Relationship with children and the psychological well-being of the elderly in Indonesia.

OBJECTIVE: Many older adults in Indonesia live with their children. This study examined the relationship between the quality of the relationship that elderly parents may have with their children living with them and any effects on psychological well-being.
METHODS: Relationship quality encompasses positive and negative aspects. This study employed convenience sampling and to reach 102 elderly participants. A measure of positive and negative social exchanges was used to measure the relationship between elderly parents and their children. Ryff's Scale of Psychological Well-Being was utilized to measure the psychological well-being of the subjects. We used descriptive statistics, Pearson correlation coefficient, an independent t-test, and one-way analysis of variance (ANOVA) to assess the statistics produced.
RESULTS: The primary results showed no correlation between the positive qualities of the relationship and psychological well-being (r = 0.092, p > 0.01). However, the negative qualities of the relationship were negatively correlated with psychological well-being (r = -0.335, p < 0.01).
CONCLUSION: Thus, negative qualities of relationships with their children were found to be more impactful on psychological well-being than positive qualities in elderly parents who maintain coresidence with their children. This means that the greater the lack of sympathy, intrusion, failure to provide needed help, and rejection/neglect from the child, the worse the psychological well-being of the elderly parent.

Introduction

Becoming elderly means reaching the last period in human development. It is a natural stage, which all individuals will reach if their lives are not cut short. Upon reaching 60, an individual may be classified as elderly.[1] Data from the 2014 National Socio-economic Survey showed that most of the elderly in Indonesia live with their children. The survey found that 42.32% of elderly Indonesians lived in a three-generation household, with their children and grandchildren.[2] The number of dependent elderly will continue to increase as the elderly population increases. This will lead to an increasing financial burden on the productive population.[3]

Aging also influences productivity. The productivity of the elderly usually decreases after they retire or leave their last position. An aging individual loses vital cells, which may result in organ weakness, physical deterioration, and the emergence of disease and degenerative disease in particular.[3] The loss of bodily functions leads to psychological problems, such as feeling useless, lack of confidence, dependency, and alienation from the environment. These can decrease the well-being of the elderly. This loss is consequential not only for its own sake, but also because it affects other aspects of life, such as health.[4] For example, good health can allow an elderly individual to become independent and efficient.[3]

Ryff[5] described psychological well-being as a condition in which an individual experiences self-acceptance, autonomy, mastery of the environment, purpose in life, and personal growth. Furthermore, that individual is able to establish positive relationships with others. According to Ryff and Keyes,[6] the condition of psychological well-being is clear in the ability to accept positive and negative aspects of oneself, the warm and satisfying relationships one has with others, the ability to make decisions independently, the potential to adapt to one’s environment and solve daily problems, find direction and goals in one’s life, and exercise the capacity for self-improvement.

Steptoe et al.[4] found that social relationships are a significant factor in psychological well-being. Similarly, Charles and Piazza[7] noted that the relationships that elderly have are essential for their psychological well-being. Usually, those elderly individuals who have retired from formal work have fewer social relationships than those who are still working.[8] Although they have few social contacts, the ones they do have tend to be close. Social convoy theory indicates that the elderly maintain social relationships with people they consider supportive and able to help them. They tend to avoid unsupportive people.[8] They are also likely to maintain stable relationships with close friends and family who can act as a support system for them. High-quality relationships like these can improve their psychological well-being.[9]

The relationships that the elderly population have with their families include social relationships that affect their psychological well-being.[4] Although they tend to have strong relationships with their peers, tend to be strong, the ones they have with their family members are stronger.[7] Suardiman[3] concluded that the family is made up of the closest people to the elderly and is the source of their welfare. Furthermore, the family can provide a sense of security and comfort. In Indonesia, children are expected to be devoted to and care for their parents.[3] Papalia and Martorell[8] noted that, even though a parent may have become elderly, the relationships between a parent and a child tend to remain stable. Children who provide significant assistance and pay close attention to their parents strengthen such bonds, which exist throughout their life. Therefore, the relationships between the elderly and their children result in a significant impact on their psychological well-being.

Previous studies[10,11] have shown that positive and negative qualities of a relationship are correlated with psychological well-being. Furthermore, it has also been found that the level of satisfaction that the elderly enjoy in their relationship with their children mediate the correlation between the qualities of relationship the elderly have with psychological well-being. Further, the negative qualities of a parent–child relationship have a stronger correlation with psychological well-being than positive qualities.

According to Lye,[12] coresidence has an impact on the relationship between elderly parents and their children. It can allow children the opportunity to show their respect, feelings of responsibility, and willingness to sacrifice to their parents.[13] It also lets them fulfilling the needs for physical and emotional support that their parents have[14] and interact more often with them.[15] However, living with children can also increase tension among the members of a family, undermining the benefits of social interaction and intergenerational support for the elderly.[16] Therefore, it is important to examine the quality of the relationship that the elderly have with their children who they live with. The positive and negative qualities of their relationships can have an impact on the psychological well-being of the elderly parents.

This research explored the correlation between relationship quality and psychological well-being in elderly parents who live with their children. We used the Positive and Negative Social Exchange (PANSE) scale to measure the positive and negative aspects of the relationship quality of the elderly parents and their children. We also used Ryff’s Scale of Psychological Well-Being (RSPWB) to measure the psychological well-being of our participants, elderly parents. We assumed that elderly parents who experience positive exchanges in their relationship with children experience psychological well-being. However, we also expect that those who experience more negative exchanges in their relationship would have poor psychological well-being. The participants in this study were married and widowed elderly who resided with their children. A correlational research design was used to allow the researcher to ascertain what the independent variables were related to the dependent variable.

Methods

Research design

There has been minimal research on the interaction between these two variables in Indonesia. This study explored the correlation between the qualities of the relationship that elderly parents have with their coresident children and their psychological well-being. To achieve this aim, we conducted a correlational study with a non-experimental quantitative research design. Relationship quality, the independent variable of this study, was not manipulated. Furthermore, participants were not randomly grouped.

Participants

The participants included 102 adults of at least 60 years old living with their children. We took the age limit from the Law of the Republic of Indonesia,[1] No. 13/1998, on Elderly Welfare, Article 1 Paragraph 2. We used convenience sampling to recruit the participants. The goal of the study did not allow any limit to be placed on the number of participants. We allowed as many participants as responded within 3 weeks to take part, so long as they met the criteria, namely, at least 60 years old, living with their children in one house, and able to speak Indonesian well.

Instruments and measurement

Two instruments were used. First, the PANSE, developed by Newsom et al.,[10] was used. This is a self-reported questionnaire that has 24 items, of which 12 function to measure positive relationship qualities and 12 to measure negative ones. The positive qualities tracked by this instrument are measured on four dimensions: informational support, instrumental support, emotional support, and companionship. The negative ones also have four dimensions: unwanted advice/intrusion, failure to provide help, unsympathetic/insensitive behavior, and rejection/neglect. Responses are given on a five-point Likert-type scale (0 = never, 1 = rarely, 2 = sometimes, 3 = often, 4 = very often). The maximum score for each of the two parts of the PANSE scale is 48, and the minimum score is 0.

The PANSE scale was translated into Indonesian before use, and a readability test was conducted with people who had matching characteristics with our participants. The translation was also submitted to expert judgment to ensure that it was accurate. Then, we conducted a trial of another group of elderly who lived with their children. The translation passed the reliability test, with Cronbach’s alpha values for 0.881 and 0.913 for the positive and negative sections, respectively. Validity was determined using internal consistency: a range was found between 0.135 and 0.781 and between 0.312 and 0.834 for the two sections, respectively. This indicated that one item was not valid. Because this item could not be replaced with another item from the instrument, we revised the translation to suit it to the research context.

RSPWB was used to measure the psychological well-being of the participants. This is a self-reported questionnaire with 18 items that measure six dimensions (self-acceptance, positive relationships with others, autonomy, environmental mastery, purpose in life, and personal growth). Each dimension is measured with three items. The responses are on a six-point scale, ranging from completely disagrees to completely agree. The maximum score possible on this instrument is 108, and the minimum score is 18.

We performed the same procedure as PANSE to validate RSPWB. The reliability and validity test produced a Cronbach’s alpha of 0.778, and the internal consistency method used to assess validity gave a range of values between −0.027 and 0.710. Three items were found not to be valid. Instead, of discard them, we revised the translation to bring it more into line with the context of the research.

Data collection procedures

The data collection was conducted over the course of 3 weeks, from April 19 to 12 May 2017. We distributed the questionnaires randomly to the participants. As data were being collected, we sought potential participants at sites were elderly individuals could come to participate in activities. For example, we looked at a sports field that coordinates athletic opportunities for the elderly, a worship center, and a community health center. We also contacted the elderly who are still relatives of our friends. Those who agreed to participate were asked to complete the questionnaires. At their option, they could either do this independently or with our assistance.

We also conducted interviews with several participants who had difficulty reading and completing the questionnaires. If a participant was more comfortable completing the questionnaire with the help of their caregiver, we gave a briefing to the caregiver to support an accurately completed form. For this purpose, a booklet was created describing how the questionnaire for the caregiver in charge. After the data were collected, statistical analyses were conducted with descriptive statistics, the Pearson correlation coefficient, an independent t-test, and one-way analysis of variance (ANOVA).

Results

The participants in this study were elderly aged 60 years old or older and lived with their children. Their ages ranged from 60 to 88 years old. Most (60.8%) were between 60 and 69 years old, and only 6.8% were elderly than 80 years. Of the 105 participants, 65 (63.7%) were women and 37 (36.3%) were married. Most of the participants lived in three-generation households (74.5%) and 40.2% lived with their own children and grandchildren.

Higher scores indicated better psychological well-being condition (M = 82.31, SD = 7.312). Meanwhile, the relationship between the participants and their children had some positive aspects (M = 23.68, SD = 7.748). This indicated that the relationship between the participants and their children had positive qualities but still needs to be improved. Furthermore, their relationships also featured negative qualities (M = 10.98, SD = 7.075) (Table 1). We also determined the correlation between the relationship the participants had with their children and psychological well-being. No significant positive correlation was found between the positive qualities of the relationship that elderly parents have with their children and psychological well-being (r = 0.092, p > 0.01). However, a significant negative correlation was found between the negative qualities of the relationship that elderly parents have with their children and psychological well-being was found (r = −0.335, N = 102, p < 0.01) (Table 2).

Table 1.

Description of psychological well-being and score of quality of relationship between elderly parent and their child.

	Mean	SD	Min.	Max.
Psychological well-being	82.31	7.312	51	96
Self-acceptance	14.21	1.245	18	8
Positive relations with others	13.62	1.797	17	8
Autonomy	12.99	1.805	16	8
Environmental mastery	13.76	1.753	17	7
Purpose in life	14.02	1.824	17	8
Personal growth	13.77	2.077	18	6
Relationship quality
Positive	23.68	7.748	3	46
Negative	10.98	7.075	0	31

Table 2.

Correlation between the qualities of the relationship elderly parents have with their children and psychological well-being.

Relationship quality	r	Sig. (p)
Positive quality	0.092	0.179
Informational support	0.046	0.322
Instrumental support	0.065	0.258
Emotional support	0.062	0.268
Companionship	0.141	0.079
Negative quality	−0.335	0.000**
Unwanted advice or intrusion	−0.079	0.215
Failure to provide help	−0.253	0.005**
Unsympathetic or insensitive behavior	−0.024	0.007**
Rejection or neglect	−0.340	0.000**

Significant at loss 0.01.

These results indicated that the correlation between the negative qualities of the relationship and the psychological well-being of the elderly participants were inversely proportional. The lower the score for negative qualities in the relationship, such as a lack of attention, lack of support, neglecting need for assistance, and absence of warmth in children’s relationship with their elderly parents, the more the elderly participants could accept themselves as elderly, adapt to their environment, find a purpose in life, be able to make decisions independently, establish positive relationships with others, and be ready to develop themselves. Likewise, the greater the score for negative qualities in the relationship between the elderly parents and their children, the worse their psychological well-being.

We conducted statistical analyses to determine which dimensions of relationship quality between elderly parents and their children correlated with psychological well-being (Table 2). These analyses showed that several aspects of negative quality, such as failure to provide needed help, unsympathetic or insensitive behavior, and rejection or neglect all had a significant negative correlation with the psychological well-being of the parents. These results also indicated that rejection or abandonment had highest correlation with psychological well-being among the participants.

We also analyzed differences in relationship quality for elderly parents and their children in relation to the sex of the participants. The results showed that the relationship between sex of the participant and the positive qualities that elderly adults experienced in their relationships with their children were significant (t = 2.251, p < 0.05). Furthermore, senior women experienced warmth, sympathy, attention, help, and pleasant interactions to a larger extent than senior men. We found no significant difference between the male and female participants with regard to psychological well-being (t = 1.168, p > 0.05). Furthermore, we analyzed the differences among results for psychological well-being in reference to their style of coresidence system. The results showed that there were significant differences in the well-being of those who lived with only their children; with spouse and children; with spouse, children, and grandchildren; and with children and grandchildren. However, no significant difference was found in relationship quality based on their living arrangements (Table 3).

Table 3.

Differences for all possible comparisons pairs of variables.

		Positive qualities				Negative qualities				Psychological well-being
	N	Mean	SD	Diff.	Sig.	Mean	SD	Diff.	Sig.	Mean	SD	Diff.	Sig.
Living arrangement				1.017	0.433			1.223	0.291			2.178	0.031*
Spouse and children	26	24.96	5.463			9.13	7.474			83.88	3.521
Spouse, children, and grandchildren	24	25.04	5.165			8.62	5.633			82.71	5.554
Children	11	29.50	2.997			9.95	4.188			83.18	5.853
Children and grandchildren	41	27.60	7.461			10.34	6.748			83.96	6.664
Sex				2.251	0.027*			−0.559	0.577			1.168	0.246
Male	37	24.22	7.772			10.46	7.647			83.43	6.230
Female	65	27.62	7.073			11.28	6.772			81.68	7.836

Significant at los 0.05.

Discussion

This study found no significant correlation between the positive qualities of the relationship of its elderly participants with their children and psychological well-being. However, it did show a significant negative correlation between the negative qualities of the relationship that elderly individuals reported having with their children and their psychological well-being. These results indicated that negative qualities of the relationship of elderly individuals with their co-resident children have a more significant impact on their psychological well-being than the positive qualities do.

This study, thus, did not support Newsom et al.[10] Those researchers found a significant positive correlation between the positive qualities of the relationship elderly individuals had with their children and psychological well-being. However, this study’s finding concerning the negative qualities in elderly parents’ relationship with their coresident children and their significant negative correlation with the elderly parents’ psychological well-being does concur with Newsom et al.[10] Previous study has also shown that the negative qualities in the relationship between elderly parents and their children have a significant impact on the negative affect of those parents.[17] Although the participants in this study did not report much that was negative in their relationships with their coresident children, it nevertheless can affect the appearance of negative affect, which reduces psychological well-being. It is suspected that the participants in the study were simply more sensitive to the negative qualities in their relationships with their children than to the positive qualities there.

Our interviews with randomly chosen participants indicated that children did not assist these participants with their daily activities. This made them feels ignored. However, some of the participants’ children reported that they did help their parents with their day-to-day responsibilities, such as tidying up the home and preparing meals. Nonetheless, it appeared that the elderly parents considered that what their children did was merely an obligation, not a form of attention from them.

The results of the study also indicated that rejection and neglect were the negative qualities that most significantly correlated with poor psychological well-being. Furthermore, companionship as a positive quality was most significantly correlated with other dimensions of psychological well-being. This supported the findings of Newsom et al.,[10] who found that rejection or neglect and companionship had the strongest correlation with psychological well-being among the elderly population.

For those who are unproductive and engage in few activities, the presence of children who are willing to spend time with them and do things with them was perceived to be positive;[10] the correlation was stronger with psychological well-being than other positive dimensions. Furthermore, behaving without considering the feelings of the elderly generated irritation, and thus, it correlated more strongly (and negatively) with psychological well-being than any other negative dimension.

The differences between positive qualities of the relationships were analyzed in reference to the sex of the participants. The results showed significant differences in the positive qualities listed by men and women: the male participants reported lower positive qualities than the female participants. This may be because the relationship that elderly men in this study had with their children was not as close as what elderly women experienced. This supports the statement of Papalia and Martorell[8] that the relationship between mother and child tends to be closer than the relationship between father and child.

In some cultures, including Indonesian culture, male children are often expected to support their parents financially, and female children perform better in the provision of personal care.[16] This allows the women to establish stronger bonds with their families than men do, which may affect the quality of the relationships that exist between parents and children.

The mean differences of the psychological well-being of the elderly participants relative the members of the family living together were also investigated. The results showed that there was a significant mean difference between participants who live in two-generation and in three-generation households. Those who live in the larger, three-generation households showed a higher level of psychological well-being than those who live with two generations. This may be because co-residence with extended family can guarantee support, including financial and emotional support, for the elderly population.[18] The interaction between the elderly individuals and their grandchildren can produce emotional value and reduce feelings of loneliness.[19]

Limitations

This study had limitations. First, it used a cross-sectional design, which produces advantages in examining the relationship between two or more variables. However, such a design cannot provide a causal relationship between those variables. This means that it is difficult to determine whether it is the quality relationship that is causing the high or low psychological well-being.

Participants were recruited through convenience sampling. This method is used when the size of the study population is not known. We do not know how many elderly people in Indonesia live with their children. However, convenience sampling can reduce the representativeness of a study sample because the sample is not chosen at random. We used two instruments in this study, each of which features several items. Large numbers of items that must be responded to can cause participants to feel demotivated and lead them to think they need help completing the instrument. Even though we offered to assist those who asked for help, there are some elderly who were happier being assisted by their caregivers. It is necessary, therefore to brief the subjects more carefully on the completion of the questionnaire.

In future studies, during data collection, more attention should be given to the participants to reduce the likelihood of biased responses. This will also ensure that the questionnaires will be more likely to be fully completed. In addition, providing a written description related to the meaning of the items in the questionnaire, would require caregivers and family members to help the elderly individuals understand the items clearly. The caregivers should be able to understand the content of all items so that any possibility of bias is minimized.

The results of this study indicated that some characteristics of the participants can alter findings; the presence of extended family members in the home, the age of the children living with them, the ownership of the house, and the person who responsible for the finances of the individual should be controlled. Qualitative studies should also be done to deepen and enrich the findings of the study. This will ensure that the information collected about the relationship quality between the elderly and their children would be more descriptive and could yield more in-depth data.

Conclusion

This study showed that the negative qualities of the relationship between elderly parents and their children have a more significant relationship with psychological well-being than positive qualities do. This means that the failure of children to pay attention to their parents can cause psychological well-being to decline. Meanwhile, children’s success in caring for their parents is not related to the psychological well-being of the elderly parents. This condition appears because parents consider that paying attention to them is an obligation that children have obligation to their parents.

Click here for additional data file.

Supplemental material, Kuesioner_PANSE_dan_PWB for Relationship with children and the psychological well-being of the elderly in Indonesia by Litha Almira, Lathifah Hanum and Adhityawarman Menaldi in SAGE Open Medicine