Perceived social support and life engagement among older adults using thermal health tourism services: the moderating role of aging anxiety.

Abstract

Background: Life engagement is a central dimension of psychological functioning in later life. Its association with perceived social support varies across levels of aging-related concern, and evidence from thermal health tourism settings remains limited.

Objective: This study examined the associations of perceived social support and aging anxiety with life engagement among older adults using thermal health tourism services, including the interaction between perceived social support and aging anxiety. Source-specific support analyses described the relative contributions of significant-other, family, and friend support.

Methods: This cross-sectional study used 415 deduplicated questionnaires from adults aged 65 years and older at one thermal health tourism facility. Scale scores required at least 80% item completion. Pearson correlations and ordinary least squares regression with HC3 heteroskedasticity-consistent standard errors formed the primary analysis. Robust regression, median quantile regression, bootstrap estimation, strict complete-item scoring, source-specific models, dominance analysis, and commonality analysis provided sensitivity and secondary results. The primary adjusted model included 384 complete cases.

Results: Perceived social support was positively associated with life engagement [b = 0.106, 95% CI (0.048, 0.164), p < .001], and aging anxiety was negatively associated with life engagement [b = -0.326, 95% CI (-0.474, -0.179), p < .001]. The interaction was negative [b = -0.061, 95% CI (-0.118, -0.005), p = .034], with an incremental R² of.014. The positive support-life engagement association was statistically significant below an aging-anxiety score of 3.15. The interaction confidence interval included zero in the strict complete-item and median quantile sensitivity analyses. The three support sources were highly correlated, and their combined incremental R² was.028 in the source-specific analysis.

Conclusion: Among voluntary users of one thermal health tourism facility, higher perceived social support and lower aging anxiety were associated with higher life engagement. The support-life engagement association was smaller at higher aging-anxiety levels. The cross-sectional interaction was modest and sensitive to the missing-item rule and conditional-distribution model.