Journal of Medical Society

ORIGINAL ARTICLE
Year
: 2021  |  Volume : 35  |  Issue : 3  |  Page : 92--97

Health-related quality of life of the geriatric population living in rural areas of West Tripura district of India: A cross-sectional study


Arpita Debnath1, Himadri Bhattacharjya1, Partha Sarathi Pal2,  
1 Department of Community Medicine, Agartala Government Medical College, Agartala, Tripura, India
2 Department of Biochemistry, Agartala Government Medical College, Agartala, Tripura, India

Correspondence Address:
Himadri Bhattacharjya
Department of Community Medicine, Agartala Government Medical College, P. O. Kunjavan, Agartala - 799 006, Tripura
India

Abstract

Background: Growing life expectancy is challenging the quality of health care for elderly. Information regarding health-related quality of life (QOL) may help policy makers to design need-based health programs for this population. Objectives: The objective of the study was to estimate health-related QOL of the geriatric population living in rural areas of West Tripura district and to compare it between ethnic and nonethnic populations in respect to important domains. Materials and Methods: This community-based cross-sectional study was conducted during February 1, 2019–March 31, 2020 among 225 geriatric subjects of rural West Tripura district chosen by multistage sampling. The World Health Organization's QOL–BREF scale was used for data collection. Results: Among the study population, 46.2% had overall good health-related QOL. About 52.9% had good QOL in the environment, and 37.3% had good QOL in social relationship domains. Marginally higher proportion of the subjects from ethnic origin had better QOL than the nonethnic, but it was not significant. A higher proportion of the Muslim subjects had better QOL than the rest, but it was also not significant. Bivariate analysis showed significant associations of QOL with age, sex, literacy, financial condition, socioeconomic status, and type of family. Multivariate analysis identified male sex, younger age, and living with spouse as significant predictors of good QOL. Conclusion: Overall health-related QOL of the geriatric people living in rural areas of West Tripura district is poor, but younger male subjects of ethnic origin and living with spouse may enjoy relatively better QOL.



How to cite this article:
Debnath A, Bhattacharjya H, Pal PS. Health-related quality of life of the geriatric population living in rural areas of West Tripura district of India: A cross-sectional study.J Med Soc 2021;35:92-97


How to cite this URL:
Debnath A, Bhattacharjya H, Pal PS. Health-related quality of life of the geriatric population living in rural areas of West Tripura district of India: A cross-sectional study. J Med Soc [serial online] 2021 [cited 2022 Nov 30 ];35:92-97
Available from: https://www.jmedsoc.org/text.asp?2021/35/3/92/347641


Full Text



 Introduction



Quality of life (QOL) is defined by the World Health Organization (WHO) as “the condition of life resulting from the combination of the effects of the complete range of factors such as those determining health, happiness, education, social and intellectual attainments, freedom of action, justice and freedom of expression.”[1]

All the aspects of health status, lifestyle, life satisfaction, mental state, and well-being together reflect the multidimensional nature of QOL.[2] As life expectancy keeps on rising, the biggest challenge to public health remains the improvement in the QOL during the later phage of life.[3] In old age, there is an increased risk of morbidity due to limitations of movements due to pain and discomfort, and this is exacerbated by financial burden and the general difficulties in accessing health care services. Geriatric health care services being a relatively newer discipline in the developing world, modern physicians of these countries need to be sensitized regarding the clinical and social implications of aging.

The medical and psycho-social challenges being faced by the elderly people should be highlighted and strategies for bringing about an improvement in their QOL should be implemented.[4] In India, the share of the population over the age of 60 years is 8.6%, which will increase to 19% in 2050.[5] According to census 2011, there were nearly 104 million elderly persons (aged 60 years) in India.[6]

Tripura state has the highest proportion of the elderly population (7.9%) among all the North-Eastern states of India, which is 206 per thousand general populations in the rural areas.[7] Though there are many global and Indian studies regarding the assessment of QOL among geriatric population, limited studies have been conducted in North-East India and the scenario in Tripura is further unexplored. In this context, the present study was designed to estimate the health-related QOL among the geriatric population living in rural areas of the West Tripura district of India and determine the associations of various factors with their QOL.

 Materials and Methods



This community-based cross-sectional study was conducted during February 1, 2019–March 31, 2020 in the rural areas of West Tripura district. A predesigned, pretested, and structured interview schedule containing sociodemographic information and WHO's QOL–BREF scale (WHOQOL-BREF)[8] were used for collecting data.

Minimum sample size requirement for this study was calculated using the formula: N = Z2α/2 σ2/d2.[9] Where, n = sample size; ỏ = standard deviation (SD) of overall QOL (10.21 in this study).[10] Zα/2 = 1.96 (value of the standard normal deviate at 5% level of significance), d = absolute precision = 2 and additional 10% for the incomplete responses was considered for this study. Thus final sample size was calculated to be 220 geriatric subjects.

Multistage random sampling technique was adopted for selecting the study subjects. West Tripura district has got nine blocks. Block-wise list of subcenters was obtained from the Directorate of Family Welfare and Preventive Medicine and used to construct sampling frame. One subcentre from each of these blocks was selected by simple random sampling without replacement. Thus, nine subcenters were selected from 9 blocks. Households having geriatric subjects were identified by studying the family registers maintained at different subcenters, and subcenter level sampling frames were prepared. Equal number of study subjects was planned to be selected from each subcenter. Thus, (220 ÷ 9) = 24.44–25 geriatric individuals were selected from each subcenter area by simple random sampling without replacement. Only one geriatric individual from each of these identified houses were selected by lottery, and thus total 225 geriatric individuals were enrolled in this study.

WHOQOL-BREF questionnaire considered four domains, namely, physical health, psychological, social relationships, and environmental domain and contained 26 questions. Likert's 5-points scale in the positive direction was used for rating each of these domains. As per the WHO guidelines, scores for each domain were calculated by adding the scores of all items of that domain and transforming them into a value ranging from 4 to 20. Overall total and mean score of all the domains were calculated. The mean score for overall QOL was considered as cutoff. Those who scored equal or more than the mean score were considered as having good QOL, and those scored below the mean were considered as having poor QOL.

Subjects aged ≥60 years were considered as geriatric subjects. Subjects residing in block or village panchayet areas were considered as the rural subjects. Subjects belonging to the tribal communities were considered as ethnic people. Socioeconomic status of the study subjects was determined using BG Prasad's socioeconomic classification scale 2019. Subjects having no formal schooling were considered as illiterate, schooling up to any level up to Class V as primary, any level between Class V to XII as secondary, and up to any level beyond Class XII were considered as graduate and above.

Data were entered and analyzed in computer using SPSS-25 for windows (IBM Corp. Released 2017. IBM SPSS Statistics for Windows, version 25.0. Armonk, NY, USA: IBM Corp.). For summarizing the qualitative data frequency and percentages and for quantitative data, mean and SD were used. Chi-square statistic was applied to test the associations of QOL with different sociodemographic parameters and also to see their significance. Binary logistic regression analysis was applied to study the effect of predictor variables in determining QOL. P < 0.05 was considered statistically significant. Institutional Ethics Committee of Agartala Government Medical College has approved this study.

 Results



Overall, QOL was found to be good in 46.2% of the geriatric subjects. Marginally higher proportion of the subjects from ethnic origin had better QOL than the nonethnic, but it was not significant. The study subjects perceived physical health as the most important factor (Mean [SD] score 73.18 [9.65]) and social health as the least (Mean [SD] score 27.5 [6.43]) for QOL. It was found that 52.9% of the study subjects were enjoying good QOL in the domain of environment and 37.3% in the social domain.

Regarding sociodemographic parameters, mean (SD) age of the study subjects was 69.67 (±8.8) years. The majority, i.e., 56% were aged between 60 and 69 years followed by 27.6% aged between 70 and 79 years, and 16.4% were aged 80 years and above. Among the study subjects, 53.3% were female, 86.2% were Hindu by religion, 12% were Christian, 1.3% was Muslim, and only 0.4% were Buddhist by religion. Regarding marital status, 72% were married, 27% were either widow or widower. Separated and unmarried were 0.9% each. Regarding community, 41.8% belonged to scheduled tribe, i.e., of ethnic origin, 18.2% to scheduled caste, 19.1% to general caste, and 20.9% to other backward communities. Regarding literacy, 66.1% were illiterate, 25.3% studied up to primary level, 4% up to secondary level, and only 3.6% studied up to either graduate level or above. Regarding occupation, 53.3% were unemployed, 13.8% were house wives, 6.7% were retired employees, 1.8% were in service, 11.6% had own business, and 12.9% were either farmer or daily labor. Majority, i.e., 72% of the study subjects belonged to joint families, 67.6% were living in kutcha houses, 36.4% belonged to lower middle class, 24% to middle class, 16.9% to lower, 16.4% to upper middle, and 6.2% to upper socioeconomic class. Among all, 46.7% of subjects possessed APL category ration cards.

Chief complaints reported by the geriatric study population are shown in [Table 1].{Table 1}

On clinical examination, 23.9% of the study subjects were found to be normotensive, 30.7% prehypertensive, 25.8% Stage I hypertensive and 14.2% Stage II hypertensive. Majority, i.e., 68% of the study subjects were euglycemic followed by 19.1% prediabetic and 12.9% diabetic. Among all 53.3% had normal body mass index, 40.9% were underweight, 4.9% were overweight, and 0.9% were obese.

Subjects aged either 70 years or less had significantly higher QOL in physical and social domains than those aged >70 years (P < 0.05). Male subjects had a significantly higher QOL in physical and psychological domains than the females. It also shows that subjects belonging to ethnic origin had significantly higher QOL in social domain than those of nonethnic origin (P < 0.05). Subjects who were Hindu by religion had higher QOL in all four domains than those belonging to other religious groups, though these were not significant. Subjects living with a spouse had significantly higher QOL in all four domains than those living singly. Higher QOL in all four domains was enjoyed by economically independent and literate subjects though statistically these were not significant (P > 0.05) [Table 2].{Table 2}

Age, sex, marital status, literacy, economic condition, type of family, and type of ration card possessed by the study subjects were significantly associated with their QOL (P < 0.05) (*Fisher's exact test) [Table 3].{Table 3}

Binary logistic regression analysis shows that female subjects had 45.5% lesser chance of having good QOL than the males, and it was statistically significant (95% confidence interval [CI] = 0.230–0.901; P = 0.024). Subjects aged more than 70 years had 43.5% lesser chance of having good QOL than those aged 70 years or less (95% CI = 0.207–0.912; P = 0.027) similarly subjects living singly had 35.3% lesser chance of having good QOL than those living with their spouse (95% CI = 0.164–0.761; P = 0.008), and these were statistically significant. The rest did not attain the level of statistical significance [Table 4].{Table 4}

 Discussion



The present study has found that only 46.2% of the elderly subjects were enjoying good QOL. This is at par with the result of the study conducted by Dasgupta et al.[11] where 45.1% of the elderly had good QOL. In a study conducted by Shah et al.[12] 3.3% of the study subjects had fair, 46% had good, and 50.8% had excellent QOL, but none of them had poor QOL. On the other hand, Qadri et al.[4] in their study found that 68.2% of the elderly subjects had good QOL, 30.9% had average, and 0.9% had poor QOL. These differences may be due to the fact that the studies were conducted in different settings.

Highest proportion of the study subjects, i.e., 52.9% had good QOL in the environmental domain, whereas only 37.3% of the subjects had good QOL in the social domain. Praveen and Rani[13] in their study also had similar findings in the environmental domain. This may be due to the fact that the elderly people living in rural areas were relatively more satisfied about their natural environment. Mudey et al.[14] in their study concluded that the QOL of the rural elderly was good in the physical and psychological domains, whereas QOL among the elderly of the urban slums was better in areas of social relationship and environmental domains.

In the present study mean (SD) age of the study subjects was found to be 69.67 (8.8) years, which is similar to the findings of a study conducted in urban Mangalore, India, where the mean age was 68.62 ± 6.59 years[15] Majority (56%) belonged to 60–69 years age group. Ghosh et al.[2] also found 68.25% of the subjects to be in the age group of 60–69 years Present study revealed that subjects aged 70 years or less had a significantly higher QOL in physical and social relationship domain than the older.

Present study showed female preponderance (53.3%), which is comparable with the studies conducted by Sowmiya[16] where female participants outnumbered males. In the present study significant gender-related differences were found in the physical and psychological domains of QOL scores. The present study also revealed that females had 45.5% less chance of having good QOL as compared to the males (95% CI = 0.230–0.901; P = 0.024). Study conducted by Lokare et al.[17] at Vidyanagar, Karnataka showed that mean score of male and female differed significantly only in the physical domain but not in others.

In the present study, the subjects were predominantly Hindu (86.2%) by religion. In the studies conducted by Akbar et al.[18] and Karmakar et al.,[19] majorities of the subjects were Hindu by religion. In the present study, relatively higher proportion of the subjects of Muslim religion had over all good QOL as compared to the rest. Subjects belonging to Hindu religion had a higher QOL than the non-Hindu in all four domains of QOL, though statistically, it was not significant (P > 0.05). A study conducted by Karmakar et al.[19] showed a significant association between QOL and religion of the respondents in the psychological domain.

In the present study lower middle class constituted 36.4% of the subjects, which is contrary to the finding of Karmakar et al.[19] where the lower middle class constituted only 14.5%. Karmakar et al.[19] also found socioeconomic status to have significant associations with psychological and environmental domains of the QOL. A study conducted by Nilsson et al.[20] in Bangladesh also reported economic status as a significant determinant of QOL among the elderly.

In the present study, good QOL was found among the subjects living with their spouse, and it was at par with the findings of a study conducted by Qadri et al.[4] Sowmiya[16] also reported a better mean QOL score in all the domains among the elderly subjects except the psychological domain.

The present study showed that overall QOL increased with the increment in the level of education. Literacy showed significant association with the overall QOL of an individual but not in domain-wise QOL. In a similar study, Qadri et al.[4] also reported literacy of an individual to be significantly associated with QOL.

In the present study occupation of the participants had a significant association with their QOL, which was at par with the findings of Rajput et al.[21] Karmakar et al.[19] in their study have shown occupation to have a significant association in the environmental domain of QOL.

This study revealed that 72% of the study participants were from joint families, which were at par with the findings of Karmakar et al.[19] and Rajput et al.,[21] where 77.6% and 73.8% of the subjects were from the joint families, respectively. Joshi et al.[22] observed better social support to the elderly with the increment in household size, but the present study did not support this finding.

 Conclusion



Geriatric people living in rural areas of West Tripura district have got poor overall health-related QOL. Age, sex, literacy, marital status, socioeconomic status, relationship with family members, and type of ration card were significantly associated with their QOL. Living with spouse, young old age, and male sex were the predictors of perceived good QOL in this population. Ethnic subjects had a better QOL than the nonethnic.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Park K. Park's Textbook of Preventive and Social Medicine. 24th ed, Jabalpur: M/s Banarsidas Bhanot; 2017. p. 38.
2Ghosh S, Sarker G, Bhattacharya K, Pal R, Mondal TK. Quality of life in geriatric population in a community development block of Kishanganj, Bihar, India. J Krishna Inst Med Sci Univ 2017;6:33-41.
3Hameed S, Brahmbatt KR, Patil DC, Prassana KS, Jayaram S. Quality of life among the geriatric population in Dakshina Kannada. Karnataka, India. Glob J Med Public Health 2014;3:1-5.
4Qadri SS, Ahluwalia S, Ganai AM, Bali S, Wani FA, Bashir H. An epidemiological study on quality of life among rural elderly population of northern India. Int J Med Sci Public Health 2013;2:514-22.
5Sivaraju S, Alam M, Gangadharan KR, Syamala T, Verma S, Gupta N. Caring for Our Elders: Early Responses, India Ageing Report. Report No: 4. New Delhi: UNPF; 2017. p. 105.
6Elderly in India-Profile and Programmes 2016. New Delhi: Social Statistics Office, Government of India; February 2016. Available from: http://mospi.nic.in/sites/default/files/publication_reports/ElderlyinIndia_2016.pdf. [Last accessed on 2019 Mar 04].
7Elderly in India: 2016. New Delhi: Ministry of Statistics and Programme Implementation; 2016. Available from: https://ElderlyinIndia_2016.pdfmospi.nic.in. [Last accessed on 2019 Mar 07].
8WHOQOL-BREF Introduction, Administration, Scoring and Generic Version of the Assessment Field Trial Version, 1996 December. Programme on Mental Health. Geneva: World Health Organization; 2018. p. 5. Available from: https://www.who.int/mental_health/media/en/76.pdf. [Last accessed on 2019 Mar 04].
9Riffenburgh RH. Statistics in Medicine. 3rd ed. USA: Elseveir; 2012. p. 378.
10Kumar G, Majumder A, Pavithra G. Quality of life (QOL) and its associated factors using WHOQOL-BREF among elderly in urban Puducherry, India. Clin Diagn Res 2014;8:54-7.
11Dasgupta A, Pan T, Paul B, Bandhopadhay 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.
12Shah V, Christian D, Prajapati A, Patel M, Sonaliya K. Quality of life among elderly population residing in urban field practice area of a tertiary care institute of Ahmedabad city, Gujarat. Family Med Prim Care 2017;6:10-105.
13Praveen V, Rani MA. Quality of life among elderly in a rural area. Int J Community Med Public Health 2016;3:754-7.
14Mudey A, Ambekar S, Goyal R, Agarekar S, Wagh V. Assessment of quality of life among rural and urban elderly population of Wardha district, Maharashtra, India. Ethno Med 2011;5:89-93.
15Devraj S, D'mello MK. Determinants of quality of life among the elderly population in urban areas of Mangalore, Karnataka. Geriatr Ment Health 2019;6:94-8.
16Sowmiya K. Study on quality of life in elderly population in Mettupalayam, a rural area of Tamilnadu. Nat J Res Com Med 2012;1:123-77.
17Lokare L, Nekar MS, Mahesh V. Quality of life and restricted activity days among the old aged. Int J Biol Med Res 2011;2:1162-64.
18Akbar F, Kumar M, Das N, Chatterjee S, Mukhopadhyay S, Chakraborty M, et al. Quality of life (QOL) among geriatric population in Siliguri sub-division of district Darjeeling, West Bengal. Nat J Res Com Med 2013;2:17-22.
19Karmakar 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;62:95-9.
20Nilsson J, Rana AK, Kabir ZN. Social capital and quality of life in old age: Results from a cross-sectional study in rural Bangladesh. Ageing Health 2006;18:419-34.
21Rajput M, Pinki, Kumar S, Jaiprakash, Kumar T. Quality of life of geriatric population in rural block of Haryana. Public Health Rev Int J Public Health Res 2019;6:192-9.
22Joshi K, Kumar R, Avasthi A. Morbidity profile and its relationship with disability and psychological distress among elderly people in Northern India. Int J Epidemiol 2003;32:978-87.