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The role of social work services in improving the living standards of the elderly in Kuwait an empirical study.

Introduction

This paper discusses the challenges that the aging population is facing in the 21st century. The rapid transformation of our society will make it more difficult for members of the aging population to maintain healthy lives if their social and health problems are not addressed. Reducing the prevalence of chronic diseases, functional dependence and other associated social problems among the elderly will improve environmental and social conditions and lead to more effective public health measures and advances in medical care.

In Kuwait, little is known about the links among family care capabilities, daily activities, housing and the physical well-being of the elderly (Al-Ghazawi, 1998). This knowledge could help refine policies toward the elderly established by the government. Kuwait is on the right track to meeting the challenges of the aging population; nonetheless, the translation of policies into actions must be closely followed to ensure effective communication among the various agencies and non-governmental organizations. It is crucial to ensure that all resolutions trickle down and are implemented at the grassroots level. These mechanisms of collaboration and communication will help avoid the duplication or under-delivery of services and optimize the utilization of scarce resources for the benefit of the elderly in Kuwaiti society.

In upcoming decades, adults aged 60 and above are expected to represent one-fourth of the population of Kuwait based on the predictions of many demographic experts (Palomino, 1998). This notable increase in the number of elderly people will make the problems, challenges and life uncertainties resulting from the rapid changes in social dynamics an issue that must be addressed at all social levels (Tobin, 1991). This process will require social responsibility, sustainable human development and the integration of all members of society, each according to his ability and in accordance with his requirements and needs (Somiran, 1994). Kuwait should strive to attain a level of social services that preserves human dignity, interests and rights while meeting the needs of all members of society, particularly the elderly (Haddad, 1999).

The importance of the theoretical and practical concerns of the elderly and the important role that social welfare services play in improving their quality of life has attracted researchers to this field. Two major factors are of particular interest. First, the percentage of elderly people in Kuwaiti society is increasing. In 2005, the total Kuwaiti population over the age of 60 was 25, 268, representing 2% of the total population of 1, 333, 327 (Central Statistical Office). By 2010, the number of elderly Kuwaitis had increased to 57, 698, representing 5% of the total population of 1, 148, 363 people in that year. Attention to their needs and care, which they deserve as human beings and not based on pity or charity. A second factor attracting researchers to this field is the importance of social welfare services in providing comfort to the elderly and treating them with respect and appreciation. In this regard, the 2010 annual report of the Ministry of Social Affairs and Labor indicated that one of the most important objectives of nursing homes is to provide social, psychological, health, rehabilitation, counseling and guidance services to the elderly as well as comfort, assurance, security and the maintenance of their dignity (Ministry of Social Affairs and Labor, 2010).

The importance of this study is confirmed by recent research that has measured the role of social welfare services in elderly nursing homes in terms of improvements in the social, psychological and health conditions of the elderly. This recent research has shown that improved conditions for the elderly lead to changes in their outlook on life and quality of life.

The Study Objectives

1. To identify the role of the social welfare services provided by nursing homes in terms of improvements in the meaning and quality of life among the elderly.

2. To identify the significant differences between elderly people's attitudes toward the role of social welfare services in improving their quality of life based on type, age, educational level, health status, the level of attention their families provide and the level of relationship between the elderly and their families.

Study Questions

1. What is the opinion of the affected elderly persons regarding the role of the social welfare services provided to them by their nursing homes in terms of improvements to their quality of life?

2. To what extent is there a statistical difference between the elderly's demographic data (type, age range, education level/qualification, health status, level of care from the families, relationship level between the elderly and their families) and their views on the role of social welfare services in improving their lives?

Employed Method

This study was designed to answer the outlined questions and achieve the goals of the descriptive method, which calls for an analytical description of the activities, services and programs that the nursing home provides for the elderly, both internally and externally, and the role the home plays in improving the quality of life for its elderly residents. Furthermore, the use of the descriptive method provided a descriptive perspective for the analysis of the role played by social welfare services in improving the quality of life for the elderly.

Study Concepts

Social Welfare Services

Social welfare services are one of the most important concepts associated with social policy and social welfare and can be defined as the range of services provided by state and civil society organizations. Social welfare services are aimed at improving people's standard of living. For example, direct revenues improve the social lives of the citizens of a society rather than increasing production, economic benefits or economic returns. Some of the most important services included among social welfare programs for the people most in need are education, health care, housing, drinking water and services directed toward environmental health, recreational services, transport and communications. Thus, social welfare services are associated with social problems facing families and affecting individuals and groups such as children, the elderly and those with special needs that arise because of a lack of resources and social conditions. Other social welfare services include medical services, mental health and psychological services, rehabilitation and training, guidance and employment, social security programs and community development.

Social welfare services include a number of FAO programs and activities directed toward satisfying the basic needs of the population. These programs are designed in accordance with the United Nations' concept of social welfare, which includes services to enable people to cope with social problems, particularly in the areas of family planning, daycare, child care, elderly care and the rehabilitation of disabled persons.

Meaning of Life

The concept of meaning of life includes a range of individual responses that reflect an awareness of the purpose of life, a sense of life's importance and value, the will to act positively, the ability to take responsibility and satisfaction with life in general (Zaatar, Abu Al-Khair, 1999).

This study will utilize the concept of meaning of life in two ways. First, the study will examine the entire life of each elderly person, assessing any contradictions between aspirations and achievements and directing each person toward his achievements, full range of activities and any other aspects of his life that have meaning and give him a sense of accomplishment. Second, the study will determine the degree to which each elderly person accepts aging, supports others, possesses conviction in life and has a positive and optimistic attitude toward life.

The Concept of the Elderly

Linguistically, "elderly" means aged, but its manifestations are not scientifically linked to a specific age; aging is a process involving more than outward appearance, and becoming "elderly" occurs over a period that can last from 30 to 50 years. Elderly people are sometimes referred to as "golden-agers" as opposed to teenagers.

Most studies on the elderly are in agreement that the term refers those individuals who are impacted by the biological, psychological and social factors that limit one's ability to comprehend, change or adapt to life's variables. According to these studies, at a certain age that differs from one individual to another, the elderly require care, whether it be financial, medical, psychological or social (Al-Zarrad, 2003).

Study Tool

The current study obtained its data through a questionnaire and a one-on-one interview in which each researcher in the field met each elderly research participant, asked the questions in the questionnaire and then recorded the participant's responses and reactions to the questions. The questionnaire included a set of demographic and social questions that were designed specifically for the elderly. The questionnaire also included a set of statements that reflect elderly attitudes toward the role of social welfare services in contributing to their sense of meaning of life. Participants' responses to each question were recorded according to the Likert scale with five dimensions (Agree/Strongly Agree/Neutral/Oppose/ Strongly Oppose).

The process of drafting the questions in the questionnaire was accomplished in two stages. First, the researchers drafted a version of the questionnaire aimed at achieving the highest degree of honesty from participants. This version was reviewed by faculty members in the Department of Sociology and Social Work in the College of Social Sciences at Kuwait University to ensure that each phrase in the survey was linked to a variable to be measured and to ensure the accuracy of the wording. After adjustments were made according to the recommendations of the faculty members, the researchers drafted the final version of the questionnaire. According to the observations of the arbitration, which consisted of two main sets, the first set of questions selected for basic data sample, and included six questions, the second group of statements embodying the elderly sample research about social care services, and the role they play in improving the meaning of life.

To test the accuracy of the study tool and the internal consistency of the statements that gauge the attitudes of the elderly toward the role of social services in enhancing their sense of the meaning of life, Cronbach's alpha coefficient was used, and its value was determined to be 0.93, meaning that the final form of the tool is valid.

Study Sample

The study sample was chosen in a deliberate way, and 43 elderly people participated, representing 67% of the 64 elderly people residing in a seniors' home. Some of the seniors refused to cooperate with researchers, and some had health conditions that prevented them from participating in the research.

Statistical Methods Used in the Data Analysis

In this research, we used SPSS Version 15.16, a descriptive and statistical analytical software package used in the social sciences that utilizes statistical methods appropriate to the nature of the data, and we applied it to the following:

1. Mean

2. Standard Deviation

3. Analysis of Variance (ANOVA)

Previous Studies

The literature on elderly care, both in Arabic and in other languages, is rich with studies whose results are in agreement that it is important to designate special social services programs to address the issues of elderly care-giving. Existing studies call on all government agencies and civil organizations (civil society organizations) to offer medical, financial, social, psychological and recreational services to the elderly to provide care and fulfill their basic needs. Despite the many studies focusing on elderly care, our study may be the first to stress the role of social care services in contributing to a sense of the meaning of life among the elderly; thus, this study addresses one of the most important issues in modem trends in elderly care (Luppi, 2009).

Qenawy's comparative study (1988) targeted the attitudes of the elderly toward their social and psychological care, the role of the family and the relationship between these attitudes and the level of psychological adjustment. Qenawy's study was conducted on a sample of 118 elderly individuals of both sexes aged 60-80. Half of the individuals in the sample resided in nursing homes, and the other half resided with their families. The results of the study indicate the following:

1. The elderly living in nursing homes have a negative attitude toward the social and psychological care that they receive.

2. The elderly residing outside of nursing homes receive better care and have a better attitude toward their families.

The results of a study in the Kingdom of Bahrain (1995) indicated that the elderly do not want to live in nursing homes. This study was aimed at identifying both the elderly and the services required for their care, future needs and requirements. The study was also designed to locate the existing social institutions and determine the activities that they provide for the elderly and then identify deficiencies and ways to remedy them.

The results of this study have shown that the majority of the elderly do not want to stay in nursing homes because they are unfamiliar with the services offered by those establishments. Elderly people who enter nursing homes may be seeking better care than what they receive at home or attempting to alleviate the burden of care on their families.

Families that prefer for their elderly relatives to live in nursing homes as opposed to living with them report that the care offered at those institutions is better than what the families are able to provide due to a lack of caregivers, the many difficulties involved in elderly care and the families' inability to provide all the necessary care services. The results of this study are in agreement with those of (Navarro, 2009) and (Boulton, 2010), and the discussion that follows involves very advanced eldercare institutions that offer services that may not be available at home, such as physical, psychological and recreational care.

A field study by Abal-khayl in 1999, titled "Aging and eldercare institutions around the world (A model for a social and medical center for the elderly in the Kingdom of Saudi Arabia)," sought to evaluate a model for a social and medical center designed to meet the needs of elderly men and women in the Kingdom of Saudi Arabia who were affected by the socio-economic changes that impacted the communities of countries in the Gulf Cooperation Council.

Among the most important findings of this study were its explanation of the concept of abandonment, the role of women and the ways in which the changing family composition affects the older age group. In particular, these changes may lead to loneliness and depression for elderly people who are switching lifestyles and moving away from places where their needs are met to new environments that do not meet their needs (Allan, 2009). This study also suggests that societal changes in the roles of men and women may not favor the elderly if this continues without the intervention of specialized institutions.

Regarding services for the elderly provided by the social welfare centers in the Kingdom of Saudi Arabia, more than 70% of elderly people in the centers are satisfied to spend their leisure time there, and 78% expressed a desire to stay in the centers. Moreover, the elderly expressed their opinion that it is important for all centers to establish social activities as well as medical and religious programs. They also indicated that recreational activities, productive activities, crafts and sporting activities should be offered in the centers; this variety of offerings will give the elderly self-confidence and change their perception of the meaning of life.

A field study on the elderly in Jeddah, Saudi Arabia, by Mona Shweikeh (1999), titled "The role of the community in satisfying the social needs of the elderly," found a consensus among the elderly that their social needs should be provided for through social welfare centers. In addition, the elderly in Shweikeh's study suggested that there should be a greater emphasis on social activities, as participation in various events will fill their free time. The elderly reported that the medical services at the centers should include proper diagnosis and appropriate treatment but also that closer attention should be paid to their psychological needs and well-being.

Tahan's (1999) study, entitled "Future perspectives on care of the elderly in light of the mental characteristics of the UAE society," found that 50% of the elderly want to live in their homes and do not want to live in nursing homes. Moreover, the majority of the elderly, approximately 94%, were interested in improvements to social welfare services provided by the Ministry of Labor and Social Affairs. These services, according to the elderly, greatly reduced the isolation and loneliness caused by the absence of children and relatives around them.

With regard to the issues of the elderly and their problems in Kuwaiti society, Ghazzawi (1988) conducted a sociological study on the phenomenon of aging and the role of social work in improving the sense of the meaning of life among the elderly. This study began with the common perception that the elderly are socially isolated and do not represent a class of people with unique diseases and disorders.

The study conducted by Al-Dhafiri (2000) on the care provided at home for the elderly in Kuwait confirmed that currently, Kuwaiti homes are unable to meet the needs of the elderly, especially those who require health care and recreational and leisure activities (Al-Dhafiri, 2000).

The results of this study confirmed that in Kuwaiti society, the elderly's social needs must be carefully considered and addressed by senior homes and social welfare services. Having the ability to stay in touch with family, the ability to socialize with others and the opportunity to participate in different social events, as confirmed by the results of this study, will enhance the social, health and psychological well-being of the elderly. Opportunities for the elderly to socialize will also eliminate the sense of loneliness, anxiety and isolation, thereby contributing to a more positive view on life and generating the tools to cope with the problems caused by old age.

El Deeb's (1988) study aimed to identify the differences in psychological, social and life satisfaction between the elderly who continued to work after the age of 60 and the elderly who are retired. The results showed that elderly people in the study (male and female) who worked after the age 60 were more compatible and more satisfied with their lives versus the elderly (male and female) who stopped working once they reached the age of retirement.

The results of Hussien Soliman's study (2005), titled "The Effectiveness of Practicing Meaning-Oriented Therapy from the Perspective of Social Service to Improve the Meaning of Life of the Elderly," concluded that when the elderly begin to advance in age, a majority of them (79%) begin to evaluate and look back on their lives through their life experiences. Moreover, the elderly begin to think about the rest of their lives, accepting the inevitability of death. At that point, some of the elderly in the study (59.4%) felt happy and satisfied with their achievements. Others (40%) felt that many of their activities resulted in no reward and caused pain and trouble for them and those around them, which weakened their sense of the meaning of life.

The results of Kimble and Ellor's study (2000), "Measuring the meaning of life for the American elders," concluded that some American elders in the study sample (15%) began to show symptoms of what is known as "meaninglessness," which required the social workers to try to improve the elders' sense of the meaning of life. It was evident to the social workers that the elders who expressed signs of meaninglessness were in greater need of an improved sense of the meaning of life than elders who did not exhibit these signs. Toward this end, the social workers sought to improve the personal and social factors affecting the elders' sense of their meaning of life.

Within this context, the results of a study conducted by Batthyan and Guttmann (2000), "Empirical Research in Logo-Therapy," determined that to be effective in their professional roles, social workers must implement activation and intervention programs to improve the sense of the meaning of life for seniors, in particular, because humans at older ages begin to question the meaning of life. Although aging may reduce a person's energy level, aging also helps people reformulate new concepts and reorder their priorities and objectives. Batthyan and Guttmann (2000) confirm that logotherapy is one of the best and most important therapeutic approaches in helping the elderly to improve their sense of the meaning of life. The theoretical assumptions of logotherapy also emphasize the importance of personal meaning in life and elderly people's acceptance of themselves.

Guttmann's (2009) study investigated the role of social professionals in solidifying the meaning of life among elders using logotherapy. This study's results indicate that therapeutic treatment helps elderly people deal with their crises, especially with regard to the need to find meaning in their lives. Guttmann also found that social workers can assist the elderly in overcoming suffering through the search for new meaning in their lives through professional intervention. More specifically, through the use of a treatment effect (highlighting the value and importance of the role of the individual in life) and the life experiences of high value if invested properly, the elderly also have the right to enjoy life after providing services to the community.

In this context, the results of Atef Abdel Gawad's study (2007), "The Relationship between Using the Meaning-Oriented Therapy Model and Alleviating the Problems of Social Relationships among the Elderly," indicate that it is possible, through the use of meaning-oriented therapy, for a social worker to assist an elderly person in understanding the true meaning of his or her life, which is to worship God alone. The social worker can also employ meaning-oriented therapy within an Islamic framework to improve the sense of the meaning of life for the elderly, as meaning-oriented therapy can be practiced in both psychological treatment and treatment from the perspective of social work. This is due to the main principles and theoretical assumptions on which meaning-oriented therapy is founded assist in practicing this type of treatment through professional intervention by the social workers, especially in modem times where the pressures of life negatively impact people's social lives in general, and especially those of the elderly.

Hind Abdel Rahman's study (2008), "The Effectiveness of Meaning-Oriented Therapy in Alleviating Death Anxiety in a Sample of Elders," measured the effectiveness of a meaning-oriented therapy program focused on alleviating death anxiety among elders. By conducting follow-ups, Rahman's research also measured the extent to which the program remained effective over a period of time. The results revealed that there were statistically significant differences between the ratings of the experimental groups (of both males and females) in the pre- and post-measurement phase. The total scores on the meaning of life scale were higher in the post-measurement phase. Thus, the program resulted in reduced rates of death anxiety and restored feelings of the importance of meaning in life among the elders involved in the study.

Analysis of the Empirical Study Data

Our set of data, gathered by administering questionnaires and conducting interviews with a non-randomly selected sample of 43 elders out of the 65 who reside at the nursing home, can be analyzed using three different approaches. (The researchers could not interview the other 22 elders living in the nursing home due either to health issues or their unwillingness to be interviewed.) First, we analyzed the basic data for elders in the sample. Second, we analyzed the attitudes of the elders in the sample toward the role played by social care services in improving their sense of the meaning of life. Finally, we analyzed the extent to which there are statistically significant differences between the basic data for the elderly in the sample (gender, age group, education, health, family care and how involved the family is with the elder) and their attitudes toward the role of social care services in improving their sense of the meaning of life.

First stage: Basic data analysis of the elderly in this study

Sample data:

1. Most of the participants (25 people, representing 58%) in this study were elderly females.

2. Fewer participants (18 people, representing 42%) were elderly males.

Results of the data based on age group:

1. Elderly people 72 years and older comprised the majority of the participants (43 people, representing 53.5% of the total data set).

2. Elderly people aged 66-71 years comprised the second largest portion of the data set (11 people, representing 25.5%).

3. Elderly people aged 60-65 years comprised the smallest portion of the data set (9 people, representing 21%).

Study results according to academic qualifications:

1. Of the total sample, 15 elderly people (35%) had completed middle school.

2. Of the total sample, 9 elderly people (21%) had completed elementary school.

3. Of the total sample, 9 elderly people (21%) had completed a high school degree.

4. Of the total sample, 6 elderly people (14%) did not know how to read or write and were considered illiterate.

5. Of the total sample, 3 elderly people (7%) had a university degree.

Study results according to health status:

1. The elderly with a very poor health status (27 people, representing 62.8%) were the largest group.

2. The elderly with a poor health status (11 people, representing 25.6%) were the second largest group.

3. Finally, the elderly with a good health status (5 people, representing 11.6%) were the smallest group.

Study results according to the level of care that the elderly receive from their families:

1. Most of the elderly (25 people, representing 58%) indicated that they receive care from their families.

2. Despite the smaller number of elderly people who indicated that they do not receive care from their families (18 people, representing 42%), this number is important in a Muslim society that values, appreciates and respects the elderly. This result is a clear indicator of the importance of having institutions to care for the elderly in society.

Study results according to the relationship between the elderly and their families:

1. Most of the elderly people in the research (21 people, representing 48%) indicated that their relationship with their families was excellent.

2. A somewhat smaller number of elderly people in the research (13 people, representing 30.0%) indicated that their relationship with their families was not very good.

3. A strikingly low number of elderly people in the research (9 people, representing 21%) indicated that their level of involvement with their families was poor.

The elderly cited the inability of their families to provide appropriate care to the same extent that the senior homes and other social institutions could as the reason that they reside in the senior homes despite their good relationships with their families. Interaction with others is generally considered a positive and necessary part of life for the elderly, and having others attend to their psychological and physical needs is crucial to their wellbeing. Social welfare facilities provide such services and conveniences, even though the elderly people who reside in them sometimes feel isolated from their families.

Second stage: An analysis of trends in the research regarding the services that social care homes provide to the elderly and their role in improving their sense of the meaning of life

We analyzed the services provided to the elderly by the social care home and their role in improving the sense of the meaning of life, as represented by the 10 phrases shown in the table. After calculating the arithmetic mean and standard deviation for the responses, we produced the following set of conclusions, which are displayed in descending order of importance:

1. The elders' responses indicating that their feelings about their social lives have improved since living in the nursing homes had a mean of 4.53 and a standard deviation of 0.708. This result demonstrates that elders have positive attitudes toward the social care services that the nursing homes offer and the role of those services in enhancing the elders' sense of the meaning of life.

2. Elders' responses suggested that contact with relatives, acquaintances and friends through services available in the senior home has improved their view of the meaning of life; this was the second most important factor, with a mean of 4.44 and a standard deviation of 0.059.

3. Elders' statements indicated that the nursing home provides for their needs (health, social and psychological) and makes them feel at ease and appreciate and love life; this was the third most important factor, with a mean of 4.41 and a standard deviation of 0.648.

4. The response, "My visits to the public cafe make me feel good and satisfied with my life" was fourth, with a mean of 4.39 and a standard deviation of 0.849.

5. The statements indicating that the elders' participation in programs and activities (visiting the cinema, theater, other leisure venues and monuments; attending meetings and symposiums) outside the nursing home provided a real sense of life showed that this was the fifth most important factor, with a mean of 4.35 and a standard deviation of 0.766.

6. The response referring to the fact that the presence of social workers in the nursing home makes the elderly feel safe was sixth most important, with a mean of 3.88 and a standard deviation of 0.9631.

7. The statement indicating that the social welfare services provided in the nursing home are crucial for the elderly ranked seventh, with a mean of 3.80 and a standard deviation of 0.887.

8. The statement indicating that the elders' participation in artistic and sports activities in the nursing home makes them feel well balanced ranked eighth, with a mean of 3.76 and a standard deviation of 1.021.

9. The response suggesting that the elders' participation in social club activities in the nursing home gave them a new sense of the meaning of life ranked ninth, with a mean of 3.53 and a standard deviation of 1.076.

10. Finally, the response indicating that having the nursing homes provide for their needs (health, social and psychological) encourages the elderly to view life positively ranked 10th, with a mean of 3.41 and a standard deviation of 1.302.

Third stage: To what extent are there significant differences between the demographic data for the elderly and their attitudes about the social care services provided by the nursing home and the role of the services in improving the elderly s sense of the meaning of life?

We used analysis of variance (ANOVA) to identify whether there are significant differences between the data for the elderly research subjects (sex, age group, educational level/degree, health status, level of family care, and their relationship with their families), their attitudes about social care services provided by the nursing homes and the role of the services in improving the elderly's sense of the meaning of life. We came to the following conclusions:

1. In this research, there are significant differences between the sex (male-female) distributions of the elders and the elders' responses to statements representing their attitudes toward the social care services offered by the nursing home and the role of those services in improving their sense of the meaning of life. The females had a higher mean and a lower standard deviation than the males in the same age group.

2. There are significant differences between the distributions of the elders in the age group 60-65 as opposed to the age group 66-71 and older. In this research, the elders' attitudes toward the social care services offered by the nursing home and the role of these services in improving the meaning of life had the highest mean and the lowest standard deviation for the age groups 66-71 and 72 and older compared to the elderly in the age group 60-65.

3. There are significant differences among the distributions of the elders according to their academic qualifications. The elders' attitudes toward the social care services offered by the nursing home and the role of these services in improving their sense of the meaning of life had the highest mean and the lowest standard deviation for the elders who were illiterate or who had an elementary, middle or high school degree compared to the elders who had a university degree.

4. There are significant differences among the correlations between the health status of the elderly (good, poor or very poor), the elders' attitudes toward the social care services offered by the nursing home and the role of these services in improving their sense of the meaning of life. The highest mean and the lowest standard deviation occurred in the elderly with poor or very poor health status compared to the elderly who enjoy good health.

5. There are significant differences in the degree of care that the family provides to the elderly, the elders' attitudes toward the social care services offered by the nursing home and the role of these services in improving the elders' sense of the meaning of life. The highest mean and the lowest standard deviation occurred in the elderly who confirmed that their family is involved in their care compared to the elderly who claim that their families do not provide care.

6. There are significant differences between the distributions of the elders according to their relationship with their families, the elders' attitudes toward the social care services offered by the nursing home and the role of these services in improving the elders' sense of the meaning of life. The highest mean and the lowest standard deviation occurred in the group claiming that their relationship with their family is excellent or strong compared to the elderly who claim that their relationship with their family is very weak.

Study results

The data in this study were measured according to the Likert scale and using arithmetic means and standard deviations. The existence of significant differences between the demographic data for the elderly (sex, age, educational level, health status, the level of care that elder's family provides, and the relationship between the elder and the family) and the elderly's responses to statements that reflect their attitudes toward social care services and the role of the services in improving the meaning of life was established by using an ANOVA. We concluded the following:

1. The elderly's view toward the senior home in this study was overwhelmingly positive. The elderly indicated that these facilities positively affect their perception of life and that their social life is much better than it was before they moved into the home. This improvement is due to the important social welfare services that the home provides for the elderly's basic needs (health, social, psychological).

2. The elderly confirmed that the efforts undertaken by the senior home have strengthened the elderly's communication with their relatives, friends and acquaintances, which, in turn, gave the elderly a new sense of the meaning of life (because the institution bears the burden of care rather than the families of the elderly).

3. The seniors confirmed that the services that the senior home offers in terms of their basic needs (health, social, psychological, entertainment) gave them inner peace, appreciation and a love for life.

4. The opportunities for social activity in the senior home and elders' frequent visits to social facilities gave them satisfaction.

5. Elders confirmed that their participation in outside programs and activities organized by the senior home (visits to clubs, casinos, entertainment venues; public outings to movie theaters, cafes, monuments, museums; attending meetings and seminars) gave them a true sense of life.

6. The elderly indicated that the presence of social workers in the home and social workers' continuous communication, interaction and interest in the elderly's problems and needs made the elders feel safe and encouraged them to think positively about life.

7. The elderly females in the study more than the elderly males confirmed that social welfare services have greatly improved their meaning and value of life. This effect is due to the fact that the females in this study have an optimistic view of life; their overwhelming passion is responsible for this optimism and their more positive outlook on life. In contrast, the elderly males become very stubborn and critical. Therefore, they do not think about improving their lives; instead, they think about approaching death.

8. The elderly in the age categories of 66-71 and 72 years and older, more so than the elderly in the age group of 60-65, confirmed that the social welfare services provided by the senior home have positively influenced their sense of the meaning of life. The difference between the age groups is due to the fact that there is a positive correlation between the higher ages and the degree to which social welfare services are provided to improve their meaning and value of life. In contrast, the elderly in the age group 60-65 feel that their families have deserted them, which causes them to perceive life in a very pessimistic way.

9. The elderly who are illiterate or who have an elementary, middle or high school certificate affirm the positive influence of social welfare services more so than the elderly who hold university degrees. The elderly who do not possess a university degree feel a sense of security, satisfaction and reassurance in the senior home, whereas university degree holders have an unrealistic vision of the meaning and value of life after having achieved so many of their life's goals after earning a university degree.

10. The elderly who suffer from poor health emphasize the role played by social welfare services (health, social, psychological) in improving then health and therefore their meaning of life more so than the elderly who enjoy good health. Those with good health statuses do not need many of these services.

11. The elderly who receive care from their families, more so than those who do not receive family care, affirm that family care in combination with what the senior home offers has had a positive impact on their view of life.

12. The elderly who enjoy excellent or good relationships with their families, more so than the elderly who lack a positive relationship with their families, emphasize the importance of a good family relationship in addition to the social welfare services provided for them as crucial elements in enhancing their views on life. The elderly who lack a positive relationship with their families do not have the same positive outlook on life, despite all the social welfare services provided to them.

Discussion of the results of the current study in light of previous studies

This study asked elderly people living in nursing homes about the role played by social welfare services in improving their sense of the meaning of life. The study revealed the existence of significant differences among the elderly regarding their attitudes toward the role of social welfare services in improving their quality of life, as reflected in the statements that generated the highest average mean and lowest standard deviation. The results of the study by Qenawi (1988) indicate that elderly residents of nursing homes have negative attitudes toward their social and psychological care, whereas elderly people living with their families and residing outside of nursing homes have positive attitudes toward their caregivers and their families. Qenawi's findings contradict the findings of the present study, which stresses the role played by the social welfare services provided by nursing homes in improving the meaning of life among elderly residents. Perhaps the tension between Qenawi's results and our own is due to the level of social welfare services available for the elderly in Kuwaiti society. In addition, the number of elderly residents living in this particular home, which does not exceed 64 people, adds to the high quality of living for the elderly. The high standard of living for the elderly residing in nursing homes in Kuwait positively influences their attitudes toward the social care services provided to them; in turn, their positive attitudes improve their sense of the meaning of life. People in Egyptian society tend to think more positively about elderly people living with their families and more negatively about elderly people receiving social care away from their families.

Moreover, the difference between the level of social welfare services for the elderly in Egypt and Kuwait may be due to the supporting role of the Kuwaiti Government, represented by the Ministry of Labor and Social Affairs. This Kuwaiti Ministry provides social welfare services for the elderly residing in nursing homes and the elderly living with their families through mobile campaigns. In Egypt, these services are run by the non-governmental sector, and the majority of nursing homes are run by family unions or the private sector. Therefore, the quality of social care services for the elderly in Egypt depends on a variety of factors: the size of the monthly contribution provided by the families of the elderly, the geographical location of the nursing home and the socio-economic level of the neighborhood or region where the nursing home is located.

The results of a study on the elderly in Bahrain (1995) affirm the findings of our study. Although the majority of the elderly in Bahraini society do not want to live in nursing homes, the study linked this desire to the elderly's lack of knowledge about what nursing homes can provide in terms of care. Thus, the Bahraini elderly's desire to avoid nursing homes is not due to negative attitudes toward such accommodation as much as it is due to the elderly's lack of knowledge about nursing homes.

The study in Bahrain also found that the elderly who desire to stay in nursing homes hope to receive better services and care than they receive in their homes or to alleviate the burden of care from their families. In this context, the results of our study are consistent with the results of the study of Bahraini society, where the elderly and their families prefer nursing homes to living with their families. This preference for nursing homes might be due to a lack of care available at their homes or the inability of the family to provide cohesive care and services for the elderly.

The results of the study that Aba Alkhail conducted, "Ageing and elderly care centers in Saudi Arabia (1999)," confirmed our study's findings. The results of Aba Alkhail's study confirm that more than 70% of the elderly living in elderly care centers are entirely satisfied with the way they spend their leisure time, and 78% of them had expressed their desire to stay in these centers. Aba Alkhai's study also affirmed the results of our study regarding the productive role played by social, arts and sports activities in enhancing the elderly's self-confidence and positive outlook on life. The studies are in agreement on the role played by social welfare services in meeting the basic needs of the elderly. Social welfare services are not limited to health care services but also incorporate services aimed at providing basic needs such as the desire to stay connected with one's family, the desire to socialize with others, the need to have others understand and listen, the need to participate in different activities and the desire to occupy one's free time with useful work. The elderly residing in nursing homes also need to feel that they are important. The studies confirm that a sense of importance will prevent the elderly from experiencing loneliness and isolation, and it will also improve the elderly's sense of the meaning of life.

Tahan's findings in his study, "Future perspective on care of the elderly in the Emirate community in light of their psychological characteristics" (1999), differed from the results of our study. Tahan's results confirm that 50% of his sample of elderly people want to live in their homes and do not want to go to a nursing home. Tahan's study also confirmed that 94% of the elderly in his sample desire improvements in social welfare services allocated by the Ministry of Social Affairs, which would, in their opinion, greatly reduce their feelings of isolation and loneliness caused by the lack of family members around them. Our study has also confirmed the important role played by social welfare services in reducing feelings of loneliness, alienation and isolation; a reduction in these feelings ultimately improves the meaning and quality of life among the elderly living in nursing homes.

Our study results also confirm Shweikeh's findings (1999) regarding the need for social welfare services to help the elderly escape feelings of emptiness and loneliness and to give them a new sense of the meaning of life.

Al-Dhafiri's study about elderly senior homes in Kuwait (2000) is consistent with our results, particularly with regard to Kuwaiti senior homes that do not meet the needs of the elderly in the areas of health care, recreation and entertainment. Al-Dhafiri's study revealed a sense of urgency in Kuwaiti society to create nursing homes that could provide these services, activities and programs for the elderly. Made possible through the efforts of social workers, these improvements altered the sense of the meaning of life among the elderly.

The Ghazzawi study, "Sociological study about the phenomenon of ageing in the Kuwaiti society, and the social welfare services role in improving the meaning of life among the elderly" (1988), rejected the common perception that the elderly are socially isolated and represent a class of people with various diseases and disorders. These findings are consistent with our results, particularly the view that it is necessary to provide the elderly with all the social welfare services that are available, which will ultimately change and improve their meaning of life.

El Deeb's study, "Understanding the differences in the degree of psychological, social and life satisfaction among investors at work after the age of 60, among the elderly who are referred to as retirement age / pension age" (1988), confirmed that those who continued working after the age of 60 are more satisfied in life compared to the same age group who stopped working and retired. However, the results of our study also emphasize the positive role played by social welfare services provided by senior homes in terms of improving the elderly's outlook on life.

The effectiveness of exercise therapy in improving the elderly's sense of self was confirmed by Hussein Suleiman (2005), who found that most of the elderly in the study sample (59.4%) reported feelings of happiness and satisfaction with their achievements. Our data also confirmed that the happiness and contentment felt by the elderly were due to their active participation in the activities provided by the senior home, whether the activities occurred inside the senior home or during their visits to external venues.

The results of the study conducted by Kimble and Ellor (2000) on the meaning of life among elders in the United States demonstrated the need for elderly Americans to offset their sense of "meaninglessness," or the feeling that one's life has no meaning. Dealing with meaninglessness required social workers to help the elderly improve their sense of the meaning of life through the improvement of personal and social resources that could offset their sense of emptiness. Kimble and Ellor's results were consistent with our findings, particularly with regard to the importance of social welfare services in caring for the elderly. Services, including activities within and outside the home, regular and permanent visits from family members to the nursing home and social workers playing an active role, encourage an optimistic view of life among the elderly.

Batthyan and Guttmann's study, "Research on therapy" (2005), was consistent with our conclusions, particularly the importance of the role of social workers in providing treatment. Effective treatment from social workers led the elderly to accept themselves and their roles in life, which confirmed their meaning and purpose in life.

Guttmann's study, "Social workers role in fostering the meaning of life among the elderly" (2009), also confirmed our findings, particularly the elderly's need to find new meaning in their lives through working with therapeutic social workers. Therapeutic practices, commensurate with professional social work, help the elderly overcome their suffering. Therapeutic practices include activities, programs and services provided by senior homes that are designed to combat feelings of suffering and instill a positive and brighter sense of the meaning of life among the elderly.

The results of Atef Abdel Gawad's study, "The relationship between the treatment model and the alleviation in the density of the elderly social relationships problems" (2007), combined with the results of our study, confirm the importance of the role played by social workers in helping the elderly understand the true meaning of their lives through vocational intervention. This concept is particularly important in the current era, when the burdens of life adversely affect the performance of human beings in general and the elderly in particular.

Finally, the results of Hind Abdul Rahman's survey, "The Effectiveness of Treatment On Relieving Elderly Anxiety of Death" (2008), are compatible with the results of the current study, particularly when applied to a pilot program for the elderly in the sample study, which eased the anxiety of death among the elderly. The results of our study also emphasize that the activities, programs and services offered by nursing homes and the professional intervention of social workers have been able to reduce the anxiety of death and improve the outlook on life among the elderly.

In summary, our study, in light of previous studies, was successful in answering the questions outlined and in achieving its central objectives.

Study Recommendations

1. Kuwaiti society is a traditional society wedded to its traditions and customs; the prestige of elders is an essential element in the establishment of this tradition. Therefore, placing the elderly in senior homes or other institutions is not welcomed or accepted in Kuwaiti society. Instead, this practice is regarded as negligent behavior on the part of the families toward their elderly relatives. As determined through numerous scientific studies, it is clear that there are situations that require serious attention because some nursing homes are ill equipped to meet the needs of the elderly. These homes lack basic necessities such as bathrooms, staircases and gardens. Furthermore, there are cases in which the elderly need care around the clock, which is not available in some senior homes.

2. Therefore, close attention should be paid and serious reform should be applied in the administration of nursing homes to provide a safe environment for the elderly. The elderly should feel at home in the nursing home, where they can be free to have visitors and meet with family members outside of the home. The home should provide stability and a sense of belonging, which will help the elderly to live a normal life. The environment and the atmosphere of the nursing home should be more like a resort or a five star hotel than an institution.

3. For that reason, this study calls for government agencies and the private sector to pay attention to the rapid growth of this phenomenon and to create suitable places for the elderly that address all their needs.

4. Developing and improving the means and methods for civil society organizations to create programs and activities and provide services that enable the elderly to continue contributing to their community, as stated in the United Nations recommendations on the care of the elderly (United Nations, 1997).

5. There should be a concerted effort on the part of both government institutions and civil society organizations to create and manage special facilities for the elderly who need specialized services that are not available in their family environment (Fahmi--1998).

6. Kuwait should develop national human resources in light of modem challenges as well as training and educational preparation in keeping with sustainable human development and the labor needs of civil society organizations, particularly in the field of social services for the elderly (Lou, 2010).

7. Kuwait should employ all means of communication to increase awareness and educate all members of society on the issues and problems facing the elderly. Furthermore, we should establish a way to deal with the issues and problems facing the elderly in accordance with our values, customs and the traditions of Kuwaiti society and the Islamic faith (Atef khalifa, 2003).

8. Educational curricula, programs and training systems should be enhanced to enable the national labor force to provide better services in the area of social care for the elderly (Hedberg, 2010).

9. Civil society organizations should be directed to focus on improving efficiency and effectiveness in the provision of social care services for the elderly (Salameh, 2009).

10. Social clubs for the elderly should be created and expanded to provide a variety of activities and programs, including social and recreational activities (Halabi, 2007).

11. Priority should be placed on preparing educational curricula that focus on the methods, standards and areas of professional intervention for therapy in the clinical social services and the role of therapy in improving the sense of the meaning of life for the elderly.

Conclusion

Societies have different attitudes regarding caring for the elderly. When people grow old in many parts of the world, family and friends care for them at home until they die. Elderly people in the United States are often sent to an assisted living or skilled nursing facility, which may appear selfish, uncaring and even callous. It is easy to make harsh comparisons between the East and the West in regard to the issue of elderly care. The values of Western cultures tend to celebrate youth, self-reliance and individualism, whereas Middle-Eastern cultures place enormous emphasis on family and the elderly, often adhering to traditional age hierarchies. A traditional Middle-Eastern household is far more likely to include a grandparent, whereas nursing homes in the United States and in many parts of the West are increasingly overcrowded.

In stark contrast to Middle-Eastern cultures, Western cultures encourage families to strike a balance between allegiance to the elderly and individual freedom. Quite often, the pursuit of individual freedom takes priority, resulting in a collapse of harmony and any reasonable sense of family dependence and unity. Routinely in the West, seniors do not live with their children, and it is often considered a major inconvenience to take care of one's parents, even if one has good intentions to do so.

According to UCLA professor Jared Diamond, Pulitzer Prize-winning author of "Guns, Germs, and Steel: The Fates of Human Societies" and recipient of a MacArthur Foundation "genius" award, "The idea that it's human nature for parents to make sacrifices for their children and, in turn, for their grown children to sacrifice for their aging parents--turns out to be a 'naive expectation." This assumption, according to Diamond, "ignores undeniable conflicts of interest between generations." From a common-sense perspective, Diamond continues, "Parents and children both want a comfortable life--there are limits to the sacrifices that they'll make for each other" (Diamond, 2010). Yet the fact remains, as Diamond says, that many societies treat their elderly better than Americans do. Nonetheless, Diamond indicates that steps can be taken to improve the lives of the elderly in the United States, such as by understanding thenchanging strengths and weaknesses as they age and appreciating their deeper understanding of human relationships and their ability to think across wide-ranging disciplines, to strategize and to share what they've learned (Diamond, 2010).

Middle-Eastern culture safeguards respect for the elderly and places a high value on the relationship and bond among members of the family, clan or tribe. Most elderly people in the Middle East receive social and economic support from their families and, in particular, from their children (typically the eldest in the family takes care of his parents). Normally, the elderly are portrayed as a source of wisdom, blessing, respect and love. The elderly represent the bond that keeps the family tied together as one unit within the clan or the tribe. In general, sending an elderly parent to a nursing home is considered a cultural and religious violation of a sacred duty toward family members, but many individuals and groups are faced with situations in which they have no other alternative (Abyad, 2006).

As the elderly population continues to grow, clinicians and geriatric professionals require advanced technologies to support them in monitoring and managing patients' quality of life in nursing homes. Currently, little research has been conducted regarding the link among the elderly's family care situation, daily activities, housing and physical well-being. Awareness and knowledge of these relationships could inform elderly-sensitive policies with the programs established by the government, such as the National Social Policy and National Welfare Policy. Kuwait already appears to be on the right track to meet the challenges of the aging population. Nonetheless, the translation of policies into actions must be closely followed to ensure that effective cooperation is achieved among the various agencies and NGOs. It is crucial to ensure that all directives trickle down and are implemented at the grassroots level. Through the mechanism of collaboration, the duplication or under-delivery of services can be avoided, and the utilization of scarce resources can be optimized. The elderly will benefit from these efforts if these guidelines are taken seriously.

This study has been able to establish that family care, social services and living arrangements are significantly correlated with psychosocial wellbeing among the elderly. The results of this study, therefore, have implications for family service agencies, social workers, nursing homes (for medical care), private social agencies, public social service agencies (governments) and other service professionals or institutions charged with meeting the needs of the elderly. Support should be provided to families and people who care for the elderly in their homes, and adequate and subsidized elder housing should be provided. Thus, senior homes in close proximity to one another can encourage a mutual helping network in which the elderly look out for and provide companionship for each other.

In conclusion, there is a need for more social workers to support the elderly, their families and the caseworkers who coordinate care for the frail and disabled elderly in Kuwaiti society. Social workers can also provide services to elderly people living in institutions. Moreover, social workers can provide protective services for and empower those who are unable to defend their own rights and meet their daily needs.

Arabic References

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Central Administration of Statistics (2009). Annual Statistical Abstract, Kuwait: 46-58.

Public Authority for Civil Information, Population and Labor Force (2010), 39: 11-16

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Al-Tahan, K., (1999). Outlook on Caring for the Elderly in Light of their Psychological Characteristics, Series of Labor and Social Studies, 1(38), Manama, Bahrain

AbaAlkhalil, R., M., (1999). Aging and Elderly Care Centers in the World (Model Healthy Social Center for the Elderly), Series of Labor and Social Studies, 1 (37), May 1999, Manama, Bahrain, p 214

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Al-Dhafiri, A., (2000). Social Policy in the State of Kuwait, Council of Scientific Publications, Kuwait University, Section Four, Care for the Elderly, p 108

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Dr. Abdulwahab Mohammad Al-Dhafiri

Department of Sociology and Social Work, Kuwait University

Research subsidized by Kuwait University-Research Administration ref. #OS01/12
Table 1. Services provided to the elderly

Descending         Phrases          Arithmetic   Standard
order                                  mean      deviation

1            I feel that my            4.53        0.708
             social life in the
             nursing home is much
             better now.

2            Communicating with        4.44        0.059
             relatives,
             acquaintances and
             friends through
             services available
             in the nursing home
             gives me a sense of
             the meaning of life.

3            The services that         4.41        0.648
             the senior home
             provides meet my
             needs (health,
             social and
             psychological) and
             make me feel at ease
             and appreciate and
             love life.

4            The ability to visit      4.39        0.849
             the public coffee
             shop in the senior
             home makes me feel
             good about my life.

5            Participation in          4.21        0.766
             outside activities
             (going to the
             cinema, theater or
             other entertainment
             venues; visiting
             monuments; attending
             meetings and
             seminars) gives me a
             true sense of life.

6            The presence of           3.88       0.9631
             social workers in
             the senior home
             makes me feel safe.

7            I think that the          3.80        0.887
             social welfare
             services provided in
             the senior home are
             necessary in my
             case.

8            My participation in       3.76        1.020
             the artistic and
             sports activities
             makes me feel well
             balanced and able to
             interact with the
             other elderly
             residents.

9            My participation in       3.53        1.076
             the social club
             activities at the
             senior home give me
             a new view on the
             meaning of life.

10           Having someone            3.41        1.302
             provide for my needs
             (health, social and
             psychological)
             always encourages me
             to think of life
             positively.
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