Journal of Religion and Health

https://doi.org/10.1007/s10943-019-00969-6

ORIGINAL PAPER

An Impact of Perceived Social Support on Old Age

Well‑Being Mediated by Spirituality, Self‑esteem and Ego
Integrity

Zahida Ilyas1 · Sarah Shahed1 · Safdar Hussain2 

© Springer Science+Business Media, LLC, part of Springer Nature 2020

Abstract
Good in physical health is a positive outcome in later life associated with well-
being. The purpose of this study was to address the factors involved in friends, fam-
ily and someone’s special support that affect physical well-being and psychological
well-being, mediated by the spirituality, self-esteem and ego integrity among older
adults. Respondents (410) were selected through questionnaire sampling technique
from the age of 61 years and above from the four different divisions of Punjab prov-
ince of Pakistan. It revealed that the hypotheses family support and someone’s spe-
cial support have a positive impact on spirituality, while friends support has a nega-
tive impact on spirituality. Spirituality has a slightly positive impact on self-esteem
and ego integrity. Self-esteem and ego integrity have a positive influence on physi-
cal and physiological well-being, whereas ego integrity has a negative effect and
physical well-being. Health and psychological well-being are closely related to each
other, which can be distinguished by life satisfaction, happiness and sadness feel-
ings, the meaning of life and sense of purpose. For the enhancement of social sup-
port mechanisms, social workers should consider community setting of older people
in the Pakistani context.

Keywords  Life satisfaction · Older adults · Physical health · Self-esteem · Well-

being

* Sarah Shahed
[email protected]
Safdar Hussain
[email protected]
1
Department of Applied Psychology, Lahore College for Women University, Jail Road,
Lahore 54000, Pakistan
2
Department of Economics, Pir Mehr Ali Shah, Arid Agriculture University Rawalpindi,
Rawalpindi 46000, Pakistan

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Introduction

In modern times with notable demographic developments, the oldest popula-

tion is being progressive virtually. In the world, European and North American
countries have the maximum ratio of older people; however, Europe is shrinking
by the young population which is a demographic weakness of its population. By
2020, one billion populations will reach over the age of 60  years, and by 2050,
it will touch near two billion, which is 22% of the total world’s population. The
segmentation of 80 years and above age, predicted higher from 1% to 4%, which
is increasing progressively than the younger population (DESA 2010; Immerfall
and Therborn 2009).
In developing countries like Pakistan, the aging population is a major concern
as well as, disabilities extents, especially after the 50 years of age, are increasing.
With the projected increase in population from the age of 60 years and above in
Pakistan, it will increase from nine million (current situation) to 42 million in
2050 approximately (Kemal et al. 2003; Nations 2002). The notation that if popu-
lation ages will increase, health system demands and expectations will also be
increased, likewise, social well-being, quality of life, living control, self-percep-
tion and personal evaluations need to be developed for older people because it is a
central issue of the process of aging (Ortman et al. 2014).
The decrease in mortality and good in physical health are positive outcomes in
later life associated with well-being. Previous studies revealed that healthy behav-
iors, socioeconomic status, and social relationships are the characteristics of well-
being which contribute related to psychological, environmental social and biolog-
ical factors (Diener and Biswas-Diener 2011; Pinquart and Sörensen 2000; Szabó
et  al. 2017). Psychological well-being, also called subjective well-being which
evaluates the primarily cognitive, experiences, pleasant and unpleasant emotions,
such as joy and depression that lead to positive and negative effects with people’s
lives. Subjective well-being is a perspective of happiness as sub-component asso-
ciated with satisfaction with life. Self-esteem, self-reliance, resiliency, anxiety,
violence, depression, discipline problems, loneliness, and hope are the charac-
teristics of psychological well-being refer to life satisfaction among positive or
negative perspective of long-term well-being (Diener et al. 1999, 2018).
For the enhancement of well-being in intend to the recipient, social support is
a concept of the complex in different ways such as resources exchanges between
individuals distinguished by the provider and positively affected by the recipient
(Temkin-Greener et al. 2004). Social support comprises the aspects of buffering
stress and basic social need of human for a sense of belonging, affection, iden-
tity, satisfaction, security, approval and esteem considered through individual or
groups with others. To facilitate assisting and coping, social support present as
conceptualization which assists the stress with the arisen of social support benefit
for the interaction of recipients that are perceived (Letvak 2002; Liu et al. 2016;
Mirowsky 2017).
Perceived and received are two major dimensions of social support that
refer to the resources and accesses for a specific time period which supports

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the significant values as shared by individuals for the interaction from others
(Ibarra-Rovillard and Kuiper 2011). Many researchers such as Ibarra-Rovillard
and Kuiper (2011), Hobfoll (2009) and Fratiglioni et  al. (2000) suggested that
social support subjective measures related to mental health than objective meas-
ures; however, perceived social support is more beneficial in later life. Having
buffering effects of old age well-being, it is an evidence that there is a relation-
ship between the people close functional relationship than a social network which
does not perceive by the actions of others to minimize the conversely, psycho-
logical distress (Berscheid 1994; Reich and Hershcovis 2011). This phenomenon
speculated that individuals look for perceived social support in later life to reduce
the stress to the benefits to health compared to received social support. Because
of the weak relationship between these supports, poor mental health and emo-
tional distress consistently relate to each other in later life (Uchino 2009).
Based upon interactions and events, the perception of participants related to the
reality relies on self-reports for the long time period in response to social functional
and structural aspects which include social network size, social contacts, and fre-
quency elements. These are the antecedents of social content support which attrib-
uted the wide range of emotional support. To listen and communicate carefully dur-
ing difficulties which occur in later life involve empathy, love, caring, and trust (Lee
and Dunkle 2010). As compared to emotional support, instrumental support is an
important support in later life when necessary such as transportation help, financial
or physical assistance. Such support reduces the risk of depression, physical limita-
tions and functional disability (Bisschop et al. 2004).
With an improvement in health care facilities, availability of modern medicines
and medical procedures, the numbers of older people are increasing; however, few
studies have been conducting on healthy aging. In developing countries, such as
Pakistan, most of the research has been done on the healthy aging and aged people
by focusing on problems, issues, and illnesses rather than an enhancement of health
promoting strategies and measures. The present study tries to develop an understand-
ing of the phenomenon of healthy aging, as well as to highlight the importance of
relevant measures of healthy aging within the Pakistani context as an alternative to
standardized social cultures. Social experiences and social perceptions about aging
are important factors for older adults, and it will help to strengthen society’s percep-
tion of aging and to improve health services for older people with the understanding
of the healthy aging experiences. Moreover, there is still a gap in the existing knowl-
edge about some positive and potential outcomes regarding supportive factors that
affect the psychological or physical well-being of old age. From last three decades,
researchers are seeking out to explore the potential outcome in numerous ways of
friends, family and someone’s special (e.g., spouses) support impact on psychologi-
cal or physical well-being for the satisfaction in old age. However, there is still a gap
available to explore some positive and potential outcomes regarding supportive fac-
tors that affect psychological or physical well-being old age. Furthermore, there is
no specific study available whether friends, family and someone’s special support
have some influence or not on spirituality, self-esteem, and ego integrity? Based
on the literature, the current study tries to find out these factors with the following
objectives:-

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• To address the factors involved in friends, family and someone’s special support
that affect the spirituality, self-esteem and ego integrity.
• To analyze the key factors of spirituality, self-esteem and ego integrity associated
with psychological or physical well-being old age.

Literature Review

Perceived Social Support

In recent years, the number of older adults has been increased globally, however,
quality of life is a more noticeable issue related to change in living situation. Social
support is a relationship that belongs to psychosocial and mental health which
reduces the effects of morbidity, mortality, and well-being among the older adults
significantly. In the absence of social support and network, psychosocial problems
increase in sense of depression and loneliness, specifically, at the age of retirement,
separation from family, neighborhoods, and away from former homes (Adams et al.
2004; Lutz et  al. 2017). Disengagement theory refers to a process in which older
adults willingly become sluggish by retiring which society expects from them, and
their supporters believe that mutual withdrawal is beneficial for older adults and
for society members (Baltes and Carstensen 1996). For daily living, interactions
and extensive social ties reduce the developing activity risk and cognitive decline
(Barnes et al. 2004; Seeman et al. 1993). For functional support and positive health,
structural social support is an essential antecedent as suggested by social support
theory, which evaluates the social perspectives of well-being for both the recipient
and provider that may influence on the quality of life (Sarason 2013). Hupcey (1998)
and Shumaker and Brownell (1984) argued that social support theory is a multi‐fac-
eted notion that linked between individuals which enhance the social support old
age well-being. Emotional and positive functioning are two major theories for psy-
chological well-being which refer to the approaches of mental health for life satis-
faction, lack of distress, life challenges and human development. Furthermore, eude-
monic and hedonic are two major types of psychological well-being to understand
the life satisfaction, living perception, emotions and feelings of happiness (Keyes
and Magyar-Moe 2003; Ryff et al. 2004).
Many of the researchers found that the density of systems, social exchange and
social networks of social support are important elements during old age in order to
social interaction (Queenan et al. 2010).
Dykstra (2007) and Quadagno (1999) demonstrated that friends support is an
important source because of providing emotional support through exchanging ideas,
experiences, advice, the frequency of contact and relations, and it can be a great
effect on old age well-being. If people are well in contact with their friends and fam-
ily members, they will be less isolated in old age. The family is a strong source to
connect with each other, particularly it helps and supports advocacy for older adults.
In daily life, when old people consider that they are being assisted and providing
care from their family, especially during in crises, chronic illness, medication, and
disabilities (Morgan and Kunkel 2007). Zeng et al. (2006) explained that from the

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last few decades, the living arrangement of family setup has reformed significantly
in developing countries. The previous studies, such as Afzal (1999) and Clark et al.
(2002) documented that due to changing in family setup as well as in housing struc-
ture, are the major causes for not supporting by their families in old age, and hav-
ing less attention because of family size and joint family setup. The situation of life
quality in Pakistan for older people demands the social networks and social protec-
tion that need to be protected from their close ones and family members.

H1  Family support, friends support, and someone’s special support have a signifi-
cant impact on spirituality.

Old Age Spirituality, Self‑esteem, and Ego Integrity

The quality of life varies the satisfaction of independence, psychological and physi-
cal health as well as spirituality among them. Spirituality is a concept of strength-
ening source, connection, meaningful life, peace, sense of value and purpose, rela-
tionship, security, hoping, inner awareness and satisfaction. It incorporates multiple
dimensions of religious, national, cultural groups deviated by deeper understanding
which can assist for the benefit of the aging process through the diversity of cross-
cultural approach (Cohen et  al. 2008; Nakasone 2004; Takahashi and Ide 2003).
Activity theory demonstrated that older adults keep themselves active and energetic
and maintain their health and wellness, which are positively correlated. On the other
hand, people who were not active in their past become sluggish and slow-down in
late adulthood (Katz 2000).
Spirituality, specifically in older people, is closely related to positive or negative
physical health controlled by the concept of well-being resource that can be a strong
relationship between age progression developments which indicate spirituality in
old age. To pursue the potential goals, spirituality involves in awareness, protective
experience and values in later adulthood (Hybels et  al. 2012; Jewell 2004; Sadler
and Biggs 2006). Musick et al. (2000) and Baltes and Smith (2003) highlighted that
88.7% adults in 55 and above age consider themselves having restrained high in reli-
giousness and spirituality stages. The relevance and serenity of spirituality increase
with increasing in ages of 70 and 95, meant allow others to take over.
Self-esteem is an individual’s perception of feelings and thoughts toward the self,
either in favorable or unfavorable conditions. It is derived from important compo-
nents of self-concept, self-identity, and self-efficacy maintained by physical, perfor-
mance and social components. In order to an emotional response, self-esteem effects
believe in themselves, influence, skills, abilities, perceptions for future (Heatherton
et  al. 2003; Rosenberg 2015). Heatherton et  al. (2003) highlighted that high self-
esteem associated with happiness, coping skills, and societal norms appear more
successful in any kind of situation and challenges in an environment that leads to
a positive relationship. High self-esteem is desirable to be considered as the levels
of higher functioning and psychological health among the elderly population. With
the need for a strong sense of self-esteem, the elderly population can struggle with
psychological functioning decreased by failing health, mobility, and disabilities.

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However, low self-esteem can be considered as a substantial role in psychiatric

disorders, depression that can influence negatively in inter-personal relationships
(Kernis 2005).
The notion of psychological or physical maturity in later life proved that ego
integrity is the most difficult stage among eight stages of man (Erikson and Erik-
son 1998). Erik Erikson theory explained the final stage of life, namely ego integ-
rity versus despair, suggested that basic psychological tasks have been completed
and this helps to enhance ego integrity level and avoid despair around 65 years. In
this stage, older adults who have a high level of ego integrity also sometimes feel
despair, accept life without regret and expectedness of death (Erikson 1982). To get
one’s involvement with respect to the inner life of order, ego integrity contains a
little because it is difficult to know about one’s outer life in the later life that expe-
rienced with community, friends, colleagues, spouse, family, children or someone
special (Slater 2003). Baltes and Mayer (2001) suggest that successful aging, which
is an essential part of ego integrity, needed more attention to focus which later life
will make more valuable to prolong and expansion apparently.

H2  Spirituality has a positive impact on self-esteem and ego integrity.

Psychological and Physical Well‑Being

To evaluate the peoples’ understanding of life satisfaction and emotional health,

demonstrated by self-esteem in their lives called psychological well-being. It may
comprise the frequency of intellectual that evaluates the experiences of pleasant or
unpleasant emotions such as joy and depression (Diener et al. 1999; Queenan et al.
2010). At older ages, health and psychological well-being are closely related to each
other which have three aspects of evaluative well-being, hedonic well-being, and
eudemonic well-being. These aspects can be distinguished by life satisfaction, hap-
piness, and sadness feelings, the meaning of life and sense of purpose (Steptoe et al.
2015). Pro-social behavior, resiliency, self-reliance, hope, and self-esteem are the
major component associated with positive psychological or subjective well-being,
whereas, depression, violence, loneliness, discipline, and anxiety are the characteris-
tics that impact negatively on well-being (Myers and Diener 1995).
Physical well-being belongs to the quality of life, value systems, cultural con-
text, positive or negative response, personal perception, emotional response, stand-
ards, and expectations of people to their experiences in their lives. Life satisfaction,
health status, happiness, and well-being are very close to the quality of life concern-
ing their lives (Camfield and Skevington 2008). Diener and Biswas-Diener (2011)
reported that the indications of the growing body improve life significantly within
social relations, health, work, income, longevity, and societal benefits with levels
of well-being. During old age, the significance of positive well-being sustaining
has been extended from the satisfaction of life with emotional strength, aging and
mortality prediction; however, negative effects in life satisfaction lead to emotional
unbalance (Gerstorf et  al. 2008). Hedonic effects indicate long-term feelings with
life satisfaction in the sense of transient experiences frequent pleasant presence of

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physical well-being (Galinha and Pais-Ribeiro 2011). Fernández-Ballesteros (2007)

emphasized that positive expectations in lives, old adults do not feel aged which
leads to maintaining the emotional balance. Disability and morbidity is very com-
mon in later life that influences functional health, and there is the main issue to
observe the understanding and experience of long-lasting physical well-being in
older people which can positively affect in old age concerning their lives (Fig. 1).

H3  Self-esteem and ego integrity have a positive impact on psychological and phys-
ical well-being.

Materials and Methods

This study was proposed to examine the relationship among variables, such as per-
ceived social support (friends support, family support, and someone’s special sup-
port), spirituality, self-esteem, ego integrity, physical and psychological well-being.
To minimize the degree of interference, for investigation, a casual study was selected
instead of correlational study in the natural environment. The non-probability pur-
posive sampling method was used to identify personal information. Questionnaire
sampling method was selected to examine the factors that influence the pattern of
physical and psychological well-being through the demographic and inferential
information (Likert scale). Old citizens were chosen as participants for this study
instead of the young adults, because no exclusive study has been revealed on the
well-being of older adults in Pakistan, on a large sample of older adults, specifically
in the context of the healthy experience of aging. Further, it may explore the health
issues, healthy experience of aging, level of social support as well as self-esteem
level to fill the research gaps in Pakistani society. For this purpose, 410 participants
were selected from the age of 61 years and above from the four different divisions
(Rawalpindi, Gujranwala, Lahore, and Multan) of Punjab province of Pakistan. Data
validity and reliability were measured through confirmatory factor analysis (CFA),
and SPSS Cronbach’s alpha. To analyze the hypotheses for regression weight and
model fitness of multifaceted model, structural equation modeling (SEM) was used
through AMOS software.

Fig. 1  The conceptual model

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The perceived social support variables, such as family support, friends support,
and someone’s special support (e.g., spouse) were measure using paradigm of Zimet
et al. (1990), Cohen et al. (1994), Reker and Wong (1988) and Zimet et al. (1988).
Family support items refer to the willingness to help, emotional help, talk about
problems, and help in decision making, whereas, friends support states helping,
counting when things go wrong, sharing joys and sorrows, and talk about problems.
Research items for someone’s special support have been selected such as support
around need, sharing joys and sorrows, a source of comfort, and care about feelings
for the said purpose. The measurement of spirituality was measured through con-
struct as developed by Underwood (2006), which refer to feel God’s presence, com-
fort in spirituality and religion, feel deep inner peace or harmony, feel the beauty
of creation, thankful for blessings, feel closer to God, desire within union divine,
and to ask for God’s help for daily activities. The measurements of self-esteem and
ego integrity were measured paradigm constructed by Rosenberg (1965) and Boylin,
Gordon, and Nehrke (1976).
The items for self-esteem are selected for this study that belongs to satisfy as a
whole, feel a number of good qualities, do not feel proud, having more respect, take
a positive attitude, feel a person of worth, and do the things same as others do. Ego
integrity refers to satisfaction with life so far, take responsibility for decisions, wor-
rying about getting old, feel proud to be done, accepting the behavior, and changing
adoption.
Physical well-being items have been adopted for this study which is physical
complaints, having a heart condition, plenty of physical energy, aches, and pains,
physically in good shape, health deterioration, and do not feel tired easily. The items
of psychological well-being variable refer to care about dead and alive, feel often
bored, exciting to be alive, wishing to never wake up, feel worth living for life, do
not care about what’s happening, and having peace of mind. So that, physical well-
being and psychological well-being variables were measured through constructs
as developed by Ryff (1989), P. B. Baltes and Mayer (2001), Diener et al. (1985),
Reker (1995) and Sheldon and Elliot (1999).

Results

The results have been elaborated in tables and figure clearly and concisely according
to the objectives. For this research, forty-three percent (178) of respondents were
selected male, and 57% (232) were female among older people. Age between 61 and
75 years old were maximum participants which are 74.6% of the total population,
whereas 57.1% (234) respondents were married. High frequency of 302 respondents
participated in this study with a secondary school certificate or lower and higher
secondary school certificate with the highest interest. Seventy-four percent (304)
respondents were living in joint family system setup and 26% were living as a sepa-
rate system, meanwhile, the middle social and economic class showed high inter-
est for this research which is 57% of total respondents. During the last 1 year sup-
ports received in sickness were found with the high frequency of 238 participants,
whereas a source of social support from family and friends were highly observed.

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Someone’s special (e.g. spouse) were observed highest participants for support in
sharing problems/worries with 41.2% and totaled 169, highly satisfied respondent
agreed with the satisfaction level of social support received in old age (see Table 1).
The different factors having forty-seven items for this study were examined after
the modification in the questionnaire for the goodness of measure. To analyze the
reliability of the data, Cronbach’s alpha of each variable was used through SPSS,
with the values of .917, .919, .838, .964, .939, .937, .938, and .934, which is accept-
able if value range is more than .7 (Hair et al. 1998). Validity analysis was estimated
of factor loadings with the values of standardized regression weights of the con-
structs and variance extract (the value ranges are .74, .76, .57, .77, .71, .77, .69, and
.69) which indicate the acceptable ranges for model fit through confirmatory factor
analysis (CFA) of each item (see Table 2, Fig. 2).
The values in Table 3 indicate the summary of model fit indexing. The value of
χ2/df (2.188) is considered an acceptable range because the values of χ2/df between
0 and 3 are acceptable (Jöreskog and Sörbom 1993). To perfect fit, the ranges of
GFI (Goodness of a fit index), AGFI (Adjusted goodness of fit index), TLI (Tucker-
Lewis Coefficient), and CFI (Comparative fit index) are recommended the values to
closely 1, and the range values of GFI, AGFI, TLI, and CFI in this study are .809,
.889, .931, and .934, which is recommended to fit. The benchmark value of root
mean square of approximation (RMSEA) for this study is .54, which indicates the
model good fit (Browne and Cudeck 1993) (see Table 3).
Table  4 indicates the summary of regression weights of each casual path, esti-
mates, standardized errors (SE), critical ratios (CR), p values and results whether
hypotheses are accepted or rejected. Family support and someone’s special support
have a positive relation to spirituality with the respective values of .479 and .636,
whereas friends support has a negative impact on spirituality (− .033). Spirituality
has a slightly positive impact on self-esteem and ego integrity with the estimated
values of .097 and .007. Self-esteem has also positively affected the physical well-
being and psychological well-being .171 and .029; meanwhile, ego integrity has a
positive influence on psychological well-being, and negatively impacted on physical
well-being, with the respective values of .114 and − .002 accordingly (see Table 4).

Discussion

This study sought the impact of family support, friends support and someone’s spe-
cial on physical well-being and physiological well-being, with the mediating role
of spirituality, self-esteem, and ego integrity. It revealed that the hypotheses “fam-
ily support and someone’s special support adopted from the studies of Zimet et al.
(1990), Cohen et al. (1994), Zimet et al. (1988), and Reker and Wong (1988), have
a positive impact on spirituality,” is accepted. The hypothesis “friends support has a
negative impact on spirituality,” is rejected because of older people think that their
friends do not really help them when things go wrong, share joys and sorrows, talk
about their problems, which can increase the chance of poor physical health as well.
The hypothesis “spirituality has a slightly positive impact on self-esteem and ego
integrity,” is accepted. In spirituality, older people feel God’s presence, find comfort,

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Table 1  Respondents demographic information of the sample (n = 410)

Frequency (n) Percentage

Gender
 Male 178 43.4
 Female 232 56.6
Age
 61–65 124 30.2
 66–70 110 26.8
 71–75 72 17.6
 76–80 64 15.6
 81 and above 40 09.8
Marital status
 Married 234 57.1
 Widowed 127 31.0
 Other (never married, divorced) 49 11.9
Education
 Secondary school certificate or lower 181 44.1
 Higher secondary school certificate 121 29.5
 Bachelor degree 79 19.3
 Postgraduate degree 29 07.1
Family setup
 Joint system 304 74.1
 Separate system 106 25.9
Social and economic class
 Lower 87 21.2
 Middle 233 56.8
 High 90 22.0
Support received in sickness
 Never 19 04.6
 Rarely 56 13.7
 Occasionally 97 23.7
 Frequently 238 58.0
Source of social support
 Friends 117 28.5
 Family 175 42.7
 Someone special (e.g., spouse) 101 24.6
 Other 17 04.2
Support in sharing problems/worries
 Friends 119 29.0
 Family 108 26.3
 Someone’s special (e.g., spouse) 169 41.2
 Other 14 03.5
Satisfaction level of social support received
 Slightly satisfied 84 20.5

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Table 1  (continued)
Frequency (n) Percentage

 Moderately satisfied 128 31.2

 Highly satisfied 198 48.3

think about the beauty of creation, feel blessed, feel closer to God with the divine,
ask God to help during daily activities (Underwood 2006).
The hypotheses “self-esteem and ego integrity were measured paradigm con-
structed by Rosenberg (1965) and Boylin et  al. (1976) have a positive influence
on physical well-being and physiological well-being,” are accepted, whereas “self-
esteem has a positive impact on physiological well-being,” is accepted, and “ego
integrity has a negative effect and physical well-being,” is rejected. Bearing in mind
of physiological well-being, old people considered to be care about themselves that
they have special attention from surrounding, in this way they will not feel often
bored, never wish to be die, exciting to be alive, considering that life is worth living,
have peace of mind (Baltes and Mayer 2001; Diener et al. 1985; Reker 1995; Ryff
1989; Sheldon and Elliot 1999).

Research and Theoretical Implications

The robust finding of this study was a strong relationship between family and some-
one’s special support on spirituality. In this era, time is a very precious thing, which
old people consider that they need time from their family, friends and someone’s
special person to care about their physical health. Older adults feel that their family
emotionally help and support them when they need, share their problems, as well
as helping in decisions. In old age, people prefer the special person that care about
their feelings, share joys and sorrows, and it is a source of comfort when need. The
present study sought that in case of self-esteem, old people considered to satisfy
toward themselves, feel having numbers of good qualities, do not feel proud, take
a positive attitude, a person of worth, ability to do things as other people do. How-
ever, older adults consider that ego integrity is an inspiration of satisfaction with
their lives, take responsibly during the decision, worrying about getting old, proud
what they have done, and wish to change toward themselves. Considering physi-
cal well-being, older adult well-thought-out that they have physical complaints, feel
heart conditions, aches, and pains, health deteriorating, considered being good shape
physically, and do not feel tired easily.

Managerial Implications

This study endeavored to identify the factors of healthy experience of aging among
older adults. The scale developed for this purpose would be helpful for future
researchers who are interested in studying older adults’ living styles and introducing
interventions, policies specifically related to medical health and social adjustment

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Table 2  The constructs and item descriptions reliability and validity analysis

Factor Item Factor loadings VE α Factor Item Factor loadings VE α

13
Family support FS1 .974 .74 .917 Self-esteem SE6 .648
FS2 .819 SE7 .810 .70 .937
FS3 .918 Ego integrity EI1 .868
FS4 .708 EI2 .857
Friends support FSS1 .915 .76 .919 EI3 .978
FSS2 .938 EI4 .776
FSS3 .852 EI5 .885
FSS4 .763 EI6 .642
Someone’s special support SSS1 .815 .57 .838 EI7 .805
SSS2 .877 Physical well-being PHW1 .937 .69 .938
SSS3 .675 PHW2 .804
SSS4 .627 PHW3 .970
Spirituality SP1 .957 .77 .964 PHW4 .766
SP2 .897 PHW5 .801
SP3 .833 PHW6 .815
SP4 .703 PHW7 .693
SP5 .941 Psychological well-being PSW1 .949 .67 .934
SP6 .883 PSW2 .768
SP7 .898 PSW3 .989
Self-esteem SE1 .880 .71 .939 PSW4 .752
SE2 .844 PSW5 .776
SE3 .968 PSW6 .772
SE4 .830 PSW7 .672
SE5 .875
Journal of Religion and Health
Journal of Religion and Health

Fig. 2  Structural equation model

Table 3  Model fit summary

Factors Values Factors Values Factors Values Factors Values

Chi square 2238.267 Degrees of freedom 1023 CMIN/DF 2.188 RMSEA .054
GFI .809 AGFI .889 TLI .931 CFI .934

Table 4  Regression weights
Casual paths Estimate SE CR Results

Spirituality ← Family support .497*** .055 9.018 Accepted

Spirituality ← Friends support − .033 .050 − .661 Rejected
Spirituality ← Someone’s special support .636*** .073 8.732 Accepted
Self-Esteem ← Spirituality .097*** .050 1.941 Accepted
Ego Integrity ← Spirituality .007*** .056 .134 Accepted
Physical Well-being ← Self-esteem .171*** .044 3.855 Accepted
Psychological Well-being ← Self-esteem .029*** .042 .681 Accepted
Psychological Well-being ← Ego integrity .114*** .038 3.010 Accepted
Physical Well-being ← Ego integrity − .002 .039 − .041 Rejected

SE standard errors, CR critical ratio

***p values ≤ .05

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Journal of Religion and Health

of the older adults in Pakistan. This study attempts to highlight those biopsycho-
social factors which are beneficial in creating a healthy experience of aging. It also
highlights the healthy hobbies and activities that minimize the risk of health dete-
rioration and help in maintaining physical and psychological health in old age. This
research has significant implications for the adaptation of healthy hobbies for older
adults to minimize the risk of health deterioration and may contribute to the exist-
ing indigenous literature in the area of developmental psychology. This may create
organizational awareness to perceive aging process positively and maintain a posi-
tive outlook in lifestyle by learning self-management skills. To explore the family
conflicts, communication patterns, mental disorder, social support network aspects,
economic and health policy, and changes in older adults need to be established for
future research with the larger representative sample. Policymakers and social work-
ers should consider the mechanisms and predictors of financial support, transpor-
tation support, supportive interventions and stressful life events for each commu-
nity setting of older people in the Pakistani context for the enhancement of social
support.

Conclusion, Limitations and Future Directions

Recently, the number of older adults has been increased globally; however, qual-
ity of life is a more noticeable issue related to change in living situation. The pre-
sent study contributes to the relevance and importance of perceived social support
for healthy aging in older adults. Good in physical health is a positive outcome in
later life associated with well-being. It has been observed that the health care sys-
tem is considered for disability and illness, whereas it should also be observed for
the improvement of psychological states. Having buffering effects of old age well-
being, it is evidence that there is a relationship between the people closes functional
relationship. To listen and communicate carefully during difficulties which occur in
later life involve empathy, love, caring. The limitations of this study were limited
time and sources, smaller representative sample form only four divisions of Punjab
province of Pakistan which need to enhance. Majority of participants in the current
study married older adults; a balanced sample of married, unmarried, widowed and
divorced older adults is suggested for future research to increase our understanding
of the aging experience across a diverse sample of older adults. Data were only col-
lected from urban areas, and future research may be included data from rural areas
as well. Future research should also focus on exploring the family conflicts, com-
munication patterns, mental disorder, social support network aspects, economic and
health policy, and changes in society’s perception regarding aging with the larger
representative sample. Policymakers and social workers should also consider the
mechanisms and predictors of financial support, transportation support, and support-
ive interventions for stressful life events for each community setting of older people
in Pakistan. Moreover, a large sample of older adults can be used to conduct a lon-
gitudinal study to explore and examine new and vast range factors related to healthy
aging in Pakistan. The current research was quantitative in nature, qualitative

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Journal of Religion and Health

researches can also be carried out to explore in detail different aspects of the healthy
experience of aging in the future.

Compliance with Ethical Standards 

Conflict of interest  All the authors declare no conflict of interest.

Human and Animal Participants All studies were approved by the Board of Studies and Research of
Lahore College for Women University, Pakistan being the part of PhD Degree Program. All procedures
performed in studies involving human participants were in accordance with the ethical standards of the
institutional research committee and with the 1964 Helsinki Declaration and its later amendments or com-
parable ethical standards.

Informed Consent  All individual participants included in the study were informed, and participant consent
was tacitly shown by completion and subsequent return of the questionnaire.

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