Influencing Factors of Quality of Life in Elderly: A Comparative Cross-sectional Study in Old Age Homes and Senior Citizen Clubs

INTRODUCTION

Across the globe, the proportion of older adults has been gradually expanding over time. Aging is a universal, inevitable process that affects everyone, regardless of age, gender, socioeconomic status, or place of residence. Today, life expectancy at birth in developed countries has nearly doubled, and so, the proportion of older adults is rising worldwide. The global population is witnessing a steady increase in the percentage of older individuals across all nations.^[1] At present, older adults make up 8.2% of India’s total population, and this proportion is projected to rise to 20% by the year 2050.^[2] Gujarat’s overall growth rate has surpassed the national average of 17.6%, increasing by over 19% in the last decade.^[3]

Improved healthcare, with advancements in medical technology, treatments, and medicines, has significantly reduced mortality rates. With increased longevity comes a range of challenges, including the transformation of family structures. Increasing urbanization and modernization are reshaping the traditional family structure in India. The shift from joint to nuclear family structures is becoming increasingly prevalent among younger couples. When children move away for education or career opportunities, elderly parents often choose to live independently or move into old age homes (OAHs) rather than relocating with their children. OAHs for the elderly are evolving as an essential requirement in modern Indian society.^[4]

Many studies have been conducted across India to evaluate health conditions, oral health, psychiatric morbidity, and quality of life (QOL) among the elderly in various settings, including rural and urban areas, OAHs, and community living. The senior social clubs are private organizations, operated exclusively to provide recreational or social services to the elderly. These clubs offer a range of activities and opportunities for social interaction and entertainment. Senior citizens gather weekly or fortnightly at a dedicated center for meetings. These regular meetings provide opportunities for socialization, recreational activities, and community engagement in a comfortable environment. It provides a space for seniors to connect, get new knowledge, and engage in leisure activities. However, there is a dearth of studies assessing the QOL of individuals who have joined senior social clubs in Indian literature. Moreover, there is a paucity of research in the western region of India, particularly Gujarat, focusing on the well-being of the elderly population. Research conducted across various states in India suggests that the QOL is often better among the elderly residing in the community than those living in OAHs.^[5,6] Conversely, other studies have reported the opposite findings, indicating that residents of OAHs tend to experience a relatively higher QOL,^[7,8] while in a Tamil Nadu study, authors found that the QOL is comparable in both settings.^[9] The findings of these studies are not consistent. However, evidence from systematic reviews, meta-analyses and a few studies indicates that similar research in developing countries like Brazil has shown a higher overall QOL among community living arrangements.^[10]

Therefore, the objective of this study is to examine the disparities in QOL among elderly populations in residential care facilities and those involved in community-based senior social clubs. Furthermore, the study seeks to identify the association of various socio-demographic factors that influence their QOL.

MATERIAL AND METHODS

RESULTS

The study included 102 elderly participants from both the old age home group and the senior social club group. Table 1 shows that among all participants, 56.8% (116) were female, and 50.9% (104) belonged to the 71–80 age range. In the senior social club group, 89 (87.3%) were married, while 13 (12.7%) were widows. In contrast, in old age home, 84 (78.4%) were widowed, representing the majority. Regarding education, 50 (49.1%) in the senior social club group had a college degree, compared to only 22 (21.6%) in OAHs. In the senior social club, only 38 (37.3%) were financially dependent, while in OAHs, the majority, 64 (62.7%), relied on others financially. About 118 (57.8%) of them had chronic morbidity related to hypertension, diabetes mellitus, or cardiovascular diseases [Table 1].

Based on the preliminary single-item question, “good” QOL was reported by 69.6% of old age home residents and 30.4% described it as “alright.” Among senior social clubs, a notably higher percentage (77.3%) characterized their QOL as “good.” Across both groups, there were no ratings of “very bad” or “bad” for overall QOL. The mean standardized score of QOL was more in the senior social club group (89.7 ± 5.5), compared to OAHs residents (70.3 ± 10.3), and the difference was statistically significant (P < 0.001). All domain-wise QOL scores were significantly higher in the senior social club compared to the OAH residents. The lowest domain score among old age home residents was in social relationships, while the highest was in home and neighborhood [Table 2].

Bivariate analysis for other socio-demographic variables showed that average QOL scores significantly differed based on marital status, educational level, and financial resources. However, scores did not reveal any statistically significant differences across various age groups, between genders, or morbidity conditions [Table 3].

Results from multiple linear regression demonstrated that three variables emerged as significant predictors of QOL: Senior social club participation (P = 0.001), higher education (P = 0.001), and receiving a pension (P = 0.022). Collectively, these variables explained 65.5% of the variance in QOL scores [Table 4].

DISCUSSION

Assessing the QOL among the elderly is important to understand their level of satisfaction during this last stage of life. Further findings can also serve as a foundation for shaping and implementing effective local policy strategies. This study facilitated a comparison of the QOL among old age home residents and those members of senior citizen clubs in Anand, Gujarat, while also examining the socio-demographic factors that influence their well-being.

In our study, 50% of the participants were aged between 70 and 80 years, whereas a study from Puducherry reported a comparable proportion of elderly individuals in the 61–69 age group.^[15] This discrepancy in age groups could be attributed to the time frame, as the comparative study was conducted half a decade earlier. In our study, female elderly participants were more prevalent, aligning with findings from other studies conducted across India.^[5,16] A similar finding was also reported in an Australian study with 76.3% female participants.^[17] The increased longevity of women, as evidenced by the population pyramids of both developed and developing countries, accounts for this phenomenon. Most of the 84 participants (80.4%) were widowed in OAHs. This suggests that the elderly widows may have had to depend on OAHs, as they lacked support and care at home. In the present study, very few participants received a pension; this contrasts with the study conducted by Soren et al., in Ranchi, where 50% of the elderly people living in rural areas received a pension living.^[18] The reason for this may be due to regional differences.

Old age home residents demonstrated a good average QOL score, consistent with the study by Thresa and Indumathi which reported that 56.2% of residents had an average or higher QOL.^[11] The reason for this might be that they were satisfied with the facilities provided to them. However, there was a significant mean difference in QOL score when it was compared with the senior social club group. This observation of high scores in the community is consistent with a study done by Kengnal et al., in Karnataka.^[16] However, in a Nagaland study, authors reported contrasting results that Older adults residing in old-age homes reported a better QOL compared to those living with their families.^[8] A study by Vignesh et al., in Tamil Nadu, also observed that the QOL did not differ significantly between OAH residents and those residing within the community.^[9] This variation may be attributed to differences in the standards of care provided in OAHs. In a few systematic reviews and meta-analyses conducted in developing countries, QOL measures did not differ significantly among participants residing in institutional settings and in community-dwellings for elderly populations.^[10] Country-wise, there might be differences in how QOL is perceived in both settings.

Consistent with prior studies in India and Nepal, the mean score for social relationships was the lowest among participants living in OAHs.^[6,19,20] The social relationships of the elderly are often influenced by separation from loved ones and diminished interaction with close contacts. There might also be fewer opportunities for social engagement and recreational activities. Conversely, senior social clubs showed significantly higher scores, likely due to the regular engagement in various activities. The enjoyment of club culture and the ability to live independently in their own homes could be important factors.

The highest domain score among OAHs was observed in “Home and Neighborhood.” This may be explained by the availability of key facilities, such as food, safety, and spacious living arrangements, within private OAHs. Supporting evidence comes from studies by Kumar et al., (Himachal Pradesh) and Thakur et al., (Uttarakhand), both of which reported maximum scores in the environmental domain for OAH residents.^[21,22]

According to the multivariable regression analysis, being a member of a senior social group had the greatest impact on QOL. This finding may be explained by the observation that the elderly who engage in recreational activities are less likely to experience feelings of isolation and loneliness. These connections not only improve mood but also provide emotional support, fostering a sense of belonging and purpose within the community. Monteiro et al., in a systematic review, underscored the role of social engagement in enhancing the QOL among older adults.^[23] This aligns with findings from a study by Devraj and D’mello, which reported significantly higher QOL scores among participants involved in social clubs.^[15]

A significant association between literacy and QOL was observed, in line with the findings of Rao et al., from Bihar.^[24] The reason could be that educated individuals tend to have a better understanding of the ageing process. In our study, receiving a pension emerged as another significant predictor of enhanced QOL among the study participants. The obtained result aligns with findings from the study by Bloom et al., conducted in India, which identified income as the most influential factor affecting QOL in older adults.^[25]

This can be attributed to the fact that financial independence provides the elderly with autonomy and allows them to meet their needs in their preferred way. However, this finding was inconsistent with the Malaysian study.^[26] This could be due to participants having other sources of income in addition to their pension.

CONCLUSION

In general, QOL was good in both settings. The findings reveal a lack of social and recreational activities among residents of OAHs. The study revealed that one in two participants was financially reliant on external sources. Members of the senior social group, higher education and getting a pension were significant predictors of QOL.