Relationship between Quality of life and Socio-demographic characteristics among older people in Tehran-Iran

Authors and Correspondence:
Soghra Nikpour PhD*
is qualified in society health nursing, and a member of the scientific board of faculty of nursing and midwifery, Iran University of Medical Sciences and Health Services, Tehran, Iran; Email: nikiniki_s@yahoo.com

Aghil Habibi Soola*
MSc is qualified in Medical surgical nursing;
Email:aghilhabibi@yahoo.com

Mahnaz Seiedoshohadaei *
MSc in medical surgical nursing
School of Nursing and Midwifery, Iran University of Medical Sciences and Health Services, Tehran, Iran;
Email: saydshohadai@yahoo.com

Hamid Haghani*
Msc is qualified in biostastistics,and is a member of the scientific board of faculty of management and information, Iran University of Medical Sciences and Health Services,Tehran, Iran;
Email: haghani511@yahoo.com

Aghil Habibi Soola*
MSc is qualified in Medical surgical nursing; Email:aghilhabibi@yahoo.com

*Address: College of nursing & midwifery Iran University of medical science health services, Rashid Yasami st. Vali ASR Ave. Tehran-Iran.

As in most other countries, the proportion of elderly people is increasing every year in Iran due to decreased birth rates and increased longevity. The proportion of those 60 years and older in Iran was approximately 12 % in 2004 and is expected to rise 15% in 2020(1) With the aging of the world's population, more than one-quarter of the world's population will be over the age of 60 by the year 2100(2). The majority of the world's elderly population lives in low-income countries; 54% of people older than age 60 years live in Asia (3). This group of people is increasing more rapidly compared to elderly people in high income countries. Intergenerational transfers will be an important source of income for most of the world's current adult populations. Recent research reveals high dependency by older persons on economic support from family members in most low-income countries (4). The World Health Organization Quality of Life Group (5) defined QOL as "an individual's perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns" (p. 1570).

As individuals live longer, QOL is even more important, particularly with regard to demographic variables (6-7-8). Issues in QOL for older persons is related to their independence in every day life, high cognitive and physical function, and active engagement with life. There is considerable evidence that improving QOL of older adults reduces the cost of health care (9- 10- 11 and 12). Particularly, culturally sensitive guidelines are becoming more important because of the rapid growth of the older population and the growing awareness of the importance of cultural differences. QOL is considered to be the key goal for health promotion in older people. Most researchers consider QOL to be a multidimensional concept encompassing health, functional status, social, as well as other aspects of an individual life (13- 14 and 15). Knowledge about the factors that influence QOL in old age is of major importance as population aging becomes a reality world-wide, yet empirically, knowledge about QOL in this population is limited (16-17).

Therefore, this study examined the degree of QOL and the relationship between QOL and demographic variables in the Iranian elderly who live in the west area in Tehran-Iran. This study will elucidate the QOL that Iranian elderly engage in. This investigation of the relationship between QOL and demographic variables will help health care professionals to develop evidence-based health promotion strategies in the community to facilitate healthy and active life for the elderly population. Ultimately, this will help these individuals achieve their highest level of health and QOL.

This study was a descriptive-correlational study to understand QOL and their Socio-demographic variables in Iranian elderly living in west area in Tehran-Iran. The sample included 410 community residents who were over 60 years old, and cognitively intact Participants were conveniently selected from 6 regions in west of Tehran. Subjects who consented to participate in the study were interviewed by trained interviewers with a structured questionnaire at the time of consent, or a subsequent interview was scheduled that was more convenient for the participants.

This study was approved by the Institutional Review Boards of the senior centers and public health centers. Short Form Health Survey (SF12) (18) (Ware et al., 1996) was revised and used to measure QOL. This contains 9 items: Physical Functioning, Role Physical, Role Emotional, Mental Health, Bodily Pain, General Health, Vitality, Social Functioning, and General QOL. These items reflect what respondents are able to do, how they feel and how they evaluate their health status with a 5-point Likert scale. A higher score indicates a lower QOL.Cronbach's alpha was .799.

Descriptive statistics were used to consider QOL, perceived health status, and number of chronic illnesses. T-test and ANOVA were used to explore the differences in quality of care by the status of specific health promotion behaviors, and socio-demographic variables.

The majority of the participants were male (55.6%), 60-74 years old (77.3%), with no schooling (30.5%), and married (80%). The mean age was 69.71±6.84 years old with a range of 60-86. Examining the living arrangements of the elderly, 55.1% of the elderly lived with a spouse, and with their family (30%), followed by alone 12.9 %.

On average, these participants had 2.18 chronic illnesses. Arthritis (60%) was the most common health problem, followed by hypertension (36%), cataract (34.9%) and gastrointestinal disorder (26.8%). In terms of perceived health status, 32.9% of the participants indicated that their health was poorer compared to their peer group of elderly people.

The mean score of Quality of life was 32.84±8.89, range 12-48, indicating that they evaluated their QOL as moderate (Table1).

There were significant differences in QOL in terms of gender, education, economic status, perceived health status, number of chronic diseases, and kind of chronic diseases.

The male QOL was significantly higher than the female (t = 3.675, p =.000). Those in the educated groups were more likely to evaluate their QOL as higher than the elementary school groups (F = 4:258; p =0.001). The QOL of the elderly with independent economic status was significantly higher than that of the elderly with dependent economic status (t =2.9055; p =0.004). There were significant relationships between QOL and perceived QOL.

Health status (F =118.04, p = 0.000), number of chronic illnesses (F =35.869, p = 0.000), (Table 2), kind of chronic diseases (p<0.05) (Table3).

The two goals of Healthy People 2010 focus on increasing the quality and years of healthy life for each individual and eliminating health disparities (19) (Resnick 2003). Improving QOL for older people in the community can be a challenging task for health Care professionals. This study investigated the relationship between QOL and Socio-demographic variables among Iranian elderly living in west area in Tehran-Iran. The goal of health promotion is to maintain function and independence, and improve QOL (7). QOL is important as population aging becomes a reality world-wide. The mean score of Quality of life was 32.84±8.89, range 12-48, indicating that they evaluated their QOL as moderate. The findings in the current study are consistent with a study by Lee et al (2005) that also found that the study participants evaluated their QOL as moderate (20). Elderly QOL in this study differed significantly on some factors. QOL is a complex phenomenon, and many factors are thought to influence it (13). There are a number of findings in the current study that are important to note. In regard to demographic variables, no differences were found in quality of life based on age, living arrangements, or marital status. Composed of perceived health status, number of chronic illnesses, perceived health status contributes to a positive QOL by enhancing positive perceptions of one's health; Raphael et al. (1995) reported a correlation of .50 between self-reported health status and QOL in a sample of healthy older adults (13). Janz et al. (2001) identified patients' perceptions of their health as the most significant correlate of Health Related Quality Life in cardiac patients. On the other hand, a statistically significant negative relationship was found between the total number of chronic illnesses and QOL (21). The positive relationships demonstrated in the current study between perceived health statuses, numbers of chronic illnesses and QOL are consistent with the findings of previous research (22-23 and 20). They reported similar findings that functional status had significant correlation with QOL in a set of demographic, functional, and social variables. Some demographic variables (gender, education, economic status, perceived health status, number of chronic diseases, and kind of chronic diseases) were found to be significantly related to QOL in this study. Quality of life (QOL) is a widely used concept in social science and relates to various aspects of life. It has been measured by assessing an individual's financial situation, and general expectations from life as well as other factors such as education, housing, social support, and health. There is no single deciding factor but a combination of factors that contribute to an individual's overall QOL. These factors have different meanings and degrees of importance in different societies. It is a concept that is of relevance across disciplines such as economics, philosophy, and health care. Because it is a highly subjective concept, the specific context must be considered carefully when studying QOL (24).

There is no consensus in the literature on the existence of differences in QOL based on demographic variables. The findings in the current study are consistent with previous studies that did find differences based on demographic factors (13).

The findings of this study suggest a more objective perspective on elderly QOL issues in Iran.

A picture of elderly population in terms of the degree of QOL in this study can be used as the basis for guiding important directions and planning QOL in the community. The first step toward promoting QOL among the elderly is to set priorities and to encourage older persons to make an informed decision abut his or her own health care practices. In the second step, differentiated promoting QOL programs that consider gender, age, and education should be developed and implemented. In addition, empirical validation of the effect of intervention such as education, home visit on elderly functional status and QOL using randomized clinical trials should also be studied. Finally, health care professionals should assess the elderly's own perception of QOL and identify interventions to improve their QOL perception. Educational programs that enhance the patient's ability to manage the disease have been found to be effective in fulfilling this purpose (25).

On the other hand, this study had several limitations. First, a cross-sectional design was used to identify the relationship between QOL and Socio-demographic variables, thereby precluding causality. Future research should use a longitudinal design to understand better the impact of QOL on Socio- demographic variables. Second, since the instruments used in this study were developed in line with Iranian culture or were based on revised Western ones, it was not easy to compare directly the results of this study with those of previous western studies. In addition, one possible reason for the absence of strong evidence for significant relationships between Socio-demographic variables and QOL is that the measures used may not have been sensitive enough to detect the modest difference of QOL in the elderly. Caution should be exercised in generalizing these results to the entire population of Iranian elderly because of the convenient sampling method through senior centers and public health centers. The current study focused only on QOL and Socio-demographic variables of Iranian elderly. In conclusion, QOL is an important outcome that is intricately linked to the goals of health care like nursing. The literature abounds with references to QOL, whereas there is little research on the correlates with QOL of elderly populations. The current study contributes to the expansion of the coherent body of knowledge about QOL, which is essential for health care professionals and others who work with older populations. Health care professionals should further facilitate for improving QOL through formal health Promotion programs, which focus on QOL of individual elderly and to improve the overall health among community.

HH participated in the second line of statistical analyses, and drafted the manuscript. A drafted parts of the document and contributed to the editing .SM contributed to the editing of the manuscript.SN served as the principal investigator, designed the study, participated and oversaw field activity, revised and edited the manuscript. All authors read and approved the final manuscript.

Table 1-Quality of life of the study samples (N = 410)

<< Back to text

Table 2-Mean and standard deviation Quality of life with Socio- demographic variables of the study samples (N = 410)

<< Back to text

Table 3 -Mean and standard deviation Quality of life diseases of the study samples (N = 410)

<< Back to text

We kindly acknowledge the research assistant of IUMS and all research units and individuals participating in this study.

1. Census of center of Iran,” population” 2002.Iran-Tehran.
   
2. World Health Organization, 2004. http://www.who.int/enAccessed, June 2004.
   
3. United Nations. (2002).Population ageing 2002.NewYork: United Nations, Population Division, Department of Economic and Social Affairs.
   
4. Palacios, R. The future of global ageing. International Journal of Epidemiology 2002; 31(4): 786-791.
   
5. World Health Organization Quality of Life Group. Development of the World Health Organization WHOQOL- BREF quality of life assessment. Psychological Medicine 1998: 28 (3): 551–558.
   
6. Goldberg, T., Chavin, S. Preventive medicine and screening in older adults. Journal of the American Geriatric Society 1997; 45: 341–354.
   
7. Leveille, S., Guralnik, J., Ferrucci, L., Langlois, J. Aging successfully until death in old age: opportunities for increasing active life expectancy. American Journal of Epidemiology 1999;149 (7): 654–664.
   
8. Sims, J., Kerse, N., Naccarella, L., Long, H. Health promotion and older people: the role of the general practitioners in Australia in promoting healthy ageing. Australian and New Zealand Journal of Public Health 2000;24 (4): 356–359.
   
9. Higgins, P.G. Biometric outcome of a geriatric health promotion program. Journal of Advanced Nursing 1988; 13(6): 710–715.
   
10. Mayer, J.A., Jermanovich, A., Wright, B.L., Elder, J.P., Drew, J.A., Williams, S.J. Changes in health behaviors of older adults. Preventive Medicine 1994;23 (2): 127–133.
    
11. Heidrich, S.M. Health promotion in old age. Annual Review of Nursing Research 1998; 16:173–195.
    
12. Beattie, B.L., Whitelaw, N., Mettler, M., Turner, D. A vision for older adults and health promotion. American Journal of Health Promotion 2003; 18 (2): 200–204.
    
13. Raphael, D., Brown, I., Renwick, R., Cava, M., Weir, N., Healthcote, K. The quality of life of seniors living in the community: a conceptualization with implications for public health practice. Canadian Journal of Public Health 1995; 86: 228–233.
14. Bowling, A., Banister, D., Sutton, S., Evans, O., Windsor, J. A multidimensional model of quality of life in older age. Aging and Mental Health 2002;6 (4): 355–371.
    
15. Osborne, R.H., Hawthorne, G., Lew, E.A., Gray, L.C.Quality of life assessment in the community-dwelling elderly: validation of the assessment of quality of life instrument and comparison with SF 36. Journal of Clinical Epidemiology 2003;56 (2): 138–147.
    
16. Huppert, F.A., Brayne, C., Jagger, M. Longitudinal studies of ageing: a key role in the evidence base for improving health and quality of life in older adults. British Geriatric Society 2000; 29: 485–486.
    
17. Mowad, L. Correlates of quality of life in older adult veterans. Western Journal of Nursing Research 2004; 26 (3): 293–306.
    
18. Ware, J., Kosinkski, M., Keller, S. SF-12: a 12 item short-form health survey. Medical Care 1996; 34 (3): 220–233.
    
19. Resnick, B. Health promotion practices of older adults: model testing. Public Health Nursing 2003; 20 (1): 2–12.
    
20. Lee, W T., KO, S., Lee, J K. Health promotion behaviors and quality of life among community-dwelling elderly in Korea: A cross-sectional survey. International Journal of Nursing Studies 2005; 43 : 293–300
    
21. Janz, N.K., Janevie, M.R., Dodge, J.A., Fingerlin, T.E., Schork, M.A., Mosca, J.L. Factors influencing quality of life in older women with heart disease. Medical Care 2001; 39: 588–598.
    
22. Andrews, G.A. Promoting health and function in an Aging population. British Medical Journal 2001; 322: 728–729.
    
23. Juenger, J., Schellberg, D., Kraemer, S., Haunstetter, A., Zugck, C and Herzog, W. Health related quality of life in patients with congestive heart failure: Comparison with other chronic disease and relation to functional variables. Heart 2002; 87:235–241.
    
24. NILSSON, J.PARKER, M G. KABIR, Z N. Assessing Health-Related Quality of Life among Older People in Rural Bangladesh. Journal of Transcultural Nursing October 2004; 15 (4): 298-307.
    
25. Helliwell, P.S., O’Hara, M., Holdworth, J., Hesselden, A., King, T., Evans, P. A 12-month randomized controlled trial of patient education on radiographic changes and quality of life in early rheumatoid arthritis. Rheumatology 1999; 38: 303–308