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Year : 2021  |  Volume : 7  |  Issue : 2  |  Page : 130-134

Assessment of quality of life and its determinants among the elderly residing in a rural area of Faridabad: A cross-sectional survey

1 ICMR, National Institute of Cancer Prevention and Research, Noida, Uttar Pradesh, India
2 Department of Community Medicine, ESIC Medical College and Hospital, Faridabad, Haryana, India
3 Department of Community Medicine, AIIMS, Guwahati, Assam, India

Date of Submission06-May-2021
Date of Acceptance14-May-2021
Date of Web Publication24-Dec-2021

Correspondence Address:
Dr. Mitasha Singh
ESIC Medical College and Hospital, Faridabad - 121 001, Haryana
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijcfm.ijcfm_32_21

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Introduction: Population aging as a result of demographic transition has brought into focus issues pertaining to health status of elderly. We aimed to assess different domains of quality of life (QoL) and its determinants among the elderly population of a rural area of Faridabad.
Material & Methods: A community-based cross-sectional study was carried out among 300 elderly people aged 60 years and above from October 2018 to January 2019 in village Pali of Faridabad, Haryana. The World Health Organization QOL-BREF scale was used for the assessment of QoL.
Results: The study included 44% males with a mean age of 67.1 ± 7 years. The mean QOL score was highest in psychological domain (63.26 ± 18.48), followed by environmental domain (62.64 ± 16.23), physical domain (60.58 ± 19.24), and lowest in social domain (59.33 ± 17.81).
Conclusion: Physical domain of QoL was significantly better in nondiseased elderly, while social domain was not significantly affected by morbidities or health-seeking behavior. Overall, QoL was fair to good. Determinants of good QoL included social as well as economic characteristics such as higher education, sex, and the absence of chronic disorders.

Keywords: Geriatric, Haryana, quality of life, World Health Organization-BREF

How to cite this article:
Gupta E, Goswami S, Aggarwal V, Singh M, Agarwalla R. Assessment of quality of life and its determinants among the elderly residing in a rural area of Faridabad: A cross-sectional survey. Indian J Community Fam Med 2021;7:130-4

How to cite this URL:
Gupta E, Goswami S, Aggarwal V, Singh M, Agarwalla R. Assessment of quality of life and its determinants among the elderly residing in a rural area of Faridabad: A cross-sectional survey. Indian J Community Fam Med [serial online] 2021 [cited 2022 Jul 4];7:130-4. Available from: https://www.ijcfm.org/text.asp?2021/7/2/130/333664

  Introduction Top

At a time of unpredictable challenges for health, one trend which is certain is population aging and this demographic transition will impact on almost all aspects of society. India currently comprises 8% of total population which is expected to increase to 12.7% by 2025.[1],[2]

The World Health Organization (WHO) has defined quality of life (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.”[3] It is a broad concept covering the individual's physical health, mental state, level of independence, social relationships, spiritual beliefs, and the environment.[4]

The share of elderly population in Haryana is 8.7% as per census 2011; higher proportion is present in rural areas as compared to urban area.[5] During the past decade, there are numerous studies describing the QoL in different geographical areas of India, but only one study has been conducted in Haryana in 2013.[6] There is no recent literature on elderly of Haryana region. Hence, this study was conducted to assess different domains of QoL and its determinants among the elderly population of a rural area of Faridabad.

  Material & Methods Top

The study was conducted among the rural elderly population residing in the field practice area of the rural health training center attached with the Department of Community Medicine of a Medical College of Faridabad, Haryana, over a period of 4 months from October 2018 to January 2019. The total rural population served by the center is about 9600 and geriatric population is about 800 (approximately 8%). A community-based cross-sectional design was adopted to study the QoL and its sociodemographic and health-related determinants among the elderly population. All elderly aged 60 years and above were included in the study, while elderly with severe illness not able to answer the questions and those who did not give consent to participate in the study were excluded from the study. Considering expected standard deviation of QoL score among elderly to be 10.97%[7] and tolerable error of 1.5% at 95% confidence interval, sample size was calculated as 206. After accounting for nonresponse and rounding off, 300 elderly were included for study. A list of elderly was obtained from the records of health workers beforehand, and subjects were selected using simple random sampling.

The WHO-QOL (BREF) is one of the best-known instruments for assessing QOL of life which has been adopted in number of countries including India. It contains 26 items covering four domains of QOL.[8],[9] A predesigned and pretested structured questionnaire in local language related to the QOL of elderly people devised by the WHO (WHOQOL)[1] was used for the study. It took into consideration four domains of QOL, i.e. physical, psychological, environmental, and social relationships.

Data collection was done by undergraduate medical students after being explained the purpose and objectives of the study. The study subjects were interviewed at their homes. For comparison of mean scores, t-test and ANOVA were applied. Level of significance was set at 5%. Multiple linear regression (MLR) model was run to identify predictors of QOL. There was no outlier and autocorrelation in our regression data, and the assumption for normality and homoscedasticity were met. Statistical analysis was done using the Statistical Package for the Social Sciences software version 21 (IBM Inc., Chicago, IL, USA).

The study was conducted following approval from the Institutional Ethical Committee (134/A/11/16/Academics/MC/2016/125), and informed consent was obtained from study participants after explaining the objectives of the study.

  Results and Discussion Top

A total of 300 elderly were interviewed with a mean age of 67.1 ± 6.9 years. Females (56%) outnumbered males. Similar findings have been observed in the studies carried out in Tamil Nadu by Sowmiya and Nagarani,[10] Jacob et al.[11] and Shah et al.[12] in Gujarat. It is because the life expectancy among women is more than males. Majority of geriatric population were either illiterate or just literate (can read and write) in current study. More than half of population was reported to be illiterate by studies conducted in rural Ambala[6] (63.9%) and rural Dehradun[7] (60.5%), rural Etawah[13] (66.5%), rural Wardha[14] (74.75%) and rural Dakshina Kannada[15] (62.9%). Other studies also reported majority of their population to be illiterate but not among more than 50% of population.[7],[12],[14],[16],[17] Major part of our study population was retired (78%) and 42% were homemaker. Shah et al., from Ahmedabad[12] reported 20% retired and Karmakar et al., from Tripura[17] had 18.4% retired geriatrics in their study which was much lower compared to our study. Contrastingly 90.8% of study population in a study by Joseph et al., were not working[16]. More than two third were currently married in current analysis. Around two thirds (66%) were living with spouse and children similar to majority of studies from rural parts of country. Studies from urban Gujarat[12] and Pondicherry[18] reported a lower proportion of elderly living in joint families. One third of elderly was economically dependent in current study. This was reported to be 34% by Krtika et al., and 49% by Bansal et al., in their study from Dehradun and Etawah respectively.[7],[13] Majority of population belonged to lower middle class of socio economic status similar to those reported from studies of Tripura and Ambala.[6],[17]

The mean total QOL score among the elderly in the current study was 61.45 ± 14.78. Mean QoL score was highest in psychological health domain and lowest in social relationships. Rural elderly probably tends to enjoy the power and have positive feeling about future due to traditional rituals hence scoring well on psychological domain in the current study. Similar findings were reported in a study from Puducherry.[14] Low social domain scores in our study points toward changing scenario of social structure of country with increasing number of nuclear families and decreasing interpersonal interactions. However, Karmakar et al.[17] in their study conducted in a rural area of Tripura found that mean QoL scores were maximum for social relationship domain and lowest mean score was seen in psychological domain. This difference may be due to difference in the sociodemographic profile of their study population having majority of males and 45% of their population were in 60–70-year age group.

The QoL scores were excellent in 11 (3.7%) subjects, good in 91 (30.3%) subjects, fair in 156 (52%) subjects, and poor in 42 (14%) subjects. Higher number of males had excellent/good QoL as compared to females, and this difference was found to be statistically significant (P = 0.002) [Figure 1]. However, community-based studies conducted in North Indian states by Qadri et al.,[6] and Kamra[18] reported a higher number of elderlies enjoying a good QoL (68.2%) with <15% elderly having a fair and poor QoL. They also reported better QoL among males, those who were currently married and graduates which is similar to our study findings.
Figure 1: Quality of life among male and female elderly subjects

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According to our study the distribution of four domain scores in different age groups shows that the mean physical, psychological, social and environmental score was highest in >80 years of age group whereas the lowest was observed in 71-80 years age group. Findings are non -concordant with the studies by Hameed et al.,[15] and Mudy et al.,[14] and Kumar et al.,[19] wherein they found an association between increasing age and reduction of QOL but similar findings to our study were reported by Ghosh et al.,[20] and Shah et al.,[12] where they found no significant association with age. A higher social relationship QOL score was reported among illiterate or just literate and no other trend was noticed. Which is non concordant with the studies by Qadri et al.,[6] Kritika et al.,[7] and Shah et al.[12] But similar to our study again no relation was reported by Bansal et al.,[13] and Karmakar et al.,[17] in their studies in rural areas of Etawah and Tripura respectively. Contrary to the fact that literacy brings better understanding of life and better opportunities of livelihood of elderly the population of our study did not rely on education to improve their QOL. Our study states the mean psychological score was highest for people in business or self-employed (currently) and lowest among homemakers in all domains while the physical health score was highest among retired population and social relationship was best in agricultural workers. The present study reported the mean score in all domains was lower among divorced/separated/widowed population as compared to currently married population. Concordant to our study results Kritika et al.,[7] from rural Dehradun also reported higher score in all domains among married elderly. Studies by Ghosh et al.,[20] and Mudey et al.,[14] conducted in rural areas of India reported a higher psychological domain score among married elderly. The study in rural Gujarat by Shah et al.,[12] reported a significant association between currently married and environmental domain score. Elderly living with their spouse are more cared and take interest in social activities hence a better score in all domains. In our study results mean scores were highest among the geriatric population who were economically independent in all domains except social relationship domain. In social relationship domain the mean score was highest in partially dependent population and lowest among independent population. It is obvious that those who are economically independent are currently working and living on their own. In both these scenarios the elderly tends to spend less time in social circle. Various other studies had a similar finding where financial independence was significantly associated with high QOL score for instance those of Kritika et al.,[7] Ghosh et al.,[20] and Bansal et al.,[13] in rural areas of Dehradun, Etawah and Bihar respectively.

The demographic and morbidity variables were subjected to Multiple Linear Regression, and it was found that only education, musculoskeletal, and central nervous system (CNS) disorders are significant predictors with QoL as dependent variable. CNS disorders had a higher impact as compared to education and musculoskeletal disorders by comparing standardized coefficient (beta) (0.178 for CNS disorders, 0.148 for education, and 0.145 for musculoskeletal disorders) [Table 1].
Table 1: Multiple linear regression model to identify predictors of overall quality of life

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The current study revealed that age and financial dependence were not found to be associated with QoL while better socio economic status (above poverty line) had better quality of life in all domains. Similar findings have been reported by Praveen and Rani[21] in Tamil Nadu, wherein age, marital status, and occupation did not have a significant association on QoL. Thadathil et al.[22] in their study in rural Kerala found that occupation, higher income, 60–69-year age group, staying with partner, and absence of comorbidity were found to be the determinants of better QOL score. Studies by Ghosh et al.[20] and Mudey et al.[14] conducted in rural areas of India reported a higher psychological domain score among married elderly similar to results of the current study. Elderly living with their spouse are more cared and take interest in social activities hence a better score in all domains.

Education was found to be the determinant of overall QoL among the elderly with literate elderly enjoying better QoL as compared to illiterate ones. This finding is concordant with findings of Hameed et al.,[15] Raj et al.,[23] Kritika et al.,[7] Qadri et al.,[6] and Kumar et al.[19] Literacy brings better opportunities of livelihood and better understanding of life processes, thereby leading to better QoL among literate elderly.

The present study had certain limitations. The study involved dealing with elderly population and assessment of QoL using a qualitative scale; hence, there are chances of recall and response bias. The study was confined to a small rural area of Faridabad; hence, generalizability of results may be an issue. Furthermore, QoL is a multidimensional parameter, and hence, its results might have been affected by some unknown confounders.

  Conclusion Top

The QoL scores among elderly of Faridabad were found to be suboptimal with scores in social relationship domain to be lowest. Periodic health checkups and strengthening of community care need to be done for early detection and control of the morbidities among the elderly. Various health promotion measures including recreational activities and environmental modification may help in improving QoL among the elderly. However, QoL is a multidimensional concept and more extensive research into the factors having a direct bearing on QoL needs to be undertaken.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Population Composition. Census of India 2011. Office of the Registrar General and Census Commissioner, India. Available from: http://www.censusindia.gov.in/vital_statistics/SRS_Report/9Chap%202%20-%202011.pdf. [Last accessed on 2020 Feb 12].  Back to cited text no. 1
Situational Analysis of the Elderly in India; June, 2011. Central Statistics Office, Government of India. Available from: http://www.mospi.nic.in/mospi_new/upload/elderly_in_india.pdf. [Last accessed on 2020 Feb 12].  Back to cited text no. 2
World Health Organization. WHOQOL-Measuring Quality of Life. Geneva: WHO; 1997. Available from: http://www.who.int/mental_health/media/68.pdf. [Last accessed on 2020 Feb 22].  Back to cited text no. 3
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World Health Organization. WHOQOL-BREF Introduction, Administration, Scoring and Generic Version of the Assessment. Field Trial Version. December 1996. Geneva: WHO; 1996. Available from: http://www.who.int/mental_health/media/en/76.pdf. [Last accessed on 2020 Jan 03].  Back to cited text no. 8
World Health Organization. Programme on Mental Health WHOQOL User Manual 1998. Geneva: WHO; 1998. Available from: http://www.who.int/mental_health/evidence/who_qol_user_manual_98.pdf. [Last accessed on 2020 Jan 03].  Back to cited text no. 9
Sowmiya KR, Nagarani R. A study on quality of life of elderly population in Mettupalayam, a rural area of Tamil Nadu. Natl J Res Community Med 2012;1:123-77.  Back to cited text no. 10
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