|Year : 2017 | Volume
| Issue : 4 | Page : 138-142
Sociodemographic factors affecting the quality of life of elderly persons attending the general outpatient clinics of a tertiary hospital, South-South Nigeria
Uduak-Obong Morgan Morgan1, Etiobong Akpan Etukumana1, Festus Abasiubong2
1 Department of Family Medicine, University of Uyo Teaching Hospital, Uyo, Akwa Ibom State, Nigeria
2 Department of Psychiatry, University of Uyo Teaching Hospital, Uyo, Akwa Ibom State, Nigeria
|Date of Web Publication||24-Apr-2019|
Dr. Uduak-Obong Morgan Morgan
Department of Family Medicine, University of Uyo Teaching Hospital, Uyo, Akwa Ibom State
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Background: In the last few decades, the evaluation of the quality of life (QoL) among older adults has become increasingly important in health as well as in social sciences. There has been growing emphasis on the need to understand what influences older people's QoL as it is argued to be of greater value than the traditional outcome measures, such as health status. Aim and Objective: The aim of this study was to determine the sociodemographic factors affecting the QoL of elderly patients attending the General Outpatient Clinics of the University of Uyo Teaching Hospital (UUTH), Uyo. Methodology: The study was a cross-sectional descriptive study. Three hundred and ten elderly persons attending the General Outpatient Clinics of the UUTH for medical conditions between July and September 2014 were consecutively recruited for the study. Details of sociodemographic information were taken, and QoL of respondents was assessed using the older persons' QoL questionnaire. Data were analyzed using the Statistical Package for Social Sciences-17.0, and the level of statistical significance was set at P < 0.05. Results: Of the three hundred and ten respondents recruited for the study, One hundred and seventy-seven (57.1%) were female and one hundred and thirty-three (42.9%) were male. The female-to-male ratio was 1.3:1. The age range of the respondents was between 60 and 90 years and the mean age (±standard deviation) was 67.4 (±6.6) years. Two hundred and thirty-two respondents (74.8%) had at least primary level of education and one hundred and sixty-one (51.9%) were married. The median monthly income was ₦ 25,500.00 with interquartile range of ₦ 10,000.00 to ₦ 50,000.00. From the study, 85.5% of the elderly reported an overall good QoL. High-income grade (P = 0.019), high social class (P = 0.036), and high level of education (P < 0.001) were the factors associated with good QoL in this study on univariate analysis. Conclusion: A high percentage of respondents reported an overall good QoL. High-income grade, high social class, and high level of education were the factors associated with good QoL.
Keywords: Elderly, hospital, quality of life, Uyo
|How to cite this article:|
Morgan UOM, Etukumana EA, Abasiubong F. Sociodemographic factors affecting the quality of life of elderly persons attending the general outpatient clinics of a tertiary hospital, South-South Nigeria. Niger Med J 2017;58:138-42
|How to cite this URL:|
Morgan UOM, Etukumana EA, Abasiubong F. Sociodemographic factors affecting the quality of life of elderly persons attending the general outpatient clinics of a tertiary hospital, South-South Nigeria. Niger Med J [serial online] 2017 [cited 2019 May 24];58:138-42. Available from: http://www.nigeriamedj.com/text.asp?2017/58/4/138/256995
| Introduction|| |
Early notions of quality of life (QoL) can be dated to Aristotle's (384-332 BC) written concepts of "the good life" and "living well" and how public policy can help to nurture it. His social ethics and perfect society doctrines explored both individual and society concepts of QoL. He said that "the most desirable life for the state cannot be known unless the nature of the most desirable life for the individual is known."
In a computerized search of electronic journal databases, the first use of the term quality and life was found in an article written by James Seth in 1889. In 'The Evolution of Morality', Seth talked about a moral end to which mankind can aspire: "we must not regard the mere quantity, but also the quality of the 'life' which forms the moral end."
In the past few decades, the evaluation of QoL among older adults has become increasingly important in health as well as in social sciences.,, There has also been growing emphasis on the need to understand what influences older people's QoL as it is argued to be of greater value than the traditional outcome measures such as health status. While physical health is widely regarded as important for QoL, other domains theorized as integral to QoL in the elderly are psychological well-being, social relationships, independence, mobility, and physical environment.
In 1991, the World Health Organization (WHO) developed a unifying and trans-cultural definition of QoL. They defined it as the individual's perception of his or her own position in life, within the cultural context and value system he or she lives in, and in relation to his or her goals, expectations, parameters, and social relations. It is a broad-ranging concept affected complexly by the person's physical health, psychological state, level of independence, social relationships, and their relationship to salient features of their environment. Based on this definition, the concept of health-related QoL was introduced, which is a broad and multi-dimensional model that includes various domains of physical, psychological, and social health. The process of senescence affects all of these domains and reduces health-related QoL generally, especially in developing countries like ours where poverty is widespread and the elderly persons are at higher risk; where social securities to the elderly are not provided and where supports from the family are fast fading out.
QoL has been widely accepted as an indicator of successful aging, and it is monitored as a means of measuring the effectiveness of social policies, welfare programs, and health care. For this reason, QoL is increasingly assessed in population surveys of older people. The WHO has further stressed that the prerequisite for a fuller life is not simply to add years to life but to add life to years. This can be no more pertinent for any other section of a population than the older population.
In view of the above, the QoL of the elderly people has become relevant more so with the impending demographic shift which will result in an increasing number of the elderly population, and with indications that concepts and concerns related to QoL in older ages are different from the general population. This study focuses on determining the sociodemographic factors affecting the QoL of elderly persons attending the outpatient clinics of a tertiary hospital in South-South Nigeria, its implication for those involved in research, health and social policy for older people.
| Methodology|| |
This study was carried out at the General Outpatient Clinics of the University of Uyo Teaching Hospital (UUTH), Uyo in Akwa Ibom State, Nigeria. The hospital is a tertiary health institution located in Uyo, Akwa-Ibom State, South-South, Nigeria. It is a 400-bed tertiary health institution which offers services to indigenes of Akwa-Ibom State and neighboring states of Cross River, Abia, and Rivers. The study was a cross-sectional descriptive study designed to determine the sociodemographic factors affecting the QoL of elderly persons who presented for medical treatment at the general outpatient clinics of the UUTH.
A total of 310 consenting elderly patients from 60 years and above who presented at the general outpatient clinics of the UUTH for medical care within the study period were consecutively recruited. Respondents were recruited daily from Monday to Friday after the morning sorting routine. Information was given to each subject in English or the local language (Ibibio) on the research objectives and informed written consent was obtained. Participation was voluntary and confidentiality ensured. Thereafter, each individual was administered a questionnaire by the researcher to provide the information therein. The questionnaire, which was semi-structured, sought information on sociodemographic characteristics such as age, sex, and marital status. Oyedeji's social classification was used to ascertain the socioeconomic status of the respondents. The older persons QoL Questionnaire is a 35-item QoL questionnaire developed by Bowling. It has 5-point Likert scale from strongly agree to strongly disagree. It assesses overall well-being, social relationships and participation, independence, control over life, freedom, psychological and emotional well-being, financial circumstances, religion, and culture. Items with negative responses were reverse coded and summed with positive responses so that scores of 106–175 correlated with poor QoL and scores of 35–105 correlated with QoL.
Data entry and analysis were performed using the Statistical Package for Social Sciences version 17.0 (IBM, Armonk, New York, USA). Descriptive statistics such as mean and standard deviation were used to analyze continuous variables while frequency and percentages of categorical variables were also determined. Inferential statistics such as the Chi-square (χ2) test and odds ratios were employed to compare differences in proportions or groups. The level of statistical significance was set at P < 0.05.
Approval for the study was sought and obtained from the UUTH Research and Ethical Committee before the commencement of the study.
| Results|| |
A total number of 310 participants were recruited for the study between July and September 2014.
Sociodemographic characteristics of respondents
The demographic characteristics of the study participants are shown in [Table 1]. Majority of the respondents were women (57.1%), the female-to-male ratio of participants recruited was 1.3:1. The minimum and maximum ages of respondents were 60 and 90 years, respectively. The mean age (±standard deviation) of the respondents was 67.4 (±6.6) years. About 74.8% of them had at least attained the primary level of education, and most were married (51.9%). The median monthly income was ₦ 25,500.00 with an interquartile range of ₦ 10,000.00–₦ 50,000.00.
Quality of life of respondents
[Table 2] shows that the majority of respondents (85.5%) had a good quality life, whereas 14.5% had a poor QoL.
Association between sociodemographic factors and quality of life of respondents
The association between sociodemographic characteristics and QoL of the respondents is shown in [Table 3].
|Table 3: Association between sociodemographic factors and quality of life of respondents|
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There was a significant level of association between the QoL and the educational levels of the respondents. Those who had at least primary education had a better QoL than those with no formal education χ2 = 16.342, (P = 0.001). Those who had a higher income grade > ₦ 100,000.00 per month were also observed to have a better QoL than those who earned <₦ 50,000.00 per month, and this association was statistically significant (χ2 = 7.943, P = 0.019). Furthermore, those in social Class 1 were found to have a better QoL than those belonging to social Class 5 (χ2 = 10.267, P = 0.036). This association was also statistically significant.
| Discussion|| |
Several studies in the developed countries have reported an overall good QoL among elderly persons.,,, Interestingly, in this study, majority of the study participants (85%) had a good QoL despite the differences in socioeconomic conditions in developed and developing countries. Studies have revealed a relationship between increasing age and QoL;,, however, this study did not show a statistically significant relationship between age and QoL of the respondents. This study found no significant difference in the QoL among the male and female respondents. This observation is similar to studies in Britain where little or no difference was observed in the QoL of elderly male and female respondents. This may be because elderly people face the same life situations that could impact on QoL whether they are males or females. The study observed a higher QoL in those that had formal education than those that had no formal education. Similar observation was also reported in other studies., The reason for this observation may be that higher educational attainment may also be associated with higher income and socioeconomic status; and this will, in turn, equip people with greater confidence in their ability to determine the path of old age and to experience satisfaction and fulfilment as they age. This study revealed that financial resources at the disposal of the elderly had a significant influence on their QoL. In Nigeria, poverty is widespread and the elderly persons are at high risk. Unfortunately, the Nigerian government does not provide social security to the elderly and the supports from the family is fast fading out. The finding from this study is similar to that of Adebowale et al. in their study on the elderly well-being in a rural community in Nigeria. He noted that poor well-being in older people was associated with not having enough money to meet daily and health needs. Majority of the respondents in that study did not also receive regular and meaningful financial support from children and relatives. Gureje et al. also noted in their study that economic status was the most consistent predictor of the four domains of QoL assessed. Other studies, outside Africa, have also shown that poor income is associated with poor QoL.,,
QoL for people with chronic physical illnesses has been the focus of a substantial body of work., Studies have shown that there is a relationship between the number of illnesses and general QoL and well-being, with those having multiple chronic medical illnesses having a significant reduction in QoL than those that have single morbidity. Multiple morbidities have been associated with feelings of being unhappy and more psychologically distressed. Lyons et al. found that after controlling for age and gender, all patient groups (asthma, diabetes, arthritis, back pain, sciatica, hypertension, angina, myocardial infarction, and stroke) had significantly poorer health-related QoL (HRQoL) than those without the condition. In this study, however, there was no statistically significant relationship in the QoL of those who had chronic medical illnesses.
| Conclusion|| |
The overall QoL in the elderly was high (85%) in this study. High levels of education, high income, high social class, were factors associated with good QoL in this study. There is, therefore, a need for the government to establish a functional social security system for the elderly as is obtainable in developed countries. It is also not out of place if the elderly benefit from the National Health Insurance Scheme coverage as many of them may not be able to afford out of pocket payment, especially for medical services. Above all, as seen from the study, attainment of higher levels of formal education has been associated with higher QoL. It, therefore, behooves every government to ensure free basic education and affordable tertiary education as this will ultimately equip individuals better, amongst other benefits, to experience a satisfying and fulfilling old age. Finally, more research is needed in areas related to the QoL of the elderly as there is an observed paucity of local literature with regard to the subject.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Smith AE. Quality of life: A review, education and ageing. Triangle J 2000;15:419-35.
Chong MS, Chan MP, Kang J, Han HC, Ding YY, Tan TL. A new model of delirium care in the acute geriatric setting: Geriatric monitoring unit. BMC Geriatr 2011;11:41.
Chan SW, Chiu HF, Chien WT, Thompson DR, Lam L. Quality of life in Chinese elderly people with depression. Int J Geriatr Psychiatry 2006;21:312-8.
Koochek A, Montazeri A, Johansson SE, Sundquist J. Health-related quality of life and migration: A cross-sectional study on elderly Iranians in Sweden. Health Qual Life Outcomes 2007;5:60.
Tajvar M, Arab M, Montazeri A. Determinants of health-related quality of life in elderly in Teheran, Iran. Public Health 2008;8:323-31.
Farquhar M. Definitions of quality of life: A taxonomy. J Adv Nurs 1995;22:502-8.
The WHOQOL Group. The World Health Organization quality of life assessment (WHOQOL): Development and general psychometric properties. Soc Sci Med 1998;46:1569-85.
World Health Organization. WHO Report of the WHOQoL Focus Group Work. WHO (MNH/PSF/93.4). Geneva: World Health Organization; 1993.
Paschoal SM. Quality of Life of the Elderly: Constructing an Instrument for Assessment by Means of the Clinical Method. Doctoral Thesis; Vindersidade de Sao Paulo; 2004.
Nutuveli G, Blanc D. Quality of life in older ages. Br Med Bull 2008;85:113-6.
Oyedeji GA. Socioeconomic and cultural background of hospitalized children in Ilesa. Niger J Paediatr 1985;12:111-7.
Bowling A. The Psychometric Properties of the Older People's Quality of Life Questionnaire, compared with the CASP-19 and the WHOQOL-OLD. Current Gerontology and Geriatrics Research. 2009. Available from: http://www.hindawi.com/journals/cggr/2009/298950/
. [Last accessed on 2019 Apr 03].
Bowling A, Seetai S, Morris R, Ebrahim S. Quality of life among older people with poor functioning. The influence of perceived control over life. Age Ageing 2007;36:310-5.
Qadri SS, Ahluwalla SK, Ganal AN, Bali SP, Wani AF, Bashir H. An epidemiological study on quality of life among rural elderly population of northern India. Int J Med Sci Public Health 2013;2:514-22.
Phaswana-Mafuya N, Peltzer K, Chirinda W, Kose Z, Hoosain E, Ramlagan S. Self-rated health and associated factors among older South Africans: Evidence from the study on global ageing and adult health. Glob Health Action 2013;6:19880.
Joensuu H, Roppanen I. Elderly People's Quality of Life in the Rural Communities of Swaziland. Paper for a Degree Programme in Health Science; 2012.
Onya ON, Stanley PC. Risk factors for depressive illness among elderly GOPD attendees at UPTH. IOSR J Dent Med 2013;5:77-86.
Uwakwe R. Psychiatric morbidity in elderly patients admitted to non-psychiatric wards in a general/teaching hospital in Nigeria. Int J Geriatr Psychiatry 2000;15:346-54.
Adebowale SA, Atte O, Ayemi O. Elderly well-being in a rural community in North-Central Nigeria, Sub-Saharan Africa. Public Health Res 2012;2:92-101.
Kearney PA, Cronin H, O'Regan C, Kamiya Y, Savva GM, Whelan B, et al
. The Irish longitudinal study on ageing. Int J Epidemiol 2011;40:877-84.
Gureje O, Kola L, Afolabi E, Olley BO. Determinants of quality of life of elderly Nigerians: Results from the Ibadan study of ageing. Afr J Med Med Sci 2008;37:239-47.
Abasiubong F, Ekott JU, Bassey EA, Etukumana EA, Edyang-Ekpa M. Quality of life in people living with HIV/AIDS in Niger Delta Region, Nigeria. J Ment Health 2010;19:211-8.
Jiman AC, Etukumana EA, Ukot IA, Udoh SB, Akinbami SO. Quality of life in Patients with low back pain in a Nigerian Tertiary Hospital. Niger J Fam Pract 2014;5:43-8.
Lyons RA, Lo SV, Littlepage BN. Comparative health status of patients with 11 common illnesses in Wales. J Epidemiol Community Health 1994;48:388-90.
[Table 1], [Table 2], [Table 3]