ORIGINAL ARTICLE
Year : 2018 | Volume
: 62 | Issue : 2 | Page : 95--99
Quality of life among geriatric population: A cross-sectional study in a rural area of Sepahijala District, Tripura
Nabarun Karmakar, Anjan Datta, Kaushik Nag, Kaushik Tripura
Assistant Professor, Department of Community Medicine, Tripura Medical College and Dr. BRAM Teaching Hospital, Agartala, Tripura, India
Correspondence Address:
Dr. Anjan Datta
Department of Community Medicine, Tripura Medical College and Dr. BRAM Teaching Hospital, Hapania, P.O. ONGC, Agartala - 799 014, Tripura
India
Abstract
Background: Quality of life (QOL) among elderly is an important area of concern which reflects the health status and well-being of this vulnerable population. Objectives: The objective of this study is to find out different domains of QOL and its association with sociodemographic factors among geriatric population. Methods: A community-based cross-sectional study was done among 76 persons aged 60 years and above from August 2016 to October 2016 in rural areas of Madhupur, Sepahijala district, Tripura. The World Health Organization QOL-BREF scale was used and analysis was done using SPSS version 20.0 statistical software. P < 0.05 was considered as statistically significant. Results: The mean QOL score was maximum in social health domain (67.32 ± 15.30), followed by environmental health (51.64 ± 10.11), lowest was in psychological domain (44.29 ± 11.50). Better physical health domain score was found among participants <70 years age. Psychological health was better among Hindu and persons from nuclear family and higher socioeconomic class, whereas male, illiterate, and businessman had better social relationship. Environmental domain score was significantly better among primary educated, businessman, and higher socioeconomic class people. Conclusion: The present study revealed social relationship domain had higher mean QOL score in comparison to other domains, but contrastingly psychological domain was affected worst in “old age group.” Further research can be done to explore the factors affecting psychological domain.
How to cite this article:
Karmakar N, Datta A, Nag K, Tripura K. Quality of life among geriatric population: A cross-sectional study in a rural area of Sepahijala District, Tripura.Indian J Public Health 2018;62:95-99
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How to cite this URL:
Karmakar N, Datta A, Nag K, Tripura K. Quality of life among geriatric population: A cross-sectional study in a rural area of Sepahijala District, Tripura. Indian J Public Health [serial online] 2018 [cited 2023 Mar 29 ];62:95-99
Available from: https://www.ijph.in/text.asp?2018/62/2/95/234494 |
Full Text
Introduction
Aging is a universal phenomenon accompanied by an increased risk of disease, disability, decreased functional capacity, and eventually death, and it affects every individual, family, community, and society. The world is in the midst of a unique and irreversible process of demographic transition which will result in increasing life expectancy and increase in the proportion of elderly population in the near future.[1] The percentage of persons aged 60 and over is expected to double between 2007 and 2050, and their actual number will be more than triple by 2050 reaching to 2 billion.[2] In India, the population of 60 years and above was 8% (8.1% in rural India) in 2011.[3] This is projected to increase from 8.6% in 2016 (103.9 million)[4] to 20% (324 million) by 2050,[5] a number greater than total US population in 2012.[6] The rising number of older Indians with changing family relationships and severely limited old-age income support brings a variety of social, economic, and health-care policy challenges.[6] This population aging, along with epidemiological transition of diseases with an increase in burden of chronic morbidity conditions, will affect the quality of life (QOL) of elderly population in the long run.
The World Health Organization (WHO) defined QOL as “an individual's perception of life in the context of culture and value system, in which he or she lives and in relation to his or her goals, expectations, standards, and concerns.”[7] It is thus a broad concept covering the individual's physical health, mental state, level of independence, social relationships, and personal beliefs, and their relationship to salient features in the environment. Sir James Sterling Ross commented “You do not heal old age, you protect it, you promote it, and you extend it.” The World Health Day theme in 2012 was “Good health adds life to years.” The major attention of the WHO was mainly on the productive lives among the elderly people and not a dependency for their families and communities. Rapid evolution of biomedical knowledge and techniques has resulted in new life expectations not only of adding years to life but also QOL to years.
Very few studies had been conducted to assess QOL among elderly population, especially in rural areas in India,[7],[8] though many studies were conducted on QOL among elderly in other countries.[9],[10],[11],[12] It was known that different sociodemographic factors such as age, education, marital status, and family structure had greatly influenced the QOL among elderly population.[7],[12] In addition to that various studies have shown that chronic morbid conditions are associated with low QOL.[13] Though few studies have been conducted in India so far, but in North-eastern part of India less work has been done till date to reveal health status of elderly population. With this backdrop, this study was done to assess different domains of QOL and its association with sociodemographic factors among geriatric population.
Materials and Methods
A community-based cross-sectional study was conducted from August to September 2016 among all persons aged 60 years and above residing in rural communities of Madhupur, Sepahijala district, Tripura; the rural field practice area under Department of Community Medicine, Tripura Medical College, and Dr. BRAM Teaching Hospital.
Sample size and sampling technique
Lot quality assurance sampling (LQAS) technique was used considering each Para (moholla) as a single lot. Four Paras, namely, Daspara, Purnasenapatipara, School Tilla, and Brajendranagar were selected randomly out of total 10 Paras under Madhupur Gram Panchayat area of Sepahijala district. Within each Para using random number table, houses were visited (with the help of preexisting house numbers from family folders of our Rural Health Training Centre (RHTC), Madhupur) until our required sample size of 19 individuals of ≥60 years age was achieved. Finally, a total sample size of 76 (=4 × 19) was attained which gives ± 11% precision considering 95% confidence interval while using LQAS technique.[14]
Selection criteria
All the inhabitants aged 60 years and more from the selected houses were included in this study, while unwilling individuals, locked homes and moribund patients were excluded from the study.
Study tool
The QOL was assessed using standard questionnaire format of WHOQOL-BREF scale.[15] This instrument contains four domains, namely, Domain 1 (Physical Health), Domain 2 (Psychological Health), Domain 3 (Social Relationships), and Domain 4 (Environmental Health) with a total of 26 questions. Each of these domains are rated on a 5-point Likert scale. As per the WHO guidelines, 25 raw scores for each domain were calculated by adding values of single items, and it was then transformed to a score ranging from 0 to 100, where 100 is the highest and 0 is the lowest value. The mean score of each domain, total score, and average score was calculated. This questionnaire was translated to Bengali, and then, back to English and Cronbach's Alpha was calculated (the value was found to be 0.794) for assessing reliability of the instrument.
Data collection
The study participants were interviewed at their family setting after explaining the academic nature of this research, and they were assured that information collected from them would be kept confidential. Sociodemographic characteristics, that is, age, sex, education, family type, marital status, and income, and data on QOL were collected using a structured questionnaire.
Ethical Consideration
The protocol of the research study was submitted to the Institutional Ethics Committee (Tripura Medical College and Dr. BRAM Teaching Hospital, Hapania, Agartala), and the study was initiated after getting approval from Institution's Ethical Committee. Informed written consent in local language was obtained from every interviewee. The female participants were interviewed in the presence of female attendants or female family members.
Statistical analysis
The collected data were entered into Statistical Package for the Social Sciences (SPSS Inc, Chicago, IL, USA) version 20.0 and checked for any duplicate or erroneous entry. Significance of association between QOL (dependent variable) with the different independent variables was analyzed by unpaired t-test and P < 0.05 was considered as statistically significant.
Results
This study was conducted among 76 participants among which majority {34 (44.7%)} belonged to 60-70 years age group, only 4 (5.3%) in ≥ 90 years age group and 44 (57.9%) were male. Most (62 [81.6%]) of them were Hindu by religion. Majority were illiterate (26 [34.2%]) and by occupation homemakers (32 [42.1%]), followed by farmers (21 [27.6%]) and businessman (9 [11.8%]). As per modified B.G. Prasad's scale May 2016,[16] majority {33 (43.4%)} of the participants belonged to upper lower socio-economic class [Table 1].{Table 1}
The mean QOL scores were maximum in social relationships domain (67.32 ± 15.30), followed by environmental health domain (51.64 ± 10.11). The lowest mean score was seen in psychological domain (44.29 ± 11.50).
[Table 2] has shown the comparison of scores in all four domains of QOL with sociodemographic variables. Comparing the scores obtained in the physical health domains and sociodemographic characteristics, individuals aged <70 years were having better score (P < 0.05). Hindu religion, nuclear family status, and higher socioeconomic class were the factors found having significantly better score in psychological health domain (P < 0.05). Comparing the scores obtained in the social relationship domains and sociodemographics variables, male participants who were illiterate and businessman by occupation were having better score (P < 0.05). In the environmental domain, the factors found to have statistically significant association were primary education, business by occupation, and higher socioeconomic class (P < 0.05).{Table 2}
Discussion
The sociodemographic characteristics of the present study conducted among 76 participants of ≥60 years in Madhupur were similar to the study findings done by Akbar et al. in Siliguri,[17] Kamra in rural Punjab,[18] and Thadathil et al. in rural Kerala.[19]
Studies were done by Akbar et al. in Siliguri [17] and by Usha and Lalitha [20] in Kerala showed that senior citizens in urban areas showed better QOL than those in rural areas; rural senior citizens scored high in environment domain and low in physical health domain.[20] Another study by Missiriya in rural Thiruvellore [21] revealed that 13.3% were more satisfied, 38.3% satisfied, and 48.3% were unsatisfied with the QOL (using WHOQOL-BREF scale). Rural population had better mean score for psychological and physical health domain and male had a higher mean score in all four domains compared to female, though only social relationship domain was statistically significant (P < 0.05).[21] However, in the present study, female had higher mean in all domains except social health (P > 0.05). Durgawale et al. in Maharastra [22] showed that best QOL in majority (52%) of their study population followed by good QOL (39%), average and bad QOL being 7% and 2%, respectively, whereas only social relationship domain was better in the present study.
Findings from another community-based study by Hameed et al. in rural Dakshina Kannada [23] showed that male had better social relations as compared to female, whereas the current study showed female having better social relations. Both studies showed that better physical domain score among et al.[24] and Kamra [18] showed that 68.2% of elderly enjoyed a good QOL, while those having a fair/poor QOL were ≤15%. QOL was better in male in all four domains; participants, who had graduated and currently married, belonged to nonscheduled caste and living in extended families (P < 0.001). Sowmiya and Nagarani in rural Tamilnadu [25] revealed that the mean QOL score for all the elderly persons was (47.59 ± 14.56), indicating moderate QOL. The highest score was for the social relationship domain (56.6 ± 19.56) such as the current study, but the lowest was for physical domain (45 ± 11.84).
Mudey et al. in Wardha [26] showed that difference in physical and psychological domain scores among rural population with respect to age was statistically significant, whereas in the current study, age <70 years had better physical health (P < 0.05). No statistically significant difference was found in psychological domain between rural male and female similar to the current study.
Thadathil et al. in rural Kerala [19] showed that mean score of QOL domains was maximum in physical health (42.44), followed by social relationship (42.16); unlike the current study, where social health had maximum score. Both the studies showed lowest mean score was seen in psychological domain (26.95). Occupation, higher income, 60–69 years' age group, staying with partner, and absence of comorbidity were found to be the determinants of better QOL score (P > 0.05). In the current study, age <70 years had better physical health, whereas businessman was found significant with social and environmental health (P < 0.05) and higher socioeconomic class had better psychological and environmental health (P < 0.05).
Conclusion
The present study revealed that the social relationship domain had higher mean QOL score in comparison to other domains, but contrastingly, psychological domain was affected the worse in “old age group.” Further, there is scope to have a better understanding of factors behind poor psychological domain through qualitative research.
Acknowledgment
We acknowledge the families who participated in this study. We are grateful to all the health workers and ASHA of respective villages for their extensive collaboration, without whom this study would not have been conducted.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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