The Role of Older Persons' Environment in Aging Well: Quality of Life, Illness, and Community Context in South Africa.

Purpose of the Study: This article evaluates the influence of local district conditions on subjective quality of life of older South African adults. Policymakers increasingly recognize that "successful" aging policies must not only address physical health needs but also factors that influence subjective well-being. Design and
Methods: To investigate the influence of area-level distribution of "public goods" on well-being in a low- and middle-income setting, nationally representative WHO-Study of Global AGEing and Adult Health (WHO-SAGE) survey data is combined with district-level data that captures built resources and health system distribution. Multilevel regression modeling is utilized to explore how community context, including built resources and health infrastructure quality, influence older persons' quality of life and how chronic health conditions may moderate this relationship while controlling for important individual characteristics.
Results: While controlling for individual and district level factors, it is found community level provision of built resources of basic services (i.e., water, sanitation, electricity, housing) has a modest but significant impact on older persons' subjective well-being. Further, this effect on older persons' perceptions of quality of life is moderated by individual chronic health status; individuals with a chronic health condition do not receive an equivalent benefit from district built condition like those without an illness do. Implications: This work adds to the literature concerning the effect of environments in low- and middle-income countries on older adults' subjective well-being. It also adds to the growing literature on the complex relationship between subjective well-being and health in diverse contexts.