Factors affecting Quality of Life of Elderly

Overview

Elderly needs continous social support and I have highlighted how different variables affect quality of Life of Elders.

Summary

As two-thirds of elderly population live in rural areas, geriatric health care services must be delivered in primary health care centers, which require training of healthcare professionals in geriatrics. The elderly must be sensitized on legal protections offered by the government of India and improve accessibility to various social welfare policies. Policymakers must focus on capacity building of health care staff working in primary health care centers, NGO’s, family members, caregivers, etc. on the care of elderly which has a direct impact on improving the QOL of elderly. Research on QOL, Activity of Daily Living (ADL), functional status, chronic diseases, etc. of elderly needs to be encouraged and further strengthened. Maintenance and improvement in Quality Of Life should be included among the goals of the welfare of the geriatric population. Medico-social services for the elderly must be prioritized in rural health care settings. Improving the Quality Of Life of elderly needs a holistic approach and concerted efforts by the various stakeholders like government and health-related sectors, family and caregivers, etc.

Author Comments

Dr Shoeb Ahmed Ilyas, B.Sc.,BDS, PGDMLE, PGDHA, PGDHM, MS, MHA, MPH, MHRM, MA, M.Sc., FHTA,
Dr Shoeb Ahmed Ilyas, B.Sc.,BDS, PGDMLE, PGDHA, PGDHM, MS, MHA, MPH, MHRM, MA, M.Sc., FHTA,
Ruby Med Plus
Dr
Dentistry, public Health, Health care Services, Health Care Policy, social Work, social policy, medical laws and ethics
Hyderabad, TELANGANA | India
Writing this article was a great pleasure as it has no co-authors with whom I may have collaborated. This article is dedicated research work of meon elderly people and I hope this article makes what people might think is how elderly quality of life is affected and what factors promote and what factors inhibit. Understanding these factors are critical to understand complex issues surrounging elderly mental health, quality of life and social support. All these issues that touches every single human being on this planet in one way or another. More than anything else, and if nothing else, I hope you find this article thought-provoking.Dr Shoeb Ahmed Ilyas, B.Sc.,BDS, PGDMLE, PGDHA, PGDHM, MS, MHA, MPH, MHRM, MA, M.Sc., FHTA,

Resources

What Elders Lost: Review of Factors Affecting Elderly Quality of Life
http://www.gerontologyindia.com/pdf/vol-34-1.pdf

What Elders Lost: Review of Factors Affecting Elderly Quality of Life

Authors:
Shoeb Ahmed

Indian Journal of GERONTOLOGY

Shoeb Ahmed (2020), Indian Journal of GERONTOLOGY, Vol. 34, No.1, pp. 84–95 ISSN: 0971–4189. (http://www.gerontologyindia.com/pdf/vol-34-1.pdf)

AbstractThis paper is based on a descriptive research design by secondary data method to describe the factors affecting the elderly quality of life. This review presents challenges faced by ageing elderly and gives a timely warning of the enormous health system challenges alarming in India’s near future, at a time when Indian social care and health system are unprepared to handle the existing burden of elderly care of the Indian population. The future burden of elderly care emphasize on the prevention of high risk factors for chronic diseases and mental health disabilities which has great impact on quality of life of elderly and there is urgent need for strong call for action on addressing socio-cultural norms, health service planning and funding, workforce training and preparation for the Indian Ageing society. The challenges for the health and social care services are huge, with substantial financial and workforce planning predicaments. Key words: Quality of life, Ageing, Social Support, NCDs, mental health, Health Care Services.Ageing is the progression of change in the biological, psychological and social formation of an individual. Aging occurs among other large social trends that have an impact on the lives of the elderly. Globally, population Aging is considered as a holistic concept with a broad range of issues and acknowledged as an important trend in which “we are in the center of a population aging revolution” and this uprising of Aging is seen the world over, but high in the developing countries like India and China affecting sustainable development. The elderly population is expected to increase its share to more than 10 per cent by the year 2021 (Central Statistics Office, 2011). India is expected to become an Aging society by 2024; the focus would be on its preparedness towards meeting the Aging crisis from the present unstructured system (Lee et al., 2011). In India, as per Census 2011, 8.6 per cent (103 million) of the population out of 1210 million total populations is above the age of 60 and 11 million of the population is over 80 years of age. It is forecasted that by the year 2026, the elderly would increase to 173.2 million and by 2050 the elderly population is expected to be around 300 million and below 60 years of age population would increase by 20 per cent, that above 60 years population would increase by 300 per cent and that above 80 years of population increase by 500 per cent. This demographic transition has intense social, economic and political implications for India. This is the extent of the challenge the Indian society and health care systems may face as “today’s youth are tomorrow’s elderly” and protecting the rights of elderly and ensuring their well-being will be the primary focus. Aging Elderly Population Burden on Health Systems Population Aging has intense social, economic and political implications for India. The growing number of older persons put a strain on health care and social care systems due to their ailment and diseases which needs to be addressed by medical services, i.e. hospitals, doctors, nurses are required and also need other facilities and resources. Very old people, due to their reduced mobility and debilitating disabilities, need support from other people to do things for them and to share their concerns and emotional support. Old age is also associated with a higher risk of exposure to various stressors such as the onset of chronic conditions, loss of functions, loss of sources of income, role losses, and loss of spouse and confidants (Nemeroff et al., 2010). Study on the appraisal of unmet needs of the elderly in India highlights that most of the elderly (46%) were unaware of the availability of any geriatric health care services near their residence and 96 per cent had never used any geriatric welfare service (Goel et al., 1999). National Sample Survey (2004) predicts that the proportion of elderly who cannot move and are confined to their bed or home ranges from 77 per 1,000 in urban areas to 84 per 1,000 in rural areas.Changing Family Structure and Elderly The conventional Indian society with an age-old joint family system has been instrumental in the protection of the social and economic security of the elderly people. The traditional socio-cultural norms and values of Indian society stressed on showing respect and providing care for the elderly. But, with the rising prevalence of nuclear family set-ups in recent years, the elderly have been exposed to emotional, physical and financial insecurity and with fewer children in the family, the care of older persons in the families gets increasingly difficult and is facing social isolation. There is increase in prevalence of neglect and abuse of elderly, violation of their rights, financial insecurity, engagement of elderly in informal sector and most importantly physical, social, economic and emotional vulnerability of elderly leads them to isolation, disability, psychological distress, less satisfaction in life which may lead to mental health issues in elderly. Elderly may face a decline in available sources of social support as a result of changes in the structure of the family, decline in fertility rates and family sizes, as fewer adult children are available to take care and support elderly (Chang, 1992). As a result of broad social changes such as migration, modernization, urbanization, the younger population has later age of marriage, higher divorce rates; preferences for one or two children, higher education, and participation of women in employment, generation gaps and intergenerational challenges have a great influence on functions of the family. Victor (2005) showed that high negative effect on family ties and relationships among family members are seen universally due to social and family changes. High out-migration of the working-age population, contributes to the process of rapid demographic Aging. According to the United Nations (UN), worldwide the „old-age support ratio was 9 in 2009, this is projected to fall to 4 persons of working age per a person aged 65 or over in 2050. In India, Old-age support ratio in 2012 was 10.8 and decline in the old-age support ratio 2012–50 was 4.8. More than 73 million persons, i.e. 71 per cent of the elderly population reside in rural areas while 31 million or 29 per cent of the elderly population is in urban areas.Lack of Social Support among Elderly Cobb (1976) defined social support as ‘the individual belief that one is cared for and loved, esteemed and valued, and belongs to a network of communication and mutual obligations’. Social support is an important issue for the elderly and research on social support has continued to be a dominant force in gerontological literature. It determines the subjective well-being in old age (Rathore, 2009). Social support is an essential requirement for elderly as old age is associated with an increased risk of exposure to various stressors such as onset of chronic conditions, loss of function, loss of sources of income, role losses, and loss of spouse and confidants (Nemeroff et al., 2010). The elderly may also suffer from ill effects of stress (Oxman et al., 1992; McLeod and Kessler, 1990). Social support acts as a buffer to these stresses and also extends practical help in facing challenges of Aging (Johnson, 1998; Langford et al., 1997). Lack of social support may have negative effects on the mental health of elderly, as social support is believed to play a key role in moderating the effects of stress (Lakey and Cronin, 2008; Cooper et al., 1999; Cohen et al., 1997). Antonucci and Akiyama (1987) stated that females have a wider social network than males and males tend to heavily rely on their spouses for social support. Social isolation and loneliness have increased over the years (Rajan, 2006). In a study done by Lena et al. (2009) almost half of the respondents felt neglected and sad and felt that people had an indifferent attitude towards the elderly. It was also found that 47 per cent feel sad in life and 36.2 per cent felt they were a burden to the family. The elderly decrease in the frequency of visits to religious places decreases the interaction with social network, companionship and needed counseling, coping mechanism and emotional support which all harm social support. Lack of social support was a significant predictor of depression for women, while this was not the case for men (Huang et al., 2011).Social support literature indicates that specifically spousal relationships appear to be more central to the emotional well-being of men than women (Dykstra and de Jong Gierveld, 2004). Mental health status differs from male individuals to female individuals. Agarawal et al. (2002) conducted a study on depressed and no depressed elderly. The results pointed out that depressing events were significantly more among females as compared to male. Women appear to be sensitive to levels of social support, and may experience more detrimental consequences to mental health when support is lacking, as the mental health of women is worse than that of men and the proposed explanation might be as women face greater exposure to life stressors and range of biosocial factors.Family Support, Size of Family and Mental Health The study conducted by Ramachandran et al. (1981) on family structure and mental illness in old age revealed that mental illness was higher in old age, and with subjects living in small size family. Taqui et al. (2007) carried out a study on depression in the elderly: Does family system play a role? A cross-sectional study with a sample of 400 elderly people revealed that those who were living in a nuclear family system were more likely to have depression than those who were living in the joint family system. Arif and Pallavi, (2016) showed that the scores on family social support, friends’ social support, and significant other social support were higher in female as compared to males and a significant difference was found in all the domain of perceived social support. Social pressure and scarce resources create many dysfunctional attitudes in elderly such as attitudes towards old age, deprivation of status in the community; problems of isolation, loneliness, and the generation gap are the well-known driving forces resulting in socio-psychological frustration among the elderly (Mohanty, 1989). Family support is found to be a significant factor for socio-psychological well-being of the elderly (Devi and Murugesan, 2006)Elderly Economic Dependency Economic conditions are the most important determinant of life satisfaction among the elderly (Jung et al., 2010). Elderly live with their children in India (Bloom et al., 2010), and their economic security and well-being are mainly dependent on the economic capacity of the family unit (Siva Raju, 2011). According to 52nd round of the National Sample Survey Organization, nearly half of the elderly are fully dependent on others, while another 20 per cent are partially dependent for their economic needs [NSSO, 1998]. The situation was even worse for elderly females [GOI, 2011]. Females depend on others, given economic dependency, lower literacy and higher incidence of widowhood among them (Gopal, 2006). The challenge to the welfare of the older person is poverty, which is a multiplier of risk for abuse (Shenoy, 2014). Migration of youth, lack of proper care in the family, insufficient housing, economic hardship and the break-up of joint family have made the old age homes seem more relevant even in the Indian context (Bajwa, Buttar, 2002).Quality of Life (QOL) of Elderly The Quality Of Life (QOL) of the elderly is a global challenge for the twenty-first century. Studying the quality of life of the elderly plays a significant role in social planning. Quality of Life is defined by Barcaccia (2013, p. 1) as ‘the general well-being of persons and societies, outlining negative and positive features of life.’ Andelman et al. (1998, p. 3) focused on the quality of life (QOL) and emphasized that ‘quality of life aggregates the seven domains like well being, health, productivity, intimacy, safety, community, and the emotional well-being. Two important indicators used in quality of life, i.e. objective approach and the subjective approach. The objective approach focuses on individual capacities to meet their needs with available resources like health, income, education, amenities, justice, etc. Whereas, the subjective approach focuses on the individual perception of his life or psychological state of mind. Good health is a very important dimension of QOL to elderly people as it enables them to continue working and functioning independently. Health is an important indicator of human capabilities which is essential for a good QOL (Sen, 1985). Quality of life (QOL) is evaluated on the following indicators like adaptation and resilience, health, social contacts, dependency, material circumstances, and social comparisons. Policymakers, researchers, clinical practitioners, social workers, national and international NGOs and geriatric agencies have been working hard to enhance how the elderly can achieve optimum quality of life. To enjoy the QOL, elderly need belonging to the society and community in which they live, which emphasize their acceptance and access to community resources by and large.Chronic Diseases and QOL in Elderly Chronic diseases such as cardiovascular diseases (coronary heart disease), hypertension, stroke, diabetes, cancer, chronic obstructive pulmonary disease, musculoskeletal conditions (arthritis and osteoporosis), mental health conditions (dementia and depression) and blindness and visual impairment, etc. (WHO, 1998) are most common in elderly people. These chronic diseases cause medical, social and psychological problems in the elderly, which can decrease physical functions and the QOL in the elderly. In old age, there is a greater probability of social disruptions such as bereavement, social isolation, physical disability, and cognitive decline, all of which contribute to depression and affects QOL (Shear et al., 2005). The QOL index of elderly is absolutely influenced by higher educational status, involvement in decision making, satisfaction with general health, level of stress and marital status (i.e. married). But factors like the advanced age of elderly, acute and chronic morbidity, living alone, financial difficulties and experience of abuse are negative influences on the QOL index of elderly (UNFPA, 1999)The Decrease in Elderly Satisfaction of Health and Accessibility to Health Care Health is one of many dimensions contributing to the overall quality of life (Rathore, 2009). The stress caused by illness and the following treatment may surpass one’s ability to cope, thus negatively affecting the quality of life (QOL). Quality of life is an important measure in order to evaluate the medical therapy of chronic diseases. Older age is one of the situations when quality of life will be decreased due to stressors. As a result of the lack of family support or reduced social support networks, elderly people might experience loneliness and may face physical and emotional health problems. Lack of physical health infrastructure and drugs in primary health centers, unaffordable medicines and treatment are major restraints for providing health care access to the aged. The other issues are lack of diagnostic infrastructure, limited manpower, poor quality of care and overcrowding in healthcare facilities due to insufficient focus on elderly care (FICCI-Deloitte, 2014) Daycare centers, old age residential homes, counseling and recreational facilities for the elderly are urban-based and not available to all the elderly. The geriatric outpatient department services are mostly available at tertiary care hospitals (Mane et al., 2014). As 75 per cent of the elderly live in rural areas, accessibility to geriatric health care services is challenging. Dhar (2005) has pointed out the neglect in the provision of facilities for geriatric patient care as well as training and development of human resource in geriatrics in the Indian public health context is challenging. As pointed out by Dey et al. (2012), the basic challenges to access and affordability of health care services for elderly population includes reduced mobility, social and structural barriers, wage loss, familial dependencies, and declining social engagement. The stigma of aging is a further social barrier to access of health in addition to the health and social conditions the elderly normally face such as dementia, depression, incontinence and widowhood (Patel, Prince, 2001). Giving access to nursing care, social support levels, medical therapy, education and counseling to the elderly, in particular to women widows, could improve QOL.Conclusion As two-thirds of elderly population live in rural areas, geriatric health care services must be delivered in primary health care centers, which require training of healthcare professionals in geriatrics. The elderly must be sensitized on legal protections offered by the government of India and improve accessibility to various social welfare policies. Policymakers must focus on capacity building of health care staff working in primary health care centers, NGO’s, family members, caregivers, etc. on the care of elderly which has a direct impact on improving the QOL of elderly.Research on QOL, Activity of Daily Living (ADL), functional status, chronic diseases, etc. of elderly needs to be encouraged and further strengthened. Maintenance and improvement in Quality Of Life should be included among the goals of the welfare of the geriatric population. Medico-social services for the elderly must be prioritized in rural health care settings. Improving the Quality Of Life of elderly needs a holistic approach and concerted efforts by the various stakeholders like government and health-related sectors, family and caregivers, etc.References Agarwal M, Hamilton Jb, Moore Ce, Crandell J., (2010): Predictors of depression among older African American cancer patients. Cancer nursing. 33:156–63. Andelman, R. et al. (1998): Quality of life: Definitions and terminology. In A. C. Robert (ed.), A discussion document from the international society of quality of life studies, International Society of Quality of Life Studies, Vol. 3.Antonucci, T. C, Akiyama, H., (1987): An examination of sex differences in social support among older men and women. Sex Roles, 17(11 and 12), 737–749. Arif Ali, Pallavi Kwan Hazarika., (2016): Gender, Quality of Life and Perceived Social Support among Rural Elderly Population: A Study from Sonitpur District, Assam. Indian Journal of Gerontology, Vol. 30, No. 4, pp. 441–451. Bajwa A, Buttar A., (2002): Principles of geriatric rehabilitation. In: Rosenblatt DE, Natarajan VS (eds). Primer on geriatric care, Cochin, Pixel studio 232–243.
January 2020
83 Reads

Similar Publications