Quality of life among elderly population residing in urban field practice area of a tertiary care institute of Ahmedabad city, Gujarat

Abstract

Introduction
Overall improvement in the living standards of country's population is leading to longer life expectancy. To emphasize the medical and psychological difficulties faced by geriatric people is essential to know status of their quality of life (QOL).

Methodology
A community-based cross-sectional study was carried out at urban field practice area of one of the teaching institutes of Ahmedabad, Gujarat. Considering the prevalence of about 7.5% of 60 years and above people sample size of 250 was calculated. A predesigned questionnaire related to the QOL of elderly people devised by the World Health Organization-QOL was used.

Results
Mean age of the study population was 65.8 years with standard deviation of 5 years. Almost two-thirds of geriatrics were currently married and having spouse alive. List of common morbidities observed among study population was joint pain (42.8%), cataract (32.8%), hypertension (22.4%), diabetes mellitus (17.2%), and dental problems (12.4%). Scoring of QOL profile revealed that none of the geriatric had poor QOL, whereas 56% fall into category “good” and 50.8% had “excellent” QOL. QOL as per four different domains was significantly better among males as compared to females. Physical, environmental, and psychological domains were better in those who were educated and married individuals living with their spouse.

Conclusion
Overall QOL was good to excellent. Social characteristics, such as education, marital status, and gender, all play role for the perceived QOL among the respondents.

Full text

Official Publication of the Academy of Family Physicians of India
Volume 6 / Issue 1 / January-March 2017
www.jfmpc.com
ISSN 2249-4863
Journal of
Family Medicine
and Primary Care
Journal of Family Medicine and Primary Care • Volume 6 • Issue 1 • January-March 2017 • Pages 1-???

© 2017 Journal of Family Medicine and Primary Care | Published by Wolters Kluwer - Medknow 101
Introduction
The World Health Organization (WHO) has dened 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.”[1] It is
a broad concept covering the individual’s physical health, mental
state, level of independence, social relationships, spiritual beliefs,
and the environment. By 2020, for the rst time in history, the
number of people aged 60 years and older will outnumber children
younger than 5 years. By 2050, the world’s population aged 60 years
and older is expected to total 2 billion, up from 841 million today.[2]
The rapidly growing numbers of older peoples’ population in both
developed and developing countries mean that they all would be at
risk of a challenge to their QOL. The challenge in the 21st century
is to delay the onset of disability and ensure optimal QOL for older
people.[3] The WHO has recently warned the member countries
that as people across the world live longer, soaring levels of chronic
illness, and diminished well-being are poised to become a major
global public health challenge.[2]
Aging is generally dened as a process of deterioration in the
functional capacity of an individual that results from structural
Quality of life among elderly population residing in
urban eld practice area of a tertiary care institute of
Ahmedabad city, Gujarat
Venu R. Shah1, Donald S. Christian1, Arpit C. Prajapati1, Mansi M. Patel1,
K. N. Sonaliya1
1Department of Community Medicine, GCS Medical College Hospital and Research Centre, Ahmedabad, Gujarat, India
Abs tr Ac t
Introduction: Overall improvement in the living standards of country’s population is leading to longer life expectancy. To emphasize
the medical and psychological difficulties faced by geriatric people is essential to know status of their quality of life (QOL).
Methodology: A community-based cross-sectional study was carried out at urban field practice area of one of the teaching institutes
of Ahmedabad, Gujarat. Considering the prevalence of about 7.5% of 60 years and above people sample size of 250 was calculated.
A predesigned questionnaire related to the QOL of elderly people devised by the World Health Organization-QOL was used.
Results: Mean age of the study population was 65.8 years with standard deviation of 5 years. Almost two-thirds of geriatrics were
currently married and having spouse alive. List of common morbidities observed among study population was joint pain (42.8%),
cataract (32.8%), hypertension (22.4%), diabetes mellitus (17.2%), and dental problems (12.4%). Scoring of QOL profile revealed that
none of the geriatric had poor QOL, whereas 56% fall into category “good” and 50.8% had “excellent” QOL. QOL as per four different
domains was significantly better among males as compared to females. Physical, environmental, and psychological domains were
better in those who were educated and married individuals living with their spouse. Conclusion: Overall QOL was good to excellent.
Social characteristics, such as education, marital status, and gender, all play role for the perceived QOL among the respondents.
Keywords: Elderly, morbidity, quality of life, urban
Original Article
Address for correspondence: Dr. Donald S. Christian,
Department of Community Medicine, GCS Medical College,
Hospital and Research Center, Opposite DRM Office, Nr. Chamuda
Bridge, Naroda Road, Ahmedabad - 380 025, Gujarat, India.
E-mail: donald_christian2002@yahoo.com
Access this article online
Quick Response Code:
Website:
www.jfmpc.com
DOI:
10.4103/2249-4863.214965
How to cite this article: Shah VR, Christian DS, Prajapati AC, Patel MM,
Sonaliya KN. Quality of life among elderly population residing in urban
eld practice area of a tertiary care institute of Ahmedabad city, Gujarat.
J Family Med Prim Care 2017;6:101-5.
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Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak,
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Shah, et al.: Quality of life among urban elderly
Journal of Family Medicine and Primary Care 102 Volume 6 : Issue 1 : January-March 2017
changes, with advancement of age.[4] Longevity must come along
with the quality, then and then feeling of contentment could be
achieved. To emphasize the medical and psychological difculties
faced by geriatric people is the need of current time. Research in
this eld would be helpful to know the exact status of the quality
of lives of the elderly people. Result of the study could provide
a baseline initiative for more research and intervention strategies.
With this in the prospect, a study would be very much benecial
among the elderly population to know their quality of lives.
Aims and objectives
• To study the QOL and morbidity patterns of people aging 60
or above in the eld practice areas of urban health training
centers of a medical college of Ahmedabad city
• To correlate the QOL with various sociodemographic factors.
Methodology
The study was conducted in urban elderly population residing in
eld practice areas of the urban health training center attached
with the Department of Community Medicine of a Medical
College of Ahmedabad city, Gujarat. The total population served
is about 4900 people in the semiurban area. A community-based
cross-sectional design was adopted for studying the health
problems of elderly and their health-related QOL. The inclusion
criterion was a person of age 60 years and above. The exclusion
criteria were very severely ill persons not able to answer to
the questions and a person who does not give consent for the
participation. A list of 60 years and above was obtained from
the center data beforehand.
Taking a prevalence of about 7.5% of 60 years and above
people for India,[5] it can be estimated that about 350 people
could be found from urban areas having a population of 4800.
Considering the limited locality of the eld practice area and the
nonresponse rate, a total of 250 participants were eligible for the
study. A predesigned questionnaire related to the QOL of elderly
people devised by the WHO (WHOQOL)[1] was used for the
survey. The questionnaire was translated in local language and
then was again back translated to maintain the content validity of
the questions. It took into consideration six domains of QOL,
i.e., physical, psychological, environmental, social relationship,
level of independence, and spirituality. The study protocol was
approved by the institutional ethical committee. A pretest was
carried out taking about twenty samples to know the feasibility
of the questionnaire. The study protocol was approved by
the institutional ethical committee. The mean score of items
within each domain was used to calculate the domain score. If
more than 20% of the data were missing from an assessment,
then the assessment was discarded. The data were collected by
house-to-house visit by trained accredited social health activist
workers, multipurpose health workers, and medical social
workers (MSWs) of the concerned areas. Informed consent was
taken from participants before initiation of the study. Taking
into consideration of the variable literacy status, a structured
interview was carried out to ll up the questionnaire for each of
the respondent. Information on treatment-seeking behavior and
the existing morbidity was also noted. Scoring WHOQOL was
done with the help of SPSS software (SPSS Inc. Released 2007.
Version 16.0. Chicago). Appropriate statistical methodologies
such as percentages, Student’s t-test, and Chi-square test were
used for analyzing data. Pro forma to study the health-related
QOL: the WHOQOL-BREF[1] was used to assess the QOL. It
took into consideration four domains of QOL, i.e., physical,
psychological, environmental, and social relationship. It had 26
questions and the mean score of items within each domain was
used to calculate the domain score. A transformed score between
0 and 100 was developed for each domain for nal analysis.
Method for manual calculation of individual scores is as follows:
Physical domain – ([6 − Q3] + [6 − Q4] + Q10 + Q15 + Q16 +
Q17 + Q18) × 4
Psychological domain – (Q5 + Q6 + Q7 + Q11 + Q19+
[6 − Q26]) × 4
Social relationship domain – (Q20 + Q21 + Q22) × 4
Envi ronme ntal doma in – (Q8 + Q9 + Q12 + Q13 + Q14 + Q23 +
Q24 + Q25) × 4
Results
Total 250 geriatric age group people (age 60 years or more)
were included in the study. Mean age of the study population
was 65.8 years with standard deviation of 5 years. Number of
people belonged to age group 60–64 were 114 (45.6%) while
103 (41.2%) were between 65 and 70 years age. Only 8% were
above 75 years. Female preponderance was found in our study
with 57.6% as compared to males (n = 106, 42.4%). People
who were married and having spouse alive, constitute 64.4%
whereas 28% were either widow or widower. Educational
status of study population showed that 35.6% were illiterate
while half of the geriatrics (n = 131, 52.4%) was primary
educated. Only nine (3.6%) were graduates or above graduate.
Twenty percent (n = 50, 20%) were living retired life, whereas
n = 70 (28%) and n = 45 (17.8%) were unskilled and skilled
workers [Table 1].
In the present study, geriatrics population living in a joint
family constitutes 56% while 27.2% had nuclear family and
15.6% of them were living alone. Quite good proportions
(n = 208, 83.2%) of geriatrics were supported by their family
as far as mode of income was concerned, n = 16 (6.4%) were
destitute [Table 2].
Preference for health facility was asked to study group. Almost
three-fourths (n = 190, 76%) of them preferred government
health facility. Twenty-four (9.2%) were having preference of
private health-care facility during illness. The reasons behind
nonuse of government facility were nonavailability of doctors
as per 66.6% of population. Same proportion (n = 4, 16.7%) of
reasons was stated by both noncooperation of staff and remote
placement of government health institute [Table 3].

Shah, et al.: Quality of life among urban elderly
Journal of Family Medicine and Primary Care 103 Volume 6 : Issue 1 : January-March 2017
Common ailments found among study population were joint
pain (42.8%), cataract (32.8%), hypertension (22.4%), diabetes
mellitus (17.2%), and teeth problems (12.4%) [Table 4].
Scoring of QOL prole was carried out using WHOQOL‑BREF
criteria. None of the geriatric fall in fourth category, i.e., poor
QOL while 56% (n = 140) belonged to good category and
50.8% (n = 102) were having excellent QOL. Mean score for
four different domains, namely, physical, psychological, social,
and environmental was depicted for QOL. Mean score of
social domain was maximum (69.4 ± 9.7) as compared to other
three domains. Lowest mean score was found in environmental
domain (57.6 ± 10.0) [Table 5].
Impact of gender, educational status, and marital status on
different domains of QOL was studied using independent t-test.
Educational and marital status signicantly affects QOL as far
as social and environmental domains were concerned. QOL as
per four different domains was signicantly better among males
as compared to females [Table 6].
Discussion
A cross-sectional study was carried out among geriatric
populations residing at the eld practice area of urban health
training center. Total 250 geriatric age group people were
interviewed. Mean age of the study population was 65.8 years
with standard deviation of 5 years. Female population (57.6%)
outnumbered males (42.4%) in the present study. Similar ndings
were seen in the studies carried out by Sowmiya and Nagarani[6]
and Jacob et al.[7] where in female elderly were more as compared
to male. Almost two-thirds of geriatrics were currently married
and having spouse alive. Educational status of study population
showed that 35.6% were illiterate. Geriatrics population living
in a joint family constitutes 56% (n = 140) while 15.6% (n = 39)
of study population were living alone. Fair proportions (83.2%,
n = 208) of geriatrics were supported by their family as far as
mode of income was concerned.
Almost three-fourths (76%, n = 190) of geriatrics preferred
government health facility for treatment of various illnesses.
Table 1: Sociodemographic prole of study
population (n=250)
Sociodemographic prole Frequency (%)
Age (years)
60-64 114 (45.6)
65-70 103 (41.2)
70-74 13 (5.2)
≥75 20 (8)
Sex
Male 106 (42.4)
Female 144 (57.6)
Marital status
Married 161 (64.4)
Unmarried 19 (7.6)
Widow/widower 70 (28)
Education
Illiterate 89 (35.6)
Primary 131 (52.4)
Secondary 21 (8.4)
Graduate and above 9 (3.6)
Occupation
Housemaker 85 (34)
Retired 50 (20)
Unskilled 70 (28)
Skilled 45 (17.8)
Total 250 (100)
Table 2: Family type and mode of wages among the
respondents (n=250)
Frequency (%)
Type of family
Joint 140 (56)
Nuclear 68 (27.2)
Three generation 3 (1.2)
Living alone 39 (15.6)
Mode of wages
Supported by family 208 (83.2)
Pension 26 (10.4)
Destitute 16 (6.4)
Total 250 (100)
Table 3: Distribution of preference of health-care facility
by the respondents (n=250)
Frequency (%)
Preferred health-care facility (n=250)
Government 190 (76)
Both government and private 36 (14.8)
Private 24 (9.2)
Reason for nonuse of government facility (n=24)
No doctors available 16 (66.6)
Uncooperative staff 4 (16.7)
Far from home 4 (16.7)
Table 4: List of morbidities present among as reported by
the respondents (n=250)
Morbidities Frequency (%)
Joint pain 107 (42.8)
Cataract 82 (32.8)
Hypertension 56 (22.4)
Acidity 44 (17.6)
Diabetes 43 (17.2)
Teeth problem 31 (12.4)
Heart disease 18 (7.2)
Spine problem 12 (4.8)
Insomnia 12 (4.8)
Deafness 10 (4)
Anemia 9 (3.6)
Skin diseases 4 (1.6)
Depression 4 (1.6)
Mood swing 3 (1.2)
Prostate problem 3 (1.2)

Shah, et al.: Quality of life among urban elderly
Journal of Family Medicine and Primary Care 104 Volume 6 : Issue 1 : January-March 2017
Those who were using private health care mentioned various
reasons for nonuse of government facility such as nonavailability
of doctors (66.6%), noncooperation of staff (16.7%), and
remote placement of government health institute (16.7%).
Similar ndings were found in the study carried out by Qadri
et al.[8] who revealed that 72% of household generally do not seek
health care from government facility. In their study, reasons for
nonutilization were poor quality of care (55%), lack of a nearby
facility (42%), and long waiting times (25%). Gupta et al.[9] stated
that more than half the respondents found lack of sympathetic
care from government doctors and that was the reason for nonuse
of government facilities.
In the present study, list of common morbidities observed
among study population was joint pain (42.8%), cataract (32.8%),
hypertension (22.4%), diabetes mellitus (17.2%), and dental
problems (12.4%). Similar nding was seen in the study by
Jacob et al.[7] who stated that most common morbidity was
joint pain/joint stiffness (43.4%), cataract (45.3%), and
dental problems (45.3%). Qadri et al.[8] observed in their study
that anemia was the most common morbidity, with 2/3 of
population (64.5%) suffering from it, followed by dental
problems (62.2%), joint pains (51.4%), cataract (46.8%), and
hypertension (44.5%), respectively. Joshi et al.[10] found that most
prevalent morbidity among elderly people was anemia followed
by dental problems, cataract, hypertension, and osteoarthritis.
Kishore et al.,[11] carried out study in Dehradun, mentioned the
most prevalent morbidity was hypertension (41.4%).
Scoring of QOL prole revealed that in the present study, none
of the geriatric had poor QOL, whereas 56% fall into category
“good” and 50.8% were having “excellent” QOL. Similar ndings
were found in the research by Qadri et al.[8] who revealed that
majority (68.2%) of elderly had good QOL whereas only 0.9%
had poor. Mean score for four different domains, namely, physical,
psychological, social, and environmental were illustrated for
QOL. Mean score of social domain was maximum (69.4 ± 9.7) as
compared to other three domains. Lowest mean score was found
for environmental domain (57.6 ± 10.0). Similar presentation
was seen in study by Sowmiya and Nagarani[6] in Tamil Nadu,
where the highest score was for the social relationship domain.
Mudey et al.[12] in their study concluded that the QOL of rural
elderly population was better in physical and psychological
domain, whereas QOL in urban slum elderly was better in social
relationship and environmental domain.
In the present study, QOL as per four different domains was
significantly better among males as compared to females.
Physical, environmental, and psychological domains were
better in those who were educated and married individuals
living with their spouse. Qadri et al.[8] also mentioned that QOL
was better among males for physical, psychological, social, and
environmental domains. It was more among the participants who
were graduated and currently married. Bhatia et al.[13] did a study
in ten villages of district Ludhiana. They reported that QOL
was signicantly associated with education. In the present study
as well, the physical, social, and environmental domain scores
are signicantly better among literates than illiterates [Table 6].
Mudey et al.[12] mentioned that the scores for psychological
domain among married elderly population were higher than
single or widowed elder people and were found to be statistically
signicant. In the present study also, the physical, social, and
environmental scores are signicantly better among married
than among singles. Barua et al.[14] also depicted in their study
on geriatric population that currently married had better QOL
than those divorced, widowed, or separated.
Conclusion
The physical, psychological, environmental, and social
domains were compared for various demographic and social
characteristics. Geriatric population surveyed under this study
had suffered from various morbidities. They found difcult to
reach government facility due to various reasons, one of it was
distance they need to travel. In such instances, specically for
minor illnesses, government health services can be provided by
Table 6: Association of quality of life with various
sociodemographic factors among the respondents (n=250)
QOL Physical
domain
Psychological
domain
Social
domain
Environmental
domain
Gender
Male 68.8±17.8 68.2±8.8 71.9±8.4 60.3±9.4
Female 62±15.7 64.7±14.1 67.4±10.1 55.4±9.9
P0.0016 0.0252 0.0002 0.0001
Educational
status
Illiterate 66.5±18.8 64.7±15.3 66.2±12 55.6±11.3
Literate* 67.3±15.3 67±10.1 71±7.6 58.5±9
P0.7160 0.2522 0.0001 0.0271
Marital status
Married 66.6±17.8 66.8±12.5 70.7±8.9 58.8±10.1
Single** 61.7±14.7 65±11.7 66.8±10.5 55.1±9.2
P0.0278 0.2659 0.0021 0.0046
*Literate include educational status primary and above. **All study participants who were unmarried, widow,
or widower were included in the single category. QOL: Quality of life
Table 5: Grading and mean scores of QOL as per
WHO-QOL-BREF scoring (n=250)
Overall grading: QOL
Grades Frequency(%)
Excellent (110-89) 102 (50.8)
Good (88-67) 140 (56.0)
Fair (45-66) 8 (3.2)
Poor (<45) 0
Total 250 (100)
Mean score: Domains of QOL
Domain of QOL Mean±SD
Physical domain 64.9±17.0
Psychological domain 66.2±12.3
Social domain 69.4±9.7
Environmental domain 57.6±10.0
SD: Standard deviation, QOL: Quality of life

Shah, et al.: Quality of life among urban elderly
Journal of Family Medicine and Primary Care 105 Volume 6 : Issue 1 : January-March 2017
mobile medical van at their door step at regular interval. Overall
QOL was good to excellent, but environmental domain was not
up to the mark which can be improved by collective efforts from
family as well as by network of geriatric support groups. Social
characteristics such as education, marital status, and gender all
play role for the perceived QOL among the respondents. Positive
outcome in the QOL could be achieved if level of education is
improved in the society.
Acknowledgment
We would like to acknowledge Ms. Shweta Vaghela and
Ms. Rizwana Mansuri (MSWs) as well as the Anganwadi and
health workers for their support during data collection and other
liaison with the community of Saijpur area, Ahmedabad.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conicts of interest.
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