Journal of Caring Sciences, 2014, 3(4), 257-263

doi:10.5681/jcs.2014.028
http:// journals.tbzmed.ac.ir/ JCS

Assessing the Quality of Life in Elderly People and Related Factors in

Tabriz, Iran
Yaser Khaje-Bishak1, Laleh Payahoo1*, Bahram Pourghasem2, Mohammad Asghari Jafarabadi3
1
Department of Nutrition, Student’s Research Committee, Students Basij of Moje Danish, Faculty of Health and Nutrition,
Tabriz University of Medical Science, Tabriz, Iran
2
Department of Nutrition, Faculty of Health and Nutrition, Tabriz University of Medical Science, Tabriz, Iran
3
Department of Epidemiology, Faculty of Health and Nutrition, Tabriz University of Medical Science, Tabriz, Iran

ARTICLE INFO ABSTRACT

Article Type: Introduction: Elderly people may suffer from the multiple health disorders due to the
Original Article
vulnerability for many physical and mental disturbances. Quality of life in elderly
population can be affected by many environmental factors. The aim of this study was
Article History: aimed to examine the quality of life in elderly people in Tabriz, Iran in 2012.
Received: 19 Agu. 2014 Methods: This cross-sectional study was carried out on 184 elderly people (male=97;
Accepted: 23 Sep. 2014 female=87) with age ≥ 60 years. The participants surveyed in this study were elderly
ePublished: 1 Dec. 2014 people who were living in the community and come voluntarily to the daily care
centers. Validated Persian self-reported version of World Health Organization Quality
Keywords: of Life-BRIEF (WHOQOL-BRIEF) questionnaire including 26 broad and
Elderly comprehensive questions were used to determine the quality of life in elderly people.
Quality of life Independent t-test and Pearson correlation were used to compare differences and
Male
Vision disorders correlation between the total score of quality of life and influential factors.
Results: Total score the quality of life in both genders was 90.75 (13.37) (range
between 26-130). Male elderly had slightly high score in the quality of life; however,
these differences were not significant. A significant difference was observed between
having cardiovascular diseases, respiratory and gastrointestinal diseases, hearing and
visual impairments with total score in the quality of life. Also, there was no significant
difference between gender and age variables with total score in the quality of life.
Conclusion: Policies and programs should be considered for improving the quality of
life. Future studies are needed for assessing other influential factors on the quality of
life in elderly population.

socioeconomic and demographic characteris-

Introduction tics.3 In 2006, United Nations (UN) reported
Aging as a natural process of life is due to that 6% of Iran population was aged 60 and
gradual changes in metabolic activity of above and it is estimated will rise to 26% by
organs and disability in regeneration capacity 2050.5,6
of cells. Worldwide, the average life span of Elderly people have higher probability of
people has been increasing. Several factors suffering from multiple health disorders due
including heredity, life style and healthy diet, to experience reduced physical and mental
avoiding smoking and physical activity can functions. Loneliness, impaired sexual
effect on the longevity of life.1 activity and chronic metabolic disorders are
According to the WHO report, there are some of causes can result in emotional
more than 600 million elderly individuals disturbances.7 These problems can decrease
worldwide;2 it is estimated this rate will be life quality of elderly.
double by 2025 and 2 billion by 2050.3,4 The According to WHO statements, quality of
number of Iranian elderly continues to grow life defined as an individual’s perception of
due to many sensible changes in cultural, their position in life in the context of the
* Corresponding Author: Laleh Payahoo (MSc), E-mail: [email protected].
This article was approved and funded by the Tabriz University of Medical Sciences (Project number: 91.1.6)

Copyright © 2014 by Tabriz University of Medical Sciences

Khaje-Bishak et al.

culture and values systems in which they live study. There were two daily care centers
and in relation to their goals, expectations, where we recruited randomly samples there.
standards and concerns.8 In addition, quality Demographic characteristics of subjects (age,
of life is described as a wellness resulting gender, diseases background) were collected
from a combination of physical, functional, through face-to-face interview. Subjects of
emotional and social factors.9 both genders, apparently and healthy,
Poor economic, cultural, educational and independent, mobile, and were able to
health care conditions and also inadequate communicate verbally defined as inclusion
social interactions can result in poor quality criteria. Exclusion criteria were individuals
of life in elderly people.10-12Chronic diseases with Alzheimer disease and other cognitive
such as diabetes mellitus, coronary heart disorders who had no ability to answer the
diseases, osteoporosis and cerebrovascular questions and took part in the interview.
are most common diseases in elderly people. Persian self-reported version of World
These disturbances that cause medical, social Health Organization Quality of Life-Brief
and psychological problems can decrease (WHOQOL) questionnaire that validated in
physical functions and the quality of elderly’s Iranian population were used to determine
in the community. As well as, burden of the quality of life in elderly population. The
diseases will be increased obviously.13-16 questionnaire consisted of 26 broad and
Considering the vulnerability of elderly comprehensive questions. The first section
people and importance of healthy status in was two questions about the Overall Quality
this population and due to the lack of studies of Life (OQOL) and Overall Health Status
regarding quality of life and associated (OHS).
factors in elderly people living in community 24 items constituted four dimensions of
and in the region, this study was aimed to health including physical, psychological,
assess the quality of life in elderly population social and environmental. Physical health
in Tabriz, Iran in 2012. domain were evaluated through seven
indicators including pain, dependence on
Materials and methods medical aids, energy, mobility, sleep and rest,
activities of daily living, and work capacity
This cross-sectional study was conducted on
measure. Psychological health was assessed
184 elderly subjects aged 60 years and over,
with six items including positive feeling,
between January 1 and March 30, 2012 in
personal belief, concentration, bodily image,
Tabriz, Iran. The regional Ethics Committee
self-esteem, and negative feeling. Regarding
in Tabriz University of Medical Sciences
social relationship dimension, three items
approved the protocol of the study. After
were completed that focused on personal
explaining the whole protocol of study, a
relationships, social support, and sexual life.
written informed consent taken from the
Environmental health with eight items
eligible participants.
deals with issues related to security, physical
Sample size was determined on the basis of
environment and financial support,
information derived from a similar study.17
accessibility of information, leisure activity,
considering a confidence level of %95,
home environment, health, and
Z=1.96, SD=14.4, Mean=41.7, 184 samples
transportation. All scores are transformed to
were calculated. The participants were
reflect 4–20 for each domain with higher
elderly people who were living in the
scores corresponding to a better QOL. There
community and come to the daily care center
was no overall score for the WHOQOL-BREF
(not resident in health care centers) in Tabriz
and each domain was calculated by
city. They were voluntarily to take part in the
summation of their specific items. Where an
item was missing, the mean of other items in

258 | Journal of Caring Sciences, December 2014; 3 (4), 257-263 Copyright © 2014 by Tabriz University of Medical Sciences
Quality of life among elderly people and related factors

the domain was inserted. Where more than reported ones with 32.6 percent. Total score
two items are missing from the domain, the of quality of life in both genders was
domain score was not calculated, except for 90.75(13.37) (range between 26-130). Male
domain 3, in which more than one missing elderly had slightly high score of quality of
item was required to discard the calculation. life; however, these differences were not
Summing the total scores for each significant (P=0.438). Regarding the score of
particular domain manifested the OQOL and OHS (range between1-5), results
individual’s perception of quality of life. All showed that overall quality of life and overall
domain scores were scaled in a positive health status in participants were about in
direction (higher score indicated higher moderate level (respectively, 3.61 (0.84) and
QOL). Scoring was done using the table 3.57 (0.81). Four dimension of quality of life
given for converting raw scores to in participated subjects were depicted in
transformed scores. Compliance of Table 2.
questionnaire by the participants was in well There was no significant differences
and the allocated time for the questionnaire between gender and age variables with total
was 30 minutes. The score more than median score of quality of life (respectively P=0.438
of total score (median=52) categorized as an and P=0.612). Regarding diseases
acceptable level of quality of life. Validity background, a significant differences was
and reliability of questionnaire were observed between having cardiovascular
approved in other study according to the diseases, respiratory diseases, gastrointestinal
confirmation of panel of experts and the score diseases, hearing and visual impairments
of alpha Cronbach=up to 0.7, respectivley.18,19 with quality of life (P<0.05). Nevertheless,
Statistical Package for Social Sciences this differences was not apparent with
(SPSS) (version 13.0, Chicago, IL, USA) was having bone diseases (P>0.05). Table 3,
used for statistical analyzing of the data. depicted differences between quality of life
Normality of data was evaluated using the variable and demographic characteristics.
Kolmogorov-Smirnov test.
Continuous variables were expressed as Discussion
mean (SD) and qualitative data were Elderly population need especially care
presented as frequency (percent). Chi-square services to maintain high level of quality of
test was used for comparison of nominal life and health status. In this study, the
variables. Independent t-test and Pearson quality of life in elderly people was assessed.
correlation were used to compare differences The results showed that participated
between the total score of quality of life with subjects had approximately acceptable level
gender, diseases background and age of quality of life. There was no significant
variables. difference between two genders, however,
males had high score than females (P=0.438).
Results In this regard, several studies manifested
Demographic characteristics of participants different results. In agreement of this result,
are shown in Table 1. Mean ages of 184 Ahmadi et al.,17 manifested that there was no
participated elderly were 69.4 (7.9) years and significant differences between gender and
about 52% were males. There was no quality of life among 200 elderly people in
significant difference in proportion of two Zahedan city aged 65 years and above, by
gender in the study (P=0.461). Fifty percent of QOL-SF- 36.
elderly had cardiovascular diseases. Also However, Ahangharan et al.,20 assessed
bone diseases were other most common and quality of life among 300 elderly in Tehran

Copyright © 2014 by Tabriz University of Medical Sciences Journal of Caring Sciences, December 2014; 3 (4), 257-263|259
 Khaje-Bishak et al.

Table 1. Demographic characteristics of elderly people (n=184)

Elderly people
Characteristics Male Female Total
Gender* 97 (52.7) 87 (47.3) 184 (100)
Age(yr)** 69.9 (8) 68 (7.0) 69.4 (7.9)
Diseases background*
Cardiovascular diseases 48 (49.5) 44 (50.6) 92 (50)
Respiratory diseases 9 (9.3) 6 (6.9) 15 (8.2)
Gastrointestinal disease 24 (24.7) 19 (21.8) 43 (23.4)
Hearing impairments 20 (20.6) 14 (16.1) 34 (18.5)
Bone disease 27 (27.8) 33 (37.9) 60 (32.6)
Visual impairments 19 (19.6) 17 (19.5) 36 (19.6)
*
N (%), **Mean (SD)

Table2. Mean (SD) of four domains of the WHOQOL-BREF in both genders

Elderly people
Domains Male (n=97) Female (n=87) Total (n=184)
Physical health*
- pain 2.97 (1.07) 2.81 (1.02) 2.90 (1.05)
- dependence on medical aids 3.02 (1.13) 3.10 (1.11) 3.05 (1.12)
- energy 3.62 (0.98) 3.50 (0.91) 3.57 (0.94)
- mobility 3.60 (1.12) 3.49 (1.01) 3.55 (1.06)
- sleep and rest 3.38 (1.21) 3.18 (1.20) 3.28 (1.20)
- activities of daily living 3.42 (0.83) 3.40 (0.81) 3.41 (0.82)
- work capacity measure 3.39 (0.88) 3.42 (0.84) 3.40 ( 0.86)
Total (range between 7-35) 23.43 (4.65) 23.02 (4.41) 23.25 (4.51)
Psychological health*
- positive feeling 3.41(0.82) 3.42 (0.83) 3.42 (0.80)
- personal belief 3.52 (0.80) 3.34 (0.91) 3.45 (0.84)
- concentration 3.59 (0.84) 3.41 (0.92) 3.51 (0.90)
- bodily image 3.72 (0.86) 3.57 (0.85) 3.66 (0.83)
- self-esteem 3.34 (0.87) 3.42 (0.78) 3.38 (0.82)
- negative feeling 3.55 (1.18) 3.54 (1.30) 3.55 (1.24)
Total (range between 6-30) 21.15 (3.60) 20.81 (3.65) 20.99 (3.62)
Social relationships*
- personal relationships 3.97 (0.77) 3.67 (0.93) 3.83 (0.86)
- social support 2.98 (1.15) 3.02 (1.13) 3.00 (1.13)
- sexual life 3.67 (0.89) 3.32 (1.00) 3.50 (0.96)
Total (range between 3-15) 11.04 (2.14) 10.54 (2.16) 10.80 (2.16)
Environmental health*
- security 3.54 (0.85) 3.44 (0.88) 3.50 (0.86)
- physical environment 3.79 (0.78) 3.59 (0.72) 3.70 (0.76)
- financial support 3.25 (1.13) 3.31(1.13) 3.28 (1.13)
- accessibility of information 3.67 (1.06) 3.43 (1.10) 3.55 (1.08)
- leisure activity 3.56 (0.99) 3.62 (0.96) 3.59 (0.98)
- home environment 3.53 (0.91) 3.49 (0.91) 3.51 (0.91)
- health 3.76 (0.92) 3.59 (0.81) 3.68 (0.87)
- transportation 3.68 (0.90) 3.72 (0.89) 3.70 (0.90)
Total (range between 8-40) 28.81 (4.89) 28.40 (4.73) 28.61 (4.81)
*
Mean (SD)

260 | Journal of Caring Sciences, December 2014; 3 (4), 257-263 Copyright © 2014 by Tabriz University of Medical Sciences
Quality of life among elderly people and related factors

Table 3. Relation between the total score of quality of life and demographic characteristics
Variables Mean (SD) Mean difference Pψ
Age 69.4 (7.5) 1.9 0.612
Gender
Male 91.48 (13.41) 1.53 0.438
Female 89.94 ( 13.36)
Diseases background
Cardiovascular diseases 87.14 (12.05) 7.22 <0.001*
Respiratory diseases 83.27 (13.65) 8.14 0.023*
Gastrointestinal disease 84.99 (11.30) 7.67 0.001*
Hearing impairments 82.19 (13.67) 10.50 <0.001*
Bone disease 89.21 (12.15) 2.28 0.278*
Visual impairments 83.18 (14.95 9.41 <0.001*
ψ
Independent t-test, *Statistically significant (P<0.05)
city using WHOQOL- BRIEF (n=223 female, diseases background and quality of life with
n=77 male) with aged 60 years and above. the exception of bone disease. In agreement
The obtained results showed that there of our study, Vahdaninia et al.,21 manifested
was significant differences between genders, that among 396 elderly in Tehran city with
male had high level of quality than females aged 60 year and above, there was a positive
(P<0.001). In agreement with this study, differences between having diseases and low
Farzianpour et al.,2 surveyed the quality of score of quality of life (P<0.001). Also,
life among 400 elderly people who were Habibi et al.,22 study, confirm the quality of
aged 60 years and above in Marivan city life among elderly people was better in those
using QOL(SF-36), the results showed that who stated their health status in good level
males had high scores than females than others who stated their health status in
(P<0.001). The obtained results were similar the same of other elderly or in not acceptable
to the Nejati et al., and vahdaninia et al., level.
study.8,21 It can be related to cultural beliefs This study had some limitations; the main
and gender discrimination in society. In the limitation of this study was small sample
majority of societies females are more size of participants. In spite of assessing
responsible and active than males. some associated factors affecting on the
Emotional nature of females’ gender can quality of life, examining the other factors
be the other causes of vulnerability of were not possible in this study and can be
them.20 suggested for the future studies.
Correlation between score of quality of life
and age was not significant in this study Conclusion
(P=0.612). In agreement with this study,
Habibi et al.,22 that assessed quality of life in A significant difference was observed
410 elderly people using QOL(SF-12) between having cardiovascular diseases,
questionnaire, and presented no significant respiratory and gastrointestinal diseases,
correlation between quality of life and age hearing and visual impairments with total
variable (P=0.100). Ahmadi et al.,17 also score in the quality of life. However, our
showed no significant correlation between study showed acceptable level of quality of
age and quality of life among 200 elderly life, planning the policies and programs that
people in Zahedan city who were aged 65 improve and promote quality of life and
decrease burden of elderly's diseases
years and above by QOL(SF-36). In contrast,
Heydari et al.,23 showed that there was through establishing governmental or
significant correlation between the quality of private elderly people clubs and information
life obtained by SF-36 with age (P=0.01). A services for educating elderly people
significant difference was observed between

Copyright © 2014 by Tabriz University of Medical Sciences Journal of Caring Sciences, December 2014; 3 (4), 257-263|261
Khaje-Bishak et al.

regarding healthy diet and doing regular 6. Kun LG. Telehealth and the global health
exercise can be effective. network in the 21st century. From home
care to public health informatics. Comput
Acknowledgments Methods Programs Biomed 2001; 64 (3):
155-67.
We are grateful to the deputy of research in 7. Farzianpour F, Hosseini Sh, Rostami M,
Tabriz University of Medical Sciences Pordanjani Sh B, Hosseini SM. Quality of
(Student Research Committee) for financial life of the elderly residents. Am J Applied
support. This paper is a part of a database Sci 2012; 9 (1): 71-74.
from thesis entitled “Assessment of health 8. Nejati V, Shirinbayan P, Akbari A,
status of elderly in Tabriz city”. Foroughan M, Taheri P, Sheikhvatan M.
Quality of life in elderly people in
Ethical issues Kashan, Iran. Middle East J Age Ageing
None to be declared. 2008; 5 (2): 21-25.
9. Ware JE Jr, Sherbourne CD. The MOS-36
Conflict of interest item short-form health survey (SF-36).
Med Care 1992; 30 (6): 473-83.
The authors declare no conflict of interest in 10. Mellor D, Russo S, McCabe MP, Davison
this study. TE, George K. Depression training
program for caregivers of elderly care
recipients: implementation and qualitative
References
evaluation. J Gerontol Nurs 2008; 34 (9):
1. Datta PP, Gangopadhyay N, Sengupta B. 8-17.
Association of psychological morbidity 11. Gureje O, Ogunniyi A, Kola L, Afolabi E.
with socio-demographic characteristics Functional disability in elderly Nigerians:
among elderly: a cross-sectional study from Results from the Ibadan study of aging. J
Eastern Indian. Int J Med Public Health Am Geriatr Soc 2006; 54 (11): 1784- 9.
2013; 3: 94-99. 12. Donmez L, Gokkoca Z, Dedeoglu N.
2. Farzian pour F, Arab M, Hosseini SM, Disability and its effects on quality of life
Pirozi B, Shadi H. Quality of life of the among older people living in Antalya city
elderly residents in Marivan. Evaluation of center. Turkey Arch Gerontol Geriatr
quality of life of the elderly population 2005; 40 (2): 213-23.
covered by healthcare centers of Marivan 13. Bussche HV, Koller D, Olonko T, Hansen
and the influencing demographic and H, Wegscheide K, et al. Which chronic
background factors in 2010. Iran Red diseases and disease combinations are
Crescent Med J 2012; 14 (11): 695–96. specific to multi morbidity in the elderly?
3. Malek Afzali H, Baradaran Eftekhari M, Results of claims data based cross-
Hejazi F, Khojasteh T, Noot RH, Falahat K, sectional study in Germany. BMC Public
et al. The effectiveness of educational Health 2011; 11: 101.
intervention in the health promotion in 14. World Health Organization. Life in the
elderly people. Iran J Public Health 2010; 21th Century: a vision for all. Geneva,
39 (2): 18-23. 1998. Available from: http://
4. Lutz W, Sanderson W, Scherbov S. The www.who.int/whr/1998/en/whr98_en.pdf.
coming acceleration of global population 15. The World Health Report 2000, Health
ageing. Nature 2008; 451 (7179): 716-19. Systems: Improving Performance, WHO,
5. Bornardz J. Family studies: an introduction. 2000. Available from: http:// www. who.
1st ed. London: Routledge; 1997. int/ whr/ 2000/en/

262 | Journal of Caring Sciences, December 2014; 3 (4), 257-263 Copyright © 2014 by Tabriz University of Medical Sciences
 Quality of life among elderly people and related factors

16. Lehnert T, Heider D, Leicht H, Heinrich 20. Ahangharan M, Kamali M, Arjoman

S, Corrieri S. Review: health care Hesabi M. Quality of life elderly's
utilization and costs of elderly persons registered in cultural centers in Tehran
with multiple chronic conditions. Med city. Iranian Journal of Ageing 2007; 2
Care Res Rev 2011; 68: 387-420. (1): 182-89. (Persian)
17. Ahmadi F, Salar A, Faghihzadeh S. 21. Vahdaninia MS, Ghashtasbi A, Montazeri
Assessing quality of life among elderly A, Maftoon F. Health-related quality of
people in Zahedan. Hayat 2004; 10 (22): life in an elderly population in Iran: a
61-7. (Persian) population-based study. Payesh 2004; 2
18. Usefy AR, Ghassemi GR, Sarrafzadegan (4): 113-20.(Persian)
N, Mallik S, Baghaei AM, Rabiei K. 22. Habibi Sola A, Nikpour S, Sohbatzade R,
Psychometric properties of the HaghaniH. Quality of life in elderly
WHOQOL-BREF in an Iranian adult people of west of Tehran. Iranian Journal
sample. Community Ment Health J 2010; of Nursing Research 2008; 2 (7): 29-35.
46 (2):139-47. (Persian)
19. Nejat S, Montazeri A, Holakouie Naieni 23. Heydari J, Rouhani S, Mohammadpour
K, Mohammad K, Majdzadeh S. The RA. Aging populations’ quality of life: an
World health organization quality of life emerging priority for public health system
(WHOQOL-BREF) questionnaire: in Iran. Life Science Journal 2012; 9 (4):
translation and validation study of the 1304-09.
Iranian version. Journal of School of
Public Health and Institute of Public
Health Research 2006; 4 (4): 1-12.
(Persian)

Copyright © 2014 by Tabriz University of Medical Sciences Journal of Caring Sciences, December 2014; 3 (4), 257-263|263