SOCIAL DETERMINANTS OF HEALTH RELATED TO THE QUALITY OF LIFE AMONG THE ELDERLY IN DEVELOPING COUNTRY (STUDY IN CENTRAL JAVA, INDONESIA) ANIK LESTARI 1 *, BHISMA MURTI 2 , SAPJA ANANTANYU 1 , DIFFAH HANIM 3 1 Doctoral Program in Health Promotion and Community Development, Sebelas Maret University, Surakarta, Indonesia, 2 Masters Program in Public Health, Sebelas Maret University, Surakarta, Indonesia, 3 Masters Program in Nutrition, Sebelas Maret University, Surakarta, Indonesia. Email: leslietarinick@yahoo.com Received: 12 December 2018, Revised and Accepted: 12 January 2019 ABSTRACT Objective: This study aimed to analyze the influence of social determinants of health on the quality of life (QOL) of the elderly. Methods: This quantitative study was cross-sectional design conducted in Surakarta City and three Regencies, Central Java Province from January to March 2017. Multi-stage random sampling was chosen as a sampling technic to determine locally integrated health services (Posyandu Lansia) which used as a place for taking data. Incidental sampling was used to determine elder people as subjects at Posyandu Lansia. There were 224 elder people selected as subjects. The dependent variable is QOL of the elderly. The independent variables are age, education, income, behaviour, family support, peer support, and support of Posyandu Lansia (integrated health service post of the elderly). Data were collected using questionnaires and analyzed using path analysis. Results: Descriptive results showed that the mean age of participants was 65.21 y ±9.89, the mean income was IDR 876.420 ± 125.267. The analytic results showed that QOL of the elderly was positively correlated with education ≥ senior high school (b=0.43, SE=0.43, p=0.668), income ≥Rp 876.420 per month (b=0.92; SE<0.001; p=0.357), positive behaviour (b=2.07; SE=0.18; p=0.039), and peer support (b=7.35; SE=0.22; p<0.001). QOL of the elderly showed a negative relationship with age (b=-1.06; SE=0.05; p=0.290). Conclusion: QOL of the elderly increases with increasing levels of education, income, positive behaviour, and peer support. QOL of the elderly decreases with increasing age. Keywords: Quality of life, Age, Education, Income, Peer support, Locus of control, Elderly. INTRODUCTION Recently, many countries in the world have successful increased life expectancy of their population which leads to change the structure and characteristics of the world population. In recent years, one- tenth of world population is occupied by elder people. By 2050, the proportion of elder people will increase five-tenth of the total world population. However, the quality of life (QOL) will decline while the individual age increases. Nowadays, there is still a big difference in QOL of elder people between developed and developing countries. In developed countries, the number of elder people has closely reached to five-tenth of total population and they are still active, healthy, and productive. These conditions are opposite with elder people who live in developing countries. It has increased incidence and prevalence of metabolic and degenerative diseases [1]. Therefore, the elder people tend to have degenerative diseases which lead to inactive, unhealthy, and unproductive depending on other people. In theory, QOL is the individual’s perception which is based on biological, psychological, and social aspects. According to the WHO (2007), QOL is defined as objective, expectation, standard, and concern of people lives in their cultural and social value contexts [2]. While, in a book of “Measuring QOL WHO-QOL,” the definition of QOL includes interaction between internal and external factors such as individual physical health, psychological condition, level of freedom, social relationships, personal beliefs, and its relationship to the environment [3]. For the QOL in elder people, it can be defined as the ability to perform daily activities and to have freedom and functional conditions [4]. One study conducted in elder people stated that the determinants of QOL were having good social relationships such as maintaining social activities and a role in society. In addition, the elder people had better health and mobility and had enough money to meet their basic needs. They were able to live in a home and surrounding environment that were given pleasure, freedom, safe, and friendly and had access to local facilities including transportation [5]. Another study reported that Japanese elder people who had higher education had better health behavior, compared with their counterpart with lower education. The result of this study also indicated that lower QOL was significantly associated with older age (≥80 years), no pension, chronic diseases, and no health insurance [6]. Based on some studies described above, QOL could be used as an outcome measure of health programs for elder populations. Kai et al. evaluated the relationship between subjective assessment of QOL (“morale scale”) and objective assessments such as active daily activities, work status, and life expectancy. This study conducted at 13.529 elder people who lived in a rural district in Japan, their findings showed that the QOL scale was positively associated with active daily living (ADL) and work status. Factors associated with lower ADL were age, lower instrumental ADL, and joblessness. Therefore, the QOL measurement and the objective variables can be incorporated into an assessment of the health status in the elder people [7]. Social support is very important in the elderly who have multiple chronic diseases and lose their relatives. Social support can be as a social determinant of health in population since this support has not only the effect of individual ability to cope loss of his/her family or relatives but also the capability to keep health of elder people, risk of various diseases, death, and other related risk factors. In recent years, research related to QOL in elder people has been encouraged in some developed countries. However, a few studies have reported integrative factors that affected the QOL in elder people. In contrast with developed countries, there are limited studies which investigate QOL in elder people in developing countries. Therefore, this study aimed to examine social determinants of health related to QOL of the elderly in Indonesia. Research Article Vol 7, Issue 1, 2019 ISSN - 2347-5536