UNDERLYING DIMENSIONS AND PREDICTORS OF

ELDERLY HAPPINESS: AN EXPLORATORY STUDY

OF RUMAH SERI KENANGAN RESIDENTS IN WEST

MALAYSIA

BY

AZMAH BINTI GHAUS

A dissertation submitted in fulfilment of requirement for the

degree of Doctor of Philosophy in Education

(Guidance and Counseling)

Kulliyyah of Education

International Islamic University Malaysia

JULY 2016

ii

ABSTRACT

This study was conducted with manifold objectives, i.e. to explore the extent of

happiness experienced by the residents of Rumah Seri Kenangan (RSK) in Peninsular

Malaysia, extract the underlying factors of elderly happiness, identify statistically

significant predictors of elderly happiness from among the extracted factors, examine

the differences between Muslim and non-Muslim residents in regard to the extracted

happiness factors, and finally, establish the psychometric properties of the elderly

happiness scale used in the study. The respondents comprised 323 seniors from nine

RSKs in Peninsular Malaysia and the instrument used was an elderly happiness scale

with 62 items rated on a 6-point Likert-type categories. The scale was developed

based on extant literature and a focus group discussion involving eight elderly

residents of RSK Cheras, and content validated by five experts in the fields of Social

Psychology, Research Methodology, Assessment, and Applied Statistics. The data

were analyzed using descriptive statistics, Principal Axis Factoring (PAF),

independent samples t-tests, and multiple linear regression (MRA). The results

indicated that a majority of the seniors reported being happy (70.9%) and satisfied

(69.4%) with their life and present condition at the RSKs. More than half (54.2%)

expressed no intention to leave the home. The PAF procedures extracted eight

underlying factors of elderly happiness - which consisted of spiritual well-being,

physical well-being, social well-being, contact with nature, quality care, choice,

autonomy and empowerment, recreation and entertainment - with a variance explained

of 69.3%. However, the eighth dimension, i.e. Entertainment, could not be validated

as its average variance extracted (AVE) fell below 0.5. Thus, the PAF was revised

with Entertainment removed from the scale. The revised PAF produced a construct

valid elderly happiness scale with seven underlying factors and AVE coefficients

ranging between .62 (social well-being) and .84 (contact with nature). All factors'

discriminant validity indexes were also below their respective AVEs. The MRA

procedures indicated that social well-being, recreation, and quality care significantly

predicted the happiness of the elderly RSK residents, with social well-being being the

strongest predictor. The t-test results produced no significant differences between

Muslim and non-Muslim residents in all of the dimensions examined, except for

spiritual well-being where Muslim seniors reported a higher mean score than non-

Muslim seniors. However, the difference was only moderate at Cohen's d of 0.53.

Given the findings, the study made six important recommendations that the RSKs may

consider in order to improve the happiness and subjective well-being of the residents.

These include conducting activities that promote greater social well-being among the

residents, providing high quality physical health care, integrating recreational

activities into the residents' schedule, organizing spiritually fulfilling religion-oriented

events or activities, providing geriatric counseling services, and providing personal

assistants to improve the mobility of the residents.

iii

ABSTRACT IN ARABIC

iv

APPROVAL PAGE

The thesis of Azmah Binti Ghaus has been approved by the following:

_____________________________

Mohamad Sahari Nordin

Supervisor

_____________________________

Nik Ahmad Hisham Ismail

Co-Supervisor

_____________________________

Tunku Badariah Tunku Ahmad

Co-Supervisor

_____________________________

Mohd Burhan Ibrahim

Internal Examiner

_____________________________

Kathleen R. Gilbert

External Examiner

_____________________________

Diana Lea Baranovich

External Examiner

_____________________________

Najibah Bt Mohd Zin

Chairman

v

DECLARATION

I hereby declare that this dissertation is the result of my own investigation, except

where otherwise stated. I also declare that it has not been previously or concurrently

submitted as a whole for any other degrees at IIUM or other institutions.

Azmah Binti Ghaus

Signature…………………....………. Date …….……………….

vi

COPYRIGHT

INTERNATIONAL ISLAMIC UNIVERSITY MALAYSIA

DECLARATION OF COPYRIGHT AND AFFIRMATION OF

FAIR USE OF UNPUBLISHED RESEARCH

UNDERLYING DIMENSIONS AND PREDICTORS OF ELDERLY

HAPPINESS: AN EXPLORATORY STUDY OF RUMAH SERI

KENANGAN RESIDENTS IN WEST MALAYSIA

I declare that the copyright holder of this dissertation are jointly owned by the

student and IIUM.

Copyright © 2016 Azmah Binti Ghaus and International Islamic University Malaysia. All rights

reserved.

No part of this unpublished research may be reproduced, stored in a retrieval system,

or transmitted, in any form or by any means, electronic, mechanical, photocopying,

recording or otherwise without prior written permission of the copyright holder

except as provided below

1. Any material contained in or derived from this unpublished research may

be used by others in their writing with due acknowledgement.

2. IIUM or its library will have the right to make and transmit copies (print

or electronic) for institutional and academic purposes.

3. The IIUM library will have the right to make, store in a retrieved system

and supply copies of this unpublished research if requested by other

universities and research libraries.

By signing this form, I acknowledged that I have read and understand the IIUM

Intellectual Property Right and Commercialization policy.

Affirmed by Azmah Binti Ghaus

……..…………………….. ………………………..

Signature Date

vii

DEDICATION

This dissertation is dedicated to my beloved parents

viii

ACKNOWLEDGEMENTS

All praise and thanks are due to the Almighty Allah for enabling me to complete this

work. Without the encouragement, help, and support of a number of dedicated people,

this research would not have been possible. It is with heartfelt gratitude that I

acknowledge and thank the following people who have made the completion of this

thesis possible.

I would like to thank, first and foremost, my major supervisor Prof. Dr.

Mohamad Sahari Nordin whose expertise on research methodology and statistical

applications really benefited me throughout the entire course of study. Secondly to my

co-supervisor, Prof. Dr. Nik Ahmad Hisham Ismail for his valuable advice, feedback

and constant checks on my progress. And thirdly, to my other co-supervisor, Assoc.

Prof. Dr. Tunku Badariah Tunku Ahmad, for her keen interest in and enthusiasm for

this research on elderly care. The many discussions with her, her valuable suggestions,

ideas and insightful comments on the whole work throughout the entire research have

been of the utmost significance in steering this study in the right direction. My sincere

gratitude and appreciation go out to all three of them for their never-ending support

and encouragement, precious thoughts and ideas and most significantly, their strong

belief in me that I have the ability to achieve what I have set out to do, even at my age.

I also wish to express my gratitude to my one and only child - my son, Tawfik

Ibrahim, for his constant support during my PhD years and undertaking while he was

abroad during his Bachelor and Master degrees. To us, the years of separation became

a source of encouragement and inspiration to one another for both of us to complete

our studies on time.

I would like to lastly extend my sincere thanks and appreciation to my young

friends, Mr. Fuad A.A. Trayek, Miss Dayang Shuzaidah Abduludin, Dr. Tunku Salha

Tunku Ahmad, and Encik Abdul Manaf Abdullah for their invaluable technical

assistance in the collection of data and writing up of my thesis.

Thank you also to all the Directors of the nine Rumah Seri Kenangan and the

323 seniors who took part in the study, as well as to all of you who were there to

encourage me, to offer help willingly whenever I needed it most, and to never let me

give up, no matter what obstacles come my way at various points along the research

process. I am blessed to have all of you in my life. I would never have been able to

face all the challenges alone in completing this thesis without your help. I can only ask

Allah to reward you abundantly.

ix

TABLE OF CONTENTS

Abstract ........................................................................................................................ ii Abstract in Arabic ........................................................................................................ iii Approval Page .............................................................................................................. iv

Declaration ................................................................................................................... v Copyright ..................................................................................................................... vi Dedication .................................................................................................................... vii Acknowledgements ...................................................................................................... viii

List of Tables ............................................................................................................... xiii List of Figures .............................................................................................................. xv

CHAPTER ONE: BACKGROUND OF THE STUDY ......................................... 1 1.1 Malaysia: An Ageing Nation ...................................................................... 1 1.2 Elderly Care in Malaysia: The Rise of Nursing Homes ............................. 4 1.3 The Emergence of Rumah Seri Kenangan.................................................. 6 1.4 Statement of the Problem............................................................................ 8

1.5 Objectives of the Study ............................................................................... 12 1.6 Research Questions ..................................................................................... 13

1.7 Theoretical Framework ............................................................................... 14 1.8 Conceptual Framework ............................................................................... 15

1.9 Significance of the Study ............................................................................ 18 1.10 Delimitations of the Study ........................................................................ 20

1.11 Operational Definition of Terms .............................................................. 21 1.11.1 Happiness ........................................................................................ 21 1.11.2 Elderly Happiness ........................................................................... 21

1.11.3 Rumah Seri Kenangan (RSK) ......................................................... 22 1.11.4 Social Well-being ........................................................................... 22

1.11.5 Spiritual Well-being ........................................................................ 22 1.11.6 Physical Well-Being ....................................................................... 23

1.11.7 Contact with Nature ........................................................................ 23 1.11.8 Entertainment and Recreation ......................................................... 24 1.11.9 Choice, Autonomy and Empowerment ........................................... 24

1.12 Chapter Summary ..................................................................................... 24

CHAPTER TWO: LITERATURE REVIEW ........................................................ 26 2.1 Introduction................................................................................................. 26

2.2 The Meaning of Happiness ......................................................................... 26 2.3 The Multidimensionality of Happiness ...................................................... 28 2.4 Existing Measures of Happiness ................................................................. 29

2.4.1 The Oxford Happiness Inventory (OHI) ........................................... 29 2.4.2 The Oxford Happiness Questionnaire (OHQ) .................................. 31

2.4.3 The Bradburn Affect Balance Scale (ABS) ...................................... 32 2.4.4 The Chinese Happiness Inventory (CHI) .......................................... 33 2.4.5 The Memorial University of Newfoundland Scale of

Happiness (MUNSH) ....................................................................... 34 2.4.6 The Depression-Happiness Scale ...................................................... 34

x

2.4.7 The Subjective Happiness Scale ....................................................... 36 2.4.8 The Mood Survey.............................................................................. 37 2.4.9 The Adolescent General Well-being Scale (AGWB) ....................... 37

2.4.10 The Happy-Reli Scale ...................................................................... 37 2.5 Research into the Correlates of Elderly Happiness .................................... 40

2.5.1 The Influence of Religion and Religiosity ........................................ 40 2.5.2 The Influence of Social Relationships and Social Contact ............... 42 2.5.3 The Influence of Physical Health and Comfort ................................ 44

2.5.4 The Influence of Contact-with-Nature Activities ............................. 46 2.5.5 The Influence of Entertainment and Recreation ............................... 48 2.5.6 The Influence of Choice, Autonomy and Empowerment ................. 50

2.6 Assessing Elderly Happiness ...................................................................... 51

2.7 Treatment of the Elderly in Islam ............................................................... 55 2.8 Geriatric Counseling: Three Clinical Therapies ......................................... 59

2.8.1 Validation Therapy ........................................................................... 59

2.8.2 Cognitive-Behavioral Therapy .......................................................... 62 2.8.3 Reminiscence Therapy ...................................................................... 67

2.9 Geriatric Counseling: Integrating Islamic Principles ................................. 73 2.9.1 Prayer ................................................................................................ 73

2.9.2 Qur'an Recitation .............................................................................. 78 2.9.3 Dhikir ................................................................................................ 82

2.9.4 Bearing Patience ............................................................................... 83 2.10 Summary of Review ................................................................................. 85

CHAPTER THREE: RESEARCH METHODOLOGY ....................................... 87 3.1 Introduction................................................................................................. 87

3.2 Research Design ......................................................................................... 87 3.3 Population of the Study .............................................................................. 88

3.4 Sample Size And Respondent Selection ..................................................... 90 3.5 Instrumentation: Development of the Elderly Happiness Scale ................. 92

Stage 1: Operationalizing the Meaning of Happiness and Elderly

Happiness ..................................................................................... 93

Stage 2: Identifying a Theoretical Framework on Elderly Happiness ....... 93 Stage 3: Identifying the Dimensions of Elderly Happiness and Their

Respective Operational Definitions ............................................. 94 Stage 4: Preliminary Drafting of Elderly Happiness Items from

Focus Group Discussion .............................................................. 94 Stage 5: Refinement of Elderly Happiness Items ...................................... 95 Stage 6: Content Validation of Elderly Happiness Items via Expert

Judgment ...................................................................................... 95 Stage 7: Pilot Testing of the Elderly Happiness Scale ............................... 97 Stage 8: Finalization of the Elderly Happiness Scale ................................ 97 Stage 9: Translation of the Elderly Happiness Scale ................................. 98

3.6 Pilot Study .................................................................................................. 98

3.6.1 Focus Group Discussion ................................................................... 98 3.6.2 Survey ............................................................................................... 106

3.7 Data Collection Procedures ........................................................................ 109 3.7.1 Obtaining Permission Letter from the Social Welfare

Department ....................................................................................... 109

xi

3.7.2 Obtaining Permission Letters from RSK Directors .......................... 110 3.7.3 Informed Consent of the RSK Residents .......................................... 110

3.8 Training of Enumerators ............................................................................. 111

3.9 Data Analysis Procedures ........................................................................... 112 3.9.1 Principal Axis Factoring (PAF) ........................................................ 112 3.9.2 Computation of the Elderly Happiness Scale's Construct

Validity ............................................................................................. 113 3.9.3 Computation of the Elderly Happiness Dimensions'

Composite Reliability ....................................................................... 114 3.9.4 Independent Samples t-Tests ............................................................ 114 3.9.5 Multiple Regression Analysis (MRA) .............................................. 115

3.10 Chapter Summary ..................................................................................... 115

CHAPTER FOUR: DATA ANALYSIS AND RESULTS ..................................... 118 4.1 Introduction................................................................................................. 118

4.2 Demographic Profile of the Respondents ................................................... 118 4.3 Data Screening ............................................................................................ 122 4.4 Extent of Happiness at The Rsk.................................................................. 122 4.5 Descriptive Exploration of Responses to the Elderly Happiness

Factors ........................................................................................................ 124 4.5.1 Spiritual Well-being .......................................................................... 125

4.5.2 Physical Well-being .......................................................................... 126 4.5.3 Social Well-being .............................................................................. 127 4.5.4 Contact with Nature .......................................................................... 128

4.5.5 Entertainment and Recreation ........................................................... 129 4.5.6 Choice, Autonomy and Empowerment ............................................. 131

4.5.7 Sources of Happiness for Large Majorities of RSK Residents:

A Summary ....................................................................................... 132

4.6 Underlying Dimensions of Elderly Happiness ........................................... 133 4.6.1 Preliminary Analysis ......................................................................... 133 4.6.2 The Final Factor Structure ................................................................ 136

4.7 Construct Validation of the Elderly Happiness Scale................................. 144

4.7.1 The Scale's Convergent Validity ....................................................... 144 4.7.2 The Scale's Discriminant Validity .................................................... 147 4.7.3 The Scale's Composite Reliability .................................................... 148

4.8 Revised Underlying Structure of Elderly Happiness .................................. 150

4.9 Differences between Muslim and Non-Muslim Residents ......................... 154 4.10 Predictors of Elderly Happiness ............................................................... 155 4.11 Summary of the Research Results ............................................................ 161

CHAPTER FIVE: DISCUSSION AND CONCLUSION ...................................... 164 5.1 Introduction................................................................................................. 164 5.2 Summary of Key Findings .......................................................................... 164 5.3 Limitations of the Study ............................................................................. 171

5.4 Recommendations for Rumah Seri Kenangan in Malaysia ........................ 172 5.5 Suggestions for Future Research ................................................................ 177 5.6 Conclusion .................................................................................................. 180

REFERENCES ........................................................................................................... 182

xii

APPENDIX 1 SKALA KEBAHAGIAAN WARGA RUMAH SRI

KENANGAN, MALAYSIA ........................................................ 195

APPENDIX 2 ENGLISH VERSION OF THE ELDERLY

HAPPINESS SCALE .................................................................. 203 APPENDIX 3 RESEARCH APPROVAL LETTER FROM THE

DEPARTMENT OF SOCIAL WELFARE .............................. 210

xiii

LIST OF TABLES

Table 2.1 Sample Items from the Oxford Happiness Inventory (OHI) 30

Table 2.2 The Oxford Happiness Questionnaire (OHQ) 31

Table 2.3 The Bradburn Affect Balance Scale (ABS) 33

Table 2.4 The MUNSH: Instructions, Items and Scoring 35

Table 2.5 The Subjective Happiness Scale 36

Table 2.6 Summary of Existing Happiness Scales 38

Table 3.1 Total Population of RSK Residents by Gender and Ethnic Group 89

Table 3.2 Krejcie and Morgan's (1970) Sample Size Guidelines 91

Table 3.3 List of Modified Items 96

Table 3.4 Some Demographic Information of the FGD Participants 101

Table 3.5 Summary of Happiness Factors and Items Drawn from the FGD 103

Table 3.6 Reliability Estimates of the Elderly Happiness Dimensions 107

Table 3.7 Individual Reliability Statistics for “Extent of Happiness” Items 108

Table 3.8 Summary of the Research Objectives and Corresponding Data

Analyses 117

Table 4.1 Detailed Demographic Profile of the RSK Respondents 119

Table 4.2 Distribution of Responses to the Extent of Happiness Items 123

Table 4.3 Distribution of Responses to the Spiritual Well-being Items 125

Table 4.4 Distribution of Responses to the Physical Well-being Items 126

Table 4.5 Distribution of Responses to the Social Well-being Items 128

Table 4.6 Distribution of Responses to the Contact-with-Nature Items 129

Table 4.7 Distribution of Responses to the Entertainment and Recreation

Items 130

Table 4.8 Distribution of Responses to the Choice, Autonomy and

Empowerment Items 131

xiv

Table 4.9 Elderly Happiness Items that Received More than 80%

Respondent Agreement 132

Table 4.10 Elderly Happiness Items Removed from the PAF Analysis 136

Table 4.11 Inter-item Correlation Matrix 138

Table 4.12 Item Communalities 139

Table 4.13 Finalized Factor Structure, Factor Loadings, Eigenvalues,

Variance Explained and Internal Consistency Index 141

Table 4.14 Average Variance Extracted (AVE) for the Elderly Happiness

Dimensions 145

Table 4.15 Convergent and Discriminant Validity Coefficients of the

Extracted Dimensions 148

Table 4.16 Composite Reliability (CR) Estimates of the Extracted

Dimensions 149

Table 4.17 The Final Factor Structure Revised 152

Table 4.18 The Re-Estimated Convergent and Discriminant Validity

Coefficients of the Revised Elderly Happiness Scale 153

Table 4.19 Summary of Independent Samples t-Test Results 155

Table 4.20 Tolerance and VIF Statistics 158

Table 4.21 Correlation, Mean and Standard Deviation of the Predictor and

Criterion Variables 159

Table 4.22 ANOVA Results 159

Table 4.23 Regression Coefficients and Confidence Intervals for the

Predictors of Elderly Happiness 160

xv

LIST OF FIGURES

Figure 1.1 Percent Increase in Population Aged 65 and Above Among

Nations: 2008-2040 3

Figure 1.2 Diener and Diener's (2011) Model of Psychological Wealth and

Happiness 15

Figure 1.3 Proposed Dimensions of Elderly Happiness 16

Figure 2.1 Six Dimensions of Elderly Happiness: The Conceptual Model 54

Figure 2.2 Mr. A's Diagnostic based on the Cognitive-Behavioral Therapy 66

Figure 3.1 The Study's Ex-Post Facto Research Approach 88

Figure 3.2 Development of the Elderly Happiness Scale 100

Figure 3.3 Barometer of Effect Size Influence 115

Figure 4.1 Visitation Frequency Reported by RSK Residents 120

Figure 4.2 Categories of Visitors 121

Figure 4.3 Extent of Happiness Reported by the RSK Residents 124

Figure 4.4 Scree Plot 137

Figure 4.5 Scatterplot for Checking the Assumption of Homoscedasticity 156

Figure 4.6 P-P Plot for Checking the Assumption of Normal Distribution 157

Figure 5.1 The Eight Extracted Dimensions of Elderly Happiness 166

Figure 5.2 The Validated 7-Factor Structure of Elderly Happiness 167

1

CHAPTER ONE

BACKGROUND OF THE STUDY

1.1 MALAYSIA: AN AGEING NATION

The World Health Organisation (WHO) in 2006 predicted that the number of elderly

people in the Western Pacific Region will double over the next twenty years (Khaw,

Teo, & Rashid, 2009). For many developed nations in Asia, population ageing has

become a common phenomenon as a result of increasing longevity, declining fertility,

improved medical care, improved living conditions, and improved quality of life.

According to the Economic and Social Commission for Asia and the Pacific (ESCAP,

2004), the number of aged citizens in Asia, i.e. individuals aged 60 and over, will

increase by 218.9% from 322 million in 2000 to about 705 million in 2025. Among

Asian countries, Japan and Singapore will most likely have the oldest population by

2030.

Malaysia is experiencing improved health, longer life expectancy, and

declined mortality as the country progresses in terms of education, economy,

healthcare, public welfare and governance. These factors combined are fast changing

Malaysia's demographic profile where the age used to define the elderly now in the

country is 60 years, which is similar to the cut-off age adopted by the United Nations

(UN). The total population of Malaysia is now closely approaching 30 million, and is

projected to increase to 38.6 million by 2040 (Department of Statistics Malaysia,

2013). Although her population is still not considered elderly in Asia, the number of

Malaysia's elderly population has recorded a steady increase since the early 1990s.

Findings from the Department of Statistics 2000 Census revealed an increase in the

percentage of the elderly from 5.9 percent in 1991 to 6.2 percent (about 1.5 million) in

2

2000. This is a clear indication that demographic ageing is taking shape in Malaysia.

The Census also projected that the elderly population aged 60 and above will increase

to 9.5 percent by 2020, which will be equivalent to 3.2 million (Zainab & Wan-

Ibrahim, 2014). And very recently, the director of Universiti Putra Malaysia's Institute

of Gerontology, Professor Dr Tengku Aizan Tengku Abdul Hamid, remarked that the

population of Malaysian persons aged 65 and above will catapult from 7% in 2020 to

14% in 2043, and by international standards, this will make Malaysia an aged nation

in the next five years (Loh, 2015). According to Kinsella and He (2009), over a span

of 32 years from 2008 to 2040, Malaysia will experience a 269% increase in her

population of adults aged 65 and older (see Figure 1.1).

The director of UPM's Institute of Gerontology also expressed a concern about

population ageing now fast taking place in the nation, explaining that between 2050

and 2055, the number of older persons aged 60 years or over will equal the number of

young people under the age of 15 years in Malaysia. In addition, life expectancy

among Malaysians is estimated to be about 73 years (Kinsella & He, 2009). This

increased longevity and rapid ageing phenomenon have significant implications on the

country's economy and society, and may likely catch Malaysia by surprise and

unprepared in terms of facing up to the challenges, especially in terms of sustaining a

strong economic growth and providing old-age security options to the increasing

number of older persons. While advanced economies like Sweden, Australia, Britain

and the United States took between 45 and 85 years to prepare for an aged nation in

terms of social infrastructure and economic stability for the elderly, developing Asian

countries like Malaysia and Vietnam are less prepared and less ready to confront this

rapid transition.

3

Figure 1.1 Percent Increase in Population Aged 65 and Above Among Nations:

2008-2040

4

Geriatric researchers highlight that the elderly population faces major issues

that need addressing by the federal government and non-profit agencies. These include

financial and health issues, elder abuse, intergenerational care, and built environment

changes that need to be made in home and public spaces. Of an immense concern are

their deteriorating health following old age and social protection as a result of

declining familial care among family members. Furthermore, those advanced in age

tend to suffer from chronic diseases, sleep disruption, psychological problems, and

cognitive decline. They are likely to be physically frail and have higher functional

disabilities than younger persons. Because of these conditions, the elderly require

specific geriatric care and counseling, which Malaysia is lacking (Loh, 2015).

Although the government is spending huge amounts of money to assist poor

elderly Malaysians through the Department of Social Welfare's Skim Bantuan Orang

Tua (Financial Aid Scheme for the Elderly) where RM 540.1 million was reportedly

spent in 2013, neither the amount nor the efforts were adequate or sustainable. Special

services, such as geriatric counseling and geriatric training for medical personnel, and

good quality but affordable long-term care institutions to address the needs of the frail,

sickly and poor elderly Malaysians are urgently needed. These are critical areas in

which Malaysia is acutely lacking (Loh, 2015).

1.2 ELDERLY CARE IN MALAYSIA: THE RISE OF NURSING HOMES

Like many Asian cultures, Malaysians have a strong sense of filial piety where the

family is the nucleus that binds all members together. The family is regarded as a

primary care institution for the elderly. For Southeast Asians especially, the family

constitutes their religious, economic, political, and social core where loyalty and

primary obligations take priority over personal pursuits and selfish interests (Morrow,

5

1989). It is a cohesive and harmonious system where grandparents and older siblings

care for the young, and adult children care for their ageing parents. This belief and

practice are derived from the teachings of Islam and Confucian ethics of filial piety

that honour the elderly and award them a special status. Morrow's (1989) observation

is supported by Kim et al. (2005) who indicated that 62% of the Asian adults surveyed

in their study believed that they should support their elderly parents and not send them

to nursing homes.

However, among Malaysians, familial care for elderly parents has noticeably

deteriorated due to the nation’s modernization process and the effects of urbanization.

In particular, the changing role of women, delay in marriage, smaller family sizes, and

the migration of the younger generation to urban areas with more jobs and education

opportunities have resulted in young adults’ living apart from their families, thus

affecting their ability to provide family care for their parents (Ahmad, 1996;

Chattopadhyay, 2000; Sim, 2007; Phillips & Chan, 2002). Inevitably these changes

bring about unfavourable implications for elderly care. We now see the extended

family structure being slowly replaced by a nuclear family structure where aged

parents tend to live alone or separately, and no longer live with their adult children.

Additionally, the increasing participation of women in the workforce and the steady

decline in their role as traditional carers have greatly affected and put a strain on the

family as the primary care giver for the elderly (Cheng, 2005; Sim, 2007; Martin,

1989; Mubarak, 1997; Ng, Lim, Jin, & Shinfuku, 2005; Selvaratnam & Tin, 2007).

As a consequence of such a demographic transition, a vacuum has been created

that has seen the development of many private and public nursing homes and other

institutional care facilities for the elderly in Malaysia. Placing elderly people in care

institutions or nursing homes is now becoming an increasingly common practice in

6

spite of Malaysians' cultural expectations and assumption that placing the elderly in

institutions is a violation of a long-standing tradition and religion-based belief

systems. In fact, the first nursing home in Malaysia was established in 1983, and by

the year 2001, there were 50 moderate-sized nursing homes with 40 beds that could

house 40 elderly individuals. In addition, there were hundreds more smaller homes in

operation with fewer than 10 beds which found location in bungalows and private

residences. By the year 2007, about 209 moderate-sized nursing homes were in

operation (Center for Medical & Medicaid Services, 2013).

Today in Malaysia, institutional care for poor elderly persons is provided by

three agencies namely the government, the private sector and non-governmental

organizations (NGOs). The government provides residential homes and long-term care

under the Social Welfare Department, while the private sector and NGOs provide

nursing home care. Of the numerous nursing homes estimated to be currently in

operation throughout Malaysia, only 188 are licensed by the Social Welfare

Department as fully qualified and licensed care centres. Of this number, only 29 are

nursing homes for the elderly accommodating 1,046 residents. Seven of these homes

are run by the NGOs and the remaining are operated by individuals. In 2001, the

Social Welfare Department processed forty-five more applications from individuals

and twenty from NGOs for licensing (Ong, 2012).

1.3 THE EMERGENCE OF RUMAH SERI KENANGAN

An important issue facing geriatric care in the country at present is that old folks

homes tend to provide shelter for the independent and the relatively healthy elderly,

according to UPM’s Malaysian Research Institute on Ageing (Loh, 2015). There are

very few options for poor, elderly Malaysians with no financial means except to stay

7

at government-funded homes. Those who cannot afford private nursing homes can

apply to stay at elderly care institutions funded by the federal government. These

homes are called Rumah Seri Kenangan (RSK); they are under the purview of the

Social Welfare Department, Ministry of Women, Family and Community

Development, Malaysia. First begun in 1942 after the second World War ended in the

then Malaya, the RSK was initially intended as a shelter for orphans, neglected or

abandoned elderly persons, and those who lost protection and a place to stay. The

home then developed into a care institution for senior citizens. At present, there are

eleven RSKs altogether in Malaysia, nine in the Peninsular and two in East Malaysia.

For those elderly Malaysians who have to leave their homes and families and

move into a nursing home, they experience a new chapter in their lives, a chapter that

holds many uncertainties and challenges where they have to make constant

adjustments to get a meaningful life experience in the facility. For instance, among

the adjustments they are expected to make immediately is how to deal with the loss of

independence, prized possessions and freedom as they enter the home. Once accepted

into the facility, life follows a certain routine where activities are performed according

to the rules, regulations and restrictions of the establishment. The same experience

applies to the senior citizens in Malaysia who enter any government-funded elderly

care home (or RSK).

Although everything is provided for in the RSK in terms of food, shelter and

medical care, life is not necessarily happy for the institutionalized elderly. Many

factors affect their happiness and contentment in the nursing homes. In a fairly recent

study of 203 RSK residents, Zainab et al. (2012) discovered that most of the

respondents had a number of issues, which included feeling stressed and neglected,

battling with personal problems, and experiencing difficulties with the RSK

8

management. The authors suggested counseling services to be implemented

appropriately at the RSKs in order to help the residents cope with their personal

problems and crises. In the context of the present study, few studies have been

undertaken to systematically explore how happy RSK residents really are in their new

home environment, or what factors contribute to their happiness while staying at the

facility. On the other hand, studies on the subject of geriatrics abound, where in

general it was found that old age is mostly associated with the onset of physical,

mental, emotional and health problems (Department of Health and Human Services,

2000; Department of Health, 2005; Parsonage & Fossey, 2011; Knapp, McDaid, &

Parsonage, 2011)

1.4 STATEMENT OF THE PROBLEM

Moving into an RSK, whether it is through one’s own choice or initiated by family

members, brings along with it a substantial amount of grief and loss, the greatest of

which is the loss of independence (Harker, 2012). Losing their independence in favour

of dependence on the institution’s care staff often gives senior citizens the feeling that

life is bleak. Indeed, the erosion of personal autonomy and the loss of self-esteem give

rise to feelings that they are no longer worth very much.

Studies have shown that institutions for the elderly tend to have a negative

effect on health and well-being as their environment is prone to creating feelings of

dependency which in turn reinforces a sick role among residents (Donnenwerth &

Petersen, 1992). In addition, these institutions and nursing homes are viewed as a

“dumping place where one would idle till death” (Lee, 1997, p. 333). Frequently,

people placed in a public care home look at it as a one stop place before dying. Few, if

any, are ever able to go back home after entering a care institution or a nursing home

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for the elderly. The elderly in these homes may also feel dissatisfied with the quality

of care, erosion of personal autonomy, loss of meaning and sense of belonging in life

as a result of institutional policy, stiffness of general routine and the hierarchical

structure of the institution (Berglund, 2007; Bowling & Formby, 2002; Brooker, 2008;

Brown, 1995; Lee, 1997). As a result, many feel isolated and lonely (Fessman &

Lester, 2000). These feelings of isolation, loneliness and depression have been shown

to affect the institutionalized elderly in a number of studies. For instance, Jones,

Marcantonio, and Rabinowitz (2003) indicated that 20.3% of the elderly people who

lived in nursing homes or institutionalized type of care were depressed. In a similar

Malaysian study conducted in Kuala Lumpur, 54% were found to be depressed

(Sherina, Rampal, Hanim, & Thong, 2006). Elsewhere, Kim et al. (2009) discovered

close to 67% of Korean elderly and 41.7% of their Japanese counterparts who were

living in nursing homes were depressed.

The causes of depression are multiple. Apart from losing independence and

feeling isolated and lonely at the home, inability to continue with previous jobs, lack

of privacy and meaningful occupations (Choi, Ransom, & Wyllie, 2008), and physical

health problems (Aris & Draman, 2007) are also contributing factors. While research

into physical and mental health problems among the elderly is abundant, little is

known about the level of their happiness, especially that of senior citizens living in

long-term care homes and RSKs. Just about how happy they are living in this new

environment is not well researched, particularly in the Malaysian context.

A glimpse into the state of happiness of these senior citizens is given in

previous research into the correlates of happiness and well-being among senior

citizens in elderly care homes. However, a large bulk of this research tends to examine

correlates of happiness as individual influencers, for example engagement in gambling