perceived health status of the respondent was obtained from the response to the question, “How would you rate your present state of health?” The self-rated responses were “good” and “poor.”

In the bivariate analysis for perceived health status and varieties of daily activity participation, because of the fact that the normality assumption is not met, the Kruskal-Wallis test is used to test the significant effect of perceived health status on the varieties of daily activity participation. For the bivariate relationship between perceived health status and categories of daily activity partici-pation, the c2 test is used to test for statistical significance of the effect of perceived health status on the categories of daily activity participation of older persons.

In the multivariate analysis, negative binomial regression analysis is used to estimate the expected varieties of daily activity participation by perceived health status after controlling for sociodemographic factors and self-esteem. Negative binomial regression analysis is appropriate in this context because the dependent variable—varieties of daily activity participation—is a count and discrete variable and has a larger variance of 3.75 compared to the mean value of 3.1.20

On the other hand, multinomial logistic regression is used to estimate the effect of perceived health status on the categories of daily activity participation, controlled for sociodemographic




factors and self-esteem. Multinomial logistic regression analysis is appropriate in this context because the dependent variable—categories of daily activity participation—is a categorical variable.20 In multinomial logistic regression, if the dependent variable has j categories, the number of nonredundant logits that can be formed is j - 1. The model for the ith category is as follows:

ln(categaory )(categaory )

= + X + X + X +i0 i1 1 i2 2 i3 3

PP

i

j

β β β β ++ Xip pβ

where bi0 is the intercept for the ith category, bi1 to bip are the regression coefficients, and X1

to Xp are the independent variables. In this study, there are 8 categories of daily activity participation, and as such, 7 nonredundant logits are formed, with daily participation in leisure activities only as the reference category, and perceived health status, selected sociodemographic factors, and self-esteem as the independent variables.

The perceived health status, sociodemographic factors, and self-esteem in the negative bino-mial and multinomial logistic regression models are defined as follows:

There are several limitations to this study. The perceived health status is self-rated by respon-dents and might not reflect the true health status of respondents at the time of survey. The cross-sectional design could not capture the changes or adjustments in activity participation as a person aged. The coverage of the survey was limited to older persons in Peninsular Malaysia. Therefore, the results of this study might not reflect the situation of older persons in Sabah and Sarawak in Eastern Malaysia; their health status and activity participation may be quite different from those in Peninsular Malaysia.

PHEALTH This represents the perceived health status of respondents. It is a dummy variable that takes the value of 1 if the respondent’s perceived health status is poor and 0 for good health

AGE This represents the age group of respondents. Two dummy variables were used: AGE70=1 for respondents aged 70-79, 0 otherwise; AGE80=1 for respondents aged 80 and above, 0 otherwise. The reference group is 60-69

SEX This is a dummy variable that takes the value of 1 if the respondent is a female and 0 if maleMARRIED This represents the current marital status of respondents. It is a dummy variable that takes the

value of 1 if the respondent is currently not married and 0 if currently marriedETHNIC This represents the ethnic group of respondents. Two dummy variables were used. CHINESE

= 1 for Chinese respondents, 0 otherwise; INDIANS = 1 for Indian respondents, 0 otherwise. The reference group is Malays

RESIDEN This represents the current place of residence of respondents, RESIDEN = 1 for rural, 0 for urban

EDU This represents the educational level of respondents. Two dummy variables were used. PRIM = 1 for primary education, 0 otherwise; SEC = 1 for secondary education or above; 0 otherwise. The reference group is no schooling

INCOME This represents the number of sources of income the respondents had at the time of the survey. For multinomial logistic regression, 2 dummy variables were used. INC0 = 1 for those respondents who had zero source of income, 0 otherwise; INC1 = 1 for those with 1-2 sources of income, 0 otherwise. The reference group is 3 or more sources of income

SESTEEM This represents the score for self-esteem. The self-esteem score is computed from 10 items that are adapted from Rosenberg’s Global Self-Esteem Scale. Two dummy variables were used. BELOWSE = 1 for respondents with below average self-esteem (<19), 0 otherwise; AVESE = 1 for those with average score (=19), 0 otherwise. The reference group is above average (>19)



Ng et al 5

Results

The age of the respondents ranged from 60 to 120 years, with a mean of 68.2 years and stan-dard deviation of 5.2; the majority of them were in their 60s. Slightly more than half of the respondents were currently married, a substantial number of respondents were widowed, and a small percentage of the respondents were never married or divorced/separated. The distribu-tion of the ethnic backgrounds of the respondents seems to reflect those of older adults in Malaysia,1 with more than half of the respondents being Malays, followed by Chinese and the Indians. About 68% of respondents were perceived to have good health status, whereas the rest of them (32%) were perceived to have poor health status. The number of sources of income of respondents ranged from 0 to 9, with a mean of 2.19 and standard deviation of 1.19. The majority of respondents had 1 to 3 sources of income; however, there were 4% who did not report any source of income. The sources of income of respondents were mainly from own income, pension, and money given by a son or daughter. Other sources of income also include receiving support from welfare programs, getting profit from business, and dividends. The respondents’ self-esteem score ranged from 8 to 30, with a mean of 19.3 and standard devia-tion of 2.8. Table 1 shows the sociodemographic characteristics, perceived health status, and self-esteem of respondents.

Out of the 1776 respondents, 64 did not provide any information on their daily activities and are therefore not included in the analysis on daily activity participation. Based on the 1-day activ-ity chart, 7% of the respondents did not engage in any activities. In a day, nearly one third of the respondents engaged in 1 or 2 activities, about 40% of them participated in 3 or 4 activities, 19% of them were involved in 5 to 9 activities, and the rest (0.6%) took part in 10 or more activities. On average, each respondent carried out about 3 activities in a day.

The percentage distribution of respondents by categories of daily activity participation is shown in Table 2. Some participated in a single activity, and others were involved in 2 or more types of activities in a day. About 48% of the respondents were engaged in a single type of activity only, and the rest of the respondents (52%) were engaged in 2 or more types of activi-ties in a day. Among the categories of daily activity participation, the most common was the leisure and family role activities; some 31% of respondents reported that they participated in these activities daily. Leisure activities only, family role activities only, and paid work only were the next most frequent types of activities. Other than daily participation in paid work, some 21% of respondents were also engaged daily in other activities. Social role activities were not common among the respondents in the study. None of the respondents was engaged in social role activities only. Only 1% of the respondents were engaged in social role activities together with other activities.

Bivariate AnalysisPerceived health status of respondents played an important role in affecting both the varieties and categories of daily activity participation. Respondents who perceived themselves as being in good health had mean varieties of daily activity participation of 3.3 compared with 2.6 for those perceived to be in poor health. The difference was statistically significant at the 5% level. This suggests that good health status is important in order for older persons to participate in more varieties of daily activities.

Table 3 shows that the percentage distribution of the categories of daily activity participation varied according to the perceived health status of the respondents. Respondents perceived to have poor health status were more likely to be involved in leisure activities only or family role




Table 1. Percentage and Frequency Distribution of Respondents by Sociodemographic Factors, Perceived Health Status, and Self-Esteem

Selected Variables Percentage n

Age group 60-69 62.4 1108 70-79 28.7 510 80+ 8.9 158Sex Male 51.2 910 Female 48.8 866Marital status Never married 5.6 99 Currently married 54.7 972 Divorced/Separated 2.2 39 Widowed 37.5 666Ethnic group Malays 54.8 974 Chinese 35.3 626 Indians 9.9 176Place of residence Rural 48.2 856 Urban 51.8 920Educational level No schooling 41.1 723 Primary 47.4 835 Secondary+ 11.5 203Number of sources of income 0 3.9 70 1 24.9 443 2 36.7 651 3 22.2 394 4+ 12.3 218Perceived health status Good 67.9 1202 Poor 32.1 568Self-esteem 8-18 (below average) 32.1 568 19 (average) 25.9 458 20-30 (above average) 42.0 743

activities only compared with those perceived to have good health (Table 3), who in turn had a significantly higher percentage of participating in paid work only, in leisure activities and paid work, and in social and other activities.

Multivariate AnalysisVarieties of daily activity participation. The Likelihood Ratio(LR) statistics for type 3 analysis in

Table 4 shows that the interaction effects of EDU*PHEALTH, PHEALTH*SESTEEM are



Ng et al 7

Table 2. Percentage and Frequency Distribution of Respondents by Categories of Daily Activity Participationa

Categories of Activities Percentage n

Leisure and family role 30.9 492Leisure only 19.1 303Family role only 16.1 256Paid work only 12.4 197Leisure and paid work 9.9 157Leisure, family role, and paid work 6.8 108Family role and paid work 3.5 56Social role and others 1.3 21Social role only 0.0 0Total 100.0 1590

aRespondents who did not participate in any of the activities were not included in this table.

Table 3. Percentage Distribution of Categories of Daily Activity Participation by Perceived Health Statusa

Categories of Daily Activity Participation

Perceived Health Status

Good Poor

Leisure and family role 30.8 31.4Leisure only 16.6 24.9Family role only 13.3 22.6Paid work only 14.6 7.0Leisure and paid work 11.8 5.3Leisure, family role and paid work 7.4 5.5Family role and paid work 3.8 3.0Social role and others 1.7 0.4Total 100.0 100.0Number of cases 1114 474

ac2 = 66.76; df = 7; P < .001.

statistically significant at the 5% level in affecting the varieties of daily activity participation; thus, the main effects of perceived health status cannot be assessed. The significance of interac-tion effects of EDU * PHEALTH and PHEALTH * SESTEEM imply that the effect of perceived health status on the varieties of daily activity participation was different for different educational levels and self-esteem of respondents.

Table 5 shows the parameter estimates for the negative binomial model on the varieties of daily activity participation. The coefficient of PRIM was -0.0124, PHEALTH was -0.1908, and PRIM * PHEALTH was 0.1862, implying that, on average, respondents with primary education and who are perceived to have poor health participated in 98% (exp[-0.0124 - 0.1908 + 0.1862]) of the varieties of daily activities in which respondents with no schooling and perceived to have good health participated. The parameter estimate of PHEALTH * BELOWSE has a significant coeffi-cient, whereas the coefficient for PHEALTH * AVESE is not significant at the 5% level. The coefficients of PHEALTH and BELOWSE are -0.1908 and -0.0412, respectively, and the coef-ficient of PHEALTH * BELOWSE is -0.2063, implying that respondents who were perceived to have poor health and below average self-esteem participated in 0.65 times (exp[-0.2063 - 0.1908




Table 4. LR Statistics for Type 3 Analysis for Negative Binomial Model on Varieties of Daily Activity Participation by Perceived Health Status, Controlled for Sociodemographic Factors and Self-Esteem With Interaction Terms

SourceDegree of Freedom c2 p > c2

PHEALTH 1 10.12 .0015AGE 2 9.62 .0081SEX 1 11.85 .0006MARRIED 1 4.16 .0414ETHNIC 2 3.93 .1405RESIDEN 1 5.66 .0174EDU 2 17.25 .0002INCOME 1 26.35 <.0001SESTEEM 2 18.71 <.0001MARRIED * RESIDEN 1 8.49 .0036ETHNIC * RESIDEN 2 12.04 .0024ETHNIC * EDU 4 15.94 .0031RESIDEN * SESTEEM 2 9.47 .0088EDU * PHEALTH 2 7.27 .0264PHEALTH * SESTEEM 2 8.69 .0130

- 0.0412]) of the expected varieties of daily activities in which respondents with good perceived health and above-average self-esteem participated.

To illustrate the interaction effects of perceived health status and education, and perceived health status and self-esteem on the varieties of daily activity participation, the parameter estimates given in Table 5 are used to predict the mean varieties of daily activity participation (l) as shown in Figures 1 and 2. Figure 1 shows that that the effect of perceived health status on the varieties of daily activity participation that was observed among respondents with no school-ing was 3.2 for those with good perceived health status compared with 2.7 for those with poor perceived health status, whereas the effect of perceived health status among respondents with primary and secondary education or higher was nonexistent. Although respondents with good perceived health status had higher expected varieties of daily activity participation regardless of the self-esteem level, the effect of perceived health status on the varieties of daily activity par-ticipation was more obvious among respondents with below average self-esteem than among respondents with other levels of self-esteem (Figure 2).

Categories of daily activity participation. The likelihood ratio tests (Table 6) show that perceived health status had a significant effect (P < .05) on the categories of daily activity participation, controlled for sociodemographic factors and self-esteem. Leisure activities only is the only category of daily activity participation that does not produce any goods and services of value; therefore, it is used as the reference group for purposes of comparison.

The 7 sets of multinomial logistic regression models are as follows:

ln( )( )

. . * . * .P FP L

= − − − +

−

0 599 0 418 70 0 619 80 1 960AGE AGE SEX*

00 450 1 500 0 081 0 088

0 13

. . . .

.

MARRIED CHINESE* INDIANS RESIDEN− + −+ 77 0 391 0 789 0 0 210 1 0 215

0 197

PRIM SEC INC INC PHEALTH

BELO

+ + + −+

. . . .

. WWSE AVESE+ 0 266. .



Ng et al 9

ln( )( )

. . * . * .

.

P WP L

= − − −

−

0 719 0 954 70 1 144 80 0 326

0

AGE AGE SEX

2232 0 745 0 471 0 671

0 216

MARRIED CHINESE* INDIANS RESIDEN*− + ++

. . .

. PPRIM SEC* INC INC PHEALTH*

BE

− − − −−

1 019 21 136 0 0 250 1 1 177

0 158

. . . .

. LLOWSE AVESE*− 0 604. .

ln( & )( )

. . . .P L FP L

= − − +

−

0 297 0 186 70 0 471 80 1 662

0

AGE AGE SEX*

.. . . .

.

246 0 797 0 363 0 108

0 57

MARRIED CHINESE* INDIANS RESIDEN*− − −+ 11 0 146 1 223 0 0 252 1 0 503

0 152

PRIM* SEC INC INC PHEALTH*

B

+ − − −−

. . * . .

. EELOWSE AVESE*+ 0 205. .

ln( & )

( ). . * . * .

P L WP L

= − − −

−

0 060 0 584 70 1 328 80 0 527AGE AGE SEX

00 366 0 477 0 115 0 314

0 65

. . . .

.

MARRIED CHINESE* INDIANS RESIDEN− + ++ 33 0 505 21 100 0 0 512 1 1 016

0 112

PRIM* SEC INC INC PHEALTH*+ − − −+

. . . * .

. BBELOWSE AVESE+ 0 188. .

ln( & )

( ). . . .

P F WP L

= − − − +

−

1 522 0 328 70 0 615 80 1 378AGE AGE SEX*

00 475 1 175 0 741 0 015

0 55

. . . .

.

MARRIED CHINESE* INDIANS RESIDEN− + ++ 22 0 689 20 687 0 0 453 1 0 780

0 417

PRIM SEC INC INC PHEALTH*

BE

+ − − −+

. . . .

. LLOWSE AVESE+ 0 147. .

ln( , & )

( ). . * . * .

P L F WP L

= − − +0 151 0 586 70 1 434 80 1 112AGE AGE SEXX*

MARRIED CHINESE* INDIANS RESIDEN− − − −+0 348 0 980 0 269 0 289

0

. . . .

.. . . . * .

.

331 0 653 20 689 0 0 904 1 0 553

0 3

PRIM SEC INC INC PHEALTH*+ − − −− 113 0 446BELOWSE AVESE− . .

ln( )( )

. . . .

.

P SP L

= − − − +

−

1 552 0 691 70 0 725 80 0 859

0 7

AGE AGE SEX

887 0 632 0 348 0 115

0 275

MARRIED CHINESE INDIANS RESIDEN

PRI

− + −−

. . .

. MM SEC* INC INC PHEALTH

BELOWSE

+ + − −−

1 316 0 623 0 0 199 1 1 413

1 499

. . . .

. −− 0 574. .AVESE

In the above equations, asterisks refer to p < .05.




Table 5. Parameter Estimates for Negative Binomial Model With Interaction Terms on the Varieties of Daily Activity Participation by Perceived Health Status Controlled for Sociodemographic Factors and Self-Esteema

Parameter EstimateExponent of

EstimateStandard

Error Z p Value

Intercept 1.1689 3.22 0.0637 18.35 <.0001PHEALTH -0.1908 0.83 0.0678 -2.81 .0049AGE70 -0.0486 0.95 0.0338 -1.44 .1506AGE80 -0.1712 0.84 0.0578 -2.96 .0031SEX 0.1109 1.12 0.0322 3.44 .0006MARRIED -0.1540 0.86 0.0439 -3.51 .0004CHINESE -0.2130 0.81 0.0634 -3.36 .0008INDIANS -0.0486 0.95 0.1103 -0.44 .6595RESIDEN -0.0817 0.92 0.0549 -1.49 .1369PRIM -0.0124 0.99 0.0487 -0.25 .7994SEC -0.0562 0.95 0.0742 -0.76 .4488INCOME 0.0659 1.07 0.0127 5.19 <.0001BELOWSE -0.0412 0.96 0.0535 -0.77 .4408AVESE -0.1746 0.84 0.0560 -3.12 .0018MARRIED * RESIDEN 0.1724 1.19 0.0591 2.92 .0035CHINESE * RESIDEN -0.0484 0.95 0.0642 -0.75 .4507INDIANS * RESIDEN -0.3809 0.68 0.1088 -3.50 .0005CHINESE * PRIM 0.1956 1.22 0.0698 2.80 .0050CHINESE * SEC 0.3499 1.42 0.1001 3.50 .0005INDIANS * PRIM 0.0783 1.08 0.1181 0.66 .5071INDIANS * SEC 0.3300 1.39 0.1714 1.93 .0542PRIM * PHEALTH 0.1862 1.20 0.0693 2.69 .0073SEC * PHEALTH 0.1389 1.15 0.1363 1.02 .3081RESIDEN * BELOWSE -0.0553 0.95 0.0707 -0.78 .4341RESIDEN * AVESE 0.1771 1.19 0.0724 2.45 .0144PHEALTH * BELOWSE -0.2063 0.81 0.0771 -2.68 .0075PHEALTH * AVESE -0.0040 1.00 0.0827 -0.05 .9616Dispersion 0.0212 0.0116

aDeviance: 1862.8046; degree of freedom: 1663; log-likelihood: 755.9670.

3.2 3.2

3

2.7

3.2

2.9

2.4

2.5

2.6

2.7

2.8

2.9

3

3.1

3.2

3.3

None Primary Secondary

Good

Poor

Figure 1. Expected varieties of daily activity participation by educational level and perceived health statusReference person: age 60 to 69 years, male, married, Malay, urban, zero sources of income, above-average self-esteem.



Ng et al 11

The values for the intercept are the log odds ratios of participating in the activities listed versus participating in leisure activities only (the reference category) if all the independent variables are 0 (age 60-69, male, currently married, Malays, urban, no schooling, 3 or more sources of income, good perceived health status, above-average self-esteem).

Perceived health status has a significant effect on daily participation in all the categories of daily activity participation relative to leisure activities only, except for family role activities only and social role and other activities. It affected the daily participation of respondents in paid work only, leisure and family role activities, leisure activities and paid work, family role and paid work, and leisure, family role activities, and paid work relative to leisure activities only. The negative coefficients of PHEALTH in all the 7 sets of multinomial logistic regression models imply that respondents perceived to have poor health were less likely than respondents with good

3.8

3.3

3.9

2.52.7

3.2

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

Below Average Average Above Average

Good

Poor

Figure 2. Expected varieties of daily activity participation by self-esteem level and perceived health statusReference person: age 60 to 69 years, male, married, Malay, urban, no education, 3 sources of income.

Table 6. Likelihood Ratio Tests for the Multinomial Logistic Regression on Categories of Daily Activity Participation of Respondents by Perceived Health Status, Sociodemographic Factors, and Self-Esteema

Effect-2Log-Likelihood of

Reduced Model c2 df p Value

Intercept 3764.040b 0.000 0PHEALTH 3800.846 36.806 7 0.000AGE 3797.620 33.580 14 0.002SEX 4000.999 236.959 7 0.000MARRIED 3770.766 6.726 7 0.458ETHNIC 3839.800 75.760 14 0.000RESIDEN 3782.253 18.213 7 0.011EDU 3814.545 50.505 14 0.000INCOME 3835.220 71.180 14 0.000SESTEEM 3794.659 30.619 14 0.006

aThe c2 statistic is the difference in -2log-likelihoods between the final model and a reduced model. The reduced model is formed by omitting an effect from the final model. The null hypothesis is that all parameters of that effect are 0.bThe reduced model is equivalent to the final model because omitting the effect does not increase the degrees of freedom.




perceived health status to participate daily in all the categories of activities relative to leisure activities only, given that other variables in the model are held constant.

For daily participation in paid work only relative to leisure activities only, the odds ratio of 0.31 (exp[-1.177]) means that a respondent perceived to have poor health status was 0.31 times as likely as a respondent perceived to have good health status to participate in paid work only relative to leisure activities only. The odds ratio of PHEALTH for the daily participation in lei-sure and family role activities, leisure activities and paid work, family role activities and paid work, and leisure, family role activities, and paid work relative to leisure activities only are 0.61, 0.36, 0.46, and 0.58, respectively.

To illustrate, the estimated probabilities of the categories of daily activity participation of respondents by perceived health status, controlling for sociodemographic factors and self-esteem, were calculated to see the effect of perceived health status on the categories of daily activity par-ticipation. Table 6 presents estimate probabilities for each of the categories of daily activity par-ticipation by perceived health status. The reference person was a married Malay man in the age group of 60 to 69 years, from an urban area, with no education; but he had 3 or more sources of income and above-average self-esteem. Respondents perceived to have poor health status had a lower probability of engaging daily in paid work only and in leisure activities and paid work than those with good perceived health (Table 7). On the other hand, respondents with poor health also had a higher probability of participating in either leisure activities only, family role activities only, or both than their counterparts.

DiscussionThe increase in the life expectancy at birth from 67.1 years for women and 63.5 years for men in the period 1975 to 1980 to 76.5 years and 71.9 years, respectively, in the period 2005 to 20102 implies that there are increasing number of men and women living longer, with many more years of free time in later life. The average number of varieties of daily activity participation for older Malaysians in this study was about 3 activities; this is slightly lower than that for older persons in Germany, who carried out about 4 activities daily.21 As expected, the most common activities in which older persons participated daily were leisure and family role activities, whereas only 1% of respondents engaged in social role activities together with other activities. This percentage is much lower than the corresponding ones for older persons in Korea,15 America,22 and Europe.23 The fewer varieties of daily activity participation and the lower percentage of older Malaysians participating in social role activities may be partly a result of higher disability prevalence among

Table 7. Estimated Probabilities From the Multinomial Logistic Regression for Categories of Daily Activity Participation by Perceived Health Status

Categories of Daily Activity Participation

Perceived Health Status

Good Poor

Paid work only 0.26 0.14Leisure and family role 0.16 0.19Leisure only 0.13 0.24Family role only 0.07 0.11Leisure and paid work 0.15 0.09Family role and paid work 0.02 0.02Leisure, family role, and paid work 0.18 0.20Social role and others 0.03 0.01Total 1.00 1.00



Ng et al 13

older persons in Malaysia compared with Germany and the United States. The prevalence of disability in Malaysia was 22.824 compared with 19.5 in Germany and 12.4 in the United States, as noted by Topinkova.25

Perceived health status played an important role in both the varieties and the categories of daily activity participation of older persons. Older persons with good perceived health status partici-pated in relatively more varieties of activity daily than those with poor perceived health status, especially among those with no education or below-average self-esteem. As regards the categories of daily activity participation, the findings of this study are consistent with past studies that show a higher level of participation for older persons with good health status in paid work,6,12,13 volun-teer activity,6,12,14,15,23 and leisure activities.16,17 Other than perceived health status, factors affect-ing participation in social role activities include age, educational level, and employment status.23

According to activity theory, one way for older persons to achieve greater life satisfaction is to be actively involved in various pursuits. Therefore, it is important to improve older persons’ health status so that they can participate actively in various types of enterprises daily. Preventive health measures such as health checks and health awareness forum should be made available to older persons on a regular basis. Information on health prevention measures should be clear, easy to understand, and easy to access for older persons.

ConclusionBoth the bivariate and multivariate analyses reveal the importance of perceived health status for both the varieties and categories of daily activity participation of older persons. Good perceived health status enables older persons to engage in more varieties of activities daily, though the effect actually varies among respondents with different levels of education and self-esteem. As regards the categories of daily activity participation, good perceived health status not only enables older persons to be in paid work daily, but it allows them to engage in leisure activities simultaneously. Older persons who perceive themselves as having poor health were more likely to engage in leisure activities only and in leisure and family role activities than those with good perceived health status.

As participation in activities was found to have positive significant effects on life satisfaction in many studies,6-8 it is necessary to encourage active participation of older persons in various activities. Because perceived health was found to have a significant effect on the daily activity participation of older persons in this study, there is a need to promote a healthy lifestyle at a younger age and encourage every person to monitor and take responsibility for their own health to ensure active participation in old age. In view of the necessity to have more effective, coordi-nated, and comprehensive health care for older persons, the National Health Policy for Older Persons was formulated by the Ministry of Health Malaysia in 200826 to ensure healthy, active, and productive aging. It has the objectives of improving the health status of older persons by encouraging participation in health promotion and disease prevention activities throughout the life course.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the authorship and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research and/or authorship of this article: The work was supported by the Ministry of Science and Technology, Malaysia, under the Intensified Research Priority Area grant.




References

1. Pala J. Population Ageing Trends in Malaysia. Population and Housing Census of Malaysia 2000. Kuala Lumpur, Malaysia: Department of Statistics Malaysia; 2005.

2. United Nations. World Population Ageing 2007. New York, NY: Department of Economic and Social Affairs, Population Division; 2007.

3. Kleemeier R. Aging and Leisure. New York, NY: Oxford University Press; 1961. 4. Kelly JR. Activity and Aging: Staying Involved in Later Life. Newbury Park, CA: Sage; 1993. 5. World Health Organization. Active Ageing: A Policy Framework. Geneva, Switzerland: World Health

Organization; 2002. 6. Aquino JA, Russell DW, Cutrona CE, Altmaier EM. Employment status, social support, and life satis-

faction among the elderly. J Couns Psychol. 1996;43:480-489. 7. Baker LA, Cahalin LP, Gerst K, Burr JA. Productive activities and subjective well-being among older

adults: The influence of number of activities and time commitment. Soc Indic Res. 2005;73:431-458. 8. Bouazzaoui B, Mullet E. Employment and family as determinants of anticipated life satisfaction:

contrasting young adults’ and elderly people’s viewpoints. J Happiness Stud. 2002;3:229-252. 9. Iannuzzelli J, England EM. The relationship between activities of daily living and life satisfaction in the

elderly: active engagement as compared to passive participation. Ursinus College; 2000. http://www .eric.ed.gov/PDFS/ED442977.pdf

10. Altergott K. Daily life in late life: concepts and methods for inquiry. In: Altergott K, ed. Daily Life in Later Life: Comparative Perspectives. Newbury Park, CA: Sage; 1988:11-22.

11. Ng ST, Tey NP. Retirement and perceived health status of the urban elderly. Asia Pac J Public Health. 2006;18(suppl):9-13.

12. Dosman D, Fast J, Chapman SA, Keating N. Retirement and productive activity in later life. J Fam Econ Issues. 2006;27:401-409.

13. Stobert S, Dosman D, Keating N. Aging well: time use patterns of older Canadians. http://www.statcan.gc.ca/pub/89-622-x/89-622-x2006002-eng.pdf. Accessed June 10, 2010.

14. Carr D. Aging in America: the link between productivity and resources in the third age. Ageing Int. 2009;34:154-171.

15. Kim J, Kang J-h, Lee M-A, Lee Y. Volunteering among older people in Korea. J Gerontol. 2007;62B:S69-S73.

16. Meer MJvd. The sociospatial diversity in the leisure activities of older people in the Netherlands. J Aging Stud. 2008;22:1-12.

17. Chou K-L, Chow NWS, Chi I. Leisure participation amongst Hong Kong Chinese older adults. Ageing Soc. 2004;24:617-629.

18. Dogra S, Meisner BA, Baker J. Psychosocial predictors of physical activity in older aged asthmatics. Age Ageing. 2008;37:449-454.

19. Tengku Aizan H, Chai ST, Jariah M, Nurizan Y. Socioeconomic status and health of older women in Malaysia. Asia Pac J Public Health. 2006;18(suppl):42-53.

20. Dobson AJ. An Introduction to Generalized Linear Models. 2nd ed. Washington, DC: Chapman & Hall; 2002.

21. Horgas AL, Wilms H-U, Baltes MM. Daily life in very old age: everyday activities as expression of successful living. Gerontologist. 1998;38:556-568.

22. Van Willigen M. Differential benefits of volunteering across the life course. J Gerontol. 2000;55B(5):S308-S318.

23. Hank K, Erlinghagen M. Volunteering in “old” Europe: patterns, potentials, limitations. J Appl Gerontol. 2010;29:3-20.



Ng et al 15

24. Siop S, Verbrugge LM, Tengku Aizan H. Disability and quality of life among older Malaysians. Paper presented at: Population Association of America 2008 Annual Meeting; April 17-19, 2008; New Orleans, LA.

25. Topinkova E. Aging, disability and frailty in old age [PowerPoint presentation]. http://czpres.mzcr.cz/file.aspx?id=655&name=Topinkova.pdf. Updated 2009. Accessed January 27, 2010.

26. Ministry of Health Malaysia. National Health Policy for Older Persons. Kuala Lumpur, Malaysia: Family Health Development Division; 2008.



asia-pacific journal of public healthrepository.um.edu.my/7513/1/1010539510374751.full_perceived...

Documents