Understanding people aged 65 and over in Türkiye from a health communication perspective: A Study on perceptions, attitudes, and behaviors regarding health and aging

In the 21st century, global aging has become a social phenomenon regarding its demographic consequences. Increasing life expectancy and decreasing birth rates have led to an increase in the older adult population. Global aging is expected to continue rapidly in the future. The global population aged 65 and over is projected to reach 1.6 billion in 2050. This rapid aging means that by 2050, one in every six people worldwide will be 65 or older. Therefore, one of the main issues of the future will be the aging of the global population. Similarly, Turkey's population is also aging rapidly, and according to population projections, the median age is increasing faster than expected. The ratio of the older adult population to the total population in Turkey is projected to be 12.9% in 2030, 16.3% in 2040, 22.6% in 2060, and 25.6% in 2080. This rapid demographic transformation in the world creates environmental, social, health, and economic consequences at the individual and societal levels and new expectations. First of all, it should be emphasized that aging the global population or old age is not a problem in itself. Aging is a natural process that continues from birth to death. Despite the aging of the world population, the fact that many countries are not prepared for this demographic change, that governments do not adequately plan policies and practices, and that this issue is not given the necessary priority is one of the most severe problems that the world and Turkey will face both now and in the future. On the contrary, an active, independent, and healthy aging process and old age period in which the quality of life and well-being of the older adults are protected, social, health, and digital inequalities are eliminated, social participation is ensured, adequate health care and care is provided, neglect and abuse of the older adults are not a problem but a profound opportunity and potential for countries. In order to improve the quality of life and well-being of older adults, the environmental, social, health, and digital inequalities they experience must be eliminated. Older adults experience problems in accessing health services, using health information and technologies, especially socio-economic and socio-demographic inadequacies, and are exposed to age discrimination, social exclusion, neglect and abuse of older adults, and negative stereotypes of old age in society. For active, healthy, independent, and appropriate aging, it is necessary to develop social and health policies based on studies that include the perceptions, attitudes, expectations, and demands of elderly individuals without making aging a problem. On the other hand, aging and old age, which is a biopsychosocial process from birth to death, is unique and unique for each individual. Aging has a multidimensional and layered structure with chronological, physiological, psychological, and social aspects. For this reason, to realize a thriving social and health policy for older adults, an approach that understands them is required by revealing how older adults feel, interpret, or evaluate their health and aging instead of generalizations based solely on chronological age. In this direction, countries must examine their older adults' self-perceptions of aging and health to develop an in-depth understanding. Self-perceptions of aging and health determine older adults' current and future physical and psychological health, health behaviors, health outcomes, well-being, and quality of life. In other words, the analysis of aging and health perceptions is a critical indicator of the health status, outcomes, future diseases, quality of life, and well-being of older adults. However, more studies on this subject need to be conducted in Turkey and around the world. For this reason, studies need to examine the mental, psychological, and behavioral processes related to the health and aging of older people in Turkey, the factors affecting this process, and the ways of relationships. In this context, the primary purpose of this study is to reveal older individuals' perceptions of their health and aging and other factors that affect or are related to these perceptions, such as socio-demographic factors, critical health literacy, perceived benefits, and to examine their attitudes and behaviors; thus, to create a resource for health and aging policies that will enable them to age actively, healthily and independently and to develop an in-depth understanding of older individuals' inner worlds. In line with this purpose, the study consists of 2 quantitative studies within the same sample to examine the perceptions, attitudes, and behaviors of individuals aged 65 and over in Turkey regarding aging and health. The population of the studies includes individuals aged 65 and over living in Istanbul. The study was conducted with 450 participants living in Istanbul. The study evaluated sampling adequacy over the scales using Kaiser Meier Olkin statistics (KMO). In this study, since the KMO statistics were above 0.7 for all four scales and the average KMO measure of the four scales was 0.805, the sampling volume of the data in the study was found sufficient. In addition, the study utilized the Socio-Economic Development Ranking Index (SEGE) of the Ministry of Industry and Technology Districts to distribute the sample homogeneously on a district basis in Istanbul. The study used a face-to-face questionnaire with open-ended and closed-ended questions as a data collection technique. The first study examined the relationships between the socio-demographic status of older adults in Turkey, their self-perceptions about aging and health, perceived benefits of ICTs, and critical health literacy levels, and how these variables affect each other. Descriptive data analysis, reliability analysis, mean comparison tests, cross-tabulation relationship tests, data visualization techniques, correlation analysis, confirmatory factor analysis (CFA), and path analysis were applied as data analysis methods. As a result of the study, older adults' self-perceptions of aging and health, health literacy levels were found to be at a medium level, and the perceived usefulness level, which shows their attitudes towards and perceptions of the benefits of information and communication technologies, was found to be at a low level. The most fundamental finding of the study is to reveal the link between the determinant effects and relationship pathways on older adults' perceptions of aging and health. According to the regression results of the path analysis in the study, it was determined that the perceived benefit levels of older adults towards information and communication technologies positively and statistically significantly affect critical health literacy, and critical health literacy positively and statistically significantly affects the health perception of older adults. Again, older adults' self-perceptions of aging and health have a positive and same-directional relationship. A positive increase in one of the health or aging perceptions of older adults increases the other perception at the same rate. Conversely, a decrease in one of the perceptions of health or aging causes the other perception to become negative. Another finding of the first study is that the socio-demographic characteristics of older adults are a significant determinant of all dimensions in the model, including aging, health perceptions, perceived benefits, and health literacy levels. The study found that as the income level and education level of older adults increased, their positive perceptions of aging increased. Older adults with higher income and educational attainment feel less old, do not identify with old age, and believe that old age will have more negative consequences rather than positive aspects. On the other hand, they believe they can manage the positive and negative consequences of aging and have a higher sense of control. On the other hand, elderly individuals whose spouses have passed away or who live with their children's families are less likely to believe that aging will negatively affect their lives and have a lower sense of control in managing the current negative consequences compared to other participants. As the income level and education level of older adults increases, their positive health perceptions, positive attitudes towards information and communication technologies, perceptions of benefits, and critical health literacy levels also increase. In terms of gender, it was found that older women perceived their health more negatively than men. All the findings of the study show that the perceptions of aging, health, perceptions of the benefits of information and communication technologies, and critical health literacy levels of older adults in Turkey need to be improved, and this improvement will be possible by eliminating the socio-economic and socio-demographic inequalities experienced by the older adults. The study's findings show that socio-demographic inequalities lead to new forms of inequality in different fields and channels, such as health literacy and attitudes towards technology, and affect older adults' perceptions, interpretations, and evaluations of their aging and health. In the second study, the use of information and communication technologies (ICT) by elderly individuals, their health information-seeking behaviors, the connections of these uses and behaviors with the socio-demographic characteristics of the older adults, the impact of perceived usefulness on usage practices, and the extent to which health literacy levels affect the health information seeking behaviors of the older adults were analyzed. The study applied descriptive data analysis, reliability analysis, and cross-tabulation relationship tests as data analysis methods. With the Shapiro-Wilk test, the suitability of the data for normal distribution was checked. When testing the significance of the relationships between categorical data, the Fisher (if the expected value is below 5) or Chi-Square independence test was preferred according to the expected value of the cells. In addition, logistic regression analysis was applied to examine the effect of independent variables on the dependent variable. According to the findings of the study, 81.78% of the older adults use television, 17.57% use smart television, 10.67% use radio, 6.67% use desktop computers, 6.44% use laptops, 3.11% use tablets, 33.78% use push-button cell phones, 65.56% use intelligent cell phones, 1.79% use smartwatches, and 1.56% use other devices. Again, the % of individuals aged 65 and over who used the Internet in the last three months was found to be 60.66%. No statistically significant relationship was found between the gender, marital status, and lifestyle of the participants and their use of television, smart television, radio, desktop computer, tablet, and smartwatch. However, the income level and education level of the older adults were significant determinants of their ICT use, and it was found that as the education and income level of the older adults increased, the rate of ICT use also increased. In terms of health information-seeking behaviors in the second study, it was found that elderly individuals most commonly preferred the family physician (62.67%) as the first source of information about their health status, ailments, or diseases, followed by health professionals (55.33%), close environment (43.78%) and online search engines (27.33%). In the study, the tendency to use online search engines to get information from social media, health experts, family physicians, and health portals increases in older adults with higher education and income levels. In contrast, the rate of using online search engines for health information decreases as income decreases. In terms of lifestyle, the study found that older people living alone were more likely to obtain health information through ICTs. In contrast, older adults living with their children's spouses were less likely to obtain information from the Internet. The logistic regression analysis findings of the second study also revealed that improving attitudes and perceptions about the benefits of ICTs increases the rate of ICT use and acceptance of new technologies, and increasing the level of critical health literacy increases the likelihood of accessing, using, and understanding more health information. All the study results show that the main determinants of the problems of older adults in Turkey are socio-demographic. For policies that aim for active, healthy, and successful aging, the primary social determinants that negatively affect the perceptions of aging and health of older adults and secondary factors such as critical health literacy and perceived benefit levels associated with social determinants need to be improved. The positive perceptions of aging and the health of older adults can guide Turkey's aging and health policies by enabling the prediction of their future quality of life, well-being, health decisions, behaviors, and outcomes.