Understanding health-related quality of life in old age : a cross-sectional study of elderly people in rural Bangladesh

Background: A rapidly growing subset of the world’s elderly population lives in Bangladesh, where the population aged 60 years and above is projected to almost double in twenty years, from 8.5 million in 2005 to 17.8 million in 2025. The recognition of population ageing and an increasing prevalence of chronic diseases are factors that recognize the importance of quality of life as an outcome measure in health research. Aim: This thesis aims to investigate health-related quality of life (HRQoL) in older people (>60 years) living in rural communities in Bangladesh, focusing on their perception of HRQoL and the impact of demographic and socio-economic factors. Methods: This thesis combines qualitative and quantitative research methods. The qualitative data was obtained through interviews with eleven elderly men and women aged 63-86 years. The quantitative data was collected through a cross-sectional survey in Bangladesh and Vietnam. A multi-stage sampling method was used to select the study sample of elderly people (>60 years). In Bangladesh (BD) the sample included 1,031 elderly people and 870 elderly people in Vietnam (VN). A pre-tested structured questionnaire was used to obtain data on HRQoL, demographic indicators, socio-economic status, self-reported health as well as social capital. Results: The findings demonstrated that there was a lack of suitable health-related quality of life instruments applicable for elderly people in rural Bangladesh. It was also found that in addition to commonly assessed dimensions of HRQoL (e.g., physical, psychological and social), the spiritual, financial and environmental dimensions are of importance for elderly people in rural Bangladesh. Qualitative data showed that having a role in the family and in the community and being functional both physically and economically was described to be of utmost importance for the elderly people’s HRQoL. It was also found that low social capital on both individual- (OR: 1.7; 95% C.I.:1.2-2.4) and community-levels (OR: 1.9; 95% C.I.:1.1-3.3) was significantly associated with poor quality of life. Results showed that belonging to the oldest age group (>75 years) (OR: 1.7; 95% C.I.: 1.2-2.5) and living in poor households (OR: 2.5; 95% C.I.:1.9-3.3) were significant determinants of poor QoL. In addition, illiterate people were found to be more likely (OR: 1.4; 95% C.I.: 0.9-2.1) to report poor QoL than those with more than 5 years of education. Significant differences were found on all dimensions of HRQoL when comparing data from Bangladesh and Vietnam. Elderly people in Vietnam (median 63, range 30-86) reported significantly more favourable HRQoL outcomes compared to Bangladesh (median 62, range 40-89), reporting higher on all dimensions except spiritual and environmental. In terms of determinants of HRQoL, similarities were found between the two countries: advanced age, being a woman, belonging to poor households, and having a poor self-reported health status were significantly associated with poor HRQoL. Illiteracy was additionally found to be a significant determinant of poor HRQoL in Bangladesh. Conclusions: This study revealed the importance of culturally appropriate and multidimensional tools when assessing HRQoL among elderly people in rural Bangladesh. Among the elderly people, there are certain groups that are particularly vulnerable and to whom interventions to improve HRQoL should be directed. These are the oldest old, women, illiterate, belonging to poor households and those with a poor health status