Quality of life of older residents of the Grodno region: sex- and residence-specific aspects

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Background

All relevant classifications confirm that the Republic of Belarus’ population is aging. Population aging is expected to continue in the nearest future, given that average life expectancy is increasing. This is consistent with trends observed worldwide [1] and in neighboring countries, notably Russia, where individuals over 60 and 65 years accounted for 23.13% and 16.04%, respectively, in 2022.¹

The state policy of the Republic of Belarus currently prioritizes active aging and preventable mortality reduction,² which includes a set of measures implemented in the healthcare system.³ Several factors influence the perception of well-being in older individuals, including typical societal preconceptions, population demographics, and objective approaches to establishing working, older, and senile ages. An objective assessment using unified tools will enable finding opportunities and completely unlocking the potential for improved quality of life.

Aim

The work aimed to analyze sex- and residence-specific (urban vs rural) differences in quality of life, using the population of the Grodno Region aged 60 years and older as an example.

Methods

A survey was performed in 1270 individuals in outpatient and inpatient health facilities, as well as the Grodno Region Center of the Belarus Red Cross Society.

Prior to the survey, each respondent was informed of the terms of participation (anonymity, voluntary participation, and generic data assessment). Continuous data were collected between June 6, 2022, and November 27, 2023.

Exclusion criteria: refusal to participate or inability to participate for health reasons.

The survey included several domains, such as the World Health Organization Quality of Life—26 items (WHOQOL-26), health literacy assessment, and sociodemographic and behavioral domains.

The sample of individuals aged 60 years and older residing in the Grodno Region adequately represented the region, sex, and place of residence (urban/rural) [2].

The study protocol was reviewed and approved by the Scientific and Technical Council of Grodno State Medical University (Order of the Vice-Rector for Research No. 47-L (a/d) of December 21, 2022). The resulting database was registered as an object of copyright.⁴

WHOQOL-26 was used to assess sex- and residence-specific differences in quality of life, both by individual domains and the integral level⁵.

Four domains were assessed using the following formula:

$R=\left(D/max\right)\times 100\%$,

where R is the percentage of the maximum possible value, D is the value for the domain in points, and max is the maximum possible total score in points for the domain.

The calculated values for domains (%) were compared with the scale used in the questionnaire:

• 0%–20%: low level;
• 21%–40%: below average;
• 41%–60%: average;
• 61%–80%: above average;
• 81%–100%: high level.

Descriptive, parametric, and non-parametric statistics were used. Descriptive statistics are presented as Me (Q1; Q3), where Me is the median, and Q1 and Q3 are the first and third quartiles. Intergroup comparisons of numerical variables were performed using the non-parametric Mann–Whitney U test. Categorical variables are presented as absolute and relative frequencies (proportions) of categories in the groups, with 95% confidence intervals (CIs) for relative frequencies calculated using the Wilson method. Intergroup comparisons of distributions were performed using the Fisher’s exact test, followed by post-hoc pairwise comparisons of proportions using the Holm correction. Moreover, the chi-squared test (χ²), Wilcoxon test (W), and Friedman test were used. The significance level was set as p = 0.05.

Results

The integral quality of life level was 64.26 ± 0.52 (95% CI for the arithmetic mean), which corresponds to the level above average. There were no sex-specific differences: the 95% CI (for the arithmetic mean R) was 64.48% ± 0.9% in males and 64.13% ± 0.63% in females (р > 0.05).

In domain 1 (Physical and Psychological Well-Being), the 95% CI (for the arithmetic mean) was 21.5 ± 0.2, which corresponds to R1 (95% CI) = 61.52 ± 0.55, or above average. There were no sex-specific differences: the 95% CI (for the arithmetic mean R1) was 61.89% ± 0.94% in males and 61.31% ± 0.68% in females (р > 0.05). However, there were residence-specific differences: the 95% CI (for the arithmetic mean R1) was 62.05% ± 0.64% for urban residents and 60.47% ± 1.04% for rural residents (U = 162,059.0; p = 0.005; t = 2.55; p = 0.011; T = −2.72; p = 0.007).

In domain 2 (Self-Perception), the D2 value in points (95% CI for the arithmetic mean) was 19.3 ± 0.2 points, which corresponds to R2 = 64.23 ± 0.52, or above average. There were no sex-specific differences: the 95% CI (for the arithmetic mean R2) was 64% ± 0.88% in males and 64.35% ± 0.64% in females (р > 0.05). However, there were residence-specific differences: the 95% CI (for the arithmetic mean R1) was 64.89% ± 0.59% for urban residents and 62.91% ± 1% for rural residents (t = 3.33; p = 0.001; T = −3.20; p = 0.001; U = 159,218.5; p = 0.001).

In domain 3 (Microsocial Support), the D3 value in points (95% CI for the arithmetic mean) was 9.8 ± 0.1 points, which corresponds to R3 (95% CI) = 65.64 ± 0.81, or above average. There were no sex-specific differences: the 95% CI (for the arithmetic mean R3) was 66.17% ± 1.39% in males and 65.34% ± 1.0% in females (р > 0.05). Moreover, there were no residence-specific differences: the 95% CI (for the arithmetic mean R3) was 66.03% ± 0.98% for urban residents and 64.87% ± 1.46% for rural residents (р >0,05).

In domain 4 (Social Well-Being), the D4 value in points (95% CI for the arithmetic mean) was 26.5 ± 0.2 points, which corresponds to R4 (95% CI) = 66.2 ± 0.6, or above average (Table 1).

Table 1. Calculation of quality of life levels by domains and the integral level in the overall sample

There were no sex-specific differences: the 95% CI (for the arithmetic mean R4) was 66.5% ± 1.1% in males and 66% ± 0.8% in females (р > 0.05). However, there were significant residence-specific differences: the 95% CI (for the arithmetic mean R4) was 66.6% ± 0.7% for urban residents and 65.3% ± 1.1% for rural residents (t = 1.92; p = 0.055; T = −2.53; p = 0.012; U = 163,737.5; p = 0.011).

There were no sex-specific differences in the distribution of the integral quality of life level (R, %) (Table 2 and Fig. 1).

Table 2. Distribution of the integral quality of life level by respondents’ sex

Note. CI, confidence interval.

Fig. 1. Distribution of the Integral Quality of Life Level indicator in men and women. R% values within the following intervals: 0%–20%, low level (not reported by respondents); 21%–40%, below average; 41%–60%, average; 61%–80%, above average; 81%–100%, high level; Vertical axis, proportion of respondents with the corresponding quality of life level; horizontal axis, sex of respondents. QoL, quality of life.

The integral quality of life level (R, %) was significantly lower in rural residents (Table 3).

Table 3. Analysis of the integral quality of life level (R, %) depending on respondents’ place of residence

Note. CI, confidence interval.

A more detailed analysis revealed that the differences resulted from a larger proportion of rural residents with moderate levels, whereas high integral quality of life levels were more common in urban residents (Fig. 2 and Table 4).

Fig. 2. Distribution of the Integral Quality of Life Level indicator by respondents’ place of residence. R% values within the following intervals: 0%–20%, low level (not reported by respondents); 21%–40%, below average; 41%–60%, average; 61%–80%, above average; 81%–100%, high level. Vertical axis, proportion of respondents with the corresponding quality of life level; horizontal axis, place of residence (urban/rural). QoL, quality of life.

Table 4. Differences in quality of life of the Grodno Region’s older population based on urban versus rural residence

Note. CI, confidence interval.

Therefore, there are differences between urban and rural residents in the distribution of the quality of life level (p = 0.0005). Intergroup pairwise comparisons of categories show significant differences in proportions for Average (28.84% for urban residents vs 39.39% for rural residents) and Above Average (67.26% for urban residents vs 54.72% for rural residents) categories.

Discussion

The findings indicate that, in order to fulfill the labor and social potential of individuals aged 60 years and older, the most susceptible quality of life domains must be addressed. These include the Physical and Psychological Well-Being domain, as well as the Self-Perception domain for rural residents.

The Physical and Psychological Well-Being domain is directly associated with the satisfaction with health and the ability of older individuals to compensate for accumulated disorders under the given conditions. Notably, the measures taken in the healthcare system of the Republic of Belarus receive substantial government support.

Positive changes in the Self-Perception domain in individuals aged 60 years and older are achievable in a micro- and macrosocial environment that facilitates physical independence in older age. This includes fall prevention, availability of socially significant facilities to those with limited mobility, visual impairment, or hearing impairment, and measures that account for individual visual perceptions. Physical obstacles create psychological barriers, leading to negative self-perception, self-isolation, and stigmatization. Differences in infrastructure may explain lower self-perception scores as a quality of life component in rural residents.

In addition to government support, social partnerships also play a significant role. Notably, current marketing strategies in the Republic of Belarus are insufficiently focused on older customers, who, for example, value the size of smartphone buttons more than its functionality. However, customers aged 60 years and older remain capable (and often employable) for a long period of time; therefore, their potential must be in demand in an aging population.

We found no research assessing quality of life in older individuals in the Republic of Belarus. Moroz et al. (2020) used WHOQOL-26 for a survey in 500 residents of the Republic of Belarus aged 25 years and older (mean age: 59.4 years) who sought medical care. There were no sex-specific differences [3]. The integral quality of life level was 66.0% (95% CI: 65.3–66.7), which is consistent with our findings. Moroz et al. found that the Self-Perception, Microsocial Support, and Social Well-Being domains had the highest scores, whereas the Physical and Psychological Well-Being domain had the lowest. Our findings for the Physical and Psychological Well-Being domain (95% CI: 61.52 ± 0.55) were higher than those reported by Moroz et al. (55.3% in individuals aged 60–74 years to 57.5% in individuals aged 90 years and older). However, this domain was the most susceptible in our study, especially in rural residents. Our findings for the Self-Perception domain (95% CI: 64.23 ± 0.52) were comparable to those reported by Moroz et al. (66.5% in individuals aged 75–89 years to 65.2% in individuals aged 90 years and older), whereas the findings for the Microsocial Support and Social Well-Being domains (95% CI: 65.64 ± 0.81 and 66.2 ± 0.6, respectively) were somewhat lower. Overall, the findings for the four domains according to WHOQOL-26 were comparable to those reported by Moroz et al.

According to Russian research, differences in quality of life can be attributed to health behaviors. Urban residents generally seek medical care more actively, which is beneficial for their health and quality of life, given the association between self-perception of quality of life and satisfaction with health, which has been demonstrated in our study. Reshetnikov et al. (2022) presented a sociological profile of a typical healthcare user in the Moscow Region: a married woman with children aged 41–70 years, residing in a regional capital, who does not smoke and rarely consumes alcohol [4]. A typical patient profile indicates that this patient category tends to be more attentive to their health, because it is difficult not to seek medical care in this age, given the accumulated burden of diseases.

Another noteworthy hypothesis is the influence of occupation on quality of life and health behavior, including professional activities prior to retirement. For example, Prisyazhnaya et al. (2022) assessed quality of life of military retirees. The authors found that this category is socially and physically active and prioritizes a healthy lifestyle. Despite the fact that returning to civil society can be stressful, military retirees regard this social adaptation as “another combat mission.” By transforming challenges into a source of motivation, they successfully integrate into a new social setting and maintain employment [5]. This is undoubtedly a protective factor for health-related quality of life. Occupation likely influences self-management and may reduce risks.

Conclusion

When assessing quality of life in individuals aged 60 years and older, the highest scores were reported for the Microsocial Support and Social Well-Being domains. The integral quality of life level was 64.26 ± 0.52 (95% CI for the arithmetic mean), which corresponds to the level above average, regardless of sex.

However, lower integral quality of life levels in rural residents are concerning and require a detailed analysis of causes. Urban residents have a better self-perception of their quality of life. A detailed analysis by domains shows that the differences are mainly associated with the Physical and Psychological Well-Being and Self-Perception domains, and to a lesser extent with the Social Well-Being domain, whereas the Microsocial Support domain shows no differences between urban and rural residents.

Additional information

Author contributions: M.Yu. Surmach: conceptualization, formal analysis, writing—review & editing; P.L. Korneiko: investigation, writing—original draft preparation. All authors confirm that their authorship meets the international ICMJE criteria (all authors have made a significant contribution to the development of the concept, research and preparation of the article, read and approved the final version before publication).

Ethics approval: The study protocol was reviewed and approved by the Scientific and Technical Council of Grodno State Medical University (Order of the Vice-Rector for Research No. 47-Л (a/d) dated December 21, 2022). The resulting database was registered as an object of copyright.

Consent for publication: The survey was conducted on the basis of informed consent from the respondents.

Funding sources: Supported by the Belarusian Republican Foundation for Fundamental Research (grant G24U-007, May 2, 2024).

Disclosure of interests: The authors have no relationships, activities or interests for the last three years related with for-profit or not-for-profit third parties whose interests may be affected by the content of the article.

Statement of originality: In creating this work, the authors did not use previously published information (text, illustrations, data).

Data availability statement: The editorial policy regarding data sharing does not apply to this work, and no new data was collected or created.

Generative AI: Generative AI technologies were not used for this article creation.

Provenance and peer-review: This paper was submitted to the journal on an unsolicited basis and reviewed according to the usual procedure. Two external reviewers, a member of the editorial board, and the scientific editor of the publication participated in the review.

¹ Federal State Statistics Service. Population of Russia by sex and age as of January 1, 2022. Statistical bulletin. Moscow, 2021. Available at: https://web.archive.org/web/20220615061535/https://rosstat.gov.ru/folder/12781?print=1 Accessed on: December 5, 2024.

² On the National Strategy of the Republic of Belarus “Active Aging 2030.” Resolution of the Council of Ministers of the Republic of Belarus No. 693 of December 3, 2020. Available at: https://pravo.by/document/?guid=3871&p0=C22000693 Accessed on: December 5, 2024.

³ On Improving the Efficacy of the Healthcare System. Presidential Decree of the Republic of Belarus No. 89rp of June 2, 2023. Available at: https://pravo.by/novosti/obshchestvenno-politicheskie-i-v-oblasti-prava/2023/june/74394/ Accessed on: December 9, 2024.

⁴ M.Yu. Surmach, P.L. Korneyko. “Quality of Life and Health Literacy in Individuals Aged 60 Years and Older Residing in the Grodno Region: A Database”. Certificate of registration No. 6-BD of June 13, 2024. Grodno State Medical University, Grodno, 2024. Available at: http://search.ncip.by/depon/index.php?pref=2&lng=ru&page=3&target=1978 Accessed on: December 5, 2024.

⁵ WHO [Internet]. Russian_WHOQOL-BREF. Available at: https://www.who.int/tools/whoqol/whoqol-bref/docs/default-source/publishing-policies/whoqol-bref/russian-whoqol-bref Accessed on: May 30, 2024.

About the authors

Marina Yu. Surmach

Author for correspondence.
Email: marina_surmach@mail.ru
ORCID iD: 0000-0002-3653-8385
SPIN-code: 3697-5235

MD, Dr. Sci. (Medicine), Professor

Pavel L. Korneiko

Email: pavelkorneiko@gmail.com
ORCID iD: 0000-0001-8449-296X
SPIN-code: 2480-2402
Belarus, Grodno

References

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2. Fig. 1. Distribution of the Integral Quality of Life Level indicator in men and women. R% values within the following intervals: 0%–20%, low level (not reported by respondents); 21%–40%, below average; 41%–60%, average; 61%–80%, above average; 81%–100%, high level; Vertical axis, proportion of respondents with the corresponding quality of life level; horizontal axis, sex of respondents. QoL, quality of life.

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3. Fig. 2. Distribution of the Integral Quality of Life Level indicator by respondents’ place of residence. R% values within the following intervals: 0%–20%, low level (not reported by respondents); 21%–40%, below average; 41%–60%, average; 61%–80%, above average; 81%–100%, high level. Vertical axis, proportion of respondents with the corresponding quality of life level; horizontal axis, place of residence (urban/rural). QoL, quality of life.

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