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Year : 2020  |  Volume : 64  |  Issue : 3  |  Page : 271-276  

Successful aging among community-dwelling palestinian older adults: Prevalence and association with sociodemographic characteristics, health, and nutritional status

1 Department of Nutrition and Food Technology, Faculty of Agriculture and Veterinary Medicine, An-Najah National University, Nablus, Palestine
2 Department of Mathematics and Physics, Faculty of Applied Sciences, Palestine Polytechnic University, Wadi Al-Harya, Hebron, Palestine
3 Department of Public Health, Faculty of Applied Medical Science Al-Azhar University, Gaza, Palestine

Date of Submission25-Aug-2019
Date of Decision11-Dec-2019
Date of Acceptance18-Jun-2020
Date of Web Publication22-Sep-2020

Correspondence Address:
Manal Badrasawi
Department of Nutrition and Food Technology, Faculty of Agriculture and Veterinary Medicine, An-Najah National University, Tolkarem
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijph.IJPH_371_19

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Background: Aging population and life expectancy are increasing globally, to cope with this trend, successful aging (SA) attracted the attention of gerontology research to determine its prevalence, risk factors, and its correlates. However, the published research about SA and older adult's health are sparse in Palestine. Objectives: This study aimed to determine the prevalence and correlates of SA, normal aging, and mild cognitive impairment (MCI) among Palestinian older adults in Hebron governorates. Methods: A cross-sectional study was conducted during March 2018–May 2018 among a total of 185 participants selected by stratified random sampling from five different areas in Hebron governance. SA was defined based on the multidimentional model; absence of chronic diseases, normal functional status with complete independency, maintains normal cognitive and psychological function and social engagement. Sociodemographic data, nutrition, and health status were also collected and analyzed. Results: The prevalence of SA among older Palestinians (22.2%), usual aging (58.9%), and the MCI (18.9%), with no significant difference in the prevalence between men and women P <0.05. The most prevalent subdomain is independent living skill (77.8%) and the lowest is the absence of chronic diseases (30.8%). SA was associated with younger older age (60–70 years), still working, and well-nourished participants. Conclusion: The results of this study revealed, successful aging is associated with younger age, still working and good nutritional status. Further research with appropriate methodology different parts of Palestine is required.

Keywords: Mild cognitive impairment, older adults, Palestine, prevalence, successful aging

How to cite this article:
Badrasawi M, Samuh M, Khallaf M, Abuqamar M. Successful aging among community-dwelling palestinian older adults: Prevalence and association with sociodemographic characteristics, health, and nutritional status. Indian J Public Health 2020;64:271-6

How to cite this URL:
Badrasawi M, Samuh M, Khallaf M, Abuqamar M. Successful aging among community-dwelling palestinian older adults: Prevalence and association with sociodemographic characteristics, health, and nutritional status. Indian J Public Health [serial online] 2020 [cited 2020 Oct 21];64:271-6. Available from:

   Introduction Top

The worldwide aging population has significantly increased in number for the past decades. The increase in life expectancy is the main reason.[1] Palestine is also witnessing increase in life expectancy, according to the Palestinian Central Bureau of Statistics, the elderly made 4.4% of the total population with 72 years of life expectancy.[1] This growing number requires proper research and planning to meet their needs and standby all challenges they face to grow up with dignity.[2]

Successful aging (SA) is not a new concept in geriatric literature; still, there is no standard definition for SA, however, there are main points that are included in any definition of SA; absence of age-related chronic diseases (such as hypertension, diabetes, and cancer), high level of physical functioning and independency, high cognitive function, and good social engagement.[3] Other researchers created a multidimensional model to define the SA that included: avoidance of major chronic diseases, physical function, and psychcognitive function.[2]

Up to our knowledge, after searching in many databases including ScienceDirect, Scopus, PubMed, and SpringerLink, there is an obvious gap in the information available about the needs of the aging population in Palestine. Aging and gerontology research is empirical and needs investigation. In this context, the present study, first of its kind in Palestine was conducted with the objectives to determine the prevalence of SA and its association with nutrition and health status among community-dwelling older adults in Hebron district.

   Materials and Methods Top

Study design, study area, and study period

The study was a descriptive cross-sectional one, conducted during March 2018–June 2018. This study was conducted at five different areas in Hebron district, West bank, Palestine. The five areas were distributed among Hebron city, villages, and camps to represent the Palestinian community.

Study population: Sample size, and sampling

Elderly individuals aged 60 years and above in the study area were considered as the study population. Age of 60 years and above was used to define the elderly as Palestine officially uses the “60 years and over” in deliberating aging trends. The inclusion criteria included elderly individuals aged 60 years and above with no known mental and terminal illness and who were agreed to sign a written consent form. Exclusion criteria included the subjects who were unable to communicate with the data collection team or had an acute illness on the days of data collection.

The sample size was calculated using a prevalence of SA as 13.8% based on a previous similar study conducted in Malaysia,[2] Z value of 1.96 at 95% confidence interval, significant level 0.05, and 80% power (the difference in the prevalence assumed to be 10%). The calculated sample size was 170, and considering 5% dropout of the required sample of 178 participants was estimated. The actual sample recruited in this study was 191 older adults and finally 185 could be analyzed.

Study subjects were selected by stratified random sampling from five different areas from Hebron districts. These five areas were randomly chosen to represent the demographic distribution of the Palestinian community: cities, villages, and camps. From each area, about 35–40 eligible participants were decided to be recruited. Finally, from each of the areas, participants were identified and recruited with the help of respective area representatives.

Study variables: Tools and techniques: Data collection

The study variables included sociodemographic characteristics, medical history, nutritional status, cognitive status, social engagement, and functional status: the activity of daily living (ADL), and instrumental ADL.

Each older adult in the study has been interviewed to collect data on sociodemographic and medical history using pretested structured questionnaires. The demographic risk factors were covered by assessing three main issues: sex, age, and marital status. The socioeconomic risk factors were assessed by income, employment, education, and family structure. The morbidity and health status were determined by dichotomized questions (yes/no) about the presence of eight chronic diseases: diabetes, hypertension, chronic lung disease, osteoporosis, musculoskeletal ailments, coronary infarction, angina, stroke, and cancer. In addition to the above mentioned chronic diseases, the participants were asked to report if they suffer from vision, hearing or eating problems i.e. loss of appetite, chewing, or swallowing problems).

All of the participants were categorized into SA, usual aging (UA), or mild cognitive impairment (MCI). SA was defined based on a multidimensional model for SA that includes absence of age-related chronic diseases (including hypertension, diabetes, stroke, heart attack, and cancer), high level of physical functioning and independency, normal cognitive and psychological function, and good social engagement.[3] UA was defined based on normal cognitive function with the presence of any of the above-mentioned comorbidities. MCI was defined based on the score of <20 on the Mini Mental Status Assessment.

Cognitive function was assessed using the validated Arabic version of the Mini-Mental State Examination.[4] The cutoff point of this tool is usually affected by the years of schooling,[5] and the current study utilized a score of 20 points as the cutoff point of MCI in the subjects.[6] The presence of depressive symptoms was assessed using the 15-item Geriatric Depression Scale (GDS-15) which is the short form of the original scale with 30 items. The current study used a validated Arabic version of GDS 15-item scale[7] to define a normal psychological function. Functional status assessments included ADL and instrumental ADL; the ADL was assessed using Katz Index of Independence in activities of daily living scale and the instrumental ADL was assessed using Lawton Instrumental Activities of Daily Living Scale. This scale is an appropriate instrument to assess independent living skills, and it is considered more complex than the ADL scale.

Social engagement was determined using the 20-item Likert Scale Questionnaire that covers the three dimensions of social engagement (personal, family, and society). For the questionnaire that has been developed by the research team, a content validity was done for the 20 items by five experts in the sociology and assessment field. After the face validity, a pilot study has been conducted to determine the reliability of the questionnaire among 40 respondents and Cronbach's alpha was 0.91. For the real study, the items were given scores and the sum of the item scores was divided into tertiles, and subjects allocated in the lowest tertile were considered to have insufficient social engagement.

Nutritional status was assessed using anthropometric measurements using the standard method which was developed by Lee and Neiman 2013.[8] Screening of malnutrition was done using the Mini Nutritional Assessment (MNA) for the elderly, which is a validated, widely used tool to screen for malnutrition among older adults in research and clinical setting.[9]

Data analysis

Statistical analysis was done using the computer IBM® Software Statistical Package for the Social Sciences version 23 (SPSS). Data were cleaned for completeness and consistency. Descriptive statistics (frequencies and percentage) were done and presented in tables to describe the main features of the collected data. Chi-square test was done to determine the association between SA and the categorical variables. P ≤ 0.05 was considered to be statistically significant.

Ethical considerations

The research and its procedures were in accordance with the ethical standards of the Helsinki Declaration of 1975 (as revised in 2000), and the study protocol was approved by the Palestine Polytechnic University Ethical Committee as a regional responsible committee on human experimentation, the reference number (\30\2018), January 2018. To respect the aged person's rights, a cover letter was attached to the questionnaire, indicating that the participation is voluntary. Privacy and confidentiality have been assured for all of the participants, also all the participants were asked to sign a consent form for agreement. Moreover, all of the assistants who were involved in the data collection signed a confidential agreement before they started the data collection.

   Results Top

Background characteristics of the study subjects

A total of 191 older adults were recruited from five different areas in Hebron district (Ras-Aljoura, Wadi-Alharya, Halhoul, Al-Thaheriya, and Al-Arroub camp). Due to missing data, only 185 participants were included in the final analysis. Among the subjects, 79 (42.7%) were men and 106 (57.3%) were women. The mean age of the participants was 71.9 (SD 7.9) years, with no significant differences between men and women. Background characteristics are presented in [Table 1]. Nearly a half of the participants were 60–70 years old and a half above 70 years, distributed between the area of living city, village, and camps without significant difference. The majority of the participants were married (65.9%), more than 47.6% of the participants had primary education, and the majority of the participants were unemployed (66.5%).
Table 1: Background characteristics of the study subjects according to the gender (n=185)

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Prevalence of chronic illnesses and nutritional status

The prevalence of chronic diseases and participant's nutritional status according to gender is presented in [Table 2]. The most common comorbidities were hypertension (51.9%), followed by osteoporosis (49.5%). The women showed a significant higher prevalence of having osteoporosis, while the other chronic diseases showed no statistically significant difference in the prevalence between men and women. In regard to the nutritional status, according to the WHO BMI criteria, 51.4% of the participants were obese and 33% were overweight. The women recorded a significant higher prevalence of being obese as compared to men, while the men have a significant higher prevalence of being overweight (P < 0.01). According to the MNA, 57.8% of the participants were well nourished, 36.2% were at risk of malnutrition, and 5.9% were malnourished.
Table 2: Chronic illnesses and nutritional status of the study participants according to the gender

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Prevalence of successful aging, usual aging, and mild cognitive impairment

[Table 3] shows that the prevalence of SA was 22.2%, UA: 58.9%, and the MCI: 18.9%. There are differences in the prevalence between men and women, but the differences were not significant (P = 0.059). In terms of SA subdomains, normal cognitive function was the most predominant subdomains, followed by independency in living skills, while the absence of chronic diseases reported the lowest subdomains.
Table 3: Prevalence of successful ageing, normal ageing, and mild cognitive impairment and domains of successful aging according to the gender

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As shown in [Table 4], SA was associated with being <70 years old, working either full time or part time, and monthly income higher than 1500 NIS. Regarding nutrition status, MCI was associated with being malnourished or at risk of malnutrition, while SA was associated with being well nourished.
Table 4: The association between successful aging, normal aging, and mild cognitive impairment with the sociodemographic variables

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   Discussion Top

This study successfully determined the prevalence of SA, normal aging, and MCI among a representative sample of the Palestinian community. Up to our knowledge, this study is the first study in Palestine which reported the prevalence of SA among community-dwelling older adults.

The literature reported variation of the prevalence of SA, UA, and MCI among older adults in different countries due to various factors including age, gender, and educational level. Furthermore, the tools used to define SA, its domains, cutoff points, and the method of participant selections all influence the prevalence rates. The findings of this study reported that 22.2% of the participants were categorized as SA, 58.9% were in the UA category, while MCI was reported among 18.9% of the participants. Women have a higher but not significant prevalence of being MCI, while men have a higher but not significant prevalence of being in SA group. The SA was associated with younger age <70 years, working, and being well nourished.

The prevalence of SA in this study was much less than the prevalence reported by Meng and Arcy 2014 who reported 42% prevalence of SA for participants 60 years old and above in community-based study conducted in Canada. They also reported increasing trend of the prevalence with age; it was 35.5% for participants aged 65 and above, with no gender disparities. They also reported that being married, exercisers, perceived better health, and satisfied with life were associated with SA.[10] In the HUNT study-Nord-Trøndelag Health Study, the researchers conducted cross-sectional analysis to determine the prevalence of SA among a population aged 70–89 years, the prevalence of SA was 14.5% (using three criteria definition of SA: absence of disease and disability, high cognitive performance, and active engagement in life) only. SA was associated with younger age, female gender, higher education, regular exercise, and nonsmoking.[11]

In another study, conducted among Malaysian older adults, the prevalence of SA was 13.8%, which was associated with younger age, higher educational level, higher economic status, and Chinese ethnicity.[2]

In a study conducted among Taiwanese older adults age 65 years and above, the prevalence of SA was 26.5%, which was significantly associated with a higher level of physical fitness using comprehensive geriatric assessment.[12] In a comparative study between China and South Korea, the prevalence of SA was 18.6% and 25.2% in China and Korea, respectively, and was associated with gender, good financial condition, lifestyle, and economic status.[13] The prevalence of SA was different according to the definition used even in the same study. Nosraty et al. conducted a study to determine the prevalence of SA among a population aged 90 years and above, the prevalence of SA ranged from 1.6% to 18.3% using different definitions.[14] As the main point, the differences in the prevalence of SA across countries and its related risk factors make it difficult to have stated number of acceptable or not acceptable prevalence due to the differences in the SA definition, participants' characteristics, and differences in the lifestyle between different countries.

The current study used the multidimensional model to define SA: the absence of chronic diseases and dependency, high cognitive function, normal psychological status, and social engagement. Normal cognitive function was the most predominant subdomains followed by complete independency, while the absence of chronic diseases reported the lowest subdomains. These findings are consistent with[9] in terms of the absence of chronic diseases as they also reported the absence of chronic diseases as the lowest, but the results are not consistent in the most predominant domains; in the current study, it was the normal cognitive function, while in some studies,[10] it was the active social engagement. In Malaysia, Hamid et al., in 2012, reported that normal physical functioning is the highest prevalent domain (75%) of SA, while the normal psychocognitive function was only reported in 22.6% of the participants.[2]

The differences in the SA domains' prevalence are most probably due to the differences in the mean age and level of education between the studies, as it is well known that cognitive function is affected by age and educational level.[15] This study reported significant association between being well nourished and meeting the criteria of SA, which is similar to findings on previous studies,[16] which reported that SA is associated with a higher score of MNA (indicate better nutritional status for older adults),[17] also reported a significant association between good nutritional status using MNA but not the body mass index with SA.[18] Some studies confirmed the relationship between SA and good nutritional status. These findings are expected as it is well-documented that there is a significant relationship between malnutrition with cognitive impairment,[19],[20],[21] level of dependency,[22] quality of life,[23] and pscychological function[24],[25] among older adults, which are the domains of SA definition.

   Conclusion Top

This study has revealed that the prevalence of SA among Palestinian older adults is 22.2% using the following domains: absence of chronic diseases, good social engagement, and good physical and mental status. The most prevalent domain of the SA is normal cognitive function, followed by independency, social engagement, then normal psychology, while the least predominant was the absence of chronic diseases. The second major finding is the prevalence of MCI (18.9%), women recorded lower score of cognitive function as compared to men. The factors that are correlated with SA were being younger than 70 years of age, still working, and well-nourished participants. This study provides evidence that the low prevalence of SA is proportional to the increased prevalence of chronic diseases.


The authors would like to acknowledge the students who helped the researchers in the data collection and also would like to express their gratitude to the Palestinian older adults who agreed to participate in this study. They also express their thanks to all co-researchers and fieldworkers involved in this study.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

   References Top

MOH. Palestinian Health Annual Report. MOH; 2017.  Back to cited text no. 1
Hamid TA, Momtaz YA, Ibrahim R. Predictors and prevalence of successful aging among older Malaysians. Gerontology 2012;58:366-70.  Back to cited text no. 2
Pruchno RA, Wilson-Genderson M, Cartwright F. A two-factor model of successful aging. J Gerontol Series B 2010;65:671-9.  Back to cited text no. 3
Wrobel NH, Farrag MF. Preliminary validation of an arabic version of the MMSE in the elderly. Clin Gerontol 2007;31:75-93.  Back to cited text no. 4
Murden RA, McRae TD, Kaner S, Bucknam ME. Mini-mental state exam scores vary with education in blacks and whites. J Am Geriatr Soc 1991;39:149-55.  Back to cited text no. 5
Ibrahim NM, Shohaimi S, Chong HT, Rahman AH, Razali R, Esther E, et al. Validation study of the mini-mental state examination in a malay-speaking elderly population in Malaysia. Dement Geriatr Cogn Disord 2009;27:247-53.  Back to cited text no. 6
Chaaya M, Sibai AM, Roueiheb ZE, Chemaitelly H, Chahine LM, Al-Amin H, et al. Validation of the arabic version of the short geriatric depression scale (GDS-15). Int Psychogeriatr 2008;20:571-81.  Back to cited text no. 7
Lee R, Nieman D. Nutritional assessment. McGraw-Hill Education; 2013.  Back to cited text no. 8
Kaiser M, Bauer J, Ramsch C, Uter W, Guigoz Y, Cederholm T, et al. Validation of the mini nutritional assessment short-form (MNA®-SF): A practical tool for identification of nutritional status. J Nutrit Health Aging 2009;13:782.  Back to cited text no. 9
Meng X, D'arcy C. Successful aging in Canada: Prevalence and predictors from a population-based sample of older adults. Gerontology 2014;60:65-72.  Back to cited text no. 10
Bosnes I, Almkvist O, Bosnes O, Stordal E, Romild U, Nordahl HM. Prevalence and correlates of successful aging in a population-based sample of older adults: The HUNT study. Int Psychogeriatr 2017;29:431-40.  Back to cited text no. 11
Lin PS, Hsieh CC, Cheng HS, Tseng TJ, Su SC. Association between physical fitness and successful aging in taiwanese older adults. PLoS One 2016;11:e0150389.  Back to cited text no. 12
Feng Q, Son J, Zeng Y. Prevalence and correlates of successful ageing: A comparative study between China and South Korea. Eur J Ageing 2015;12:83-94.  Back to cited text no. 13
Nosraty L, Sarkeala T, Hervonen A, Jylhä M. Is there successful aging for nonagenarians? The vitality 90 + study. J Aging Res 2012;2012:868797.  Back to cited text no. 14
Lopez OL, Jagust WJ, Dulberg C, Becker JT, DeKosky ST, Fitzpatrick A, et al. Risk factors for mild cognitive impairment in the cardiovascular health study cognition study: Part 2. Arch Neurol 2003;60:1394-9.  Back to cited text no. 15
Formiga F, Ferrer A, Megido MJ, Chivite D, Badia T, Pujol R. Low co-morbidity, low levels of malnutrition, and low risk of falls in a community-dwelling sample of 85-year-olds are associated with successful aging: The Octabaix study. Rejuvenation Res 2011;14:309-14.  Back to cited text no. 16
Scheirlinckx K, Nicolas A, Nourashemi F, Vellas B, Albarède J, Garry P. The MNA score in successfully aging persons. Mini NutritAssessm 1998;75:12.  Back to cited text no. 17
Nelson RC, Franzi LR. Nutrition and aging. Med Clin North Am 1989;73:1531-50.  Back to cited text no. 18
Donini LM, Scardella P, Piombo L, Neri B, Asprino R, Proietti A, et al. Malnutrition in elderly: Social and economic determinants. J Nutrit Health Aging 2013;17:9-15.  Back to cited text no. 19
González-Gross M, Marcos A, Pietrzik K. Nutrition and cognitive impairment in the elderly. Br J Nutrit 2001;86:313-21.  Back to cited text no. 20
Saka B, Kaya O, Ozturk GB, Erten N, Karan MA. Malnutrition in the elderly and its relationship with other geriatric syndromes. Clin Nutr 2010;29:745-8.  Back to cited text no. 21
Goisser S, Schrader E, Singler K, Bertsch T, Gefeller O, Biber R, et al. Malnutrition according to mini nutritional assessment is associated with severe functional impairment in geriatric patients before and up to 6 months after hip fracture. J Am Med Dir Assoc 2015;16:661-7.  Back to cited text no. 22
Amarantos E, Martinez A, Dwyer J. Nutrition and quality of life in older adults. J Gerontol Series A 2001;56 Suppl 2:54-64.  Back to cited text no. 23
Cabrera MA, Mesas AE, Garcia AR, de Andrade SM. Malnutrition and depression among community-dwelling elderly people. J Am Med Directors Assoc 2007;8:582-4.  Back to cited text no. 24
Mokhber N, Majdi M, Ali-Abadi M, Shakeri M, Kimiagar M, Salek R, et al. Association between malnutrition and depression in elderly people in Razavi Khorasan: A population based-study in Iran. Iran J Public Health 2011;40:67-74.  Back to cited text no. 25


  [Table 1], [Table 2], [Table 3], [Table 4]


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