Asia Journal of Public Health Journal homepage:http://www.ASIAPH.org Original Articles Quality of Life of the Elderly People in Einme Township Irrawaddy Division, Myanmar Myo Myi
Trang 1
Asia Journal of Public Health
Journal homepage:http://www.ASIAPH.org
Original Articles
Quality of Life of the Elderly People in Einme Township
Irrawaddy Division, Myanmar
Myo Myint Naing* Sutham Nanthamongkolchai** Chokchai Munsawaengsub**
*Medical officer, Medicines Sans Frontieres-Holland ,Myanmar
**Department of Family Health, Faculty of Public Health, Mahidol University, Bangkok,Thailand
4
ARTICLE INFO
Article history :
Received July 2010
Received in revised form September 2010
Accepted October 2010
Available online January 2011
Keywords:
Quality of life
Elderly people
Self-esteem
Family relationship
Corresponding Author:
Nanthamongkolchai S,
Department of Family Health,
Faculty of Public Health,
Mahidol University,
Bangkok 10400,Thailand
Email : phsnt@mahidol.ac.th
Asia J Public Health 2010; 1(2):4-10
ABSTRACT
Objective: To study the quality of life of the elderly people in Einme
Township, Irrawaddy Division, Myanmar, and factors related
Materials and Methods: A cross-sectional survey was conducted
among 209 elderly aged 60 and over, who lived in Einme Township, Irrawaddy Division, Myanmar Data were collected by using structured interview questionnaire from February 1 to 21, 2010 Statistics used for data analysis were frequency, percentage, mean, standard deviation, Pearson product moment correlation coefficient, and Multiple regression
analysis Results: The majority of the elderly people (80.9%) had a
moderate level of quality of life, followed by high level(17.2%) and low level(1.9%) The factors that were statistically significantly related to the quality of life of elderly were education level, current illness, self-esteem, family income, family relationship and social support In addition, self-esteem and family relationship could significantly predict the quality of life of elderly by 53.3% Self-esteem had the highest
predictive power of quality of life Conclusion: The factors related to
quality of life of elderly people were self-esteem and family relationship To promote quality of life of the elderly, responsible organizations should establish activities that enhance elderly self-esteem and promote good family relationship
INTRODUCTION
Quality of life is essential Improving the
quality of life is now a common aim of
international development However, enjoyment
in life and a sense of purpose and happiness can
still elude elderly people, making these important
problems that need to be solved, especially in
one’s advanced years1 It is not easy growing old
and most times, depression attacks elderly people,
and especially they tend to feel helpless and
inactive after retirement, with their role as primary
provider having finished So, they are more
negative and sensitive and rely on others, so they should be cared for to achieve a good quality of life
The quality of life of elderly people has become relevant with the demographic shift towards an aging society There are indications that concepts and concerns related to quality of life in elderly people are different from the general population The majority of the elderly people evaluate their quality of life positively on the basis of social contacts, dependency, health, material circumstances and social comparisons
Trang 2Adaptation and resilience might play a part in
maintaining a good quality of life With all other
influences controlled, ageing does not influence
quality of life negatively, and a long period of
good quality of life is possible2 Therefore, the
maintenance and improvement of the quality of
life become important issues The proportion of
elderly people (aged 60 or over) in the world
population3 has increased, and also, in Asia4, the
size and proportion of the elderly population was
281 million and 8.2% respectively This means
that 52% of the world’s elderly populations are
living in Asian countries In developing countries,
including Asia, the elderly populations are
increasing rapidly These demographic changes
are a direct result of the success of
socio-economic development that has led to a decline in
mortality rates at all ages and a reduction in
fertility However, an aged population might be
expected to suffer with the problems of
dependency and disability leading to an increased
burden of disease Myanmar5 has also emerged as
a nation with an ageing population, and the
proportion of elderly people over 60 has
gradually increased from 6.4% in 1980-81 to
8.3% in 2005-06 Einme is a sub-urban area in the
Myaungmya District, Irrawaddy division The
district is a deltaic tract, bordering south on the
sea and traversed by many tidal creeks The
occupations of rice cultivation and fishing engage
practically all the inhabitants of the district
According to a report from Help Age
International6, 2008, dependency ratio of the total
older people in delta region, was 51.8% with the
highest dependency ratio found in the poorest,
female, old-old group Also, 6.8% of the elderly
live alone The highest percentage of loneliness
was found in the poorest male, old-old group
59.8% of the elderly have no means of earning a
living and 82% do not own property 63.2% of the
elderly are classified as the poorest of the poor
29.2% are considered poor and only 7.7% are
moderately self-sustainable The highest
percentage of the poorest was found in the oldest
female group Moreover, the study of the health
status and quality of life of Thai elderly by
Assantachai P and Maranetra N7 show that 61.4 %
had a good quality of life and 38.6% had a low
quality of life The factors associated with a low
quality of life were not living with the spouse,
poor financial status, no regular exercise, sleeping
or hearing difficulty, suffering from joint pain or
diabetes mellitus, and history of a fall within the
last 6 months It is obvious that the elderly have
faced both physical and mental problems and
resulting bad health that led to negative mind and
lower quality of life Thus, it is no longer possible
to ignore the commencing ageing phenomenon in
Myanmar and therefore, it is vital to anticipate the requirements of the old age group in Myanmar in order to plan appropriate policies to address their growing needs and to support their quality of life
In Myanmar, there is no specific policy for elderly people such as compulsory welfare services for the elderly or health insurance coverage, and there is still low awareness of the special needs for elderly people and staff working
in the homes for the aged who have yet to understand the basics of care for the elderly (daily physical activity, minor illnesses and social support) Cooperation between health staff and social welfare staff is still weak regarding services
at the homes for the aged5 So, the researcher was interested in studying quality of life of the elderly people in Einme Township, as well as factors affecting the quality of life of elderly people in Einme Township The researcher also believes that the results derived from the study will be beneficial to public health sectors and other related organizations for conducting an effective plan and aid management to help and take care of elderly people in future
MATERIALS AND METHODS
The research was a cross-sectional survey on quality of life of the elderly people with a sample group of 209 elderly people both male and female, aged 60 years and over Data were collected from February 1 to 21, 2010 by the researchers and village health volunteers The sample groups were selected by simple random sampling from 6 villages of Einme Township, and were made up of those who had been living in the selected village
at least 1 year The research instrument was an interview questionnaire, developed by the researcher and consisted of 6 parts Part 1 employed general characteristics of elderly people such as age, sex, education level, marital status, family type, occupation of the old aged, family income and any chronic diseases that they had and included 9 questions Part 2 was to determine the instrumental activities of daily living by using Barthel ADL index, 8 which was used for measuring the functional status and included 10 questions Part 3 evaluated family relationships and examined feeling and opinion of elderly people towards family relations such as, love and care, interaction among family members, respect among family members, unity among family members, and relaxation among family members The family relationships included 10 questions and were developed by the researchers by reviewing the family relationships in later life by SmithS9 Part 4 determined the social support by
reviewing the work of Cobb S10 The set of questionnaires included 10 items relating to social
Trang 3support from family and relatives or friends Part
5 assessed self-esteem by using quick self-esteem
assessment and included 11 questions Part 6
evaluated the quality of life by using
WHOQOL-BREF11 assessment form to provide a quality of
life assessment that looks at domain level profiles
It had a total of 26 questions
This structured questionnaire was assessed for
content validity by three experts Also, the tested
interview questionnaire was then tested for
reliability by doing a pretest in the pilot study
among 30 elderly people with similar
characteristics to those of the study population
The results were analyzed by calculating the
Cronbach’s Alpha Coefficient of each set The
reliability results were as follows: questionnaire
for family relationship was 0.88, social support
was 0.78, self-esteem was 0.88, and quality of life
was 0.97 The data were analyzed by descriptive
statistics in terms of frequency, percentage, mean,
standard deviation and applied to show the general
characteristics of elderly people Chi-square test
and Pearson product moment correlation
coefficient were used to determine the factors that
were related to the quality of life of elderly people
and stepwise multiple regressions were also
applied to predict the factors that influence the
quality of life of elderly people A p-value of less
than 0.05 was set
to consider as statistically significant
Ethical Approval
The research proposal was approved by the
Research Ethics Committee, Faculty of Public
Health, Mahidol University, Bangkok Thailand:
Ref No MUPH2010-027
RESULTS
The total sample of 209 elderly people showed
that males made up 48.8% of the group and
females 51.2% The age was between 60 and 96
years with the median age of 69 years (SD = 8.2
years) More than half of them (51.2%) were
between 60 and 69 years, followed by 35.4% who
were between 70 and 79 years and 13.4% who
were more than 80 years The majority (70.3%)
had a primary school education and 22.5%,and
7.2% had no education, and secondary school
respectively More than half, 55%, were married,
27.8% were single and 14.8% were divorced
Among them, 52.6% of the respondents lived with
nuclear family members and 47.4% lived with
their extended family About half (55.5%) had no
occupation in contrast with 44.5% who had an
occupation There were many farmers, 40.3% of
respondents (Table 1).
Table1 Number and percentage of elderly people classified by general characteristics (n=209)
Gender
age (Years)
Median = 69, Minimum = 60, Maximum = 96, Mean = 69.4, S.D.=8.2
Education level
Marital status:
Family type
Occupation of elderly people:
Current illness
Chronic diseases
Heart disease and
Health condition (Activities of Daily Living)
Need help at moderate
Totally need help from
Trang 4Table1 Number and percentage of elderly
people classified by general characteristics
(n=209) (cont.)
Personal
Family income: (in Kyats)
Median = 10000, Minimum = 1000, Maximum = 300000,
Mean = 21665.07, S.D = 28951.1
Self-esteem
Family relationship
Social support
Almost half of the respondents (42.6%) were
healthy now and 57.4% had some current illness
75.6% of the elderly people were free of chronic
diseases and 24.4% had chronic diseases, with the
common diseases of hypertension and heart
disease afflicting 18.2% of the respondents
Regarding the health condition (activities of daily
living) of the 209 elderly people, the majority of
the respondents, 97.6%, could perform tasks
themselves and just needed some help (Table 1)
Most of the respondents (68.4%) had a
moderate level of self-esteem, 29.2% had a high
level and only 2.4% had a low level The results
showed that more than half of the elderly people
had an income of less than 10000 Myanmar Kyats
per month, and 25.4% earned between 10000 and
30000 Kyats monthly The rest (18.7%) had an
income of more than 30000 Kyats per month The
median income per month was 10000 Kyats
(SD.28951.1), with the lowest being 1000 Kyats
and highest 300000 Kyats (Table 1)
Among the 209 elderly people, 54.1% had a
moderate level of family relationship, 33.5% had
a high level and 12.4% a low level of family
relationship As for the level of social support in
the group, 68.4% had a moderate level of social
support, followed by 21.1% and 10.5% with high
level and low level of social support respectively
(Table 1)
Quality of life of the elderly people
This study indicated that the majority of the elderly people, that is 80.9% had a moderate level
of quality of life 17.2% had a high level of quality of life and only 1.9% showed a low level
of quality of life (Table 2)
Table 2 Number and Percentage of the quality
of life of elderly people (n = 209)
Correlation between personal factors, family factors and social factors, and quality of life of the elderly people
In testing the relationship between the factors and quality of life of the elderly people by using Chi-square and Pearson’s Correlation Coefficient, the results revealed that education level, current illness, self-esteem, family income, family relationship and social support were significantly correlated with the quality of life of the elderly people in the study at a statistically significant level (p-value) of <0.05 However, sex, marital status, and occupation of elderly people, family type, age and health condition (activities of daily living) were not associated with the quality of life
of elderly people (p-value >0.05) (Table 3,4)
Factors influencing the quality of life of elderly people
Using stepwise multiple regression analysis, self-esteem and family relationship were found to
be the factors that had power to predict the quality
of life of elderly people in the study These two factors could predict 53.3% of the quality of life
of the subjects The factor that best predicted the quality of life of the elderly people was self-esteem (Beta = 0.574), followed by family relationship (Beta = 0.226) Therefore, quality of life of elderly people = 16.180 + 0.574 self-esteem + 0.226 family relationship (Table 5)
DISCUSSION
In this study, it was found that a majority (80.9%) of the elderly had a moderate level of quality of life, followed by 17.2% having a high level Most of the elderly had a moderate level of quality of life because Myanmar is a developing country and the majority of people live in rural areas, and the socioeconomic status was not very high In the study, even though most of the elderly
Trang 5Table 3 Factors associated with quality of life of elderly people (n=205)
General characteristics Total
respondents
Moderate High
p-value*
No % No %
Table 4 Correlation coefficient between personal factors, family factors and social factors, and quality
of life of elderly people (n=209)
Table 5 Stepwise Multiple Regression Analysis between predictors and quality of life of elderly people
(n=209)
B0 = 16.180, R = 0.733, R2 = 0.533, Sig F = <0.001
Trang 6had a health condition (activity of daily living) of
just need some help, they carried out daily
activities by themselves and only one fourth had
chronic diseases, and more than half (57%)
suffered acute current illness This can affect
self-reliance and cause negative mind and also affect
the quality of life But, due to the support from
family and friends and neighbors, they were not
lonely and had good self-esteem and can confront
their problems For that reason, most of the
elderly had a moderate level quality of life and
some had a high level This result was consistent
with that of Sirivanarungsan P et al12 who found
that most Thai elderly people had a moderate level
of quality of life However, this was different
from what was discovered in a study of early
retired government officers in Nonthaburi
Province,Thailand13, which stated that mostly,
70% of these elderly people had a high level
quality of life Also, a difference was found in the
study of Assantachai P and Maranetra N7, in a
nationwide survey of the health status and quality
of life of elderly Thais attending clubs for the
elderly from 66 provinces, which showed that
61.4 % had a good quality of life These studies
investigated the quality of life among elderly
populations residing in Thailand In the present
study, the majority of elderly people had a
moderate level of quality of life This could be
explained by the fact that the study took place in a
different country, in Myanmar The education
level was also different, most of the elderly
(70.3%) in this study were primary school level as
compared with the early retired government
officer’s study, in which most of the elderly had a
bachelor’s degree (65.5%)
When tested with the Stepwise Multiple
Regression Analysis, by controlling the other
variables, self-esteem, and family relationship are
only two variables that can predict the quality of
life of the elderly These two factors predicted the
quality of life of elderly in Einme Township at
53.3% The strongest factor that influenced the
quality of life was self-esteem This is because
most of the elderly in this township had at least a
moderate level of self-esteem even though they
were poor They had an informal social network,
that is a culture and religion in Myanmar and
those elements could have affected the
self-esteem These facts could increase life satisfaction
and increase the quality of life also This
corresponds with the study of early retired
government officers in Nonthaburi Province13,
which found that factors influencing the quality
of life of early retirement elderly people were
self-esteem, social participation, and social support
Self-esteem is the attitude, perception and belief
of elderly people towards themselves that they are
capable and important including their virtue and power to achieve their objectives and success In this study, most of the elderly live in rural areas and can find satisfaction in life and have good environmental conditions in which to live Moreover, they have good social support and family relationships which is the culture of the rural area in Myanmar In the study by Qunnapiruk L et al14, it was found that self-esteem had an influence on quality of life in the elderly
In addition, Jo KH and Lee HJ,15 who studied the factors related to life satisfaction in elderly women, found that self-esteem was the only predictor in explaining the level of life satisfaction among old women, regardless age.
Family relationships were another important factor that could predict the quality of life of elderly people because elderly people feel lonely when they retire from work and lose their role in the community due to the effects of aging such as physical, psychological and social changes They need good family relationships such as care and warmth from their spouses and family members This could lead to closeness, sense of security and perceived love and then to happiness in life and a good quality of life If there was no family relation to other family members, they felt lonely and depressed and that reduced the quality of life This result was the same as Netuveli G et al16 who studied the quality of life at older ages, and found that the quality of life was improved by having trusting relationships with family and friends, frequent contacts with friends, living in good neighborhoods, and having two cars In addition, Nanthamongkolchai S et al17 found that family relationships had an influence on life happiness among elderly females in Rayong province, which
is congruent with the present study
The results of this research suggest that self-esteem and family relationships were the only two factors predicting the quality of life of elderly So,
to promote a good quality of life of elderly people,
we should promote their self-esteem by establishing formal as well as informal social networks like elderly clubs and religious activities Moreover, to have good family relationships, we need to make the public aware that the elderly still need to have physical and psychological support Finally, government and local authorities need to set up the specific policy for elderly people such as compulsory welfare services for the elderly or health insurance coverage for the old people
ACKNOWLEDGEMENTS
The authors wish to thank all the participants
in the study and we would like to thank Dr Arpaporn Powwattana for her kind support The
Trang 7authors would also like to acknowledge Mr Eric
Curkendall at the Mahidol Public Health Office of
International Relations for his help editing this
paper
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