Abstract
Background: As societies worldwide experience rapid aging, maintaining psychological well-being in later life is increasingly important. In Japan, where spirituality often takes noninstitutional forms, the concept of spiritual health remains underexplored. Purpose in Life (PIL), a core component of spiritual health, has been shown to predict well-being and healthy aging, yet its correlates remain unexplored in rural Japanese populations. This study aimed to assess PIL levels and examine its sociodemographic, social and health-related correlates among older adults living in Shimane Prefecture, a super-aged region in Japan. Methods: A cross-sectional survey (May-August 2024) included 308 adults aged ≥65 years. The 20-item PIL scale categorized respondents into low, moderate, and high PIL. Group differences were examined with chi-square/Fisher tests; unadjusted associations were used with ordered logistic regression. Multivariable analyses used a generalized (partial) proportional-odds model, adjusted for age and sex, with results reported as odds ratios and 95% CIs. Results: 42.9% of participants were classified as high PIL and 18.8% as low. Volunteering showed threshold-specific effects: it was unrelated to moderate PIL levels but was associated with approximately 2.4-times higher odds of high PIL (95% CI 1.32-4.38, p = 0.004). University education showed a trend-level association with higher PIL after controlling for false discovery rate (aOR 3.16, 95% CI 1.28-7.82, p = 0.013). The worse self-rated health was associated with lower PIL after adjustment. Conclusions: Subjective health and psychosocial engagement are key correlates of PIL in rural older adults. Culturally sensitive interventions may help promote purpose and well-being in aging populations.