Quality of Life of the Elderly During the COVID-19 Pandemic in Iran; A Cross-Sectional Study

Document Type : Descriptive & Survey

Authors
M. Lotfizadeh 1
Sh. Habibi 2
Z. Karimi 3
Z. Davoodi 4
R.R. Marzo 4
F. Fatahian 5
1 School of Health, Shahrekord University of Medical Sciences, Shahrekord, Iran
2 Department of Community Medicine, Faculty of Medicine, Shahrekord University of Medical Sciences, Shahrekord, Iran
3 Students Research Committee, Shahrekord University of Medical Sciences, Shahrekord, Iran
4 Department of Community Medicine, International Medical School, Management and Science University, Shah Alam, Malaysia
5 Department of Health Education and Health Promotion, Faculty of Health, Isfahan University of Medical Sciences, Isfahan, Iran
10.58209/hehp.11.5.749
Abstract
Aims: Populations are generally susceptible to the new coronavirus, but the elderly are more susceptible to severe disease and are admitted to the intensive care unit, and the mortality rate is higher in elderly patients. This study aimed to evaluate the quality of life of the elderly during the COVID-19 pandemic in Iran.

Instrument & Methods: The present cross-sectional survey was conducted on 461 Iranian elderly. Data collection tools include a questionnaire focusing on the quality of life in physical and mental dimensions. Stark quality of life questionnaire to adapt and be useful in COVID-19 disease outbreak conditions; only short phrases have been added to relate it to the disease. Data analysis was done using independent t and ANOVA tests.

Findings: Out of 461 participants in this study, 236 (51.2%) were men and the rest were women. Their average age was 70.46 years. The mean score of the mental component was 7.6±1.8 in women and 6.8±1.9 in men. The mean score of the physical component was 17.3±5.6 in women and 14.9±5.8 in men. There has been a significant relationship between the mental and physical components of gender. The results also showed that physical states of men enjoy better conditions compared to women (p=0.001).

Conclusion: Therefore, it can be concluded that the quality of life of the elderly during the COVID-19 pandemic was low. Men also enjoyed better conditions in comparison with women.

Keywords

Subjects

Introduction
Coronaviruses are a large family of viruses that can cause respiratory infections ranging from colds to severe diseases such as MERS and Sars [1]. In December 2019, a series of unexplained cases of pneumonia were reported in Wuhan, China, and the government and health researchers in China took rapid measures to control the epidemic and began etiological research. On January 12, 2020, the World Health Organization (WHO) provisionally named this new virus as novel coronavirus-2019. On January 30, 2020, WHO declared the 2019 novel coronavirus pandemic as a public health emergency of global concern. On February 11, 2020, WHO officially named the disease caused by the novel coronavirus-2019 the disease COVID-19 [1, 2].
Coronavirus spreads rapidly in Iran, like in other countries of the world, and puts people's mental and physical health in danger. The symptoms of this virus vary from mild to severe, and usually, the symptoms of infection are fever, cough, and breathing problems [3]. Populations are generally susceptible to the novel coronavirus, but the elderly are more susceptible and are more likely to develop severe illness and be hospitalized in intensive care units, and mortality is higher in elder patients. Moreover, the chances of contracting and dying increase in elderly people who suffer from diseases such as diabetes, high blood pressure, and cardiovascular diseases [4, 5]. The reason why elderly people suffer from a more severe type of disease can be because of physiological changes, reduced immune system function, and chronic diseases in these people [6].
In the second half of the 20th century, medical and health advances increased human life expectancy so that according to the statistics of the World Health Organization in 2000, the population of people aged 60 and over was almost 600 million people, and this figure will reach 1.2 billion by 2025 [7]. Iran, as one of the developing countries, is not exempt from this rule, so the increase in the growth of old age can be seen in the aging process of the country's population. Therefore, according to the increasing trend of the old population, attention should be paid to the well-being of the elderly in all physical, mental, and social dimensions as the needs of the elderly population. In order to improve the health of the elderly and prevent and control diseases, the first step is to identify the condition of the elderly. In this regard, one of the indicators that expresses the condition of the elderly well is the quality-of-life index. Although aging causes a disturbance in the quality of life of the elderly, other underlying factors are also effective in this reduction [8].
Therefore, considering the considerable control of the COVID-19 disease through widespread vaccination and compliance with health procedures, this disease is still considered to be a threat to people’s health, especially the elderly, so in this study, we aimed to evaluate the quality of life in elderly people during the COVID-19 pandemic in Iran.

Instrument and Methods
Study design and participation
This cross-sectional survey was conducted on 461 Iranian elderly in 2022. In order to select the desired samples, the sampling method was available samples. A sample link of the questionnaire was provided to the collaborating researchers across the country, and with their cooperation, the questionnaires were completed through interviews. In the present study, sampling was done using the convenience sampling method. After explaining the aim of the study and obtaining the consent of the participants, patients who met the inclusion criteria were enrolled in the study. The inclusion criteria were the elderly (people over 60 years old), any elderly who is willing to cooperate with this study and complete the consent to participate in the research, the elderly whose health is at a level where the ability to hear, see and the minimum required have their own lives and be able to see the forms prepared in the questionnaire and hear the voice of the person who is chosen as a liaison in the research, and the exclusion criteria of this study included the elderly with known mental illnesses and the elderly with Alzheimer's and incurable diseases.
Questionnaire development
The questionnaire used in this study was the Stark QoL questionnaire, focusing on the quality of life in physical and mental dimensions which was designed by Hardt in 2015 [9]. The questionnaire indicates good reliability (Cronbach's alpha=0.93) and good construct validity. It consisted of a 5-point Likert scale whose first item measures mood with 5 smiles at one end for a very happy face, and a very sad one at the other end. The second item measures energy and presents two pictures of a person walking; The walker on the left is full of energy and on the right, he seems to be walking almost as if depressed. The third item measures social contact and displays three pictures showing a group of five persons each, one white and four grey. The white person symbolizes the probed himself and the grey ones, a possible peer group. On one end, the white person is standing in the middle of the group; On the other end alone. Together, these three items constitute the mental component. All items are displayed on one page and are to be answered by making a cross under the picture that best applies to one’s situation. On the second page, six items measuring physical functioning are presented. The pictures show activities like carrying a shopping basket, moving a table, tying shoes, etc. To adapt and be usable in the conditions of the outbreak of COVID-19 diseases, only short phrases have been added to relate to the disease. The questionnaire included 24 questions (15 demographic questions, 3 questions in the psychological dimension, and 6 questions in the physical dimension). It should be noted that the higher the mean score of the physical and mental components, the more unfavorable the quality of life.
Statistical analysis
Analysis was done using SPSS 24 software, and data analysis was done using descriptive statistics, including frequency percentage, mean, and standard deviation, and analytical statistics, including independent t and ANOVA tests. In this study, p<0.05 was considered to be statistically significant.

Findings
The mean age of the participants was 70.46±7.97 (60 to 95) years. Most of the participants were women (51.2%), lived in the city (76.4%), were married (78%), had primary education (76.6%), were housewives (43.2%), had regular insurance (52.5%), and had neither good nor bad views of their lives (46.9%; Table 1).

Table 1. Frequency distribution of demographic parameters of the elderly enrolled in the study



Comparing the quality of life in terms of physical and mental dimensions in both sexes using independent t-test showed that the mean score of the physical condition was 7.6±1.8 in women, 6.8±1.9 in men, and the average psychological state was achieved component in women 17.3±5.6, men 14.9±5.8 and a significant statistical relationship between mental and physical components with gender was observed (p=0.001).
There were significant relationships between the mean score of the psychological dimensions considering the place of residence (p=0.001), education (p=0.001), employment status before retirement (p=0.013), type of insurance (p=0.01), and visiting family (p=0.036), but no significant relationship was observed between the average score of the psychological dimension with the amount of pension and marital status. There were statistical differences between the average score of physical components considering the place of residence (p=0.003), level of education (p=0.015), employment status before retirement (p=0.038), and marital status (p=0.036). However, there was no statistically significant relationship between the average score of physical components with the type of insurance used by the elderly, visits with family, and the amount of pension (Table 2).

Table 2. The relationship between demographic variables and mental and physical dimensions


Discussion
The present study was conducted with the aim of evaluating the quality of life of the elderly during the COVID-19 pandemic in Iran. The elderly are known as a vulnerable group against COVID-19 due to their physical and immune system function being weaker than other people and should be given more attention and care [10]. Home quarantine and social restrictions were among the things that were imposed by the governments in the early days of the pandemic and caused many elder people to be locked in their homes. In this regard, the results of many studies have shown that the loneliness of the elderly in the long term can cause the weakening of the immune system, the occurrence of psychological and physical disorders, and ultimately death [11].
In this study, it was found that the mental and physical health of people was affected during the COVID-19 pandemic and the overall quality of life of people decreased. A lot of research has been done in this field, which we will mention below. Meng et al., in their study in relation to the psychological impact of COVID-19 among the elderly population in China, showed that a total of 1556 samples were collected, of which 602 were men and 954 were women. The age of 706 cases was from 60 to 64 years, 336 cases from 65 to 69 years, 263 cases from 70 to 74 years, 115 cases from 75 to 79 years, and 136 cases were at least 80 years old. 37.1% of the elderly experienced depression and anxiety during the period of COVID-19, and women experienced this feeling more than men [12].
In Italy, research was conducted by Guida & Carpentieri and the results showed that elderly people living in remote cities received poor health services, which negatively affected their quality of life and mental health, and the rate of infection and mortality in these elderly people was higher than others [13]. In the United States, Hamm et al. emphasized the conclusion that the quality of life of the elderly is affected during the COVID-19 disease and that the elderly are prone to anxiety, depression, and self-harm. There was also a tile [14]. Rantanen et al. in Finland showed that the health and quality of life of the elderly were affected during the COVID-19 pandemic, and the quality of life of the elderly decreased during this period [15]. Ping et al. conducted a study in China during the COVID-19 pandemic on 1139 elderly people and concluded that elderly people and people with chronic diseases reported lower quality of life [16]. Due to the fact that the COVID-19 epidemic has affected the quality of life of people, especially the elderly, and has led to physical and mental injuries in the elderly [17, 18].
In the present study, it is concluded that the quality of life of women is lower in comparison with men. Female gender, older age, and admission to the intensive care unit were the most commonly reported factors associated with a low level of quality of life [19]. In addition, Lee et al. obtained a similar result [20]. According to the mentioned results, it seems that women probably have higher expectations than men for their well-being and quality of life. In the present study, there was a significant relationship between the components of quality of life (mental and physical condition), education level, employment status before retirement, and marital status. In this regard, Khorani et al.'s study showed that the level of education, marital status, place of residence, and economic status were the most important predictors of quality of life in the elderly during the COVID-19 pandemic [21]. Also, Duan et al. in a cross-sectional study conducted on 516 elderly with an average age of 67.6±6.6 showed that the quality of life of the elderly during the COVID-19 pandemic is significantly different in relation to education, marital status, economic status, living status, and employment status. The elderly have lower educational levels and should be prioritized in the implementation of interventions to improve their quality of life in the elderly [22]. Consistent with our study, one study regarding the quality of life of the elderly during the COVID-19 pandemic in six Asian countries showed that demographic factors including age, marital status, country of residency, type of health insurance, current employment status, frequency of meeting with family members, ability to pay household bills, and receiving social support during the COVID-19 pandemic are factors affecting the aspect physical and mental health are the quality of life [23]. Perhaps the reason for the existing discrepancies and differences in the variables affecting the quality of life in the results of various studies is due to the fact that the quality of life is a completely subjective concept and cannot be seen by others and refers to people's perception and experiences of different aspects of life. Therefore, people's perceptions of the quality of life may vary according to their region, culture, and expectations of life.
Like other studies conducted during the COVID-19 pandemic, this study had limitations, such as the lack of direct access to the samples and the questionnaire's online completion. therefore, health politicians are expected to plan and take appropriate measures in order to reduce the damage caused by the spread of COVID-19 during the outbreak of the disease and even after it in order to improve the quality of life of the elderly, both physical and mental dimensions. The results of this study can be used in possible future pandemics. It is suggested to examine the general health of the elderly along with the quality of life in future research. It is also suggested that elderly women should be given more attention in future studies.

Conclusion
The spread of COVID-19 affected the physical and mental health and overall quality of life of the elderly. The quality of life (physical and mental dimension) of elderlies during COVID-19 was low and the men’s situation was better than women’s.

Acknowledgments: We would like to thank our colleagues at the University's Research division and all the participants who, with their patience, helped the researchers in this study.
Ethical Permissions: The present study has the code of ethics No. IR.SKUMS.REC.1399.072 from Shahrekord University of Medical Sciences and also the details of the participants remained confidential and the data was analyzed and reported as a group.
Conflicts of Interests: There was no conflict of interest.
Authors’ Contributions: Lotfizadeh M (First Author), Introduction Writer/Methodologist/Discussion Writer/Statistical Analyst (25%); Habibi SH (Second Author), Methodologist/Discussion Writer (15%); Karimi Z (Third Author), Introduction Writer/Discussion Writer (15%); Davoodi Z (Fourth Author), Methodologist (10%); Rillera Marzo R (Fifth Author), Assistant Researcher (10%); Fatahian F (Sixth Author), Introduction Writer/Methodologist/Discussion Writer (25%)
Funding/Support: This research has been carried out as an approved research project with the support of the Vice Chancellor for Research and Technology of Shahrekord University of Medical Sciences from the Research Center for Social Determinants of Health. It did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
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Health Education and Health Promotion
Volume 11, Issue 5
Autumn 2023
Pages 749-753