Archives of Gerontology and Geriatrics 59 (2014) 415–421

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Archives of Gerontology and Geriatrics

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Quality of life of older adults in Turkey

Naile Bilgili a,*, Fatma Arpacı b
a
Gazi University, Health Science Faculty, Department of Nursing, Besevler, Ankara, Turkey
b
Gazi University, Vocational Educational Faculty, Department of Family Economics Education, Besevler, Ankara, Turkey

A R T I C L E I N F O A B S T R A C T

Article history: The purpose of this study was to examine the factors affecting the quality of life of the elderly people in
Received 22 January 2014 Turkey. Three-hundred community-dwelling older adults (Mage = 68.35, SD = 5.80 years) participated in
Received in revised form 1 July 2014 this study. The quality of life was examined through World Health Organization Quality of Life
Accepted 3 July 2014
Questionnaire-Older Adults Module Turkish Version (WHOQOL-OLD Turkish).
Available online 12 July 2014
Analysis of Variances (ANOVA) showed significant age differences in sensory abilities, social
participation, and intimacy sub-scale scores. Post hoc Scheffe Test results indicated that elderly people
Keywords:
aged 75 years and over differed from other age groups; although their scores in social participation and
Elderly
intimacy were lower; they had higher scores in sensory abilities than those aged 60–65 and 66–74 years.
Quality of life
WHOQOL-OLD There were significant differences between the educational levels of these elderly people in sensory
Turkish older adults abilities, autonomy, past-present-and-future activities, social participation, and death-and-dying sub-
scales. The autonomy, past-present-and-future activities, social participation, and death-and-dying
scores of those with high school education were higher than that of those with secondary school or less
education except in sensory abilities scores.
There were differences found between the variable of with whom the elderly people lived and of QOL
sub-scales of the elderly people’s sensory abilities, past-today-and-future activities, death-and-dying,
social participation, and intimacy. In addition, the total average score of the QOL sub-scales with the
sufficiency of income of the elderly people were interconnected.
In conclusion, the findings revealed that gender, age, education, marital status, childbearing, social
insurance, health status, living arrangement and income variables are the determinant to improving the
quality of life of elderly people.
ß 2014 Elsevier Ireland Ltd. All rights reserved.

1. Introduction The increase in life expectancy at birth is another indicator of

The rapid increase in the elderly people population is a known
fact. A reduction in childhood diseases, lower maternal mortality,
and women’s achievements in the control of their own fertility are
considered to be responsible for this increase (World Health
Organization Centre for Health Development, 2012a). Although the
number of people over the age of 60 was 600 million in the year
2000, it is expected to be 1.2 billion by 2025 and 2.0 billion by 2050
(World Health Organization Centre for Health Development,
2012b). The age group of 65-and-over today, accounts for about
7.3% of the Turkey’s population (Turkish Statistical Institute, 2011).
However, it is foreseen to reach 10% by 2023 (Koc, Eryurt, Adalı, &
Seckiner, 2010).
* Corresponding author. Tel.: +90 05327984600; fax: +90 312 216 26 36.
E-mail addresses: nailebilgili@hotmail.com, nbilgili@gazi.edu.tr (N. Bilgili).
the level of the states’ welfare. On the other hand, this increase
brings comes with problems such as the uncontrollable growing
numbers of severe health issues, declining functional abilities,
economic difficulties and changes in social status, and loss of
spouse and friends (Flood & Phillips, 2007). Services provided to
the elderly people were aimed to enable such individuals to
physically act as independently as possible, to have high cognitive
and intellectual levels, to sustain active lives, and to be satisfied
with their lives (to maintain a good quality of life). However, a
longer lifespan does not always mean quality survival for elderly
people; due to increased longevity and life expectancy, quality of
life (QOL) has been considered an important issue, which has
attracted the researchers’ attention (Hall, Opio, Dodd, & Higginson,
2011).
The World Health Organization Quality of Life Group defines
QOL as follows: ‘‘Quality of life is the individuals’ perception of
their position in life in the context of the culture and the value
systems in which they live in relation to their goals, expectations,

http://dx.doi.org/10.1016/j.archger.2014.07.005
0167-4943/ß 2014 Elsevier Ireland Ltd. All rights reserved.
416 N. Bilgili, F. Arpacı / Archives of Gerontology and Geriatrics 59 (2014) 415–421
standards and concerns. It is a broad concept affected in a complex
way in which the persons’ physical health, psychological state,
level of independence and social relationships are salient features
of their environment’’ (World Health Organization Quality of Life
[WHOQOL] Group, 1995). In general, QOL is a subjective and
complex concept; its most important component is the health-
related QOL (Tuzun & Eker, 2003). How an individual physically
feels about himself/herself and the extent to which the individual
is capable of fulfilling his/her daily work and efforts are examples
of health-related qualities of life. In addition, health-related QOL, in
the psychological sense, it is being able to feel and express
emotions such as anger, resentment, fear, and happiness (Peel,
Bartlett, & Marshall, 2007). On the other hand, the concept of
health-related QOL is often used to assess the impact of illness on
QOL (Ware, 2003).
Health, functional status and social support, especially family
and friends’ support, and social relations are among the important
factors affecting the QOL of elderly people (Pinquart & Sorensen,
2000; Sparks, Zehr & Painter, 2004). Furthermore, sufficient
economic resources, personal houses, and suitable physical
environment are other factors affecting QOL (Knesebeck, Wah-
rendorf, Hyde, & Siegrist, 2007; Low and Molzahn, 2007).
Dragomirecka et al. (2008) showed that the most important factor
affecting the QOL of elderly people was depressive emotional
status. In another study reported that the factors affecting QOL
were health status, economic status and the meaning of life (Low &
Molzahn, 2007). Robinson and Molzahn (2007) stated that the
most important factors, which explain the difference in the QOL of
elderly people, are personal relations, health status, and sexual
activity.
QOL requires a critical consideration in both national and
international healthcare policies and decisions in each country.
Therefore, it is important to determine and analyse factors
influencing QOL in this study population. Relatively, few
researches had examined the QOL of older adults across cultures
and countries. Majority of the recent QOL studies of older adults
have focused on the instrument of validation and/or of cultural
adaptation (Paskulin & Molzahn, 2007). A number of studies have
used the WHO Quality of Life Assessment for Older Adults
(WHOQOL-OLD) assessments with community-dwelling Turkish
older people. It is important to understand the determinants of
QOL of various subgroups of older adults to support the evidence-
based policy guidelines, the program development and the policy
decisions in the Turkish health and social systems.
Therefore, the purpose of this research was to determine the
QOL and the factors affecting QOL of a group of elderly people
living in their own homes in Ankara, Turkey.
2. Methods
2.1. Study design
The current study is a cross-sectional study of the QOL of older
adults and factors influencing life quality. A survey approach was
used for data collection.
2.2. Sample and data collection
The study was conducted among 300 community-dwelling
elderly people aged 60 years and over. A door-to-door household
survey of elderly adults from a large metropolitan area of central
Turkey was utilized for data collection. Fifty out of the one hundred
and twenty district streets were randomly selected; with 10
elderly people living on each street by random selection, the side
and section of each street were sought. The selected participants
were interviewed. Forty-eight refused to participate; 22 elderly
adults were unable to respond to the interview questions, while a
response rate of 76.6% were collated.
The study inclusion criteria were as follows: individuals
performing activities of daily living independently, capable of
communication and social activity, capable of reading and writing
in Turkish and volunteering to participate in the study. One of the
criteria for participating in the survey was being at or over 60 years
of age. The reason for choosing the age of 60 is that most of the
surveys and studies have been applied on the elderly at or over the
age of 60 (Chachamovich, Fleck, Trentini, & Power, 2008;
Halvorsrud, Kalfoss, & Diseth, 2008; Heydari, Khani, & Shahhos-
seini, 2012; Low and Molzahn, 2007; Lucas-Carrasco, Laidlaw, &
Power, 2011; Paskulin & Molzahn, 2007; Top, Eris, & Kabalcıoglu,
2012).
2.3. Measurements
The data were collected using the personal information form,
which consist of descriptive information about the older adult and
WHOQOL-OLD Turkish used to evaluate their QOL.
The personal information form was designed as a document
consisting of 18 questions about the older adult’s socio-demo-
graphical background (such as age, gender, health status, educa-
tion level, marital status and income). They were asked whether
they had illness or had not assessed their health status; those that
declared a history of illness were regarded as having illnesses. In
the case of economic status, they were asked whether they had an
income or not; if they had, then they were asked whether this
income was sufficient for them to meet their needs. In the end, the
economic difficulty status of the elderly people was classified as
follows: None/Little, Moderate, Much/Extreme.
To determine the QOL of the elderly people, the WHOQOL-OLD
Turkish version was used. The WHOQOL-OLD Scale of Life Quality,
developed by the World Health Organization, a new instrument
recently developed and tested in 22 countries. This instrument is
an add-on module for the WHOQOL measures to be used for older
adults (Power et al., 2005). Among the 22 study centers, the
Turkish (Izmir) Centre simultaneously developed the Turkish
version of the scale. The WHOQOL-OLD is the first generic QOL
measure for the elderly developed in Turkey. A Turkish validity and
reliability study of the WHOQOL-OLD Scale of Life Quality was
conducted by Eser et al. (2010). The WHOQOL-OLD Module
consists of 24 items and a 5-point Likert-type scale assigned to six
facets: sensory abilities (items 1, 2, 10, and 20); autonomy (items 3,
4, 5, and 11); past, present, and future activities (items 12, 13, 15,
and 19); social participation (items 14, 16, 17, and 18); death and
dying (items 6, 7, 8, and 9); and intimacy (items 21, 22, 23, and 24).
Possible facet scores range from 4 to 20. A total score can also be
calculated by adding each of the individual item values. Higher
scores indicate higher QOL.
In the case of Sensory Abilities questions assessed the effects of
visual, auditory, sensory, and taste and appetite changes on the
quality of life were assessed. Autonomy questions examined
independence, respect, general control over life, ability to make
free decisions, and the effects of these factors on QOL. In the case of
Past-Present-and-Future Activities, successes achieved in the
past and satisfaction with these successes, recollections of the past,
and feelings and opinions about the future were analyzed. In the
case of Social Participation, opinions about the use of time and the
state of taking part in crucial activities were examined. In the case
of Death-and-Dying, opinions about the acceptance of death, its
inevitability, and its meaning were questioned. Finally, in the case
of Intimacy, relationship with other people and social support
were examined.
Eser et al. (2010) reported that Alpha values for the facets and
the overall scale (range: 0.68–0.88) (>0.70), and the item total
 N. Bilgili, F. Arpacı / Archives of Gerontology and Geriatrics 59 (2014) 415–421 417

correlations and the overall scale success were satisfactory. As a
measure of the construct validity of the scale, confirmatory factor
analysis showed very high comparative fit index (CFI) values
(range: 0.936–0.999) for each of the domains (Eser et al., 2010). The
Chronbach’s alpha values calculated for reliability were 0.48 for
sensory faculties, 0.78 for autonomy, 0.76 for past-present-and-
future activities, 0.81 for social participation, 0.88 for death-and-
dying, and 0.88 for intimacy. The alpha value of the reliability
coefficient for the overall scale structure was found to be 0.69.
2.4. Ethical consideration
Ethical approval was obtained from the ethical committee by
Gazi University Institutional Review Board committee overseeing
the project. Participation was voluntary. All respondents were
informed about the purpose of the study, and their oral consent
was obtained before initiating the interview.
2.5. Data analysis
ANOVA was conducted to detect age, education, living
arrangement and financial difficulties differences on quality of
life. Scheffe test was used for post hoc comparisons. In addition,
gender, marital status, childbearing, social security, and history of
the present illness differences were analysed using t test.
The correlation between sub-scale scores of the WHOQOL-OLD
Turkish version and age, education, living arrangement, financial
difficulties was analyzed by Pearson Product Moment Correlation
coefficient.
3. Results
3.1. Demographic characteristics of study participants
The participants included were approximately equal numbers
of men and women. The mean age of the participants was
68.35  5.80 years, and 67.3% of the elderly people were graduates of
a primary school or had lower education. Nearly half of them (49.3%)
were married. Among these participants, 74.3% had an illness. The
majority of the elderly people (92.0%) had children, and 29.4% were
living alone. In addition, 90% of the elderly people had their own
income, and 42.3% perceived their income as being moderate
(Table 1).
An examination of the state of the elderly people dependency in
daily activities shows that 29.3% were partially dependent on
doing housework, whereas 12.7% were partially dependent on
activities outside the home (e.g., arranging personal travel and
shopping); 14.3% were partially capable of dispensing their
medication, while 7.3% were completely not capable of dispensing
their medication.
3.2. Quality of life and factors affecting quality of life of the elderly
people
Table 2 shows the mean values of the sub-scales scores of the
WHOQOL-OLD. The mean values of the sub-scales scores of the
WHOQOL-OLD were as follows: sensory abilities – 10.78  2.63;
autonomy – 13.73  2.80; past, present, and future activities –
13.25  2.92; social participation – 12.61  3.13; death and dying –
14.74  2.92; and intimacy – 11.36  4.22. Death-and-dying sub-
scales had the highest mean; while sensory abilities had the lowest
sub-scales score, followed by intimacy.
Table 3 compares the demographic characteristics of the elderly
people with the main areas of WHOQOL-OLD. Elderly men had
higher average scores in the sub-scales of sensory abilities,
autonomy, past-present-and-future activities, social participation,
and death-and-dying, whereas elderly women had higher average
scores in the intimacy sub-scales and total average score. An
examination of the effect of gender variables on sub-scales shows
the difference in the sub-scales of autonomy (t = 4.67; p < 0.01),
past-present-and-future activities (t = 2.29; p < 0.05), and inti-
macy (t = 3.96; p < 0.01) to be statistically significant.
When the relationship between marital status and the QOL of
the elderly people was examined, married elderly people had
higher scores in the sub-scales of autonomy, past-present-and-
future activities, social participation, and death-and-dying, where-
as unmarried elderly people had higher scores in the sub-scales of
sensory abilities and intimacy. A significant differences between
marital status and mean scores of the sub-scales of past-present-
and-future activities (t = 2.36; p < 0.05), social participation
(t = 2.57; p < 0.05), and death-and-dying (t = 2.00; p < 0.05)
were found. The total score shows that married elderly people had
higher scores, and there were significant differences found
between the groups (t = 2.03; p < 0.05).
In the case of the differences between elderly people having a
child and quality of life, it was seen that the elderly people having

Table 1
Demographic characteristics of study participants (N = 300).
n % n %
Gender Having a child
Female 145 48.3 Yes 276 92.0
Male 155 51.7 No 24 8.0
Age (year) Number of Children (n = 276)
60–65 94 31.3 3 142 53.3
66–74 172 57.4 4 72 26.0
75 34 11.3 5 57 20.7
Education Living arrangement
Primary school or less (5 years or less) 202 67.3 Spouse 112 37.3
Secondary school (8 years) 65 21.7 Spouse and children 100 33.3
High school (11 years) 33 11.0 Alone 88 29.4
Marital status Income
Married 148 49.3 Yes 270 90.0
Single + widow/widower 152 50.7 No 30 10.0
Duration of marriage (year) Financial difficulties (n = 270)
40 63 42.6 None/little 144 53.3
41–50 59 39.8 Moderate 114 42.3
51 26 17.6 Much/extreme 12 4.4
Present Presence of chronic illness Social security
Yes 223 74.3 Yes 288 96.0
No 77 25.7 No 12 4.0
418 N. Bilgili, F. Arpacı / Archives of Gerontology and Geriatrics 59 (2014) 415–421

Table 2
Distribution of the mean scores on the WHOQOL-OLD Turkish (N = 300).

Sub-scales Minimum Maximum Mean Median Standard deviation

Sensory abilities 5.00 18.00 10.78 11.00 2.63

Autonomy 4.00 20.00 13.73 14.00 2.80
Past-present-and-future activities 4.00 20.00 13.25 13.00 2.92
Social participation 4.00 20.00 12.61 12.00 3.13
Death-and-dying 5.00 20.00 14.74 16.00 2.92
Intimacy 4.00 20.00 11.36 11.00 4.22
Total scores 50.00 103.00 75.79 75.79 8.52

WHOQOL-OLD Turkish: Turkish version of the World Health Organization Quality of Life Instrument-Older Adults Module.

a child had higher scores in the sub-scales of sensory abilities and
death-and-dying; while elderly people without a child had higher
scores in other sub-scales. Considering the QOL and the state of
having social security, the elderly people with social security had
higher scores in the sub-scales of autonomy (t = 3.39; p < 0.01),
past-today-and-future activities (t = 3.06; p < 0.01), social partici-
pation (t = 1.98; p < 0.05), and death-and-dying (t = 4.23;
p < 0.01). The difference between the groups was statistically
significant. The total score showed that the elderly people with
social security had higher scores. The difference between the
groups was significant (t = 3.54; p < 0.01).
The elderly people with diseases had higher scores in the sub-
scales of sensory abilities, and there was a significant difference
between the groups (t = 4.46; p < 0.01). The elderly people without
disease had higher scores in the sub-scales of autonomy (t = 2.96;
p < 0.01), past-today-and-future activities (t = 3.51; p < 0.01),
and social participation (t = 7.26; p < 0.01). The difference
between the groups was also statistically significant. A statistically
significant difference was found between the average total score of
quality of life and the state of having a disease (t = 4.20; p < 0.01).
ANOVA showed age significant differences only in sensory
abilities (F = 25.14; p < 0.01), social participation (F = 12.49;
p < 0.01), and intimacy sub-scales (F = 6.68; p < 0.01). Post hoc
Scheffe Test results indicated that elderly people aged 75 years and
over differed from the other age groups in these sub-scales. Their
scores of the social participation and intimacy sub-scales were
lower, but had higher scores in sensory abilities than those aged
60–65 and 66–74 years.
ANOVA yielded significant differences between education
levels of elderly people in sensory abilities (F = 18.84; p < 0.01),
autonomy (F = 15.51; p < 0.01), past-present-and-future activities
(F = 13.58; p < 0.01), social participation (F = 32.89; p < 0.01), and
death-and-dying (F = 3.13; p < 0.05) sub-scales. Scheffe post hoc
comparisons showed that the high school graduate elderly people
were significantly different from the other groups. The autonomy,
past-present-and-future activities, social participation, and death-
and-dying scores of those with high school education were higher
than those with secondary school or less education except sensory
abilities sub-scale scores.
A differences was found between the variable of with whom the
elderly people lived and of QOL sub-scales of the elderly of sensory
abilities (F = 18.84; p < 0.01), past-today-and-future activities
(F = 3.95; p < 0.05), death-and-dying (F = 6.67; p < 0.01), social
participation (F = 3.31; p < 0.05), and intimacy (F = 4.74; p < 0.01).
There was a difference between the income levels of the elderly
people and the sub-scales of autonomy (F = 16.41; p < 0.01), past-
today-and-future activities (F = 16.21; p < 0.01), social participa-
tion (F = 11.94; p < 0.01), death-and-dying (F = 10.93; p < 0.01),
and intimacy (F = 5.79; p < 0.01). The total average score of the
QOL sub-scales of the elderly people was connected with the
sufficiency of their income (F = 11.77; p < 0.01). Scheffe post hoc
comparisons showed that much/extreme financial difficulties of

Table 3
The comparison of demographic characteristics of the elderly with the sub-scales of WHOQOL-OLD Turkish (N = 300).

Variable Sensory abilities Autonomy Past-present-and-future Social Death-and-dying Intimacy Total scores
activities participation
M  SD M  SD M  SD M  SD M  SD M  SD M  SD

Gender
Female 10.71  2.58 12.97  2.96 12.85  2.94 12.13  3.03 14.47  2.72 12.33  4.10** 75.24  8.39
Male 10.84  2.68 14.44  2.45** 13.62  2.87* 12.20  3.24 15.00  3.09 10.44  4.14 76.30  8.64
t 0.420 4.673 2.294 0.190 1.553 3.969 1.078

Marital status
Married 10.49  2.73 13.87  2.77 13.65  2.87* 12.63  3.15* 15.08  2.78* 11.29  4.05 76.80  8.70*
Single + widow/widower 11.06  2.50 13.59  2.84 12.86  2.93 11.71  3.06 14.41  3.03 11.42  4.39 74.81  825
t 1.890 0.862 2.364 2.576 2.001 0.280 2.030

Having a child
Yes 10.86  2.60 13.65  2.79 13.19  2.89 12.04  3.11 14.68  2.87 11.30  4.16 75.47  8.44
No 9.79  2.81 14.66  2.80 13.87  3.31 13.58  3.16* 15.50  3.50 12.04  4.91 79.54  8.48*
t 1.931 1.697 1.084 2.323 1.315 0.823 2.259

Social security
Yes 10.74  2.66 13.84  2.75** 13.35  2.87** 12.23  3.10* 14.88  2.78** 11.30  4.25 76.14  8.29**
No 11.75  1.71 11.08  2.84 10.75  3.16 10.41  3.60 11.33  4.16 12.66  3.39 67.41  9.95
t 1.299 3.399 3.064 1.982 4.236 1.093 3.542

History of the present illness

Yes 11.17  2.51** 13.45  2.59 12.91  2.63 11.45  2.72 14.56  2.69 11.33  4.22 74.61  7.63**
No 9.66  2.66 14.54  3.24** 14.24  3.48** 14.23  3.34** 15.27  3.48 11.44  4.27 79.22  9.98
t 4.466 2.969 3.517 7.262 1.835 0.196 4.200
*
p < 0.05.
**
p < 0.01.
 N. Bilgili, F. Arpacı / Archives of Gerontology and Geriatrics 59 (2014) 415–421 419

Table 4
Analysis of variance of sub-scales results of WHOQOL-OLD Turkish with age, education, living arrangements, economic status (N = 300).

Variable Sensory Autonomy Past-present-and- Social Death-and-dying Intimacy Total scores

abilities future activities participation
M  SD M  SD M  SD M  SD M  SD M  SD M  SD

Age (yr)
60–65 9.56  2.48 13.64  3.17 13.39  3.34 12.86  3.37 14.39  3.32 12.48  4.41 76.09  9.72
66–74 11.03  2.45 13.85  2.50 13.16  2.73 12.24  2.72 14.94  2.72 11.07  3.96 76.08  8.32
75 12.88  2.23 13.38  3.21 13.29  2.71 9.85  3.40 14.73  2.73 9.67  4.33 73.50  6.57
p 0.000** 0.628 0.834 0.000** 0.346 0.001** 0.249
F 25.147 0.467 0.182 12.495 1.066 6.682 1.395

Education
Primary school or less (5 years or less) 11.37  2.41 13.19  2.70 12.74  2.78 11.31  2.88 14.58  277 11.20  4.21 74.11  8.00
Secondary school (8 years) 9.89  2.64 14.40  2.74 13.75  2.59 13.24  2.46 14.64  3.09 12.27  3.93 78.01  8.31
High school (11 years) 8.93  2.65 15.75  2.41 15.36  3.34 15.24  3.28 15.93  3.33 10.48  4.69 81.72  8.59
p 0.000** 0.000** 0.000** 0.000** 0.045* 0.094 0.000**
F 18.843 15.514 13.582 32.895 3.130 2.388 15.489

Living arrangement
Spouse 10.41  2.75 14.10  2.62 13.83  2.63 12.64  3.01 15.39  2.43 10.92  3.94 77.10  7.94
Spouse and children 11.59  2.53 13.63  2.62 13.06  2.77 11.55  3.09 14.77  2.82 10.83  4.32 75.08  8.40
Alone 10.32  2.39 13.38  3.18 12.72  3.33 12.26  3.24 13.89  3.39 12.51  4.28 74.94  9.23
p 0.001** 0.177 0.020* 0.038* 0.001** 0.009** 0.120
F 7.362 1.740 3.956 3.312 6.670 4.748 2.133

Financial difficulties
None/little 10.36  2.47 14.47  2.56 14.04  2.76 12.98  3.04 15.52  2.58 10.68  4.01 77.86  7.52
Moderate 11.15  2.66 13.35  2.49 12.78  2.60 11.50  2.77 14.00  3.03 11.45  4.21 73.96  8.13
Much/extreme 11.00  3.69 10.25  5.15 9.91  4.01 9.83  3.78 13.41  3.08 14.75  4.37 69.50  10.7
p 0.053 0.000** 0.000** 0.000** 0.000** 0.003** 0.000**
F 2.962 16.415 16.219 11.949 10.930 5.792 11.775
*
p < 0.05.
**
p < 0.01.

the elderly people were significantly different from the other
income groups. The autonomy, past-present-and-future activities,
social participation, and death-and-dying scores of those with
much/extreme financial difficulties were lower than those with the
other income groups except intimacy sub-scale scores (Table 4).
Pearson correlation analysis showed that there was significant
relationship between age and sensory abilities (r = 0.37; p < 0.01).
There were weak and negative relationships between age and
social participation and intimacy scores (r = 0.24, 0.20;
p < 0.01, respectively). In addition, there were weak relationships
between education [r(300) = 0.307; p < 0.01], financial difficulties
[r(300) = 0.284; p < 0.01] and the total average score of the QOL
sub-scales.
4. Discussion
The mean scale score of the elderly people who participated in
the research was 75.79. The average score was similar to those in
the studies conducted by Ozyurt et al. (2007) in Manisa, Top and
Dikmetas (2012), Top et al. (2012), and Ercan (2010) in nursing
homes in Ankara with the same scale. The average score obtained
from the reliability and validity study of the Eser et al. (2010)
WHOQOL-OLD quality of life scale was lower (56.02). In the
present study, the death-and-dying sub-scale had the highest
average score. ‘‘Intimacy’’ in the studies of Ozyurt et al. (2007) and
Top and Dikmetas (2012) and ‘‘sensory abilities’’ in the studies of
Ercan (2010) and Top and Dikmetas (2012) were the sub-scales
that had the highest averages.
When the average score of gender of the elderly people was
compared with their average QOL score, men had higher scores in
all sub-scales except intimacy. The QOL of men was higher than
that of women in most studies using the same scale or different
QOL scales (Arslantas, Metintas, Unsal, & Kalyoncu, 2006; Calıstır,
Dereli, Ayan, & Canturk, 2006; Drageset et al., 2008; Hsu, 2007;
Kaya et al., 2008; Kirchengast & Haslinger, 2008; Ozyurt et al.,
2007). Men have better QOL, which likely stems from the fact that
they are more educated, have more income, are more active in
decision-making than women, and their interaction with the
external environment is much more than that of women. However,
some studies have shown that there is no statistical difference in
the points of life quality of elderly men and women (Bowling,
Banister, Sutton, Evans, & Windsor, 2002; Eser et al., 2010; Power
et al., 2005; Top et al., 2012; Top & Dikmetas, 2012; Wiggins, Higgs,
Hyde, & Blane, 2004).
Married elderly people had higher mean scores in the sub-
scales of autonomy, past-today-and-future activities, social
participation, and death-and-dying, whereas unmarried elderly
had higher mean scores in the sub-scales of sensory abilities and
intimacy. It can be seen from the total score that married elderly
had higher QOL than unmarried elderly (p < 0.05). Life quality of
widowed elderly people was lower, which was similar to the study
of Ozyurt et al. (2007). Alexandre, Cordeiro, and Ramos (2009)
found that marital status affected the quality of life in a study
conducted with WHOQOL-BREF to determine the life quality of the
elderly people in Brazil. Lee, Kom, and Leey (2005) and Heydari
et al. (2012) found that married participants had a higher average
score of QOL than the singles, the divorced, the widows, and the
widowers. The relationship between marital status and QOL could
not be determined in similar studies conducted by Ercan (2010) in
Turkey and Tseng and Wang (2001) in Taiwan to examine the life
quality of the elderly people living in nursing homes.
Social support and variables pertaining to social networks
(family-children and friends) are also important factors related to
the QOL of older adults. The elderly people having a child were
found to have higher mean scores than those without a child in the
sub-scales of sensory abilities and death-and-dying. The elderly
people without a child had higher mean scores in other sub-scales.
Living with family and having children could increase the life
quality of an elderly individual by providing social and psycholog-
ical support. In a meta-analysis, Pinquart and Sorensen (2000)
420 N. Bilgili, F. Arpacı / Archives of Gerontology and Geriatrics 59 (2014) 415–421
examined 286 studies and found a positive relation among the
social status of the elderly people, social relations, competence and
well-being. Similarly, Sparks et al. (2004) found that social
interaction is the only factor that explains life satisfaction when
health status and social status are stable. Chappell (2003) also
found that social support and health contributed significantly to
the variance of subjective QOL.
The present study showed that the elderly people with social
security had higher mean scores in the sub-scales of autonomy
(p < 0.01), the past-today-and-future activities (p < 0.01), social
participation (p < 0.05), and death-and-dying (p < 0.01); in addi-
tion, they had higher average scores in total. It was also found in
the study conducted by Calıstır et al., 2006, using the 14 SF-36 scale
of life quality, that the elderly people with social security had a
higher quality of life; however, could not find any statistically
significant relationship between quality of life and the social
security variance, although the elderly people without social
security had a lower average life quality scores in the studies
conducted by Ercan (2010) using WOQOL-OLD and by Luleci, Hey,
and Subası (2008) using WOQOL-BREF. It might be thought that
having social security could have a positive impact on life quality of
the elderly people since it would facilitate benefiting from health
services.
Health status is an important factor directly affecting QOL.
Health-related life quality includes the individual’s perception of
his/her health status, being active in physical, social and
psychological terms. Studies have shown a significant relationship
between the health status of the elderly and QOL (Cheung, Kwan,
Chan, & Ngan, 2005; Paskulin & Molzahn, 2007; Tseng & Wang,
2001). In the present study, a statistically significant difference was
found between the state of having a disease and the average total
score of life quality. Ozyurt et al. (2007) support the findings of our
study. However, no differences could be found between the
presence of chronic disease and QOL in the studies of Ercan (2010)
and Luleci et al. (2008).
In the present study, it was found that as age increases, the
QOL mean scores decrease. It is a widely known fact that quality
of life points usually decrease as age increases. When elderly
individuals are divided according to age variants such as ‘‘<80’’
and ‘‘80 and higher’’, no difference is found in the dimensions
other than in ‘‘emotional functions’’ and ‘‘death-and-dying’’ (Eser
et al., 2010). This situation may be thought of as people losing
their emotional functions, as they get older and as being closer to
death as they grow older and may be accepted as an expected
result. In the analysis of the results of another study where age
groups are divided into two groups, similar results have been
obtained, implying that emotional functions are lower in higher
ages (Power et al., 2005); Lucas-Carrasco et al. (2011) reported
similar findings. As age increases, life quality decreases; as
determined in the studies conducted by Ercan (2010) and Ozyurt
et al. (2007) using the WOQOL-OLD scale of life quality, and by
Kaya et al. (2008) using the 15 SF-36 scale of life quality. The
mean scores of sensory abilities decrease in line with age, as
indicated in the study of Ercan (2010), and ‘‘past-today-and-
future activities’’ and ‘‘social participation’’ in the study of Ozyurt
et al. (2007).Education is an important indicator that may
directly or indirectly influence QOL through its association with
higher social class and economic status. As the level of education
increases, the quality of life equally increases (p < 0.01). It has
been found that QOL increases with increasing levels of
education; furthermore, the results of the present study is
similar with the results of the studies conducted by Calıstır et al.
(2006) using the SF-36 scale of life quality, Arslantas et al. (2006)
using the WHOQOL-BREF scale of life quality, and Ercan (2010)
using the WOQOL-OLD scale of life quality. Similarly, Lucas-
Carrosco et al. found that the younger group (males) and those
with higher education scored higher than the older group
(females), and those with lower education. However, statistically
significant differences were only found on the level of education.
Lower levels of education have been found to be associated with
lower QOL (Altug, Yagcı, Kitis, Buker, & Cavlak, 2009; Skevington,
Lotfy, O’Connell, & T, 2004). According to Lasheras, Patterson,
Casado, & Fernandez (2001), lower educational level is associated
with unhappiness, poor social relationships, poor self-assessed
health, and sensory problems among the elderly people. Ercan
(2010) showed that the average quality of life points of the
elderly people who were not educated were found to be lower
than those of the other groups. The ‘‘autonomy’’ sub-scales points
of the individuals that had received high school or university
education are higher (Ercan, 2010). Literature findings also
emphasize that social autonomy is a determinant in quality of life
(Borg, Hallberg, & Blomqvist, 2006; Borglin, Jakobsson, Edberg, &
Hallberg, 2006; Constanca, Fonseca, Ignacio, & João, 2003;
Hellstrom, Persson, & Hallberg, 2004).
The income level of the elderly people was found to be
associated with QOL (p < 0.01). Paskulin and Molzahn (2007)
found that having enough money contributed strongly and
independently to QOL. In the study of Knesebeck et al. (2007),
which was conducted to determine the relationship between
socioeconomic status and quality of life, the income factor was
found to be an important determinant. According to the study of
Ercan (2010), autonomy, average of emotional skills sub field
points, and averages of total scores are lower in the elderly people
without a regular income. A strong relationship was found
between the economic status and quality of life of the elderly
people. Elderly people with sufficient income had a higher quality
of life in all the studies conducted with similar or different scales of
quality of life (Ercan, 2010; Knesebeck et al., 2007; Paskulin &
Molzahn, 2007; Tseng & Wang, 2001).
5. Conclusions
In conclusion, the findings of the present study according to the
mean scores of life quality of the elderly people indicate that
the field of death-and-dying had the highest average. The quality of
life in the elderly people was affected by variables such as gender,
age, educational level, marital status, having children, social
security status, health status, income, and with whom they live.
6. Limitations of study
This study was conducted and planned in a city in Turkey; we
used a convenience sample. It is difficult to say with any precision
how representative these results are for a wider population. In this
study, participants were relatively independent, healthy, and
living in their own homes. They do not adequately represent the
wider population, particularly frail elderly people living in
institutional settings. Other limitations include the non-assess-
ment of cognitive impairment, disease severity, and co-morbidity,
which could have impacts on the results.
Although this study provides important findings, which add to
the body of knowledge of QOL among community-dwelling elderly
people, more research is required in different cultures and
geographic regions. Consequently, the authors recommend that
the research model be tested in future studies using a longitudinal
design and with a larger number of participants. Doing so, may
clarify the relationship between the underlying variables and the
QOL of elderly people.
Conflict of interest
The authors declare no conflict of interest.
 N. Bilgili, F. Arpacı / Archives of Gerontology and Geriatrics 59 (2014) 415–421
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