Association of Family Type with Happiness Attributes Among Older Adults

Background: This study used secondary data from the 2017 Korean Community Health Survey to 15 compare the associations between depressive symptoms, present health status, socio-physical 16 environment, social support networks, and social activities with happiness among older adults from 17 three different family types. 19 Method: The study employed a non-experimental, cross-sectional research design. The data were 20 analyzed using the chi-square test, one-way ANOVA, and Logistic regression. 21 Results: Findings revealed a significant difference in the happiness index among older adults living 22 alone (6.22 ± 2.11), older adults living with their spouse (6.76 ± 1.99), and older adults living with 23 their family (6.46 ± 1.94) (F = 88.69, p < .001). As the result of logistic regression, older adults living 24 alone (odds ratio (OR) = 0.75, 95% confidence interval (CI) = 0.57–0.99) and those living with their 25 family (OR = 0.80, 95% CI = 0.65–0.99) demonstrated greater happiness as the frequency of contact 26 with their family increased. Older adults living with their spouse indicated an increase in happiness 27 when their contact with friends was higher (OR = 0.69, 95% CI = 0.56–0.84). 28 Conclusion: It was confirmed that factors influencing happiness differed according to older adults’ 29 family type, thus suggesting that older adults’ happiness could be facilitated through interventions 30 that consider their circumstances, including family type.


33
In South Korea, the proportion of people aged 65 years and older was 7.03% of the total 34 population in 2000, thus making it an aging society [1]. Subsequently, in 2018, South Korea went on 35 to become an aged society as the proportion of people aged 65 years and older became 14.76% of the total population. With this rapid aging rate, older adults' family types have changed in various ways.
Satisfaction with socio-physical environment was assessed using the following seven items: 143 "trust in neighbors," "help from neighbors," "neighborhood safety level (disasters, traffic accidents, 144 work accidents, crime)," "natural environment (air and water quality)," "life environment (electricity,  Social support networks were assessed using the following three items: "contact with family (or 152 relatives)," "contact with neighbors," and "contact with friends." Each item was rated on a six-point 153 Likert scale (1 = less than once a month, 2 = once a month, 3 = two or three times a month, 4 = once a week, 5 = two or three times a week, 6 = four or more times a week).
Participation in social activities was assessed using the following four items: "religious activities,"

160
The KCDC provides the data used in this study free of charge for research purposes after     (Table 1). There were significant 172 differences in the sociodemographic characteristics of the three groups (p < .001). Among older adults 173 living alone, 692 (4.7%) were male and 2,367 (16.1%) were female. Among those living with their 174 spouse, 3,786 (25.8%) were male and 2,858 (19.4%) were female. Among those living with their family, 175 1,845 (12.6%) were male and 3,139 (21.4%) were female. The average age was 74.86 ± 6.45 years, 72.47 176 ± 5.50 years, and 73.56 ± 6.75 years for older adults living alone, those living with their spouse, and 177 those living with their family, respectively (p < .001). Although the educational category of 178 elementary school graduates had the highest percentage in all three groups, there was a significant 9 older adults living alone were widowed and 2,736 older adults living with their family were married, all three groups, the highest percentage was observed for those not eligible for basic livelihood rights.
for older adults living alone, 1,000,000 to 1,990,000 Korean won for those living with their spouse, 186 and over 2,000,000 Korean won for those living with their family (p < .001).

218
Significant factors influencing happiness in the three family type groups were as follows. Among 219 older adults living alone, females were 1.39 times more likely to be happy than were males (odds 220 ratio (OR) = 1.39, 95% confidence interval (CI) = 1.08-1.78). As compared to participants with a college 221 graduate degree or higher, happiness was 63% lower in middle school graduates (OR = 0.63, 95% CI 222 = 0.42-0.95). Further, happiness was 74% lower in older adults who were employed (OR = 0.74, 95% 223 CI = 0.59-0.92) than in unemployed older adults living alone, while happiness was 68% lower in those 224 who were eligible for basic livelihood rights (OR = 0.68, 95% CI = 0.53-0.88) than in those not eligible 225 for basic livelihood rights. Happiness was 48% lower in those with a monthly income of less than 226 500,000 won (OR = 0.48, 95% CI = 0.32-0.72) than for those with a monthly income of over 2,000,000 227 Korean won. Further, happiness scores decreased with an increase in depressive symptoms (OR = 228 0.87, 95% CI = 0.85-0.90), and increased with an increase in the present health status level (OR = 1.21, 229 95% CI = 1.15-1.28). With reference to social support networks, those who trusted their neighbors were 1.45 times more likely to be happy than those who did not (OR = 1.45, 95% CI = 1.16-1.82).
Further, happiness was 70% and 75% lower in those who had contact with their family only once a 232 month (OR = 0.70, 95% CI = 0.51-0.95) or two to three times a week (OR = 0.75, 95% CI = 0.57-0.99), 233 respectively, than those who had contact with their family four or more times a week. Similarly, 234 happiness was 62% lower in those who had contact with neighbors only once a week (OR = 0.62, 95% 235 CI = 0.42-0.93) than those who had contact with neighbors four or more times a week. Happiness was 236 1.44 times higher in those who had contact with friends two to three times a week (OR = 1.44, 95% CI 237 = 1.05-1.96) than those who had contact with friends four or more times a week. With reference to 238 participation in social activities, those who participated regularly in religious activities were 1.49 239 times more likely to be happy than those who did not (OR = 1.49, 95% CI = 1.24-1.79). Further, those 240 who participated regularly in belonging to communities were 1.25 times more likely to be happy than 241 those who did not (OR = 1.25, 95% CI = 1.03-1.52), and those who participated regularly in leisure 242 activities were 1.38 times more likely to be happy than those who did not (OR = 1.38, 95% CI = 1.05-243 1.80).

244
Among older adults living with their spouse, as age increased, the probability of being happy 245 increased (OR = 1.02, 95% CI = 1.01-1.03). As compared to those who were college graduates or higher, 246 all those with an educational level of below high school graduation were less likely to be happy (OR 247 = 0.73, 95% CI = 0.58-0.92). As compared to those with a monthly income of over 2,000,000 Korean 248 won, those with a monthly income of below 1,990,000 Korean won were less likely to be happy (OR

251
(OR = 1.26, 95% CI = 1.21-1.31). Those who trusted their neighbors were 1.32 times more likely to be 252 happy than those who did not (OR = 1.32, 95% CI = 1.13-1.54). Additionally, those who were satisfied 253 with condition of public transportation were 1.24 times more likely to be happy than those who were more times a week, happiness was 83% lower in those who had contact with neighbors less than once a month (OR = 0.83, 95% CI = 0.69-0.99). Similarly, as compared to those who had contact with friends 257 four or more times a week, happiness was 69% lower in those who had contact with friends only once did not (OR = 1.22, 95% CI = 1.07-1.40), while those who participated regularly in belonging to 261 communities were 1.20 times more likely to be happy than those who did not (OR = 1.20, 95% CI = 262 1.05-1.39). Additionally, those who participated regularly in leisure activities were 1.47 times more 263 likely to be happy than those who did not (OR = 1.47, 95% CI = 1.24-1.75).

264
Among older adults living with their family, females were 1.39 times more likely to be happy 265 than were males (OR = 1.39, 95% CI = 1.16-1.66). Further, the probability of being happy increased 266 with an increase in age (OR = 1.02, 95% CI = 1.01-1.03). As compared to those with a college graduate 267 degree or higher, those with an educational level of high school graduation or lower were less likely 268 to be happy (OR = 0.61, 95% CI = 0.45-0.82). Further, as compared to older adults who had never 269 married and lived with their family, happiness was 29% lower in those who were divorced (OR = 270 0.29, 95% CI = 0.11-0.78). As compared to those with a monthly income of over 2,000,000 Korean won,

274
95% CI = 1.18-1.29). Further, those who trusted their neighbors were 1.19 times more likely to be 275 happy than those who did not (OR = 1.19, 95% CI = 1.01-1.42). Additionally, those who were satisfied 276 with their natural environment were 1.32 times more likely to be happy than those who were not (OR 277 = 1.32, 95% CI = 1.09-1.59). As compared to those who had contact with their family four or more 278 times a week, happiness was 80% lower in those who had contact with their family less than once a 279 month (OR = 0.80, 95% CI = 0.65-0.99). As compared to those who had contact with neighbors four 280 or more times a week, happiness was 1.62 times higher in those who had contact with neighbors two 281 to three times a week (OR = 1.62, 95% CI = 1.18-2.22). With reference to participation in social activities, 13 those who participated regularly in religious activities were 1.31 times more likely to be happy than 283 those who did not (OR = 1.31, 95% CI = 1.13-1.51). Similarly, those who participated regularly in 284 leisure activities were 1.37 times more likely to be happy than those who did not (OR = 1.37, 95% CI 285 = 1.12-1.68).   programs catered to females. Therefore, programs targeting older males need to be developed to 306 improve their happiness levels. The present study also found that, among older adults living with study, older adults living with their spouse had the highest happiness score, while those living alone 309 had the lowest happiness score. Further, older adults living alone had the highest depression score 310 and the lowest health status score. It was also found that divorced participants were less likely to be happy than participants who had never married. On the contrary, older adults living with their 312 spouse had the lowest level of depression and the best overall present health status. According to

359
In this study, the common aspect of social support networks that was associated with happiness 360 in all three family type groups was contact with neighbors. However, the nature of this association 361 differed between the three groups. Specifically, happiness among older adults living alone and those 362 living with their spouse increased in proportion to their contact with neighbors. In contrast, older 363 adults living with their family were happier if they had optimal rather than excessive contact with 364 their neighbors. This finding suggests that, in older adults living with their family, contact with 365 neighbors or friends did not seem to be significantly associated with happiness. The older adults 366 living with their family were more dependent and focused on the family, such as children [14].
Therefore, this study showed that neighbors are an important support system for older adults living

389
In the present study, in older adults living alone, family and neighborhood contact were   with "restricted" networks tend to have the poorest well-being, but those with "diverse" networks 401 have even better well-being than co-residing older adults. Therefore, to improve older adults'

405
In this study, the common aspects of participation in social activities that were associated with 406 happiness in all three family type groups were religious activities, and leisure activities. Religious    happiness. The present study also found that most older adults living alone had contact with friends 427 two or three times per week, and that the more social activities they had, the higher was their 428 happiness. This seems to favor the idea of being in contact with friends based on activities with a 429 purpose rather than simply meeting them without any purpose. This finding suggests that

445
The interesting differences observed between the three groups have been summarized below.

446
First, trust in neighbors was found to be a significant influence factor of happiness in all three groups.

447
While the physical environment was significantly associated with happiness among older adults 448 living with their spouse and those living with their family, it was not so for older adults living alone.

449
Second, with reference to social support networks, while contact with family and neighbors was 450 significantly associated with happiness among older adults living alone, contact with neighbors and 451 friends was an important factor for older adults living with their spouse, and contact with family was 452 significant for older adults living with their family. Third, while social activity participation was 453 significantly correlated with happiness in all three groups, this association was not observed with 454 reference to participation in charity activities. Considering these characteristics, it is evident that 455 happiness promotion programs for older adults need to consider their family type.

457
This study had several limitations. All the secondary data collected were cross-sectional, making 458 it difficult to make causal inferences. Further, those who were depressed may have been more likely 459 to live alone, and those living alone may be more likely to have a lower income as compared to those living with their families. In old age, income has a significant impact on quality of life [3]. Attempts 461 to generalize the results of this study, which were obtained using secondary data originally collected 462 for another purpose, must be undertaken with caution. The data acquired had inherent limitations.
The data used in this study were collected using a self-report questionnaire. Thus, the possibility of

479
Among older adults living alone, female gender; higher educational level; economic ability to 480 survive without working; absence of depression; good health status; trusted neighbors; more 481 frequent contact with family and neighbors; contact with friends two or three times a week; and 482 regular participation in religious, belonging to communities, and leisure activities were associated 483 with a higher likelihood of happiness. Among older adults living with their spouse, older age; higher educational level; income; absence of depression; good health status; convenience in using public transportation; more frequent contact with trusted neighbors and friends; and regular participation 486 in religious, belonging to communities, and leisure activities were associated with a higher likelihood 487 of happiness. Among older adults living with their family, female gender; older age; higher 488 educational level; never having been divorced; income; absence of depression, good health status, 489 more frequent contact with family, contact with trusted neighbors two or three times a week, and 490 regular participation in religious and leisure activities were associated with a higher likelihood of 491 happiness.

492
Together, the present findings suggest that the family is an essential support system for older 493 adults. It was confirmed that factors associated with older adults' happiness differed according to 494 their family type. Therefore, attempts to ensure the happiness of older adults must adequately