Effect of Elderly School Policy on Quality of Life among Thailand’s Senior Citizens: A Propensity Score Matching Approach

Worapath Kratoo; Nuchanad Hounnaklang

doi:10.12688/f1000research.151221.2

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Research Article

Revised

Effect of Elderly School Policy on Quality of Life among Thailand’s Senior Citizens: A Propensity Score Matching Approach

[version 2; peer review: 3 approved]

Worapath Kratoo¹, Nuchanad Hounnaklang ¹

PUBLISHED 31 Mar 2025

Author details Author details

¹ College of Public Health Sciences, Chulalongkorn University, Bangkok, Bangkok, 10330, Thailand

Worapath Kratoo
Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Methodology, Project Administration, Resources, Software, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing

Nuchanad Hounnaklang
Roles: Conceptualization, Formal Analysis, Investigation, Methodology, Project Administration, Software, Supervision, Validation, Visualization, Writing – Review & Editing

OPEN PEER REVIEW

REVIEWER STATUS

Abstract

Background

As Thailand’s population ages, promoting senior citizens’ quality of life (QoL) is crucial. In 2017, the Ministry of Social Development and Human Security launched the “elderly school” initiative to foster lifelong learning and enhance the QoL among senior citizens. However, comprehensive evaluations of its impact on QoL remain limited.

Methods

This cross-sectional survey aimed to assess the policy’s effect on QoL in Phetchabun province, Thailand. Using quota and systematic sampling, 1,374 senior citizens aged 60-80 participated. Propensity score matching (PSM) with a 1:1 match was employed to estimate the average treatment effect (ATE) of attending the elderly school on QoL. Additionally, multiple linear regression was analyzed to assess the association between QoL and its associated factors.

Results

PSM were matched successfully, the standardized difference was less than 10 percent, and the baseline after matching indicated balances with 687 elderly people in each group. The mean QoL score of the non-attending group was 44.40 (SD = 7.11), and that of the attending group was 57.50 (SD = 7.53). The ATE for elderly people attending school was 10.67 scores (95% CI: 9.67 – 11.67 scores) higher than those unattended. Being female, having monthly income higher than 20,000, having employment, having a caregiver, and attendance at elderly school were positively associated with QoL, and the standardized beta coefficients were 0.078, 0.059, 0.094, 0.066, and 0.550, respectively. Additionally, higher education was positively associated with higher QoL.

Conclusion

The elderly school policy significantly enhanced the QoL of the attending senior citizens. Findings suggest continued collaboration among stakeholders to sustain and optimize this policy for improved seniors’ QoL, which has the potential to utilize lifelong learning to create an inclusive framework for healthy aging among senior citizens.

Keywords

Elderly school, Health policy, Quality of life, Propensity score matching

Corresponding author: Nuchanad Hounnaklang

Competing interests: No competing interests were disclosed.

Grant information: The author(s) declared that no grants were involved in supporting this work.

Copyright: © 2025 Kratoo W and Hounnaklang N. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

How to cite: Kratoo W and Hounnaklang N. Effect of Elderly School Policy on Quality of Life among Thailand’s Senior Citizens: A Propensity Score Matching Approach [version 2; peer review: 3 approved]. F1000Research 2025, 13:735 (https://doi.org/10.12688/f1000research.151221.2) First published: 03 Jul 2024, 13:735 (https://doi.org/10.12688/f1000research.151221.1) Latest published: 31 Mar 2025, 13:735 (https://doi.org/10.12688/f1000research.151221.2)

Revised Amendments from Version 1

This version includes additional details on the sampling technique, a participant flow diagram following the CONSORT guidelines, measurement and an expanded discussion on and policy implications and recommendations. Furthermore, the results in Table 4 have been reorganized for clarity.

See the authors' detailed response to the review by Ueamporn Summart
See the authors' detailed response to the review by Andrew Kweku Conduah
See the authors' detailed response to the review by Aye Sandar Mon

Introduction

A global surge in the elderly population, defined as those aged 60 and above, presents a major challenge and opportunity for healthcare systems worldwide. From 2015 to 2050, the proportion of elders is projected to nearly double, from 12% to 22%¹, with 80% residing in middle-income countries.² This trend is particularly evident in Thailand, where the elderly population is expected to reach 17 million by 2040, exceeding one-quarter of the national total.³^,⁴ This necessitates immediate attention to preparing and evolving healthcare systems to adequately support the QoL of senior citizens.

Thailand, with its rapidly aging population, stands at the forefront of this global challenge. By acknowledging the urgency of the situation and proactively adapting its healthcare systems, Thailand can not only serve as a model for other countries but also ensure the health and QoL of its senior citizens, paving the way for a brighter future for all.⁵^,⁶

The concept of QoL encompasses an individual’s or population’s overall QoL, integrating both positive and negative experiences over a defined timeframe.⁷ The World Health Organization (WHO) defines QoL as an individual’s subjective perception of their life position, influenced by cultural and value systems.⁸^,⁹ This multidimensional concept, as outlined by the WHO, encompasses four key domains: physical health, mental health, social relationships, and the environment.¹⁰ QoL serves as a crucial indicator for achieving Sustainable Development Goals (SDGs), particularly for the elderly population, with relevance to SDG 3: Good Health and Well-being.¹¹

Despite achieving a moderate average QoL amongst senior citizens nationwide, Thailand faces disparities in urban-rural QoL, with literature suggesting consistently lower QoL for rural older adults¹²^–¹⁴ which is similar to Myanmar, and South India¹⁵^,¹⁶ This presents a significant challenge for Lomkao district, Phetchabun province, a rural area boasting a 24.8% elderly population and exhibiting moderate QoL scores for elder residents.¹⁷^,¹⁸ Research points beyond individual characteristics such as age, income, education, and chronic health conditions as sole determinants of QoL for older adults. Living arrangements and social interactions have also emerged as crucial factors deserving consideration in an effort to enhance elderly QoL.¹⁹^–²¹ Therefore, a comprehensive approach addressing both individual and environmental factors is essential to effectively improve QoL for Thailand’s rural elderly population.

In response to the crucial role of health promotion interventions in improving and maintaining QoL for older adults, numerous such programs have been implemented globally.²²^–²⁴ These interventions typically share three core objectives: enhancing functional capacity, promoting self-care behaviours, and preventing or delaying chronic illness onset.²⁵ Implementation often involves collaboration among social welfare organizations, healthcare professionals, and educational systems.²⁶^,²⁷ Thailand exemplifies this trend with the 2017 establishment of the elderly school initiative by the Department of Older Persons, Ministry of Social Development and Human Security.²⁸ This program, grounded in the concepts of awareness, empowerment, and lifelong learning, aims to equip older adults with the knowledge and skills necessary to achieve optimal QoL.²⁹^,³⁰

In 2018, Lomkao district was identified as one of 73 districts in Thailand by the District Health Board for the implementation of specific programs to address the challenges posed by an aging population. Recognizing the district’s demographic shift, the Board selected Lomkao as a priority area due to the prevalence of older adults residing within its boundaries. One of the key initiatives implemented in Lomkao to address this demographic trend is the “Elderly School” program. This program represents a targeted intervention aimed at improving the well-being and QoL for older adults in the district.³¹^,³² As of 2022, Thailand boasts a network of 2,370 elderly schools established through partnerships with local administrative organizations (LAOs), private entities, and community groups.³³ These schools offer a core curriculum encompassing four key modules: health, social, economic, and environmental education, in which the officers invite elderly people in communities to attend through voluntary participation.²⁸^,³⁴^,³⁵ Program adaptations cater to specific regional contexts, aligning with the curriculum framework developed by the Department of Older Persons (DOP), Ministry of Social Development and Human Security. Annual budgetary allocations for elderly school support have ranged from $283,700 to $425,687 USD over the past five years. Notably, the 2021 allocation fell below the minimum due to the COVID-19 pandemic necessitating online instruction in some areas where there is hardly any regular class.³³^,³⁶^–³⁹

Recognizing the program’s value, alternative funding avenues through LAOs, the Community Health Security Fund, and the Thai Health Promotion Foundation have been established to bolster implementation initiatives.⁴⁰ Beyond budgetary considerations, elderly schools demonstrably contribute to active aging, improved QoL, and ongoing learning among senior citizens. They provide valuable social interaction, alleviating loneliness and fostering a sense of community. Moreover, they empower older adults to productively utilize their free time, contributing to a sense of agency and QoL.⁴¹^,⁴²

The establishment of the Elderly School initiative in Thailand in 2017 aimed to address the growing needs of the nation’s aging population. However, despite its implementation across various districts, a comprehensive and dedicated assessment of its impact on senior citizens’ QoL remains elusive. This lack of evaluation presents a significant gap in understanding the effectiveness of the program and its potential for improvement. Existing research has primarily focused on the program’s development and limitations of design, which could not control the influence of covariates. This might lead to a selection bias, leaving a critical gap in understanding its effectiveness.⁴³^–⁴⁶ To address this void, the present study employs PSM to evaluate the initiative’s causal effect on QoL within an aging society. Through PSM, we compare the QoL of two groups: senior citizens not attending and attending elderly schools. This approach facilitates the creation of comparable groups in real-world settings, mimicking an experimental study while mitigating selection bias and strengthening the robustness of regression analyses. In addition, investigating the association between various factors and QoL. Our findings aim to contribute to the existing body of literature, providing valuable guidance for the future implementation and refinement of lifelong learning initiatives for senior citizens in Thailand.

Methods

Research design

This cross-sectional study was conducted in Lomkao, Phetchabun province, Thailand between December 2022 to June 2023.

Sample size

The study population consisted of 11,254 elderly individuals aged 60–80 years in Lomkao district, Phetchabun province, Thailand.¹⁷ The sample size was calculated for the continuous data since this study analyzed multiple linear regression. A pilot test comparing the QoL between elderly individuals who attended and did not attend elderly school indicated a small effect size of 0.02, a power of 0.8, 13 predictors, and a significance level of 0.05.⁴⁷ There are 901 elderly people, with a minimum of 451 participants in each group. Inclusion criteria were 1) age between 60 and 80 years 2) residency in Lomkao, Phetchabun province, for at least one year and 3) literacy and proficiency in Thai communication (listening and speaking). The exclusion criteria focused on individuals with mental health illnesses that include anxiety disorders, mood disorders, and physical disabilities that would significantly impede their ability to participate in the study activities.

Sampling technique

In this study, researchers utilized a combination of quota and systematic sampling techniques. The quota sampling was based on a 1:1 matching model, comparing elderly people who attended an elderly school with those who did not. For systematic sampling, the sampling interval was determined using the formula I = N/n, where “I” represents the sampling interval, “N” is the total population (11,254), and “n” is the sample size (902). This calculation resulted in a sampling interval of approximately 13 (I = 11,254/902 ≈ 12.5 ≅ 13). Therefore, we included every 13th elderly person in the population who met the eligibility criteria. A random starting point between 1 and 13 was selected using a random number generator, and from this random start, every 13th elderly person in the population who met the eligibility criteria was included in the sample.

Figure 1. Participant flow diagram (CONSORT).

Data collection

Data were collected through face-to-face interviews conducted from December 2022 to June 2023. Prior to data collection, the research team, composed of the lead investigator and five experienced healthcare workers in geriatric care, underwent one week comprehensive training. This training covered the study protocol, interview techniques, and participant selection criteria. During data collection, the research team rigorously adhered to inclusion and exclusion criteria for each potential participant.

All participants were provided with written informed consent before the interview process began. We thoroughly explained the study’s objectives, methods, potential risks and benefits, and participants’ rights. Each participant received and signed a written consent form, confirming their voluntary participation. Confidentiality was assured, and participants were informed of their right to withdraw from the study at any time without consequences. To ensure data quality, the lead researcher provided ongoing supervision and support to the research assistants throughout the data collection process.

Measurement

The questionnaires were used for data collection as follows: part 1: Individual characteristics, part 2: the Activities of Daily Living (ADLs), and part 3: the World Health Organization Quality of Life – BREF (WHOQOL-BREF).

Part 1, included 12 questions assessing demographic and socioeconomic factors, including age, gender, educational level, monthly income of the elderly person, employment, number of family members, living arrangement, illnesses, caregiver, and ADLs. Additionally, participation in an elderly school program was recorded.

Part 2, The Barthel Index, an ordinal scale with 10 items, was used to measure ADL performance. Each item, encompassing activities like feeding, toileting, bathing, dressing, and mobility, is scored on a 0-2 scale, reflecting the degree of assistance required. The total score, ranging from 0 to 20, indicates functional capability, with lower scores suggesting greater disability.⁴⁸ The Cronbach’s alpha was 0.83.

Part 3, we used WHOQOL-BREF (Thai version), in which there are 26 questions, ranging from 26 to 130. This questionnaire contains four domains (physical health, psychological health, social relationships, and environment). According to a 5-point Likert scale, each of these domains was scored.⁴⁹ Following the T-score, raw scores were transformed into a T-score with a range of 20 to 80, with higher scores denoting better QoL in each domain. The WHOQOL-BREF questionnaire showed a Cronbach’s alpha of 0.80.

Treatment variable

The Elderly School program in Thailand operates on a two-semester basis, with each semester consisting of 50 hours (3 hours per week). This collaborative initiative brings together diverse stakeholders, including the government, Local Administrative Organizations (LAOs), local communities, the private sector, and network partners. Their combined contributions ensure the provision of a wide range of activities and essential facilities for program participants.

The core curriculum for this learning process adheres to the established standards set by the Ministry of Social Development and Human Security. Quality control of teachers and curriculum implementation falls under the responsibility of LAOs, ensuring adherence to national guidelines. However, recognizing the importance of contextually relevant learning, the program allows for flexibility. Additional activities can be specifically tailored to cater to the unique needs and interests of each participating community. This customization plays a crucial role in enhancing engagement and ensuring the program addresses the specific challenges and opportunities faced by local senior citizens.²⁹ In this study, we operationalize the elderly school program as the treatment variable. Individuals who attend more than 80% of classes throughout the program are as “attending elderly school” while those who do not attend classes regularly are “non-attending elderly school”.

The elderly school curriculum consists of physical and mental health, social, economic, and environmental domains. The content can be delivered through workshops, seminars and training. LAOs is the main source for providing staff, financial, and material support, as detailed in Table 1.

Table 1. The elderly school curriculum.

Subjects	Content
Physical and mental health	Focusing on understanding and coping with the evolving health needs of elderly populations requires a multifaceted approach that addresses various dimensions of QoL. This encompasses physical, oral, and mental health, nutrition, alongside chronic disease management and responsible medication use. Recognizing the potential value of complementary and integrative practices, such as traditional Thai massage and natural therapies, can further enhance the health care provided to older adults.
Social	This subject tackles the crucial task of adapting social activities to better suit the functional abilities of older adults, covering the topics of laws and benefits, aging and living, knowledge exchange, religious principles, meditation, local wisdom transmission, volunteering, technology, music, singing, rhythm activities, and preserving local traditional cultures. The approach emphasizes tailoring activities to individual needs, considering physical limitations, cognitive abilities, sensory impairments, and social and emotional needs.
Economics	Empowering older adults with the knowledge and skills necessary to achieve financial security and improve their overall QoL, the subject covers such areas as Household Accounting; Sufficiency Economy; Craft Development and Income Generation; Vocational Reskilling and Upskilling, etc.
Environmental	This subject delves into the crucial topic of raising awareness and shaping positive attitudes towards the environment among older adults. It focuses specifically on environment development, encompassing the creation and maintenance of environments, housing, and infrastructure that promote and enhance their QoL. By fostering environmental awareness, promoting safe and accessible environments, and collaborating with key stakeholders, the subject empowers older adults to live healthier, more fulfilling lives while contributing to the creation of sustainable communities for all.

Covariates

This study employed PSM to address potential selection bias. Demographic variables were considered to calculate the predicted probability of covariates (gender, age, educational level, monthly income, employment, number of family members, living arrangement, illnesses, caregiver, and ADLs) for each individual. A balancing score of the propensity score, and distribution of measured baseline covariates between elderly people who attend elderly school and those who do not attend were compared in Table 2 and Figure 2.

Table 2. Demographic characteristics and covariate balancing by standardized difference of non-attending and attending the elderly school.

Factor	Non-attending elderly school n = 687		Attending elderly school n = 687		Standardized difference
Factor	N	%	N	%	Raw	Matched
Gender
Male	213	31.00	146	21.25
Female	474	69.00	541	78.75	0.22	- 0.02
Age (years) (Mean (SD))	67.75 (5.16)		68.66 (4.78)		0.18	0.01
Educational level
No Education	94	13.68	30	4.37
Primary school	413	60.12	286	41.63	- 0.38	- 0.06
Secondary school	72	10.48	136	19.80	0.26	0.01
Higher than Vocational Certificate	108	15.72	235	34.21	0.44	0.03
Monthly income (Baht)
20,000 or less	539	78.46	464	67.54
Higher than 20,001-30,000	148	21.54	223	32.46	0.25	0.04
Employment
Unemployed	174	25.33	113	16.45
Employed	513	74.67	574	83.55	0.22	0.01
Number of family members
Mean (SD)	3.69 (1.53)		3.75 (1.38)		0.04	- 0.01
Living arrangement
Living alone	30	4.37	40	5.82
With family	465	67.69	450	65.50	- 0.05	- 0.04
With a partner	175	25.47	177	25.76	0.01	0.04
With relatives	15	2.18	12	1.75	- 0.03	- 0.04
With friend	2	0.29	8	1.16	0.10	0.01
Hypertension
No	357	51.97	408	59.39
Yes	330	48.03	279	40.61	- 0.15	- 0.02
Diabetes
No	516	75.11	575	83.70
Yes	171	24.89	112	16.30	- 0.21	- 0.03
Heart disease
No	676	98.40	682	99.27
Yes	11	1.60	5	0.73	- 0.08	0.08
Caregiver
No	140	20.38	153	22.27
Yes	547	79.62	534	77.73	- 0.46	- 0.09
The activities of daily living (ADLs) Mean (SD)	18.46 (1.98)		18.90 (1.60)		0.16	- 0.01

Figure 2. Density of propensity scores before and after match between non-attending and attending the elderly school.

Statistical analysis

Categorical variables were described by frequency and percentage (%). Continuous variables were described by mean and standard deviation (SD). PSM was applied to match between the elderly people who attended the elderly school and those who did not. A regression model based on characteristic variables was used to compute propensity scores for each participant. K-nearest neighbor 1:1 matching model with no replacement and no callipers was employed as the propensity score matching estimator in Python. The standardized difference was used to examine the balance of covariate distribution between groups, which was independent of the unit of measurement. It allows comparison between variables with different units of measurement to calculate the propensity scores with a maximum standardized difference of 10%. Then, the average treatment effects of the population (ATE) were analyzed to investigate the effect size of the elderly schools on QoL, and multiple linear regression was analyzed to investigate the association between elderly school attendance and QoL using Stata 17.0. The level of two-sided statistical significance was set at p < 0.05.

Results

There were 1,508 participants who completed the interview in this study. Following PSM, the sample size remained at 1,374 individuals, with 687 in each group (elderly school non-attending group and attending group).

Comparison of the demographic characteristics of elderly people between non-attending and attending the elderly school

There were 687 participants in each group, with 474 (69.00%) elderly women in the non-attending elderly school group and 541 (78.75%) in the attending group. The average age of elderly people in the non-attending group was 67.75 (SD = 5.16) and in the school-attending group was 68.66 (SD = 4.78). Most participants had completed primary school, monthly income of less than 20,000 baht, and were employed in both groups, as over half of the participants lived with their families and had caregivers to take care of them. The results indicate the standardized difference was less than 10% on all covariates, which identified improved balance between the two groups ( Table 2).

The effect of elderly school on quality of life

The average overall QoL of elderly people in the attending elderly school group was 57.50 (SD = 7.53) and that of those in the non-attending elderly school group was 44.40 (SD = 7.11). The ATE of overall QoL was 10.67 (95% CI: 9.67–11.67, p-value <0.001), indicating a positive effect of attending the elderly school on QoL. Additionally, the ATE between the two groups for QoL domains: physical health, psychological, social relationships, and environmental dimensions were 8.89, 8.17, 6.37, and 8.41, respectively. There was a statistically significant difference in each QoL domain between the two groups ( Table 3).

Table 3. The average treatment effects (ATE) on quality of life after PSM.

Outcome	Mean (SD)		ATE (scores)	SE	95% CI of ATE	p-value
Outcome	Non-attending elderly school n = 687	Attending elderly school n = 687	ATE (scores)	SE	95% CI of ATE	p-value
Overall QoL	44.40 (7.11)	57.50 (7.53)	10.67	0.51	9.67 – 11.67	<0.001
Physical health	45.40 (8.09)	56.22 (8.51)	8.89	0.60	7.71 – 10.08	<0.001
Psychological	45.61 (8.41)	57.32 (8.57)	8.17	0.56	7.06 – 9.27	<0.001
Social relationships	46.64 (8.80)	54.46 (9.51)	6.37	0.61	5.16 – 7.58	<0.001

The association between elderly school attendance and quality of life

A multiple linear regression was conducted to assess the relationship between factors and QoL. As presented in Table 4, QoL was significantly associated with gender, educational level, monthly income, employment, caregiver, and elderly school attendance (F (8, 1365) = 251.88, p < 0.001 $R^{2}$ = 0.5962 and adjusted $R^{2}$ = 0.5938). Notably, elderly school attendance showed a strong association with QoL. The unstandardized beta coefficient for elderly school attendance was 10.811. Higher education levels among elderly people were also associated with higher QoL. The unstandardized beta coefficients for primary, secondary, and education higher than vocational certificates are 5.472, 10.090, and 10.157, respectively. This suggests that, for each elderly person with a higher educational level, the QoL score increases by the respective unstandardized beta coefficient ( Table 4).

Table 4. The association between elderly school attendance and quality of life.

Factors (n=1,374)	Full model			Final model
	Unstandardized		Standardized	Unstandardized		Standardized
	B	SE of B	β	B	SE of B	β
Constant	29.918	3.118
Age (years)	0.052	0.034	0.027
Elderly school attendance
No	Ref.
Yes	10.674	0.098	0.544*	10.811	0.360	0.550*
Gender
Male	Ref.
Female	1.812	0.392	0.081*	1.754	0.389	0.078*
Educational level
No Education	Ref.
Primary school	5.478	0.644	0.279*	5.472	0.619	0.279*
Secondary school	9.965	0.822	0.364*	10.090	0.803	0.368*
Higher than vocational certificate	10.04	0.840	0.443*	10.157	0.824	0.448*
Monthly income (Baht)
20,000 or less	Ref.
Higher than 20,001-30,000	1.380	0.580	0.062**	1.313	0.576	0.059*
Employment
Unemployed	Ref.
Employed	2.284	0.438	0.095*	2.270	0.434	0.094*
Number of family members	0.168	0.119	0.025
Living arrangement
Living alone	Ref.
With family	- 0.927	0.794	- 0.045
With a partner	- 1.582	0.831	- 0.070
With relatives	- 0.103	1.427	- 0.001
With friend	- 0.928	2.124	- 0.008
Hypertension
No	Ref.
Yes	- 0.306	0.365	- 0.015
Diabetes
No	Ref.
Yes	- 0.499	0.454	- 0.021
Heart disease
No	Ref.
Yes	- 0.629	1.591	- 0.007
Caregiver
No	Ref.
Yes	1.528	0.418	0.064*	1.574	0.414	0.066*
Elderly school attendance
No	Ref.
Yes	10.674	0.098	0.544*	10.811	0.360	0.550*
The activities of daily living (ADLs)	0.066	3.118	0.012

* p < 0.001.

** p < 0.005.

Discussion

This study investigates the effect of elderly school policy on QoL across its four domains: physical health, psychological, social relations, and environment. Furthermore, the associations between the factors and QoL were identified. Notably, in our study, the QoL of elderly people in the attending elderly school group was higher than that of those in the non-attending elderly school group, and the ATE indicated a positive effect of attending the elderly school on QoL. This finding is comparable with previous research on elderly schools in the northern and eastern regions of Thailand, which similarly found higher QoL among attending elderly school groups compared to non-attending elderly school groups.⁵⁰^–⁵² Physical health was shown to be the highest domain in ATE, followed by the psychological, environmental, and social relationships domains, all of which had similar values except for social relationships. This result reflects the fact that the elderly people emphasized their health deterioration with increasing age and the burden of diseases.⁵³^,⁵⁴

Moreover, our results resonate with broader international research highlighting the positive impact of interventions based on the concept of lifelong learning. Our finding was consistent with a study in Portugal that investigated the effect of participation in community intervention programs and indicated that QoL was better in the physical domain than others.⁵⁵ Similarly, a systematic literature review on the effects of later-life formal education on the QoL of elderly people also revealed a positive impact on QoL.⁵⁶ Additionally, a study in Canada regarding community-based participation in programs for mental health found a positive impact on psychological well-being, particularly in the context of non-formal lifelong learning⁵⁷ and the elderly individuals attending evening schools for lifelong learning in Korea experienced positive well-being impacts, including in the environmental dimension.⁵⁸

Our study further strengthens the evidence for a significant positive association between elderly school attendance and QoL after adjusting for other independent variables in a multiple linear regression model. This finding mirrors that of a study in Rayong Province, Thailand, which similarly identified the participation of senior citizens in educational management in elderly schools as a positive predictor of QoL, demonstrating the program’s potential to elevate QoL among attendees.⁵⁹ Furthermore, our results confirmed that sociodemographic factors, including gender, educational level, monthly income, and employment, were significant factors in QoL. For instance, this result was consistent with a study conducted in a rural area of the northern and northeast region of Thailand that found sociodemographic factors related to the elderly’QoL.⁶⁰^,⁶¹ Additionally, male gender, lack of education, and lower economic status are associated with low QOL of elderly people in rural area, India.⁶² In Korea, higher monthly income of elderly people had a positive effect on QoL.⁶³ Furthermore, the presence of a caregiver was a positively significant factor in the QoL of elderly people. This result was consistent with a study conducted by developing caregivers’ potential to improve the QoL for the elderly in the southern region of Thailand.⁶⁴ It is important to note that the specific factors associated with QoL vary across these studies. This variability can be attributed to differences in research methodology.

Strengths and limitations

This study displays several key strengths that contribute to its significance and pave the way for future research. Firstly, the utilization of PSM and estimation of average treatment effects (ATEs) strengthens the study’s internal validity. By creating a setting that mimics real-world conditions, PSM facilitates a comparison between elderly school attendees and non-attendees, minimizing selection bias. Furthermore, it stands as a pioneering analysis of the elderly school policy’s influence on QoL. This comprehensive approach provides a nuanced understanding of the policy’s multifaceted impact, surpassing previous research that primarily focused on program development.

However, this study acknowledges several limitations. Firstly, geographical scope: conducted in a single district, the results may not directly generalize to other populations or cultural contexts. Nevertheless, Lomkao district with its significant elderly population serves as a valuable study, offering important insights applicable to similar demographics. Secondly, cross-sectional design: While providing valuable data on QoL and its association with elderly school attendance, the cross-sectional design restricts the ability to establish causal relationships. Longitudinal studies are needed to definitively examine the impact of the policy over time. Future studies may benefit from incorporating additional assessments and corroborative data sources.

Policy implications and recommendations

The findings of this study offer profound policy implications and recommendations towards optimizing Thailand’s approach to senior citizens through lifelong learning initiatives like the elderly school program. 1) Integration into broader health promotion strategies: recognizing the significant QoL improvements associated with elderly school attendance underscores the imperative to embed this program within broader health promotion strategies for aging populations. This integration can leverage synergies between lifelong learning and other QoL initiatives. 2) Fostering continuous education policies: our results further advocate for the development of dedicated policies specifically aimed at supporting and promoting continuous education among senior citizens. Such policies could range from targeted funding mechanisms for elderly school expansion to incentivizing the creation of age-friendly learning materials and curricula. 3) Collaborative action for strong support systems: to maximize the impact of elderly schools and similar initiatives, we propose enhanced collaboration and awareness promotion among relevant authorities and stakeholders. This could involve partnerships between government agencies, community organizations, and the private sector to foster robust support systems for aging societies, prioritizing elderly schools, health promotion programs, and QoL initiatives. 4) Rural-specific models for inclusive QoL enhancement: recognizing the unique needs and challenges of rural elderly populations, we strongly recommend the development and promotion of elderly school models specifically tailored for rural communities. These models may require adaptations to curriculum content, delivery methods, and resource allocation to ensure equitable access and maximize QoL improvements for all senior citizens regardless of location. By embracing these policy implications and recommendations, Thailand can leverage the power of lifelong learning to establish a comprehensive and inclusive framework for healthy aging within its growing senior population.

More importantly, to broaden the context and enhance the study’s global relevance, it is essential to consider how the findings from Thailand’s elderly school policy could inform similar initiatives in other countries with aging populations. Many middle-income countries facing rapid demographic aging share similar socioeconomic and healthcare challenges, including limited access to educational and social support services for older adults. Developing elderly school models tailored to rural communities, as proposed in this study, could serve as a valuable framework for other nations seeking to improve the quality of life among their senior citizens. For instance, countries in Southeast Asia, Latin America, and Eastern Europe, where rural aging populations are growing, could adopt and adapt Thailand’s approach by modifying curriculum content, delivery methods, and resource allocation to reflect local cultural, economic, and infrastructural conditions. This cross-cultural application would not only promote healthy aging but also foster social inclusion and lifelong learning on a global scale.

Conclusion

The present study underscores the elderly school policy as a potentially impactful health promotion intervention, offering valuable insights into its effectiveness. Notably, the study reveals significantly higher overall QoL, and improvements across specific domains, among senior citizens attending elderly schools compared to their non-attending counterparts. Additionally, attendance at elderly schools emerges as a significant predictor of QoL, highlighting the program’s direct contribution to QoL. While certain sociodemographic factors also exhibit significant associations with QoL, the study’s findings provide compelling evidence that the lifelong learning policy embodied by elderly schools has demonstrably enhanced the QoL of senior citizens in Thailand.

To maximize the program’s potential, policymakers should prioritize robust support efforts across various domains. Crucial areas include adequate human resources, dedicated financial resources, well-equipped facilities, and effective management structures. Furthermore, encouraging collaboration with LAOs, communities, and the private sector can play a vital role in promoting and expanding the implementation of elderly schools. By prioritizing such strategic investments and collaborative efforts, Thailand can leverage the powerful potential of lifelong learning initiatives to significantly improve the QoL of its aging population.

Ethical and consent

This study received ethical approval from the Institutional Review Board (IRB) of Phetchabun Hospital (approval number IEC-20-2565, date: November 9, 2022). The study adhered to the ethical principles outlined in the Declaration of Helsinki, The Belmont Report, CIOMS Guideline, and International Conference on Harmonization in Good Clinical Practice (ICH-GCP). Written informed consent was obtained from all participants before the interview process began. Participants were informed that they could withdraw from the study at any time without providing a reason. The confidentiality of participant data was ensured throughout the entire study.

Data availability

Underlying data

Figshare: Effect of elderly school policy on quality of life among Thailand’s senior citizens, https://doi.org/10.6084/m9.figshare.25894831.v2.⁶⁵

The project contains the following underlying data:

• Data.xlsx
• Ethical considerationsap
• Participant information sheets and consent forms
• Questionnaire

Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0).

Extended data

Questionnaire, ethical considerations, participant information sheets and consent forms were provided in data availability https://doi.org/10.6084/m9.figshare.25894831.v2.⁶⁵

Acknowledgements

We would like to express our genuine appreciation to all participants in the dissertation seminars at the College of Public Health Sciences, the research assistants involved in this research, the Celebration of Chulalongkorn University 100th Anniversary Scholarship and all the participants in this study. We are also immensely grateful to Dr. Suwanchai Hounnaklang for the comments and editing on an English version of the manuscript, despite the fact that any mistakes are our own.

References

1. Affairs UND of E and S: World Population Ageing 2019. United Nations; 2020. Publisher Full Text
2. World Health Organization: Ageing and health.Published October 1, 2022. Accessed July 11, 2023. Reference Source
3. The world bank group: Thailand Economic Monitor - June 2016: Aging Society and Economy. World Bank; Accessed July 11, 2023. Reference Source
4. World Health Organization: Thailand’s leadership and innovations towards healthy ageing.Published September 2, 2023. Accessed July 11, 2023. Reference Source
5. Institute for Population and Social Research, MU, Foundation of Thai Gerontology Research and Development Institute (TGRI): Situation of the Thai Older Persons 2021. Institute for Population and Social Research, Mahidol University and Foundation of Thai Gerontology Research and Development institute (TGRI); 2022. Reference Source
6. Department of Older Persons: Situation of The Thai Older Persons 2022. Foundation of Thai Gerontology Research and Development Institute and Institute for Population and Social Research, Mahidol University; 2023. Reference Source
7. Teoli D, Bhardwaj A: Quality Of Life. StatPearls. StatPearls Publishing; 2023. Accessed September 26, 2023. Reference Source
8. WHOQOL - Measuring Quality of Life|The World Health Organization: Accessed November 18, 2021. Reference Source
9. van Leeuwen KM , van Loon MS , van Nes FA , et al.: What does quality of life mean to older adults? A thematic synthesis. PLoS One. 2019; 14(3): e0213263. PubMed Abstract | Publisher Full Text | Free Full Text
10. Vahedi S: World Health Organization Quality-of-Life Scale (WHOQOL-BREF): Analyses of Their Item Response Theory Properties Based on the Graded Responses Model. Iran J Psychiatry. 2010; 5(4): 140–153. PubMed Abstract
11. Shevelkova V, Mattocks C, Lafortune L: Efforts to address the Sustainable Development Goals in older populations: a scoping review. BMC Public Health. 2023; 23(1): 456. PubMed Abstract | Publisher Full Text | Free Full Text
12. Chantakeeree C, Sormunen M, Estola M, et al.: Factors Affecting Quality of Life among Older Adults with Hypertension in Urban and Rural Areas in Thailand: A Cross-Sectional Study. Int J Aging Hum Dev. 2022; 95(2): 222–244. PubMed Abstract | Publisher Full Text | Free Full Text
13. Quashie NT, Pothisiri W: Rural-urban gaps in health care utilization among older Thais: The role of family support. Arch Gerontol Geriatr. 2019; 81: 201–208. PubMed Abstract | Publisher Full Text
14. Hongthong D, Somrongthong R, Ward P: Factors Influencing the Quality of Life (Qol) Among Thai Older People in a Rural Area of Thailand. Iran J Public Health. 2015; 44(4): 479–485. PubMed Abstract
15. Krishnappa L, Gadicherla S, Chidambaram P, et al.: Quality of life (QOL) among older persons in an urban and rural area of Bangalore, South India. J Fam Med Prim Care. 2021; 10(1): 272–277. PubMed Abstract | Publisher Full Text | Free Full Text
16. Zin PE, Saw YM, Saw TN, et al.: Assessment of quality of life among elderly in urban and peri-urban areas, Yangon Region, Myanmar. PLoS One. 2020; 15(10): e0241211. PubMed Abstract | Publisher Full Text | Free Full Text
17. Phetchabun provincial public health office: HDC - Gender classified population yearly age group report. Gender classified population yearly age group.Published August 15, 2023. Accessed August 16, 2023. Reference Source
18. Panvongsa P, Sonthon P, Yusook K: FACTORS ASSOCIATED WITH QUALITY OF LIFE OF ELDERLY IN RURAL, PHETCHBUN PROVINCE. Acad J Uttaradit Rajabhat Univ. 2020; 15(2): 41–56.
19. Chang HK, Gil CR, Kim HJ, et al.: Factors Affecting Quality of Life Among the Elderly in Long-Term Care Hospitals. J Nurs Res JNR. 2020; 29(1): e134. PubMed Abstract | Publisher Full Text | Free Full Text
20. Talarska D, Tobis S, Kotkowiak M, et al.: Determinants of Quality of Life and the Need for Support for the Elderly with Good Physical and Mental Functioning. Med Sci Monit Int Med J Exp Clin Res. 2018; 24: 1604–1613. PubMed Abstract | Publisher Full Text | Free Full Text
21. Acharya Samadarshi SC, Taechaboonsermsak P, Tipayamongkholgul M, et al.: Quality of life and associated factors amongst older adults in a remote community, Nepal. J Health Res. 2021; 36(1): 56–67. Publisher Full Text
22. Davodi SR, Zendehtalab H, Zare M, et al.: Effect of Health Promotion Interventions in Active Aging in the Elderly: A Randomized Controlled Trial. Int J Community Based Nurs Midwifery. 2023; 11(1): 34–43. PubMed Abstract | Publisher Full Text | Free Full Text
23. Salmannezhad M, Momtaz YA, Sahhaf R, et al.: The effect of “Elder Care by Elderly People Program” on life satisfaction and quality of life among institutionalized senior citizens. J Educ Health Promot. 2022; 11: 1. PubMed Abstract | Publisher Full Text | Free Full Text
24. Srivarathan A, Jensen AN, Kristiansen M: Community-based interventions to enhance healthy aging in disadvantaged areas: perceptions of older adults and health care professionals. BMC Health Serv Res. 2019; 19(1): 7. PubMed Abstract | Publisher Full Text | Free Full Text
25. Chiu CJ, Hu JC, Lo YH, et al.: Health Promotion and Disease Prevention Interventions for the Elderly: A Scoping Review from 2015–2019. Int J Environ Res Public Health. 2020; 17(15): 5335. PubMed Abstract | Publisher Full Text | Free Full Text
26. Fulmer T, Reuben DB, Auerbach J, et al.: Actualizing Better Health And Health Care For Older Adults. Health Aff Proj Hope. 2021; 40(2): 219–225. Publisher Full Text
27. Tay YL, Abu Bakar NS, Tumiran R, et al.: Effects of home visits on quality of life among older adults: a systematic review protocol. Syst Rev. 2021; 10: 307. PubMed Abstract | Publisher Full Text | Free Full Text
28. Department of Older Persons TM of SD and HS: The elderly school manual.Published online September 2017. Accessed October 11, 2021. Reference Source
29. Kasemsuk W, JItjarut S, Makaphon J, et al.: THE GUIDELINE TO PROMOTE LIFELONG LEARNING FOR ELDERLY SCHOOL. J Police Nurses. 2019; 11(2): 261–271.
30. Dhirathiti NS, Pichitpatja P: Characteristics and differences of lifelong learning policy implementation for the elderly in Thailand. Educ Res Policy Pract. 2018; 17(1): 53–68. Publisher Full Text
31. Phetchabun provincial public health office: Public health action plan Phetchabun province 2018.2017. Accessed January 24, 2024. Reference Source
32. Sutapan S, Promsuan W, Howharn C, et al.: The Roles and Responsibilities as District Health Board: From Perspective to Practice for Community Health. J Prev Med Assoc Thail. 2020; 10(2): 254–273.
33. Department of older persons: Annual report 2022. 2022:80. Accessed October 26, 2023. Reference Source
34. Kongjareon M: CURRICULUM DEVELOPMENT OF TRAINING FOR TEACHERS IN THE ELDERLY LEARNING CENTER. Panyapiwat J. 2021; 13(2): 190–206.
35. Thariwong S, Konkong C, Rodkaew A: System and Mechanism for Implementation of A Center for Promotion and Development of Quality of Life for Elderly people (Senior School) in Plai Chumphon Subdistrict Municipality, Muang District, Phitsanulok Province. Soc Sci Res Acad J. 2023; 18(2): 61–76.
36. Department of older persons: Annual report 2018. 2018:63. Accessed October 26, 2023. Reference Source
37. Department of older persons: Annual report 2019. 2019:70. Accessed October 26, 2023. Reference Source
38. Department of older persons: Annual report 2020. 2020:70. Accessed October 26, 2023. Reference Source
39. Department of older persons: Annual report 2021. 2021:68. Accessed October 26, 2023. Reference Source
40. Thai health resource center: The elderly school establishment. Establishment of a school for the elderly.Published May 9, 2019. Accessed December 11, 2023. Reference Source
41. Erwanto R, Kurniasih DE, Amigo TAE: THE EFFECTIVENESS OF INFORMAL EDUCATION: ELDERLY SCHOOL ON THE HEALTH STATUS OF ELDERLY. Proceeding Int Conf. 2019; 1(1): 550–556.
42. Atijitta P: Elderly School for the Community Strengthening. CRRU. J Commun. 2021; 4(3). Accessed October 26, 2023. Reference Source
43. Kandamri S, Sungrugsa N; University S et al.: THE DEVELOPMENT EMPOWERING MODEL TO PROMOTE THE QUALITY ELDERS LIFE IN THE ELDERLY SCHOOL OF NAKHON PATHOM PROVINCE. Silpakorn University; 2023. Thesis. Accessed October 26, 2023. Reference Source
44. Liamyu P, Sinjindawong S, Manisri C: The Proposed Policy of Elderly Schools Management for Local Government Organizations in Thailand. Ratchaphruek J. 2023; 21(2): 112–127. Publisher Full Text
45. PhrakhrutheerasatpaisalPonlamaungdee W, Sutta C: MANAGEMENT MODELS OF THE ELDERLY BUDDHIST SCHOOLS IN CHIANG RAI PROVINCE. J MCU Ubon Rev. 2023; 8(2): 975–988.
46. Phrakruarunsutalangkarn: SCHOOL OF ELDERS: WELL-BEING SYSTEM MANAGEMENT AND BENEFITS IN THE SCHOOLS IN CASE OF THE SOUTH OF THAILAND. J MCU Nakhondhat. 2019; 6(3): 1339–1362.
47. Soper DS: A-priori Sample Size Calculator for Multiple Regression [Software].2023. Accessed August 18, 2023. Reference Source
48. Mahoney FI, Barthel DW: FUNCTIONAL EVALUATION: THE BARTHEL INDEX. Md State Med J. 1965; 14: 61–65. PubMed Abstract
49. World Health Organization: Thai_WHOQOL-BREF.Published May 3, 2020. Accessed August 4, 2023. Reference Source
50. Pajuwang K: Quality of Life in Elders, Attending in The Elderly School of Rong Kho, Wang Nua District, Lampang. University of Phayao; 2017. Accessed October 26, 2023. Thesis. Reference Source
51. Phuttajorn A: DEVELOPMENT OF THE LIFE QUALITY OF THE ELDERLY PEOPLE BY THE SENIOR SCHOOL COURSE, NAPHU SUBDISTRICT, PHEN DISTRICT, UDON THANI. J MCU Nakhondhat. 2021; 8(3): 250–263.
52. Sarnsang C, Rattanapunya S: A Study of Quality of Life of Elders in the Elderly School, Thungkhowpuang Sub-district, Chiang Dao District, Chiang Mai Province. Thai Sci Technol J. Published online June 8, 2019; 964–974.
53. Jaul E, Barron J: Age-Related Diseases and Clinical and Public Health Implications for the 85 Years Old and Over Population. Front Public Health. 2017; 5: 335. PubMed Abstract | Publisher Full Text | Free Full Text
54. Gruzieva TS, Diachuk MD, Inshakova HV, et al.: HEALTH OF THE ELDERLY PEOPLE AS THE BASIS FOR FORMATION OF MEDICAL AND SOCIAL NEEDS. Wiadomosci Lek Wars Pol 1960. 2021; 74(3 cz 2): 658–664. Publisher Full Text
55. Bastos MAM d SC, Monteiro JMM d P, de Faria CMGM , et al.: Participation in community intervention programmes and quality of life: findings from a multicenter study in Portugal. Rev Bras Geriatr E Gerontol. 2020; 23: e190017. Publisher Full Text
56. Noble C, Medin D, Quail Z, et al.: How Does Participation in Formal Education or Learning for Older People Affect Wellbeing and Cognition? A Systematic Literature Review and Meta-Analysis. Gerontol Geriatr Med. 2021; 7: 233372142098602. PubMed Abstract | Publisher Full Text | Free Full Text
57. Narushima M, Liu J, Diestelkamp N: Lifelong learning in active ageing discourse: its conserving effect on wellbeing, health and vulnerability. Ageing Soc. 2018; 38(4): 651–675. PubMed Abstract | Publisher Full Text | Free Full Text
58. Choi I, Cho SR: A Case Study of Active Aging through Lifelong Learning: Psychosocial Interpretation of Older Adult Participation in Evening Schools in Korea. Int J Environ Res Public Health. 2021; 18(17): 9232. PubMed Abstract | Publisher Full Text | Free Full Text
59. Huangkasem S, Kunametheekoon T, Intaramat T: Participation of Senior Citizens in Educational Management of Local Administrative Organizations Affecting the Quality of Life: A Case Study of Schools for Senior Citizens in Rayong Province. J Humanit Soc Sci Mahasarakham Univ. 2022; 41(3): 149–163.
60. Seangpraw K, Ratanasiripong NT, Ratanasiripong P: Predictors of quality of life of the rural older adults in Northern Thailand. J Health Res. 2019; 33(6): 450–459. Publisher Full Text
61. Sirisuwan P, Phimha S, Banchonhattakit P: Influence of active ageing and health literacy on quality of life among elderly persons in northeast Thailand. Health Educ J. 2022; 81(6): 693–704. Publisher Full Text
62. Singh A, Palaniyandi S, Palaniyandi A, et al.: Health related quality of life among rural elderly using WHOQOL-BREF in the most backward district of India. J Fam Med Prim Care. 2022; 11(3): 1162. Publisher Full Text
63. Kim BR, Hwang HH: Analysis of Major Factors Affecting the Quality of Life of the Elderly in Korea in Preparation for a Super-Aged Society. Int J Environ Res Public Health. 2022; 19(15): 9618. PubMed Abstract | Publisher Full Text | Free Full Text
64. Romyen A: EFFECTS OF THE DEVELOPMENT OF CAREGIVER POTENTIAL FOR THE GOOD QUALITY OF LIFE OF ELDERLY, CHUMPHON PROVINCE. J MCU Nakhondhat. 2023; 10(1): 307–320.
65. Kratoo W, Hounnaklang N: Effect of elderly school policy on quality of life among Thailand’s senior citizens. figshare. 24-May-2024. Publisher Full Text

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Author details Author details

¹ College of Public Health Sciences, Chulalongkorn University, Bangkok, Bangkok, 10330, Thailand

Nuchanad Hounnaklang
Roles: Conceptualization, Formal Analysis, Investigation, Methodology, Project Administration, Software, Supervision, Validation, Visualization, Writing – Review & Editing

Competing interests

No competing interests were disclosed.

Grant information

The author(s) declared that no grants were involved in supporting this work.

Article Versions (2)

version 2

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Published: 31 Mar 2025, 13:735

https://doi.org/10.12688/f1000research.151221.2

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https://doi.org/10.12688/f1000research.151221.1

© 2025 Kratoo W and Hounnaklang N. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Kratoo W and Hounnaklang N. Effect of Elderly School Policy on Quality of Life among Thailand’s Senior Citizens: A Propensity Score Matching Approach [version 2; peer review: 3 approved]. F1000Research 2025, 13:735 (https://doi.org/10.12688/f1000research.151221.2)

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Version 2

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Reviewer Report 16 Apr 2025

Aye Sandar Mon, University of Public Health, Yangon, Myanmar

Approved

https://doi.org/10.5256/f1000research.179137.r374503

No further comments from my side. All my ... Continue reading

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Reviewer Report 13 Feb 2025

Ueamporn Summart, Faculty of Nursing, Roi Et Rajabhat University, Tha Muang, Thailand

Approved

https://doi.org/10.5256/f1000research.165851.r310490

Title: Effect of Elderly School Policy on Quality of Life among Thailand’s Senior Citizens: A Propensity Score Matching Approach.

After conducting a thorough analysis of all your articles, this manuscript seeks to assess the impact of geriatric education on the quality of life of older individuals. The findings of this article are essential for informing government policies aimed at enhancing the quality of life for this specific demographic. The author employs statistical tools to mitigate biases and apply the results to favorable health outcomes. However, there are certain aspects that leaders should comprehend and acknowledge:

1. Calculation of the required sample size: Please provide further elaboration on the concept of "effect size = 0.02," including information on how to compute it and the specific value obtained from the pilot study.
2. Study samples: This study employed quota and systematic simple random sampling techniques, which can be considered a two-step sampling process or referred to as multi-stage random sampling. In this section, I suggest that the author include a CONSORT diagram detailing the process of participant enrollment in the trial, which would enhance the reader's comprehension.
3. Results: This study employed the beta coefficient to represent the extent of the study's influence. Given that this study used multiple linear regression to assess the impact of covariates on quality of life (QOL), it is necessary to report the mean difference.

Is the work clearly and accurately presented and does it cite the current literature?

Yes
Is the study design appropriate and is the work technically sound?

Yes
Are sufficient details of methods and analysis provided to allow replication by others?

Yes
If applicable, is the statistical analysis and its interpretation appropriate?

Yes
Are all the source data underlying the results available to ensure full reproducibility?

Yes
Are the conclusions drawn adequately supported by the results?

Yes

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: Nursing and Public Health

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

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Author Response 31 Mar 2025

Worapath Kratoo, College of Public Health Sciences, Chulalongkorn University, Bangkok, 10330, Thailand

31 Mar 2025

Author Response
We sincerely appreciate the reviewer's insightful comments, which have significantly helped us to improve the clarity of our manuscript. We have addressed each point as follows:

Comment 1: Calculation ... Continue reading
We sincerely appreciate the reviewer's insightful comments, which have significantly helped us to improve the clarity of our manuscript. We have addressed each point as follows:

Comment 1: Calculation of the Required Sample Size: Effect Size

Response: An effect size of 0.02 in the sample size calculation, derived from a pilot study comparing QoL between the means of the two groups (attending and not attending elderly school) divided by the standard deviation.

Comment 2: Study Samples: Sampling Process and CONSORT Diagram

Response: We have already added CONSORT diagram

Comment 3: Results: Beta Coefficients and Mean Differences

Response: In our analysis, we have chosen to present Average Treatment Effects (ATE) as our primary measure of impact, as these values provide a more robust estimate of causal effect by accounting for potential confounding variables. The ATEs reported in our results section represent the estimated average effect of each variable on quality of life after controlling for other covariates in the model. We believe this approach is more appropriate for our study design than unadjusted mean differences because it addresses potential selection bias and confounding factors that could influence the outcomes.

We believe that these revisions have addressed the reviewer's concerns and significantly improved the manuscript. We are grateful for the opportunity to enhance the quality of our work.
We sincerely appreciate the reviewer's insightful comments, which have significantly helped us to improve the clarity of our manuscript. We have addressed each point as follows:

Comment 1: Calculation of the Required Sample Size: Effect Size

Response: An effect size of 0.02 in the sample size calculation, derived from a pilot study comparing QoL between the means of the two groups (attending and not attending elderly school) divided by the standard deviation.

Comment 2: Study Samples: Sampling Process and CONSORT Diagram

Response: We have already added CONSORT diagram

Comment 3: Results: Beta Coefficients and Mean Differences

Response: In our analysis, we have chosen to present Average Treatment Effects (ATE) as our primary measure of impact, as these values provide a more robust estimate of causal effect by accounting for potential confounding variables. The ATEs reported in our results section represent the estimated average effect of each variable on quality of life after controlling for other covariates in the model. We believe this approach is more appropriate for our study design than unadjusted mean differences because it addresses potential selection bias and confounding factors that could influence the outcomes.

We believe that these revisions have addressed the reviewer's concerns and significantly improved the manuscript. We are grateful for the opportunity to enhance the quality of our work.
Competing Interests: No competing interests were disclosed. Close
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Author Response 31 Mar 2025

Worapath Kratoo, College of Public Health Sciences, Chulalongkorn University, Bangkok, 10330, Thailand

31 Mar 2025

Author Response
We sincerely appreciate the reviewer's insightful comments, which have significantly helped us to improve the clarity of our manuscript. We have addressed each point as follows:

Comment 1: Calculation ... Continue reading
We sincerely appreciate the reviewer's insightful comments, which have significantly helped us to improve the clarity of our manuscript. We have addressed each point as follows:

Comment 1: Calculation of the Required Sample Size: Effect Size

Response: An effect size of 0.02 in the sample size calculation, derived from a pilot study comparing QoL between the means of the two groups (attending and not attending elderly school) divided by the standard deviation.

Comment 2: Study Samples: Sampling Process and CONSORT Diagram

Response: We have already added CONSORT diagram

Comment 3: Results: Beta Coefficients and Mean Differences

Response: In our analysis, we have chosen to present Average Treatment Effects (ATE) as our primary measure of impact, as these values provide a more robust estimate of causal effect by accounting for potential confounding variables. The ATEs reported in our results section represent the estimated average effect of each variable on quality of life after controlling for other covariates in the model. We believe this approach is more appropriate for our study design than unadjusted mean differences because it addresses potential selection bias and confounding factors that could influence the outcomes.

We believe that these revisions have addressed the reviewer's concerns and significantly improved the manuscript. We are grateful for the opportunity to enhance the quality of our work.
We sincerely appreciate the reviewer's insightful comments, which have significantly helped us to improve the clarity of our manuscript. We have addressed each point as follows:

Comment 1: Calculation of the Required Sample Size: Effect Size

Response: An effect size of 0.02 in the sample size calculation, derived from a pilot study comparing QoL between the means of the two groups (attending and not attending elderly school) divided by the standard deviation.

Comment 2: Study Samples: Sampling Process and CONSORT Diagram

Response: We have already added CONSORT diagram

Comment 3: Results: Beta Coefficients and Mean Differences

Response: In our analysis, we have chosen to present Average Treatment Effects (ATE) as our primary measure of impact, as these values provide a more robust estimate of causal effect by accounting for potential confounding variables. The ATEs reported in our results section represent the estimated average effect of each variable on quality of life after controlling for other covariates in the model. We believe this approach is more appropriate for our study design than unadjusted mean differences because it addresses potential selection bias and confounding factors that could influence the outcomes.

We believe that these revisions have addressed the reviewer's concerns and significantly improved the manuscript. We are grateful for the opportunity to enhance the quality of our work.
Competing Interests: No competing interests were disclosed. Close
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Reviewer Report 20 Sep 2024

Andrew Kweku Conduah, University of Professional Studies, Madina, Ghana

Approved

https://doi.org/10.5256/f1000research.165851.r302071

Effect of Elderly School Policy on Quality of Life among Thailand’s Senior Citizens: A Propensity Score Matching Approach.

Summary of the Manuscript:
This manuscript evaluates the impact of Thailand’s 'elderly school' initiative on the quality of life (QoL) among senior citizens using a propensity score matching (PSM) approach. The study, conducted in Phetchabun province, found that attending the elderly school significantly improved QoL compared to non-attendees, offering a beacon of hope for the elderly population. The research also identified several factors positively associated with QoL, including gender, income, employment, caregiving, and education.
Evaluation of the Introduction
Global Context: The introduction effectively situates the research within the global context by highlighting the significant increase in the elderly population worldwide. It references the international trend of an ageing population, emphasizing the impact on healthcare systems. Statistics about the projected growth of the elderly population from 2015 to 2050 and the concentration in middle-income countries provide a strong foundation for understanding the global scale of the issue. The comparison with other regions, such as South India and Myanmar, also enhances the global perspective.
Research Problem Articulation and Justification: The research problem is well-articulated and justified. The introduction clearly identifies the urgent need for effective interventions to improve senior citizens' quality of life (QoL) in the face of the ageing population in Thailand. The discussion on the disparities in QoL between urban and rural areas, as well as the specific context of Lomkao district, further justifies the need for the study. The problem is contextualized by noting the lack of comprehensive evaluations of the elderly school initiative’s impact, which underscores the significance of the research.
Objectives: The introduction does not explicitly state the research objectives. While the problem is well-defined and justified, and the gap in the literature is highlighted, the study's specific aims should be more clearly articulated. For instance, the introduction could explicitly state that the study aims to evaluate the causal effect of the elderly school initiative on QoL using propensity score matching (PSM) and to investigate the association between various factors and QoL among senior citizens.
Opinion: The introduction provides a robust and comprehensive background for the study. It effectively places the research in a global context, identifies the problem, and justifies the need for the study. However, the specific research objectives should be clearly stated to strengthen the introduction. This will provide readers with a clear understanding of the study’s aims and how it intends to address the identified gap in the literature. Additionally, expanding the discussion on similar interventions in other regions could further enhance the global context and relevance of the research. Overall, the introduction sets a solid foundation for the study but would benefit from a more explicit articulation of the research objectives.

Methodology
1. Research Design
Cross-Sectional Study:

Appropriateness: The cross-sectional design is suitable for simultaneously assessing the prevalence of characteristics or conditions. This study is used to compare the quality of life (QoL) of elderly individuals who attended and did not attend an elderly school. This design effectively examines differences in QoL and determines associations with the elderly school program.

2. Sample Size
Sample Size Calculation:

Appropriateness: The sample size calculation is based on continuous data and considers effect size, power, predictors, and significance level. The study's sample size of 901 participants is derived from these calculations, ensuring sufficient statistical power for detecting meaningful differences.

3. Sampling Technique
Quota and Systematic Sampling:

Appropriateness: Combining quota sampling with systematic sampling ensures a representative sample of elderly individuals attending and not attending the elderly school. Quota sampling ensures demographic representation, while systematic sampling introduces randomness into the selection process.

4. Data Collection
Face-to-Face Interviews:

Appropriateness: Face-to-face interviews effectively collect detailed and accurate data concerning literacy or language barriers. The research team’s training ensures consistency and reliability in data collection.

5. Measurement
Instruments Used:

Demographic and Socioeconomic Factors: Detailed questionnaires assess various factors relevant to QoL.
Activities of Daily Living (ADLs): The Barthel Index is an established tool for measuring ADL performance, suitable for evaluating functional capacity.
WHOQOL-BREF: This validated instrument assesses QoL across multiple domains. Using the Thai version ensures cultural and linguistic relevance.

6. Treatment Variable
Elderly School Program:

Appropriateness: The definition and criteria for attendance in the elderly school program are clear and relevant to the study's objectives. Participants are categorised based on their attendance, which aligns with the study’s aim to evaluate the program’s impact.

7. Covariates and Propensity Score Matching (PSM)
PSM for Addressing Selection Bias:

Appropriateness: PSM is a robust method for controlling confounding variables and ensuring balanced groups. Demographic and socioeconomic factors are used as covariates, enhancing comparability between attendees and non-attendees of the elderly school.

8. Statistical Analysis
Analysis Methods:

Appropriateness: The use of PSM, standardised differences, and multiple linear regression is appropriate for analysing the effect of the elderly school program on QoL. These methods effectively control for confounding and assess the treatment's impact.

Results
Demographic Characteristics of the Participants
A total of 1,508 participants completed the interview. After Propensity Score Matching (PSM), 1,374 individuals remained, with 687 participants in the non-attending and attending elderly school groups. In the non-attending group, 474 (69.00%) were women, and 541 (78.75%) were women in the attending group. The average age in the non-attending group was 67.75 years (SD = 5.16), while in the attending group, it was 68.66 years (SD = 4.78). Most participants in both groups had completed primary school, had a monthly income of less than 20,000 baht, and were employed. More than half of the participants lived with their families and had caregivers. The standardised difference was less than 10% for all covariates, indicating improved balance between the two groups (Table 2).
Quality of Life Outcomes
The average overall Quality of Life (QoL) score was 57.50 (SD = 7.53) in the attending group and 44.40 (SD = 7.11) in the non-attending group. The Average Treatment Effect (ATE) of attending elderly school on overall QoL was 10.67 (95% CI: 9.67–11.67, p < 0.001). The ATEs for QoL domains were as follows: physical health (8.89), psychological (8.17), social relationships (6.37), and environmental (8.41). Each domain showed a statistically significant difference between the two groups (Table 3).
Associations Between Elderly School Attendance and QoL
Multiple linear regression analysis revealed that QoL was significantly associated with gender, educational level, monthly income, employment, caregiver presence, and elderly school attendance (F (8, 1365) = 251.88, p < 0.001, R² = 0.5962). Elderly school attendance had a strong positive association with QoL, with an unstandardised beta coefficient of 10.811. Higher education levels were also associated with higher QoL scores (Table 4).
Discussion
This study examined the impact of attending an elderly school on QoL across four domains: physical health, psychological well-being, social relationships, and environment. The findings revealed that elderly school attendance significantly improved QoL compared to non-attendance. The positive effect of elderly school attendance was consistent with previous research in different regions of Thailand, which also found higher QoL among school attendees. The highest impact was observed in the physical health domain, followed by the psychological, environmental, and social relationships domains.
The study's results align with international research, highlighting the benefits of lifelong learning for elderly populations. Studies from Portugal, Canada, and Korea have observed similar positive impacts on QoL, underscoring the global relevance of these findings.
Strengths and Limitations
The study's strengths include using PSM to enhance internal validity and provide a realistic comparison between groups. It is one of the first to analyze the elderly school policy's impact on QoL comprehensively.
However, limitations include the study's geographical scope, as it was conducted in a single district, limiting generalizability. The cross-sectional design also restricts the ability to establish causality, and future longitudinal studies are needed to confirm these findings.
Policy Implications and Recommendations
The findings suggest important policy implications for optimizing Thailand's approach to ageing populations. The study recommends integrating elderly schools into broader health promotion strategies, developing continuous education policies for seniors, fostering stakeholder collaboration, and creating rural-specific models to enhance QoL for elderly populations in similar contexts.

The conclusion is well-structured and effectively summarizes the essential findings and implications of the study. Here’s a brief evaluation:

Clear Summary of Findings: The conclusion restates the primary outcomes, particularly the positive impact of elderly school attendance on Quality of Life (QoL). It effectively highlights the significance of these schools in enhancing overall QoL among senior citizens in Thailand.
Implications for Policy: The discussion on policy implications is well-founded. By recommending robust support across various domains (human resources, finances, facilities, and management), the conclusion addresses practical steps that policymakers can take to enhance the program's effectiveness.
Encouragement of Collaboration: A strategic recommendation is to emphasise collaboration with local administrative organisations (LAOs), communities, and the private sector. This suggests a comprehensive approach to expanding the program and ensures the reader understands the context needed for success.
Forward-looking Perspective: The conclusion reflects on the current findings and looks ahead, suggesting how Thailand can further leverage these initiatives to improve the QoL of its ageing population. This gives the study a forward-looking angle, which is valuable in research conclusions.

Minor Suggestions for Enhancement:

Reinforce Study Limitations: Depending on what was discussed earlier in the paper, briefly mentioning any limitations or areas for future research here might be helpful. This adds balance and shows a critical engagement with the study’s scope.
Broaden the Context: While the focus on Thailand is appropriate, you could briefly mention how these findings might inform similar initiatives in other countries, especially those with ageing populations, to widen the study's impact.

Overall, the conclusion is appropriate, but adding a sentence or two to address limitations or broader implications could make it even stronger.

Is the work clearly and accurately presented and does it cite the current literature?

Yes
Is the study design appropriate and is the work technically sound?

Yes
Are sufficient details of methods and analysis provided to allow replication by others?

Yes
If applicable, is the statistical analysis and its interpretation appropriate?

Yes
Are all the source data underlying the results available to ensure full reproducibility?

Yes
Are the conclusions drawn adequately supported by the results?

Yes

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: § Population Estimates and Projections.§ Population Health and Mortality- Health Emergencies & Preparedness, Ageing & Intergeneration Relations, and Non-Communicable Disease & Health Projection (Physical Activity, Obesity, Tobacco Control, etc.)§ Business Demography§ Business Policy and Strategy§ Business Management§ Public Administration, Entrepreneurial Innovation

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

CITE

Report a concern

Author Response 31 Mar 2025

Worapath Kratoo, College of Public Health Sciences, Chulalongkorn University, Bangkok, 10330, Thailand

31 Mar 2025

Author Response
We sincerely appreciate the reviewer's insightful comments, which have significantly helped us to improve the clarity of our manuscript. We have addressed each point as follows:

Suggestion 1: Reinforce ... Continue reading
We sincerely appreciate the reviewer's insightful comments, which have significantly helped us to improve the clarity of our manuscript. We have addressed each point as follows:

Suggestion 1: Reinforce Study Limitations

Response: Thank you for your thoughtful suggestion to reinforce the study limitations. We would like to note that the manuscript already includes a detailed discussion of the study limitations in the 'Strengths and limitations' section. Specifically, we have addressed geographical limitations (the single-district scope and generalizability concerns), methodological limitations (cross-sectional design and its constraints on establishing causality), and have suggested directions for future research including longitudinal studies and additional assessment approaches.

Suggestion 2: Broaden the Context

Response: Thank you for your suggestion to broaden the context. We agree this would strengthen the paper's impact. While our policy implications section currently focuses on the Thai context, we will add a paragraph explicitly discussing how our findings could inform similar initiatives in other countries with aging populations. This addition will highlight the potential transferability of our findings regarding elderly education models to various cultural and socioeconomic contexts globally, particularly in other middle-income countries experiencing rapid demographic aging.

We believe that these revisions have addressed the reviewer's concerns and significantly improved the manuscript. We are grateful for the opportunity to enhance the quality of our work.
We sincerely appreciate the reviewer's insightful comments, which have significantly helped us to improve the clarity of our manuscript. We have addressed each point as follows:

Suggestion 1: Reinforce Study Limitations

Response: Thank you for your thoughtful suggestion to reinforce the study limitations. We would like to note that the manuscript already includes a detailed discussion of the study limitations in the 'Strengths and limitations' section. Specifically, we have addressed geographical limitations (the single-district scope and generalizability concerns), methodological limitations (cross-sectional design and its constraints on establishing causality), and have suggested directions for future research including longitudinal studies and additional assessment approaches.

Suggestion 2: Broaden the Context

Response: Thank you for your suggestion to broaden the context. We agree this would strengthen the paper's impact. While our policy implications section currently focuses on the Thai context, we will add a paragraph explicitly discussing how our findings could inform similar initiatives in other countries with aging populations. This addition will highlight the potential transferability of our findings regarding elderly education models to various cultural and socioeconomic contexts globally, particularly in other middle-income countries experiencing rapid demographic aging.

We believe that these revisions have addressed the reviewer's concerns and significantly improved the manuscript. We are grateful for the opportunity to enhance the quality of our work.
Competing Interests: No competing interests were disclosed. Close
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COMMENTS ON THIS REPORT

Author Response 31 Mar 2025

Worapath Kratoo, College of Public Health Sciences, Chulalongkorn University, Bangkok, 10330, Thailand

31 Mar 2025

Author Response
We sincerely appreciate the reviewer's insightful comments, which have significantly helped us to improve the clarity of our manuscript. We have addressed each point as follows:

Suggestion 1: Reinforce ... Continue reading
We sincerely appreciate the reviewer's insightful comments, which have significantly helped us to improve the clarity of our manuscript. We have addressed each point as follows:

Suggestion 1: Reinforce Study Limitations

Response: Thank you for your thoughtful suggestion to reinforce the study limitations. We would like to note that the manuscript already includes a detailed discussion of the study limitations in the 'Strengths and limitations' section. Specifically, we have addressed geographical limitations (the single-district scope and generalizability concerns), methodological limitations (cross-sectional design and its constraints on establishing causality), and have suggested directions for future research including longitudinal studies and additional assessment approaches.

Suggestion 2: Broaden the Context

Response: Thank you for your suggestion to broaden the context. We agree this would strengthen the paper's impact. While our policy implications section currently focuses on the Thai context, we will add a paragraph explicitly discussing how our findings could inform similar initiatives in other countries with aging populations. This addition will highlight the potential transferability of our findings regarding elderly education models to various cultural and socioeconomic contexts globally, particularly in other middle-income countries experiencing rapid demographic aging.

We believe that these revisions have addressed the reviewer's concerns and significantly improved the manuscript. We are grateful for the opportunity to enhance the quality of our work.
We sincerely appreciate the reviewer's insightful comments, which have significantly helped us to improve the clarity of our manuscript. We have addressed each point as follows:

Suggestion 1: Reinforce Study Limitations

Response: Thank you for your thoughtful suggestion to reinforce the study limitations. We would like to note that the manuscript already includes a detailed discussion of the study limitations in the 'Strengths and limitations' section. Specifically, we have addressed geographical limitations (the single-district scope and generalizability concerns), methodological limitations (cross-sectional design and its constraints on establishing causality), and have suggested directions for future research including longitudinal studies and additional assessment approaches.

Suggestion 2: Broaden the Context

Response: Thank you for your suggestion to broaden the context. We agree this would strengthen the paper's impact. While our policy implications section currently focuses on the Thai context, we will add a paragraph explicitly discussing how our findings could inform similar initiatives in other countries with aging populations. This addition will highlight the potential transferability of our findings regarding elderly education models to various cultural and socioeconomic contexts globally, particularly in other middle-income countries experiencing rapid demographic aging.

We believe that these revisions have addressed the reviewer's concerns and significantly improved the manuscript. We are grateful for the opportunity to enhance the quality of our work.
Competing Interests: No competing interests were disclosed. Close
Report a concern

Views

Reviewer Report 23 Aug 2024

Aye Sandar Mon, University of Public Health, Yangon, Myanmar

Approved with Reservations

https://doi.org/10.5256/f1000research.165851.r310486

General comment

The manuscript is well written and the study findings could contribute to the substantial policy implication.

Specific comments

In sampling technique, the researchers applied quota

General comment

The manuscript is well written and the study findings could contribute to the substantial policy implication.

Specific comments

In sampling technique, the researchers applied quota and systematic sampling. For systematic sampling, how to calculate the sampling interval was described but I did not find about the random start. Could you please clarify it?
In data collection method, was any pre-testing conducted? If so, please mention the procedure and the results including the reliability of the questionnaire and participants’ understanding of the question items.
According to previous literature and evidence from international studies, in addition to the factors you considered as covariates in the statistical model, the social support and mental health status such as depression have been recognized as the important predictors for QoL. Although your questionnaire included the items assessing the social support and mental health status (DASS-21), why weren’t these variables considered as covariates in the statistical model?
While presenting the results of multiple linear regression in “Table 4”, as the variable “elderly school attendance” is the main factor of interest, this variable should be described first instead of being the second-to-last description.
I did not find the statistical procedures for assumption checks for multiple linear regression (regression diagnostics) in the 'Methods' or 'Results' sections. Were these tests performed? If not, please check the necessary assumptions, and if they were, please mention the results in the manuscript.

Is the work clearly and accurately presented and does it cite the current literature?

Yes
Is the study design appropriate and is the work technically sound?

Yes
Are sufficient details of methods and analysis provided to allow replication by others?

Yes
If applicable, is the statistical analysis and its interpretation appropriate?

Partly
Are all the source data underlying the results available to ensure full reproducibility?

Yes
Are the conclusions drawn adequately supported by the results?

Yes

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: My areas of research include maternal health and other public health-related topics, epidemiological studies in communicable and non-communicable diseases, and the application of advanced statistical models in various types of research.

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

CITE

Report a concern

Author Response 31 Mar 2025

Worapath Kratoo, College of Public Health Sciences, Chulalongkorn University, Bangkok, 10330, Thailand

31 Mar 2025

Author Response
We sincerely appreciate the reviewer's insightful comments, which have significantly helped us to improve the clarity of our manuscript. We have addressed each point as follows:

Comment 1: Sampling ... Continue reading
We sincerely appreciate the reviewer's insightful comments, which have significantly helped us to improve the clarity of our manuscript. We have addressed each point as follows:

Comment 1: Sampling Technique (Systematic Sampling - Random Start)

Response: Thank you for pointing out the omission regarding the random start in our systematic sampling procedure. To clarify, we have now added this important information to the sampling technique section. Specifically, we used a random number generator to select a starting point between 1 and 13, and from this random start, we then selected every 13th elderly person in the population who met our eligibility criteria. This random start was essential to ensure the systematic sample maintained randomness properties.

Comment 2: Data Collection Method (Pre-testing and Reliability)

Response: We conducted a pilot study for pre-testing, and the reliability of the questionnaire was evaluated using Cronbach's alpha. All items demonstrated reliability coefficients between 0.80-0.83, indicating good internal consistency. These reliability measures have been incorporated into the methodology section.

Comment 3: Covariates (Social Support and Mental Health)

Response: The propensity score matching (PSM) analysis, we focused on demographic characteristic variables that enable the matching of similar characteristics, thus maintaining’s model simplicity, focusing on direct effects rather than confounding relationships that could complicate analysis.

Comment 4: Presentation of Multiple Linear Regression Results (Elderly School Attendance)

Response: We agree that the variable 'elderly school attendance, being the main factor of interest, should be highlighted. In the revised manuscript, we have reordered the results in Table 4.

Comment 5: Regression Diagnostics (Assumption Checks)

Response: There is no multicollinearity, as indicated by the VIF scores, which are all less than 10 in Table 4.

We believe that these revisions have addressed the reviewer's concerns and significantly improved the manuscript. We are grateful for the opportunity to enhance the quality of our work.
We sincerely appreciate the reviewer's insightful comments, which have significantly helped us to improve the clarity of our manuscript. We have addressed each point as follows:

Comment 1: Sampling Technique (Systematic Sampling - Random Start)

Response: Thank you for pointing out the omission regarding the random start in our systematic sampling procedure. To clarify, we have now added this important information to the sampling technique section. Specifically, we used a random number generator to select a starting point between 1 and 13, and from this random start, we then selected every 13th elderly person in the population who met our eligibility criteria. This random start was essential to ensure the systematic sample maintained randomness properties.

Comment 2: Data Collection Method (Pre-testing and Reliability)

Response: We conducted a pilot study for pre-testing, and the reliability of the questionnaire was evaluated using Cronbach's alpha. All items demonstrated reliability coefficients between 0.80-0.83, indicating good internal consistency. These reliability measures have been incorporated into the methodology section.

Comment 3: Covariates (Social Support and Mental Health)

Response: The propensity score matching (PSM) analysis, we focused on demographic characteristic variables that enable the matching of similar characteristics, thus maintaining’s model simplicity, focusing on direct effects rather than confounding relationships that could complicate analysis.

Comment 4: Presentation of Multiple Linear Regression Results (Elderly School Attendance)

Response: We agree that the variable 'elderly school attendance, being the main factor of interest, should be highlighted. In the revised manuscript, we have reordered the results in Table 4.

Comment 5: Regression Diagnostics (Assumption Checks)

Response: There is no multicollinearity, as indicated by the VIF scores, which are all less than 10 in Table 4.

We believe that these revisions have addressed the reviewer's concerns and significantly improved the manuscript. We are grateful for the opportunity to enhance the quality of our work.
Competing Interests: No competing interests were disclosed. Close
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Respond or Comment

COMMENTS ON THIS REPORT

Author Response 31 Mar 2025

Worapath Kratoo, College of Public Health Sciences, Chulalongkorn University, Bangkok, 10330, Thailand

31 Mar 2025

Author Response
We sincerely appreciate the reviewer's insightful comments, which have significantly helped us to improve the clarity of our manuscript. We have addressed each point as follows:

Comment 1: Sampling ... Continue reading
We sincerely appreciate the reviewer's insightful comments, which have significantly helped us to improve the clarity of our manuscript. We have addressed each point as follows:

Comment 1: Sampling Technique (Systematic Sampling - Random Start)

Response: Thank you for pointing out the omission regarding the random start in our systematic sampling procedure. To clarify, we have now added this important information to the sampling technique section. Specifically, we used a random number generator to select a starting point between 1 and 13, and from this random start, we then selected every 13th elderly person in the population who met our eligibility criteria. This random start was essential to ensure the systematic sample maintained randomness properties.

Comment 2: Data Collection Method (Pre-testing and Reliability)

Response: We conducted a pilot study for pre-testing, and the reliability of the questionnaire was evaluated using Cronbach's alpha. All items demonstrated reliability coefficients between 0.80-0.83, indicating good internal consistency. These reliability measures have been incorporated into the methodology section.

Comment 3: Covariates (Social Support and Mental Health)

Response: The propensity score matching (PSM) analysis, we focused on demographic characteristic variables that enable the matching of similar characteristics, thus maintaining’s model simplicity, focusing on direct effects rather than confounding relationships that could complicate analysis.

Comment 4: Presentation of Multiple Linear Regression Results (Elderly School Attendance)

Response: We agree that the variable 'elderly school attendance, being the main factor of interest, should be highlighted. In the revised manuscript, we have reordered the results in Table 4.

Comment 5: Regression Diagnostics (Assumption Checks)

Response: There is no multicollinearity, as indicated by the VIF scores, which are all less than 10 in Table 4.

We believe that these revisions have addressed the reviewer's concerns and significantly improved the manuscript. We are grateful for the opportunity to enhance the quality of our work.
We sincerely appreciate the reviewer's insightful comments, which have significantly helped us to improve the clarity of our manuscript. We have addressed each point as follows:

Comment 1: Sampling Technique (Systematic Sampling - Random Start)

Response: Thank you for pointing out the omission regarding the random start in our systematic sampling procedure. To clarify, we have now added this important information to the sampling technique section. Specifically, we used a random number generator to select a starting point between 1 and 13, and from this random start, we then selected every 13th elderly person in the population who met our eligibility criteria. This random start was essential to ensure the systematic sample maintained randomness properties.

Comment 2: Data Collection Method (Pre-testing and Reliability)

Response: We conducted a pilot study for pre-testing, and the reliability of the questionnaire was evaluated using Cronbach's alpha. All items demonstrated reliability coefficients between 0.80-0.83, indicating good internal consistency. These reliability measures have been incorporated into the methodology section.

Comment 3: Covariates (Social Support and Mental Health)

Response: The propensity score matching (PSM) analysis, we focused on demographic characteristic variables that enable the matching of similar characteristics, thus maintaining’s model simplicity, focusing on direct effects rather than confounding relationships that could complicate analysis.

Comment 4: Presentation of Multiple Linear Regression Results (Elderly School Attendance)

Response: We agree that the variable 'elderly school attendance, being the main factor of interest, should be highlighted. In the revised manuscript, we have reordered the results in Table 4.

Comment 5: Regression Diagnostics (Assumption Checks)

Response: There is no multicollinearity, as indicated by the VIF scores, which are all less than 10 in Table 4.

We believe that these revisions have addressed the reviewer's concerns and significantly improved the manuscript. We are grateful for the opportunity to enhance the quality of our work.
Competing Interests: No competing interests were disclosed. Close
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Version 2

VERSION 2 PUBLISHED 03 Jul 2024

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Version 2 (revision) 31 Mar 25	read
Version 1 03 Jul 24	read	read	read

Aye Sandar Mon, University of Public Health, Yangon, Myanmar
Andrew Kweku Conduah, University of Professional Studies, Madina, Ghana
Ueamporn Summart, Roi Et Rajabhat University, Tha Muang, Thailand

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Reviewer Report

2 Views

16 Apr 2025 | for Version 2

Aye Sandar Mon, University of Public Health, Yangon, Myanmar

2 Views Cite this report Responses(0)

Approved

No further comments from my side. All my previous comments have been addressed in the revised version.

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

My areas of research include maternal health and other public health-related topics, epidemiological studies in communicable and non-communicable diseases, and the application of advanced statistical models in various types of research.

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

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13 Views

13 Feb 2025 | for Version 1

Ueamporn Summart, Faculty of Nursing, Roi Et Rajabhat University, Tha Muang, Thailand

13 Views Cite this report Responses(1)

Approved

Is the work clearly and accurately presented and does it cite the current literature?

Yes
Is the study design appropriate and is the work technically sound?

Yes
Are sufficient details of methods and analysis provided to allow replication by others?

Yes
If applicable, is the statistical analysis and its interpretation appropriate?

Yes
Are all the source data underlying the results available to ensure full reproducibility?

Yes
Are the conclusions drawn adequately supported by the results?

Yes

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Nursing and Public Health

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

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Author Response

31 Mar 2025

Worapath Kratoo, College of Public Health Sciences, Chulalongkorn University, Bangkok, 10330, Thailand

We sincerely appreciate the reviewer's insightful comments, which have significantly helped us to improve the clarity of our manuscript. We have addressed each point as follows:

Comment 1: Calculation of the Required Sample Size: Effect Size

Response: An effect size of 0.02 in the sample size calculation, derived from a pilot study comparing QoL between the means of the two groups (attending and not attending elderly school) divided by the standard deviation.

Comment 2: Study Samples: Sampling Process and CONSORT Diagram

Response: We have already added CONSORT diagram

Comment 3: Results: Beta Coefficients and Mean Differences

Response: In our analysis, we have chosen to present Average Treatment Effects (ATE) as our primary measure of impact, as these values provide a more robust estimate of causal effect by accounting for potential confounding variables. The ATEs reported in our results section represent the estimated average effect of each variable on quality of life after controlling for other covariates in the model. We believe this approach is more appropriate for our study design than unadjusted mean differences because it addresses potential selection bias and confounding factors that could influence the outcomes.

We believe that these revisions have addressed the reviewer's concerns and significantly improved the manuscript. We are grateful for the opportunity to enhance the quality of our work.

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Competing Interests

No competing interests were disclosed.

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Reviewer Report

20 Views

20 Sep 2024 | for Version 1

Andrew Kweku Conduah, University of Professional Studies, Madina, Ghana

20 Views Cite this report Responses(1)

Approved

Appropriateness: The cross-sectional design is suitable for simultaneously assessing the prevalence of characteristics or conditions. This study is used to compare the quality of life (QoL) of elderly individuals who attended and did not attend an elderly school. This design effectively examines differences in QoL and determines associations with the elderly school program.

2. Sample Size
Sample Size Calculation:

Appropriateness: The sample size calculation is based on continuous data and considers effect size, power, predictors, and significance level. The study's sample size of 901 participants is derived from these calculations, ensuring sufficient statistical power for detecting meaningful differences.

3. Sampling Technique
Quota and Systematic Sampling:

Appropriateness: Combining quota sampling with systematic sampling ensures a representative sample of elderly individuals attending and not attending the elderly school. Quota sampling ensures demographic representation, while systematic sampling introduces randomness into the selection process.

4. Data Collection
Face-to-Face Interviews:

Appropriateness: Face-to-face interviews effectively collect detailed and accurate data concerning literacy or language barriers. The research team’s training ensures consistency and reliability in data collection.

5. Measurement
Instruments Used:

Demographic and Socioeconomic Factors: Detailed questionnaires assess various factors relevant to QoL.
Activities of Daily Living (ADLs): The Barthel Index is an established tool for measuring ADL performance, suitable for evaluating functional capacity.
WHOQOL-BREF: This validated instrument assesses QoL across multiple domains. Using the Thai version ensures cultural and linguistic relevance.

6. Treatment Variable
Elderly School Program:

Appropriateness: The definition and criteria for attendance in the elderly school program are clear and relevant to the study's objectives. Participants are categorised based on their attendance, which aligns with the study’s aim to evaluate the program’s impact.

7. Covariates and Propensity Score Matching (PSM)
PSM for Addressing Selection Bias:

Appropriateness: PSM is a robust method for controlling confounding variables and ensuring balanced groups. Demographic and socioeconomic factors are used as covariates, enhancing comparability between attendees and non-attendees of the elderly school.

8. Statistical Analysis
Analysis Methods:

Appropriateness: The use of PSM, standardised differences, and multiple linear regression is appropriate for analysing the effect of the elderly school program on QoL. These methods effectively control for confounding and assess the treatment's impact.

Clear Summary of Findings: The conclusion restates the primary outcomes, particularly the positive impact of elderly school attendance on Quality of Life (QoL). It effectively highlights the significance of these schools in enhancing overall QoL among senior citizens in Thailand.
Implications for Policy: The discussion on policy implications is well-founded. By recommending robust support across various domains (human resources, finances, facilities, and management), the conclusion addresses practical steps that policymakers can take to enhance the program's effectiveness.
Encouragement of Collaboration: A strategic recommendation is to emphasise collaboration with local administrative organisations (LAOs), communities, and the private sector. This suggests a comprehensive approach to expanding the program and ensures the reader understands the context needed for success.
Forward-looking Perspective: The conclusion reflects on the current findings and looks ahead, suggesting how Thailand can further leverage these initiatives to improve the QoL of its ageing population. This gives the study a forward-looking angle, which is valuable in research conclusions.

Minor Suggestions for Enhancement:

Reinforce Study Limitations: Depending on what was discussed earlier in the paper, briefly mentioning any limitations or areas for future research here might be helpful. This adds balance and shows a critical engagement with the study’s scope.
Broaden the Context: While the focus on Thailand is appropriate, you could briefly mention how these findings might inform similar initiatives in other countries, especially those with ageing populations, to widen the study's impact.

Overall, the conclusion is appropriate, but adding a sentence or two to address limitations or broader implications could make it even stronger.

Is the work clearly and accurately presented and does it cite the current literature?

Yes
Is the study design appropriate and is the work technically sound?

Yes
Are sufficient details of methods and analysis provided to allow replication by others?

Yes
If applicable, is the statistical analysis and its interpretation appropriate?

Yes
Are all the source data underlying the results available to ensure full reproducibility?

Yes
Are the conclusions drawn adequately supported by the results?

Yes

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

§ Population Estimates and Projections.§ Population Health and Mortality- Health Emergencies & Preparedness, Ageing & Intergeneration Relations, and Non-Communicable Disease & Health Projection (Physical Activity, Obesity, Tobacco Control, etc.)§ Business Demography§ Business Policy and Strategy§ Business Management§ Public Administration, Entrepreneurial Innovation

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

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Author Response

31 Mar 2025

Worapath Kratoo, College of Public Health Sciences, Chulalongkorn University, Bangkok, 10330, Thailand

Response: Thank you for your thoughtful suggestion to reinforce the study limitations. We would like to note that the manuscript already includes a detailed discussion of the study limitations in the 'Strengths and limitations' section. Specifically, we have addressed geographical limitations (the single-district scope and generalizability concerns), methodological limitations (cross-sectional design and its constraints on establishing causality), and have suggested directions for future research including longitudinal studies and additional assessment approaches.

Suggestion 2: Broaden the Context

Response: Thank you for your suggestion to broaden the context. We agree this would strengthen the paper's impact. While our policy implications section currently focuses on the Thai context, we will add a paragraph explicitly discussing how our findings could inform similar initiatives in other countries with aging populations. This addition will highlight the potential transferability of our findings regarding elderly education models to various cultural and socioeconomic contexts globally, particularly in other middle-income countries experiencing rapid demographic aging.

We believe that these revisions have addressed the reviewer's concerns and significantly improved the manuscript. We are grateful for the opportunity to enhance the quality of our work.

View more View less

Competing Interests

No competing interests were disclosed.

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Reviewer Report

16 Views

23 Aug 2024 | for Version 1

Aye Sandar Mon, University of Public Health, Yangon, Myanmar

16 Views Cite this report Responses(1)

Approved With Reservations

General comment

The manuscript is well written and the study findings could contribute to the substantial policy implication.

Specific comments

In sampling technique, the researchers applied quota and systematic sampling. For systematic sampling, how to calculate the sampling interval was described but I did not find about the random start. Could you please clarify it?
In data collection method, was any pre-testing conducted? If so, please mention the procedure and the results including the reliability of the questionnaire and participants’ understanding of the question items.
According to previous literature and evidence from international studies, in addition to the factors you considered as covariates in the statistical model, the social support and mental health status such as depression have been recognized as the important predictors for QoL. Although your questionnaire included the items assessing the social support and mental health status (DASS-21), why weren’t these variables considered as covariates in the statistical model?
While presenting the results of multiple linear regression in “Table 4”, as the variable “elderly school attendance” is the main factor of interest, this variable should be described first instead of being the second-to-last description.
I did not find the statistical procedures for assumption checks for multiple linear regression (regression diagnostics) in the 'Methods' or 'Results' sections. Were these tests performed? If not, please check the necessary assumptions, and if they were, please mention the results in the manuscript.

Is the work clearly and accurately presented and does it cite the current literature?

Yes
Is the study design appropriate and is the work technically sound?

Yes
Are sufficient details of methods and analysis provided to allow replication by others?

Yes
If applicable, is the statistical analysis and its interpretation appropriate?

Partly
Are all the source data underlying the results available to ensure full reproducibility?

Yes
Are the conclusions drawn adequately supported by the results?

Yes

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Respond to this report

Responses (1)

Author Response

31 Mar 2025

Worapath Kratoo, College of Public Health Sciences, Chulalongkorn University, Bangkok, 10330, Thailand

We sincerely appreciate the reviewer's insightful comments, which have significantly helped us to improve the clarity of our manuscript. We have addressed each point as follows:

Comment 1: Sampling Technique (Systematic Sampling - Random Start)

Response: Thank you for pointing out the omission regarding the random start in our systematic sampling procedure. To clarify, we have now added this important information to the sampling technique section. Specifically, we used a random number generator to select a starting point between 1 and 13, and from this random start, we then selected every 13th elderly person in the population who met our eligibility criteria. This random start was essential to ensure the systematic sample maintained randomness properties.

Comment 2: Data Collection Method (Pre-testing and Reliability)

Response: We conducted a pilot study for pre-testing, and the reliability of the questionnaire was evaluated using Cronbach's alpha. All items demonstrated reliability coefficients between 0.80-0.83, indicating good internal consistency. These reliability measures have been incorporated into the methodology section.

Comment 3: Covariates (Social Support and Mental Health)

Response: The propensity score matching (PSM) analysis, we focused on demographic characteristic variables that enable the matching of similar characteristics, thus maintaining’s model simplicity, focusing on direct effects rather than confounding relationships that could complicate analysis.

Comment 4: Presentation of Multiple Linear Regression Results (Elderly School Attendance)

Response: We agree that the variable 'elderly school attendance, being the main factor of interest, should be highlighted. In the revised manuscript, we have reordered the results in Table 4.

Comment 5: Regression Diagnostics (Assumption Checks)

Response: There is no multicollinearity, as indicated by the VIF scores, which are all less than 10 in Table 4.

We believe that these revisions have addressed the reviewer's concerns and significantly improved the manuscript. We are grateful for the opportunity to enhance the quality of our work.

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Competing Interests

No competing interests were disclosed.

Alongside their report, reviewers assign a status to the article:

Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested

Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.

Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions

[1] 1. Affairs UND of E and S: World Population Ageing 2019. United Nations; 2020. Publisher Full Text

[2] 2. World Health Organization: Ageing and health.Published October 1, 2022. Accessed July 11, 2023. Reference Source

[3] 3. The world bank group: Thailand Economic Monitor - June 2016: Aging Society and Economy. World Bank; Accessed July 11, 2023. Reference Source

[4] 4. World Health Organization: Thailand’s leadership and innovations towards healthy ageing.Published September 2, 2023. Accessed July 11, 2023. Reference Source

[5] 5. Institute for Population and Social Research, MU, Foundation of Thai Gerontology Research and Development Institute (TGRI): Situation of the Thai Older Persons 2021. Institute for Population and Social Research, Mahidol University and Foundation of Thai Gerontology Research and Development institute (TGRI); 2022. Reference Source

[6] 6. Department of Older Persons: Situation of The Thai Older Persons 2022. Foundation of Thai Gerontology Research and Development Institute and Institute for Population and Social Research, Mahidol University; 2023. Reference Source

[7] 7. Teoli D, Bhardwaj A: Quality Of Life. StatPearls. StatPearls Publishing; 2023. Accessed September 26, 2023. Reference Source

[8] 8. WHOQOL - Measuring Quality of Life|The World Health Organization: Accessed November 18, 2021. Reference Source

[9] 9. van Leeuwen KM , van Loon MS , van Nes FA , et al.: What does quality of life mean to older adults? A thematic synthesis. PLoS One. 2019; 14(3): e0213263. PubMed Abstract | Publisher Full Text | Free Full Text

[10] 10. Vahedi S: World Health Organization Quality-of-Life Scale (WHOQOL-BREF): Analyses of Their Item Response Theory Properties Based on the Graded Responses Model. Iran J Psychiatry. 2010; 5(4): 140–153. PubMed Abstract

[11] 11. Shevelkova V, Mattocks C, Lafortune L: Efforts to address the Sustainable Development Goals in older populations: a scoping review. BMC Public Health. 2023; 23(1): 456. PubMed Abstract | Publisher Full Text | Free Full Text

[12] 12. Chantakeeree C, Sormunen M, Estola M, et al.: Factors Affecting Quality of Life among Older Adults with Hypertension in Urban and Rural Areas in Thailand: A Cross-Sectional Study. Int J Aging Hum Dev. 2022; 95(2): 222–244. PubMed Abstract | Publisher Full Text | Free Full Text

[13] 13. Quashie NT, Pothisiri W: Rural-urban gaps in health care utilization among older Thais: The role of family support. Arch Gerontol Geriatr. 2019; 81: 201–208. PubMed Abstract | Publisher Full Text

[14] 14. Hongthong D, Somrongthong R, Ward P: Factors Influencing the Quality of Life (Qol) Among Thai Older People in a Rural Area of Thailand. Iran J Public Health. 2015; 44(4): 479–485. PubMed Abstract

[15] 15. Krishnappa L, Gadicherla S, Chidambaram P, et al.: Quality of life (QOL) among older persons in an urban and rural area of Bangalore, South India. J Fam Med Prim Care. 2021; 10(1): 272–277. PubMed Abstract | Publisher Full Text | Free Full Text

[16] 16. Zin PE, Saw YM, Saw TN, et al.: Assessment of quality of life among elderly in urban and peri-urban areas, Yangon Region, Myanmar. PLoS One. 2020; 15(10): e0241211. PubMed Abstract | Publisher Full Text | Free Full Text

[17] 17. Phetchabun provincial public health office: HDC - Gender classified population yearly age group report. Gender classified population yearly age group.Published August 15, 2023. Accessed August 16, 2023. Reference Source

[18] 18. Panvongsa P, Sonthon P, Yusook K: FACTORS ASSOCIATED WITH QUALITY OF LIFE OF ELDERLY IN RURAL, PHETCHBUN PROVINCE. Acad J Uttaradit Rajabhat Univ. 2020; 15(2): 41–56.

[19] 19. Chang HK, Gil CR, Kim HJ, et al.: Factors Affecting Quality of Life Among the Elderly in Long-Term Care Hospitals. J Nurs Res JNR. 2020; 29(1): e134. PubMed Abstract | Publisher Full Text | Free Full Text

[20] 20. Talarska D, Tobis S, Kotkowiak M, et al.: Determinants of Quality of Life and the Need for Support for the Elderly with Good Physical and Mental Functioning. Med Sci Monit Int Med J Exp Clin Res. 2018; 24: 1604–1613. PubMed Abstract | Publisher Full Text | Free Full Text

[21] 21. Acharya Samadarshi SC, Taechaboonsermsak P, Tipayamongkholgul M, et al.: Quality of life and associated factors amongst older adults in a remote community, Nepal. J Health Res. 2021; 36(1): 56–67. Publisher Full Text

[22] 22. Davodi SR, Zendehtalab H, Zare M, et al.: Effect of Health Promotion Interventions in Active Aging in the Elderly: A Randomized Controlled Trial. Int J Community Based Nurs Midwifery. 2023; 11(1): 34–43. PubMed Abstract | Publisher Full Text | Free Full Text

[23] 23. Salmannezhad M, Momtaz YA, Sahhaf R, et al.: The effect of “Elder Care by Elderly People Program” on life satisfaction and quality of life among institutionalized senior citizens. J Educ Health Promot. 2022; 11: 1. PubMed Abstract | Publisher Full Text | Free Full Text

[24] 24. Srivarathan A, Jensen AN, Kristiansen M: Community-based interventions to enhance healthy aging in disadvantaged areas: perceptions of older adults and health care professionals. BMC Health Serv Res. 2019; 19(1): 7. PubMed Abstract | Publisher Full Text | Free Full Text

[25] 25. Chiu CJ, Hu JC, Lo YH, et al.: Health Promotion and Disease Prevention Interventions for the Elderly: A Scoping Review from 2015–2019. Int J Environ Res Public Health. 2020; 17(15): 5335. PubMed Abstract | Publisher Full Text | Free Full Text

[26] 26. Fulmer T, Reuben DB, Auerbach J, et al.: Actualizing Better Health And Health Care For Older Adults. Health Aff Proj Hope. 2021; 40(2): 219–225. Publisher Full Text

[27] 27. Tay YL, Abu Bakar NS, Tumiran R, et al.: Effects of home visits on quality of life among older adults: a systematic review protocol. Syst Rev. 2021; 10: 307. PubMed Abstract | Publisher Full Text | Free Full Text

[28] 28. Department of Older Persons TM of SD and HS: The elderly school manual.Published online September 2017. Accessed October 11, 2021. Reference Source

[29] 29. Kasemsuk W, JItjarut S, Makaphon J, et al.: THE GUIDELINE TO PROMOTE LIFELONG LEARNING FOR ELDERLY SCHOOL. J Police Nurses. 2019; 11(2): 261–271.

[30] 30. Dhirathiti NS, Pichitpatja P: Characteristics and differences of lifelong learning policy implementation for the elderly in Thailand. Educ Res Policy Pract. 2018; 17(1): 53–68. Publisher Full Text

[31] 31. Phetchabun provincial public health office: Public health action plan Phetchabun province 2018.2017. Accessed January 24, 2024. Reference Source

[32] 32. Sutapan S, Promsuan W, Howharn C, et al.: The Roles and Responsibilities as District Health Board: From Perspective to Practice for Community Health. J Prev Med Assoc Thail. 2020; 10(2): 254–273.

[33] 33. Department of older persons: Annual report 2022. 2022:80. Accessed October 26, 2023. Reference Source

[34] 34. Kongjareon M: CURRICULUM DEVELOPMENT OF TRAINING FOR TEACHERS IN THE ELDERLY LEARNING CENTER. Panyapiwat J. 2021; 13(2): 190–206.

[35] 35. Thariwong S, Konkong C, Rodkaew A: System and Mechanism for Implementation of A Center for Promotion and Development of Quality of Life for Elderly people (Senior School) in Plai Chumphon Subdistrict Municipality, Muang District, Phitsanulok Province. Soc Sci Res Acad J. 2023; 18(2): 61–76.

[36] 36. Department of older persons: Annual report 2018. 2018:63. Accessed October 26, 2023. Reference Source

[37] 37. Department of older persons: Annual report 2019. 2019:70. Accessed October 26, 2023. Reference Source

[38] 38. Department of older persons: Annual report 2020. 2020:70. Accessed October 26, 2023. Reference Source

[39] 39. Department of older persons: Annual report 2021. 2021:68. Accessed October 26, 2023. Reference Source

[40] 40. Thai health resource center: The elderly school establishment. Establishment of a school for the elderly.Published May 9, 2019. Accessed December 11, 2023. Reference Source

[41] 41. Erwanto R, Kurniasih DE, Amigo TAE: THE EFFECTIVENESS OF INFORMAL EDUCATION: ELDERLY SCHOOL ON THE HEALTH STATUS OF ELDERLY. Proceeding Int Conf. 2019; 1(1): 550–556.

[42] 42. Atijitta P: Elderly School for the Community Strengthening. CRRU. J Commun. 2021; 4(3). Accessed October 26, 2023. Reference Source

[43] 43. Kandamri S, Sungrugsa N; University S et al.: THE DEVELOPMENT EMPOWERING MODEL TO PROMOTE THE QUALITY ELDERS LIFE IN THE ELDERLY SCHOOL OF NAKHON PATHOM PROVINCE. Silpakorn University; 2023. Thesis. Accessed October 26, 2023. Reference Source

[44] 44. Liamyu P, Sinjindawong S, Manisri C: The Proposed Policy of Elderly Schools Management for Local Government Organizations in Thailand. Ratchaphruek J. 2023; 21(2): 112–127. Publisher Full Text

[45] 45. PhrakhrutheerasatpaisalPonlamaungdee W, Sutta C: MANAGEMENT MODELS OF THE ELDERLY BUDDHIST SCHOOLS IN CHIANG RAI PROVINCE. J MCU Ubon Rev. 2023; 8(2): 975–988.

[46] 46. Phrakruarunsutalangkarn: SCHOOL OF ELDERS: WELL-BEING SYSTEM MANAGEMENT AND BENEFITS IN THE SCHOOLS IN CASE OF THE SOUTH OF THAILAND. J MCU Nakhondhat. 2019; 6(3): 1339–1362.

[47] 47. Soper DS: A-priori Sample Size Calculator for Multiple Regression [Software].2023. Accessed August 18, 2023. Reference Source

[48] 48. Mahoney FI, Barthel DW: FUNCTIONAL EVALUATION: THE BARTHEL INDEX. Md State Med J. 1965; 14: 61–65. PubMed Abstract

[49] 49. World Health Organization: Thai_WHOQOL-BREF.Published May 3, 2020. Accessed August 4, 2023. Reference Source

[50] 50. Pajuwang K: Quality of Life in Elders, Attending in The Elderly School of Rong Kho, Wang Nua District, Lampang. University of Phayao; 2017. Accessed October 26, 2023. Thesis. Reference Source

[51] 51. Phuttajorn A: DEVELOPMENT OF THE LIFE QUALITY OF THE ELDERLY PEOPLE BY THE SENIOR SCHOOL COURSE, NAPHU SUBDISTRICT, PHEN DISTRICT, UDON THANI. J MCU Nakhondhat. 2021; 8(3): 250–263.

[52] 52. Sarnsang C, Rattanapunya S: A Study of Quality of Life of Elders in the Elderly School, Thungkhowpuang Sub-district, Chiang Dao District, Chiang Mai Province. Thai Sci Technol J. Published online June 8, 2019; 964–974.

[53] 53. Jaul E, Barron J: Age-Related Diseases and Clinical and Public Health Implications for the 85 Years Old and Over Population. Front Public Health. 2017; 5: 335. PubMed Abstract | Publisher Full Text | Free Full Text

[54] 54. Gruzieva TS, Diachuk MD, Inshakova HV, et al.: HEALTH OF THE ELDERLY PEOPLE AS THE BASIS FOR FORMATION OF MEDICAL AND SOCIAL NEEDS. Wiadomosci Lek Wars Pol 1960. 2021; 74(3 cz 2): 658–664. Publisher Full Text

[55] 55. Bastos MAM d SC, Monteiro JMM d P, de Faria CMGM , et al.: Participation in community intervention programmes and quality of life: findings from a multicenter study in Portugal. Rev Bras Geriatr E Gerontol. 2020; 23: e190017. Publisher Full Text

[56] 56. Noble C, Medin D, Quail Z, et al.: How Does Participation in Formal Education or Learning for Older People Affect Wellbeing and Cognition? A Systematic Literature Review and Meta-Analysis. Gerontol Geriatr Med. 2021; 7: 233372142098602. PubMed Abstract | Publisher Full Text | Free Full Text

[57] 57. Narushima M, Liu J, Diestelkamp N: Lifelong learning in active ageing discourse: its conserving effect on wellbeing, health and vulnerability. Ageing Soc. 2018; 38(4): 651–675. PubMed Abstract | Publisher Full Text | Free Full Text

[58] 58. Choi I, Cho SR: A Case Study of Active Aging through Lifelong Learning: Psychosocial Interpretation of Older Adult Participation in Evening Schools in Korea. Int J Environ Res Public Health. 2021; 18(17): 9232. PubMed Abstract | Publisher Full Text | Free Full Text

[59] 59. Huangkasem S, Kunametheekoon T, Intaramat T: Participation of Senior Citizens in Educational Management of Local Administrative Organizations Affecting the Quality of Life: A Case Study of Schools for Senior Citizens in Rayong Province. J Humanit Soc Sci Mahasarakham Univ. 2022; 41(3): 149–163.

[60] 60. Seangpraw K, Ratanasiripong NT, Ratanasiripong P: Predictors of quality of life of the rural older adults in Northern Thailand. J Health Res. 2019; 33(6): 450–459. Publisher Full Text

[61] 61. Sirisuwan P, Phimha S, Banchonhattakit P: Influence of active ageing and health literacy on quality of life among elderly persons in northeast Thailand. Health Educ J. 2022; 81(6): 693–704. Publisher Full Text

[62] 62. Singh A, Palaniyandi S, Palaniyandi A, et al.: Health related quality of life among rural elderly using WHOQOL-BREF in the most backward district of India. J Fam Med Prim Care. 2022; 11(3): 1162. Publisher Full Text

[63] 63. Kim BR, Hwang HH: Analysis of Major Factors Affecting the Quality of Life of the Elderly in Korea in Preparation for a Super-Aged Society. Int J Environ Res Public Health. 2022; 19(15): 9618. PubMed Abstract | Publisher Full Text | Free Full Text

[64] 64. Romyen A: EFFECTS OF THE DEVELOPMENT OF CAREGIVER POTENTIAL FOR THE GOOD QUALITY OF LIFE OF ELDERLY, CHUMPHON PROVINCE. J MCU Nakhondhat. 2023; 10(1): 307–320.

[65] 65. Kratoo W, Hounnaklang N: Effect of elderly school policy on quality of life among Thailand’s senior citizens. figshare. 24-May-2024. Publisher Full Text

Effect of Elderly School Policy on Quality of Life among Thailand’s Senior Citizens: A Propensity Score Matching Approach

Abstract

Background

Methods

Results

Conclusion

Keywords

Revised Amendments from Version 1

Introduction

Methods

Research design

Sample size

Sampling technique

Figure 1. Participant flow diagram (CONSORT).

Data collection

Treatment variable

Table 1. The elderly school curriculum.

Covariates

Table 2. Demographic characteristics and covariate balancing by standardized difference of non-attending and attending the elderly school.

Figure 2. Density of propensity scores before and after match between non-attending and attending the elderly school.

Statistical analysis

Results

Comparison of the demographic characteristics of elderly people between non-attending and attending the elderly school

The effect of elderly school on quality of life

Table 3. The average treatment effects (ATE) on quality of life after PSM.

The association between elderly school attendance and quality of life

Table 4. The association between elderly school attendance and quality of life.

Discussion

Strengths and limitations

Policy implications and recommendations

Conclusion

Ethical and consent

Data availability

Underlying data

Extended data

Acknowledgements

References

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