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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 9  |  Issue : 1  |  Page : 21-25

Hopelessness and quality of life in elderly: A community-based cross-sectional study


Department of Psychiatry, Yenepoya Medical College, Yenepoya Deemed to be University, Mangaluru, Karnataka, India

Date of Submission30-Mar-2022
Date of Decision27-May-2022
Date of Acceptance25-Jun-2022
Date of Web Publication03-Aug-2022

Correspondence Address:
Dr. Amithabh Sajeev
Department of Psychiatry, Yenepoya Medical College, Yenepoya Deemed to be University, Mangaluru, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jgmh.jgmh_12_22

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  Abstract 


Introduction: Elderly population has a higher vulnerability to many physical and mental disturbances. These setbacks can lead to decreased quality of life (QOL) which may increase the feeling of hopelessness among the elderly. Aim: This study aims to assess the association between hopelessness and the QOL among the elderly in the community. Materials and Methods: This cross-sectional study involved 100 elderly people with 50 participants each from two different locations of South India. The study was conducted from February 2020 to December 2020 after obtaining the institutional ethics committee approval. Beck's Hopelessness Scale and the World Health Organization quality of life (WHOQOL)-BREF instrument were used to assess hopelessness and QOL. Results: The average age of the sample was 66.26 ± 5.29 years with a male predominance. The Beck's hopelessness score was greater in females, whereas the WHOQOL score was higher in males. We also found a significantly strong negative strength of association (Pearson's correlation score of − 0.954) between Beck's hopelessness score and WHOQOL scoring systems. Our study showed that hopelessness and QOL were significantly influenced by educational status, marital status, annual income, medical illness, psychiatric illness, and duration of hospital admissions. Conclusion: Elderly people with good financial stability are more secure with a higher QOL.

Keywords: Elderly, hopelessness, quality of life


How to cite this article:
Sajeev A, Kakunje A, Karkal R. Hopelessness and quality of life in elderly: A community-based cross-sectional study. J Geriatr Ment Health 2022;9:21-5

How to cite this URL:
Sajeev A, Kakunje A, Karkal R. Hopelessness and quality of life in elderly: A community-based cross-sectional study. J Geriatr Ment Health [serial online] 2022 [cited 2022 Aug 16];9:21-5. Available from: https://www.jgmh.org/text.asp?2022/9/1/21/353161




  Introduction Top


Aging is a multifaceted process that involves numerous physical and psychological changes. Due to normal brain aging and declining physical health, the prevalence of mental and behavioral disorders, in general, tends to increase with age.[1] In India, the elderly account for 7% of the total population, of which two-thirds live in villages and nearly half of them in poor conditions.[2] The United Nations fixed cutoff for the elderly is 60+ years and further classified as oldest-old (age of 80+), centenarians (100+), and even supercentenarians (110+) are also made.[3] In the elderly, some people lose their loved ones or relocate away from their social networks. Some might have changes in their financial status or have an onset of a disease. These factors can impact mood, confidence, and sense of self-worth. One of the frequent negative emotions in the population is hopelessness. The community-based mental health studies in India have found that the point prevalence of depressive disorders among the elderly population varies between 13% and 25%.[4],[5] According to Beck, hopelessness is a decisive factor in suicide since it weakens the will to move forward and can develop a negative vision of future in an individual, leading them to retreat into themselves and foresee suicide as the solution to their issues.[6] The World Health Organization has defined quality of life (QOL) as “the individual's perception of his or her position in life in the context of the culture and value systems in which he or she lives and in relation to his or her goals, expectations, standards, and concerns.”[7] Hopelessness is a key element of suicidal intent and operates as a modulating variable between depression and suicidal behavior. QOL in the elderly population can be affected by many environmental factors. The elderly population has a higher vulnerability to many physical and mental disturbances. These setbacks can lead to decreased QOL which may increase the feeling of hopelessness among the elderly. This study is being conducted to assess and also relate hopelessness to the QOL which would help in early intervention in dealing with mental health issues of the elderly.


  Materials and Methods Top


This cross-sectional study was conducted among 100 elderly individuals through purposive sampling (house-to-house visits) with 50 participants each from two different locations of two states in South India. This study was conducted from February 2020 to December 2020 after obtaining the institutional ethics committee approval (YEC2/252). Any elderly (male or female) ≥60 years and those willing to participate and understand the questionnaire were included. Participants with severe sensory impairment and intellectual problems clinically were excluded.

Assessment tools

Beck's Hopelessness Scale is a 20-item true/false self-report instrument to assess three aspects of hopelessness: feelings about future, loss of motivation, and expectations. It is expected that respondents give answers concordant with the scoring key. Nine of the items are keyed false (1, 3, 5, 6, 8, 10, 13, 15, and 19th questions) and eleven are true (2, 4, 7, 9, 11, 12, 14, 16, 17, 18, and 20th questions). For every statement, each response is assigned a score of 0 or 1, and the total ''hopelessness score'' is the sum of the scores of the individual items. Thus, the possible range of scores is from 0 to 20. High scores indicate that the level of hopelessness is high. Languages administered were English, Malayalam, and Kannada. Administration time is 5–10 min.[8]

The World Health Organization QOL (WHOQOL)-BREF instrument is a self-report measure which produces a QOL profile. It has two general questions and 24 specific questions assessing four QOL domains: physical (seven items), psychological (six items), social relationships (three items), and environmental (eight items). Domain scores are scaled in a positive direction (i.e., higher scores denote higher QOL). The mean score of items within each domain is used to calculate the domain score. Mean scores are then multiplied by four to make domain scores comparable with the scores used in the WHOQOL-100. The first transformation method converts scores to a range between 4 and 20, comparable with the WHOQOL-100. The second transformation method converts domain scores to a 0–100 scale. Languages administered were English, Malayalam, and Kannada. The assessment time is 15 min.[9]

Data obtained were recorded in MS Excel worksheets and statistical analysis was done using IBM Corp. Released 2015. IBM SPSS Statistics for Windows, Version 23.0. Armonk, NY: IBM Corp. running on the Windows operating system. Categorical variables are displayed in terms of percentage and proportions. Continuous variables were expressed as mean and standard deviation. Student t-test and Chi-square test for categorical data were used to test the statistical significance of the difference between means. The best model fit for the determination of the predictor was done using the linear regression and P < 0.05 was considered statistically significant.


  Results Top


The sociodemographic profile of participants is described in [Table 1]. In our study, all the participants were included and no participants were excluded from the study. The average age of participants was 66.26 ± 5.29 years. There were 60% of males and 40% of females among the 100 participants, with a male predominance. By educational status, 34% were with primary education, 31% with a graduate degree, and 28% with high school education. By occupation, 63% were unskilled participants, 25% were retired, and 12% were skilled workers. Among the 100 participants, 84% belonged to nuclear families, 13% belonged to extended nuclear families, and 3% belonged to joint families. Eighty percent of the participants were married, 18% were widows, and 1% were separated and divorced. Sixty percent of study participants were below the poverty line and 40% were above. The majority of participants relied on the family as a source of income, with 13% having a job and 24% receiving a pension. In total, 52% of the individuals had never undergone surgery before, and 95% of them had never had a psychiatric disorder. This study found that 41.9% of the elderly population received an employment pension.
Table 1: Sociodemographic profile (n=100)

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[Table 2] shows the mean of Beck's hopelessness score, WHOQOL total, and the mean scores of the different domains of the questionnaire among participants. The comparison of the mean scores of Beck's hopelessness score and WHOQOL score with the demographic characteristics of the participants is described in [Table 3]. The mean Beck's hopelessness score among the participants was found to be 8.07, and WHOQOL mean was 69.10 ± 16.61. The Beck's hopelessness score was greater in females than in males, whereas the WHOQOL was higher in males than in females. Beck's score was higher among the unskilled and retired participants compared to skilled. WHOQOL was lower in unskilled and retired participants compared to the skilled. Religion did not show any difference in the score measured in the present study. Illiterate participants had a higher mean Beck's hopelessness score and lowest WHOQOL score in them compared to the educated participants at different grades. The mean Beck's hopelessness score among the divorced and widow participants was found to be higher than the married, and WHOQOL score was least among the divorced and widow participants compared to the married and separated participants. Beck's hopelessness score among the employed was significantly higher and WHOQOL score among the unemployed was lower compared to the employed participants. The participants with current medical illnesses had a significantly higher mean Beck's hopelessness score and lower WHOQOL score compared to those who did not have any current medical illnesses. Similarly, participants with psychiatric illness had a significantly higher mean Beck's hopelessness score and lower WHOQOL score compared to those who did not have any psychiatric illnesses. In our study, we found a significantly strong negative strength of association between Beck's hopelessness score and WHOQOL scoring systems.
Table 2: The mean of Beck's hopelessness score, the World Health Organization quality of life total, and the mean scores of the different domains of the questionnaire among participants

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Table 3: Comparison of the mean score of Beck's hopelessness score and World Health Organization Quality Of Life score with demographic characteristics of the participants

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The determinant of QOL and Beck's hopelessness score among the subjects was assessed using the multiple linear regression technique. The statistically significant characteristics were integrated into the multivariate analysis. The significant determinant of the hopelessness measured by Beck's hopelessness score was found to be educational status, marital status, annual income, presence of medical illness, presence of psychiatric illness, and duration of hospital stay. The significant determinants of the WHOQOL were found to be educational status, marital status, annual income, present medical illness, psychiatric illness, and duration of hospital stay.


  Discussion Top


The purpose of this cross-sectional study was to investigate the relationship between hopelessness and QOL among the older population. Thirty-four percent of the sample had primary education, 31% with graduation, and 28% had high school education. Majority were in unskilled occupations; however, 25% were retired and 12% were skilled workers. Among the participants, the majority stayed in nuclear families, were married, and belonged to below the poverty line. The majority of participants relied on the family as a source of income, with 13% being employed and 24% received a pension. Among participants, the majority had never undergone surgery before nor had a psychiatric illness. A study by Tajvar et al. witnessed that 7.4% of the elderly group were living alone; in a similar survey conducted in urban Tehran, Iraq, 15% of the elderly were living alone, which is slightly higher than the present study.[10] This study found that 41.9% of the elderly population received an employment pension, whereas, in urban Gujarat, only 10.4% received a pension.[11]

The mean Beck's hopelessness score among the participants was found to be 8.07, and WHOQOL mean was 69.10 ± 16.61. The Beck's hopelessness score was greater in females, whereas WHOQOL was higher in males. Beck's hopelessness score was higher among the unskilled and retired participants compared to skilled. WHOQOL score was lower in unskilled and retired participants compared to the skilled. Religion did not show any difference in the score measured in the present study. Similar to the present study, Khaje-Bishak et al. documented a significantly higher mean of QOL among males compared to females. This was attributed to the patriarchal society norms, cultural beliefs, gender dominance, and higher accessibility to most of the services among males.[12] In agreement with this study, Farzianpour et al.[13] surveyed the QOL among 400 elderly people who were aged 60 years and above in Marivan city using QOL (SF-36), and the results showed that males had higher scores of WHOQOL than females (P < 0.001). The obtained results were similar to Nejati et al.'s study.[14] Although the present study found similar results, was not statistically significant as the females in the society had a major responsibility and were active in conjunction with the males of the house. Illiterate participants had a higher mean Beck's hopelessness score and lowest WHOQOL score compared to the educated participants at different grades. The mean Beck's hopelessness score among the divorced and widow participants was found to be higher than the married, and WHOQOL score was least among the divorced and widowed participants compared to the married and separated participants. Beck's hopelessness score among the employed was significantly higher and WHOQOL score among the unemployed was lower compared to the employed participants. The participants with the present medical illness had a significantly higher mean Beck's hopelessness score and lower WHOQOL score compared to those who did not have any current medical illnesses. Similarly, participants with psychiatric illness had a significantly higher mean Beck's hopelessness score and lower WHOQOL score in them compared to those who did not have any psychiatric illnesses. Comparable to the present study, Nejati et al. also documented a better QOL among the participants who were married and employed.[14]

In our study, we found a significantly strong negative strength of association between Beck's hopelessness score and WHOQOL scoring systems. Similar to the present study, Devraj et al. found in the physical domain, the score ranged between 12 and 33, with a mean of 24.4 ± 2.7. In the psychological domain, it was between 15 and 27, with a mean of 22.02 ± 1.7. The social relation domain score ranged between 8 and 15, with a mean of 11.33 ± 1.3. In the environment domain, the score ranged between minimum of 22 and maximum of 36, with a mean of 27.8 ± 2.2.[15] The result was similar to the present study.

The determinants of WHOQOL and Beck's hopelessness score among the subjects were assessed using the multiple linear regression technique. The statistically significant characteristics were integrated into the multivariate analysis. A study done by Devraj et al. showed the determinants of the QOL and hopelessness as gender, marital status, living status, education, occupation, socioeconomic status, use of mobile phone, use of social media, participation in social clubs, interaction with people, involvement in decision making, medication, ill treatment at home, and health insurance. These were found to have statistical significance with QOL (P < 0.05).[15] In a study by Tejvar in Iran, it was found that the economic status of the elderly was the most significant predictor of their QOL.[10]

In our study, the significant determinants of the hopelessness measured by Beck's hopelessness score were found to be educational status, marital status, annual income, presence of medical illness and/or psychiatric illness, and duration of stay at the hospital. The significant determinants of the WHOQOL were found to be educational status, marital status, annual income, presence of medical illness and/or psychiatric illness, and duration of stay at the hospital. The findings of the study revealed that the elderly population frequently experienced feelings of hopelessness. The major contributing factors are being unmarried, divorced, psychiatric illness, and low income. The strengths of the study are that it is a community-based study conducted in two centers which included both genders among the elderly population. The limitation of the study is that it is a cross-sectional study, with sampling bias with limited sample size.


  Conclusion Top


The present study showed that hopelessness and QOL were significantly influenced by educational status, marital status, annual income, medical illness, psychiatric illness, and duration of hospital stay. Although the government brings new schemes through a new mode of communication, getting access to the services is inevitably challenging for most of the older adults. Policies and programs should be considered for improving the QOL among the elderly. Elderly people with good financial stability are more secure with a higher QOL.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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  [Table 1], [Table 2], [Table 3]



 

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