This study aimed to assess the QOL and its correlates among older adults in Eastern Nepal and found that seven in ten participants had poor QOL, which was significantly associated with age, socioeconomic status, religion, ethnicity, physical activity, osteoarthritis, and depression.
The overall poor QOL observed in this study is consistent with previous studies from Nepal’s capital city of Kathmandu, where older patients in an outpatient clinic 14 and nursing homes 15 settings, had a lower overall QOL score. Previous studies, from international settings, are in line with our findings 21,22. Further, a gradient decline in the odds of poor QOL was noted by increasing age group which is in line with a previous study from Nepal where age was inversely associated with QOL 23. The declining QOL with age is plausible, given that older adults are at increased risk of chronic diseases and infection 6,24. Furthermore, age is associated with a progressive decline in muscle mass, strength, power, and physical performance 8,9. As a result, they have reduced mobility and functional capacity which ultimately influences the overall wellbeing and lowers the QOL at later life 8,9.
A significant finding of this study is the role of socioeconomic status and its implications for QoL. Better socioeconomic status, as indicated by literacy and higher income in this study, was associated with higher QOL among older adults in our study as well as others 25−27. Socioeconomic status is considered as one of the driving forces for the existing health disparities globally 28. Given the well-established relationship between socio-economic status and well-being, in terms of perceived health 29, mortality, and morbidity 30,31, the observed association with QOL was anticipated. Education increases health literacy and influences one’s ability to make informed decisions about their health and healthy behaviours 32. Likewise, income increases purchasing capacity, access to health care, and affordability of everyday need 33. Together, education and income may determine one’s social status and the psychosocial advantages gained through social networks 33. Specifically, among the older adults from the life-course approach to aging, the better SES may reflect the relative advantages, in terms of better economic and social positions, accumulated over the life course that may lead to better QOL in later life 34.
Similar to prior studies35,36, physical activity among the elderly was associated with QOL. The role of physical activity in the reduction of risk of chronic diseases and premature mortality, as well as the promotion of physical functionality and health in the general population, is well established 37−39. However, within the confines of this population, it provides evidence for the continual effect of physical activity over the life course. The pathways linking physical activity with QOL may be through the prevention of chronic diseases and the promotion of physical functioning and overall well-being. Previously, among older adults, several mediators such as better physical and mental health status increased exercise self-efficacy, increased physical self-worth, and reduced disability limitations, has been identified in the pathways between increased physical activity and QOL 35,36.
In the context of Nepal, an individual’s ethnicity has similar effects as their socio-economic status. Hence, it is not surprising to find that ethnicity was associated with QOL. Thus, compared to Brahmin/Chettri/Thakur, which is considered as the upper caste, participants from Indigenous, Dalit, and Madhesi/other ethnic groups had 75%, 77%, and 71% lower odds of having good QOL respectively. This is consistent with previous studies from Nepal, which have also suggested lower QOL scores among Dalits than the upper castes, although the findings were statistically non-significant 14,23. Likewise, our finding aligns with the established notion that the Madhesi, Dalits, and Indigenous, being one of the marginalised groups, have poor outcomes in health and wellbeing, and socioeconomic status 40,41. Historically, these ethnic groups were considered disadvantaged in the society, in terms of their access to education and employment, and were discriminated against by the upper caste groups. Although, in recent years, such discrimination against them is criminalised by the law and many organisations are in place to uplift their social mobility, the quest for equality is still a long journey, especially in rural parts where illiteracy is high and traditions are deep-rooted 4. This finding may suggest that the ethnic group you are born into may determine your QOL.
Another significant finding made from this study is the significant association between religiosity and QOL. Here, compared to a Hindu participant, QOL was higher among Buddhist participants and lower among Christian participants. Although the underlying explanations for the observed differences in QOL by religion are unknown, the literature does suggest that spirituality and religiosity are important components of QOL at any age 42. Religious involvement may buffer stress and increase happiness, meaning, purpose, hope in life, which ultimately leads to better QOL 43. Future studies have the opportunity to delve more on the observed association between religion and QOL; specifically, qualitative studies may be helpful to explore participant’s perceptions.
Physical and mental ailments were associated with lower QOL. Absence of osteoarthritis and depression was associated with higher odds of better QOL. Previously, low perceived QOL among patients with osteoarthritis is reported 44,45. The pain and limitations of daily living activities resulting from osteoarthritis may explain the observed reduced QOL 45,46.
Our findings of an inverse association between QOL and depression are consistent with previous studies from Nepal and globally 22,47,48. A meta-analysis of 24 studies reported moderate improvements in QOL following treatments for depression 49. Depression may lower the QOL by impairing physical and social functioning, and overall health 50.