Association of quality of life of urban elderly with socio-demographic factors

Introduction: Quality of life (QOL) of elderly often deteriorates due to many factors. This study was planned to find out the different domains of QOL of elderly people affected by socio-demographic factors. Materials and Methods: This was a community-based cross-sectional study conducted in Kolkata and Sonarpur area of West Bengal, India from January to December, 2013. The qQOL questionnaire developed by World Health Organization was used (BREF). The scores of QOL were assessed in the light of different socio-demographic characteristics. Results and Analysis: The QOL was significantly lower among people having more age, female, illiterate, financially fully dependent and those having lower socio-economic status. Conclusion: QOL is an important determinant of the living status of elderly and socio-demographic factors determine the QOL in this age group.


INTRODUCTION
Quality of life (QOL) is an individual's understanding of his/her life situation with respect to his/her values and cultural context as well as in relation to his/her goals, expectations and concerns.QOL has many dimensions such as material well-being, close relationships, health, emotional well-being, and productivity.QOL differs from individual to individual and is dependent on different factors.As the demographic pattern has changed with more elderly people, the overall QOL of a nation has also changed. [1]Loneliness, social disconnection, poor physical and mental health status contribute to poor QOL of elderly.This study has been planned to find out the different domains of QOL of elderly people affected by socio-demographic factors.

Study period
The study was conducted from January to December, 2013.

Study design
It was a community-based cross-sectional study.

Study tools
• One predesigned, pretested, semi-structured questionnaire was used to collect data regarding the socio-demographic parameters.

•
QOL was assessed using QOL BREF questionnaire developed by World Health Organization (WHO). [1] WHOQOL-BREF is a subset of 26 items taken from WHOQOL-100.Each domain raw score is converted to a 0-100 scale using the formula of transformed scale.
This transformation converts the lowest and highest possible scores to 0 and 100 respectively.The scores between these values represent the percentage of the total possible raw score achieved.

Sample design
The sampling was done using a stratified random sampling method.
One district having metropolitan city and one other district were selected.Kolkata is the main metropolitan city, and so it was selected.Out of rest 19 districts in West Bengal, one was selected using a simple random sampling technique.The selected district was South 24 Parganas.In Kolkata district, there are 15 boroughs out of which borough VIII was selected using a simple random sampling technique.Two wards out of 12 wards in borough VIII were selected using a simple random sampling technique.In South 24 Parganas, Sonarpur municipality was chosen using simple random sampling technique and in this area two wards were selected using simple random sampling.In the selected wards, all elderly people were encouraged to take part in the present study.The study was done among those elderly people who gave informed consent to take part in the study.
The study was conducted after clearance from Institutional Ethics Committee.

Study technique
Data were collected by interviewing study subjects by the house to house visits.

Statistical analysis
After collection of data, it was double entered in Microsoft Excel sheet for verification.The clean data set was copied into SPSS IBM sheet (version 16.0) for analysis.For demographic factors having binary outcome independent sample t-test was used to find out their relationship with QOL score.For socio-demographic factors having more than two categorical outcomes, ANOVA was used and for socio-demographic factors having the continuous outcome correlation test was used.P < 0.05 was considered to be statistically significant.

RESULT
This study highlighted the association of socio-demographic factors with QOL score of the study population.Table 1 shows that the majority (40.3%) of the elderly were in the age group of 60-64 years.17.6% were in the age group of 65-69 years, 16.3% were in the age group of 70-74 years, 14.6% of the elderly were aged 80 years and above and only 11.2% were in the age group of 75-79 years of age.
The percentage of female elderly (50.6%) was slightly more than male (49.4%).The majority of the study participants were Hindu (83.1%)Only 16.9% were from the Muslim community.Most of the study respondents were illiterate (44.5%).39.6% had primary level education, 3.4% had secondary level education, 6.1% had higher secondary level education and 6.4% were graduate or above.
The majority of the respondents were financially fully dependent on others (54%), 41.3% were independent and 4.7% were partially dependent.Table 2 highlights that mean of transformed scores of QOL is maximum in the environmental health domain (48.36) and minimum in the social relationship domain (39.62).Table 3 shows that with an increase in age the scores of QOL decrease significantly in all domains (P < 0.001 in the physical, psychological, and social interaction domain and P = 0.002 in the environmental domain).
Figure 1 highlights that QOL scores were significantly more in males than females (P < 0.001) in all domains.Figure 2 shows that there was no significant difference in QOL between elderly persons of different religions (P > 0.05) in any domain.Table 4 highlights that QOL score improved significantly with an increase in per capita income (P < 0.05 in all domains except social interaction domain).
Table 5 shows that scores in all domains of QOL of people who were illiterate or had primary level education were significantly lower than people who had an educational level at the secondary level and above.In all domains excluding the physical health domain the scores of the illiterate population were also significantly lower than people having a primary level education.Table 6 indicates that in physical health and psychological health domain the study population who were independent or partially dependent had better QOL scores than those who were fully dependent.In the rest two domains, that is, the social relationship and environmental domain the independent study population had significantly better QOL scores than those who were fully dependent.

DISCUSSION
The present study has highlighted the association of sociodemographic parameters with QOL scores of the study population.
The present study has found out that QOL deteriorates significantly with an increase in age.A study was done by Joshi et al., it was seen that health-related QOL score was associated with age. [1]In a study by Lakshmi Devi et al., it was found that QOL significantly decreased with increase in age. [2]This finding was corroborated with a study conducted by Kumar et al. on QOL of elderly in urban Puduchery in 2013. [3]They found that older age was associated with poor QOL.In another study conducted by Lokare et al., they found that QOL was significantly better among young people. [4]This finding is corroborated with the finding of a study done by Lahariya et al. [5,6] As the age advances, the health related problems become more common to a person.Gradually and gradually the power to work decreases and people are more confined to his/her own house.In this scenario loneliness is a very common problem.As age increases, the chance of losing spouse becomes more.In that scenario, loneliness increases to a much greater extent.So, overall the physical and psychological QOL becomes poorer with the advancement of age.Beside this, the social interaction decreases with increased age.So, the social relationship domain of QOL becomes worse.In a study conducted by Joshi et al., the association of health-related QOL with sex was highlighted. [1]A study conducted by Qadri et al., it was found that the QOL was significantly better in the male sex. [7]n another study by Lokare et al., they have found that QOL was significantly better among male elderly. [4]This finding is matched with the finding of a study done by Lahariya et al. [5] Male participants scored significantly higher in all domains in the present study than females.Kumar et al. have also found that gender played an important and significant role in determining QOL of elderly. [8]Like these studies another study conducted by Ibrahim et al. also found that men scored significantly better in QOL in Iraq. [9]According to study by Muhwezi et al. in Uganda, they found that females scored significant poor QOL in the physical health domain in WHOQOL-BREF questionnaire. [10]e present study has showed that with an increase in per capita monthly income the QOL score improve significantly.economic status was a significant determinant of poor QOL among the elderly. [11]In a study conducted by Kumar et al., they have found that socio-economic status played an important and significant role in determining the QOL of elderly. [8]The Brazilian version of WHOQOL-BREF was used to study the QOL of elderly in Brazil by Alexandre Tda et al.They also found that income had an impact on the QOL. [12]Niedzwiedz CL et al. found that individuals having poor socioeconomic status had lower QOL score. [13]derly people live with many physical as well as mental problems, and social detachment deteriorates the condition.QOL of elderly people is closely associated with different socio-demographic factors.The triple evils of ill-health, loneliness, and social disconnection deteriorate the QOL of elderly.The modern philosophy is that old must continue to take their responsibilities and in the enjoyment of the privileges like others.Social interaction can directly or indirectly assist the aged to fight the triple evils of ill health, loneliness, and social disconnection.
International Journal of Medicine and Public Health | Oct-Dec 2015 | Vol 5 | Issue 4

Figure 2 :Figure 1 :
Figure 2: Scores of different domains of quality of life according to religion of the study population The increase in per capita income indicates better socio-economic status.A study conducted by Nilsson et al. in Bangladesh also showed that poor International Journal of Medicine and Public Health | Oct-Dec 2015 | Vol 5 | Issue 4

Table 1 : Socio-demographic characteristics of the study population
International Journal of Medicine and Public Health | Oct-Dec 2015 | Vol 5 | Issue 4

Table 2 : Transformed scores of QOL
SD = Standard deviation, QOL = Quality of life