Menuka Shrestha et al. / BIBECHANA 16 (2019) 221-227: RCOST p. 221 (Online Publication: Dec.

, 2018)

BIBECHANA
A Multidisciplinary Journal of Science, Technology and Mathematics
ISSN 2091-0762 (Print), 2382-5340 (0nline)
Journal homepage: http://nepjol.info/index.php/BIBECHANA
Publisher: Research Council of Science and Technology, Biratnagar, Nepal

Quality of life of elderly people living with family and in old age
home in Morang District, Nepal
Menuka Shrestha1*, Heera KC2, Prem Bhattarai3, Anjali Mishra4, Surya B. Parajuli4,5
1
Department of Nursing, Purbanchal University, College of Medical and Allied Health Sciences,
Gothgaun, Nepal
2
Department of Nursing, Purbanchal University, Birat Health College, Biratnagar, Nepal
3
Department of Physiology, Kathmandu University, Birat Medical College & Teaching Hospital,
Tankisinuwari, Nepal
4
Department of Community Medicine, Kathmandu University, Birat Medical College & Teaching
Hospital, Tankisinuwari, Nepal
5
Nepal Medical Volunteer Society, Biratnagar, Nepal
*
E-mail: mennusb@gmail.com
Article history: Received 16 September 2018; Accepted 10 November 2018
http://dx.doi.org/10.3126/bibechana.v16i0.21643
This work is licensed under the Creative Commons CC BY-NC License.
https://creativecommons.org/licenses/by-nc/4.0/

Abstract
Introduction: Nepal like many other developing countries in the world is witnessing the rapid ageing
of population. Quality of life (QOL) of elderly people is becoming even more relevant towards an
ageing society. In Nepal, less is known regarding special needs and quality of life of elderly people
either in familial situations or in old age residences.
Objectives: The present study was undertaken to assess and compare the quality of life of elderly
living with the family and in old age home.
Methodology: A Cross sectional descriptive study was conducted from October 2016 to April 2017
among elderly population aged 60 years and above. A total of 50 elderly people were enrolled from
old age home (OAH) using total enumeration sampling technique and equal number of sample was
selected from the family setting. QOL of elderly was assessed using WHOQOL-BRIEF questionnaire
after taking informed consent from the participants. Data was analyzed using SPSS.
Results: The mean scores of QOL domains were better among the age group 60-70 years, males,
married, literates and who had children. The mean scores of QOL in physical, psychological and
environmental domains were better in elderly living with the family than living in OAH. Low scores
were found on social domain among elderly compared to other domain irrespective of their residence.
Conclusion: QOL score among elderly is average, while social relationship domain of QOL scores
was found to be low. Social activities should be expanded for these residents in order to promote
social health. The QOL which each individual possesses is very important in all aspects be it physical,
psychological, social & environmental. Furthermore, programs that help elderly people live in their
own homes and social environments should be promoted.

Keywords: Humans; Homes for the Aged; Quality of Life.

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1. Introduction
Ageing is inevitable developmental facts that bring along a number of changes in the physical,
psychological, hormonal and social status. Most of these changes are expected to affect quality of life
of the elderly [1]. One of the greatest challenges to public health is to improve the quality of later
years of life as life expectancy continues to rise [2]. WHO defines the concept Quality of Life (QOL)
as ‘individuals’ 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 [3]. Quality of life
elderly people (QOL) is becoming even more relevant with demographic shift happening towards an
ageing population. There are signals that concerns related to QOL in elderly people are different from
that of other general population. In Nepalese society, there is very low awareness about special needs
of elderly and caretakers are yet to understand the vitals of elderly care (physical and mental,
psychological and social needs). Additionally, among elderly there is difference between those living
in old age homes and those living in community [4]. Nepal like many other developing countries in
the world is observing the rapid ageing of people. The urbanization, modern character, tendencies and
values and world integration have led to change in the weakening of social values, economic
structure, the erosion of societal values, and social structure such as the joint family. In this changing
economic and social environment, the younger age group is searching for new identities about
economic independence and redefined social roles inside, as well as outside the family. The shifting
economic structure has reduced the dependence of rural families on land which has provided strength
to tie between generations [5]. The problem has broad social, economic, political and health
implications and is viewed as a concern by many different people-administrators, health professionals
and general public. Care of the elderly is also one of the priority areas in Nepal. The Government of
Nepal has also recently adopted National Policy on Ageing since its 9th long-term plan. Above all,
not much research work has been carried out in this topic in Nepal, though it is a topic of concern. We
believe the research will help administrators and policy makers to plan and implement necessary
changes to address the special needs of elderly. The main objective of this study was to assess and
compare the quality of life of elderly living with family and old age home.

2. Methodology
This is a cross sectional study was carried out in an Old age home at Birateswhor Bridhashram,
Biratnagar and home setting at Sundar Haraincha Municipality from October 2016 to April 2017.
Total Sample size was 100; 50 elderly people were taken from old age home using total enumeration
sampling technique and equal number of sample was taken from the home setting. Elderly people
aged 60 years and above were included but those elderly who were suffering from mental illness were
excluded from the study. Data were collected through face to face interview method. Informed
consent was taken from each participant and ethical approval was taken from Purbanchal University
Department of research. Quality of life was measured with the validated World Health Organization
Quality of Life Instrument-Brief Version (WHOQOL-BREF). It evaluates perceived quality of life
using 26 items categorized into Physical domain (7 items), Psychological domain (6 items), Social
Relations domain (3 items), and Environment domain (8 items). Two items evaluates perception of
general health and quality of life. Each item is ranked on a 5-point Likert scale. Higher scores indicate
higher quality of life. The physical health domain includes items on mobility, daily activities,
 Menuka Shrestha et al. / BIBECHANA 16 (2019) 221-227: RCOST p. 223 (Online Publication: Dec., 2018)

functional capacity, energy, pain and sleep. The psychological domain measures include self-image,
negative thoughts, positive attitudes, self-esteem, mentality, learning ability, memory concentration,
religion, and the mental status. The social relationships domain contains questions on personal
relationships, social support, and sex life. The environmental health domain covers issues related to
financial resources, safety, health and social services, living physical environment, opportunities to
acquire new skills and knowledge, recreation, general environment (noise, air pollution, etc.) and
transportation.

3. Results
Hundred elderly people participated in the study where 50 participants from OAH and 50
from the family.
More than half (52% and 58%) were in the age group 60- 70 years in the OAH and in the family
setting respectively. The mean age of the respondents living in OAH was 70.42±8.33 years while the
mean age of respondents living with the family was 71.08±8.08 years. Majority of the respondents
were male, Hindus and Brahmin/Chhetri in both the places. In OAH both male and female were more
or less equal in number. In OAH most of the respondents (70%) were widow/widower while in the
family setup 72% of the respondents were married and living together with their spouses. There were
no unmarried and separated persons in the family setup. Most of the respondents (68%) were found to
be illiterate in the family in comparison to those living in OAH (20%). In OAH, most of the
respondents (74%) had children while in family setup all the respondents had children (table1).
Age is significantly associated with the physical domain as compared to other domain. As the age
increases the mean QOL scores were decreasing in other domains too but it was not found to be
statistically significant. The mean QOL scores of psychological and environmental domains were
significantly less in females as compared to males. The mean QOL scores of physical and social
domains were also less among females. Education and marital status were significantly associated
with the physical, psychological and environmental domains of quality of life. Significant association
was found between the elderly who had the child and psychological and environmental domains (table
2).
The mean scores and comparison of QOL (domain wise) between elderly people living in old age
home and within family setup. Significant association was found in terms of physical, psychological
and environmental health among elderly people living in old age home and within family setup at p
value <0.001. The mean score of physical health between elderly people living with the family
(21.88±4.37) was better than the elderly people living in old age home (16.50±4.11). Also, the mean
score of psychological health of elderly people living with family (20.80 ±3.8) was better than those
living in old age home (12.82 ±3.15). It indicates that elderly people living with the family had better
psychological health than elderly people living in old age home. Similarly, the mean score of
environmental health of elderly living with the family (26.18±3.52) was better than those living in old
age home (20.64±3.63). The mean score of QOL between elderly people living with family
(79.08±11.16) was better than the elderly people living in old age home (60.06±10.70). It indicates
that elderly people living with family had better QOL than the elderly people living in old age home
(table 3).
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Table 1: Distribution of Socio-Demographic Characteristics of elderly people (n=100).

Variable Old age home (n=50) Family (n=50)
n (%) n (%)
Age in years
60-70 years 26 (52) 29(58)
>70years 24(84) 21(42)
Mean age in years ± SD 70.42±8.33 71.08±8.08
Gender
Male 26(52) 39(78)
Female 24(48) 11(22)
Caste/Ethnic Group
Dalit 8(16) 1 (2)
Janajati 12(24) 18(36)
Madhesi 6(12) -
Brahmin/Chhetri 24(48) 31(62)
Religion
Hindu 43(86) 46(92)
Buddhist 7(14) 4(8)
Marital status
Unmarried 3(6) -
Married 7(14) 36(72)
Widow/Widower 35(70) 14(28)
Divorced/Separated 5(10) -
Have children
Yes 37(74) 50(100)
No 13(26) -

Table 2: Association of Socio demographic characteristics with domains of QOL scores (n=100).
Physical Psychological Social Environment
Variable
(Mean ±SD) (Mean ±SD) (Mean ±SD) (Mean ±SD)
Age
60-70 years 20.75 (4.44) 17.04 (5.01) 10.29 (1.21) 23.80 (4.14)
>70years 17.29 (5.06) 16.53 (5.74) 10.00(1.39) 22.93 (4.94)
P value <0.001 0.641 0.268 0.343
Sex
Male 19.62 (5.21) 18.08 (5.33) 10.31 (1.40) 24.51 (4.52)
Female 18.40 (4.58) 14.46 (4.53) 9.89 (1.05) 21.37 (3.79)
P value 0.25 <0.001 0.122 <0.001
Education status
Illiterate 17.68 (4.63) 14.64 (4.70) 9.98 (1.13) 21.32 (3.97)
Literate 21.11 (4.87) 19.57 (4.82) 10.39 (1.46) 26.07 (3.73)
P value <0.001 <0.001 0.123 <0.001
Marital status
Unmarried 20.67 (4.93) 15.67 (1.52) 10.33 (0.57) 20.67 (0.57)
Married 21.98 (3.70) 20.00 (4.01) 10.48 (1.40) 25.66 (3.46)
Divorced 16.52 (4.92) 14.15 (5.27) 9.83 (1.22) 21.67 (4.81)
Separated 19.40 (2.19) 15.00 (0.70) 10.40 (.548) 22.00 (2.00)
P value <0.001 <0.001 0.117 <0.001
Religion
Hindu 19.33 (4.92) 16.99 (5.20) 10.16 (1.33) 23.64 (4.50)
Buddhist 18.09 (5.82) 15.36 (6.39) 10.18 (0.98) 21.55 (4.39)
P value 0.444 0.343 0.95 0.148
Have children
Yes 19.47 (5.04) 17.38 (5.39) 10.18 (1.36) 23.97 (4.48)
No 17.31 (4.53) 13.00 (2.82) 10.00 (0.81) 19.69 (2.75)
P value 0.148 0.005 0.637 <0.001
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Table 3: Comparisons of Domains of QOL by Their Place of Living (n=100)

Group
Variable Old age home Family set up
(QOL Domains) (n=50) (n=50) P value
Mean ± SD Mean ± SD
Physical (mean ±SD) 16.50±4.11 21.88±4.37 <0.001
Psychological (mean ±SD) 12.82±3.15 20.80±3.87 <0.001
Social relationship (mean ±SD) 10.10±1.01 10.22±1.54 0.647
Environment (mean ±SD) 20.64±3.63 26.18±3.52 <0.001
Total QOL 60.06±10.70 79.08±11.16 <0.001

4. Discussion
The mean score was found higher in environmental (23.41±4.52) and physical domain (19.19±5.01)
as compared to social (10.16±1.30) and psychological domain (16.81±5.33) of quality of life of
elderly. Overall mean score of QOL was found to be good but mean score for social relationship and
psychological domain was comparatively lower than other domains which are similar to the other
study where the physical domain of quality of life had the highest mean score 14.3 (±2.7), while the
social domain had the lowest mean score 10.8 (±3.4) [6]. Another study conducted in India also
reported lowest score in the social domain [7]. This could be due to the growing number of elderly
that face abandonment and neglect. However, other studies have reported lower scores in the physical
domain compared to other domains. [8, 9]. The study revealed that age was significantly associated
with physical domain. This is because the older age group had more functional limitations compared
to the younger age group. Similar findings was found in a study which reported impaired physical
health among older age groups [6]. As growing age increases the probability of developing physical
problems like musculoskeletal problems, so age was significantly associated with physical domain.
Women had a significantly lower quality of life in all domains compared to men. This could be
because the women perceive ageing more negatively than the men. Other studies reported that low
quality of life scores among women and recognized their findings to feelings of unattractiveness
among elderly women, which could lead to low self-esteem and also add to negative perception of
ageing among elderly women [9]. Marital status was significantly associated with quality of life in
this study except in social domain. This is perhaps because married residents live in their homes with
their spouses in the home setting. Previous studies reported contradictory findings [10]. Level of
education was significantly associated with the physical, psychological and environmental domains of
quality of life. Evidence from studies suggests that people with higher level of education are more
likely to engage in healthy behaviors which could improve physical health compared to those with
lower level of education [11]. In addition higher level of education can improve psychological spirit,
coping mechanisms [12] and social relationships [13]. Higher level of education also had higher
scores in the environment domain of quality of life. Previous studies [14] have reported significantly
better quality of life among people with higher level of education compared to those with lower level
or no education, further highlighting the positive impact of higher education on quality of life. The
mean score of physical (21.88±4.37), psychological (20.80±3.87) and environmental (26.18±3.52)
 Menuka Shrestha et al. / BIBECHANA 16 (2019) 221-227: RCOST p. 226 (Online Publication: Dec., 2018)

health domain was found higher among the elderly living with family than those elderly living in old
age home with physical (16.50±4.11), psychological (12.82±3.15) and environmental (20.64±3.63)
health domain. This finding was supported by a study which revealed that institutionalized elderly
showed low level of quality of life compared to non-institutional [15]. This finding is in contrast to
the study titled “quality of life between elderly people living in old age home and within family setup”
where physical, psychological and environmental domain mean score was reported high among
elderly living in old age home than elderly living with family [16]. Similar findings was found in
previous study [17]. The total mean score of QOL between elderly people living with family
(79.086±11.16) was better than the elderly people living in old age home (60.06±10.70) at p value
<0.001. It indicated that elderly people living with family had better QOL than the elderly living in
old age home which was contradicted with the previous study [18] which observed that people living
in old age home had good QOL. Social health domain’s mean score was found lowest among QOL
domain in both places and it was not statistically significant with residence. Similar findings were
revealed by other studies done in rural area of South India7and Tamilnadu [19]
5. Conclusion
QOL score among elderly was average, while social relationship domain of QOL scores was found to
be low. The physical health, psychological health and environmental health domains of QOL were
better in the people living with family than the elderly living in old age home. QOL of elderly
decreases as the age increases. The social relation domain revealed very poor among elderly living in
both places. The QOL which each individual possesses is very important in all aspects be it physical,
psychological, social & environmental. Only if they have fulfillment in all these aspects of life they
have a high QOL.
Recommendations
Despite some limitations, this community based cross-sectional study gives valuable information on
the QOL and its associated factors among elderly population. Health education related to activity and
environmental modification as well as increase in the social relationship may help in improving the
QOL of elderly people. Further analytical studies will help in understanding the association of factors
influencing QOL. Additionally, programs that help elderly people live in their own homes and social
environments should be developed. Social activities should be diversified for these residents in order
to compensate for their lack of freedom.
Limitation of the Study
Small sample size is the limitation of study. Under reporting of chronic diseases in elderly, which has
impact on QoL is another limitation. We could not include some factors like mental health status,
complications of chronic morbid conditions of the elderly.
Acknowledgement
We would like to acknowledge all respondents for their cooperation, time and participation. We
appreciate director of Birateswor Bridhasram for granting the permission and cooperation during the
study. We would also like to thank Purbanchal University, department of research for financial
support for the successful completion of this study.
Conflict of Interest
We declare no conflict of interest.
 Menuka Shrestha et al. / BIBECHANA 16 (2019) 221-227: RCOST p. 227 (Online Publication: Dec., 2018)

Financial Disclosure
Faculty grant received from Research department of Purbanchal University.

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