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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 18  |  Issue : 4  |  Page : 196-200

A comparative study on quality of life of elderly among those living with families and in old age homes in a District in South India


1 Department of Community Medicine, Dhanalakshmi Srinivasan Medical College Hospital, Perambalur, Tamil Nadu, India
2 Department of Community Medicine, Srinivasan Institute of Medical Science, Samayapuram, Tamil Nadu, India

Date of Submission11-Aug-2022
Date of Decision12-Oct-2022
Date of Acceptance27-Oct-2022
Date of Web Publication27-Dec-2022

Correspondence Address:
Dr. Neethu George
Department of Community Medicine, Dhanalakshmi Srinivasan Medical College and Hospital, Perambalur, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiag.jiag_40_22

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  Abstract 


Introduction: The elderly population in India is steadily increasing and it is expected to triple in 2050 as of the census 2011. Drastic improvements in health care made betterment in physical health but their subjective well-being remains unaccounted. Therefore, the present study aims to assess the quality of life (QoL) among elderly and to compare the differences in QoL among elderly population residing in homes and in old age homes. Methodology: An analytical cross-sectional study among elderly above the age of 60 years residing with families and other 40 elderly population residing in old age homes. A questionnaire-based interview was conducted using a standard semistructured World Health Organization-BREF QoL questionnaire. Results: In the study, most of the participants 45 (56.3%) were male and 35 (43.8%) belonged to the age group of 70–79 years with a mean (standard deviation) age of 73.96 (7.44) years. The study found that there is nil significant difference in QoL among elderly living in old age homes and in family setups. The domain scores of psychological, social, and environmental domains showed a slight nonsignificant increase in elderly among old age homes. Conclusion: The study showed nil significant difference in QoL score in all domains for the elderly. The concept of QoL needs to be looked into with more preference to psychological, social, and environmental domains.

Keywords: Elderly, families, old age homes, quality of life


How to cite this article:
Vignesh NJ, George N, Hemadharshini S. A comparative study on quality of life of elderly among those living with families and in old age homes in a District in South India. J Indian Acad Geriatr 2022;18:196-200

How to cite this URL:
Vignesh NJ, George N, Hemadharshini S. A comparative study on quality of life of elderly among those living with families and in old age homes in a District in South India. J Indian Acad Geriatr [serial online] 2022 [cited 2023 Feb 8];18:196-200. Available from: http://www.jiag.com/text.asp?2022/18/4/196/365771




  Introduction Top


The population of India is around 138 billion.[1] Of the total population, the old age dependency ratio of 2021 is projected to be 15.7%. The national policy for older persons defines “senior citizen” or “elderly” as a person who have neared or surpassed the average life span of human beings' age and a person who is of age 60 years or above is usually considered elderly.[2] There is a steady state of the rise of the elderly population in India due to demographic transition and as per population census data, the decadal growth of the elderly population from 2011 to 2021 is 35.7% which is expected to rise on further projections.[3] The reason for this improved life expectancy was due to improved health-care facilities and economic well-being and all of which have contributed to improvement in physical health of the elderly. Physical health is defined as the optimal functioning of all cells, tissues, and organs in the body. However, improvement in physical health did not necessarily result in improvement of the overall well-being of the elderly.[4],[5]

According to the Centers for Disease Control and Prevention, well-being is defined as the “presence of positive emotions and moods, the absence of negative emotions, satisfaction with life, fulfillment, and positive functioning.”[6] A very good measure of a person's subjective well-being is through quality of life (QoL) assessment.[7],[8] The World Health Organization (WHO) has defined QoL as an individual's perception of their position in life in the context of the culture and value systems, in which they live and in relation to their goals, expectations, standards, and concerns.[9] Hence, the present study used the QoL Scale, developed by the WHO to measure the subjective well-being of the elderly. In the Indian context, the elderly population mostly resides with their children as a joint family. With modernization, the proportion of joint families has significantly reduced and there is an increasing dependency on old age homes for the elderly.[10] As per the “Elderly in India 2021” report, the percentage of the elderly population residing as inmates in old age homes is around 4.4% in India as a whole and the data from Tamil Nadu indicates such utilization at 9.5% which is double the national average.[11] Although all their basic needs are addressed in old age homes, they lack the care and support which is most needed. This leads to a void and deterioration in overall well-being of the elderly. Therefore, the present study aims to assess the QoL among elderly and to compare the differences in QoL among elderly population residing in the home setting and in old age homes.

Objectives

  1. To estimate the QoL among elderly residing at home and in old age homes of Perambalur
  2. To compare the QoL among elderly residing in homes and in old age homes of Perambalur.



  Methodology Top


An interview-based cross-sectional study was conducted among elderly population residing in homes and old age homes within a period of a month (July 2021August 2021). The data were collected from the elderly population who were above the age of 60 years, in these two settings around Perambalur. Ethics committee approval and informed consent were taken before the start of the study.

The sample was collected using a convenient sampling technique and the sample size was 80. The study collected data among 40 elderly who were residing with families and another 40 elderly who were residing at an old age home. The participants were selected from the respective groups based on consecutive sampling with an inclusion criterion where we took subjective who were more than 60 years and willing to participate in the study.

A questionnaire-based interview was conducted, and the objective was assessed using a validated semistructured WHO QoL BREF scale which contains 26 questions. Each of the questions assesses a facet and four domain scores are obtained in the final analysis. The domains are physical, psychological, social relationships, and environmental. Along with the assessment of QoL, participants' basic sociodemographic details such as age, gender, and marital status were obtained.

The data collected were entered into SPSS Inc. Released 2007. SPSS for Windows, Version 16.0. Chicago, SPSS Inc. The descriptive analysis was analyzed using frequencies, mean, standard deviation (SD), and proportions. The tests of association were performed using appropriate tests like independent/unpaired t-test and P < 0.05 was considered statistically significant.


  Results Top


Data were collected from 80 elderly people during the study period. Most of the participants 45 (56.3%) were male and 35 (43.8%) belonged to the age group of 70–79 years. The mean (SD) age was 73.96 (7.44) years. Most of the participants were pensioners 40 (50%) and were married 49 (61.3%) [Table 1].
Table 1: Basic characteristics of study participants (n=80)

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The data about QoL were collected using the WHO BREF questionnaire and the mean score and SD for all four domains were calculated. The physical health domain had the highest mean (SD) score 45.56 (7.56), whereas the environment domain had the least 39.02 (10.21). The mean scores of the psychological domain and social relationships domain were 42.90 (9.89) and 39.06 (16.32) [Table 2].
Table 2: Quality of Life scores across the domain (n=80)

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The association between the quality of life score and residence was tested using independent t test [Table 3]. The elderly living in old age homes had domain scores of physical 45.93 (7.98), psychological 44 (12.97), social relationships 41.53 (18.94), and environment 40.48 (37.58). The elderly living along with families had a domain score of physical health 45.20 (7.20), psychological 41.80 (5.24), social relationships 36.60 (12.98), and environment 37.58 (6.52). All four QoL domains were not significantly associated with place of residence. This shows that the elderly living along with families and in old age homes has the same QoL and there is no difference in their subjective well-being.{Table 2}

For the elderly population, the psychological domain score decreased with aging (60–69 years = 45.81 ± 10.77, 70–79 years = 43.03 ± 10.39, and ≥ 80 years = 38.68 ± 5.75), and it was found to be significantly associated (t = 7.478, P = 0.024). The psychological domain score was also found to be significantly associated with marital status (t = 9.284, P = 0.026) where scores were high for the elderly who were unmarried and divorced compared with married and widowed (Divorced = 43.88 ± 12.16, Married = 42.94 ± 9.07, Unmarried = 47.62 ± 10.68, and Widowed = 35.80 ± 7.94).

All other domain scores were not found to be associated with demographic characteristics such as age, gender, education, and marital status.


  Discussion Top


The present study was carried out among elderly population residing with families and in old age homes. Data were collected from a total of 80 elderly age group persons. The study was conducted to identify the difference in QoL among elderly living in old age homes and in family setup. In our study, we found that there is no significant difference in QoL among elderly living in old age homes and family setup.

Most of the elderly population belonged to the age group of 70–79 years with a prevalence of 43.8%. In a study conducted by Amonkar et al.[12] in Maharashtra, the majority of the participants in old age homes were 80 years older and above (46.7%). This is in contrast to the age groups of the study conducted by Shah et al.[13] in Ahmedabad, where the mean age of study participants was 65.8 years. The reason for this difference might be that only the elderly living in family setup is included in Shah et al.'s study.

In the present study, the elderly females were 43.8% and the elderly males were 54.2%. In a study conducted by Khaje-Bishak et al.[14] in Iran, the female participants (47.3%) were less compared to male participants which are similar to our study. The reason for this may be due to regional differences.

32.5% of elderly people had no formal education in our study which is similar to the study conducted by Shah et al.[13] in Ahmedabad, where 35.6% of the elderly had no formal education.

The mean score for four different domains, namely, physical, psychological, social, and environmental was illustrated for QOL. Scoring of the QOL profile revealed that the mean scores of QoL in various domains are distributed almost in equilibrium. This is different from a study conducted by Devraj et al.[15] in Karnataka, where QoL scores in social domain were more less compared to other domains. In the present study, the mean score of physical health domain was maximum among both elderly living in old age homes (45.93 ± 7.98) and in family setup (45.20 ± 7.20) as compared to other three domains. The lowest mean score was observed among social relationship domain in family setup (36.60 ± 12.98) and in environmental domain among elderly living in old age homes (40.48 ± 12.82). This is in contrast to the study conducted by Sowmiya and Nagarani[16] in Tamil Nadu, where the highest score was for the social relationship domain.

The mean scores of physical health in old age homes and in family setup were 45.93 ± 7.98 and 45.20 ± 7.20. This is similar to the study conducted by Chandrika et al.[17] in Vishakapatnam, where the physical health scores of the elderly living in old age homes and in family setup were 52 and 51.35. In both studies, the physical health QoL scores are similar in both old age homes and in family setup. The overall physical health score is also not very low. However, in a study conducted by Thresa and Indumathi[18] in Kancheepuram, it was found that physical health QoL scores are low in both old age homes (22.5 ± 4.18) and in family setup (19.6 ± 4.08). This is also similar to a study conducted by Shrestha et al.,[19] where the physical domain score for the elderly in old age homes and in family setup was 16.50 and 21.88. The reason for this disparity may be due to the distinction between access to health-care facilities and health-seeking behavior.

The psychological domain scores of the elderly living in old age homes and in family setup are 44.00 ± 12.97 and 41.80 ± 5.24. In a study conducted by Kengnal et al.[20] in Karnataka, the psychological domain scores were 44.47 for the elderly in old age homes and 45.43 for the elderly living in family setup. In both studies, the psychological domain scores are not very less and similar. One possible reason for this similarity may be due to the number of married couples and the number of widows. The majority (61.3%) of the elderly population in our study are currently married and have their spouse alive. Having someone to talk to could have a good impact on mental and psychological health.

The environmental domain score for the elderly overall was 57.6 based on the study in Gujarat conducted by Shah et al.[13] This is different from the environmental domain scores (39.02) in our present study. In another study conducted among Turkish elders,[21] the environmental domain scores were 75.9 ± 17.9 in old age homes and 66.5 ± 17.2 for elders living with family. This contrasts with our present study, where the environmental domain scores were 40.48 ± 12.82 and 37.58 ± 6.52 for elderly in old age homes and in family setup. This huge difference in environmental domain scores may be due to differences in economic development and lifestyle conditions between these places.

The social relationships domain score in our study is 41.53 ± 18.94 and 36.60 ± 12.98 for elderly in old age homes and in family setup, respectively. In a study conducted by Qadri et al.[22] in Haryana, the mean social relationships score among the elderly was 88.25 ± 12.38. The reason for this huge variation in social relationship score may be due to the type of residence. The above study was conducted in specific among rural elderly, whereas our study was conducted in both urban and rural settings.

In our study, the QoL of the elderly living in old age homes is not significantly different from the QoL of the elderly living with families. However, this contrasts with the study conducted by Prakash R. Kengnal et al.,[20] where the mean psychological and environmental domain scores are significantly higher for elderly living with family when compared with old age home. Furthermore, in another study conducted by Kohl Iii et al.,[5] the QoL of elderly living with families was found to be better when compared to the QoL of elderly living in old age homes. The elderly living with families have a better QoL and this indicates the importance of emotional attachment and the importance of blood relationships. Although a peaceful environment can be provided through old age homes, family support has a significant influence in improving the QoL of the elderly. However, in a study conducted by Mao et al.[23] in Nagaland, the mean QoL scores of elderlies living in old age homes are higher when compared to the QoL of elderly living with families. This may be due to the improved quality standards in old age homes when compared with housing quality of standards of their families.

A study conducted by Devraj et al.[15] shows that the QoL is significantly associated with marital status which is similar to our study findings. However, the scores were highest for the married elderly in there which is in contrast to our study. The reason for this difference may be because the majority of the participants are married in their study while there is difference in marital status distribution of the elderly in our study.

The country is going to face an avalanche of the elderly population due to improved health-care facilities and better health-seeking behavior. Therefore, measures should be adopted in the family itself to promote physical, psychological, environmental, and social well-being of such participants. The incorporation of peer group meetings, support group in terms of exercise, and psychology and mandatory physical checkups may improve the well-being a little more. Along with measuring subjective well-being, objective measures should be assessed using laboratory tests and clinical examinations to make the result clearer. Future research focusing on measuring QoL should choose a sample population from a wide number of old age homes rather than a single old age home along with added variables to measure depression, etc., should be focused.

The present study has few limitations which may affect the results. One limitation is a selection of the sample population. The elderly population chosen for our study is pooled from a single old age home. The elderly population living in different old age homes may show different scores in QoL. The study was conducted through convenient sampling which makes the result to be less clear and lacks externally validity. Although a standard questionnaire has been used to measure the QoL, the individual scores are affected due to subjective variation and the way it is perceived. The investigator is also new to the participants and there is inadequate communication between them. This led to a lack of adequate rapport of interviewer with the participant making the participants hesitate to tell the truth to a stranger.


  Conclusion Top


In the present study, no significant difference was observed in QoL scores in physical health, psychological, social relationship, and environment domain between elderly living in old age homes and among elderly living in family setup. A minor nonsignificant increase in social, psychological, and environmental domains of QoL scores was seen in those who lives in old age homes.

One way to improve the overall QoL of the elderly would be to sustain and improve the communication and interaction skill with the elders in a family environment. Since many observational studies are available to assess the QoL, various intervention strategies focusing on improving QoL among elderly population should be conducted.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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