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 adults ^{12 – 14} which is similar to Myanmar, and South India ^{15 , 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.

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).

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 learning ⁵⁷ 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.

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.