Ageing is a normal, inevitable, biological and universal phenomenon, and it affects every individual irrespective of caste, creed, rich and poor.  Sir James Sterling Ross said “You do not heal old age, you protect it, you promote it and you extend it”.  The ageing population is growing at an unprecedented rate. There are presently 740 million individuals in the world aged 60 years or over, and that number is expected to rise to 1 billion by the end of the present decade and possibly to 2 billion by mid-century.[1] India alone has around 100 million elderly at present, and the number is expected to increase to 323 million, constituting 20 per cent of the total population, by 2050.[2] Longevity has increased significantly in the last few decades mainly due to the socio-economic and health care developments. Elderly are the precious asset of our country.  Quality of life for elder person has become increasingly important as an outcome in public health research. The elderly population presently in India and state of Odisha is 8.6% and 9.5 % respectively. [3]

Life satisfaction (LS) is the way in which people show their emotions, feelings (moods) and how they feel about their directions and options for the future.  It is a measure of well-being assessed in terms of mood, satisfaction with relationships, achieved goals, self-concepts, and self-perceived ability to cope with one's daily life. Life satisfaction involves a favorable attitude towards one's life rather than an assessment of current feelings. Life satisfaction has been measured in relation to economic standing, degree of education, experiences, residence, among many other topics. LS is an important component of successful aging. Level of LS indicates the subjective wellbeing which is associated with the health and mortality status among the elderly. Older people who experienced bad health tend to express low level of LS. However, having higher socioeconomic status, adequate family support, higher level of satisfaction with one’s living environment/condition, and staying in their own home among the elderly population plays a crucial role in achieving successful aging [4, 5]. LS refer to a judgmental process, in which individual access their quality of life (QoL) in accordance with some unique set of criteria’s. Elderly are more sensitive to their LS and health conditions, which is further influenced by their socioeconomic situations, and limited work performance [6, 7]. As per the WHO, four factors which directly influences the level of LS among the elderly are: physical health condition, mental health condition, social relationship and environment [8]. LS is influenced by various factors like demographic, socio-economic, health, physical status, mental status, social support, social adjustment and number of morbidities. LS is a forecaster of longevity and morbidity, disease and injury.

Aims & Objectives: To find out the levels of satisfaction among the elderly and to find out problem faced by elderly in activities of daily life.

Using a cross-sectional study design, a community-based study was conducted from January to March 2018 by Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India; in the rural and urban field practice area of a medical college covering a total population of 54,360 in the rural and 25,000 (slum and non-slum population) in the urban. Ethical clearance was obtained from the ethical committee of the institute, prior to the study

The study population comprised of consenting elderly (>60 years old) residents, of both sexes, who belonged to the rural and urban field practice area, as per following inclusion and exclusion criteria.

Inclusion criteria

• All individuals more than or equal to 60 years of age.
• All elderly who gave informed written consent.

Exclusion criteria-

• Participants who were not in a position or unable to give information due to any reason.

[The deaf/dumb/blind, those with diagnosed psychiatric illness (schizophrenia, mental retardation) or neurological disorders (Parkinsonism, severe head injury, or brain neoplasm), and those who were ill at the time of the study were excluded, as there was no way to obtain reliable information from them.].

Sample Size Calculation: Assuming the health morbidity in elderly persons, 60 year and above as 20% [9] and precision as 5% with level of confidence as 95%, non-response of 10%, to calculate sample size of 270 the following equation was applied [((Z_1-α/2)² p (1-p)) / d²]; p= prevalence= 0.2, d= allowable error of 5%= 0.05 and 1-p = 0.8. [10] From a total of 1982 elderly from urban and 4332 elderly from rural area, 270 each were randomly selected by simple random sampling, making a final sample size of 540.

Sampling Technique: Simple random sampling was used for sample collection. A list of all elderly in the urban and rural field practice area was obtained from respective family survey registers. Line listing of cases satisfying inclusion criteria, after house-to-house visit were made with the help of health worker. Study participants were selected randomly.

Study Tool:  A semi-structured questionnaire having socio- demographic characteristics that included age, sex, education, family type, marital status and income, addiction, utilization of health services, etc was used, which had five sections.

1. Socio-demographic details
2. Awareness regarding existing welfare and social security measures
3. Problems faced by the elderly
4. Satisfaction with life
5. Utilisation of social assistance schemes
6. Challenges faced in utilisation of the schemes.

Satisfied with life questionnaire (SLQ) Questionnaire is a set of fifteen item scale to identify the satisfaction with life. Respondents indicate their degree of agreement with each statement on a seven-point scale, with 7 =Strongly agree, 6=Agree, 5=Slightly Agree, 4 = Neither agree nor disagree, 3=Slightly Disagree, 2= Disagree and 1= Strongly disagree. [11] The overall scores were calculated by total of (each scale column multiplied by the scale score) divided by (no of participants multiplied by no of questions and 7).

Data Analysis: Data was entered into Microsoft Excel spreadsheet and analyzed using Epi Info 7 software [version 3.5.4]. Descriptive statistics with appropriate statistical methods like percentage, student’s t- test, chi square test was used; taking a p value of< 0.05 as statistically significant.

This community-based cross-sectional study was done amongst the rural and urban elderly population of the field practice area of a medical college, to find out the differences in their awareness and utilisation of the existing social security schemes and enlist the challenges faced by them. Among the 540 sampled elderly people, the mean age of the study participants was 70.25±7.11 years in urban while 72.70 ± 7.84 years in rural.  Maximum (54.44%) belonged to 60-69 years age group in the urban while 53.33% belonged to the 70-79 years age group in the rural area; 54.26% were males, with males (61.11%) outnumbering the females in rural areas; 90.56% were Hindus (Table 1). 56.3% of the urban and 76.30% of the rural sampled participants were literates.

Table-2 and Table-3, describes factors attributing to life satisfaction of rural and urban study participants respectively. Table-5 illustrates the overall satisfaction level of the total study population. The LS level of overall, rural and urban participants is 73.50%, 74.23% and 72.77% respectively (Fig-1). The participants who agreed or strongly agreed on the 15 queries on LS were high at 63.38%, 65.24% and 64.31 for urban, rural and overall participants.

In our study, the number of males (61.11%) in rural population were more compared to females (38.39%) while in urban population females (52.59%) outnumbered males. In a study by Syed Qadri et al in rural population of Ambala District of Punjab, India the female and male population were almost equal.[9] Whereas in another study by Mohd Maroof et al, amongst the rural Uttar Pradesh population the number of elderly females were more than elderly males.[12] These differences can be explained due to the different geographical areas of study and life expectancy of that population. In a study by Saravanan et al amongst urban Puducherry people similar findings were found with more females (70.24%) than males.[13]

Out of the total subjects, in rural maximum (53.33%) were in the age group of 70-79 years. While in other studies maximum population were in the age group of 60-69 years. [9,14] In our study in urban population 147(54.44%) were in the age group of 60-69 years; similar findings were seen in a study by Joseph et al in urban Mangalore.[15] In our study, majority of the subjects were married (61.1% in rural and 65.19% in urban). Similar results were also seen in other studies. [9,12,14,15]

In their study by Banjare et al Factors analyzed factors  associated with the life satisfaction amongst the rural elderly in Odisha, India on the basis of hypothesis H1: Elderly having better cognitive health are having better LS, H2: Elderly having good social support are having better LS and H3: Elderly having no morbidities are having better LS.[16] Their study further showed that a) cognitive health was the most influential factor in determining LS among both men and women. Individual’s social support also plays an influential role in LS among rural elderly b) elderly who are living alone and have any sort of disability and had low score of activities of daily living (ADL) have also reported significantly lower perceived LS for both the genders.

Raj et al in their study observed that An overwhelming majority (61.45%) of elderly had an average quality of life, where as 24.10% and 14.45% elderly had a poor and good quality of life respectively.[17] Their study It also revealed that majority of elderly had an average quality of life quality of life. There is an urgent need of social protection in form of assuring old age pension and compulsory health insurance.

The life satisfaction level was 74.23% in rural, 72.77% in urban and 73.50% in the total population under our study. The study shows despite low-income levels in rural areas, the life satisfaction level is higher than urban areas because of lower level of wants & needs in rural areas, better environment in rural areas and now-a-days availability heath care facilities to rural areas.

Life satisfaction level in rural area is more than urban area. Level of satisfaction lies between 70-80% which needs to be improved substantially and therefore all out efforts to be made by Government to augment social security schemes for elderly.

Limitation of the study: the study being conducted in a single district of Odisha; results may not be generalizable to the whole state.

Relevance of the study: Odisha faces the unique challenge of modernization and population ageing with a significant proportion of its ageing population either economically dependent or in poverty. LS is an important indicator of nature of life of elderly and this is the first such study to compare the LS level which is calculated empirically for rural and urban areas.

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