Challenges in Nursing Education and Research
© 2020 by Taylor & Francis Group, London, ISBN 978-1-003-04397-3
QUALITY OF LIFE IN ELDERLY WITH RHEUMATOID
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With the increasing number of elderly people, various chronic diseases emerge in the elderly. One of them is rheumatoid arthritis. Rheumatoid arthritis sufferers worldwide reached 355 million in 2009, meaning that 1 in 6 people in the world suffer from rheumatoid arthritis. Rheumatoid arthritis has developed and attacks 2.5 million Europeans. World Health Organization (WHO) reports that 20% of the world’s population suffers from rheumatoid arthritis, of which 5–10% are over 60 years of age (Chintyawati, 2013).
The prevalence of rheumatoid arthritis in 2004 in Indonesia reached 2 million, with the number of women sufferers tripling more than men. Rheumatoid arthritis sufferers in Indonesia in 2011 estimated the prevalence to reach 29.35%, in 2012 with a prevalence of 39.47%, and in 2013 with a prevalence of 45.59%
(Bawarodi, 2017).
Based on preliminary data that the author obtained from the North Aceh District Health Office, the number of elderly (aged 60–69 years) who suffered from rheumatoid arthritis in 2018 there were 850 cases (North Aceh Health Office, 2019).
Problems that are often experienced by the elderly with rheumatoid arthritis are pain, stiffness (stiffness) and weakness, and the presence of three main signs, namely:
joint swelling, muscle weakness, and movement disorders (Hyulita, 2014). Increased pain during activity, impaired function and structure of the body makes the activities of the elderly become limited (Oktarina, 2016). This causes a change in their quality of life.
Quality of life is a multi-dimensional phenomenon. World Health Organization (WHO) developed an instrument to measure a person’s quality of life from 4 aspects namely physical, psychological, social and environmental. How important these various dimensions are without evaluating it is difficult to determine which dimensions are important from the quality of one’s life (Putri, 2016).
Some studies show a decrease in the quality of life of the elderly due to the occurrence of the disease process (physiological) in the elderly, such as a decrease in the quality of life in the elderly with rheumatoid arthritis. Based on research conducted by Gezer, et al (2018) which evaluates the situation in elderly patients with rheumatoid arthritis and shows that pain, levels of depression, fatigue, and sleep quality worsen with age. Research conducted by Oguro, Nobuyuki, and Yusuke (2018), elderly patients with rheumatoid arthritis will have more difficulty in achieving a satisfying quality of life after receiving treatment with biological agents. And research conducted by Fajri (2019) on the quality of life of rheumatoid arthritis sufferers in the community showed that the quality of life of rheumatoid arthritis in the good category 91.2% had decreased quality of life according to the complaints felt by rheumatoid arthritis sufferers, but this rheumatoid arthritis sufferer able to manage pain felt well, able to control stress well, there is support from the family and the availability of information.
A decrease in the quality of life of the elderly with rheumatoid arthritis can occur due to the chronic nature of the disease, which has an impact on the treatment and therapy being undertaken (Utami, 2014). The quality of life of rheumatoid arthritis
Quality of Life in Elderly with Rheumatoid Arthritis in Aceh Regency
patients is influenced by several factors, such as a weaker physical condition, poor personal relationships, lack of opportunities to obtain information, new skills, and so on (Rohmah, 2012).
Based on the facts above and seeing the high number of rheumatoid arthritis sufferers in the elderly in North Aceh District, the researchers are interested in examining the quality of life of the elderly with rheumatoid arthritis in the North Aceh District Health Office Work Area.
II. METHODS
This descriptive study was conducted in North Aceh Regency. Participants in this study were 365 people, with the criteria: aged between 60–69 years, diagnosed with rheumatoid arthritis, willing to be a respondent, and living in North Aceh Regency. They were chosen based on the results of the examination and treatment they did at the puskesmas in North Aceh District. But puskesmas with many elderlies with rheumatoid arthritis are only a few puskesmas. There are no specific inclusion and exclusion criteria for prospective respondents. All respondents were asked to fill in WHO demographic data and the WHOQOL- BREF questionnaire.
Settings
The first part of the questionnaire consisted of demographic information: age, sex, ethnicity, religion, education, occupation, income and duration of rheumatoid arthritis.
Demographic Variables
Language of the questionnaire is provided in Indonesian. Several WHOQOL-BREF instruments in Indonesian have been available from previous studies such as those of Salim, et al (2007) and Fajri (2019).
Quality of Life Questionnaire (WHOQOL-BREF)
The World Health Organization’s Quality of Life Questionnaire (WHOQOL) provides a detailed assessment of each aspect of the individual relating to quality of life. At present WHOQOL is an instrument that applies internationally, can be compared cross-culturally and generically for the assessment of quality of life. The original WHOQOL was made by the WHOQOL Group in 1995 and consists of 100 items. After the development of WHOQOL-100, the WHOQOL Group developed an abbreviated form, namely the Quality of Life of the World Health Organization (WHOQOL-BREF). WHOQOL-BREF contains a total of 26 questions. To provide a broad and comprehensive assessment, one item from each of the 24 aspects contained in WHOQOL-100 has been included. In addition, two items of overall quality of life and general health were included. WHOQOL-BREF is available in 19 different
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languages. The appropriate language version, and permission to use it, can be obtained from The WHOQOL Group, Mental Health Program, World Health Organization, CH-1211 Geneva 27, Switzerland (WHOQOL-BREEF, 1996).
WHOQOL-BREF which has been translated into Indonesian is given a score that covers four domains, namely: physical consisting of 7 questions, psychological 6 questions, social relations 3 questions, and environment 8 questions. Each question is given a score of 1 to 5, and a higher score is a better quality of life. The score of the domain is calculated by multiplying the average of each facet by 4 (Salim et al, 2007).
If more than 20% of the data is missing from an assessment, the assessment must be discarded. Where items are lost, on average, other items in the domain are replaced.
If more than two items are missing from the domain, the domain score cannot be calculated, apart from domain 3, where the domain will only be counted if 1 item is lost (WHOQOL-BREF, 1996).
Table 16.1 Characteristics of Respondent Demographics
Characteristics (F) (%)
Mean of age (64 years) Gender
Girl Male
Mean of the tribe (Aceh) Religion
Islam Catholic
Mean of education (elementary school) Occupation
Tutor Housewife Trader Farmers Civil Retired Entrepreneur Does
Mean of income (<Rp 1.000,000.00) Long illness RA
1 – 6 years 7 – 12 years
37
240 125 317
363 2 133
7 161
29 95 11 7 18 37 274
255 110
10.1
55.5 44.4 86.8
99.5 0.5 36.4
1.9 44.1
7.9 26.0
3.0 1.9 4.9 10.1 75.1
69.9 30.2
Quality of Life in Elderly with Rheumatoid Arthritis in Aceh Regency
Data Analysis
Descriptive test is used to determine the distribution of demographic data, quality of life, and domains of quality of life.
III. RESULTS
The sample consisted of 37 (10.1%) with a mean age of 64 years, 240 (65.8%) were female and 125 (34.2%) were male. Most of the Acehnese (n = 317; 86.8%) and Muslim (n = 363; 99.5%). Average education was elementary school (n = 133;
36.4%) and most were housewives (IRT) (n = 161; 44.1%). The average income is less than Rp 1,000,000.00 per month (n = 274; 75.1%) and the maximum duration of rheumatoid arthritis is 1–6 years (n = 255; 69.9%) (Table 1).
Univariate Analysis
Table 2 shows the quality of life of the elderly which was assessed based on 4 sub variables namely the physical domain, psychological domain, social domain, and environmental domain obtained a mean value of 1.78 (SD=0.42). Table 3 shows that the physical domain is the highest sub variable with a mean value of 25.88 (SD=1.51), then followed by the environmental domain with a mean of 24.44 (SD=3.18), psychological domain with a mean of 22.61 (SD=1.47), and finally the social domain with a mean of 8.62 (SD=1.39).
Table 16.2 Minimum, Maximum, Mean and Standard Deviation Values of Respondents’
Quality of Life
Variable Minimum Maximum Mean SD
Quality of Life 64.00 107.00 81.55 5.56
Quality of Life
The results of the study conducted to 365 respondents obtained a picture of a minimum value of 64.00, a maximum value of 107.00, and obtained a mean of 81.55 (SD = 5.56).
The frequency of quality of life with a high category is 244 respondents (77.8%). This shows that most of the elderly have a high quality of life. This shows that the health of patients with rheumatoid arthritis is not only influenced by physical health, but can be influenced by support from others, patient independence, social relations with others and environmental factors.
Physical Health Domain
The results of a study conducted to 365 respondents obtained a description of the physical health domain with a minimum value of 21.00, a maximum value of 32.00,
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and a mean of 25.88 (SD = 1.51), a high frequency category of 228 respondents (62, 5%), shows that the average physical health domain of the elderly with rheumatoid arthritis is high.
Psychological Domain
The results of the study conducted to 365 respondents obtained a description of the psychological domain with a minimum value of 18.00, a maximum value of 27.00, and obtained a mean of 22.61 (SD = 1.47), high frequency category 196 respondents (54%) , shows that the average psychological domain of the elderly with rheumatoid arthritis is high.
Table 16.3 Minimum, Maximum, Mean and Standard Deviation Values of Respondents’
Quality of Life domains
No Variable Minimum Maximum Mean SD
1 Physical Domain 21.00 32.00 25.88 1.51
2 Psychological Domain 18.00 27.00 22.61 1.47
3 Social Domain 6.00 13.00 8.62 1.39
4 Environmental Domain 16.00 38.00 24.44 3.18
Domain of Social Relations
The results of the study conducted to 365 respondents obtained a description of the domain of social relations with a minimum value of 6.00, a maximum value of 13.00, and a mean of 8.62 (SD =1.39), a high frequency category of 171 respondents (46, 8%), shows that the average domain of social relations of the elderly with rheumatoid arthritis is low.
Environmental Domain
The results of the study conducted to 365 respondents obtained a description of the environmental domain with a minimum value of 16.00, a maximum value of 38.00, and obtained a mean of 24.44 (SD = 3.18), high frequency category 168 respondents (46%) , shows that the average environmental domain of the elderly with rheumatoid arthritis is low.
IV. DISCUSSION
The results of the research that have been done show that the age characteristics of the respondents are on average 60–64 years with a percentage of 55.5% or as many as 203 respondents. These results are in line with research conducted by Relas and Silja (2018) at the Rheumatology Clinic of the University of Helsinki Hospital
Quality of Life in Elderly with Rheumatoid Arthritis in Aceh Regency
in 161 rheumatoid arthritis patients, where respondents who were diagnosed with rheumatoid arthritis were on average aged 18–65 years with a percentage of 24.18% or 39 respondents. From the results of the above research equation it can be concluded that the age of 60–65 years is at great risk of developing rheumatoid arthritis.
Table 16.4 Frequency and Percentage Distribution of Quality of Life and Respondents’
Quality of Life Domains
Variable Category Frequency Percentage
Quality of Life High
Low
284 81
77.8 22.2
Physical Domain High
Low
228 137
62.5 37.5 Psychological Domain High
Low
196 169
54 46
Social Domain High
Low
171 194
46.8 53.2 Environmental Domain High
Low
168 197
46 54
Based on gender characteristics, women are the highest number of respondents, 65.8%
or 240 respondents. Men and women have different abilities in dealing with diseases, especially in patients with rheumatoid arthritis women 2–3 times diagnosed with rheumatoid arthritis than men. These results are in line with research conducted by Berner, et al (2018) in a cross-sectional study conducted in rheumatoid outpatient clinics in Vienna, Austria in 120 patients with rheumatoid arthritis, where respondents diagnosed with rheumatoid arthritis were more numerous in women with a percentage of 82, 5% or 99 respondents. From the above research equation, it can be concluded that the female sex is more susceptible to rheumatoid arthritis.
Based on the results of this study, the average level of education of respondents was Elementary School (SD) with a percentage of 36.4% or 133 respondents. The level of education will affect one’s knowledge, someone with a good level of education will affect their knowledge and can receive information well so that it can improve the quality of life (Nainggolan, 2009). According to Klin (2018) in his research regarding the level of knowledge of Turkish rheumatoid arthritis patients about their diseases with a percentage of 62.7% or 141 respondents. Based on the above research equation supports the results of this study and it can be concluded that the higher the level of education the better the knowledge and information received.
Based on the results of this study that the majority of the respondents’ work was as a housewife (IRT) with a percentage of 44.1% or 161 respondents. Housewives generally do a lot of activities at home which can result in a lot of movement in the joints. These results are in line with research conducted by Andriyani (2018), the
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results show that the most work done is as a housewife with a total of 53.2%. Work is one of the factors that can cause joint disease. Free and strenuous activity and pressure can worsen the condition of the joints and doing work that moves a lot of the hands and feet in the long term can cause complaints that will be felt by people with rheumatoid arthritis (Bawarodi, Rottie and Malara, 2017).
Based on family income earned each month the average income is below Rp 1,000,000.00 with a percentage of 75.1% or 274 respondents, This is in line with the research of Berner, et al (2018), revealing that the variables of age, marital status, education level, monthly net income, the number of additional drugs, the presence of comorbidities, pain, disease activity, functional disability, fatigue, adverse social interactions and all dimensions of disease perception are significantly related to the quality of physical health.
Based on the duration of rheumatoid arthritis, the average respondent suffered from rheumatoid arthritis for 1–6 years with a percentage of 69.9% or 255 respondents.
The long duration of suffering from rheumatoid arthritis caused respondents to be uncomfortable because they sometimes experienced relapses at any time. This is in line with research conducted by Berner, et al (2018) at the rheumatoid outpatient clinic in Vienna, Austria, showing that most respondents had suffered from rheumatoid arthritis for 5–10 years with a percentage of 33.3% or 40 respondents.
The results of the research conducted to 365 respondents obtained a description of the quality of life of respondents with a minimum value of 1.00, a maximum value of 2.00, and obtained a mean of 1.78 (SD = 0.42), indicating that the mean quality of life of respondents was in high category. This shows that a small proportion of respondents have low quality of life. This is supported by age, education and low income, and the length of time suffering from rheumatoid arthritis. This is not much different from the research conducted by Lai, Leung, Kwong, and Lee (2015) in Hong Kong, the results show that pain is one of the factors that can reduce the quality of life of the elderly in nursing home residents. Tavares, Dias, Santos, Hass, and Miranzi (2013) say that the decline in quality of life is caused by limited bodily functions, illness, education, low income and lack of contact with others.
The results of studies that have been conducted on the physical domain obtained a minimum value of 21.00, a maximum value of 32.00, and obtained a mean of 25.88 (SD = 1.51), indicating that the physical domain of the quality of life of respondents is high. This is supported by the respondent’s age, education, occupation, income, and duration of rheumatoid arthritis. This is not much different from research conducted by Berner, et al (2018) in Austria, the results show that the age, marital status, education level, monthly net income, the amount of additional drugs, the presence of comorbidities, pain, disease activity, functional disability, fatigue, adverse social interactions and all dimensions of disease perception significantly affect physical health.
The results of studies that have been conducted on the psychological domain obtained a minimum value of 18.00, a maximum value of 27.00, and obtained a mean
Quality of Life in Elderly with Rheumatoid Arthritis in Aceh Regency
of 22.61 (SD = 1.47), indicating that the psychological domain of the quality of life of respondents is high. This is supported by the respondent’s age, education, occupation, income, and duration of rheumatoid arthritis. This is not much different from research conducted by Campos, Ferreira, Vargas, and Albala (2014) conducting research with WHOQOL-BREF on elderly people living in communities in the Brazilian region showing that women who have good physical condition and psychosocial health have a quality of life higher. Meanwhile, in men quality is associated with high socioeconomic and physical condition and good psychosocial health. Healthy elderly people do have a better quality of life.
The results of research conducted on the social relations domain obtained a minimum value of 6.00, a maximum value of 13.00, and obtained a mean of 8.62 (SD = 1.39), indicating that the social relations domain of the quality of life of respondents was low. The family is the main support system needed by the elderly in maintaining their health. According to Ryan (2014) that when someone suffers from rheumatoid arthritis there is a role in the family that must change and not every family member can accept the changes that occur. According to Agarwal, et al (2007) that the level of social support is known to have an impact on psychological well-being, and they have social support in the good category and tend to be less depressed.
Quality of life in the domain or environmental aspects of RA patients on average is low. This is supported by the state of physical health, psychological, and social relations of respondents. According to Malm, et al (2017) say that quality of life in patients with rheumatoid arthritis is good if it is independent in terms of physical function and to. This is supported by the state of physical health, psychological, and social relations of respondents. According to Malm, et al (2017) said that the quality of life in patients with rheumatoid arthritis is good if it is independent in terms of physical and financial functions, resources, empowerment in managing life and participating in experiences related to social context.
V. CONCLUSION
General description of the characteristics of respondents with the incidence of rheumatoid arthritis susceptible to occur in the age of 60–64 years. The sex of RA sufferers mostly occurs in women. The last education of RA sufferers is known to be mostly elementary schools. The occupational status of RA sufferers is mostly housewives. Monthly family income is below Rp. 1,000,000.00. Most RA sufferers suffer from 1–6 years ago. Quality of life in the physical health domain of RA sufferers is largely high. Quality of life in the psychological domain of RA sufferers is largely high. Quality of life in the social domain of RA sufferers on average is low.
Quality of life in the domain or environmental aspects of RA patients on average is low.
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