|RESEARCH IN BRIEF
|Year : 2019 | Volume
| Issue : 1 | Page : 73-77
A comparative study on quality of life of older adults
Lidziisa Mao1, Kasturi Mondal2, Madhushree Manna2
1 College of Nursing, CIHSR, Dimapur, Nagaland, India
2 College of Nursing, Asia Heart Foundation, Kolkata, India
|Date of Web Publication||09-Oct-2019|
Ms. Lidziisa Mao
College of Nursing, CIHSR, 4th Mile, P.O. ARTC, Post Box - 31, Dimapur - 797 115, Nagaland
Source of Support: None, Conflict of Interest: None
Old age is a critical period which requires special attention in adapting to the changes of life. A descriptive comparative research study was conducted to assess the quality of life (QOL) and its components among the older adults staying in old-age home and staying with family in selected area of Kolkata, West Bengal. A total of 100 senior citizens above the age of 60 years were selected as samples for the study, of which 50 were from old-age home and 50 from those staying with family. Standardised tool Short-Form 36 Version 2 - Health Survey and Multidimensional Scale for perceived social support were used to measure the QOL. Descriptive and inferential statistics were used to analyse the data. The study findings showed that there was a significant difference in the mean scores of QOL and the different domains of QOL of older adults staying in old-age home and family at (P < 0.05). Older adults staying in old-age home perceived better QOL as compared to those staying with family.
Keywords: Family, old-age home, older adult, quality of life
|How to cite this article:|
Mao L, Mondal K, Manna M. A comparative study on quality of life of older adults. Indian J Cont Nsg Edn 2019;20:73-7
| Introduction|| |
Ageing is a universal phenomenon; old age is not a disease, but a normal part of the human span. Ageing is normal, universal, progressive and irreversible process. It is an inevitable physiological phenomenon. A human's life is normally divided into five main stages, namely infancy, childhood, adolescence, adulthood and old age. In each of these stages, an individual has to find himself in different situations and face different problems, and the old age is not exceptional. Old age is accompanied with several physical and psychological problems. Old age is also considered as a social problem, since there is a change in socioeconomic status which adversely affects the individual's way of life. In old age, physical strength deteriorates, mental stability diminishes; money power becomes bleak coupled with negligence from the children and relatives. Physical changes in an individual cause decline in the normal functioning of the body. The elderly also feel low self-esteem due to loss of earning power and social recognition.
The Census of 2011 shows that India has reached a population of 1210 million. The size of India's population aged 60 and above is expected to increase from 77 million in 2001 to 179 million in 2031 and will rise to 301 million in 2051. As the ageing population is becoming more and more pronounced, the concern for the quality of life (QOL) and well-being of the older adults is also growing both in developing and developed countries. The World Health Organisation describes the QOL as a broad-ranging concept that incorporates individual's physical health, psychological state, level of independence, social relationships, personal beliefs and their association to salient features of the environment.
Vishal et al. conducted a cross-sectional study on depression among aged in Surat city among 105 elderly people each from the elderly living in the old-age homes, and those living in the affluent areas and in the slums of Surat city using a probability sampling technique. The results showed the overall prevalence of depression to be 39.04%, in which 20% in severe depression needed institutional treatment and were more in affluent areas and old-age home, and it was twice that in slum areas.
Saini and Jaswal conducted a comparative study on appraisal of QOL of older people living with sons and living with daughters in Ludhiana, Punjab. The study was based on 200 samples above the age of 65 years. The study findings were divided into three domains of QOL, positive, borderline and negative domains of QOL. The positive domain and adequate or borderline were found to be higher (56%–42%), with those staying with sons as compared to those staying with daughter (33%–34%). The third domain which is problematic or negative domain was found to be higher (33%) with those living with daughters as compared to (2%) with sons, which reveals the existing mindset and the inhibition of elderly persons to reside with their daughters except under unavoidable circumstances when they are left with no other option.
Dubey et al. conducted a comparative study to understand the feeling of elderly women above 60 years residing in old-age home and within family setup in Jammu. The study reveals that 60% of the elderly women living in the families had positive attitude towards old age. Majority (63.3%) of the elderly women living in family felt that it was a period of dependency, 16.6% felt economically insecure and 20% perceived old age as a stage of loneliness, whereas 40% of elderly residing in old-age home stated about economic insecurity and loneliness. Most (96.6%) of the elderly living at home had social support and only 33.2% of elderly living in old-age home perceived receiving social support.
Naik conducted a comparative study to assess the emotional well-being of senior citizens staying in old-age home versus senior citizens staying with family and found that majority (90%) of the senior citizens from old-age home were under borderline emotional well-being (61–80), 5% of them under negative emotional well-being (40–60) and only 5% are under positive emotional well-being. Whereas senior citizens staying with family, 92% were under positive emotional well-being, but in both groups of senior citizens, no one was under extremely positive emotional well-being.
Although a specific reason to why an older person suffers from emotional problems cannot be articulated, many factors such as physical, psychological, biological, genetic and environmental factors may trigger adverse reactions and problems. Thus, there is a need to identify the problems of the elderly client, so that intervention could be planned or recommended to improve the QOL of the elderly population. Keeping in view the findings observed in scientific literature, the present study intended to compare the quality life of older adults living in the old-age home and with a family.
Objectives of the study
The main objectives of the study are as follows:
- To assess the QOL of the older adult staying in old-age home and staying with family
- To compare the QOL of the older adults staying in old-age home and staying with family.
The conceptual framework of the study was based on the revised Wilson–Cleary conceptual model of health-related QOL (HRQoL).
The conceptual framework of the present study is based on the revised Wilson–Cleary conceptual model of HRQoL. Wilson and Cleary have challenged the field of HRQoL, by moving it from descriptive models to an explanatory model by explaining the causal relationships among each of the components of HRQoL. The components of the model comprise five primary levels of patient characteristics including (1) biological-physiological factors, (2) symptom status, (3) functional status, (4) general health perceptions and (5) overall quality of life. In addition, characteristics of the individual as well as the environmental factors are included in the model as non-specific predictive variables of symptom status, functional status, general health perceptions and overall quality of life. Overall quality of life should be related to HRQoL but is also determined by other salient life circumstance and experiences. Using the Wilson and Cleary model of HRQoL, relationship of all the various components faced by the older adults with his individual characteristic and the effects of environment in attaining the quality of life can be explained [Figure 1].
|Figure 1: Conceptual framework based on revised Wilson and Cleary model of health-related quality of life.|
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| Methods|| |
Descriptive comparative research design was used for the study. Older adults above the age of 60 years staying in old-age home were selected by using total enumerative sampling technique. Convenient sampling technique was used for selecting sample of older adults staying with family. The sample size was calculated as 100 out of which 50 were from old-age home and 50 from elderly residing in family. The instrument consisted of two tools. The first tool consisted of two parts. Background information of the sample as Part A which was developed and the tool was validated by expert from Community medicine, Community Health Nursing and Mental Health Nursing Departments. Reliability of this tool was done using inter-ratter and 100% agreement was obtained. The Part B of the first tool was a standardised tool, the tool, Multidimensional Scale for Perceived Social Support, was used to assess the social support of the older adults. The tool II, Short-Form 36 Version 2 - Health Survey is also a standardised tool used for assessment of QOL of older adults.
This study was approved by the Ethical Committee of Asia Heart Foundation; RTIICS, Mukundapur. Formal administrative permission was obtained from the authority of the old-age home. Participants who fit the inclusion criteria were conveniently selected from residential areas for elderly living with families. Consent was obtained from the client after introducing self, establishing rapport and explaining the objectives of the study. The investigator collected the data using the standardised questionnaire by interview technique which took about 30–40 min for each person. The data analysis was done using the descriptive and inferential statistics (correlation coefficient using Pearson formula and t-test to check the significant difference) based on the objective of the study.
| Results|| |
The data given in [Table 1] indicate that out of 50 older adults staying in old-age home, 44% falls within the age group of 70–79 years, whereas 46% falls within the age group of 65–69 years in family. The data also show that majority of the participants (70%) in old-age home and 54% staying with family were female. Fifty percent of old-age home participants had completed their graduation, whereas in family, maximum (52%) had high school qualification. Majority of the participants in old-age home (66%) were widow or widower, whereas 64% staying with family were living with spouses.
|Table 1: Frequency and percentage distribution of older adults in old-age home and staying with family|
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The data presented in [Figure 2] show that majority (76%) of participants in old-age home had above average QOL. With regard to participants living with family, 50% had either above or below average QOL.
|Figure 2: Frequency and percentage distribution of older adults staying in old-age home and with family according to their quality of life.|
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There was a statistically significant difference between the QOL of the older adults staying with family and staying in old-age homes (P< 0.05) [Table 2].
|Table 2: Difference in quality of life mean scores between older adults staying in old-age home and family|
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[Table 3] shows that the mean score for bodily pain of older adults staying in old-age home is significantly higher than older adults staying with family (P< 0.01). Fatigue scores were significantly higher in older adults staying in the family than for those in the old-age home (P< 0.05).
|Table 3: Difference in physical domain of quality of life of older adults in old.age home and family|
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[Table 4] shows that the mean score for general health perception of older adults staying in old-age home (54.7) was significantly higher than the mean score (35.9) for those who stayed with families (P< 0.001).
|Table 4: Difference in emotional domain of quality of life of older adults in old-age home and family|
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The mean score for social functioning was significantly higher in older adults in old-age home (P< 0.05) and the mean scores for social support was statically higher in participants staying with family (P< 0.001) [Table 5].
|Table 5: Difference in social domain of quality of life of older adults in old-age home and with family|
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| Discussion|| |
Majority of older adults in old-age home in this study were above 70 years (72%), were females (70%) and had retired from work (70%). About half (50%) also had completed graduate or professional level education. In comparison, most (46%) living with families were <70 years, were also females (54%), half the proportion had retired from work and majority had completed high school level education (52%) or had not attended school (36%). The common reason for older adults living in old-age homes in India can be attributed to the break in traditional family systems, resulting in neglect and rejection of elderly. As they grow older and become dependent, they may be considered as a burden. Therefore, older adults may live in old-age homes on their own choice or by force. The findings in this study do not elaborate on the reason for older adults living in old-age home. However, the demographic features of participants living in old-age home in this study allude to a group of educated retired individuals who could have chosen to live in old-age home, especially in the specific study centre where there is assistance for all type of needs. This does have an influence on the study findings.
The mean QOL scores, in this study, were significantly higher in older adults living in old-age homes than those who were living with families (P< 0.05) which is contrary to other study findings which reveal that older adults living with families had a better perception of well-being and satisfaction with life, and a positive attitude towards old age. The presence of helper/assistant in the old-age home to meet the needs of older adults in this study centre could be a major influencing factor which needs exploration.
The domains of QOL measured are physical functioning, role limitations due to physical health, role limitation due to emotional problem, energy/fatigue, emotional well-being, social functioning and bodily pain. Each component for the older adults who stayed in old-age home was statistically significant at P < 0.05 level except general health perception and social support which were highly significant (P< 0.001) for those who stayed with family in this study. The mean scores for bodily pain although was higher in participants in old-age home (72.1 vs. 57.75), fatigue and physical functioning had a higher mean score (65 vs. 58.4) in older adults living with families. Physical functioning and fatigue can be attributed to the participatory activities that older adults take up in families such as child rearing, household chores, simple shopping or cooking. These activities can also contribute to the overall low mean score in general health of participants living with families. The participatory activities, however, could have contributed to participants living with families to perceive better emotional well-being (57 vs. 50.08). Participation in family activities also facilitate social interactions and expression of feelings leading to better perception about social support revealed by the higher mean scores in the older adults living with family (77.34 vs. 47.68) compared to their counterparts in old-age homes. Similar findings regarding higher social relationship was perceived by family-dwelling older adults in another study. While living with family is considered good and acceptable, the findings from this study indicate that on many aspects older adults living in old-age homes perceive better QOL.
| Conclusion|| |
Elderly living in old-age home have better QOL as compared to those living with family due to the presence of helper who can help them at any time, whereas older adults living with family do not get the required attention from their family and maybe expected to provide assistance with family activities and chores. Elderly living in family have more social support as compared to those living in old-age homes. It is, therefore, necessary to provide more care to older adults living with family and more social support to those living in old-age home. The community health nurse has a vital role to play in uplifting the QOL of older adults by educating the community people on issues related to health. They can help this vulnerable group in planning ways to improve their QOL. Old-age homes with assisted living facilities may now be an attractive option for many older adults, especially those who can afford. This paradigm shift in the life of elderly also needs to be considered when planning health and well-being activities for older adults.
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Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]