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Investigating Holistic Wellness Dimensions During Older Adulthood: A Factor Analytic Study

Thomas Foster1 • Caitlyn Galjour1 • Stephanie Spengel1

Published online: 29 July 2015

� Springer Science+Business Media New York 2015

Abstract The purpose of this study was to examine what

dimensions of holistic wellness emerged in a sample of

older adults (N = 229) using the Perceived Wellness Sur-

vey, and if these dimensions resembled developmental

theories of aging. Results from an exploratory principal-

axis factor analysis revealed a four-factor solution of

holistic wellness: Existential Success, Existential Despair,

Physical Wellness, and Future Physical Wellness. Discus-

sion pertaining to how these factor solutions corroborate

with the developmental literature is provided, as well as

suggestions for further research and humanistic counseling

strategies.

Keywords Holistic wellness � Older adults � Perceived Wellness Survey � Exploratory principal-axis factor analysis

Introduction

Older adulthood has been defined as beginning at age 60

and includes a series of physical, psychological, and social

changes that can be both positive and negative (Cavanaugh

and Whitbourne 1999; Moody and Sasser 2011). Many

older adults can navigate through these changes effectively

with the help of family, friends, and other support systems;

however, an increasing number of individuals struggle to

cope with the changes aging brings. One explanation for

this is the growing population of aging individuals. Cur-

rently, the number of older adults in the USA is at a record

high (US Census Bureau 2011) and continues to increase as

the baby boom generation ages (Maples and Abney 2006).

Researchers predicted by 2030 that 72.1 million Americans

will be aged 65 years or older (Administration on Aging

2014), and by 2020 longevity rates will reach 82 years for

women and 77 years for men (US Census Bureau 2011).

Mental and emotional disorders are not a normal part of

the aging process (National Institute of Health 2013), as the

prevalence rates for older adults with mental illness are

lower than younger age groups. Researchers with the

National Institute of Mental Health (NIMH 2012) reported

the prevalence rate for individuals aged 50 and older

diagnosed with a mental illness was 15.8 %, a lower rate

compared to individuals aged 18–25 (19.6 %) and 26–49

(21.2 %). When divided into anxiety and depressive dis-

orders, the prevalence rates for individuals aged 60 and

older with generalized anxiety disorder (3.6 %) and major

depressive disorder (5.5 %) are considerably lower than

younger age groups (NIMH 2012). However, as the pop-

ulation of older adults is projected to increase in the

coming years, these prevalence rates of mental illness will

likely increase. This will change the demographic makeup

of referrals mental health professionals will receive, as

more individuals will seek mental health services to man-

age and cope with mental illness during older adulthood.

To accommodate this need, mental health professionals

must be prepared to work with older adults who present

with mental illness (Foster and Kreider 2009) using a

combination of medical model and holistic wellness

& Thomas Foster [email protected]

Caitlyn Galjour

[email protected]

Stephanie Spengel

[email protected]

1 Department of Counseling, Loyola University New Orleans,

6363 St. Charles Ave., Box 66, New Orleans, LA 70118,

USA

123

J Adult Dev (2015) 22:239–247

DOI 10.1007/s10804-015-9215-4

approaches within their practice (Myers and Sweeney

2005, 2008). However, much of the literature mainly

describes counseling older adults from a medical model

perspective (Blando 2011; Cavanaugh and Whitbourne

1999; Knight 2004). Researchers must explore and sub-

stantiate other approaches to expand the selection of

interventions mental health professionals can use with this

population. We recommend using a holistic wellness

approach in conjunction with established medical model

strategies that will address client symptomology from a

strength-based perspective and promote a balanced

approach to counseling (Myers and Sweeney 2008). In the

following section, we review the wellness literature as it

relates to older adulthood.

Holistic Wellness and Aging

A number of holistic wellness models exist within the lit-

erature and across disciplines (Adams et al. 1997; Archer

et al. 1987; Ardell 1988; Dunn 1961; Myers and Sweeney

2008). Myers, Sweeney, and Witmer (2000) defined

holistic wellness as a lifestyle-oriented pursuit of optimal

health that integrates the body, mind, and spirit. Further-

more, mental health professions such as counselor educa-

tion and counseling psychology adopted holistic wellness

as a philosophical cornerstone and integrated it into their

professional identity (Myers 1992; Roger and Stone 2014),

student training procedures (Foster 2010; Witmer and

Granello 2005), and clinical practice (Myers and Sweeney

2008). By integrating a holistic wellness perspective into

the clinical process, humanistic counselors and psycholo-

gists can work with clients from a unique perspective that

emphasizes optimal human potential, personal responsi-

bility, and a strength-based approach (Myers and Sweeney

2005, 2008) that will promote client empowerment and

independence. But the concept of holistic wellness, like

many other human attributes, changes as individuals move

across the lifespan. Specifically, individuals’ perception

and definition of the dimensions that make up holistic

wellness evolves over time (Foster and Levitov 2012). For

example, an adolescent and an older adult might perceive

the dimensions of holistic wellness differently based upon

their developmentally specific challenges. Using Erikson’s

(1980) psychosocial theory of development, individuals at

different points on the lifespan would perceive these

wellness dimensions differently as they work through the

challenges of the eight psychosocial stages of development.

Consider the social dimension of wellness, defined as

‘‘Perception of having support available from family or

friends in times of need and the perception of being a

valued support provider’’ (Adams et al. 2000, p. 167). An

adolescent engaged in the Identity versus Role Confusion

stage might possess the social need to have many friends

that will help shape their identity, while family influence

decreases. An older adult’s social need looks differently in

the Integrity versus Despair stage. Researchers found

family involvement to be the most important social need

for older adults, while having supportive friends and

neighbors prevents loneliness and postpones institutional-

ization (Bernardo Gonçalves Marques et al. 2014). Thus, as

the social needs of individuals change as they reach dif-

ferent life stages, their view of social wellness will also

change.

To date, a paucity of research exists that examines how

holistic wellness models account for developmental chan-

ges across the lifespan. Models such as the indivisible self

model of wellness (IS-Wel; Myers and Sweeney 2008) and

the perceived wellness model (PWM; Adams et al. 1997)

possess distinct wellness dimensions, but the models do not

depict how the structure of these dimensions might evolve

at different points on the lifespan due to specific develop-

mental changes. For instance, the IS-Wel Model possesses

the five second-order factors of Creative, Coping, Essen-

tial, Social, and Physical; within each, second-order factor

consists of multiple third-order factors [see Myers and

Sweeney 2008 for a description of these factors].

Researchers established the validity of these second- and

third-order factors using a large sample of participants aged

from 10 years old to late adulthood (Hattie et al. 2004);

however, these factors were not tested using participants

from specific age groups to determine whether the factors

would emerge differently between these groups.

The same point can be made for the PWM. Adams et al.

(1997) described how the PWM consists of the Physical,

Psychological, Emotional, Intellectual, Social, and Spiritual

wellness dimensions. Most attempts to substantiate these

theoretically based dimensions were conducted using

younger samples (Adams et al. 1997, 1998, 2000). In addi-

tion, Adams et al. (1997) did not describe how each wellness

dimension might evolve as individuals age. Foster and

Levitov (2012) conducted a factor analytic study using the

Perceived Wellness Survey (PWS; based on the PWM) to

determine the validity of these six wellness dimensions using

a sample of midlife and older adults. These authors found a

four-factor solution (i.e., Optimism, Existential Despair,

Physical, and Family/Friends) that depicted how these par-

ticipants perceived holistic wellness, with three of the four

factors resembling the last two stages of Erikson’s psy-

chosocial theory of development. Also, only the factor

labeledPhysical resembled Adams et al. (1997) dimension of

Physical Wellness. Foster and Levitov noted one major

limitation within their study, namely that they combined

midlife and older adults for their sample. The question

emerged in terms of how there might be differences in

wellness perceptions between these groups. Our goals for

this current study are to determine what wellness dimensions

240 T. Foster et al.

123

exist specifically for older adults, if these dimensions relate

to the developmental literature of older adulthood, and if

they resemble the factor solutions found by Foster and

Levitov. Our research question is as follows:

• What wellness dimensions emerge within the Perceived Wellness Survey when applied specifically to older

adults?

Method

Participants

We recruited participants (N = 229) from four states

located in the Midwest and southern regions of the USA

using a convenience sample. The mean age for participants

was 71 years (SD = 10.11), ranging from 60 to 97 years;

59 % of participants (n = 111) were female and 51 %

were male (n = 117). One participant did not report their

sex. When asked about with which racial group participants

identified, 93 % reported Caucasian (n = 212), 4 %

reported African–American (n = 9), 1 % reported Asian–

American (n = 3), 1 % reported American–Indian

(n = 2), and 1 % identified as multiracial (n = 2). One

participant did not report their race.

Seventy-one percent of participants (n = 164) reported

being married, while 18 % identified themselves as a

widow (n = 32) or widower (n = 10). Sixteen participants

(7 %) were divorced, one identified as separated, four were

single, and two were single but in a committed relationship.

Regarding education, participants indicated a varied range

of education levels: 28 % reported their highest degree was

some college (n = 64), 21 % reported a high school

diploma (n = 50), 20 % reported a bachelor’s degree

(n = 45), 17 % reported a master’s degree (n = 40), 8 %

possessed a doctorate (n = 19), 3 % had some graduate

school (n = 8), two reported other, and one participant did

not list their education; 62 % of the participants were still

employed (n = 141), while 35 % identified as retired

(n = 81), unemployed (n = 2), or volunteering (n = 3).

Two participants did not list their employment status.

Instrumentation

The Perceived Wellness Survey (PWS) contains 36 items

that produce an overall wellness score and six subscale

scores pertaining to Physical, Psychological, Emotional,

Intellectual, Social, and Spiritual wellness (Adams et al.

1997). Each of these six subscales contains six items sys-

tematically ordered within the measure. The Likert-type

items range from 1 (Very Strongly Disagree) to 6 (Very

Strongly Agree). A higher overall score and higher

subscales scores suggest higher levels of wellness. The

PWS takes 15 min to complete (Adams et al. 1997; Bezner

et al. 1999).

Researchers identified varied results when determining

the psychometric validity of the PWS. Adams et al. (1998)

found sufficient temporal stability, construct validity, and

discriminant validity with the PWS. In addition, Adams

et al. (1997) reported adequate internal consistency in the

overall wellness score of the PWS (a = .91) and the six subscales [Physical (a = .81), Psychological (a = .71), Social (a = .64), Intellectual (a = .64), Spiritual (a = .77), Emotional (a = .74)]. However, Adams et al. (1997) conducted a principal component analysis using the

PWS to investigate its factor structure and found all but

two of the items loaded on the first factor at .30 or higher,

suggesting a unidimensional measurement of wellness and

recommending a reassessment of the existing subscales.

Harari et al. (2005) examined the PWS for its psycho-

metric properties pertaining to overall wellness and the six

subscales using a sample of young adults as participants.

Results indicated the PWS had high internal consistency

(a = .91) and adequate criterion validity when compared to other mental health measures, such as the Beck

Depression Inventory-II, Beck Anxiety Inventory, and

Hopkins Symptom Checklist-21. However, the authors

(2005) examined the factor structure of the PWS using

confirmatory and exploratory factor analysis. Results of the

confirmatory factor analysis indicated a poor model fit

[Chi-square (579) = 1459.77, p \ .001; Tucker–Lewis Index = .75; adjusted goodness-of-fit index = .76] for

Adams et al. (1997) six hypothesized wellness dimensions;

findings of the exploratory principal-axis factor analysis

were similar to Adams et al. (1997), suggesting a one-

factor model to fit the data.

Procedure

We contacted representatives (i.e., directors, clergy people,

and human resources) from retirement communities,

churches, and businesses from four states that spanned

from the Midwest to the southern region of the USA to

seek permission to recruit participants who qualified for

our study. The only inclusionary criterion was that indi-

viduals must have been aged a minimum of 60 years to

participate. Due to this specific age requirement, we

worked with representatives to determine how many survey

packets they needed for their respective site. The repre-

sentatives from each site invited their residents, members,

or employees to participate and distributed the survey

packets. Individuals who chose to participate were given

3 weeks to complete the survey packet, seal it, and return it

to their representative. At the end of the 3-week period, we

met with each representative and collected the surveys. We

Investigating Holistic Wellness Dimensions During Older Adulthood: A Factor Analytic Study 241

123

had no direct contact with the participants, and participants

gave no identifying information for this study. From the

500 survey packets distributed to representatives, we

received 248 back and used 229 (three were blank and 16

were only partially completed) that gave us a 46 %

response rate. Of these 229 surveys, the majority of

responses came from churches (60 %; n = 138), while

25 % (n = 58) came from retirement communities and

15 % (n = 33) were from businesses. The surveys included

an informed consent letter, the PWS, and a demographic

form. We randomized the placement of the PWS and

demographic form to minimize any influence one may have

upon the other (Fowler 2013). IRB approval was granted

for this study.

Results

We analyzed the data using SPSS version 21. The research

question examined what wellness dimensions would

emerge within the PWS when applied to a sample of older

adults. We conducted an exploratory principal-axis factor

analysis using a promax rotation to determine what factor

solutions emerged within the data. We used principal-axis

factor analysis to test for latent factor structures that exist

within the observed variables (Hair et al. 2010); we used a

promax, or oblique rotation, because it theoretically

assumes variables are correlated with some extent

(Tabachnick and Fidell 2013). The Kaiser–Meyer–Olkin

(KMO) measure of sampling acceptability was high (.87),

and Bartlett’s test of sphericity was significant (test

value = 2922.32, p \ .001), suggesting the data could be used for exploratory factor analysis. We established the

number of factor solutions using a number of procedures.

First, we employed parallel analysis procedures as rec-

ommended by Preacher and MacCallum (2002); specifi-

cally, we set the number of parallel data sets at 5000 at the

95th percentile and used permutations of the raw data to be

used for the analysis. Second, Turner (1998) noted that

parallel analysis should be used with other techniques

when establishing the number of factor solutions, such as

the total number of items found within each factor, scree

plot analysis, internal consistency, and the factor solutions’

theoretical interpretability. Based on our sample size, the

significance level and a power level set at .05 and .80, and

the minimum factor pattern coefficients were set at .35

(Hair et al. 2010).

Parallel analysis results provided a seven-factor solu-

tion; however, the seventh factor possessed only one item

and had no theoretical interpretability. Using the promax

rotation, we rotated the six, five, four, and three factor

solutions and found the four-factor solution to account for

the most variance (43 %), had the clearest theoretical

interpretability, had the highest internal consistency for

each factor, and was substantiated by the scree plot. We

identified names and themes for each factor. Two items

that loaded on the four-factor solution were multivocal

above the .35 minimum factor coefficient (see Table 1 for

the pattern matrix). Four of the items were not included in

the four-factor structure because they did not reach the

minimal coefficient requirement of .35 (1. ‘‘I am always

optimistic about my future.’’; 19. ‘‘In the past, I have

expected the best.’’; 32. ‘‘In the past, I have felt sure of

myself among strangers.’’; 33. ‘‘My friends will be there

for me when I need help.’’), reducing the PWS to a 32-item

instrument.

We provided a name and description for each of the four

identified factors. Factor one (N = 13 items) was named

Existential Success because it represents a positive outlook

on life. These items characterized themes focused on

possessing purpose and mission in life from a past, present,

and future perspective (‘‘It seems that my life has always

had purpose.’’; ‘‘I believe there is a real purpose for my

life.’’; ‘‘I feel a sense of mission about my future.’’). Other

themes found within Existential Success speak to intel-

lectual ability (‘‘I will always seek out activities that

challenge me to think and reason.’’; ‘‘In the past, I have

generally found intellectual challenges to be vital to my

overall well-being.’’; ‘‘Generally, I feel pleased with the

amount of intellectual stimulation I receive in my daily

life.’’; ‘‘The amount of information I process in a typical

day is just about right for me’’), interpersonal importance

(‘‘Members of my family come to me for support.’’; ‘‘My

friends know they can always confide in me and ask me for

advice.’’; ‘‘My family has been available to support me in

the past.’’), and confidence (‘‘In general, I feel confident

about my abilities.’’; ‘‘I will always be secure with who I

am.’’; ‘‘I always look on the bright side of things.’’). No

items that loaded on Existential Success are inverse items

and do not need reverse scored.

Factor two (N = 13 items) was named Existential

Despair because it embodies a negative outlook on life,

and many of the items that loaded on this factor were

opposite to the items of Existential Success. These items

centered on themes related to meaninglessness (‘‘I have felt

in the past that my life was meaningless.’’; ‘‘Sometimes I

don’t understand what life is all about.’’), a bleak past and

future attitude (‘‘I rarely count on good things happening to

me’’; ‘‘In the past, I hardly ever expect things to go my

way’’; ‘‘Things will not work out the way I want them to in

the future.’’; ‘‘Life does not hold much future promise for

me.’’), intellectual ineptitude (‘‘I avoid activities which

require me to concentrate’’; ‘‘My life has often seemed

void of positive mental stimulation.’’), feelings of worth-

lessness (‘‘I sometimes think I am a worthless individ-

ual.’’), interpersonal uncertainty (‘‘Sometimes I wonder if

242 T. Foster et al.

123

my family will really be there for me when I am in need.’’;

‘‘There have been times when I felt interior to most of the

people I knew.’’; ‘‘In the past, I have not always had friends

with whom I could share my joys and sorrows.’’), and a

lack of confidence (‘‘I am uncertain about my ability to do

things well in the future.’’). All of the items found within

Existential Despair were initially inverse items that

required reverse scoring in order to calculate the originally

proposed wellness subscales of Adams et al. (1997).

Because Existential Despair represents a negative view of

wellness, we recommend no longer reverse scoring these

items when calculating this factor; thus, lower scores

would represent lower levels of despair and higher scores

suggest higher levels of despair.

The third factor (N = 4 items) was named Physical

Wellness because it assesses the perception of physical

health. The items create themes related to the evaluation of

physical health from a past and present perspective as an

individual compares his or her health to the health of

others. The items that loaded on this factor are the fol-

lowing: ‘‘My physical health has restricted me in the

past.’’; ‘‘My body seems to resist physical illness very

Table 1 Factor loadings from the pattern matrix using a promax rotation

Item # Percentage of explained variance

1 2 3 4

25.86 % 7.70 % 6.19 % 4.00 %

6. I will always seek out activities that challenge me to think and reason .75

5. I believe there is a real purpose for my life .74

8. In general, I feel confident about my abilities .68

26. I will always be secure with who I am .65

23. I feel a sense of mission about my future .65

3. Members of my family come to me for support .63

13. I always look on the bright side of things .59

15. My friends know they can always confide in me and ask for advice .54

18. Generally, I feel pleased with the amount of intellectual stimulation I receive in my daily life .53

24. The amount of information that I process in a typical day is just about right for me .52

21. My family has been available to support me in the past .48

30. In the past, I have generally found intellectual challenges to be vital to my overall well-being .48

35. It seems that my life has always had purpose .43

25. In the past, I hardly ever expect things to go my way .80

14. I sometimes think I am a worthless individual .74

7. I rarely count on good things happening to me .69

36. My life has often seemed void of positive mental stimulation .64

29. I have felt in the past that my life was meaningless .61

31. Things will not work out the way I want them to in the future .51

12. I avoid activities which require me to concentrate .51

9. Sometimes I wonder if my family will really be there for me when I am in need .50

11. Life does not hold much future promise for me .49

17. Sometimes I don’t understand what life is all about .47

2. There have been times when I felt interior to most of the people I knew .44

20. I am uncertain about my ability to do things well in the future .41

27. In the past, I have not always had friends with whom I could share my joys and sorrows .40

16. My physical health is excellent .80 .37

22. Compared to people I know, my past physical health has been excellent .73

4. My physical health has restricted me in the past .63

10. My body seems to resist physical illness very well .59

28. I expect to always be physically healthy .45 .65

34. I expect my physical health to get worse .60

Factor coefficients not bolded are multivocal

Investigating Holistic Wellness Dimensions During Older Adulthood: A Factor Analytic Study 243

123

well.’’; ‘‘My physical health is excellent.’’; ‘‘Compared to

people I know, my past physical health has been excel-

lent.’’ The first item listed is an inverse item and must be

reversed scored when calculating Physical Wellness.

The fourth factor (N = 2 items) was termed Future

Physical Wellness because it depicts an individual’s

expectations about their future physical health. The items

that loaded on this factor are as follows: ‘‘I expect to

always be physically healthy.’’; ‘‘I expect my physical

health to get worse.’’ The second item listed is an inverse

item and needs to be reversed scored when calculating

Future Physical Wellness.

We calculated the overall score by first reverse scoring

the remaining 15 inverse items found in the revised 32-item

PWS (items 2, 4, 7, 9, 11, 12, 14, 17, 20, 25, 27, 29, 31, 34,

and 36) and then summing all 32 items together; a higher

score suggests a higher overall level of wellness. We cal-

culated each subscale by adding their respective items

together. Higher scores on Existential Success, Physical

Wellness, and Future Physical Wellness suggest higher

wellness, while a lower score on Existential Despair sug-

gests higher wellness. Descriptive statistics, bivariate

analyses, and internal consistency results are found in

Table 2. Bivariate analyses were calculated using Pearson

product-moment correlation; results ranged from insignif-

icant to moderate correlations (Munro 2005), suggesting

that they are measuring different constructs.

Discussion

The goals of this study were to examine what factor

solutions emerged for older adults in terms of how they

perceived holistic wellness, determine if these factor

solutions resembled any developmental theories of older

adulthood, and compare the factors to the four-factor

solution reported by Foster and Levitov (2012). Based

upon our results, we suggest the PWS offers a four-factor

solution to describe how older adults perceive holistic

wellness. We labeled these factors Existential Success,

Existential Despair, Physical Wellness, and Future Physical

Wellness based upon the themes that emerged within the

loadings. These results suggest that older adults perceive

holistic wellness differently than the originally proposed

six-dimensional model of the PWM (Adams et al. 1997). In

addition, these factor solutions resembled the develop-

mental theories of older adulthood related to Erik Erikson’s

Ego Integrity versus Despair and the concept of successful

aging. Next, we describe how these factors resemble these

developmental theories and compare the factors Existential

Success, Existential Despair, Physical Wellness, and

Future Physical Wellness to the four-factor solution of

Foster and Levitov.

Ego Integrity Versus Despair

The factor solutions Existential Success and Existential

Despair resemble Erik Erikson’s eighth stage of psy-

chosocial development known as Ego Integrity versus

Despair. During this stage, individuals examine their lives

and attempt to achieve resolution that brings fulfillment,

reconciliation, meaning, and wisdom, while failure can

result in despair (Erikson et al. 1986). Themes that

emerged from Existential Success embodied an overall

sense of achievement that included a positive outlook of

life and the future, purpose and meaning, intellectual

abilities, interpersonal importance, and overall confidence.

Individuals who score high on the Existential Success

subscale suggest they would have succeeded at these

themes and have achieved Ego Integrity.

In addition, we found similarities between Existential

Success and Foster and Levitov’s (2012) factor labeled

Optimism. Thirteen items loaded on Existential Success

and 12 items loaded on Optimism, with ten items over-

lapping (see Table 3). We named our factor Existential

Success rather than Optimism because the latter factor

possessed additional items related to expectations and

optimism (‘‘In the past, I have expected the best.’’; ‘‘I am

always optimistic about my future.’’) that did not load on

Existential Success. Also, Existential Success had two

more items related to family support (‘‘Members of my

family come to me for support.’’; ‘‘My family has been

Table 2 Descriptive statistics, internal consistency, and bivariate analyses

M SD Range a Existential Success

Existential

Despair

Physical

Wellness

FPW

Total wellness 116.09 11.19 66–157 .90 .82* -.84* .44* .01

Existential Success 62.75 9.24 20–77 .88 -.51* .37* .05

Existential Despair 29.84 10.85 13–68 .85 -.17* -.07

Physical Wellness 16.38 2.73 7–24 .80 .23*

Future Physical Wellness 7.13 1.42 2–11 .70

* p \ .01. a = Cronbach’s alpha. FPW = Future Physical Wellness

244 T. Foster et al.

123

available to support me in the past.’’) that provided a

stronger theme of social connectedness.

The factor solution Existential Despair represents the

opposite themes of Existential Success and thus identify

with the unsuccessful resolution of Erikson’s Ego Integrity

versus Despair stage. Themes that emerged from Existen-

tial Despair embodied an overall sense of failure that

included a negative outlook of life and the future, intel-

lectual incompetence, worthlessness, meaninglessness,

lack of confidence, and social isolation. Theoretically,

individuals who score high on Existential Despair might

not have achieved Ego Integrity. We found that 11 of the

13 items that loaded on our factor solution overlapped with

Foster and Levitov’s factor solution Existential Despair

(see Table 3), with the two additional items pertaining to

social isolation. Thus, the items that loaded on Foster and

Levitov’s factor Family/Friends now load on our factors of

Existential Success and Existential Despair.

Successful Aging

The themes of the four factors also substantiated the con-

cept of successful aging. Successful aging is a multidi-

mensional construct that integrates and promotes the

development of physical and psychological health, social

connectedness, intellectual ability, spiritual growth, and a

sense of meaning and purpose as people age (Troutman

et al. 2011). In addition, successful aging is construed as an

individual’s ability to adapt to the cumulative functional

changes aging brings related to physical and cognitive

ability, while maintaining meaning and purpose (Flood

2002). We suggest a theoretical overlap exists between the

four factors and the dimensions of successful aging. For

example, the themes of Existential Success overlap with

the dimensions of successful aging related to intellectual

ability, psychological health, social connectedness, pur-

pose, and meaning; theoretically, individuals who score

higher on these factors suggest they are aging successfully.

The themes of Existential Despair (i.e., intellectual inep-

titude, worthlessness, meaninglessness, bleak future atti-

tude, lack of confidence, social isolation) run contrary to

Existential Success and also speak to the successful aging

dimensions of intellectual ability, psychological health,

social connectedness, purpose, and meaning. The results of

our bivariate analyses suggest individuals who score high

on Existential Despair might score low on Existential

Success, which theoretically suggests a lower level of

successful aging.

The factor solution Physical Wellness evaluates the

perception of physical health from a past and present per-

spective in comparison with the health status of others,

while the factor solution Future Physical Wellness

Table 3 Item comparison

Existential

Success a

Optimism b

Existential

Despair a

Existential

Despair b

Physical

Wellness a

Physical b

Future Physical

Wellness a

Physical b

Items Items Items Items Items Items Items Items

1 2 2 4 4 4

3 7 7 10 10 10

9 16

5 5 11 11 16 16 22

6 6 12 12 22 22 28 28

8 8 14 14 28 32

13 13 17 17 32 34 34

15 15 20 20 34

18 18 25 25

27

19 29 29

21

23 23 31 31

24

26 26 36 36

30 30

35 35

a Factors from the current study

b Factors from the Foster and Levitov (2012) study

Investigating Holistic Wellness Dimensions During Older Adulthood: A Factor Analytic Study 245

123

evaluates future physical health expectations. Much liter-

ature exists that describes the decline and maintenance of

physical health during older adulthood (Boyd and Bee

2012; Moody and Sasser 2011), and how physical health

plays a role in successful aging. An older adult’s health

status can predict their abilities to complete both basic

(e.g., bathing and dressing) and instrumental (e.g., house-

work and shopping) activities of daily living (Bookman

et al. 2007), and will ultimately determine if they need

supplemental care (Kane and Kane 2000). Individuals who

possess higher levels of physical functioning may also

contribute to a higher level of successful aging. The four

items that loaded on Physical Wellness and the two items

that loaded on Future Physical Wellness overlapped with

six of the seven items that loaded on Foster and Levitov’s

(2012) Physical factor loading (see Table 3).

Limitations

Three limitations exist that affect the internal validity of

this study. First, we based this study on survey research

using a correlational design, which cannot explain causa-

tion between variables (Gliner et al. 2009). We derived

themes from the factor solutions that are developmentally

based, but cannot definitively conclude that the develop-

mental stage of older adulthood directly influenced these

loadings. This lends credence to the second limitation

pertaining to what extraneous variables might be present

that influenced these results, such as family dynamics,

spiritual affiliation, career satisfaction, and disability status.

Last, the PWS is a self-report instrument that participants

were given 3 weeks to complete. We cannot be certain who

completed these survey packets or what their state of mind

was at the time they completed them. In addition, the social

desirability bias could have occurred (Gliner et al. 2009).

The one limitation that affects external validity is the

homogeneity of the sample. Participants were primarily

Caucasian and married, and thus, the results were not

generalizable to other races and marital statuses.

Implications for Future Research

Based upon the results and limitations of this current study,

we recommend further research be conducted to examine

how older adults conceptualize holistic wellness. We sug-

gest using longitudinal studies to investigate how the factor

structures of holistic wellness change over time as indi-

viduals move across the lifespan and into older adulthood.

Within these longitudinal studies, researchers should

account for other variables to determine how they relate to

factor structures of holistic wellness, such as race, gender,

education level, spiritual affiliation, career satisfaction,

disability status, and socioeconomic status. Qualitative

methods could be used in conjunction with longitudinal

designs to gain a more in-depth understanding of holistic

wellness during older adulthood.

In addition, we suggest that researchers determine if

other age groups possess unique perceptions of holistic

wellness and if developmental themes influence these

perceptions. Longitudinal studies could investigate how

perceptions of holistic wellness evolve from one point on

the lifespan to another, for instance how adolescents’

wellness perceptions change as they move into young

adulthood. Researchers using a mixed method approach

that utilizes qualitative design could uncover participants’

perspectives of why their perceptions of holistic wellness

changed as they progressed to the next point on the

lifespan.

Clinical Implications

This study provides mental health practitioners with a new

perspective of holistic wellness during older adulthood.

Specifically, this perspective suggests an interaction exists

between holistic wellness perceptions and developmental

theories of aging. Mental health practitioners can use this

new perspective to assess for specific holistic wellness

dimensions of their older clientele. These assessment out-

comes can bring about specific wellness-based interven-

tions tailored toward older clients’ perceptions of holistic

wellness and the developmental challenges they face

related to resolving despair, increasing a sense of success,

and maintaining/increasing physical health.

Conclusion

With the projected population increase in older adults in

the USA, their need for counseling services will also grow.

Mental health practitioners who integrate holistic wellness

assessments and interventions into their practice must

understand how this age group uniquely perceives holistic

wellness to offer the best care possible. We set out to

determine what factor solutions emerged in a sample of

older adults who completed the PWS. We found a four-

factor solution that resembled themes of developmental

theories of older adulthood. Additional research is needed

to further understand how individuals perceive holistic

wellness during both the time of older adulthood and at

other points on lifespan using mixed method approaches.

Uncovering how holistic wellness perceptions change over

time will provide mental health practitioners age-specific

assessments and interventions that will provide a more

tailored approach to counseling.

246 T. Foster et al.

123

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