Every person – in every country in the world – should have the opportunity to live a long and healthy life. The number and proportion of people aged 60 years and older in the population is increasing.¹

People worldwide are living longer. Today most people can expect to live into their sixties and beyond. Every country in the world is experiencing growth in both the size and the proportion of older persons in the population. The pace of population ageing is much faster than in the past. In 2020, the number of people aged 60 years and older outnumbered children younger than 5 years. Between 2015 and 2050, the proportion of the world's population over 60 years will nearly double from 12% to 22%. The number of persons aged 80 years or older is expected to triple between 2020 and 2050 to reach 426 million. By 2030, 1 in 6 people in the world will be aged 60 years or over. ²

At global level, QOL among elderly is an important area of concern which reflects the health status and well-being of this vulnerable population. In developing countries, demographic transition results in increasing life expectancy and increase in proportion of elderly population in near future.³ It was known that socio demographic factors like age, education, marital status and family structure influence the QOL among elderly population.^4,5 In addition, various studies have shown that chronic morbid conditions are associated with low QOL.⁶ But, there is paucity of information with regard to this in developing countries including India. WHOQOLBREF instrument includes four domains of QOL namely physical health, psychological, social relationships and environment. This study aimed to explore and compare QOL in four domains and its associated factors among elderly in Visakhapatnam.

OBJECTIVES

1. 1. To assess the Quality of Life of
2. To know the factors affecting the quality of life of septuagenarians

Study design and setting: A Descriptive cross-sectional study was conducted among elders who were aged between 70-79 years in Visakhapatnam as a part of NTRUHS UGSRS Project during the months of August and September 2021.

Study population: Elders who were aged 70-79 years.

Inclusion criteria:

• Participants aged between 70-79 years of either gender.
• Caregivers who are willing to participate and give consent.
• The information will be obtained from those septuagenarians who were leading a healthy life.

 Exclusion criteria: Those who are not willing to participate and persons who are very sick.

Sample size and Sampling technique:  Simple random sampling

 381 is the minimum sample required for study but we included 461 participants.   

Population of septogenarians⁶ in Visakhapatnam – 38970.

Marginal error - 5%, Confidence level - 95%

Formula:

 Z=1.96, P=0. 5     

 Study Tools and Statistical Analysis: Tool used to assess QOL of elderly people was World Health Organization QOL (WHO QOL) –BREF questionnaire³. This questionnaire contained 26 questions and is divided into four domains: physical, psychological, social, and environmental. The scale of values for each domain can vary from 0 to 100 point indicating that higher the score better the quality of life in that domain. For the illiterates the questionnaire was explained and responses were filled by the investigator. The data was entered on to a computerized Excel (MS-EXCEL) spread sheet. Subsequently it was analyzed using SPSS (Statistical package for social sciences). The findings were expressed in terms of mean and standard deviation. The difference between mean scores was tested by using unpaired t-test and ANOVA test. P value < 0.05 was considered as significant.

 Ethical approval: Institutional ethics committee approval was obtained before starting the study.

Table 1: Socio demographic information of participants

Majority of the study subjects were in the age group of 70-75years, 80% of them were Hindus by religion, 2/3^rd of them were still working, 1/3^rd of them belong to the upper lower social class and main source of income was pension for half of them.

Table 2: Mean scores of individual domains of Quality of Life (QOL)

Mean scores of the physical and psychological domains were almost the same (56.65+ 14.12 and 56.53+ 15.33) likewise mean scores of the social and environmental domains were slightly differed (62.55 ± 18.45 and 63.21 ± 18.36) and all the domains have highest maximum scores (100)  except physical domain.

Table 3: Association between domains of QOL and socio-demographic variables

The mean scores of all the domains were higher among 76-79 years as compared to 70-75 years age group. There was a significant difference in mean scores of psychological, environment, and social domains (p=<0.05) between the two age groups.

The mean scores of all the domains were higher among males as compared to females. There was a statistically significant difference in mean scores of psychological and social domains (p=0.005 and 0.046 respectively).

Religion-based difference in mean scores was found to be significant for psychological and environmental domains (p=0.046 and 0.036 respectively).

The mean scores of social and environment domains were higher among married and widowed persons than unmarried and divorced. This difference was statistically significant in social (p=0.012) and environmental (p=0.031) domains.

The study subjects who had professional education had the highest mean scores in the psychological environmental and social domains and illiterates had the lowest scores in all domains. These differences in mean domain scores across different levels of literacy were statistically significant (p=<0.001, <0.001, 0.009, and <0.001 for physical, psychological, social and environmental domains, respectively).

Participants who were in professional work had higher mean scores in physical and psychological environmental and social domains while unskilled workers had scored low for all 4 domains. There was a significant difference in different occupations for physical, psychological, social relationships, environmental domains. (p=<0.001, <0.001), <0.001and <0.001 respectively).

The study participants belonging to Upper socioeconomic class (according to the Modified Kuppuswamy Socioeconomic Status Classification) had the highest mean scores in the physical, psychological, social and environmental domains while who were in lower class scored lowest scores for all domains. The differences in mean physical, psychological, social and environmental domain scores across different socioeconomic classes was statistically significant (p=<0.001, p=<0.001, 0.006 and p=<0.001 respectively).

Those who had the income from the land as a source had scored highest for physical, psychological, social and environmental domains. The difference was significant only for psychological domain (p=0.002).

This study was carried out among elderly aged 70-79years with 80% of them were Hindus by religion, 2/3^rd of them were still working, 1/3^rd of them belonged to the upper lower social class and the main source of income was pension for half of them. Research by Praveen V, Rani AM et al, showed that mean scores were a little lower as compared to this study.⁷ The mean scores of all the domains were higher among 76-79 years as compared to 70-75 years age group. There was a significant difference in mean scores of psychological, environment and social domains (p=<0.05) between the two age groups. Study findings of other researchers were contrary to this study which showed older group had a lesser QOL score.^8,9 whereas a study by Praveen V, Rani AM et al, the middle-old age group QOL score is lower than the young-old age group but the difference was not statistically significant.⁷ In this study Education, occupation and social class seem to play an important role in improving the mean scores of QOL, as they are determining factors of the standard of living of the society leading to a better quality of life. The disparity observed in QOL scores of this study as compared to other studies can be attributed to the variation in influence of associated factors as QOL can be affected by many social and demographic factors.  In this study mean score of the environmental domain was higher as compared to other domains. Results of Rajput M. et al and Praveen V, Rani AM et al were in line with this study which shows that elderly were more satisfied about their environment. Where as Shah, et al. Sowmiya and Nagarani observed lowest mean scores in environmental domain.^10,11 In the present study, QOL as per four different domains was significantly better among males as compared to females. Qadri et al. also mentioned that QOL was better among males for physical, psychological, social, and environmental domains.¹² Bhatia et al reported that QOL was significantly associated with education. In the present study as well, the physical, social, psychological and environmental domain scores are significantly better among literates than illiterates.¹³ Rajput M. et al revealed that the subjects who illiterate, financially dependent, were having any health problem, of lower socio-economic class, living without partner, unemployed/homemakers had poor quality of life.¹⁴

Overall mean scores for social, physical, psychological, and environmental domains were good. The mean scores of the physical and psychological domains were almost the same, likewise, the mean scores of the social and environmental domains were slightly differed) and all the domains had the highest maximum scores except the physical domain. Education, occupation, and social class seems to play an important role in improving the mean scores of QOL. Males had better quality of life compared to females. The mean scores of social and environment domains were higher among married and widowed persons than unmarried and divorced. This may be because elderly married living with their partner were socially welcoming for social relationships.

More chances of recall bias as this study were conducted among the elderly.

Small sample from one place so we cannot generalize the findings to the whole population.

Emphasises the need for optimal utilization of geriatric health services under National health programs. A multiprongial approach should be applied to improve the quality of life of the elderly at the family and community levels.

FUNDING: It was funded by Dr NTRUHS, Vijayawada.

CONFLICTS OF INTEREST: None

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