1. Introduction

Happiness is a concept that has been tried to be defined since ancient times, either from hedonism or from virtue, but to date there is no consensus on its precise definition (^{Domínguez Bolaños & Ibarra Cruz, 2017}). However, its study has become important, especially with the birth of positive psychology as a science, which main task is understanding what makes life worth living (^{Seligman, 2002}). In particular, it has been planted as an objective to promote the development of qualities for life, that is, work on the strengths that help to cope with different life situations and in the prevention of mental illnesses (^{Ryff, 2022}).

To achieve this, there are several areas that this field of knowledge seeks to incorporate. Thus, at the subjective level, it includes the positive subjective experience, in which well-being, satisfaction, joy, and happiness are addressed, as well as constructive cognitions about the future such as optimism, hope, and faith. Also, there are the individual and social areas. The first emphasizes positive personal traits, as the capacity for love and vocation, interpersonal skills, aesthetic sensitivity, perseverance, forgiveness, among others. Finally, regarding the group, the civic characteristics and the institutions that move individuals towards better citizenship are treated (^{Ryff, 2022}).

Regarding the positive subjective experience, ^{Veenhoven (2018)} states that there are four basic elements for its study: the opportunity of a good life, the good life itself (as a result), and the characteristics, which can be internal or external. Thus, by uniting the internal characteristics with the good life itself, the authors approach the concept of subjective enjoyment of life, that is, in Veenhoven’s words, “the quality of a life in the eye of the beholder of that life” (^{Veenhoven, 2018}, p. 5). In this way, this subjective enjoyment corresponds to the following terms: subjective well-being, satisfaction with life, and happiness.

In turn, the subjective satisfaction of life has several distinctions, fundamental for the study of happiness, and these are based on four polarities: whether it is part of life, or life as a whole, and pleasure as a passenger or satisfaction durable. Based on this, and supported by the postulates of Jeremy Bentham, Veenhoven defines happiness as “the degree to which an individual judges the overall quality of his/her own life-as-a-whole favorably-in other words, how much one likes the life one leads” (^{Veenhoven, 2018}).

In line with this, ^{Alarcón (2006)} adopted happiness as an “affective state of full satisfaction that a person experiences subjectively”¹ (p. 101), which is considered synonymous with subjective well-being. In addition, he developed the Lima Happiness Scale, where he proposes an approach to this construct through the positive sense of life, the satisfaction with life, the personal fulfillment, and the joy of living (^{Alarcón, 2006}). This instrument, initially designed for the Peruvian population, has had wide research acceptance in Latin America, being adapted in countries such as Venezuela, Argentina, and Mexico (^{Árraga Barrios & Sánchez Villarroel, 2012}; ^{Auné et al., 2017}; ^{Rodríguez-Hernández et al., 2017}).

In general, happiness is a construct that contributes to the development of a full life, which includes both physical and mental well-being, but it takes on special relevance in the aging stage, which can be established, according to the life cycle, from 60 years onwards (^{Alvarado García & Salazar Maya, 2014}; ^{Rice, 1997}), since there is an expected physical and cognitive deterioration. Consequently, this makes older adults more vulnerable to present negative thoughts, feelings, and behaviors that affect their perception of worth and meaning of life (^{Gómez-Restrepo et al., 2013}).

In addition, the aging of the population worldwide has been increasing. According to the World Health Organization (WHO), between 2015 and 2050, the population over 60 years of age will increase from 12% to 22% (2017), figures that coincide with those estimated for Colombia (^{Dirección de Epidemiología y Demografía, 2018}). This implies an increase in the demand for health care related to chronic diseases and deterioration of both physical and mental health, which requires looking at the needs of this age group (^{World Health Organization, 2017}).

In contrast, Alvarado et al. found that satisfaction with life can increase with age, as long as there is social support, adequate and stable economic income, and a good perception of physical health. Otherwise, life satisfaction tends to decrease (^{Alvarado et al., 2017}). It has also been documented that happiness tends to increase when social, physical, cognitive, and restful activities can be carried out, in addition to being studied as a mediating variable (^{Cardona Arango et al., 2018}). Thus, the authors found that happiness is a predictor of family functionality in older adults, which in turn is associated with not having a risk of depression and having social support, among other variables (^{Cardona Arango et al, 2018}).

According to the previous statements, it can be said that the importance of the study of happiness has been identified, both as a result of the interaction of social, family, economic, and individual situations and conditions, as well as the role it plays in the perception of aging and its mediating role in social situations and health outcomes, which reflects the complexity of this phenomenon.

Likewise, aging in rural populations should begin to arouse greater interest for researchers and government entities, since they are areas in which access to health services and social protection is more limited, an aspect that impacts the possibility and opportunity of reaching active and healthy aging. In turn, this plays an important role in their perception of well-being and happiness. Some studies show that in this context there are higher rates of chronic diseases, and the social determinants of health are increasingly precarious, which has repercussions on the physical and mental health of these population groups (^{Garbaccio et al., 2018}; ^{Segura-Cardona et al., 2018}).

Regarding the rural population of Túquerres, in the department of Nariño, there are no research references that include, in addition to sociodemographic data and social support, the study of emotional states and happiness, which could give an approximation to the state of mental health of this population, and thus be able to rely on sufficient data to support decision-making in health care and social protection.

The total population of this municipality is 40599 inhabitants, of which 17503 (43.11%) live in urban areas and 23096 (56.89%) live in rural areas, and 49.46% are women (^{Alcaldía Municipal de Túquerres en Nariño, 2016}). According to this, the rural area of Túquerres is inhabited in a higher percentage than the total of the municipality and has low living conditions. According to the Índice de pobreza multidimensional municipal [Municipal Multidimensional Poverty Index], for 2018, the populated and dispersed rural centers had an index of 42.3%, which classifies these households in a situation of poverty, while in the municipal seat of Túquerres it was 18 .1% (^{DANE-Departamento Administrativo Nacional de Estadística, 2018}).

In particular, the situation of the older adult in rural areas is classified as vulnerable, not only because they belong to the rural area, but also due to conditions such as low levels of schooling, houses built with mud and tiles, unpaved access roads, among others, hindering mobility, both for the extraction of products and for access to appropriate health systems, social resources, and transportation (^{Alcaldía Municipal de Túquerres en Nariño, 2016}; Castillo Burbano, n.d.).

Based on this, the present study sought to contribute to the development of knowledge of the happiness of older adults in rural areas, with a view to making decisions in health, with a preventive approach. Therefore, the objective of the present study was to explore the association between happiness and sociodemographic characteristics, medical history and symptoms, emotional state, social support, cognitive performance, and functional dependence in older adults of this area.

2. Methodology

3. Results

4. Discussion

This research sought to explore happiness in a vulnerable population that demands more and more attention, older adults living in rural areas, since the world population has been aging and will increase its proportion to 22% by 2050 (^{Organización Mundial de la Salud [World Health Organization], 2017}). In this sense, it is essential to know the factors that may be related at this stage of life with healthy aging, subjective well-being, full satisfaction and that, in addition, can provide sufficient data to support decision-making in health care and social protection, either for damage mitigation or prevention in future generations. Thus, the main objective of this study was to explore the association between level of happiness and sociodemographic characteristics, medical history and symptoms, emotional state, social support, cognitive performance, and functional dependence in this population.

In general, old adults from the municipality of Túquerres rural area have precarious socioeconomic conditions, where the level is mainly low, since 78.6% of the participants are at level 1. When levels 0 and 1 are compared with respect to happiness, it is possible to identify that the lower the socioeconomic level, the lower the happiness, although, as shown in the results section, the effect is small. It is worth noting that these results ratify one of the findings of the Encuesta Nacional de Demografía y Salud [National Demographic and Health Survey] carried out in 2015, in which it was clear that there was a “detriment of rural areas, where the lowest quintiles of wealth are found and that they are the least developed territories” (^{Profamilia & Ministerio de Salud y Protección Social, 2015}, p. 38). These figures constitute a warning to take serious actions into the perpetuation of less favorable socioeconomic conditions that are affecting the health of its inhabitants, in this case, the elderly of Túquerres.

Although there are not many studies on well-being in rural older adults in Latin America, there are two studies that stand out. One, by ^{Lobos et al. (2016)} in a group of rural older adults in Chile, in which they did not find an association between socioeconomic level and happiness, but did identify that older adults reported greater happiness at older ages, although with a limit of 73 years, which suggests that, in their study population, happiness begins to decline after that age. However, in the present study no association was found between age and level of happiness. The second study, conducted by ^{Alvarado San Román et al. (2017)} sought to identify the factors associated with subjective well-being, which they defined as “the evaluations that people make of their own lives, for example satisfaction with life, which are based on feelings” (p. 2), finding that satisfaction with life, regarding the Chilean older adults with whom they worked, was greater as age increased, but they clarify that this result must go hand in hand with the analysis of the income level of the participants.

Although no effect was found between the level of income and the level of happiness, this variable has reported effect in other studies. In addition to the one mentioned by ^{Alvarado San Román et al. (2017)}, ^{Amorim et al. (2017)} carried out a study in Brazil, in which they compared the level of happiness of older adults who lived in rural areas with those who lived in urban areas, finding that one of the factors that predicted the level of happiness was the economic situation, as well as health and social support. Additionally, a study carried out in Portugal, which sought to identify the predictive and explanatory variables of self-perceived health and happiness, reported that gender and age were factors that influenced the level of happiness, but the greatest effect was exerted by income, that is, the lower the income, the lower the perceived happiness (^{Silva, 2014}). In the United States, it was reported that the inhabitants of rural areas, especially older adults, are under less favorable economic and health conditions and that this impacts their emotional well-being, but it is not an exclusive case in this country, as it has also been reported in other countries such as Canada (^{Henning-Smith, 2020}; ^{Varin et al., 2020}).

Regarding the type of occupation, it was found that the participants with a pension presented a higher level of happiness than those who were dedicated to the home, while when comparing the latter with those who had a job, greater happiness was observed among those who were dedicated to housework, these being carried out mostly by women (64.5%). Given these findings, it is worth noting that only 1.20% of the participants were pensioners, while the general percentage of older adults who are pensioners in the country, for rural areas, is 7% (Oficina Internacional del Trabajo, n.d.). This should draw attention at the state level in order to guarantee health rights and social protection, considering this occurs despite the fact that in Colombian legislation the pension age is set at 57 years for women and 62 years for men (Colpensiones, n.d.).

These figures have a background of inequity, since although life expectancy has increased, as proposed by ^{Arrubla Sánchez (2010)}, “it is not enough to live longer, it is necessary to live old age with quality” (p. 231), and this old age is the reflection of social, economic, cultural and political conditions of each society, of government decisions, and of how aging is seen, that is, if it is from a fatalistic notion, in which it is considered a problem that contributes to the slowdown of progress and the pressure on the health and social security system, or if it is seen from the notion of democratization of aging, in which it is recognized that older adults have made their contribution to society and it is necessary to work for the guarantee of their human rights, their independence and their autonomy, which inevitably implies considering the unequal access and possession of resources (^{Arrubla Sánchez, 2010}). Although the concept of democratization of aging is not very widespread, the concept of healthy aging has made visible the influence socioeconomic inequities, educational level, and income have on aging (^{Wagg et al., 2021}), which goes from hand in hand with the current World Health Organization calls for the Decade of Healthy Aging 2020-2030 (2020).

The pension issue is something that has been worrying governments, given that the world population is gradually aging, and this requires actions to promote healthy aging conditions. In countries like Brazil, China or Australia, where this issue is becoming more visible, studies have been carried out in which the influence of retirement on the well-being of rural older adults has been identified, finding that retirement implies stable income and a decrease in stressors, an aspect that impacts their perception of well-being and satisfaction with life. Nevertheless, it is not presented in the same way in men and women, since the latter only access retirement when they are heads of household, especially in the case of Latin America, which reflects the existing inequality gap in the conditions of access to retirement in the rural population (^{Handley et al., 2021}; ^{Ko & Möhring, 2021}; ^{Oliveira & Coelho, 2021}).

Regarding the educational level, 70.60% of the participants had not completed primary school, which also had an effect on happiness, since those who were in the second group reported greater happiness than those who had not finished primary school. Regarding that, in the study carried out in Chile by ^{Alvarado San Román et al. (2017)}, it was found that older adults with higher education were the ones who reported the greatest life satisfaction.

In relation to the characteristics and health symptoms, although not enough evidence was found to establish an association between the perception of the state of health and happiness, it is important to point out that 79.70% have a perception of their health between poor and regular. In addition, 80.2% of the older adults who participated in this study have a history of chronic disease. Regarding happiness, those who do not report such a history of chronic disease present a higher level, although the effect size is small. The same occurs, with a moderate effect, with the variable referring to presenting pain in the joints at least once a week. When contrasting these results with other studies that sought to analyze the state of health and happiness, a metaanalysis carried out in 2017 stands out, in which they were seeking to establish the association of health state with subjective well-being, defining it as happiness and satisfaction with life, and reported that the association between health status and subjective well-being was positive and with a moderate effect. This indicates that the better the perceived the state of health, the greater the subjective well-being (^{Ngamaba et al., 2017}). Furthermore, they identified that the association between health status and happiness is much stronger in lowand middle-income countries, compared to high-income countries (^{Ngamaba et al., 2017}).

^{Miret et al. (2017)} analyzed the association between evaluated and experienced well-being with health in nine countries of different income levels. The authors defined evaluative well-being as how satisfied people are with their lives and experienced well-being as the positive and negative emotions people experience day after day. Considering this, they found that the evaluated well-being, that is, satisfaction with life and health, are related and this relationship was similar in the nine countries the study was carried out, which can also be identified in other studies (^{Amorim et al., 2017}; ^{Lobos et al., 2016}; ^{Steptoe et al., 2015}). As can be seen, the difference in the results of the previous studies does not lie in whether or not there is an association between the state of health and happiness, but rather in the strength of this association depending on the country in which the study is carried out. It is worth asking from this, what makes this association strong in places with lower incomes? Is care and access to health services more difficult, more expensive? These types of findings recall the multicausality of a complex phenomenon, such as happiness or subjective well-being, and that it can also be a bidirectional relationship, since the state of happiness in turn can favor health-disease processes (^{Steptoe et al., 2015}).

Regarding the emotional state, depression had a prevalence of 42.9% and showed a small effect on happiness; in the case of anxiety, the prevalence of moderate to severe symptoms was 82.9%, likewise, with a small effect. These results are in line with those reported on depression in the Encuesta de Salud, Bienestar y Envejecimiento de Colombia [Colombian Health, Well-being and Aging Survey], carried out in 2016, in which they reported a prevalence of 41%, although they did not provide data on anxiety (^{Ministerio de Salud y Protección Social, 2015}). In Colombia, the study of depression in older adults has been gaining value, since suicide attempts in this population can be 4 times more effective than in young people (^{Gómez-Restrepo et al., 2013}), which has made that the interest in the study of happiness has not been only perceived as an outcome, but as a mediator or an additional exposure to variables such as depression or social support (^{Gómez-Restrepo et al., 2013}; ^{Ramírez Arango et al., 2020}; ^{Segura-Cardona et al., 2015}).

Another element that reveals this situation is the approach to subjective well-being in public health and mental health in a rural context, since in a country with highly vulnerable populations, victims of violence and inequity, the emphasis is on addressing the disease and not on the potentialities or positive qualities that help maintain states of well-being. However, this association has been reviewed elsewhere, although not always in a unique and isolated way, but in relation to other variables, such as cognitive performance and functional dependence, which, in the present study, did not provide enough evidence to affirm that they have an association with happiness.

Concerning the previous statements, a study conducted in Singapore by Hui ^{Tan et al. (2019)} evaluated the mediating role of depression, physical disability, the frequency of social contact and loneliness, in the relationship between cognitive impairment and happiness, finding that this relationship was totally mediated by these variables, so the interventions to improve happiness levels should focus on depression, physical disability, and loneliness, from a comprehensive and multicausal approach. In Spain, Rodríguez et al. found that cognitive performance had a negative relationship with functional dependency, and, in turn, these factors had a positive correlation with symptoms of depression and anxiety, but not with life satisfaction (2014). No evidence was found in the previous study of a direct relationship between cognitive performance and happiness, nor between functional dependence and happiness. However, it does show a relationship with other mental phenomena of primary approach such as depression and anxiety, which continues to point out the importance of addressing mental and emotional phenomena as multicausal. Similar results were found in a study in Korea, in which social activity was found to influence life satisfaction with cognitive function as the mediating variable (^{Bae & Kim, 2021}).

Specifically, regarding social support, it was initially expected that this variable would present an association with happiness, considering reviewed studies such as the one conducted by ^{Amorim et al. (2017)}, social support was one of the main predictors of happiness, along with health and economic status. Ann W. Nguyen et al. conducted a study with African-American older adults, focusing on social support, its dimensions, and subjective well-being, finding that there is a positive association between subjective closeness to family with life satisfaction. In addition, when there is no subjective closeness, life satisfaction increases if there is more family contact (^{Nguyen et al, 2016}). Similarly, in other cultures such as China, it has been found that trust and family support are positively associated with life satisfaction (^{Pan, 2018}). Based on this, the findings of the present study should be contrasted with future investigations, which could have larger samples that increase the inferential power of statistical analyses.

5. Conclusions

The present study sought to contribute to the knowledge of happiness in rural older adults, in an area of Colombia in which this type of phenomenon had not been addressed, and less so in this population. This knowledge is expected to contribute to government decisionmaking, in terms of health as well as social protection, as it highlights the need to approach the social determinants of health to improve the mental health conditions of the population.

Another of the strengths of the research was being able to address such a complex phenomenon, based on a multidimensional evaluation, which highlights the needs of this vulnerable population in this specific area of Colombia.

Happiness is a multicausal variable, a psychological dimension resulting from social, economic, emotional, and biological characteristics, which requires attention if working work for healthy and quality aging is the desire. At the level of mental health in rural areas, especially in older adults, there is a significant research gap, an absence of instruments and methodologies designed specifically for them, which require attention and a multidimensional and focused approach. For this reason, a dialogue between knowledge, in this case areas of mental health and public health, and the population is important, thus facilitating a more effective approach that considers the sociocultural and idiosyncratic characteristics, which will help reduce the barriers of access and care in these areas of the country.