Active aging, autonomy, and mental health among older adults with chronic illness - focus on optimism

Abstract Background In the active aging framework, the focus has shifted to the quality of life of the elderly, where autonomy plays an important role. Chronic illnesses often lead to autonomy limitations, impacting activities of daily living (ADL) and increasing the risk of depression. Fostering an optimistic outlook can mitigate depression’s severity and promote healthy aging. Methods The data is from a cross-sectional survey in Hungary (n = 832). 60,1% of the sample had at least one chronic illness. Measurements included the EQ-5D-5L, Mental Health Continuum-SF, Life Orientation Test, and the Geriatric Depression Scale. Results We found worse mental health (p = 0,024), lower levels of optimistic outlook (p = 0,002), and higher levels of depression (p < 0,001) among those who reported ADL limitations. ADL limitations (ß = -0,27, p < 0,001) showed the strongest association with perceived health status, followed by mobility (ß = -0,22, p <; 0,001) and self-care (ß =-0,14, p < 0,001). Considering mental health, only ADL limitations (ß = -0,15, p < 0,001) were a significant predictor from the above-mentioned dimensions. Additional analysis showed that depression affected mental health both directly (effect = -1,90, p < 0,001) and indirectly, mediated by an optimistic outlook (effect = -0,88). Conclusions 1. Limitations in autonomy were negatively linked to perceived health status and mental health. 2. The optimistic orientation toward life can mediate the association between depression and mental health among the elderly with chronic conditions. 3. The Implications of the results could enlighten the necessity of preventive initiatives on autonomy preservation and enhance an optimistic outlook to maintain healthy aging and a favorable quality of life. Key messages • Preventive interventions focusing on health-preserving behaviors could be designed for specific groups with a higher risk of ADL limitations in the future. • Optimism could mediate depression’s impact on the mental health of the elderly with chronic illnesses, suggesting that interventions should target enhancing optimism for improving active aging.