Factors Associated with Well-being and Spiritual Health Among Older Adults in Thailand: A Cross-Sectional Study

Introduction Contemporary discussions on health definition, as highlighted by the World Health Organization (WHO), emphasize the significant role of spiritual health (SH) in contributing to overall well-being, alongside physical, mental, and social dimensions. In Thailand, the rapidly ageing population has elevated the importance of improving the well-being of older adults, making it a critical national concern. In this context, SH plays a crucial role and is recognized in Thai national legislation as a key element of health. However, specific research on the relationship between SH and well-being among Thai older adults remains limited. This study aimed to investigate the current state of well-being among independent older adults in Central Thailand and to examine factors associated with SH and well-being. Methods This cross-sectional study was conducted from June 1 to July 31, 2025, using a Paper-based questionnaire survey targeting 500 older adults aged 60 and over within Ratchaburi Province, central Thailand. The well-being was assessed using the ICECAP-O (ICEpop CAPability measure for Older people). Descriptive statistics (frequency, percentage) and univariate analysis (one-way ANOVA, t-test) were conducted. Multivariate linear regression analysis was performed to examine the relationships between well-being, socioeconomic characteristics, health perception, and the Purpose in Life (PIL) test. Stata/BE17.0 was used, with a significance level set at p<0.05. This study was approved by the ethics review boards of both countries' institutions: Juntendo University, Japan (E23-0364-M03), and Chulalongkorn University, Thailand (COA No.197/68). Results Among the 471 valid responses, the median ICECAP-O tariffs score was 0.868, and participants were classified into low (10.6%), moderate (33.8%), and high (55.6%) PIL groups. In multivariate linear regression analysis, the adjusted predictive margins revealed a stepwise gradient, where ICECAP-O tariffs score for the moderate and high PIL groups were 0.098 and 0.149 points higher, respectively, compared to the low PIL group (0.735). Subjective health, economic status, and caregiving roles were also positive predictors, whereas older age was negatively associated. Conclusion Given the critical role of spiritual health, targeted strategies to promote PIL are needed to enhance healthy aging. The findings highlight PIL as the strongest predictor of capability well-being, alongside subjective health and financial factors within the Thai cultural context.