International Journal of Physical Medicine & Rehabilitation
Open Access

Exploring Psychological Well-being and Integrated Care Approaches in Older Adults: A Quantitative and Descriptive Analysis of Key Factors in Lifelong Education

Pablo Rosser^1* and Seila Soler^{2 *}Correspondence: Pablo Rosser, Department of Education, Universidad Internacional de La Rioja, Logroño, Spain, Email:

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Introduction

The aging of the population is a global phenomenon that poses significant challenges and opportunities in various spheres, including education [1]. In this context, the study at the Lifelong Learning University for Older Adults in Alicante (UPUA) aims to understand the interrelation between well-being and emotions in the older adult population, especially those involved in educational programs [2]. This concept is closely related to psychological and social well-being, emphasizing the importance of social integration, active participation, and continuous learning [3].

This research gains relevance in an era where lifelong learning has become a crucial element for the personal and social enrichment of older adults [4].

In recent decades, interest in the psychological well-being of older adults has been on the rise [5]. Various studies have explored how different aspects such as self-esteem, life satisfaction, self-efficacy, and perception of personal achievements influence the quality of life of this population [6,7]. However, there is a significant gap in the literature regarding how these elements interact and manifest in specific educational environments for older adults.

This research addresses this gap, examining how the education provided at the UPUA influences, or could influence, the emotional and psychological well-being of older adults. Through a detailed analysis of data collected through a well-being survey, the study aims to comprehensively describe the well-being profile of this population and evaluate the reliability of the survey used.

This study is structured around several hypotheses. The Null Hypothesis (H0) posits that there are no significant differences in self-reported levels of well-being among different categories of the sample. The Alternative Hypotheses (H1, H2, and H3) explore the existence of variations in well-being perception and the reliability of the well-being survey, respectively. These hypotheses are based on the premise that education and lifelong learning can play a vital role in the well-being of older adults.

The significance of this study lies not only in its contribution to the academic field but also in its practical implications. By identifying key factors that impact the well-being of older adults in educational contexts, specific pedagogical recommendations can be formulated to enhance the quality of life and personal satisfaction of this growing demographic.

Therefore, this study aims to fill a significant gap in the understanding of the well-being of older adults within education, providing valuable initial conclusions for educators, policymakers, and other key stakeholders in adult education. The research, along with its subsequent developments, aligns with the broader goal of optimizing the learning experience and promoting psychological well-being in the classroom, thereby contributing to the holistic enrichment of older adults.

Materials and Methods

This initial research has been configured as a descriptive and quantitative analysis, representing a preliminary phase [8]. It constitutes a segment of a more extensive inquiry that will unfold in the coming months with a significantly more diverse and broader student population, exceeding a hundred participants [9]. As the primary instrument, a questionnaire based on Ryff’s psychological well-being and mood scale was employed [5,10- 22]. A descriptive and frequency evaluation was conducted, integrating statistics of central tendency and dispersion, with the aim of analysing responses in relation to the various elements of the well-being scale. This analysis has focused on the distribution of responses, the identification of recurring patterns, the interpretation of the results obtained, their relevance in the context of psychological well-being, and the development of pedagogical proposals grounded in these findings.

Study sample

The study targeted older adults enrolled in online education programs offered by the Lifelong Learning University for Older Adults in Alicante (UPUA). In this pilot stage, the participation of 15 individuals from a course on the History of Spain through Poison, taught by one of the researchers, was included. Despite the small sample size, this pilot group will inform future stages, expanding the scope to include the entire student body of the UPUA (over a hundred participants).

Participation was entirely voluntary and anonymous, with no additional incentives provided. Informed consent was obtained, detailing the study’s purposes, potential risks, contact information for the researchers and the institution, as well as the benefits derived from participating in the research. This procedure ensured the autonomy and protection of participants’ personal data, in compliance with current data protection legislation. No specific exclusion criteria were established, aiming to create a diverse and representative sample of the target population, a fundamental aspect for the generalization and relevance of the research results.

Assessment tools

A single questionnaire, previously validated and used in educational studies, was employed as a reliable and valid instrument for assessing online students aligned with the research objectives. The application of this questionnaire, crucial in the evaluation process, was estimated to take 20 to 30 minutes and was conducted at the beginning of the classes. Each question in the questionnaire was designed to align with a specific dimension of the survey, and appropriate statistical analyses were carried out to explore relationships between these dimensions and other study variables. The chosen instrument for this purpose was the Ryff psychological well-being assessment questionnaire, as mentioned earlier [5]. This questionnaire is recognized and validated in the scientific literature, with necessary adaptations made for its suitability in the specific study context [21,23,24].

For the assessment of well-being and mood, the responses obtained through the Ryff questionnaire were utilized. Each questionnaire question was associated with a specific dimension related to wellbeing or mood. The treatment of responses was conducted using six-point Likert scales, ranging from 1 (completely disagree) to 6 (completely agree). In this second stage of the pilot study, the analysis focused on comparing the well-being and mood levels of participants and investigating other variables of interest for the study.

Data analysis procedure

A descriptive analysis was conducted, including the determination of measures of central tendency (mean and median) and dispersion (standard deviation and range) for each item in the survey. This analysis is crucial for assessing the quality of the collected data, encompassing the identification of missing values and atypical responses. Additionally, it provides an initial and fundamental understanding of the inherent characteristics of the obtained datasets. Similarly, Cronbach’s Alpha was calculated to assess the internal consistency of the ítems.

In subsequent phases, the data analysis will be expanded with T-Test/ANOVA results and correlation analysis. ANOVA will be used to compare three or more groups, and Kendall’s Tau-b correlations, like Spearman’s Rho, will be employed. Factor analysis will also be conducted as part of the extended data analysis.

Objectives

The main purpose of this study is to explore and analyze the relationship between well-being and emotions in older adults participating in programs at the Lifelong Learning University for Older Adults in Alicante (Spain). The goal is to identify key factors that can explain how the provided education impacts their emotional state and overall well-being. Additionally, the research aims to determine pedagogical adjustments that can enhance the quality of life and personal satisfaction of these older adults.

The specific objectives of this research are, firstly, to comprehensively describe the well-being profile of the older adult population. This will be achieved through the application of statistical analyses-including measures of central tendency and dispersion-to the data collected in the well-being survey. Secondly, the study aims to determine the reliability of the well- being survey through the use of Cronbach’s Alpha, ensuring the internal consistency of the survey items. Thirdly, based on the results of the analysis, the intention is to establish a series of recommendations that can be positively implemented in classrooms to contribute to the future well-being development of older adult students.

Research hypothesis

The hypotheses formulated in this study are as follows

H0 (Null hypothesis): There are no statistically significant differences in self-reported levels of well-being when comparing different categories within the selected sample. This hypothesis suggests that, regardless of demographic variables or any other categorization applied to the sample, the perceived levels of well- being by participants do not vary significantly.

H1 (First alternative hypothesis): Moderately statistically significant differences are observed in the perception of well-being among the students participating in the study. This hypothesis proposes that, although variations in well-being perception may not be extremely pronounced, there are moderate differences that are statistically detectable.

H2 (Second alternative hypothesis): There are statistically significant differences in the perception of well-being among the students involved in the research. This hypothesis suggests that variations in self-reported levels of well-being are notable and statistically relevant among different groups or categories within the studied sample.

H3 (Third alternative hypothesis): The internal consistency of the well-being questionnaire items is ensured through the reliability established by Cronbach’s Alpha. This hypothesis focuses on validating the reliability of the instrument used, ensuring that the questionnaire items are consistent with each other and provide reliable measures of the constructs intended to be assessed.

Reliability: Cronbach’s alpha results for each scale

Given that the survey items are designed to measure similar constructs (e.g., overall well-being), we can calculate Cronbach’s Alpha to assess the internal consistency of the items [25-29].

Cronbach’s alpha value: An alpha of 0.580 indicates moderate to low reliability. Generally, an alpha value above 0.7 is considered acceptable in social research, although values between 0.6 and 0.7 may be permissible in the early stages of research. With 41 items, the scale is quite extensive. The means and standard deviations of the items vary, indicating different levels of agreement among participants (Table 1).

Table 1: Moderate to low reliability statistics.

Interpretation for well-being index research: The scale exhibits moderate to low internal consistency. This could suggest that some items are not effectively measuring the same well-being construct in the group of older adult students. Cronbach’s Alpha is a measure of internal consistency or reliability of a questionnaire. A Cronbach’s Alpha value of 0.580, although moderately low, is not unusual in social sciences, especially in studies involving human attitudes and perceptions, which tend to be more subjective and variable (Tables 2 and 3).

Table 2: The means and standard deviations of the items statistics.

Table 3: Summary element statistics.

The variability in the ages of the survey respondents could contribute to a lower Cronbach’s Alpha (Table 4). Indeed, differences in life stages can significantly influence how people respond to questions about their well-being, relationships, and self-perceptions. Each age group may have different perspectives and experiences that impact their response to questionnaire questions.

Table 4: Frequency and percentage of age of students.

1. Changing perspectives with age: Priorities, concerns, and values of an individual can change significantly throughout their life. For instance, younger individuals may be more focused on career development and relationships, while older individuals may reflect more on life satisfaction and deep personal connections.

2. Differences in life experiences: Life experiences accumulated over time can alter one’s perception of oneself and relationships. Older individuals may have a more nuanced perspective or accept aspects of their lives that younger individuals are still exploring or challenging.

3. Changes in social relationship networks: The quantity and quality of social relationships tend to change with age. Younger individuals may have broader but less profound social networks, while older individuals may have smaller but more intimate networks.

These differences may lead to greater variability in responses between age groups, potentially reducing the internal consistency of the questionnaire as measured by Cronbach’s Alpha. However, it’s essential to note that a moderately low Cronbach’s Alpha does not necessarily invalidate the study results, but it does suggest caution in interpreting the data and considering the possibility of variability due to factors such as age.

Assessment of age differences as an explanation for cronbach’s alpha

To assess whether age differences are significantly influencing the responses, we have conducted a more detailed analysis, namely the application of Analysis of Variance (ANOVA) to compare responses between different age groups (from 46 to 85 years).

ANOVA compares means between different groups (in this case, age groups) to see if there are statistically significant differences. Specifically:

Sum of squares between groups: Indicates variability due to differences between age groups.

Sum of squares within groups: Shows variability within each age group.

F and Significance (Sig.): The F value compares variability between groups with variability within groups. A high F value and a low Sig. value (usually less than 0.05) suggest that differences between age groups are statistically significant.

We will highlight some questionnaire items that show significant differences between age groups according to the ANOVA (Table 5):

Table 5: Analysis of Variance (ANOVA).

• Item 2 (“I often feel lonely because I have few close friends to share my concerns with”): Sig.=0.025, indicating a significant difference between age groups.

• Item 9 (“I tend to worry about what other people think of me”): Sig.=0.026, also suggesting significant age-related differences.

• Item 12 (“I am an active person in carrying out the projects I set for myself”): Sig.=0.011, indicating significant differences between age groups.

• Item 17 (“I feel good when I think about what I have done in the past and what I hope to do in the future”): Sig.=0.002, showing a significant difference.

• Item 22 (“The demands of daily life often get me down”): Sig.=0.012, indicating significant variability by age.

• Item 26 (“I have not experienced many close and trusting relationships”): Sig.=0.041, suggesting significant differences between age groups.

• Item 29 (“I’m not clear about what I’m trying to accomplish in life”): Sig.=0.014, indicating a significant difference between age groups.

• Item 34 (“I don’t want to try new ways of doing things; my life is fine as it is”): Sig.=0.027, showing significant differences.

• Item 34 (“I don’t want to try new ways of doing things; my life is fine as it is”): Sig.=0.027, showing significant differences.

The mentioned items above exhibit significant variations in responses based on the respondents’ age. This suggests that attitudes and perceptions related to these specific aspects vary among different age groups. These results can be valuable for better understanding how age influences people’s perceptions and experiences regarding aspects of their personal and social life.

To link the results of ANOVA by age with those items that, when removed, decrease or maintain Cronbach’s Alpha, we need to compare both sets of data (Table 6):

Table 6: Element total statistics.

Items with significant differences in ANOVA by age: These are items that show significant variations in responses among different age groups. This suggests that the perception or experience related to these items varies depending on the respondents’ age.

Items affecting cronbach’s alpha: These are items that, when removed, result in a change in Cronbach’s Alpha. An increase in Alpha after removing an item indicates that this item was not aligned with the overall construct of the questionnaire, while a decrease or maintenance of Alpha suggests that the item is in line with the overall construct.

Now, let’s compare these two sets of data. So, first, we have Items with significant differences in ANOVA that affect Cronbach’s Alpha:

Item 2 (“I often feel lonely...”): Significant ANOVA (Sig.=0.025), and according to the total item statistics, this item has a relatively high corrected item-total correlation of 0.395. Removing this item would decrease Cronbach’s Alpha to 0.542, suggesting alignment with the overall construct of the questionnaire.

Item 9 (“I tend to worry about what other people think of me”): Significant ANOVA (Sig.=0.026), and it has a very high corrected item-total correlation of 0.609. Its removal would decrease Alpha to 0.513, indicating alignment with the overall construct.

Item 12 (“I am an active person in carrying out the projects...”): Significant ANOVA (Sig.=0.011), but there is no specific information about the effect of its removal on Cronbach’s Alpha.

For items such as 2 and 9, where the removal of the item significantly decreases the Alpha, and there are significant variations in responses based on age, we can infer that these items are relevant to the overall construct of the questionnaire. However, their interpretation or importance may vary depending on age. This could suggest that aspects such as loneliness and concern for others’ opinions have different levels of relevance or are experienced differently across different life stages.

Results

The items have been examined in comparison to their opposing counterparts to identify the most significant contrasts. These antagonistic relationships illustrate how different aspects of attitudes and perceptions among older adults may be in conflict or not fully aligned with each other. These discrepancies, therefore, provide a more nuanced insight into their psychological and social well-being.

In each case, predominant proportions were analyzed, and inherent variability was explored. This process is crucial for gaining a deeper understanding of the psychological well-being of the studied sample. Based on the obtained results, relevant recommendations were formulated for the implementation of educational strategies, aiming to optimize the learning experience and promote psychological well-being in the classroom context.

Antagonistic relationship between personal pride (Item 31) and difficulty expressing opinions (Item 27)

On one hand, we will analyze responses to the statement in Item 31 (“For the most part, I feel proud of who I am and the life I lead”), using the Likert scale where 1 represents completely disagree and 6 completely agree.

A large majority of respondents (73.4%, combining categories 5 and 6) indicate feeling very or extremely proud of who they are and the life they lead. A smaller proportion (26.7%, combining categories 2 and 4) feels less proud, though still with a certain degree of pride (Table 7).

Table 7: Item 31. For the most part, I take pride in who I am and the life I lead.

These results suggest that the majority of respondents have a positive perception of themselves and high satisfaction with their lives, which may reflect good self-esteem and a sense of accomplishment. Although most feel proud, there is variability in the degree of pride, which could reflect differences in life experiences, achievements, and personal perception.

Regarding the relevance to psychological well-being, feeling proud of oneself and the life one leads is important, as it is linked to self-acceptance and life satisfaction. A high degree of pride is often associated with a sense of self-efficacy and personal fulfilment. For those who feel less proud, it would be useful to explore strategies in their training to improve self-esteem and life satisfaction. Promoting the recognition of personal achievements and the development of a positive self-image can be beneficial in increasing a sense of pride and satisfaction.

On the other hand, we will analyze responses to the statement in Item 27 (“It is difficult for me to express my own opinions on controversial matters”). The majority of respondents (53.3%, combining categories 1 and 2) indicate not having much difficulty expressing their opinions on controversial topics. 33.3% of respondents (combining categories 4,5 and 6) moderately agree with the difficulty of expressing their opinions on controversial matters (Table 8).

Table 8: Item 27. It is difficult for me to express my own opinions on controversial matters.

A significant proportion of respondents feel comfortable expressing their opinions on controversial issues, which may indicate confidence in themselves and their beliefs. The expressed difficulty by other respondents may reflect challenges in confidence, communication, or fear of social repercussion.

Regarding the relevance to psychological well-being, the ability to express one’s opinions is important for self-esteem and psychological well-being. For those who encounter difficulties, it may be useful to develop communication skills and confidence in their training.

The analysis of antagonistic relationships between “Personal pride” (Item 31) and “Difficulty expressing opinions” (Item 27) on the well-being scale effectively fulfills the objective of illustrating significant contrasts in the attitudes and perceptions of older adults. This analysis reveals how different aspects of psychological and social well-being may be in conflict or not fully aligned. On one hand, we find that the majority of respondents feel proud of themselves and their lives, with a high percentage indicating feeling very or extremely proud. On the other hand, while a majority does not find it difficult to express their opinions on controversial topics, there is a considerable percentage that does experience some difficulty in this aspect.

This contrast between the high degree of personal pride and the difficulty expressing opinions reveals significant complexity in the experience of older adults. While personal pride reflects a positive self-image and satisfaction with life, the difficulty expressing opinions may indicate a discrepancy between this positive selfimage and the confidence to engage in social or controversial discussions. This suggests that, although individuals may feel satisfied and positive about themselves and their achievements, they may face challenges when communicating their ideas and opinions in social contexts, especially on controversial topics.

Given this analysis, it is recommended to develop training programs for older adults that strengthen their communication and opinion expression skills, thus promoting greater alignment between their self-esteem and their ability to express themselves in public. This may include workshops on assertive communication and handling debate situations, supporting older adults not only in feeling proud of who they are but also in feeling confident and capable of expressing their opinions effectively. These strategies could enhance their learning experience and contribute significantly to their overall well-being.

Confidence in own opinions (Item 21) vs. Susceptibility to others’ convictions (Item 15)

On one hand, we will analyze responses to the statement in Item 21 (“I have confidence in my opinions even if they are contrary to general consensus”). A significant majority of respondents (73.3%, combining categories 5 and 6) show high or very high confidence in their opinions, even if they are contrary to general consensus. 26.6% (combining categories 3 and 4) indicate moderate or fairly high confidence to not having that confidence (Table 9).

Table 9: Item 21. I have confidence in my opinions even if they are contrary to the general consensus.

These results suggest that the majority of respondents have confidence in their own opinions and are willing to maintain them even in the face of contrary opinions or group pressures. Regarding the relevance to psychological well-being, maintaining confidence in one’s opinions is an important aspect, also for self-affirmation, as it reflects a person’s ability to maintain individuality and autonomy. It is important to balance confidence in one’s opinions with openness to new ideas and the ability to consider alternative perspectives.

For those with a lower level of confidence, strategies to strengthen self-confidence and self-affirmation could be explored in training. It would be beneficial to promote the development of healthy selfesteem and critical thinking skills while encouraging openness and flexibility in thinking.

On the other hand, we will analyze responses to the statement in Item 15 (“I tend to be influenced by people with strong convictions”). A significant majority of respondents (66.6%, combining categories 1 and 2) indicate not being strongly influenced by individuals with strong convictions. 26.6% of respondents (combining categories 4 and 5) show some degree of agreement with being influenced by people with strong convictions (Table 10).

Table 10: Item 15. I tend to be influenced by people with strong convictions.

These results suggest that the majority of respondents tend to maintain their own opinions and beliefs, even in the face of individuals with strong convictions. Regarding the relevance to Psychological Well-being, the ability to maintain autonomy in one’s beliefs and opinions is important for psychological well-being, as it reflects self-affirmation and individuality. It is important to balance openness to new ideas with the ability to maintain autonomy in one’s beliefs and decisions.

For those who feel more influenced, it could be useful to work on strengthening self-affirmation and confidence in their own beliefs in training. Promoting the development of critical thinking skills and self-confidence can be beneficial for those seeking to increase their autonomy in the face of external influences.

The analysis of antagonistic relationships between “Confidence in own opinions” (Item 21) and “Susceptibility to others’ convictions” (Item 15) on the well-being scale serves the purpose of identifying significant contrasts in the attitudes and perceptions of older adults. This analysis demonstrates how different aspects of psychological well-being may be in conflict or not fully aligned, providing a nuanced insight into the studied sample.

In the case of Item 21, we observe that a significant majority of respondents exhibit high confidence in their own opinions, even if these opinions are contrary to the general consensus. This reflects strong self-affirmation and confidence in their personal beliefs. In contrast, the results of Item 15 reveal that a majority also indicates not being strongly influenced by individuals with strong convictions, suggesting a tendency towards autonomy in opinions and beliefs, even in the face of strong external influences.

This antagonism between confidence in one’s own opinions and resistance to being influenced by the convictions of others highlights a complexity in the dynamics of self-affirmation and social influence. On one hand, confidence in one’s own opinions can be seen as a sign of strength and self-assurance. On the other hand, lower susceptibility to being influenced by others suggests independence in thinking and an ability to stand firm against social pressures or external convictions.

These findings are crucial for gaining a deeper understanding of the psychological well-being of the studied sample and provide a foundation for the implementation of educational strategies. The development of critical thinking skills and self-confidence can be encouraged, while also promoting openness and flexibility in thinking. For those with lower confidence or higher susceptibility, it would be beneficial to explore strategies to strengthen their selfaffirmation and self-expression skills. These recommendations can help optimize the learning experience and promote psychological well-being in the classroom context, considering the variability in responses and the inherent subjectivity in the perception of these attitudes.

Satisfaction with personal achievements (Item 25) vs. Disappointment with personal achievements (Item 25)

We will analyze responses to the statement in Item 25 (“In many ways, I feel disappointed with my achievements in life”). A majority of respondents (66.6%, combining categories 1 and 2) do not feel disappointed with their achievements in life. 20.0% of respondents (category 5) agree with feeling disappointed with their achievements (Table 11).

Table 11: Item 25. In many aspects, I feel disappointed with my achievements in life.

These results suggest that the majority of respondents are generally satisfied with their achievements in life, although there is a significant proportion that feels some level of disappointment. Regarding the relevance to psychological well-being, satisfaction or disappointment with personal achievements has a significant impact, also on self-esteem.

For those who feel disappointment, it may be useful in training to reassess and adjust their goals and expectations to better align them with their values and current circumstances. It is important to address the concerns of those who feel significant disappointment, possibly through counselling or support for goal reassessment. Encouraging a realistic and healthy perspective on personal achievements and providing support for expectation management and goal redefinition can be beneficial.

The analysis of antagonistic relationships between “Satisfaction with personal achievements” and “Disappointment with personal achievements” within the same item (Item 25) on the well-being scale provides a detailed insight into how different aspects of attitudes and perceptions among older adults may not align completely. This approach, comparing predominant proportions and exploring inherent variability, is crucial for gaining a deep understanding of the psychological well-being of the studied sample.

In this item, it is observed that a majority of respondents do not feel disappointed with their achievements in life, indicating a general tendency toward personal satisfaction and a sense of accomplishment. However, there is a significant proportion of respondents who do experience disappointment regarding their achievements, suggesting diversity in the perception of personal achievements and levels of aspiration among participants. This contrast reflects differences in how individuals perceive and value their achievements and successes in life, directly impacting their self-esteem and personal satisfaction.

The ability to generalize these results is limited due to the sample size and the perception of achievements and related disappointment is highly subjective, possibly influenced by personal and contextual factors. In terms of relevance to psychological well-being, satisfaction or disappointment with personal achievements has a significant impact, and for those who feel disappointment, it may be helpful to reassess and adjust their goals and expectations to better align them with their values and current circumstances.

In conclusion, the predominance of satisfaction over disappointment in personal achievements suggests a generally positive trend. However, addressing the concerns of those who experience disappointment is important, possibly through counselling or support for goal reassessment. Encouraging a realistic and healthy perspective on personal achievements and providing support for expectation management and goal redefinition can be beneficial. This analysis, along with other survey responses, provides a more comprehensive understanding of how respondents perceive their achievements and their overall life satisfaction.

Perception of personal responsibility (Item 16) vs. Disappointment with personal achievements (Item 25)

On one hand, we will analyze responses to the statement in Item 16 (“In general, I feel that I am responsible for the situation I am in”). A significant majority of respondents (80.0%, combining categories 5 and 6) feel very or extremely responsible for the situation they are in. 20.1% of respondents (combining categories 1, 3, and 4) show a lower degree of agreement with feeling responsible for their situation (Table 12).

Table 12: Item 16. Overall, I feel responsible for the situation in which I live.

These results suggest that the majority of respondents feel a high degree of personal control and responsibility for their current situation, reflecting a strong sense of self-efficacy. Regarding the relevance to psychological well-being, feeling responsible for one’s own situation is crucial, as it is associated with personal agency and the ability to make positive changes. A strong sense of personal responsibility is related to proactivity and the ability to adapt and manage challenges.

For those who feel less responsibility, it would be beneficial to promote, during training, the development of personal agency and skills to manage their environment. Encouraging selfefficacy, conscious decision-making, and adaptation strategies can be beneficial for those seeking to increase their sense of responsibility over their situation.

On the other hand, we will return to the statement in Item 25 (“In many ways, I feel disappointed with my achievements in life”). As we have seen earlier, a majority of respondents (66.6%, combining categories 1 and 2) do not feel disappointed with their achievements in life. 20.0% of respondents (category 5) agree with feeling disappointed by their achievements (Table 11). These results suggest that the majority of respondents are generally satisfied with their achievements in life, although there is a significant proportion that feels some level of disappointment.

The analysis of antagonistic relationships between “Perception of personal responsibility” (Item 16) and “Disappointment with personal achievements” (Item 25) on the well-being scale reveals how different aspects of attitudes and perceptions among older adults may be in conflict or not fully aligned. This analysis is crucial for understanding in-depth the psychological well-being of the studied sample and provides a nuanced insight into their emotional and social state.

On one hand, the “Perception of personal responsibility” shows that a significant majority of respondents feel very or extremely responsible for the situation they are in. This suggests a high degree of personal control and responsibility for their current situation, reflecting a strong sense of self-efficacy. On the other hand, in Item 25, we find that, while the majority of respondents do not feel disappointed with their achievements in life, there is a significant segment that does experience disappointment.

This contrast between the sense of personal responsibility and disappointment with personal achievements illustrates how the perception of control and responsibility over one’s life may be in tension with feelings of disappointment or dissatisfaction with personal achievements. While the perception of personal responsibility implies a proactive and controlling attitude, disappointment with personal achievements may indicate a gap between expectations and lived reality, impacting self-esteem and personal satisfaction.

The ability to generalize these results is limited due to the sample size, and perceptions of both responsibility and achievements are highly subjective, influenced by personal and contextual factors. In terms of psychological well-being, feeling responsible for one’s own situation is crucial, as it is associated with personal agency and the ability to make positive changes. However, disappointment with personal achievements requires attention, as it may be necessary to reassess and adjust goals and expectations.

In conclusion, the prevalence of the sense of personal responsibility suggests a generally proactive attitude, but it is important to address the concerns of those experiencing disappointment. Encouraging a realistic and healthy perspective on personal achievements and providing support for expectation management and goal redefinition can be beneficial. This analysis, along with other survey responses, provides a more comprehensive understanding of how respondents perceive their control, responsibility, and satisfaction with their lives.

Proactivity in personal projects (Item 12) vs. Ceasing to try improvements or changes (Item 30)

On one hand, we will analyze responses to the statement in Item 12 (“I am an active person in carrying out the projects I have set for myself”). A significant majority of respondents (80.0%, combining categories 5 and 6) feel very or extremely active in carrying out their personal projects. 20.1% of respondents (combining categories 2,3 and 4) show a lower degree of agreement with being active in the realization of their projects (Table 13).

Discussion

The discussion of the study on the well-being of older adults at the Permanent University for Adults in Alicante is deepened by contrasting the obtained results with previous research, providing a more comprehensive perspective on how these findings align or differ from current trends in scientific literature. This comparison is crucial to contextualize the research within the broader field of well-being in old age.

Starting with a summary of the main findings, the study highlights the interrelation between various psychological aspects such as personal pride, the ability to express opinions, satisfaction with personal achievements, and self-awareness in older adults. These elements reflect a complex interplay of factors contributing to overall well-being. The research by Wright, et al., and Fernández, et al., for example, emphasizes the importance of self-esteem and satisfaction with personal achievements, aspects that this study corroborates and extends to the context of adult education, including the online teaching environment [30-32].

Regarding the generalizability of the results, it is important to consider that, although the findings are relevant to the participants in this particular study, they may not be directly applicable to other contexts or cultures. This limitation opens opportunities for future research that could explore whether these results are consistent in different educational settings or demographic groups [33].

The practical relevance of the results is highlighted in their potential application in pedagogical strategies and clinical practices. Educators and healthcare professionals could use these findings to develop interventions and programs aimed at improving the psychological well-being of older adults, taking into account the various identified factors [19,33,34].

A reflection on the strengths and limitations of the study is crucial. While the detailed focus and the wide range of variables studied are strengths, limitations such as sample size and potential response bias in the questionnaire must be acknowledged. These limitations suggest caution in interpreting the results and provide directions for our already designed future research endeavors [9].

Concerning future research, this study raises important questions about how perceptions and attitudes of well-being evolve over time in older adults [3,8,9]. Longitudinal and comparative studies in different educational contexts could offer a more comprehensive insight into these aspects.

Continuing from the previous discussion, it is essential to consider the impact of these findings on the existing knowledge in the field [5,6,35]. By challenging or reinforcing previous theories, this study significantly contributes to our understanding of well-being in old age, especially in educational contexts. This comprehensive approach not only enriches existing literature but also guides future research and educational and clinical practices focused on older adults.

Integrated approaches to patient care in the elderly population: An analysis from the perspective of continuing education

Comprehensive patient care, especially in the elderly population, has gained importance in recent decades, recognizing the intersection between various physical, psychological, social, and educational factors that influence quality of life and overall wellbeing. Within this framework, continuing education emerges as a vital component, offering opportunities to improve psychological well-being and, therefore, the overall health of the elderly. This document explores how the integration of educational programs, focused on lifelong learning, can be part of an integrative approach to patient care, highlighting research conducted at the University for the Elderly in Alicante (Spain).

Intersection between continuing education and comprehensive care

Continuing education has been shown to have a significant impact on the psychological well-being of the elderly, addressing crucial aspects such as self-esteem, self-efficacy, and satisfaction with personal achievements. Participation in educational programs fosters a sense of purpose, enhances cognitive and social skills, and strengthens self-confidence, which is essential for healthy aging. In the context of integrated patient care, these programs not only serve as tools for empowerment and personal development but also as preventive and therapeutic strategies against common age-related problems, such as loneliness, isolation, and cognitive decline.

In this regard, for example, the impact of patient-centered practice in healthcare on the use of wearable devices and the role of this technology in improving patients’ mental health has been analyzed [36].

Integrated care model: A holistic approach

The adoption of an integrated care model for the elderly requires multidisciplinary collaboration among health professionals, educators, and community organizations. This model proposes a holistic vision that considers the individual as a whole, recognizing the interdependence between physical, mental, and social well-being. Continuing education programs, especially designed for this population, should be considered within this model as interventions that significantly contribute to mental and emotional health, complementing medical and rehabilitation interventions.

It is for this reason that the importance and costs of complex biopsychosocial healthcare needs in elderly people are investigated, suggesting the evaluation of interdisciplinary treatment plans [37].

Similarly, the four Italian telemedicine experiences aimed at chronic, geriatric, or partially self-sufficient subjects are noteworthy. The main goal of the OPLON project, supported by the Italian Ministry of Education, Universities, and Research, is to identify and prevent frailty and improve the quality of life of elderly subjects. A general model of tele-monitoring and teleassistance for frail and pre-frail people with different needs and pathologies is proposed, characterized by three macro-processes (enrollment, assessment, and assistance) and four groups of actors (Patient, general practitioner/specialist physician, multidisciplinary team, and healthcare professionals) [38].

Implementation and challenges

The effective implementation of an integrative approach to patient care faces several challenges, including the need to adapt educational programs to the capabilities and needs of the elderly. It is crucial to develop flexible curricula that allow the active participation of this demographic group, promoting meaningful learning and social interaction. Additionally, it is essential to establish collaboration mechanisms between educational and health institutions to facilitate a coordinated approach that addresses all facets of elderly well-being.

In this sense, for example, the impact of an orthopedic-geriatric continuing education program for nurses on elderly patients who have suffered a hip fracture has been evaluated [39].

Results and potential benefits

The benefits of integrating continuing education into comprehensive patient care are multifaceted. From a mental health perspective, educational programs can mitigate symptoms of depression and anxiety, increase resilience, and promote a positive attitude towards life.

This is how, for example, recent developments in the care of elderly transgender patients are investigated, highlighting the need for appropriate and sensitive care guidelines [40].

In terms of physical health, participation in educational and social activities can lead to a more active lifestyle, reducing the risk of chronic diseases and improving personal autonomy. Additionally, these programs promote social inclusion, combating isolation and promoting community support networks.

Recommendations for practice

To maximize the impact of educational programs within an integrated approach to patient care, it is recommended to:

• Develop personalized educational programs that consider the preferences, abilities, and limitations of the elderly.

• Encourage cross-sector collaboration between educational institutions, health services, and community organizations to create a cohesive and holistic approach to the well-being of the elderly.

• Incorporate assistive technologies and digital platforms to make educational programs accessible to a wider population, especially those with physical limitations or residing in remote areas.

• Regularly evaluate programs to ensure their effectiveness and adaptability to the changing needs of the target population.

Conclusion

In our research, we have carefully evaluated the hypotheses and arrived at specific conclusions for each. Regarding the Null Hypothesis, which posits the absence of significant differences in self-reported well-being among different categories of the sample, we have found that it is not fully supported. Our analysis reveals variations in certain aspects of well-being and emotions among different subgroups, especially in relation to age and other demographic factors, suggesting significant differences in some areas of well-being, confirming the rest of the research hypothesis.

Indeed, concerning the first Alternative Hypothesis, proposing the existence of statistically moderate differences in the perception of well-being, our findings support it. We have detected moderate differences in the perception of well-being among participants, particularly in aspects such as confidence in expressing opinions and satisfaction with personal achievements. This reflects moderate variability in well-being perceptions among study participants.

The second Alternative Hypothesis, suggesting statistically significant differences in the perception of well-being among students, is also partially supported by our results. We have observed significant differences in responses to certain questionnaire items, indicating notable variations in self-reported well-being levels among different groups within the sample.

Finally, the third Alternative Hypothesis, related to the internal consistency of the questionnaire items, is only partially fulfilled. The obtained Cronbach’s Alpha indicates moderate to low reliability, suggesting that while some items are consistent in measuring the well-being construct, others may not be effectively aligned. However, we have been able to explain and statistically demonstrate this variance in age and the logical contrast of opinions.

Our study focused on exploring the complex interaction between various psychological and social aspects, using a detailed approach to better understand the experiences and perceptions of this population, we have derived important conclusions from it.

Firstly, we observed that a significant proportion of the respondents demonstrate a high level of personal pride and confidence in their opinions, suggesting strong self-esteem and self-efficacy. This finding is noteworthy as it underscores the importance of fostering and maintaining a positive self-image and a confident attitude among older adults, fundamental aspects for their overall well-being.

On the other hand, we have also identified certain challenges, such as difficulty expressing opinions on controversial topics and susceptibility to others’ convictions. These aspects highlight the need to develop communication skills and confidence in this demographic group, something that can be particularly valuable in educational and social environments.

Furthermore, our study has revealed that, while many respondents feel satisfied with their achievements and have a clear direction and goals in life, there is a significant group experiencing disappointment in their personal accomplishments and displaying resistance to change. This indicates the diversity in life experiences and perceptions among older adults, emphasizing the importance of addressing these differences through personalized educational and support programs.

Our findings also highlight the relevance of balancing satisfaction with the past and future with practical competence in handling daily responsibilities. We have observed that the majority of participants effectively manage their daily responsibilities while maintaining a positive outlook on their past and future experiences, a combination that contributes significantly to their overall well-being.

Finally, the relationship between high self-awareness and the desire for personal change has proven to be a particular area of interest. Our results suggest that, while many older adults continue to learn about themselves and maintain an open attitude toward change, they also value stability and consistency in certain aspects of their lives.

Regarding the antagonistic relationship between personal pride and the difficulty expressing opinions, addressing selfesteem and communication skills is crucial. Programs could include workshops that encourage the appreciation of personal achievements and the development of a positive self-image. At the same time, it is crucial to teach effective communication skills and confidence-building to help students express their opinions more easily.

Confidence in one’s opinions versus external influence requires an approach that strengthens self-confidence and critical thinking. Courses could include activities that promote individual reflection, self-assertion, and the development of a critical and open mindset. This would help students form and trust their own convictions, reducing susceptibility to external influence.

As for satisfaction with personal achievements, it is essential to provide support for managing expectations and redefining goals. This could include counseling sessions and workshops on setting realistic goals and adapting aspirations to each individual’s current circumstances and values.

The perception of personal responsibility in the face of disappointment with personal achievements can be enhanced by promoting personal agency and skills for navigating the environment. This could include programs that teach decisionmaking, adaptability, and strategies to increase self-efficacy.

To address proactivity in personal projects versus the cessation of improvement or change attempts, it would be useful to provide training in project management techniques, goal setting, and motivation. For those who have stopped seeking improvements, it would be beneficial to focus on personal development and motivation through reflection and continuous learning.

High self-awareness and personal growth versus resistance to personal change would benefit from strategies that encourage introspection and self-knowledge. Activities such as meditation, reflection, and journal writing can be helpful, as well as workshops focused on self-exploration and identifying areas for personal growth.

In terms of well-being when reflecting on the past and the future, it is important to promote a positive and realistic outlook. This could include strategies to enhance satisfaction with the past and optimism toward the future, along with efficiency in managing daily responsibilities.

Finally, satisfaction with life goals and self-appreciation can be enhanced by reviewing and adjusting goals to be realistic and achievable, and by promoting self-acceptance and the development of a positive self-image. Additionally, for those struggling with managing daily demands and clarity of direction and goals, it would be helpful to provide psychological support and strategies to define and achieve personal goals effectively.

Integrating continuing education into a comprehensive patient care model offers a promising path to improving the quality of life of the elderly. By addressing psychological and emotional well-being through education, it is possible not only to enrich the lives of individuals but also to promote healthy and active aging. Future research should focus on evaluating the long-term impact of these programs and exploring new ways of integration between education and patient care, ensuring a truly holistic approach to the care of the elderly.

Acknowledgment

It is necessary to express gratitude for the facilities and enthusiasm that the fantastic team at the Permanent University of Adults of Alicante (UPUA) is providing for our research project, especially its Director, Mrs. Marian Alesón Carbonell.

Conflict of Interest

The authors of this study declare that there are no competing interests associated with this research. Each author has carefully examined any potential conflicts of interest, including financial, personal, or professional relationships that could be construed as influencing the research process or its outcomes. After thorough consideration, it has been determined that there are no such interests present. This declaration is made to affirm the objectivity, transparency, and integrity of the research and its findings.

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