Depression and Factors Associated with the Quality of Life among the Elderly in Numpong and Somsoong District, Khonkean Province, Thailand

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1 European Journal of Scientific Research ISSN X / X Vol. 138 No 3 March, 2016, pp Depression and Factors Associated with the Quality of Life among the Elderly in Numpong and Somsoong District, Khonkean Province, Thailand Korravarn Yodmai Corresponding Author, College of Public Health Sciences Chulalongkorn University, Thailand korravarn.y@hotmail.com Ratana Somrongthong College of Public Health Sciences Chulalongkorn University, Thailand Abstract This cross-sectional study aims to assess the quality of life (QOL) and depression among the elderly in two districts in the Khonkean province, and to determine the factors associated with QOL. Two hundred people of aged between years were randomly selected. QOL was measured with a WHOQOL-OLD questionnaire. Depression was measured with the Thai Geriatric Depression questionnaire. Logistic regression was used to determine the association between potential factors and QOL. The results showed that the QOL among older people was fair (55.0%), 44.5% of them have good QOL and only 0.5% of them have low QOL. Most of them (84.5%) have no depression, followed by mild depression (13%), moderate depression (2%), and severe depression (0.5%). It found that having a friend as a consultant for stress (OR = 12.36, 95% CI = ) and access to information by mass media (OR = 2.74, 95% CI = ) were associated with QOL. In contrast, being a member of the village committee (OR = 0.098, 95% CI = ), inadequate monthly income and being indebted (OR = 0.400, 95% CI = ) had a negative association with QOL. Background In Thailand, the proportion of elderly was the second fastest aging countries in South East Asia (3.7% per years) (UNFPA; 2006). In 2002, the proportion of elderly was 9.4 % of the entire population. It has increased to 10.7 % in 2007 (NSO; 2007).Moreover, it was 11.5% or more than 7 million in 2010 (UNFPA; 2006).The rapid population structure was changed related to rapid declines of fertility rates due to successful family planning in Thailand. The number of elderly is expected to rise dramatically from decreasing fertility rates and increasing life expectancy as a result of medication and health advancement (UNFPA; 2006). Thailand undergoes rapid ageing population; the impacts on families and society at large are significant. Ageing is one of the most critical policy challenges facing Thailand and is receiving greater attentions by the government, the private sector, civil society and other players (John K. et.al. 2013). In terms of the quality of life, WHO defined quality of life as an individual perception in their life as the concept of culture and value system and related with goal, expectation, standard, and concerns. And the quality of life in age group depend on autonomy as the perception of ability to control, coping, and decision making in daily living, and being independent as ability of activity in

2 Depression and Factors Associated with the Quality of Life among the Elderly in Numpong and Somsoong District, Khonkean Province, Thailand 194 daily life functions are performed (WHO, 2002). Quality of life (QOL) is related with the goal, expectation, standard and concerns of each person in the context of culture and value system in their life (WHO, 2002). QOL was used to measure the effectiveness of social research after World War II to indicate the good life. In the context of care, the term of quality of life was more useful. It is similar with Orem s definition that is a personal perception of happiness and satisfaction of their life (Orem; 1995). Quality of life assessment in elderly was useful for policy and health providers to evaluate health needs and improve the effectiveness of health care services (Power M; 2005). Quality of life questionnaire was developed and used in several versions but have no specific for elderly version. In 2004, WHOQOL working group has developed quality of life for people aged 60 and above which were tested to have been used in several countries. This study obtained permission for translation into Thai version to evaluate the quality of life in Thai elderly. The study is the first part of improving quality of life project among elderly in Khonkean province. It aims to determine quality of life among elderly in rural Khonkean province by using WHOQOL-OLD questionnaire (Thai version) and to explore factors associated with quality of life. Depression refers to a psychological disorder expressed through emotions, thoughts and behaviours (Department of Mental Health, 2006). Depression symptom is a negative emotional state that is commonly found in elderly. It also influences the quality of life. Previous studies showed that depression symptom of elderly depend on their health conditions (Kang S.K., 2010). In 2009, National Health Examination Survey Organization (NHESO) found that elderly in Thai were 4.6%, especially female. Depression was negatively correlated with social activities in elderly that social activity was associated with quality of life (Kand S.K., 2010). In Thailand, children take responsibility of their parents that young adults were declining to coresidence with and thus increase urbanisation. Elderly are living alone when their children migrate to other places (Malinie A. A. et. al., 2009). This study was used to standardize the depression symptom in elderly. Thai Geriatric Depression scale is applied into 14 institutes throughout Thailand. This study also aims to determine the prevalence of depression and factors associated with elderly in rural area of Knon Kean Province, Thailand by using TGDS questionnaire due to its high prevalence of depression in Thailand and it would be a data base to support policy makers in decision making. Methods This cross-sectional study aims to determine quality of life and depression level among the elderly in rural Khonkean Province, Thailand and to explore factors associated with it. KhonKean province was purposely selected to study due to its population as the second largest population of elderly in the Northeast of Thailand and its location at the central Northeast of Thailand. Two districts of Khonkean Province were used as sample. Random sampling techniques were to select the study area. Two hundred elderly of aged 60 to 75 years were randomly selected to enroll in this study. The household survey questionnaire consists of 4 parts as follows: 1. General Information of the elderly sample that includes: sex, age, marital status, educational level, job type and financial income, number of children and caretaker. 2. Health Status which includes: history of personal check up, personal illness, health problems, health services from the health facility and the healthcare card and 3. Quality of life in older age WHOQOL-OLD (World Health Organization [WHO], 2004) consist of 6 facets which compose of 24 items. Of these, there are 17 positive and 7 negative feelings on questions and each question has 5 levels (1-5 points). Four items are included for each facet, as well as covering the overall subject of the QOL and health in the four general items. The main content of the WHOQOL-OLD module are composed of 6 facet namely;sensory Abilities,Autonomy, Past, Present, and Future Activities, Social Participation, Death and Dying, and Intimacy. The Sensory Abilities facet assesses sensory functioning and the impact of loss of sensory abilities on quality of life. The Autonomy facet refers to

3 195 Korravarn Yodmai and Ratana Somrongthong independence in old age and thus describes the amount of being able to live autonomously and to take own decisions. While the Past, Present, and Future Activities facet describes satisfactions about achievements in life and at things looking forward to, the Social Participation facet refers to the participation in activities of daily living, focusing in the community. The Death and Dying facet is related to concerns, worries, and fears about death and the Intimacy facet related to being able to have personal and intimate relationships (WHO, 2004). In terms of quality of life scores for the elderly people, the higher scores mean better quality of life. The overall scores run from points. It is classified as the following: Scores from indicate not so good quality of life, Scores from indicate fair quality of life, and Scores from indicates good quality of life. Depression level was used in the Thai Geriatric Depression Scales (TGD) questionnaire. It consists of 30 items including 20 positive questions if they answer yes will get 1 score and 10 negative questions, if they answer no will get 1 score. The overall scores are between 0 30 points. It is classified as 0-12 score indicated no depression, scores indicated mild depression, scores indicated moderate depression, and score indicated severe depression (Train The Brain Forum: 1994).Health problems include 12 - chronic diseases and health complain consists of muscle pain (e.g. back pain, legs pain etc.), eyes problem/blur vision, hearing problem, insomnia, testing problem, urinary incontinence, and constipation. A social activity questions included was did they participate in elderly club, how many close friend they have, who are they spend their daytime with, if they have stress who will they talk with. The validity of this research tools ensured from the following steps: for content validity, the researchers have received guidance and support from 3 experts in the geriatric field to accurately verify and give suggestion in regards to the contents and any adjustments of the questionnaires. In terms ofreliability,a pre-test of the research tools was taken among the elderly in the non-studied community with Cronbach s Alfa Coefficient = 0.7. Descriptive statistics was used to describe the quality of life, depression levels and demographic characteristic factors. The factors associated with the quality of life were used in logistic regression analysis. Results The findings revealed that more than half of the respondents were females (61.0%). The mean age of the study population was (SD = 5.59). In terms of marital status, 69.5 % of them were married and followed by divorce (24.5 %), single 3.5%, and widow (2.5%). The majority (92%) of elderly finished their education at primary school, interestingly, 5.5 of the elderly were the secondary school or higher, and 2.5% were no education.most of elderly have 1 3 children (62%) following by 4 children and more (32.5%) and no children (5.5%). (Table 1) Table 1: The Number and Percentage of Socio-demographic among Elderly in Khonkean Province, Thailand Socio-demographic n % Gender Male Female Marital Status Single Married Divorced Widow Education Level No education Primary School High School Number of Child No Children

4 Depression and Factors Associated with the Quality of Life among the Elderly in Numpong and Somsoong District, Khonkean Province, Thailand 196 Socio-demographic n % 1-3 persons > 3 persons Economic Status, Most of them (74%) are still currently working. Nearly two third (64.50%) of them, the major occupants were agriculturists following by Labour in the small factory near the village (4.0%), Retired government employee (2.5%), seller (1.5%), and others (1.5%). Almost 42% of the elderly reported that their income were sufficient but no savings. In contrast, only 9.5% of them were with sufficient income and enough for savings. Table 2: Economic Status Variables n % Employment Status Unemployed Employ Occupational (n= 148) Retired government Employees Seller Agriculturists Labour Other Sufficiency Income Not sufficient and in debt Not sufficient not in debt Sufficient but not for saving Sufficient and enough for saving In terms of health status, the finding showed that most of participants (58.0%) had history of chronic illness. Diabetes (50.0%) was the highest disease among the non-communicable diseases in participants, and followed by Hypertension (44.8%), heart disease (9.5%), kidney disease (6.5%) and other diseases (20.7%). The majority of health problems stated by the elderly are legs pain (75.5%), following by vision problem (71.5%), back pain (63.0%), sleep problem (54.0%), Urination (47.5%), Constipation (47.0%), Ear problem (44.5%), pass stool (38.0%), uncontrolled hands (36.0%) and loss of testing (33.0%).The majority of the elderly participants 86.5% have been to the annual health checkup at least once, only 58.0% of the participants knew they had chronic illness. In terms of depression, most of them (84.5%) did not have depression symptom, however 12% of them shown mild depression, 2.5% was moderate depression, and 1% was severe depression. Both severe and moderate depressions which were found in this study were females. Table 3: Health Status Variables n % History of illness (n=200) No history of chronic illness Have history of chronic illness Type of Chronic Disease (n=116) Diabetes Hypertension Heart Disease Kidney disease Other Annual health check up Never Attended last year

5 197 Korravarn Yodmai and Ratana Somrongthong Variables n % Attended last 2 years ago History of Fall down Never Yes, within 1 Month Yes, within 1 year Yes, More than 1 year Depression level No Depression Mid Depression Moderate Depression Server Depression Number of Close Friend No Close Friend persons persons persons Consultant Coupler Children Relative Neighbour Other Instrument Support Spouse Children/grandchild Relative Neighbour/community Others In terms of quality of life measured by the WHOQOL-OLD Questionnaire, an overall Quality of life among elderly in rural Khonkean Province was fair (55.0%). 44.5% of them had high quality of life and only 5% had low quality of life. Table 4: Number and Percentage of the Quality of Life among elderly in rural of Khonkean province, Thailand by WHOQOL-OLD Variables (n=200) n % Low level Moderate level High level Multiple regression analysis was found that elderly who have a friend as a consultant for stress had good quality of life times (OR = 12.36, 95% CI = ) statistically significant. Moreover, this study found that in elderly who is able to access any information by mass media was found associated with good quality of life 2.74 times (OR = 2.74, 95% CI = ) statistically significant. In contrast, being a member of the village committee (OR = 0.098, 95% CI = ), inadequate monthly income and being indebted (OR = 0.400, 95% CI = ) had a negative association with QOL as in table 5. Discussion This study aims to assess the level of quality of life and health status among the rural elderly in Khonkean Province. Household survey was conducted among the elderly people on April The collecting techniques are complementary and appropriate to be combined in such a way as to maximize the strengths and minimize the limitations for this study (WHO, 1996). The findings revealed that more

6 Depression and Factors Associated with the Quality of Life among the Elderly in Numpong and Somsoong District, Khonkean Province, Thailand 198 than half of the respondents were female (61.0%). Not surprisingly, the ratio of female to male in aging was 1.3:1 (MoI, 2010). The majority of the participants are within age range years. Almost two third of the elderly stated that they were married, One third of the participants were divorce, separate and single. Most of the participants (92%) had finished up to their primary school (grade 4), only a few had finished the higher education (5.5%) and only 2.5% had no education. 64.5% of the elderly participants have not yet retired. Among active working groups, they are agricultural, labourers in a factory or in firm, and sellers. This study was in good agreement with the results of other information from previous studies. The national survey in 2004 found that 64.4 % of population in Khonkean Province were farmers. Most of population in Somsung district (77.2 %) were farmers (NSO: 2004). Although, more than one third of the elderly (42.5%) reported that their incomes were not enough to cover their monthly expenses. Only 9.5% of them have savings. All these results signified the economic status among the Thai elderly, which suggested that one third of the elderly in this study were living in the condition of poverty. In terms of health status, almost two third of them had annual physical check-up. Among these, 58.0% of them were diagnosed with chronic diseases. The majority of metabolic disease syndromes were found: hypertension, diabetes mellitus, hyperlipidaemia and muscle and joint pain. These findings were in line with the WHO report that the main health burdens for older people are from noncommunicable diseases (WHO, n.d.). The majority (93.7%) reported that they had universal health insurance card which they received from the health coverage scheme in Thailand since 2001 (MoPH, 2001). Due to this program, there has been an exponential increase in term of health service; especially 84.3%have visited governmental health facilities whereas only 6 % have visited private sectors and others. Depression level was found in elderly15.5% which should be supported by government and community to release depression among elderly, although in this study did not show association between depression and quality of life. In terms of quality of life measured by the WHOQOL-OLD, an average overall QOL was in moderate level. Majority of elderly had QOL at moderate level with 55.5%, followed by high level with 44.5% and very few (0.5%) reported low QOL. In consistent with the previous findings by (Hongthong, Somrongthong, & Pongpanich, 2011), using the same mixed method, and same measurement tools among 400 elderly people in a rural community in the north of Thailand, the results showed that the highest QOL group was also at fair level 85.8%. Given the similar results, it is clear that the majority elderly from both the Northern and the Southern part perceived their quality of life as fair. Interestingly, the participants of the Northern Province 30.5% have a higher QOL in comparison to 8% participants of the Southern Province. However, there has been no study to identify which factors have a major influence among these 2 regions and their quality of life. Conclusion and Recommendation The majority of the elderly participants had fair quality of life by using WHOQOL-OLD questionnaire. However, the results revealed that the majority of elderly faced more chronic health problems, especially metabolic syndromes and muscle and joint pain. Therefore health promotion activities need to be taken into account in order to deliver better QOL to elderly. References [1] Cutler, D. M., Knaul, F., Lozano, R., Mendez, O., & Zurita, B. (2002). Financial crisis, health outcomes and aging: Mexico in the 1980s and 1990s. Journal of Public Economics, 84(2), [2] Hongthong, D., Somrongthong, R., & Pongpanich, S. (2011). Quality of life, lifestyle and the impact of economic crisis toward elderly people in a rural community: a mixed methods study

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