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ORIGINAL ARTICLE
Year : 2018  |  Volume : 11  |  Issue : 6  |  Page : 527-531  

Quality of life of elderly people in a rural area of West Bengal: A community-based study


Department of PSM, All India Institute of Hygiene and Public Health, Kolkata, West Bengal, India

Date of Submission09-May-2018
Date of Acceptance24-Jul-2018
Date of Web Publication15-Nov-2018

Correspondence Address:
Tania Pan
All India Institute of Hygiene and Public Health, 110 C R Avenue, Kolkata - 700 073, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mjdrdypu.mjdrdypu_78_18

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  Abstract 


Introduction: The quality of life (QOL) among the elderly is a neglected issue, especially in developing countries, including India. This study aims to assess the QOL and its associated factors among the elderly population residing in villages of Singur, West Bengal. Materials and Methods: A community-based cross-sectional study was conducted among 146 elderly participants (aged 60 years and above) selected using simple random sampling from Singur block from April to June 2017. A structured questionnaire was used to collect data on sociodemographic characteristics and self-reported comorbidities and QOL assessment was done using the validated Bengali version of EQ-5D-3L (EuroQol) questionnaire. Data entry and analysis were performed using SPSS version 16.0. Categorization of good and poor QOL was based on the median score. Results: Of 146 participants, 54.1% of the participants were found to have poor QOL. The mean (standard deviation) age of the study participants was 68 (5.87) years and 59% of the respondents were female. Most of the study participants (76.7%) had reported comorbidities. Higher percentage of participants reported problems in the dimensions of pain/discomfort and anxiety/depression in both the 60–69 and >69 age groups. In multivariable logistic regression, increasing age, financial dependence, and the presence of one or more comorbidities were significantly associated with poor QOL after adjusting with the other variables. Conclusion: The findings suggest the need for effective health promotion strategies with an emphasis on the prevention and management of chronic diseases. Provision for geriatric care with counseling and social assistance such as old age pension will further help improve their QOL.

Keywords: Community based, elderly, EuroQol, quality of life, rural population


How to cite this article:
Dasgupta A, Pan T, Paul B, Bandopadhyay L, Mandal S. Quality of life of elderly people in a rural area of West Bengal: A community-based study. Med J DY Patil Vidyapeeth 2018;11:527-31

How to cite this URL:
Dasgupta A, Pan T, Paul B, Bandopadhyay L, Mandal S. Quality of life of elderly people in a rural area of West Bengal: A community-based study. Med J DY Patil Vidyapeeth [serial online] 2018 [cited 2018 Dec 19];11:527-31. Available from: http://www.mjdrdypv.org/text.asp?2018/11/6/527/245437




  Introduction Top


Aging is an inevitable biological phenomenon. It is accompanied by an increased risk of disease, disability, decreased functional capacity, and eventually death. Although the United Nations does not have a standard criterion to define the aged, 60 and above years of age is generally referred to as the elderly population.[1] The population aging is a universal reality, both in developed and developing countries.[2] In the developing countries, the elderly population is increasing due to demographic transition, with a deterioration in their health as a result of rapid modernization and urbanization.[3] According to the United Nations estimates, the world population of the elderly 60 years and above will achieve 1.2 billion by 2050, increasing from 901 million in 2015.[4] That the number of older persons is growing rapidly in an international reality. Consequently, the share of older persons in the total population is increasing virtually everywhere.

At present, India is passing through a stage of demographic transition, and it has the world's second largest aged population.[4] As per census 2011, 8.6% of the total population is in the age group of 60 years and above (103.9 million) and most of them are residing in rural areas.[5] Currently, life expectancy at age 60 is 17.9 years.[5] Advances in health care and improvement in socio-economic status have not only resulted in increased longevity, but also led to changes in age structure and a higher dependency ratio.[6] Coexistence of multiple medical conditions makes them prey of functional decline, disability, higher hospital admissions.[7] The most common morbidities observed among the elderly are depression (31.4%) followed by musculoskeletal disorder (25.5%), hypertension (24.1%), gastrointestinal problems (11.5%), diabetes mellitus (5.9%), and neurological problems (4.7%).[8] Retirement, loss of spouse, and economic hardship have shown to account for the rise in the loss of functional ability and physical control in older ages.[9] Rapid growth and modernization have led to increase in the concept of nuclear family. Due to this reason, the elderly face psychological distress, and sometimes, they move to nursing home.[10] Thus, the combined effects of aging, social changes, and diseases are likely to cause a breakdown in health and their well-being.[11]

At this juncture, we need to reappraise the quality of life (QOL) of this vulnerable population. At the global level, QOL among the elderly is an important area of concern as it reflects their health status and well-being.[12] Many studies were conducted on QOL among the elderly in other countries.[13],[14],[15],[16],[17],[18] It remains to be a neglected issue especially in developing countries including India.[12] Very few studies had been conducted to assess the QOL among the elderly in rural India.[2],[19] There is a very little literature on the problems and issues faced by rural elderly.

Given the above, it is imperative to analyze the QOL and its associated factors among this vulnerable population so that effective measures to improve it can be implemented at the community level. Keeping this in mind, the study was carried out to assess the QOL of the elderly and its associated factors so that necessary healthcare can be delivered and appropriate plan of preventive measures can be drawn to help them lead a healthy and socially productive life.

Objectives

  1. To find the sociodemographic and lifestyle characteristics of the elderly people in a rural area of West Bengal
  2. To assess the QOL of the study participants
  3. To determine the various factors associated with their QOL.



  Materials and Methods Top


Study design and setting

An observational, community-based cross-sectional study was conducted for 3 months (April–June 2017) in a rural area of West Bengal, India, which is the service area of Rural Health Unit and Training Centre and All India Institute of Hygiene and Public Health. Ethical approval was obtained from the Institutional Ethics Committee.

Study participants

Elderly people (age 60 years and above) residing in the study area and who agreed to give informed consent were enrolled in this study. Out of 3 Gram Panchayats (GP) in the study area, one GP was selected at random. The sampling frame was prepared by enlisting all the elderly from the records of the GP. A total of 146 study participants were then selected using simple random sampling.

Study tool

A predesigned and pretested structured questionnaire was used to collect data on sociodemographic characteristics and self-reported comorbid conditions. The QOL was assessed using the validated Bengali version of EQ-5D-3L (EuroQol) questionnaire with due permission.

Quality of life

EQ-5D-3L instrument[20] comprises five-item descriptive system of health states (five dimensions) as follows: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Each dimension has three levels as follows: no problems, some problems, and extreme problems scored 0–2, 0 being the worst response and 2 being the best response. The responses were summed into a score ranging from 0–10. In this study, the median score of 8 was considered as a cutoff those scoring 8 or less were considered to have “poor QOL” and those scoring >8 had “good QOL.”

Data analysis

Statistical package for social sciences (SPSS) version 16 was used for the analysis of data. Measures of central tendency and dispersion were used to summarize numerical data and proportions to summarize categorical variables. The association between poor QOL and different variables was estimated in univariate and multivariable logistic regressions. Odds ratio with 95% confidence interval was computed. Explanatory variables found to be statistically significant in univariate logistic regression were entered into multivariable logistic regression. Value of P < 0.05 was considered statistically significant.


  Results Top


Of 146 participants, 86 (58.9%) were female and 60 (41.1%) were male. The mean age of the study participants was 68 (±5.87) years. The majority (62.3%) belonged to 60–69 years age group. About 35% of the participants were at present earning through their occupation and 26% widow/widower. All except seven participants lived in a joint family. Furthermore, 76% of the participants belonged to socioeconomic status Class II and III (according to Modified B. G. Prasad's Scale 2016). Among the participants, 30.8% of the participants were illiterate whereas 54.1% of the participants were addicted to tobacco. Most of the participants (76.7%) had reported comorbidities. Among them, hypertension (41.9%), diabetes (42.8%), and arthralgia (80.3%) were the most commonly reported conditions. Approximately, one-third (36.3%) of the participants reported having at least two of the five comorbid conditions.

A higher percentage of participants reported problems in the dimensions of pain/discomfort and anxiety/depression in both the 60–69 and >69 age groups [Figure 1].
Figure 1: Distribution of the study participants according to percentage reporting problems in dimensions of the quality of life and age groups (n = 146)

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Scoring based on EQ-5D-3L instrument showed that 79 (54.1%) had poor QOL [Table 1].
Table 1: Distribution of the study participants according to their quality of life (n=146)

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The association between poor QOL and different variables was examined employing univariate logistic regression [Table 2]. It was found that increasing age, female sex, loss of spouse, low level of education, financial dependence, and presence of one or more comorbidities were significantly associated with poor QOL.
Table 2: Bivariate logistic regression between poor quality of life and different variables (n=146)

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From [Table 3], it was obvious that, in the multivariable logistic regression analysis, only three of the explanatory variables, increasing age, financial dependence, and the presence of one or more comorbidities, retained their significance after adjustment. Value of Nagelkerke being 0.281 with nonsignificant Hosmer–Lemeshow test supported good fit of the model.
Table 3: Multivariable logistic regression between poor quality of life and explanatory variables (n=146)

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  Discussion Top


Majority of the participants in our study belonged to the age group of 60–69 years. Overall, the female participants were greater in number. The predominant religion was Hinduism. A study conducted among the geriatric population of Meerut by Charan et al. showed similar findings with respect to the age, religion, and gender composition.[21] In our study, the proportion of females (58.9%) outnumbered the males (41.1%). This finding is similar to that by other studies.[22],[23] The present study revealed that 26% geriatric population were living alone without any life partner. This figure is lower than that of a previous study by Shashi et al. in 2002 that found 39% of the geriatric population was living alone.[24] In this study, 30.8% of the elderly participants were illiterate, which is again lower than the 50.5% reported in a study by Sowmiya et al.[23] Financial independence in our study was found to be 35%. A previous study by Goel et al. had reported a slightly higher figure of 41.5% for financial independence.[25]

In this study, the proportion of the elderly with poor QOL was 54.1%. The present study found that the poor QOL is associated with increasing age, indicating that the despair of aging greatly affected their QOL. This situation also prevails in other countries where similar results are seen in the study conducted in Brazil by Helena A. Figueira where the young old (60–69 years) have better QOL scores than the old-old (70–79 years) and the oldest-old (80 and above).[26] Similar finding was available in studies by Heydari et al.[27] in Iran in 2012 and Lima et al.[28] in Brazil in 2009 using SF-36. Older people are more likely to be affected by illness, and it is a natural phenomenon. This statement is explained by the statement made 5 lines above, where the age range of oldest-old is defined. Hence, older people may perceive their health as poorer. Our finding is consistent with this hypothesis.

In this study, financial dependence was associated with poor QOL. In a study of the elderly in 2012 by using the National Sample Survey Organization 60th round data, economic independency was associated with perceived good health.[29] This may be because persons engaged in the occupation are less bothered about their minor difficulties in normal daily activities. Furthermore, one might argue that most elderly in rural India are poor and often their income does not adequately cover their living expenses and thus the elderly, particularly women, face multiple problems that influence the quality of their life. Financial independence is recognized as the most important predictor of QOL of the elderly among other factors examined. Having enough money is important to at least cover and meet the basic needs of life.

Last but not least, poor QOL was significantly more among those with one or more morbidities when compared to the elderly without any morbidity. Similar results are seen in the study conducted at Trivandrum by Kumar et al. they found that poor health in the presence of morbidity and dependence in activities of daily living (ADL) greatly lowered their QOL.[30] In the study conducted by Joshi et al. found that health status was an important factor that had a significant impact on the QOL of the elderly population.[31] Canbaz et al. showed that those who were suffering from chronic diseases had a lower QOL than those who were without any chronic disease.[32]

Limitations of the study

The present study has its own limitations. The sample size calculation was not done to elicit various associations. These were done only as exploratory exercises. Therefore, most of the deductions were more speculative than empirical. Underreporting of comorbidities is also another limitation. As this was a house-to-house survey, most morbidities were elicited by simple questions and self-reporting. We could not study some factors such as mental health status, complications of chronic morbid conditions of the elderly, and environmental factors due to feasibility constraints. In spite of these limitations, this community-based cross-sectional study gives valuable information on the QOL and its associated factors among the elderly population.


  Conclusion Top


Although the process of aging, disorders, and disabilities of old age cannot be totally prevented, suitable measures can be taken that would retard this progress, thereby leading to a longer period of health and thus preserving their QOL. The findings suggest the need for effective health promotion strategies to improve overall health status among the elderly. The health systems need to be aligned to meet the needs of the older people. Increasing awareness among the elderly about the available benefits is primary to its utilization among them. Emphasis should be on the prevention and management of chronic diseases. Provision for geriatric care with counseling should be arranged in the community to serve the elderly people especially to them who perceive their health as poor. Schemes need to be organized to meet the needs of reduced mobility and safety precautions of this vulnerable population. Providing for social assistance such as old age pension will further help improve their QOL.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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  [Table 1], [Table 2], [Table 3]



 

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