ABSTRACT
This study was conducted from November, 2007 to May, 2008 to evaluate the health status of the elderly and correlated factors affecting their health. We collected data from 682 individuals 65 years or older (214 male) from greater Tashkent City in Uzbekistan. The study revealed that 75.4% of the respondents were aged <75 years and that 16.8% of them were not educated. About three-quarters of the respondents rated themselves as ‘healthy.’ The odds ratios (ORs) and 95% confidence intervals (CIs) were estimated through a logistic regression model to determine correlations of elderly health, and adjusted for age and sex. The elderly who had additional income were 2.6 times (95% CI=1.8–4.0) more likely to be healthy. Similarly, those <75 years old (OR=1.5, 95% CI=1.0–2.2), were able to do everyday duties (OR=6.0, 95% CI=3.8–9.3), and those who were married (OR=4.1, 95% CI=1.7–9.7) were also healthy. Conversely, males (OR=0.6, 95% CI=0.4–0.9) and the elderly who were supported by sources other than their own income from work were not healthy. We concluded that having a strong family relationship and adhering to a traditional lifestyle are important for protecting elderly health in Uzbekistan. Substantial financial support and personal care are necessary for the elderly. Creating a healthy atmosphere for them at an individual and family level could ensure a better quality life for the elderly in Uzbekistan.
Key Words: Elderly, Elderly health, Correlations, Uzbekistan
INTRODUCTION
Decreases in infant mortality and fertility combined with an increasing life expectancy have led a large number of countries to have a growing proportion of aged individuals with specific healthcare needs.1) As the prevalence of most chronic diseases is high in old age, societies need changes in their healthcare systems capable of coping with the growing concerns of elderly health. Population aging is caused primarily by decline in fertility, and is thus associated with a decline in family size and a rise in the number of the elderly in relation to the younger population. This increases pressure on children, who are a major source of support for the elderly.2)
Uzbekistan is the most populated country in Central Asia. Since the 1970s, its population has more than doubled. The most recent estimates put the total population at 27 million,3) and the share of the population aged 0–14 decreased from 45% of the total population in 1970 to 33.2% in 2005.4) The share of the population aged over 65 years had reached 4.7% in 2005 in Uzbekistan,5) and pressures on the healthcare system from an aging population (which also arise in many countries of Western Europe) are not yet apparent. However, if the elderly population continues to increase as expected, Uzbekistan could be faced with this problem in the near future. It also signals the upcoming pressures on the Uzbek healthcare system that has already emerged as a threat to many Western countries and Japan.5)
In many developing countries and countries with economies in transition, the ageing population is a stringent problem.6) Older persons often are left behind without traditional family support and even without adequate financial resources. Elderly women are particularly vulnerable economically, especially when their role is restricted to non-remunerated work for family upkeep and they are dependent on others for their support and survival.7) Even older persons in developed countries and countries with economies in transition lack basic services and have insufficient economic and community resources.6) In most situations, a large number of persons reaches old age with minimal literacy, which limits their capacity to earn a livelihood and may thus influence their enjoyment of health and well-being.2) But significant differences exist between developed and developing countries in terms of the kinds of households in which older persons live. In developing countries, a large proportion of older persons live in multigenerational households.2) On the other hand, there has been a significant rise in the proportion of elderly living alone in industrialized countries.5)
Until now, strong family relationships and adherence to a traditional lifestyle have been preserved in Uzbekistan, where the idea of elderly people living separated from the family is inconceivable. Parents in declining years usually live with their children and are taken care of by them. This is usually with one of the sons and his family.8) Traditionally, families have provided financial, physical, and psychological support to their parents in the same household. Substantial financial support is necessary for older people, and when they become frail, personal care is also essential.9)
Self-rated health is easily measured in population surveys, and is a useful “opener” in interview situations that allows interviewers to seek more nuanced and complex responses about people’s perceptions of their health.10) Also, self-rated health can be useful for socio-epidemiological studies.11) Despite being a subjective measure of health, self-rated health has shown itself to be a valid indicator, being a good predictor of mortality,12) morbidity, and disability.13) Furthermore, it has good test-retest reliability.14)
Although there has been much international research dedicated to the problem of care for the elderly by family caregivers,15-17) few researchers have examined the correlates affecting self-rated health in the older population, and self-rated health has, to our knowledge, hitherto not been examined. Therefore, our study was aimed at exploring possible obstacles and related factors which are a hindrance to healthy living for the elderly in Uzbekistan, and also to find associations between those related factors and self-rated health status.
MATERIALS AND METHODS
A cross-sectional study was conducted to collect data from 682 elderly persons aged 65 years or older (214 males, 486 females). Data were collected by face-to-face interviews from respondents of two regions (Tashkent City, Tashkent Region) in Uzbekistan from November, 2007 to May, 2008, using structured questionnaires. Households were selected from these two regions through a simple random sampling from the list of eligible households, provided by the local government office. Extremely frail elderly who were unable to respond to the interview were excluded. Although our target sample was 728, we could interview only 682, with a response rate of 93.7%. Some of the respondents were absent, some were sick, and a few were reluctant to participate. The questionnaire included items on socio-demographic factors (age, gender, place of residence, ethnicity, religion), socioeconomic factors (education level, marital status, personal income, and family support), and self-assessment of their health status. The questionnaire was developed and pre-tested among elderly volunteers before actual data collection. Before data collection, written informed consent was obtained from all the respondents after explaining the study to them in detail.
Health indicators
Self-rated health was used to measure health status in this study. The question asking respondents to rate their own health was phrased as follows: “How would you rate your health today?” Respondents were given five options: very good, good, satisfactory, bad, and very bad, to rate their health on the day of the interview. We subsequently regrouped their answers into either healthy (ratings of “very good,” “good” and “satisfactory”) or not healthy (ratings of “bad” and “very bad”).
Socio-demographic factors
The following socio-demographic factors were studied for possible associations with self-rated health: age groups (<75 years, 75 years and over), gender (male, female), marital status (married, not married, divorced, widowed) and place of residence (urban, rural). We determined the association of each socio-demographic factor with self-rated health status.
Socio-economic factors
The following socio-economic factors were studied for possible associations with self-rated health: education (in 6 groups: not educated, primary, low secondary, secondary, vocational education, and higher), occupation (in 3 groups: still working, jobless, and retired), kind of job (in 4 groups: state employee, family business, private firms, and jobless) and monetary support (in 7 groups: work, pension, savings, son’s support, daughter’s support, relative’s support, and others). Family support also was examined by means of item questions “who takes care of you when you are ill?” “who accompanies you to the doctor?” and “who pays for your treatment?” (in 6 groups: self, spouse, son, daughter, daughter-in-law, and others). We determined the association of each socio-economic indicator with self-rated health.
Statistical analysis
Descriptive statistics like the frequency (percentage) for categorical data and the mean (±standard deviation, SD) for continuous data were used where appropriate. The association between the correlating factors and self-rated health status were examined by calculating odds ratio (OR) and 95% confidence interval (CI) using a logistic regression model. The OR was adjusted for age and sex.
Data were analyzed using the Statistical Package for the Social Science® (SPSS) for Windows, version 15.0 software (SPSS Inc., Ill., USA).
RESULTS
Table 1 shows the background characteristics of the elderly. The average age of the respondents was 71.0 years, 75.4% of which were in the age group of <75 years, and 68.6% of total respondents were female. More than half of respondents were living in urban areas and 72.4% were married.
Table 1.
Background characteristics of respondents
| Characteristics | Male | Female | Total | |||
|---|---|---|---|---|---|---|
| N (%) | N (%) | N (%) | ||||
| Total | 214 (31.4) | 468 (68.6) | 682 (100.0) | |||
| Age groups (years) | ||||||
| <75 ≥75 |
168 (78.5) 46 (21.5) |
346 (73.9) 122 (26.1) |
514 (75.4) 168 (24.6) |
|||
| Mean=71.0 SD=5.1 Minimum=65.0 Maximum=87.0 | ||||||
| Residence | ||||||
| Urban Rural |
158 (73.8) 56 (26.2) |
279 (59.6) 189 (40.4) |
437 (64.1) 245 (35.9) |
|||
| Region | ||||||
| Tashkent City Tashkent Region |
98 (45.8) 116 (54.2) |
212 (45.3) 256 (54.7) |
310 (45.5) 372 (54.5) |
|||
| Education | ||||||
| Not educated Primary Low secondary Secondary Vocational education Higher |
44 (20.6) 37 (17.3) 70 (32.7) 35 (16.4) 18 (8.4) 10 (4.7) |
71 (15.2) 134 (28.7) 122 (26.1) 103 (22.0) 21 (4.5) 17 (3.6) |
115 (16.8) 171 (25.1) 192 (28.2) 138 (20.2) 39 (5.7) 27 (4.0) |
|||
| Marital status | ||||||
| Married Not married Divorced Widowed |
152 (71.0) 8 (3.7) 21 (9.8) 33 (15.5) |
342 (73.1) 15 (3.2) 34 (7.3) 77 (16.4) |
494 (72.4) 23 (3.4) 55 (8.1) 110 (16.1) |
|||
| Self-rated health status | ||||||
| Very good Good Satisfactory Bad Very bad |
13 (6.1) 51 (23.8) 87 (40.7) 45 (21.0) 18 (8.4) |
8 (1.7) 172 (36.8) 193 (41.2) 90 (19.2) 5 (1.1) |
21 (3.1) 223 (32.7) 280 (41.1) 135 (19.8) 23 (3.4) |
|||
| Overall health statusa | ||||||
| Healthy Not healthy |
151 (70.6) 63 (29.4) |
373 (79.7) 95 (20.3) |
524 (76.8) 158 (23.2) |
|||
a Overall health status constitutes combination of satisfactory, good, and very good health in ‘Healthy,’ and bad and very bad health in ‘Not healthy’ group.
People who could write and read Uzbek characters were considered as educated. Accordingly, 83.2% were educated, most of whom were between the primary and secondary level of education (about 73.5%); however, 16.8% of them were not educated. The percentage of elderly persons who belonged to the higher education groups was smaller than that of those who belonged to the lower groups. Among the 682 interviewees that self-rated their health, 3.1% evaluated their health as “very good,” 32.7% as “good,” 41.1% as “satisfactory,” 19.8% as “bad” and 3.4% evaluated their health as “very bad.”
Table 2 describes the association of self-rated health (healthy or not healthy) of the respondents with different related factors e.g., age, sex, marital status, place of residence, education, job status, kind of job, source of monetary support, additional earnings, activity (can still work or not), and family support. The results showed that male respondents were not satisfied with their health status (OR=0.6, 95% CI=0.4–0.9). Similar low OR was found among urban respondents (OR=0.8, 95% CI=0.5–1.1), and state employees (OR=0.6, 95% CI=0.1–3.3). Those who had additional earnings were three times more likely to have a “feel good” health status (OR=2.6, 95% CI=1.8–4.0) compared with their counterparts. Self-rated health status was significantly different between subjects who were able to do everyday duties and those who could not (OR=6.0, 95% CI=3.8–9.3): i.e., those who were able to do every day duties were six times more likely to feel healthy. Associations between self-rated health and family support (to be accompanied, to be taken care of, to have treatment paid for) showed that in most cases, those who were accompanied by somebody, were taken care of by family and had their treatment paid for by family members more likely to be in good health conditions.
Table 2.
Associations of related factors with self-rated health of respondents
| Characteristics | Healthy | Not healthy | ORa | 95% CIb | p value | |
|---|---|---|---|---|---|---|
| N (%) | N (%) | |||||
| Age group (years) | ||||||
| ≥75 <75 |
120 (71.4) 404 (78.6) |
48 (28.6) 110 (21.4) |
1 1.5 |
Ref 1.0–2.2 |
0.056 | |
| Sex | ||||||
| Female Male |
373 (79.7) 151 (70.6) |
95 (20.3) 63 (29.4) |
1 0.6 |
Ref 0.4–0.9 |
0.009 | |
| Marital status | ||||||
| Married Single |
382 (77.3) 142 (75.5) |
112 (22.7) 46 (24.5) |
1 1.1 |
Ref 0.8–1.7 |
0.619 | |
| Place of residence | ||||||
| Rural Urban |
195 (79.6) 329 (75.3) |
50 (20.4) 108 (24.7) |
1 0.8 |
Ref 0.5–1.1 |
0.201 | |
| Educational level | ||||||
| Educated Not educated |
438 (77.2) 86 (74.8) |
129 (22.8) 29 (25.2) |
1 0.9 |
Ref 0.5–1.3 |
0.570 | |
| Job status | ||||||
| Retired Still working |
457 (75.0) 67 (91.8) |
152 (25.0) 6 (8.2) |
1 3.7 |
Ref 1.5–8.7 |
0.001 | |
| Kind of job | ||||||
| State employee Others |
4 (66.7) 520 (76.9) |
2 (33.3) 156 (23.1) |
1 0.6 |
Ref 0.1–3.3 |
0.553 | |
| Monetary support | ||||||
| Others Self |
148 (75.1) 376 (77.5) |
49 (24.9) 109 (22.5) |
1 1.1 |
Ref 0.7–1.6 |
0.501 | |
| Additional earnings | ||||||
| No Yes |
300 (70.9) 224 (86.5) |
123 (29.1) 35 (13.5) |
1 2.6 |
Ref 1.8–4.0 |
<0.001 | |
| Ability to perform everyday duties | ||||||
| No Yes |
45 (44.1) 479 (82.6) |
57 (55.9) 101 (17.4) |
1 6.0 |
Ref 3.8–9.3 |
<0.001 | |
| Can you still work? | ||||||
| No Yes |
409 (75.9) 115 (80.4) |
130 (24.1) 28 (19.6) |
1 1.3 |
Ref 0.8–2.0 |
0.253 | |
| Who accompanies you to the doctor? | ||||||
| Others Self |
347 (78.2) 177 (74.4) |
97 (21.8) 61 (25.6) |
1 0.8 |
Ref 0.5–1.1 |
0.264 | |
| Care provider | ||||||
| Others Self |
500 (77.5) 24 (64.9) |
145 (22.5) 13 (35.1) |
1 0.5 |
Ref 0.2–1.1 |
0.076 | |
| Treatment payer | ||||||
| Others Self |
453 (78.5) 71 (67.6) |
124 (21.5) 34 (32.4) |
1 0.6 |
Ref 0.4–1.0 |
0.015 | |
a OR: Odds ratio; ORs were adjusted for sex in age group, for age in sex group, and both for age and sex in other variables. b CI: Confidence interval.
Logistic regression analysis with self-rated health as a dependent variable was performed. Table 3 shows the results of age and sex-adjusted associations between the health status of respondents and some related factors, such as marital status, kind of job, job satisfaction, source of monetary support, and family support in case of illness. The results indicate that marital status had a significant impact on the self-rated health status of the elderly, and the possibility of good self-rated health was higher in those who were married (OR=4.1, 95% CI=1.8–9.7). In the analysis of the source of monetary support, results showed that those who were supported by pension, a son, or relatives were not healthy (OR ranges from 0.5–0.7).
Table 3.
Results of binary logistic regression to explore association between health status of respondents and related factors
| Characteristics | Healthy | Not healthy | ORa | 95% CIb | p value | |
|---|---|---|---|---|---|---|
| N (%) | N (%) | |||||
| Marital status | ||||||
| Never Married | 11 (2.1) | 12 (7.6) | 1 | Ref | ||
| Married | 382 (72.9) | 112 (70.9) | 4.1 | 1.7–9.7 | 0.001 | |
| Divorced | 44 (8.4) | 11 (7.0) | 4.4 | 1.5–12.7 | 0.007 | |
| Widowed | 87 (16.6) | 23 (14.6) | 4.7 | 1.7–12.2 | 0.006 | |
| Kind of job | ||||||
| State employee | 9 (1.7) | 5 (3.2) | 1 | Ref | ||
| Family business | 17 (3.2) | 4 (2.5) | 2.0 | 0.4–9.8 | 0.373 | |
| Private firms | 32 (6.1) | 6 (3.8) | 3.0 | 0.7–12.1 | 0.134 | |
| Jobless | 466 (88.9) | 143 (90.5) | 1.8 | 0.6–5.6 | 0.307 | |
| Do you like your job? | ||||||
| Yes | 40 (7.6) | 14 (8.9) | 1 | Ref | ||
| No | 18 (3.4) | 1 (0.6) | 5.5 | 0.7–45.3 | 0.113 | |
| Jobless | 466 (88.9) | 143 (90.5) | 1.2 | 0.6–2.2 | 0.676 | |
| Source of monetary support | ||||||
| Work | 25 (4.8) | 4 (2.5) | 1 | Ref | ||
| Pension | 346 (66.0) | 104 (65.8) | 0.6 | 0.2–1.7 | 0.299 | |
| Savings | 5 (1.0) | 1 (16.7) | 1.0 | 0.9–11.2 | 0.996 | |
| Son’s support | 113 (21.6) | 40 (25.3) | 0.5 | 0.2–1.6 | 0.234 | |
| Daughter’s support | 25 (4.8) | 5 (3.2) | 1.0 | 0.2–4.1 | 0.967 | |
| Relative’s support | 6 (1.1) | 2 (1.3) | 0.7 | 0.1–4.8 | 0.693 | |
| Others | 4 (0.8) | 2 (1.3) | 0.3 | 0.1–2.5 | 0.288 | |
| Who will care for you in case of illness? | ||||||
| Self | 49 (9.4) | 16 (10.1) | 1 | Ref | ||
| Spouse | 105 (20.0) | 33 (20.9) | 1.2 | 0.6–2.3 | 0.677 | |
| Son | 48 (9.2) | 15 (9.5) | 1.2 | 0.5–2.6 | 0.716 | |
| Daughter | 155 (29.6) | 43 (27.2) | 1.1 | 0.6–2.2 | 0.732 | |
| Daughter-in-law | 133 (25.4) | 48 (30.4) | 0.9 | 0.4–1.7 | 0.632 | |
| Others | 34 (6.5) | 3 (1.9) | 3.5 | 0.7–16.8 | 0.116 |
a OR: Odds ratio; ORs were adjusted for age and sex. b CI: Confidence interval.
Table 4 shows associations of related factors with the self-rated health of the respondents by age. In the age group under 75, those who were still working were 2.6 times more likely to be healthy (OR=2.6, 95% CI=1.1–6.3). Of the elderly aged 75 or older, those with additional earnings were six times more likely to feel in good health compared with those without such earnings. These results demonstrate that additional income had a significant impact on self-rated health status of the older elderly (OR=6.5, 95% CI=2.7–15.6). Also, self-rated health status was significantly different between those who were able to do every day duties and those who could not, in the group of the elderly under 75 (OR=9.8, 95% CI=5.6–16.6).
Table 4.
Associations of related factors with self-rated health of respondents by age
| Characteristics | Age group (< 75 years) | Age group (≥ 75 years) | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| Healthy | Not healthy | ORa | 95% CIb | p value | Healthy | Not healthy | OR | 95% CI | p value | ||
| Frequency (%) |
Frequency (%) |
Frequency (%) |
Frequency (%) |
||||||||
| Sex | |||||||||||
| Female | 282 (81.5%) | 64 (18.5%) | 1 | Ref | 91 (74.6%) | 31 (25.4%) | 1 | Ref | |||
| Male | 122 (72.6%) | 46 (27.4%) | 0.6 | 0.4–0.9 | 0.021 | 29 (63.0%) | 17 (37.0%) | 0.6 | 0.3–1.2 | 0.140 | |
| Marital status | |||||||||||
| Married | 286 (79.2%) | 75 (20.8%) | 1 | Ref | 96 (72.2%) | 37 (27.8%) | 1 | Ref | |||
| Single | 118 (77.1%) | 35 (22.9%) | 1.1 | 0.7–1.8 | 0.596 | 24 (68.6%) | 11 (31.4%) | 1.2 | 0.5–2.7 | 0.674 | |
| Residence | |||||||||||
| Rural | 131 (81.9%) | 29 (18.1%) | 1 | Ref | 64 (75.3%) | 21 (24.7%) | 1 | Ref | |||
| Urban | 273 (77.1%) | 81 (22.9%) | 0.7 | 0.5–1.2 | 0.223 | 56 (67.5%) | 27 (32.5%) | 0.7 | 0.3–1.3 | 0.262 | |
| Educational level | |||||||||||
| Educated | 369 (79.0%) | 98 (21.0%) | 1 | Ref | 69 (69.0%) | 31 (31.0%) | 1 | Ref | |||
| Uneducated | 35 (74.5%) | 12 (25.5%) | 0.8 | 0.4–1.5 | 0.469 | 51 (75.0%) | 17 (25.0%) | 1.3 | 0.7–2.7 | 0.398 | |
| Job status | |||||||||||
| Others | 351 (77.1%) | 104 (22.9%) | 1 | Ref | 106 (68.8%) | 48 (31.2%) | 1 | Ref | |||
| Still working | 53 (89.8%) | 6 (10.2%) | 2.6 | 1.1–6.3 | 0.025 | 14 (100%) | NCd | NC | NC | 0.013 | |
| Kind of job | |||||||||||
| Others | 400 (78.7%) | 108 (21.3%) | 1 | Ref | |||||||
| State employee | 4 (66.7%) | 2 (33.3%) | 0.5 | 0.1–3.0 | 0.473 | NAc | NA | NA | NA | NA | |
| Monetary support | |||||||||||
| Others | 107 (76.4%) | 33 (23.6%) | 1 | Ref | 41 (71.9%) | 16 (28.1%) | 1 | Ref | |||
| Self | 297 (79.4%) | 77 (20.6%) | 1.2 | 0.7–1.9 | 0.463 | 79 (71.2%) | 32 (28.8%) | 1.0 | 0.5–2.0 | 0.918 | |
| Additional earnings | |||||||||||
| No | 243 (74.8%) | 82 (25.2%) | 1 | Ref | 63 (90.0%) | 7 (10.0%) | 1 | Ref | |||
| Yes | 161 (85.2%) | 28 (14.8%) | 1.9 | 1.2–3.1 | 0.005 | 57 (58.2%) | 41 (41.8%) | 6.5 | 2.7–15.6 | <0.001 | |
| Ability to perform | |||||||||||
| everyday tasks | |||||||||||
| No | 28 (37.8%) | 46 (62.2%) | 1 | Ref | 37 (26.4%) | 11 (22.9%) | 1 | Ref | |||
| Yes | 376 (85.5%) | 64 (14.5%) | 9.8 | 5.6–16.6 | 0.000 | 103 (73.6%) | 17 (60.7%) | 1.8 | 0.8–4.2 | 0.169 | |
| Can you still work? | |||||||||||
| No | 290 (78.0%) | 82 (22.0%) | 1 | Ref | 119 (71.3%) | 48 (28.7%) | 1 | Ref | |||
| Yes | 114 (80.3%) | 28 (19.7%) | 1.2 | 0.7–1.9 | 0.566 | 1 (100.0%) | 0 (0.0%) | NC | NC | 0.526 | |
| Who accompanies you to the doctor? | |||||||||||
| Others | 250 (80.4%) | 61 (19.6%) | 1 | Ref | 97 (72.9%) | 36 (27.1%) | 1 | Ref | |||
| Self | 154 (75.9%) | 49 (24.1%) | 0.8 | 0.5–1.2 | 0.222 | 23 (65.7%) | 12 (34.3%) | 0.7 | 0.3–1.6 | 0.400 | |
| Care provider | |||||||||||
| Others | 384 (79.5%) | 99 (20.5%) | 1 | Ref | 116 (71.6%) | 46 (28.4%) | 1 | Ref | |||
| Self | 20 (64.5%) | 11 (35.5%) | 0.5 | 0.2–1.0 | 0.049 | 4 (66.7%) | 2 (33.3%) | 0.8 | 0.1–4.5 | 0.793 | |
| Treatment payer | |||||||||||
| Others | 343 (80.9%) | 81 (19.1%) | 1 | Ref | 110 (71.9%) | 43 (28.1%) | 1 | Ref | |||
| Self | 61 (67.8%) | 29 (32.2%) | 0.5 | 0.3–0.8 | 0.006 | 10 (66.7%) | 5 (33.3%) | 0.8 | 0.3–2.4 | 0.669 | |
a OR: Odds ratio. b CI: Confidence interval. c NA: Not applicable. d NC: Not calculable.
Table 5 demonstrates associations of related factors with the self-rated health of respondents by sex. In both groups, all the factors listed had significant influences on self-rated health status. Also, male respondents who still work were almost two times (OR=6.3, 95% CI=0.8–49.2) more satisfied with their self-rated health status than were females (OR=3.0, 95% CI=1.2–7.7). Similar high OR was found for males who had additional earnings (OR=3.8, 95% CI=2.0–7.6) and who were able to perform every day duties (OR=6.0, 95% CI=3.0–11.9) in comparison with females overall.
Table 5.
Associations of related factors with self-rated health of respondents by sex
| Characteristics | Male | Female | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| Healthy | Not healthy | ORa | 95% CIb | p value | Healthy | Not healthy | OR | 95% CI | p value | ||
| Frequency (%) |
Frequency (%) |
Frequency (%) |
Frequency (%) |
||||||||
| Job status | |||||||||||
| Others | 14 (93.3%) | 1 (6.7%) | 1 | Ref | 53 (91.4%) | 5 (8.6%) | 1 | Ref | |||
| Still working | 137 (68.8%) | 62 (31.2%) | 6.3 | 0.8–49.2 | 0.045 | 320 (78.0%) | 90 (22.0%) | 3.0 | 1.2–7.7 | 0.018 | |
| Additional earnings | |||||||||||
| No | 75 (85.2%) | 13 (14.8%) | 1 | Ref | 149 (87.1%) | 22 (12.9%) | 1 | Ref | |||
| Yes | 76 (60.3%) | 50 (39.7%) | 3.8 | 2.0–7.6 | <0.001 | 224 (75.4%) | 73 (24.6%) | 2.2 | 1.4–4.0 | 0.002 | |
| Ability to perform everyday tasks | |||||||||||
| No | 133 (79.2%) | 35 (20.8%) | 1 | Ref | 346 (84.0%) | 66 (16.0%) | 1 | Ref | |||
| Yes | 18 (39.1%) | 28 (60.9%) | 6.0 | 3.0–11.9 | <0.001 | 27 (48.2%) | 29 (51.8%) | 5.6 | 3.1–10.1 | <0.001 | |
a OR: Odds ratio. b CI: Confidence interval.
The elderly retired for various reasons. Considering that stresses arising from the job environment greatly influence physical well-being and the psychological status of people, we analyzed reasons for their work cessation under such stresses. The results showed that out of 609 working people 70.8% retired because they had reached pension age, 10.0% because of health problems, and 3.1% because of other (domestic) reasons. Only 1.6% of the elderly expressed that they retired because they did not need the job any more (data not shown).
Family support is considered one of the important issues for healthy living of the elderly: parents’ treatment was paid for by their sons in 46.5% of cases and by a daughter-in-law in 8.1% of cases. Only 15.4% of the elderly paid for their treatment by themselves (data not shown).
DISCUSSION
About a quarter of the elderly population in this study rated their health status as bad or very bad. This result is in agreement with findings reported in some European and Asian countries and North America. A similar study conducted in Shanghai reported that 50.6% of respondents rated their health in the lower two categories of a four category scale.18) Another study19) found that 16% of the adult population in Rotterdam viewed their health as not very healthy or not healthy at all (the lowest two of five categories), and Zack et al.20) reported that 15.5% of adult Americans rated their health as fair or poor (the lowest two of five ordinal categories) in 2001. However, another study in Singapore indicated that 98.5% of Singaporeans rated their health as very good, good, or moderate, with only 1.5% reporting bad or very bad health.10) This reflects the overall health situation of their country. An average Singaporean might feel healthier than an average American. Moreover, differences in methodology of the survey, such as the kinds of rating scales used, the method involved in eliciting a response, and the way in which questions were phrased, might in part explain the differences observed. The results suggest that older adults in Uzbekistan do not necessarily appear more negative in their ratings of their health compared with those in other countries.
Age is shown to be a very important and relevant factor in evaluating one’s health status. With increasing age, non-communicable diseases like diabetes and hypertension tend to rise. Sometimes fatal consequences arise from these diseases in the form of heart disease, kidney disease, and paralyses that cripple the life of the elderly. Given that the majority of these illnesses are more prevalent among the elderly, self-rated health usually worsens with advanced age.20-22) In addition, results of our study might reflect poor self-evaluation of the health status which declines with age.
Disparities between the sexes are well documented in the international literature.23,24) As was found in the present study, females, more than males, generally evaluated their own state of health as good. The principal explanation given for this poor self-perception of male health status can be related to the distinct nature of Uzbek adult life, including the fact that males participate in the paid work market most of the time. Males in Uzbek culture are the breadwinners of the whole house, which involves many work-related stresses. Our findings are also in agreement with similar results obtained from a study in Estonia which reported that women had higher ratings for health.24) However, in some countries, such as Pakistan and Finland, females were more likely to report poor self-rated health than men.25,26) This inconsistency may arise from differences in the culture and customs of those countries.
Among indicators of socioeconomic level, education probably has been used the most, since it is a stable attribute in adult life, in contrast to occupational and income statuses, which can vary with time.22) As expected, the results showed that a large percentage of the elderly belonged to the lowest education level. The current Uzbek older generation had fewer opportunities to receive a formal education, because their childhood and youth were during World War II and postwar devastation. American national statistics show that about 20% of the population aged 65 and older graduated from college.27) 6.8% of Korean older adults were college graduates,28) whereas in our study only 5.7% of elderly Uzbeks were. Education has a direct influence on the individual’s attitude toward his/her health. Educated people are more health conscious, make more effective use of preventive measures, are more likely to practice a healthy life style and are quick to notice disease, and are more able to give themselves first aid and to seek quality health care services.29) Against our expectation that education does have some value as an essential socioeconomic predictor of health in an ageing society, we did not find any significant impact of education status on the health status of the elderly. This may be because very few elderly (only 4%) received higher education, and most of them were below secondary level of education.
We found that those having some type of job expressed better health status. It was also found that those who were still capable of working felt six-times healthier than those who were not. This implies that having a job is important not only for earning money, but also for living a healthy life. Szwarcwald et al. discussed that in relation to the other socioeconomic determinants of self-evaluation of health, work status plays an important role as well as material assets, particularly for males. For males, paid work is essential for social well-being. For females, quality of life does not depend on work alone, but also on the support of a companion or family providing necessities for material comfort.20) Although strenuous work is not appropriate for the health of the elderly, a provision of light and entertaining work can strengthen their morale in the sense that they feel themselves important members of society, not as a redundant or as a burden.
Elderly people usually depend on pensions as a source of income. Of those who need additional monetary support from others, most of their additional financial help comes from their sons. In Uzbek culture, men earn much more than women, and women are usually employed in a lower paying job in addition to their normal household chores.30) Support from the son is usually most common after beginning to receive a pension, and although support from sons is usually inadequate, most of the elderly were happy with support from their daughters. Similar situations exist in some other countries with similar family structures. The findings of Dalstra et al. corroborated our study data; they mentioned that after retirement, elderly people do not gain income by paid work, but only rely on pensions and some other sources.31) If income is decreased after retirement,32) it increases the risk of poor health.11) Hence, income source can be used as a predictor of health among the elderly. Soong-Nang Jang et al., in their study of people aged 65 or older,28) discussed the importance of personal income, which plays an important role in successful ageing. They also found that those with a higher socio-economical status were more likely to age with few health problems.
Many international studies have addressed the problem of care for the elderly by family caregivers.15-17) Some studies have documented the differences in caregivers between sons and daughters. In Japan, the eldest son is gradually becoming more common as an informal caregiver, accounting for 25% of actual child caregivers in 2004 compared to 20% in 2001. Most informal care is provided by daughters: 41% by daughters-in-law and 34% by daughters, compared to 25% by sons and 1% by sons-in-law among all child caregivers.33) Also, Brodsky et al. found that children are a major source of support to the elderly.2)
Informal care by adult children is still one of the characteristic sources of caregiving for elderly parents, because the family in Uzbekistan continues to play its traditional unifying role of taking care of elderly people. In our study, the majority of the caregivers were women; daughters and daughters-in-law. The elderly usually receive necessary support at home from their family members. This kind of support is apparently related to customs and traditions of the community in which they belong.
Our study design is cross-sectional in nature and it is hence difficult to establish cause-effect relationships between self-rated health and various socio-economic factors. A longitudinal study is needed to ascertain these relationships in the future. This study, however, sampled a representative cross-section of Uzbek society. Other limitations were that our sampling took into account only non-institutionalized individuals, and excluded frail elderly persons unable to be interviewed, and persons living in long-term nursing homes and hospitals because of chronic illness. Such a design may bias measurement of self-rated health towards the positive end. We consider that the same relationship between poor self-rated health and increased mortality observed worldwide is present in Uzbekistan, and that this relationship should be confirmed. Unfortunately, we were unable to extend our study to track the mortality rate of our study population. We were also unable to take serial measurements of self-rated health, which may confer more information than a single point measurement as we have done.
In conclusion, job status, additional earnings, and the ability to perform everyday duties were significantly associated with self-rated health status. A strong family relationship and adherence to a traditional lifestyle are still preserved in Uzbekistan. Substantial financial support is necessary for older people, and personal care is also essential. Thus, creating a healthful atmosphere for the elderly with provisions of a necessary support system at the individual and family level can prepare the Uzbek community to face upcoming challenges with elderly health-related issues in Uzbekistan. The findings of the present study can help in this process by highlighting the most important areas to protect elderly health and to promote quality of life for the elderly.
ACKNOWLEDGMENTS
The authors express their sincere gratitude to the staff of the Young Leaders’ Program, Graduate School of Medicine Nagoya University, Japan. This work was supported in part by a non-profit organization “Epidemiological and Clinical Research Information Network (ECRIN).” We would also like to thank the Alfressa Foundation for their generous financial support as CSR. Cordial thanks to Professor Adham Ikramov, Minister for Health of Uzbekistan. Our special thanks to Dr. Bahodir Yusupaliev, Head specialist for Department of Health care, social matters and education of the Cabinet Ministers, for his valuable advice and suggestions. Our warm thanks also go to Drs Tura Ahmedov, Head for Health care Department of Tashkent region, Uzbekistan. We are also indebted to all of the respondents from the studied areas for their kind responses during data collection.
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