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Quality of life QoL is an important health index for the elderly, necessary for assessing interventions, and prioritising medical and social care needs. As the ageing population in Vietnam continues to increase, understanding important dimensions of QoL for the elderly is essential.

There is a paucity of research in this area, however, and the available literature focuses on functional capacities. The purpose of this article is to explore perceptions on the dimensions of QoL among the elderly in Vietnam, to use these perceptions to broaden the concept, and to explore similarities and differences between those living in urban compared to rural areas. Qualitative methods included in-depth interviews IDI with experts in ageing and elderly persons, as well as focus group discussions FGDs in three communes in Hai Duong province.

NVivo software was used to analyse the data. Thematic analysis identified physical, psychological, social, environmental, religious, and economic as important dimensions of QoL. For elderly participants in both urban and rural areas, physical health, social relations, finances and economics, the physical and social environment, and psychological health were reported as important. Rural participants also identified religious practice as an important dimension of QoL.

In terms of relationships, the elderly in urban areas prioritised those with their children, while the elderly in rural areas focussed their concerns on community relationships and economic conditions. Isolating individual factors that contribute to QoL among the elderly is difficult given the inter-relations and rich cross-linkages between themes.

Elderly participants in urban and rural areas broadly shared perspectives on the themes identified, in particular social relationships, but their experiences diverged around issues surrounding finances and economics, their respective physical and social environments, and the contribution of religious practice.

The study findings may help provide guidance for the development of a socially and culturally relevant instrument for measuring QoL among the elderly in Vietnam. The results will also be useful for developing policies and interventions that are responsive to the needs of the elderly, and reflect the themes perceived to be important.

Vietnam is in the process of social and economic transition. The changes are reflected not only in their rising Gross Domestic Product, but also in almost all aspects of social and economic life 1 , 2.

With its recent economic growth and effective primary health coverage, life expectancy has increased from In order to improve the lives of ageing people in Vietnam there is a pressing need to develop comprehensive policies that cover the aspects identified as important to QoL. The following points summarise the key policy recommendations for the elderly drawn from this study:. National policy promotes the development of inte-grated services by setting out a clear vision with the goals of maximising ageing people's QoL.

Involvement of older people should be modelled in the way in which policy is developed, monitored, and evaluated. National policy supports integrated approaches that are centred on older people in the way in which they are planned and delivered, and in their quality.

This involves supporting innovative approaches that offer choice, flexibility, and control by older people. Resource allocation supports the development of balanced service systems and is not directed to acute health care at the expense of prevention, comprehensive primary, and community services. Additionally, it is necessary to have prioritised policies focussing on the different needs of the elderly, such as improving social activities and connection for urban older people while creating mechanisms to provide economic stability for the rural aged.

However, this growth and associated urbanisation has also been associated with an increase in inequity, with a widening rural—urban income gap, as well as growing disparities related to geographic, social, ethnic, and linguistic isolation 6. Urban migration has been one response to these changes, offering opportunities to redistribute income between rural and urban areas 7 , 8.

On the other hand, however, migration has left the elderly isolated in rural communities without their traditional family support, as the younger generation seeks to take advantage of new opportunities.

Family structures have altered, with shifts in the patterns of interdependence, and the elderly face many challenges in the transition because of changes in social structure and value systems, family structures, and living arrangements 8. The negative synergy between an ageing population and an increasing burden of non-communicable disease has major implications for the health system, for the economy and for the QoL of the aged themselves.

Previous studies have examined health needs, utilisation of health services and counselling for the aged, and the influence of lifestyle factors on health in ageing 9 — While in urban centres, aged care facilities are now being promoted as an innovative alternative to direct support from the family, options for the elderly living in rural areas are limited, with most currently unable to access health care insurance, and dependent on basic state primary health care facilities QoL is an important health index for the elderly in every country, playing a key role in assessing interventions, and establishing essential medical and social care needs for the ageing population.

With increasing aged populations in most developed countries, understanding QoL of the aged has become a particular area of interest.

However, research in the Vietnamese context is currently lacking, though the traditional sayings included in the headings of this article suggest that there is a long history of observation of issues of ageing, relationships, and perspectives on living that inform local debate.

Although the sense of psychological well-being is increasingly seen as influencing self-perception of health, much of the existing research on QoL among the Vietnamese elderly has focussed on the contribution of functional capacity to health. More recently however, there has been some emerging literature addressing the broader concepts of QoL among the elderly in Vietnam 16 — Exploring socio-economic determinants of health, two studies conducted in examined the association between health-related quality of life HRQoL and socio-economic factors among elderly rural populations in Vietnam 16 , While these studies used different tools to assess QoL, the results were similar, with both finding inequalities in health status and QoL, specifically noting age, being female, and poor household economic status as being determinants of poor HRQoL.

While the results of these recent studies underscore the role of culture and socio-ecological context in influencing health and QoL among the elderly, a deeper understanding of the dimensions of QoL as a function of the local social and cultural realities specific to Vietnam is still needed.

This article describes research undertaken to explore the important dimensions of QoL that reflect the culture, life-experience, and views of the rural and urban elderly in Hai Duong province, Vietnam.

The study was conducted in Hai Duong province about 60 km Northeast of Hanoi. Socio-economic development and urbanisation processes are similar to that of other Red River Delta provinces in the North of Vietnam The study employed qualitative methods to explore and compare the dimensions of QoL for urban and rural dwelling elderly Vietnamese. In the first stage, key informant IDIs were undertaken with five Hanoi-based experts in ageing to seek their opinions on the QoL for the aged.

Experts included sociologists, geriatricians, demographers, and sexual and psychological counselors for the elderly who had been identified during the literature review process, and were then contacted by email or phone to invite them to participate. During the interview, participants were asked to discuss their knowledge and experience of QoL research in Vietnam, and other countries, as well as the dimensions they perceived to be important and the factors that may serve to influence them.

Mixed gender FGDs were conducted concurrently to broadly explore the general themes identified from the literature and expert IDIs, while the aim of the elderly IDIs was to explore in greater depth and specificity more sensitive issues such as sexuality, finance, and social relationships. Eligibility for both the FGDs and IDIs required participants to be over age 60 years, physically and mentally capable of participating in an approximately one and a half hour interview.

Heads of the Elderly People's Union were contacted by phone, provided with the eligibility criteria, and then asked to identify potential participants. Eligible individuals were then asked by Heads of the Elderly People's Union to attend a meeting, where they were provided with information about the study, and invited to participate in either an IDI or a FGD. As some themes included areas that were at times controversial — particularly in relation to sexuality — use of both IDIs and FGDs provided a mechanism for triangulating the findings.

FGDs and IDIs with elderly people were conducted in a conversational manner by experienced interviewers and were tape-recorded and transcribed in the Vietnamese language. The IDIs and the FGDs included similar questions, which asked the participants to discuss their perception and understanding of the term QoL, as well as its potential dimensions, they were also asked to discuss what would make life better or worse for elderly persons, and to compare how gender or location would affect how one values QoL.

Transcripts of the elderly IDIs and elderly FGDs were coded using NVivo software by a group of five experienced researchers, with emergent themes not previously flagged for discussion. Selected transcripts were independently re-coded by a second researcher, to ensure consistency between coders.

Reconciliation of codes, including emergent themes, was agreed by consensus of the whole group before all transcripts were finally coded. Thematic analysis revealed a set of six themes of QoL perceived to be most important for the elderly in Vietnam: physical health, social relationships, finance and economics, physical and social environment, psychological health, and religious practice.

These themes along with the sub-themes identified as corresponding with them can be found in Table 1. Descriptions of each theme are provided below, and each of these begins with a Vietnamese idiom, expressions which we found to be consistent with the contents of the particular theme. Informants considered physical health a higher priority than material assets, linking it to harmony within the family and a sense of purposive community engagement.

Access to health services was perceived to be important for maintaining health. Within urban FGDs, concerns for material needs were minimised, with health issues and access to services seen as more important. In one FGD an older man offered a poem, reminiscing on a life well spent, and the importance of a peaceful soul and a settled mind.

But health within the family also means harmony and the maintenance of tradition, important in a society still influenced by Confucian values 1 : I care firstly about my family, secondly about keeping family tradition. Good health for the elderly was understood by informants to be purposive, the key to their continued usefulness and engagement in rural society. It allows them to remain part of the community, keeping their garden, picking up the grandchildren, and doing the housework.

Key informant interviews with experts tended to reflect their focus on the clinical, with arthritis and muscle pain, prostate disease, nocturia, and bladder control identified as key issues affecting QoL. Problems with seeing and hearing were recognised as impacting on social interactions and compromising the confidence of the elderly in engaging in community activities. Experts acknowledged that disease and disability were often accepted by the elderly as a natural part of aging — and not seen to be negatively affecting life.

The analysis of the social dimension showed the largest disparity in opinion between the elderly informants in both urban and rural areas and experts. Within FGDs, in contrast to expert IDIs, discussion around the theme of social relationships revealed quite prescriptive marital and filial relationships, with clear expectations around roles, and pleasure found for the elderly in the successful lives of their children and in their sense of connectedness to their communities and ancestors.

Elderly IDIs gave insight into the tensions between social expectations and the personal experience of individuals coping with the compromises demanded by social change, and in particular the impact of rural—urban migration of the more economically productive family members.

The issue of sexuality divided opinions. The experts — largely clinically oriented geriatricians — insisted that continuing sexual activity is a key element of QoL for the elderly.

All groups saw these inter-generational relationships as crucial to QoL. When urban participants in the research raised issues related to sexual activity in the elderly, it was to indicate the inappropriateness of the idea. In one case, the opposition mixed implicit concern around the appropriateness of a widowed parent's intention to re-marry a younger woman — with clear sexual implications — and the explicit financial risks to his children's inheritance, with them insisting that he reimburse them for the value of their shared home if he was to re-marry.

In another, there are clear prescriptions for what is expected of the elderly — even by their siblings:. I have a brother in Hanoi who calls me continuously asking me to find him a woman who is hard-working and honest for him to marry. Your children are all grown up, and you should be a mirror for them to look in and a strong shoulder for them to lean on.

Older people indicated that they want to live close to their children but not necessarily together. Increasingly, they may live together but not eat together — keeping their own kitchen to accommodate different diets, and more independent living — though sharing meals reasonably regularly.

Some multi-generational households persist, though less than in rural areas. Most confronting was the refusal to accept the obligation to care for elderly parents:. In our day, people always cared for each other regardless of whether they were poor or rich, but now, they do not.

They only feel responsible for their own immediate [nuclear] family, not thinking of their parents. Did you have to feed your father when you were my age? With increasing age, strong traditional desires for a son and grandson to continue the family line are often expressed. The issue of sexual activity in the elderly was downplayed in rural interviews and discussions; if anything, this was considered more of an issue in urban areas, linked to a loss of culture:.

In the city, their way of living seems to be westernised. In the rural, we think sexual life is not necessary at this age. What important now is how to live healthy and merry. Old people should live pure, should go to pagoda 2 to pray for their children and grandchildren. The relationships between elderly parents and their children and grandchildren were seen to be of prime importance for both urban and rural informants. Given the more limited cash economy in rural areas, there was less discussion of how this was expressed financially — more in terms of respect, physical assistance, the links to grandchildren and the need for contact between generations.

With closer living more common in rural contexts, tensions in the relationships with sons or daughters-in-law were raised here. But this comfort in living is dependent on harmony within the household, with harmonious relationships between elderly parents creating a positive environment for their children. In contrast, the changing socio-economic environment brings uncertainty — particularly where children migrate to urban centres and are open to the corrupting influences of modern life.

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Quality of life QoL is an important health index for the elderly, necessary for assessing interventions, and prioritising medical and social care needs. As the ageing population in Vietnam continues to increase, understanding important dimensions of QoL for the elderly is essential. There is a paucity of research in this area, however, and the available literature focuses on functional capacities.

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Exploring quality of life among the elderly in Hai Duong province, Vietnam: a rural–urban dialogue

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