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 Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 32  |  Issue : 2  |  Page : 158-163

Quality of life of senior citizens: A Rural-Urban comparison


1 Department of Psychiatric Nursing, Government College of Nursing, Kottayam, Kerala, India
2 Department of Nursing, NIMHANS, Bengaluru, Karnataka, India

Date of Web Publication25-Apr-2016

Correspondence Address:
Dr. V K Usha
Government College of Nursing, Kottayam, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-9962.181104

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  Abstract 

Background: The experience of aging is unique to every individual because of the individual differences in personalities, varying social support network, and differing cultures to which one belongs. Quality of life (QOL) of senior citizens is greatly influenced by their previous lifestyle, culture, education, health care beliefs, family strengths, and integration into the communities. Aims: To assess the sociodemographic profile, QOL, and to compare the QOL of senior citizens in rural and urban areas. Methodology: Data were collected from 830 rural senior citizens and 120 urban senior citizens through multistage random sampling technique. The tools used in this study were sociodemographic data sheet and WHO QOL-BREF-26. Results: Majority of senior citizens belonged to the age group 65–75 years in rural (65.3%) and urban (65%) areas and majority were females (rural 61.4% and urban 66.7%). A major percentage (44.7%) of senior citizens in rural areas lived with their spouses and children, whereas 40% of them in urban areas lived with their children and 40% with their spouse and children. Majority of study subjects in rural (90.6%) and urban areas (97.5%) were not involved in any social activities. The senior citizens in urban areas showed better QOL than the senior citizens in rural areas. This was statistically significant in the overall perception of QOL, the overall perception of health, physical health, psychological health, and environment (P < 0.05). Conclusion: This study showed that QOL was poorer among senior citizens in rural areas. In India, the population of senior citizens is greater in rural areas where the health care facilities are minimal. Hence, policies and programs related to senior citizens should be launched in rural areas without neglecting the needs of urban senior citizens. Training of voluntary workers, health care professionals, and family members on the care of senior citizens should be implemented. QOL of senior citizens could be enhanced only with the support of family members.

Keywords: Quality of life, rural areas, senior citizens, urban areas


How to cite this article:
Usha V K, Lalitha K. Quality of life of senior citizens: A Rural-Urban comparison . Indian J Soc Psychiatry 2016;32:158-63

How to cite this URL:
Usha V K, Lalitha K. Quality of life of senior citizens: A Rural-Urban comparison . Indian J Soc Psychiatry [serial online] 2016 [cited 2019 Aug 24];32:158-63. Available from: http://www.indjsp.org/text.asp?2016/32/2/158/181104


  Introduction Top


Aging is a universal phenomenon, which is experienced by every human being across various cultures. The experience of aging is unique to every individual because of the individual differences in personalities, varying social support network, and differing cultures to which one belongs. The response of the society to the aged also differs across cultures because of the abilities or inabilities of the society due to various economic, social, and political factors.

In India, 90% of older persons are from the unorganized sector, with no social security at the age of 60. Thirty percentage of older persons live below the poverty line and another 33% just marginally over it. Moreover, 80% live in rural areas, 73% are illiterate, and can only be engaged in physical labor, 55% of women over 60 are widows, and there are nearly 200,000 centenarians in India.[1]

In Kerala, out of a population of 3.1 crores, 10.1% are elderly citizens. According to the 1961 census, the number of elderly was just 1.0 million; by the time of 2001 census, the number increased to 3.4 million. According to the projections, the number of elderly is expected to exceed 6.6 million by 2021. In Kottayam District, out of 1953,646 population, 251,835 (12.8%) are elderly.[2]

Quality of life (QOL) is a multidimensional concept including physical, psychological, social, and economic components. Life satisfaction is an individualized, subjective assessment of a person's QOL according to his or her chosen criteria. Combining perception with performance or capacity is an important aspect of QOL of persons with chronic illness or disability. Research has found that the effect of physical disability or chronic illness cannot be appreciated without taking into consideration both the specific areas of functioning affected by the person's condition and those aspects of QOL (social, psychological, and functional) that are of particular importance to the individual.[3]

QOL of senior citizens is greatly influenced by their previous lifestyle, culture, education, health care beliefs, family strengths, and integration into the community.[4] QOL for older adults is greatly enhanced by their involvement in planning, sponsoring, and evaluating programs and services in institutional, outpatient, and community settings.

The QOL of the elderly depends on various factors such as 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.[3] There is a dearth of literature related to QOL of senior citizens in rural and urban areas living with their own family members, and this study attempted to bridge the gap.

Methodology

This study was intended to compare the QOL of senior citizens in rural and urban areas of Kottayam District and hence a nonexperimental descriptive survey design was used. The study was conducted in selected wards of Kottayam District under Panchayat and Municipal administration. The sampling technique used in this study was multistage random sampling.

Senior citizens from urban areas were selected by the following method. The Kottayam District was divided into urban and rural zones according to the administration as the first stage. There are four municipalities in Kottayam District, namely, Changanassery, Kottayam, Pala, and Vaikom. From these, Kottayam municipality was selected randomly by lottery method as the second stage. There are thirty-eight wards for the Kottayam municipality. From the list, four wards namely, Veloor, Karapuzha, Thiruvathukkal, and Illickal (approximately 10%) were selected randomly as the third stage. The fourth stage includes a selection of senior citizens. Systematic random sampling was used to select thirty subjects from each ward. A sampling frame of senior citizens was prepared for each ward based on voter's list. The sampling interval width (k) was established by dividing the size of the population (N) by the required sample size (n). The number of senior citizens in each ward varies from 70 to 90, and the required sample size was 30 per ward. The first subject was selected randomly from the list, and every k th senior citizen was selected accordingly. The same procedure was repeated in other three wards, and thus 120 subjects formed the sample from an urban area.

The same method was followed for the selection of senior citizens from the rural area. There are 75 Grama Panchayats in Kottayam District. Out of that, eight (approximately 10%) Grama Panchayats were randomly selected by lottery method as the second stage. The selected Grama Panchayats were Athirampuzha, Ettumanoor, Arpookara, Kumaranalloor, Ayarkunnam, Pampady, Aymanam, and Puthuppally. Each Grama Panchayat has got 12–20 wards and altogether there are 132 wards. As the third stage, 13 wards (10%) were again selected randomly by lottery method. The fourth stage included selection of subjects by systematic random sampling method. A sampling frame of senior citizens was prepared for 13 wards based on voter's list. The sampling interval width (k) for each ward sample was established by dividing the size of the population (N) of that ward by the required sample size (n). The number of senior citizens in each ward varies from 120 to 150, and the required sample size from each ward was 64. Then, the first subject was selected randomly from the list, and every k th senior citizen was selected. The same procedure was repeated in other 12 wards to comprise 830 senior citizens from the rural area.

The data were collected by the investigator first from the urban areas and then from the rural areas. The sociodemographic data sheet was prepared to collect information regarding personal, health, social, and spiritual aspects of the senior citizens.

The QOL of senior citizen was assessed by WHO QOL-BREF-26. This tool focuses on client's life during past 2 weeks. The WHOQOL-BREF contains a total of 26 questions. The first two questions deal with the overall perception of QOL and overall perception of health. The remaining 24 questions are included under four domains. The domains of the tool are physical health, psychological health, social relationships, and environment. All items were rated on a 5-point scale with a higher score indicating a higher QOL. 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.[5] The investigator obtained approval from Institutional Review Committee, Medical College, Kottayam and received written informed consent from all participants of the study.


  Results Top


The data collected for the study were analyzed using SPSS version 17.0 (SPSS for Windows, Version 17.0, Chicago, SPSS Inc). The sociodemographic data of senior citizens include personal, health, social, and spiritual aspects which were analyzed using frequencies and percentages and presented in [Table 1],[Table 2],[Table 3],[Table 4],[Table 5].
Table 1: Frequency distribution and percentage of senior citizens based on age, gender, marital status, education, employment status, monthly income and cohabitation (n=950)

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Table 2: Frequency distribution and percentage of senior citizens based on exercises performed, preference on diet, immunizations received, and system of treatment followed (n=950)

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Table 3: Frequency distribution and percentage of senior citizens according to place of seeking medical help, frequency of medical consultation, distance to medical care facility, availability of geriatric welfare clinic (n=950)

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Table 4: Frequency distribution and percentage of senior citizens according to social activities involved, membership in social clubs, leisure time activities, feeling of social isolation, and belief in God (n=950)

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Table 5: Frequency distribution and percentage of senior citizens based on property ownership, writing of will, issues related to division of properties, anticipation on death/funeral, and place of preference to die (n=950)

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The overall perception of QOL and overall perception of health were shown in [Table 6] and [Table 7].
Table 6: Frequency and percentage of senior citizens in rural and urban areas based on overall perception of quality of life (n=950)

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Table 7: Frequency and percentage of senior citizens in rural and urban areas based on overall perception of health (n=950)

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The majority of senior citizens in rural (51.1%) and urban areas (53.3%) rated their overall perception of QOL as good.

The majority of the senior citizens in rural (42%) and urban areas (45.8%) also rated their overall perception of health as good. The findings in [Table 8] show that the urban senior citizens expressed a better QOL than rural senior citizens in all the four domains. Both rural and urban senior citizens scored high in environment domain (13.82 and 14.88) and low in physical health domain (12.21 and 13.09).
Table 8: Mean scores, standard deviation and t value of domains of quality of life of senior citizens in rural and urban areas (n=950)

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There was a statistically significant difference in the overall perception of QOL and health between the rural and urban senior citizens (P < 0.05 for both). 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).


  Discussion Top


This study revealed that majority of senior citizens belonged to the age group 65–75 years both in rural (65.3%) and urban (65%) areas. A study on senior citizens in rural areas showed that 66% of study subjects belonged to the age group of 65–75 years.[6] Similar finding was also shown in a study conducted in a geropsychiatric clinic.[7],[8] Females formed the major group (rural 61.4% and urban 66.7%) compared to males. Similar finding was observed in studies conducted in Kerala.[6],[7],[8] Moreover, the greater life expectancy of females compared to males also might be a reason for this finding. Majority of study subjects in rural (61.9%) and urban (55%) areas were married and living with their spouses. This is the true reflection of Indian culture where spouses live together until their last breath. Similar observations were made by the investigators in their study on senior citizens in rural areas.[6],[8] Majority (56.6%) of senior citizens in rural areas had primary education, whereas 45% of them in urban areas had a secondary level of education. This finding is in consistent with previous studies.[6],[7] Majority of senior citizens (rural 74.1% and urban 52.5%) were unemployed during the time of data collection. Similar finding was observed in studies, where the majority of senior citizens were unemployed.[6],[7] Furthermore, old age may be considered as a period of rest and relaxation. Majority of senior citizens in urban areas (57.5%) had no regular income, whereas 53.6% of study subjects in rural areas had monthly income between Rs. 1001–3000. This finding was supported by the previous studies.[7],[8],[9] A major percentage of senior citizens in rural (44.7%) and urban areas (40%) lived with their spouse and children's family. This finding was in tune with a previous study where 51.1% senior citizens lived in extended families, 35.5% in nuclear families, and only 13.3% in joint families.[8] Majority of senior citizens in rural (47.1%) and urban (43.3%) areas were engaged in household activities. This might be due to the fact that, in Kerala, both men and women go for work and thus senior citizens at home were engaged in rearing of grandchildren and other household activities. Awareness about the primary prevention of illness among senior citizens and the need for a regular health checkup were less, and they followed allopathic system of treatment considering its quick relief and convenience. A major percentage of senior citizens in rural (66.7%) and urban (58.3%) areas sought medical help from private hospitals, and they consulted the physician only when illness arise. Similar finding was observed in a previous study.[6] The concept of geriatric care facility has yet to come in the country as in developed country.

Majority of study subjects in rural (90.6%) and urban areas (97.5%) were not involved in any social activities and not having membership in social clubs (89.5% and 100%). During old age, people might have preferred to sit idly at home. Majority of senior citizens in rural and urban areas (71.1% and 75%) engaged in watching television and listening to music during their leisure time. It was observed in Kerala that almost every house has a television irrespective of their economic status, and entertainment programs are available from various channels for 24 h. Most of these programs are good sources of entertainment for the senior citizens and hence they spent quite a lot of time in watching television and listening to music. Elderly in a rural population have been observed to enjoy their leisure time at home.[6],[10] A study on psychosocial problems and utilization of leisure hours of aged persons revealed that the group of elderly persons who were engaged in meaningful leisure time activities felt less psychosocial problem than those without meaningful leisure time activities.[11] Majority of senior citizens (rural 66.3% and urban 65%) did not feel social isolation because most of them either lived with their spouse or children or grandchildren. This finding was supported by a previous study.[6] Both the groups (99.1% rural and 99.2% urban senior citizens) believed in God. In a study to assess the needs of elderly, 80% of them perceived the spiritual need as the most important need.[12]

In this study, majority (51.1%) of senior citizens in rural and urban areas (53.3%) rated their overall perception of QOL as good. This study also elicited that majority of senior citizens in rural (42%) and urban areas (45.8%) rated their overall perception of health as good. The urban senior citizens expressed a better QOL than rural senior citizens in all the four domains. Both rural and urban senior citizens scored high in environment domain (13.82 and 14.88) and low in physical health domain (12.21 and 13.09). Furthermore, the urban senior citizens expressed better health than the rural senior citizens. Although there are no studies to substantiate, it could be assumed that the health status of an individual might have an influence over QOL.

This study 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. In a study to find out the health-related QOL among elderly in urban, rural, and island community in Taiwan showed that the urban elderly population had the greatest health-related QOL, particularly on the physical health. The remote island elderly population had the highest scores on the vitality and mental health, whereas the rural elderly population had the poorest health-related QOL, particularly rural women.[13] An Indian study showed that senior citizens in various age groups differed significantly in the domains of physical, psychological, and social relations, whereas single and married subjects differed significantly in the domains of environmental and social relations.[14]

Since the terminally ill and bedridden senior citizens and senior citizens with severe hearing impairment were excluded from the study, their QOL could not be assessed. The study was limited to one district of Kerala alone and hence the findings could not be generalized.


  Conclusion Top


This study depicted that senior citizens in urban areas were having better QOL than the senior citizens in rural areas. In India, the population of senior citizens is high in rural areas where the health care facilities are very minimum. Hence, policies and programs related to senior citizens should be launched in rural areas without neglecting the needs of urban senior citizens. Training of voluntary workers, health care professionals, and family members on the care of senior citizens should be implemented. To enhance the QOL of senior citizens, several things can be done including formulating self-help groups in the local area with the help of voluntary organizations or village level workers, setting up multidisciplinary geriatric clinics all over the country in all health care settings both in public and private sector so as to manage specific age-related problems, conducting regular health check-up camps, and immunization programs for the senior citizens at village level, financially supporting all needy senior citizens through pension schemes and arranging counseling programs for the senior citizens and family members.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
HelpAge India. Directory of Old Age Homes in India. New Delhi: Research and Development Division, HelpAge India; 2003.  Back to cited text no. 1
    
2.
Census Report, Kerala; 2001. Available from: http://www.crd.kerala.gov.in/kerala_popu.pdf. [Last retrieved on 2010 Jun 15].  Back to cited text no. 2
    
3.
Lueckenotte AG. Gerontologic Nursing. 2nd ed. St. Louis: Mosby; 2000.  Back to cited text no. 3
    
4.
Hogstel MO. Geropsychiatric Nursing. St. Louis: Mosby; 1990.  Back to cited text no. 4
    
5.
WHOQOL-BREF. Introduction, Administration, Scoring and Generic Version of the Assessment. Field Trial Version: December, 1996. Available from: http://www.who.int/. [Last retrieved on 2010 Jun 15].  Back to cited text no. 5
    
6.
Usha VK, Lalitha K. Physical problems of senior citizens: A gender perspective. Kerala Nurs Forum 2011;6:5-15.  Back to cited text no. 6
    
7.
Usha VK, Lalitha K. Social problems of senior citizens. Nightingale Nurs Times 2011;7:12-5, 64.  Back to cited text no. 7
    
8.
Indu PV, Subha N, Ramachandran A. An experience from psycho-geriatric clinic of a tertiary care centre. Kerala J Psychiatry 2007;22:15-22.  Back to cited text no. 8
    
9.
Usha VK, Lalitha K, Padmavathi D. Depression and cognitive impairment among old age people. Nightingale Nurs Times 2009;5:21-3.  Back to cited text no. 9
    
10.
Venkatorao T, Ezhil R, Jabbar S, Ramakrishnan R. Prevalence of disability and handicaps in geriatric population in rural South India. Indian J Public Health 2005;49:11-7.  Back to cited text no. 10
[PUBMED]  Medknow Journal  
11.
Gyanani TC, Kushwaha SS. Psychosocial problems and utilization of leisure hours of aged persons. Behav Sci 2003;4:37-41.  Back to cited text no. 11
    
12.
Lillypet S. A study to assess the needs of the elderly as perceived by them and their significant family members in a selected urban community. Nightingale Nurs Times 2006;2:24-7.  Back to cited text no. 12
    
13.
Tsai SY, Chi LY, Lee LS, Chou P. Health-related quality of life among urban, rural, and island community elderly in Taiwan. J Formos Med Assoc 2004;103:196-204.  Back to cited text no. 13
    
14.
Barua A, Mangesh R, Kumar HN, Saajan M. Assessment of the domains of quality of life in the geriatric population. Indian J Psychiatry 2005;47:157-9.  Back to cited text no. 14
[PUBMED]  Medknow Journal  



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8]


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