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Table of Contents
ORIGINAL ARTICLE
Year : 2022  |  Volume : 54  |  Issue : 2  |  Page : 51-56

Gender differences in quality of life and subjective happiness in Indian Elderly: A cross-sectional survey


1 National Institute for Locomotor Disabilities-Regional Centre, SCERT Campus, Aizawl, Mizoram, India
2 Department of Occupational Therapy, Institute of Human Behaviour and Allied Sciences, New Delhi, India

Date of Submission31-Jan-2021
Date of Acceptance03-Jul-2022
Date of Web Publication4-Aug-2022

Correspondence Address:
Sarju Moirangthem
National Institute for Locomotor Disabilities-Regional Centre, SCERT Campus, Chaltlang, Aizawl - 796 012, Mizoram
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijoth.ijoth_32_21

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  Abstract 


Background: As aging is associated with lower quality of life (QOL), it is important to determine overall QOL and its related factors among older adults. Studies have shown that gender plays an essential role in the perception of health across cultures. As very few studies has been conducted on gender disparity in the elderly in India. Thus, the study was conducted to assess the differences in QOL and subjective happiness between male and female community-dwelling elderly. Objectives: The study was conducted to assess the differences in QOL and subjective happiness between male and female community-dwelling elderly in India. Study Design: The study design involves a cross-sectional survey. Methods: The data were collected from community-dwelling elderly (>60 years of age) based on convenient sampling. QOL and subjective happiness were tested by World Health Organization QOL (WHOQOL)-BREF and the Subjective Happiness Questionnaire. Informed consent was taken before administering the study-specific questionnaire via mail, telephone, or in person. Only completed questionnaires were used. Data hence collected were analyzed. Results: The data were analyzed by descriptive analysis, whereas the differences between gender on QOL and happiness were computed using the t-test and Mann–Whitney test, respectively. Gender and educational qualification correlated with QOL measure WHOQOL (P = 0.05; 95% confidence interval [CI]: 0.014, 0.527). Furthermore, a positive correlation (P = 0.01; 95% CI: 0.994, 0.998) was found between WHOQOL-BREF and the Subjective Happiness Questionnaire. For the overall QOL and general health section in WHOQOL-BREF, males scored a mean ± standard deviation (SD) of 3.825 ± 0.71 and 3.275 ± 1.15, whereas females scored a mean ± SD of 3.875 ± 0.56 and 3.35 ± 1.21. For the four domains of WHOQOL-BREF except for domain 4 (t = 2.17; 95% CI: 26.13, 28.06), mean ± SD (27.10 ± 4.35), (P = 0.033), and Subjective Happiness questionnaire, the differences in the means of elderly males and females were nonsignificant on Mann–Whitney test. Conclusion: This study shows that gender-related factors influence specific areas of QOL, such as females scoring less in physical and psychological factors, whereas scoring better than males in social relationship and environment areas.

Keywords: Gender Differences, Quality of Life, Subjective Happiness, Well-Being


How to cite this article:
Moirangthem S, Ojha GJ. Gender differences in quality of life and subjective happiness in Indian Elderly: A cross-sectional survey. Indian J Occup Ther 2022;54:51-6

How to cite this URL:
Moirangthem S, Ojha GJ. Gender differences in quality of life and subjective happiness in Indian Elderly: A cross-sectional survey. Indian J Occup Ther [serial online] 2022 [cited 2022 Nov 30];54:51-6. Available from: http://www.ijotonweb.org/text.asp?2022/54/2/51/353355




  Introduction Top


Quality of life (QOL) is defined as individuals' perceptions 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.[1] There is currently an agreement that the construct of QOL has a multidimensional character.[2] According to the Indian Population Census 2011, there are 53 million female and 51 million male elderly persons (aged 60 years or above).[3]

Studies have shown that gender plays an essential role in decision-making as well as the perception of health and well-being across cultures. Although worse HQOL among women in developed countries has been reported, it is still not fully understood what role gender plays in overall QOL.[4] Hsu HC, in his study, showed that elderly women in the Taiwan area, unlike in mountains and offshore islands, showed lower HQOL in almost every dimension.[5] In a similar study in Austria, it concluded that gender influenced HQOL depending on the age groups (<or = 70 vs. >70 years).[6] In a study on the pattern of family support and QOL the elderly who gave and receive care are found to be more satisfied with life than those who do not exchange any support with their children.[7]

Kumar, in his study, found that the overall QOL among the elderly suggests that women are more vulnerable and the physical environment also has a crucial role to play in it which has a great effect on their mobility and daily life like the weather condition, physical infrastructure.[8]

As very few studies has been conducted on the gender disparity in the elderly in India. It is necessary to build the knowledge base on the role of gender in QOL and self-reported happiness associated with aging in India. The knowledge that happier societies reduce healthcare burden and cost can help policymakers with the development of programs to effectively enhance their citizens' happiness (the key elements of well-being).[9]

Thus, the study was conducted to assess the differences in QOL and subjective happiness between male and female elderly in India.


  Methods Top


A cross-sectional survey study was conducted on community-dwelling elderly of Aizwal (Mizoram), Odisha, and Delhi. In this study, 60 years and above aged elderly were included; adapted from Newman and Newman's (1991) classification of life stages and associated developmental tasks and psychosocial developmental stages by Erikson (1950).

A total of a hundred elderly were contacted using convenient sampling. Those elderly with cognitive deficits or who were severely ill or bed-ridden, elderly who could not give informed consent, and elderly who left during data collection or had filled-in incomplete data or those unwilling of participating in the study were excluded. Few of them who were contacted through e-mails did not respond within a stipulated time. Hence, the final sample size consisted of 80 elderly and 40 from each gender participated. Data were collected by administering the World Health Organization QOL instrument (WHOQOL-BREF) and Subjective Happiness Scale (SHS) in person and through the mail after getting their due consent. Participation was voluntary and anonymous. All elderly were assured of confidentiality and were also informed to assert their right to withdraw at any time. The research work was conducted adhering to the principles of the “Declaration of Helsinki” guideline.[10]

Measures and Procedure

The data relating to sociodemographic variables were collected as per the WHOQOL-BREF questionnaire for the present study, including age, sex, religion, marital status, etc.

World Health Organization Quality Of Life-BREF

The WHOQOL-BREF[11] is a shorter version of the WHOQOL-100. Both were developed by the WHO and published in 1995. The questions stem from multiple statements about QOL, health, and well-being from people with and without the disease. The WHOQOL-BREF is a self-administered questionnaire comprising 26 questions and four domains on the individual's perceptions of their health and well-being over the previous 2 weeks. Responses to questions are on a 1-5 Likert scale where 1 represents “disagree” or “not at all” and 5 represents “completely agree” or “extremely.” The physical health domain covers facets such as activities of daily living, dependence on medicinal substances and medical aids, energy and fatigue, mobility, work capacity, etc., The psychological domain has items on bodily image and appearance, negative feelings, self-esteem, spirituality/religion/personal beliefs, etc., Social relationships cover personal relationships, social support, etc., The environment has items on financial resources, freedom, physical safety and security, accessibility and quality, home environment, and physical environment (pollution/noise/traffic/climate, transport, etc.)

There are also two separate questions reported separately and denominated as WHOQOL-1 and WHOQOL-2, which ask specifically about (1) the individual's overall perception of their health and (2) the individual's overall perception of their QOL.

Subjective Happiness Scale

SHS[12] by Lybomirsky and Lepper (1999): A global subjective assessment of whether one is happy or unhappy was used. Each of the items is completed by choosing one of the seven options that finish a given sentence fragment ranging from not a very happy person to a very happy person, less happy to happier, and not at all to a great deal. Each of the four questions has different options. The sum of the scores for all four items gives the total subjective happiness score of the respondent. Higher score indicates a higher level of subjective happiness.

Statistical Analysis

The responses given for each item of the scale were entered into a Microsoft Excel spreadsheet (Version 2007, Microsoft Office 12) and analyzed using SPSS software (Version 17, SPSS Inc., Michigan Avenue, Chicago, IL, USA 60611).

Descriptive statistics were used for the different variables. Data were presented in terms of percentage and mean where ever appropriate, whereas the differences between gender on QOL and happiness were computed using t-test and Mann–Whitney test, respectively. In addition, t-test by marital status, illness, religion, and analysis of variance (ANOVA) for education and location on WHOQOL-BREF were also computed. The level of significance was set at P < 0.05 at the outset of the study, and 95% confidence interval (95% CI) values were also computed.


  Results Top


The sociodemographic characteristics of the elderly (N = 80) are shown in [Table 1]. Out of the total 80 elderly, both genders consisted of 40 each, with 50 (62.5%) belonging to suburban, 28 (35%) to urban, and 2 (2.5%) to the rural area. The age range was 60–93 years, with a mean age of 68.4 ± 5.7 years. The majority of the elderly were married, 63 (79%), while the rest were single or divorced or separated, 17 (21%). Among them, 50 (62.5%) practiced Christianity and 30 (37.5%) Hinduism. Around 46 (57.5%) of the elderly reported illness, while 34 (42.5%) enjoyed good health. Most of the elderly had primary schooling 29 (36.25%), 14 (17.5%) were illiterate, 14 (17.5%) were educated up to secondary school and 23 (28.75%) had a tertiary level or higher education. Gender and educational qualification correlated with QOL measure WHOQOL (P = 0.05; 95% CI: 0.014, 0.527).
Table 1: The Sociodemographic Characteristics of the Elderly

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For overall QOL and general health items (denominated as WHOQOL-1 and WHOQOL-2, respectively) in WHOQOL-BREF, males scored mean ± standard deviation (SD) of 3.825 ± 0.71 and 3.275 ± 1.15 mean, whereas females scored a mean ± SD of 3.875 ± 0.56 and 3.35 ± 1.21. In contrast, the mean ± SD of the total score for both the questions was 142 ± 15.56 for males and 144.5 ± 14.85 for females. However, the difference of scores of both the genders on these two questions was statistically nonsignificant on the t-test.

The findings of this study, as shown in [Table 2], have found that both males and females elderly have scored very less in the social relationship (Domain 3) as compared to all other domains.
Table 2: Domain Wise Score: Depicts the Mean Domain Score for Both Genders Across the Four Domains of World Health Organization Quality of Life-BREF

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In Domain 1 (physical health): the mean of the responses of all the total 7 items was 3.45 ± 0.29 (males) and 3.35 ± 0.19 (females) respectively. Wherein Domain 2 (psychological): the mean of the responses of all the 6 items was 3.48 ± 0.27 (males) and 3.22 ± 0.51 (females) respectively. For all the three items in Domain 3 (social relationship): the mean of the responses was 3.6 ± 0.11 (males) and 3.85 ± 0.25 (females) respectively. Domain 4 (environment) consisted of eight items with mean score of 3.24 ± 0.17 (males) and 3.53 ± 0.36 (females).

For the four domains of WHOQOL-BREF, the differences in the means of elderly males and females were nonsignificant on the t-test except for Domain 4 (environment), where the difference was statistically significant.

In addition, on the t-test by marital status, illness, religion, and ANOVA for education and location on WHOQOL-BREF, married subjects performed better than singles, Hindus had a better score on all the domains except social relationships in which Christians and those with higher education scored better. Subjects from urban areas had higher scores than those from semi-urban. Overall, 5 (6.25%) of the total subjects had fair QOL, while 57 (71.25%) had good and 18 (22.5%) had excellent QOL scores on WHOQOL-BREF.

Furthermore, a positive correlation was found between WHOQOL–BREF and SHS.

The mean of all responses for all the four items of SHS for both the genders as represented in [Table 3] was comparable and statistically, no difference (Z = 0.81) was found on the Mann–Whitney test. The average normative score for SHS range from 4.5 to 5.5 and both the genders in our study scored within this range.
Table 3: The Mean of the Responses for Each Gender in Subjective Happiness Scale

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  Discussion Top


This study has some interesting findings which warrant localized ethnic gender studies with regard to QOL and well-being.

Socio-Demographic Characteristics of the Participants

The majority of the elderly in the present study were from the sub-urban region of Aizwal (a Christian-dominated state) practicing Christianity. As per the 2011 census, the gender gap in literacy is insignificant in Mizoram.[13],[14] This study showed males were literate as compared to females and more educated at tertiary or higher education levels, whereas the majority of females had primary and secondary schooling than males. Those residing in urban areas scored better than semi-urban.[15] Christians had better social support and relationship as attributed to regular visits to church for Sunday mass offering better opportunities of social contact for the elderly. Hence, they scored better in the social relationship domain than Hindus who are residing in urban areas, while they scored better in other domains.

In the present study in the Domain 1 (physical health) findings showed females were less healthy than males though it was not statistically significant. Bora and Saikia found that Indian women live longer but report poorer health than men.[16] In terms of morbidity by gender, studies report that in rural areas, morbidity is lower for females as compared to males, but it is higher in urban areas and with age 60 + years for females.[14]

Arthritic pain is more common in elderly females as compared to males of 60 plus years. Thus, it reflects the hard life faced by women who never retire from household work unless totally disabled. The prevalence of multi-morbidity among rural elderly males in Odisha was reported to be higher in males though the difference was not significant it might be because males are more open to reporting health issues.[17]

Findings with regard to Domain 2 (psychological) have shown male elderly scoring better. It indicated that females because of the gender paradox of morbidity versus longevity[16],[18] may face ageism, and hormonal changes post 60 years resulting in a lesser score.

The results of Domain 3 (social relationship) as represented in [Table 2] A revealed that females scored slightly higher in contrary to general Indian studies where males scored higher though it was not statistically significant. In a study conducted by Lokare et al. in Vidyanagar, Karnataka, it was observed that the mean scores of males and females were significantly different in the physical domain but not in the other domains.[19] Despite many studies reporting higher QOL in males in comparison to females, our study found no statistical difference in most of the areas or domains of QOL between both the genders as reported in an Indian study.[20],[21] In Domain 4 (Environment), a statistically significant difference was noted. That indicated that more female participants had increasing freedom and considered their physical and home environment healthy and safe. There has been global progress in the equity and empowerment status of women, substantial evidence from different parts of the world highlights this.

The present study showed that male elderly reported a slightly greater happiness mean ± SD (5.06 ± 0.86) than female elderly mean ± SD (4.93 ± 0.87); though statistically not significant. This is supported by earlier research findings which showed that there is a decline in happiness reported by women in comparison to men with age[22],[23] and are more likely to face distress in social relationships resulting in unhappy feelings. Furthermore, many studies have shown no significant difference in happiness between women and men.[23],[24],[25] In our study as women now possess a much higher status in the Mizo Christian society[14] the level of their happiness may have increased with no significant statistical difference from males. Pinquart and Sorensen had concluded in their study that although in some studies gender differences were small, they continue to exist in old age to the disadvantage of women.[25]

The study's sample is small and its results cannot be generalized to the entire population of individuals 60 years or older. The dimensions influencing these individuals' perception of QOL need to be investigated to understand what needs affect the level of satisfaction elderly people experience in their lives, especially in the case of those who are dependent on others. Among these aspects, evaluating how the lives of these people can be improved is also needed. Even though they do not complain about the company or social life, they acknowledge their desire to relate with people their age. Overall, in our study, 71.25% had good and 22.5% had excellent QOL similar to a study conducted in urban Ahmedabad.[26] Certain characteristics, both negative and positive ones, are attributed to elderly individuals, though negative characteristics like loneliness seem to be more rampant, a fact that contributes to older individuals not feeling useful in society. With increasing age, the individual may realize that given her/his age and disease, s/he is not actually in so bad a situation and consequently does not place much weight on necessary and relevant aspects such as social relationships. Nevertheless, older individuals' perception of QOL is not entirely bad, and many appear fairly happy and satisfied with their current life similar to the findings of this study.[27] Since QOL is a direct indicator of the outcome of services delivered by occupational therapists local cultural influence should be considered while planning interventions like social clubs for the elderly to improve social connections.

Limitations

  • The sample was collected by using a convenient sampling technique and the sample size was small; hence, the generalization of the result remains doubtful
  • Since the majority of the sample was predominantly collected from the semi-urban cohort of Aizwal which cannot be seen as a representative of the community populations of India
  • Self-administered questionnaire was used.


Future Direction

  1. In the future, such a study should be carried out with a larger sample (with sample size calculation) with equal representation of both genders in different ethnic groups. Furthermore, in-depth analysis of the characteristics of such a sample can be valuable
  2. To develop more culture-specific sensitive tools for measurement
  3. To develop and test gender-specific interventions tailored to the local context and culture.



  Conclusion Top


The findings of this study demonstrate that females have scored less in the area of physical health and psychological well-being of QOL. However, females have scored more in the area of social relationships and environment of QOL than males. The present study also showed that male elderly reported a slightly greater happiness than females. Understanding those influencing factors such as accessibility and autonomy in the environment (physical, home, and societal) can help tailor interventions to meet the unique and gender-specific needs of the elderly.

Acknowledgment

Firstly, we thank all the study elderly participants for their contributions. And would like to extend thanks to Mr. Dr. T. C. Tolenkhomba, Assistant Professor (SG) College of Veterinary Sc. and A. H. Central Agricultural University, Selesih, Aizawl, Mizoram, and Mr. Lalhriapuia Ralte for their help in statistical analysis.

Financial Support and Sponsorship

Nil.

Conflicts of Interest

There are no conflicts of interest.



 
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  [Table 1], [Table 2], [Table 3]



 

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