A comparative study to assess the quality of life among the elder people living in rural and urban areas

Bince Varghese; MR Selvan; Deepika Kushwaha; Divya Pathak; Deepali Prajapati; KM Anju; Asheesh Kumar

doi:10.4103/IOPN.IOPN_3_20

ORIGINAL ARTICLE

Year : 2020 | Volume : 17 | Issue : 1 | Page : 18-23

A comparative study to assess the quality of life among the elder people living in rural and urban areas

Bince Varghese¹, MR Selvan², Deepika Kushwaha³, Divya Pathak³, Deepali Prajapati³, KM Anju³, Asheesh Kumar³
¹ Ph.D Scholar (JJTU), Assistant Professor, Hind College of Nursing, Safedabad, Barabanki, Uttar Pradesh, India
² Associate Professor, Hind College of Nursing, Safedabad, Barabanki, Uttar Pradesh, India
³ B.Sc Nursing Final year students, Hind College of Nursing, Safedabad, Barabanki, Uttar Pradesh, India

Date of Submission	15-Mar-2020
Date of Decision	21-Apr-2020
Date of Acceptance	28-May-2020
Date of Web Publication	08-Aug-2020

Correspondence Address:
Mr. Bince Varghese
Ph.D Scholar (JJTU), Assistant Professor, Hind College of Nursing, Barabanki, Uttar Pradesh – 225003
India

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/IOPN.IOPN_3_20

Abstract

Introduction: Quality of life (QOL) is defined as the combination of an individual's functional health, feeling of competence, independence activities of daily living, and satisfaction of social circumstances. Aim: This study aimed to assess and compare the QOL among the elderly people in selected rural and urban areas of Uttar Pradesh. Materials and Methods: A quantitative nonexperimental comparative study research design was adopted for the study. The data were collected using convenience sampling technique. The total sample comprised 70 elder people, 35 each from the urban and rural areas. A standardized World Health Organization-QOL BREF questionnaire containing 26 items was used for assessing the QOL of the subjects. Data were analyzed using the Statistical Package for the Social Sciences version 25. Results: The urban elders had better QOL in the only environmental domain (P = 0.003) than the rural population, and all the other domains such as physical (P = 0.45), psychological (P = 0.33), and social relationship (P = 0.42) did not have any significant difference. There was no association found between QOL among the elderly people in rural and urban areas with their selected sociodemographic variables. Conclusion: There is a significant difference in the environmental domain QOL among the elderly living in urban areas than the rural one. A qualitative approach can be used to explore comprehensive findings in future studies.

Keywords: Elders, quality of life, rural, urban

How to cite this article:
Varghese B, Selvan M R, Kushwaha D, Pathak D, Prajapati D, Anju K M, Kumar A. A comparative study to assess the quality of life among the elder people living in rural and urban areas. Indian J Psy Nsg 2020;17:18-23

How to cite this URL:
Varghese B, Selvan M R, Kushwaha D, Pathak D, Prajapati D, Anju K M, Kumar A. A comparative study to assess the quality of life among the elder people living in rural and urban areas. Indian J Psy Nsg [serial online] 2020 [cited 2023 May 28];17:18-23. Available from: https://www.ijpn.in/text.asp?2020/17/1/18/291618

Introduction

Aging is a universal phenomenon characterized by an increased risk of morbidity, disability, reduced functional capacity, and eventually death. Globally, life expectancy of geriatric population has increased due to the betterment in the quality of life (QOL) of the elderly because of the increased accessibility and availability of quality health-care services, a continuous demographic transition is occurring leading to an increase in life expectancy. The proportion of people aged 60 years and above is increasing over a period of time. By 2020, for the first time in history, the number of people aged 60 years and older will exceed than the children younger than 5 years among the total population. By 2050, the world's population aged 60 years and older is expected to become 2 billion, up from 841 million today.^[1]

In 2011, the Indian census shows that the elderly was 8% of the total population in which 7.70% and 8.40% comprise male and females, respectively.^[2] According to the National Family Health Survey-4, the elderly accounts for 9% of all age groups and in rural, it accounts for 9.5% of the total population in Uttar Pradesh.^[3] The traditional values and norms in the society were broken by the industrialization and globalization which results in the breakdown of joint or extended family structures into nuclear ones, this increases the susceptibility of the older population.^[4],[5] Mental and neurological problems account for 6.6% of disability-adjusted life years and 17.4% of years lived with disability among the elderly. The mental health of elderly has an influence on their physical health.^[6]

One of the greatest tasks of public health is to improve the QOL of geriatric population through which we can increase the life expectancy of the elderly by every year.^[7] The World Health Organization (WHO) defined 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.”^[8] Thus, QOL is a broad concept consisting the individual's physical health, mental state, level of independence, social relationships, and personal beliefs and their relationship to salient features in the environment.

The aging of the population along with the epidemiological changes of diseases with an increase in burden of chronic morbidity conditions will affect the QOL of the elderly population in the long run.^[9] Some of the factors that affecting the QOL of the elderly are physical health, psychological health, the living arrangement and level of independence, personal and social relationships, working capacity, access to health and social care, home environment, transportation facilities, and the ability to acquire new skills.^[10]

The elderly population is very prone to chronic comorbid conditions, isolation, social insecurity, and depression. Since QOL cannot be measured directly, it is a subjective component of well-being. Therefore, studies related to the determination of the QOL and its associated factors in the elderly population are very few in India. The objectives of this study were to assess and compare the QOL among the elderly people in selected rural and urban areas and they find the association of various factors with QOL.

Materials and Methods

A quantitative research approach with nonexperimental comparative study research design was used to conduct the study in selected rural and urban areas of Uttar Pradesh. The study setting was in the rural Sarthara area and in urban New Gulistha Colony area from Uttar Pradesh. Nonprobability convenience sampling technique was adapted to select 70 elderly (35 each from rural and urban) of selected areas of Uttar Pradesh. WHOQOL-BREF QOL questionnaire was used to assess the QOL among the elderly people. Ethical approval for conducting the study was obtained from the Hind College of Nursing, Safedabad, Uttar Pradesh. Administrative approval and permission were taken from chief medical officer in concerned areas. The consent form was prepared for the study participant regarding their willingness to participate in the research study.

Inclusion criteria

Elderly people aged 60–75 years, available during the study period, were willing to participate and able to answer.

Exclusion criteria

Persons with chronic illness were excluded from the study.

The research tool for data collection consists of two sections

Part-I

It consists of demographic variables such as age, sex, education, religion, types of family, family monthly income, and source of income. The content validity of the tool was determined by experts in the field of psychiatry, psychiatric nursing, and psychology. Content appropriateness, clarity, and relevance were ascertained by the language expert.

Part–II

It composed of a standardized WHO's QOL BREF scale^[11] for assessing the QOL among the elderly. The first two questions deal with the overall perception of QOL and overall perception of health. The remaining 24 questions consist of four domains such as physical health, psychological health, social relationship, and environment. Each item is rated on a 5-point scale ranging from 1 to 5, with a higher score indicating a higher QOL. In these, items 3, 4, and 26 are negative items, hence it is scored reversly i.e. 5, 4, 3, 2, and 1; the remaining positive items scored as 1, 2, 3, 4, and 5. A transformed score between 0 and 100 was developed for each domain for the final 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
Environmental domain: (Q8 + Q9 + Q12 + Q13 + Q14 + Q23 + Q24 + Q25) × 4.

It is a standardized tool, and the Cronbach's alpha coefficients ranged from 0.73 to 0.81 indicating good internal consistency among the items within a domain. The administration time for scale is 15–20 min. This scale is in the public domain to use. Statistical analysis was performed through differential and inferential statistics using the Statistical analysis was performed through descriptive and inferential statistics by using Statistical Package for the Social Sciences (SPSS 25) and 0.05 was considered as the level of significance.

Results

[Table 1] shows that the majority both in urban and rural elders were in the age group 60–65 years like 13 (31.1%) and 21 (60%), respectively. The majority of the elderly were female both urban 18 (51.4%) and rural 26 (74.3%). The majority of elders in urban (23 [65.7%]) were literate, whereas majority of elders in rural (28 [80%]) were illiterate. The majority both in urban and rural elders were Hindu's like 26 (74.3%) and 22 (62.9%), respectively. Both the majority of urban 29 (82.9%) and rural 19 (54.3%) were from joint family. The majority of elders in urban 28 (80%) had family monthly income more than 10,000 rs in comparison to majority of 22 (62.9%) elders had less than 10,000 rs in the rural area. Regarding the source of income, the majority of urban (19 [54.3%]) and rural (22 [62.9%]) elders depended on their children.

Table 1: Frequency and percentage distribution of demographic variables of subjects (n=70)

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[Table 2] shows that comparison of QOL scores between urban and rural area using independent t-test, in Domain 1 (physical health), the mean scores of the urban and rural areas were 56.23 ± 9.6 and 54.17 ± 12.73, respectively, and the obtained t value is 0.76 which is not significant (P > 0.05) at 68 df. In Domain 2 (psychological), the mean scores of the urban and rural areas were 56.71 ± 15.16 and 53.63 ± 10.9, respectively, and the obtained t value is 0.98 which is not significant (P > 0.05) at 68 df. In domain 3 (social relationship), the mean scores of the urban and rural areas were 65.14 ± 14.98 and 62.34 ± 15.33, respectively, and the obtained t value is 0.77 which is not significant (P > 0.05) at 68 df. The overall mean scores of the elderly in urban and rural area were 91.9 ± 13.7 and 85.3 ± 13.7, respectively. It is inferred that there is no significant difference in Domain 1, 2, and 3 among the elders in urban and rural. However, in Domain 4 (environment), the mean scores of the urban and rural areas were 67.06 ± 11.63 and 57.6 ± 14.34, respectively, and the obtained t value is 3.03, which is significant (P < 0.05) at 68 df. It is inferred that there is a statistically significant difference in Domain 4 (environment) among the elders in urban and rural. Urban elders have better environmental QOL than rural elders.

Table 2: Comparison of quality of life score between urban and rural area

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The data from [Table 3] show that Chi-square value was computed in urban area QOL among the elderly with the demographic variable age (0.56), sex (1.45), education (0.13), religion (0.09), types of family (0.04), income (0.02), and source of income (4.99) which were not significant (P > 0.05). Thus, it can be conducted that there is no significant association between QOL score among elders in urban areas with their selected demographic variables.

Table 3: Association of quality of life among urban elders with their demographic variables

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The data from [Table 4] show that Chi-square value was computed in rural area QOL among the elderly with the demographic variable age (0.33), sex (1.12), education (1.4), religion (0.04), types of family (3.54), income (1.39), and source of income (1.41) which were not significant (P > 0.05). Thus, it can be conducted that there is no significant association between QOL score among elders in rural areas with their selected demographic variables.

Table 4: Association of quality of life among rural elders with their demographic variables

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Discussion

In the present study, the demographic variables were supported with the study conducted by Verma et al. which show that the majority of respondents were Hindus (95.7%), lived in joint families (59%), illiterate (43.75%), were either retired or not working (53%), and belonged to lower class (34.75%).^[12]

The present study reveals that the urban elders had better QOL in the only environmental domain than the rural population and all the other domains such as physical, psychological, and social relationship did not have any significant difference. On the contrary, Usha and Lalitha, conducted a study and indicated that there was a statistically significant difference between the senior citizens in rural and urban areas in all the domains of QOL (P < 0.05) except the social relationship domain (P > 0.05). The urban samples expressed a better QOL.^[13] Some other studies conducted by Mudey et al. been supported with the present study that the elders living in the urban area reported significantly lower levels of QOL in physical 51.2 ± 3.6 and psychological 51.3 ± 2.5 domains than the rural elderly populations. The rural elders reported a significantly lower level of QOL in social relation 55.9 ± 2.7 and environmental 57.1 ± 3.2 domains than the urban population.^[14] Some studies conducted in different parts of India shown that the urban geriatric population had higher scores for all the domains as compared to the rural geriatric population, but a significant difference was elicited for psychological and environmental domains.^[15] This difference can be attributed to a difference in their lifestyle and sociodemographic factors.

In the present study, there was no association found between QOL among the elderly people in a rural and urban area with their selected sociodemographic variables. On the contrary, Bansal et al., in their study reported gender, type of family, financial status, and staying with partners which were found to be the determinants of better QOL (P > 0.05).^[16] Mittal et al.'s study found that male participants had a higher mean score for QOL as compared to the female participants.^[17] It was found that increasing age, female sex, loss of a spouse, low level of education, financial dependence, and presence of one or more comorbidities were significantly associated with poor QOL.^[18] Overall, QOL scores were found to be associated with education and financial dependency.^[19] Barua et al. study findings show that the overall well-being of elders was significantly affected in those who were single (unmarried/widowed) or in the age group of 60–69 years.^[20] Other studies done by Kumar et al.^[21] and Sowmiya and Nagarani^[22] had shown that the elderly living in joint families had better QOL than those living in nuclear families.

Implications and recommendation

This study can be used as a reference for policymakers regarding the implementation of successful community health programs such as the elderly club, self-help groups, effective participation, and rehabilitation for the elderly in our country and preserving their QOL. The present study helps to develop necessary health services for the geriatric population which will promote better utilization of health facilities. A similar study can be replicated on a large scale and for a longer period for more reliability and accessibility. Knowledge and practice of the QOL among elders also can be assessed in future studies.

Conclusion

The present study concluded that the urban elders had better QOL in the only environmental domain than the rural population, and all the other domains such as physical, psychological, and social relationship did not have any significant difference. The overall findings of the study showed that there is no significant association between QOL score among elders both in rural and urban areas with their selected demographic variables. A qualitative approach can be used to explore comprehensive findings in future studies.

The study is limited to the sample and the elderly people of selected areas in Uttar Pradesh, India. This study had not assessed any health-related illness of the elderly, and there was no intervention to improve the QOL among the geriatric population.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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