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Quality of life (QoL) among the elderly is a big problem in Vietnam due to a growing proportion of the elderly in Vietnam while many conditions, including policies, social facilities, culture and other factors are not ready to support for QoL among elderly.
JOURNAL OF MEDICAL RESEARCH FACTORS ASSOCIATED WITH QUALITY OF LIFE AMONG ELDERLY IN URBAN VIETNAM Dao Thi Minh An¹, Vu Toan Thinh¹, Dunne P Michael² ¹Institute for Preventive Medicine and Public Health, Hanoi Medical University ²School of Public Health, Queensland University of Technology, Australia Quality of life (QoL) among the elderly is a big problem in Vietnam due to a growing proportion of the elderly in Vietnam while many conditions, including policies, social facilities, culture and other factors are not ready to support for QoL among elderly This cross-sectional study was conducted to explore QoL and factors associated with QoL among the elderly in Trung Tu ward, Ha Noi, Viet Nam The findings showed that the four domains of QoL the among elderly fluctuated around 50 Mean scores of social and psychological QoL were higher than those in the physical and environmental domains A statistically significant difference in mean scores of QoL by socio-demographics was recorded (age profile, educational attainment, and occupation) All four domains of QoL were positively correlated with each other Furthermore, age, psychological, social and environmental domains collectively contributed to 47.59% of the physical domain; while the physical, social, and environmental domains accounted for 56.13% of the psychological domain We also found that occupation (worker), as well as physical, psychological, and environmental metrics, accounted for 34.19% of the social domain Moreover, physical, psychological, social domains and occupation (home-wife) collectively accounted for 45.92% of the transformation of environmental domain Our study suggests that it is essential to evaluate overall QoL to have a comprehensive view of its effects in the long run Keywords: Quality of Life, Elderly, Hanoi, WHO QoL-Bref I INTRODUCTION Vietnam’s population structure is in a period of dramatic change, presenting a number of public health benefits as well as challenges Today, one of the most prominent issues is how to address a rapidly growing Corresponding author: Vu Toan Thinh, Institute for Preventive Medicine and Public Health, Hanoi Medical University Email: vutoanthinhdhy@gmail.com Received: 05 June 2017 Accepted: 16 November 2017 114 elderly population Statistics from the Living Standard Survey of Households in Vietnam showed that the number of elderly people (defined as men and women aged 60 years plus) grew from 3.71 million people in 1979 (6.9% of the total population) to 7.72 million in 2009 (9% of the total population) At this rate, by 2020, it is estimated Vietnam’s elderly population will be greater than 12 million [1] With this in mind, quality of life (QoL) among the elderly is the most pressing isJMR 111 E2 (2) - 2018 JOURNAL OF MEDICAL RESEARCH sue QoL is a multi-dimensional, highly subjective concept and, as recommended by the World Health Organization (WHO), is measured using four major domains, including physical, psychological, social, and environmental [2] Within these categories, QoL has its own characteristics according to different economic and socio-cultural levels, producing trend where an overall negatively asociates with age QoL [3] Within Vietnam’s cultural context of multiple generations living together in the same household, as well as the impact of urbanization on a rapidly aging population, QoL and mental disorders among the elderly need to be paid more attention A recent study conducted in provinces on the health status of Vietnam’s elderly population showed that about 95% of the participants were infected with at least one disease On average an elderly person suffers from 2.6 diseases With this in mind, about 23% of the elderly people have difficulties in their daily life, of which more than 90% need supports from other people [4] According to the statistic of the National Institute of Gerontology, 9.2% of the Vietnamese population suffer from depression, one third of which were elderly and largely retired populations in major cities [5; 6] This is an important point to understand in an age of rapid urbanization The proportion of elderly in urban areas is quickly rising and becoming a far more difficult problem to properly address Compared to the elderly living in rural areas, the elderly in urban zones have distinct lifestyles such as extensive free time, more available information JMR 111 E2 (2) - 2018 relating to health problems, but most of all, less integrated neighborhood relationships compared to those in rural areas Further, after retirement, may confront psychological loneliness, emptiness, and even abandonment by their children and neighbors, this would put the elderly in isolated situations Hanoi is the capital of Viet Nam where there is a rapidly developing economy and growing population in which many Vietnamese households have to generations live together [7] QoL of the elderly in Hanoi after retirement is often influenced by many factors such as home economics, relationship with their spouse and children, social issue, physical and mental health, and the medical system [8 - 10] However, few studies have specifically analyzed the extent that these factors impact QoL among the elderly, especially among those living in urban wards in Hanoi In Vietnam, there were some studies conducted on QoL among the elderly [11]; however, none focused on the population living in major cities Therefore, this study aims to analyze the quality of life based on the four main domains among the elderly population living in Hanoi’s Trung Tu ward II SUBJECTS AND METHODS Subjects Target population is the elderly living in urban areas in Hanoi city Particularly, the study population is defined as the elderly living in Trung Tu ward, Hanoi Participants who were recruited into this study if they met the following criteria 1) People who living in Trung Tu ward, Hanoi for at least year; 2) 115 JOURNAL OF MEDICAL RESEARCH Aged ≥ 60 years old (according to the ordinance of the elderly, issued by the President of the National Assembly on 28th April 2000, the elderly are defined as citizens of the Socialist Republic of Vietnam from 60 years old or more [12]); and 3) Willing to participate in this study after giving informed consent Individuals were excluded if they were living in Hanoi temporarily, refused to participate, or had difficulties in understanding or completing the questionnaire Methods Research site This cross-sectional study was conducted in Trung Tu ward, Hanoi, which is located in Northern Viet Nam This ward has one of the densest populations in Hanoi and is mainly comprised of government officers that live in 62 dormitories and residential districts with convenient transportation and close proximity to entertainment venues, national hospitals, and schools Until 2012, there were 1,593 elderly people in Trung Tu, accounting for 11.78% of the total population of the ward Sample size and data collection This is a pilot study, so we decided on a convenience sample of 2% (or 299) of Trung Tu ward’s total elderly population, who volunteered for the study The first step of recruiting participants was effectively announcing the study Ten health collaborators of Trung Tu’s health center wrote an introduction about the study and announced the recruitment on the boards at dwelling areas that they are in charge of The announcement ordered those who wanted to voluntarily participate in the study to call a 116 toll-free number for registration After being contacted by potential subjects, the second step was to screen them for eligibility using a questionnaire that assessed each participant’s recruiting criteria They were then recruited into the study based on these criteria until the target sample size of 299 elderly people was met In the last step of sampling, collaborators contacted registered participants at home and provided them with consent forms After reading the consent form, if the elderly agree to participate in the study, they would then receive a self-administered questionnaire from collaborators They then allowed at least weeks for participants to complete their questionnaires and return them to health collaborators in Trung Tu ward, either by themselves or their relatives If their relatives delivered the questionnaire, it would be sealed in an envelope to ensure confidentiality The self-administered questionnaires were immediately screened to check for missing information to ensure participants could circle responses they missed If their relatives delivered their questionnaires, we used the telephone number which was recorded on that questionnaire to call the elderly After that, the participants' phone number was deleted to secure their personal information If the elderly refused to answer, that questionnaire was considered as ineligible Measures Demographics: Includes questions about participants’ age, marital status (married vs unmarried), education level, living arrangements, and occupation before retirement JMR 111 E2 (2) - 2018 JOURNAL OF MEDICAL RESEARCH Quality of Life: WHO QoL-Bref questionnaire is self-assessment that antains 24 items, each presenting one facet of QoL and two “benchmark” items in an individual’s overall QoL and general health The facets are defined as those aspects of life that are considered to contribute to a person’s QoL QoL comprises of four main domains – physical health (7 items relating to pain and discomfort, dependence on medical treatment, energy and fatigue, mobility, sleep and rest, activities of daily living, and working capacity), psychological health (6 items relating to positive feelings, spirituality, religion and personal beliefs, thinking, learning, memory and concentration, body image, self-esteem, negative feelings), social relationship (3 items relating to personal relations, sex life, practical social support), and environment (8 items relating to physical safety and security, physical environment, financial resources, information and skills, recreation and leisure, home environment, access to health and social care, and transportation) These facets were scored on a Likert scale from to with = Very poor, = Poor, = Neither poor or good, = Good, and = Very good; = Very satisfied, = Dissatisfied, = Neither dissatisfied or satisfied, = Satisfied, and = Very satisfied; = Not at all, = A little, = A moderate amount, = Very much, and = Extremely; or = Never, = Seldom, = Quite often, = Very often, and = Always The raw score from each domain of QoL include varying scales; for instance, the physical domain ranges from to 35 points; psychological domain ranges from to 30 points; social domain scores ranges from to 15 JMR 111 E2 (2) - 2018 points; and environmental domain are from to 40 points The raw scores of each domain were then converted to a scale of to 100 to compare with other populations, with lower scores indicating poor QoL A domain was treated as missing when over 20% of its items were missing With regard to QoL scores, they are on a positive scale (higher scores represent better QoL) and there is no cut-off point to determine a specific score by which the QoL could be assessed as “good” or “bad” [13] Data analysis Data had been cleaned by checking missing data before it was entered into the database Data was entered and cleaned for outlier and illogical data using Epidata software, then converted into file.data to be analyzed in Stata version 10 The results were initially analyzed using means, standard deviations, and frequencies Mean and standard deviation were used to assess normal distribution Subsequently, Man-Whitney tests were employed to compare means between the four domains of QoL by socio-demographics The relationships between each domain of QoL were identified by conducting Spearman tests, since domains of QoL were not normally distributed To analyze the influence of independent variables of each domain of QoL, bivariate and multiple linear regression analysis were used, in which dependent variables were transformed into ranks because of the absence of normal distribution (physical and social variable was squared to meet this condition) Some socio-demographic factors (age, marital status, gender, occupation, education lev117 JOURNAL OF MEDICAL RESEARCH els, and living arrangement) and significant factors in bivariate linear regression or in literature documents were then put into multiple linear regression for the full model The final model was selected by performing stepwise linear regression The significance level adopted for statistical test was 5% Co-efficient, constant, p value, confidence interval and R-square for each model were calculated and presented The final model was tested for its fitness by 1) checking its linear predicted value (_hat) and linear predicted value squared (_hatsq); 2) check goodness of fit ("predict resid, r"; 3), by checking for multi-collinearity Ethics The risk of discomfort to participants and risk of confidentiality loss were marginal There were some questions about individual feelings among the elderly about their happiness with their life, family members, sex life, and surrounding physical environment, as well as their social connectedness To reduce these risks, in the consent form, participants were advised that they can withdraw at any time and that they can refuse to answer any question which made them uncomfortable They were also advised that all their refusal or withdrawal will not have any effect on them in any way Moreover, an anonymous self-administered questionnaire was developed and used, in which can complete by participants without the survey privately Additionally, participants were asked to return their completed questionnaire by themselves to the field workers, who are outside the participants’ wards The 118 consent form with participants’ agreement to participate in the study and their administration group numbers was detached from the main body of the questionnaire and sent to the principle investigator (PI) to be securely stored Therefore, all individual information will be separate throughout the data collection procedure Our approach was to ensure that participants feel that they have control over the proceedings of the survey They were clearly advised that all information is anonymous and will only be analyzed at the group level In the consent form, the PI’s contact number was printed and participants were instructed to if they have any questions If participants become distressed during or after filling out the questionnaire, they could also contact the PI for further counseling All survey questionnaires were anonymous (no name and individual address identified) and securely stored This study was submitted and approved by the Ethical Committee of the School of Public Health and accepted in May, 2012 III RESULTS Among the 299 participants, the proportion of males to females was balanced at 48.8% and 51.2%, respectively The mean age of study participants was 70.6 years, while the mean age of males was higher than females (p < 0.05) The proportion of the elderly in the group under 70 years was 45.5% compared to these age 70 years and older 54.5% The majority of participants (40.6%) were post-graduation, working as government officers (80.3%), married (84.6%) and living primarily with their husJMR 111 E2 (2) - 2018 JOURNAL OF MEDICAL RESEARCH band or wife and children (47.8%) Table Mean scores of four domains of quality of life by socio-demographics Socio - demographic characteristics Mean of scores (Mean ± SD)a Physical Psychological Social relationship Environment 53.4 ± 12.1 57.4 ± 11.3 60.4 ± 14.1 54.3 ± 11.3 52.9 ± 13.4 57.0 ± 11.8 60.2 ± 14.1 54.3 ± 11.7 Female 53.8 ± 10.9 57.7 ± 10.9 60.7 ± 14.2 54.2 ± 10.9 p value 0.88 0.76 0.81 0.82 < 70 56.7 ± 10.2 59.4 ± 10.6 62.7 ± 13.8 55.2 ± 11.3 >= 70 50.6 ± 13.0 55.7 ± 11.6 58.5 ± 14.1 53.6 ± 11.2 0.0001 0.0042 0.0095 0.396 Single 53.6 ± 12.1 57.6 ± 11.4 60.6 ± 13.9 54.6 ± 11.1 Married 51.8 ± 12.5 56.2 ± 11.1 59.6 ± 15.1 52.7 ± 12.1 p value 0.26 0.57 0.79 0.60 Government officers 53.4 ± 12.2 58.0 ± 11.7 61.0 ± 14.1 55.1 ± 11.3 Others 53.1 ± 12.2 54.9 ± 9.5 59.3 ± 14.1 50.8 ± 10.7 p value 0.83 0.04 0.35 0.0138 College/Intermediate school and less 52.5 ± 12.1 55.7 ± 11.1 58.6 ± 14.7 52.5 ± 11.2 Post-graduation 54.6 ± 12.1 59.9 ± 11.3 63.2 ± 12.9 56.9 ± 10.9 0.13 0.0006 0.011 0.0012 Alone 51.5 ± 15.0 53.1 ± 13.3 59.7 ± 14.1 53.1 ± 12.8 Family 53.4 ± 12.0 57.5 ± 11.2 60.5 ± 14.1 54.3 ± 11.2 p value 0.47 0.18 0.77 0.89 Mean ± SD Gender Male * Age group p value Marital status Occupation Education P value Living arrangement JMR 111 E2 (2) - 2018 119 JOURNAL OF MEDICAL RESEARCH Score in range from - 100; *Man-Whitney test The mean scores of four domains of QoL fluctuated around 50 (table 1) Meanwhile, the social domain had the highest score (60.4), followed by the psychological, physical, and environmental domain (57.4; 53.4; and 54.3, respectively) We found that participants under 70 years had higher QoL in physical, psychological and social domains than those aged at or over 70 years of age (56.7 vs 50.6; 59.4 vs 55.7; and 62.7 vs 58.5 with p < 0.01, respectively) However, this trend was not observed in the environmental domain Additionally, statistically significant differences were found in the psychological and environmental domains among the elderly who worked as govern- ment officers and others (57.9 vs 54.9; and 55.1 vs 50.8 with p < 0.05, respectively) These differences were not seen in the physical and social domains The more highly educated participants were, the better their QoL in psychological, social and environmental domains (55.7 vs 59.9; 58.6 vs 63.2; 52.5 vs 56.9 with p < 0.05, respectively), however this was not the case in the physical domain We did not find statistically significant differences in mean scores on all four domains based on gender, marital status and living arrangement (whom living with) (p > 0.05) Interestingly, all domains of QoL were correlated positively with each other (p < 0.001) (Figure1) Specifically, high correlations were identified between the physical a (0.6), environmental (0.5), social (0.5), and psychological domains Table Factors associated with physical domain Number of obs Model summary Physical_QoL 299 Prob > F 0.0000 R-squared 0.4759 Coef P>t [95% Conf Interval] - 29.04 0.00 - 42.93 - 15.14 Psychological_QoL 48.80 0.00 36.66 60.95 Environmental_QoL 16.64 0.03 4.87 28.41 Social_QoL 9.44 0.01 1.82 18.06 771.47 0.22 - 46.09 20.03 Age Cons For the physical domain (table 2), R-square equal 0.4759 (p < 0.001), meaning that age, psychological, social, and environmental domains contribute 47.59% to this facet of participants’ QoL All determinants were positively correlated except for age, which was inversely correlated For every one unit increase in psychological, environmental and social domains, we would expect a 48.80; 16.64; and a 9.44 unit increase in the physical domain, respectively The coefficient for age was 29.04, meaning that for a one unit increases with age; a 29.04 unit 120 JMR 111 E2 (2) - 2018 JOURNAL OF MEDICAL RESEARCH decreases in physical domain Table Factors associated with psychological domain Number of obs Model summary 299 Prob > F 0.0000 R-squared 0.5613 Psychological_QoL Coef P>t [95% Conf Interval] Physical_QoL 0.36 0.00 0.27 0.44 Social_QoL 0.14 0.00 0.06 0.21 Environmental_QoL 0.36 0.00 0.26 0.45 Cons 10.57 0.00 5.71 15.45 For psychological domain (Table 3), we found that physical, social, and environmental domains were positively correlated with psychological domain, which collectively accounted for 56.13% (p < 0.001) The domain that contributed the most to psychological domain were physical and environmental (whose coefficient was 0.36, meaning that the psychological domain increases 0.36 ranked units, p < 0.001), followed by social (whose coefficient was 0.14, meaning that the psychological domain increases 0.14 ranked units, p < 0.001) Table Factors associated with social domain Number of obs Model summary 299 Prob > F 0.0000 R-squared 0.3419 Social_QoL Coef P>t [95% Conf Interval] Physical_QoL 19.81 0.02 3.17 36.45 Psychological_QoL 41.30 0.00 21.51 61.09 Environmental_QoL 30.91 0.00 13.11 48.71 Workers 539.23 0.04 32.01 106.44 Business man - 61.64 0.23 - 160.91 385.63 Freelance worker - 38.70 0.30 - 119.02 363.61 63.43 0.91 - 100.85 113.73 Others - 50.91 0.51 - 207.25 109.43 Cons - 124.25 0.01 - 211.56 - 36.94 Home wife For the social domain (Table 4), occupation (worker), physical, psychological, and environmental domains were positively correlated and together accounted for 34.19% (p < 0.001) The coefficient for occupation was 539.23, meaning that the elderly individulas who worked JMR 111 E2 (2) - 2018 121 JOURNAL OF MEDICAL RESEARCH as workers have a score of 539.23 ranked units greater than those who were government officers; the coefficient for physical, psychological and environmental domain was, in turn, 19.81; 41.30 and 30.91, meaning that a one unit increases in physical, psychological or environmental domain produces a 19.81; 41.30 and 30.91unit increase in the social domain, respectively Table Factors associated with environmental domain Number of obs Model summary 299 Prob > F 0.0000 R-squared 0.4592 Environmental_QoL Coef P>t [95% Conf Interval] Social_QoL 0.14 0.00 0.06 0.22 Psychological_QoL 0.44 0.00 0.32 0.56 Physical_QoL 0.14 0.01 0.03 0.25 Worker - 3.11 0.06 - 6.34 0.13 Businessman 1.34 0.68 - 5.02 7.71 Freelance worker - 0.37 0.88 - 5.13 4.40 Home wife - 10.22 0.00 - 17.11 - 3.33 Others - 4.14 0.40 - 13.81 5.52 Cons 13.38 0.00 7.85 18.90 Data from Table shows factors associated with the environmental domain Physical, psychological, social, and occupational (home-wife) determinants together accounted for 45.92% The physical, psychological, and social domains were positively correlated with the environmental domain and the correlation coefficient of these domains were 0.14, 0.44, and 0.14, respectively, meaning that for a one unit increase in physical, or psychological, or social domain, we would expect that a 0.14, 0.44, and 0.14 unit increase in the environmental domain Working as a homemaker was inversely related and its coefficient was 10.22, meaning that elderly with working as homemakers have a score of 10.22 ranked units lower than those with government officers 122 IV DISCUSSION We found that QoL scores of the elderly living in Trung Tu ward fluctuated around 50 and compared to the maximum score in the 0-100 scale, they presented a moderate QoL level for the four domains of WHO QoLBref (table 1) These results are very similar to other studies on QoL among the elderly in Brazil [13] and two studies conducted in Can Tho and Ho Chi Minh city, Viet Nam, which indicated that the QoL of people aged at 18 and over stayed at moderate level [14] These similarities in QoL between these locations can be explained by rapid economic development and urbanization However, the average scores of all four domains of QoL in this study were lower than findings detected in other developing countries, JMR 111 E2 (2) - 2018 JOURNAL OF MEDICAL RESEARCH such as among the elderly living in South Jakarta (Indonesia), in Taiwan (2010), and in adults with sickle cell disease in Jamaica , as well as in France among people age 80 and patients after intensive care unit [15] In this study, the mean scores of physical and environmental domain were lower compared to the psychological and social domain (Table 1) These findings were similar to the results of other studies and indicated that social domain had the highest mean score when compared to other domains [8; 16] In a study conducted on 240 participants, Sanghee Chun et al also indicated that environmental and psychological domains had higher mean scores compared to physical and social domains (78.9; 74.2 vs 73.4; 65.6, respectively) [17] Likewise, a Vietnamese study performed by Phung Duc Nhat et al also showed this trend [14] We suggest that the elderly in Trung Tu ward have a lower perception of their QoL in the physical domain This was indicated by their self-reported pain and discomfort, medicine dependence, energy and fatigue, issues related to mobility capability, as well as sleeping and rest, activities of day-today life, and working abilities This was also the case of it environmental QoL, which includes a diversity of physical security; supports for finance; information sources and skills; entertainment; housing environment; accessibility to health services and social care; and transportation as well This highlights the importance of improving elderly’s physical and environmental QoL via urging them to participate in clubs and recreational activities while accessing to health services Several studies showed the effect of age JMR 111 E2 (2) - 2018 on QoL of the elderly [18; 19] The higher age was, the lower QoL on physical, psychological and social domains (Table 1) These results are similar to the findings by Barua et al in 2007, Abhay Mudey et al in 2011 [2], Abdul Rashid in 2013 [20], Phung Duc Nhat et al in 2011 [14] As seen in García et al., old age was associated with the worst levels of health-related to QoL Likewise, Laxmikant Lokare’s study in 2011 indicated that the mean score in the age group of under 70 years old and above 70 years old were significantly differences in the psychological domain (p < 0.05) [21] We found that those with higher education level attained better QoL This finding supports a study conducted in Can Tho city, Vietnam, which indicated that people aged 18 years or over with the highest level of education had better QoL on all four domains compared to the lower educated participants [14] In a study by Ping Xia et al., participants who had a degree, vocational training or above had mean scores in all domains higher than those without (p < 0.001) [16] A study conducted on 205 elderly in Malaysia indicated that the elderly who had secondary school level education had higher QoL as compared to those with primary level or no education (26.7% vs 21.5% and 2.2%, with p < 0.01, respectively) Likewise, the elderly who worked as government officers had better QoL than other participants This result supports previous studies indicating that the elderly who were employed had 22.6% of higher level of QoL when comparing to those who were not (13.4%) [22] Additionally, a study conducted in Nonthaburi, Thailand revealed that the 123 JOURNAL OF MEDICAL RESEARCH majority of government officers who retired early (70.5%) had a high level of QoL, followed by moderate level (28.5%) and low level (1.0%) [23] This reflects our finding that the elderly with higher levels of education generally have a stable job, positive social relationships, and a monthly salary after retirement In other words, in addition to state allowance, those who have higher education and state officials had better QoL Therefore, it is important to improve care for elderly who were state officials to balance the QoL within the population of those employed by the government and those who were not The current study indicated that there was no statistically significant difference on mean scores for QoL by socio-demographics, including gender, marital status and living arrangement (living with whom) These findings reflected the results of Abhay Mudey et al [2], Ping Xia [16], Abdul Rashid [20] and Myo Myint Naing [22] Though we showed no difference in mean scores of QoL by gender, some studies found males had higher QoL than females [9; 10; 16; 24] These results differed from our study One explanation of this trend may be the fact that most of the elderly in Trung Tu ward had many similar characteristics such as higher education, balanced proportion of males and females, and similar professional status When attempting to identify a correlation between all four domains of QoL, we found a high positive correlation between physical, social, environmental domain and psychological domain (Figure 1) These results are supported by other studies [17; 25] For 124 instance, Ginieri’s study provided strong correlations between the scores of all domains, particularly physical, psychological and social [25] A study conducted on QoL in Wilson’s disease showed strong Pearson correlation between environmental and psychological domain (r = 0.53) [26] Likewise, Sanghee Chun et al also revealed that psychological domain was significantly correlated with physical, social and environmental domains (r = 0.56; 0.50; and 0.52 with p < 0.01, respectively) [17] To determine some determinants of QoL among the elderly, we conducted two types of analysis, including bivariate and multiple linear regression to understand the relationship of socio-demographic factors to QoL scores Several investigations have shown that socio-economic variables and health comorbidities affect WHO QoLBref scores [8] Recent studies have shown that WHOQoL-Bref domain scores among middle-aged and elderly are influenced by socio-demographic variables such as age [18; 19; 21], gender [8 - 10; 27], marital status and living arrangement [24] However, a study conducted on QoL of Nigerian clinic patients with type Diabetes Mellitus also indicated that in general, the QoL measures were not influenced by characteristics such as gender, education level or marital status Nevertheless, we still chose to analyze QoL scores with the socio-demographic variables such as age, marital status, education, and living arrangement Four linear regression models were established, and for each model, we used one domain as a dependent variable and socio-demographic factors that were set as independent variJMR 111 E2 (2) - 2018 JOURNAL OF MEDICAL RESEARCH ables To achieve this, a bivariate linear regression analysis was performed with each independent variable (such as gender, age, level of education, marital status, living arrangement, and occupation) and each domain of QoL (after transforming into the ranks because of absence of normal distribution) was analyzed as a dependent variable As a result of bivariate regression, we found that age (p < 0.001) was statistically significant in the physical domain while gender, levels of education, marital status, living arrangement and occupation did not contribute substantially to explain the variation in this model Secondly, age, level of education, and occupation (p < 0.05) were statistically significant in the psychological domain while gender, marital status, and living arrangement were not In the social domain, age (p < 0.001), level of education, occupation, and living arrangement (p < 0.05) were statistically significant while gender and marital status were not Concerning environmental domain, we found that only education level and living arrangement (p < 0.05) were statistically significant while age, gender, marital status, and occupation were not Bivariate linear regression was used to identify prospective determinants QoL; these predictors were then inputteded into the multiple linear regression models' Some determinants that were indicated in previous studies to be significant took to multiple linear regression models, although we could not find the statistically significant correlation We analyzed and identified some determinants that effect on all four domains of QoL including physical, psychological, social and environmental domain JMR 111 E2 (2) - 2018 When analyzing multiplelinear regression for independent effects on each domain of QoL we found that age, psychological, social and environmental domain were statistically related to the physical domains with p < 0.001 A study conducted in Chinese urban community found that age was negatively associated with physical domain because the older community had worse physical domain score than younger community [16] Our finding was similar to the results of other studies such as Ankur Barua in 2005; Lokare et al., and Mudey in 2011 [2; 21] Concerning psychological domain, we found that physical, social, and environmental domain were statistically significant associated These findings were consistent with previous research [17; 26] For social domain, we found that physical, psychological, and environmental domains were positively related to the social domain Meanwhile, working as home-maker was resatively associated Our findings support previous studies In Oye Gureje et al study, age and social factors (practical social support, personal relationship) were the strongest determinants of the physical domain For psychological and environmental domain, social factors such as being in contact with family members and participation in community activities were much more strongly related A study conducted on 1,301 elderly in Brazil revealed that four domains, including physical, psychological, social and environmental domain together accounted for 36.1% of overall QoL Among these determinants, social domain has little contribution covered 0.4% (p > 0.05) meanwhile the domain that contributed the most 125 JOURNAL OF MEDICAL RESEARCH to overall QoL was physical health (28.8%), followed by environmental health (6.2%), and psychological health (1.3%) with p < 0.05 Therefore, changes in one or more domain may imply change in overall QoL and other domains Although we did not determine multiple linear regression between all four domains of QoL and overall QoL, there were many studies conducted all over the world that research this correlation To be specific, a study conducted in Brazilian community-dwelling older adults indicated that overall QoL was significantly related to the reported health condition, educational status, likelihood of participation in physical activities, medical status, age bracket and utilization of primary health care [28] It could be considered as a limitation of this study It is due to the fact that we have yet to evaluate overall QoL and factors associated with it Many findings depicted that a lot of different factors could contribute to the explanation of the same independent variable and the interpretation of overall QoL is quite difficult, too For example, we use a single form to operationalize an individual’s evaluation, and the results of these evaluations could change dramatically because of the variation of priority problems and the circumstances which have influences on life changes This study is important in illustrating how to evaluate QoL as a whole (overall domain) and give a comprehensive view of QoL among elderly living in urban areas, especially in Trung Tu ward, Hanoi city. V CONCLUSION Quality of life of the elderly: QoL of four 126 domains among elderly living in Trung Tu ward stayed at moderate level as compared to WHO’s standard Mean scores of psychological and social domain are higher than those of physical and environmental domain (60.44; 57.37; 53.37; and 54.27, respectively) There is statistically significant difference in mean scores of QoL by socio-demographics: 1) The higher the age, the lower the QoL on physical, psychological and social domain 2) The higher the education, the better QoL on psychological, social and environmental domain 3) Elderly working as government officers had higher QoL on psychological and environmental domain than others Determinants of each domain of QoL: All four domains of QoL were positively correlated Inparticular, we found a high correlation between physical, social, environmental and psychological domain (0.61; 0.53 and 0.51, respectively) Particularly, 1) Age, psychological, social and environmental domain contribute 47.59% to physical domain; 2) Physical, social, and environmental domain contribute 56.13% to psychological domain; 3) Occupation (worker), physical, psychological, and environmental domain together accounted for 33.19% regarding social domain; 4) Physical domain, psychological domain, social domain, and occupation (home-wife) together accounted for 45.92% contributing to environmental domain POLICY RECOMMENDATION Improving QoL, especially physical and environmental QoL, for the elderly through JMR 111 E2 (2) - 2018 JOURNAL OF MEDICAL RESEARCH encouraging them to participate in local clubs, recreation activities and accessing to health services, medical treatment, etc is important Also important is paying more attention about QoL among elderly who are not with governmental occupation, especially on psychological and environmental QoL, through health communication and education to provide information and skills that they need in their day-to-day life, improving health services for elderly, encourage them to involve in recreational activities to ameliorate their health as well as sharing their feelings, etc, to substantially equal QoL between elderly had different occupation It is especially essential to evaluate QoL as a whole (overall domain) to have a comprehensive view of QoL of elderly in Trung Tu ward in particular and other urban wards in Hanoi in general. 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Maharashtra, India Ethno Med 2011, 52(2), 89 - 93 Applying the modified measurement for assessing quality of life of elderly and tested on a number of groups of Vietnamese elderly Nguyen Binh (2012) Elderly. .. of the global quality of life determined by emotional status? Qual Life Res, 13(8), 1347 - 1356 20 Rashid A, Manan AA (2013) The 128 Quality of life of Elderly Living in a Home for the aged in. .. city. V CONCLUSION Quality of life of the elderly: QoL of four 126 domains among elderly living in Trung Tu ward stayed at moderate level as compared to WHO’s standard Mean scores of psychological