DISSERTATION QUALITY OF LIFE OF THE OLDEST OLD A CASE STUDY OF NONAGENARIANS IN THAI SOCIETY angestrebter akademischer Grad Doktor der Naturwissenschaften (Dr. rer.nat.) Verfasser: Mag. Kanvee Viwatpanich Matrikel-Nummer: a0409574 Dissertationsgebiet (lt. Studienblatt): Anthropologie Betreuer: Univ.-Prof. Dr. Harald Wilfing Wien, Oktober 2008 1 To Viwatpanich’s Family 2 An afternoon to find the research conclusion with my co-supervisor (Dr. Clemens Mayrhofer- Grünbühel) Café Merkur, Florianigasse, Vienna, Austria January 29, 2008 3 ACKNOWLEDGEMENT Throughout the several years (October 2005 – October 2008) of carrying out my Ph.D., I have received supports, guidance and encouragements from numerous people. From these persons, I have to acknowledge them for their kindness. First of all, I would like to express my most appreciate and heartfelt thanks to my supervisors Prof. Dr. Harald Wilfing, Prof. Dr. Karl Husa, Dr. Clemens Mayrhofer -Grünbühel and Dr. Ulrike Bechtold for their supports and challenged me to find my own answers to my questions, and generously offered their excellent recommendations. Without their tremendous guidelines and supervision, it was not possible for me to complete this work successfully. Importantly, I would say that I had own the huge debt to Prof. Dr. Somboon Kietinun, the first person who believes in my ability to study doctoral degree and reinforcing me to go abroad. Without her inspiration and supports, the fulfillments of this work also could not be possible. I do recognize the Faculty of Medicine, Thammasat University for the doctoral scholarship and providing the two round trips of air tickets to Thailand for my fieldwork. Additionally, I never forgot to mention to all my colleagues in Department of Community and Family Medicine for their benevolence to take responsibilities all my classes and lectures. They work so hard instead of me during the four years of my study in Austria, thank you very much. However, this dissertation would not have been possible without the information, time, and co-operation of the people in Mae Sariang district. I am deeply indebted to all my respondents and their families for spent days and times with me, opening themselves, telling their stories, showing their secrets, sharing their experiences, and explaining their problems. It is not only opened me a new chapter of my life, but also gave me an inspiration what to do for the next future in the area of gerontological anthropology. A special place in my heart is reserved for my new family, which I found them at the beginning of my fieldwork, Khun Kru Junta Suksomchit and her family who broad-mindedly accepted me into their home and shared their everyday life with me. I also wanted to convey my regards to the staffs from Social and Development Unit 43, in Mae Sariang district. Especially, Phee Nho-Gu and Phee Sriwan, my closed friends who provided me a motorcycle and gave their hands all the time when I asked for help. These things made me completely forgot the loneliness when I lived in Mae Sariang. 4 Most importantly, I am indebted to my respected father and mother who brought me up with freedom of thought and believe, without coercions and any forces, especially, on the way of thinking in my education improvement. Thank you to give me all the time the family power, which this feeling I can touch wherever I be. Above-all, this success is not only for me, but also goes to others Viwatpanich family members. Thanks that all of you never neglecting me to ask “How are you?” when we met, even on MSN, Webcam, or Oversea calls. In addition, some part of my life in Vienna is more colorful because of “Eufa & Lega” my lovely nephew and niece, thanks kids for bring me sunshine in the cold Viennese winter-days. Last but not least, I would love to say thank you to all Thai students and Thai people here in Vienna, who helped me in one way or another. Thanks that all you are here, I could not imagine how my life would be if without all of you. Learning the new world, sharing the good and bad times, and making or eating Thai food together were meant a lot to me. I really hope to meet you again in our lovely home country. Please remember that Thailand is waiting us for more development. Please do not be jealous her, my special thank is given to “Ta”, the small Thai lady student who was helping me since the first day I arrived Vienna until the last day when she back to Thailand. Moreover, without my best FARANG friends, “Erwin and Saadia”, this dissertation would also not be possible, thank you very really much that both of you help me to prove and correct my simple English into academic sentences. Finally, if it possible, I would like to offer all values and merits which can be found from this dissertation to all my teachers and the nonagenarian respondents, who already passed away before this dissertation has been completed and do not have an opportunity to perceive on my success. I really hope all you recognize by yourself that I can use “Dr.” in front of my name and have this great day because of your mercy. Thank you very much, my beloved people, may all you rest in peace. 5 ABSTRACT To study the quality of life of the oldest old, the objectives are threefold, first is to investigate factors affected to the increasing number of the elderly in Thai society, second is to explore life situation and quality of life of the oldest old in Thai society and finally is to explain the residential and gender differences in quality of life of the oldest old. The six months of anthropological fieldwork was occurred in Mae Sariang district, Mae Hong Son province. The 35 cases of nonagenarian (90-99 years old) are the respondent for this research. The first objective; the 14 possible factors which are related to the longevity are explained. The correlation between the increasing number in proportion to the aging people in Thai society and 14 possible factors were tested. The research illustrates that improving hygienic toilet, drug consumption, numbers of doctors, crude death rate, and numbers of professional nurses are statistically significant correlated at the 0.01 level. While improving the poverty, literacy rate, and decreased smoking are statistically significant correlated at the 0.05 level. The second objective; according to the six domains of active aging framework which is providing by World Health Organization (health condition, behavioral determinant, psychological health, physical environment, social condition, and economic well being), the study illustrates that 55.2% the respondents are associated of active aging at fair level, 28.1% are good and approximate 16.7% are at poor level. Moreover, to identify the most important components of the responses to the 23 factors about active aging, an exploratory factor analysis ware carried out. They are family and social security, psycho-economic well- being, enjoy of life, food consumption, subjective health, accidental risk, physical ability and medical accessibility, and objective health. The third objective, the study found that there are no statistically significant differences between males and females in the six domains of active aging. While at the social conditions there are statistically significant differences between urban and rural areas. This means the urban nonagenarians are more enjoying with their family members, receiving visits, social contact and support as well as more freedom from domestic violence. 6 Zusammenfassung Für das Studium der Lebensqualität der ältesten Bevölkerungsschicht ist das Forschungsziel dreigeteilt. Zum Ersten muss man die stetig ansteigende Bevölkerungszahl der Älteren in Thailand berücksichtigen, zweitens muss man die Lebensqualität und Situation der Ältesten in der thailändischen Gesellschaft untersuchen, und drittens wären noch die Differenzen bezüglich des Wohnstandortes und der Genderaspekt zu erklären. Die sechsmonatige Feldforschung fand im Distrikt Mae Sariang, Mae Hong Son Provinz statt. Dort wurden insgesamt 35 Personen im Alter von 90-99 vorgefunden, die für diese Forschungsfrage in Betracht gezogen werden konnten. Im ersten Forschungsziel werden 14 Faktoren, die im Zusammenhang mit der Langlebigkeit stehen, erläutert und erklärt. Die Korrelation zwischen der ansteigenden Zahl in Proportion zu dem steigenden Alter der Bevölkerung in der thailändischen Gesellschaft und diese 14 Faktoren wurden getestet. Diese Forschung verdeutlicht, dass Verbesserungen in der Hygiene, Medikamentenkonsum, Anzahl der Doktoren, (rohe) Sterberate und die Anzahl des professionellen Pflegepersonals statistisch korrelierend sind bei einem Level von 0.01. Verbesserungen in Bezug auf Armut, Alphabetisierungsrate, und Rückgänge im Tabakkonsum hingegen korrelieren signifikant auf einem Level von 0.05. Das zweite Forschungsziel widmet sich den sechs Domänen der Rahmenbedingungen für ein aktives Altern, die von der Welt Gesundheitsorganisation der UNO aufgestellt wurden (Gesundheitszustand, behavioristischen Determinanten, psychologische Gesundheit, physische Umgebung, und ökonomisches Wohlbefinden). Die Studie zeigt, dass 55.2% der Befragten demzufolge sich im angemessen guten Niveau des aktiven Alterns befinden, 28.1% in guten und 16.7% in schlechteren Umständen. Zur Identifizierung der wichtigsten Komponenten der Gesprächspartner, die die 23 Faktoren des aktiven Alterns ausmachen wurde eine erforschende Faktorenanalyse durchgeführt. Diese waren familiäre und soziale Sicherheit, psycho-ökonomisches Wohlbefinden, Lebensfreude, Nahrungsaufnahme, subjektive