Assessment of Quality of Life for Elderly Residents: A Cross Sectional Study in Nursing Home Settings

Introduction

According to the World Health Organization (WHO), the percentage of the global population aged over 60 years is projected to double, rising from 12% in 2015 to 22% by 2050 [1]. As people age, there is a decline in physical and cognitive abilities, leading to an increased prevalence of disabilities, particularly after reaching the age of 85 [2], which significantly affects the quality of life. With the change in demographic structure, there is an increased need for health assistance. Relying solely on family support cannot meet the fundamental requirements for medical and health services, leading older individuals, especially those with no spouse or offspring and those with multiple health conditions, to opt for nursing homes for assisted living and healthcare [3]. Nursing homes can provide professional care for older individuals with severe impairment, improving their QoL and lessening the stress on family caregivers. However, the decision to place a loved one in a nursing home should be made thoughtfully [3]. The transition to nursing homes comes with various changes such as physical dependency, change in living arrangements, and loss of social interactions. Therefore, this transition causes poor QoL.

Also, a good QoL for the elderly is defined as independence, carrying out basic everyday activities, and feeling better. QoL is a target for programs designed to help the elderly [4]. Quality of life considers both physical and mental soundness and serves as a crucial measure of the overall health status of an individual. It is a multidimensional and subjective concept influenced by factors such as socio-demographic characteristics, social support, and psychological and physical characteristics [5].

Therefore, QoL is a crucial consideration in healthcare policies, focusing on promoting peace, mental well-being, and physical health alongside treating illnesses. A holistic approach to healthcare, including prevention and well-being, is essential for effective policies [6].

Elderly individuals in nursing homes often experience significant changes in their circumstances, including limited physical and mental abilities, loss of their homes and belongings, reduced contact with relatives and friends, the rigid structure of institutional living, and a sense of powerlessness in decision-making [7].

Therefore, older adults in care facilities often face increasing physical disabilities, leading to higher levels of depression, anxiety, and reduced interest in social activities. This can result in a poor quality of life compared to the community-dwelling elderly due to the loss of independence and social disconnection [8]. Also, spending time on meaningful activities is important to sustain QoL. If elderly residents are disengaged, it can cause loneliness and apathy that accelerate mental and physical deterioration [9].

BMI is a factor that influences the QoL in the Geriatric population. Elderly people with high BMI have a worse quality of life than people with normal weight [10].

Older individuals with higher BMI have a poorer quality of life and institutionalization tends to exacerbate that condition due to lack of physical activity and associated physiological effects.

Moreover, the social environment within the nursing homes shapes the perception of resident’s perception of QoL [11]. Residents with more social network and family support have better cognitive impairment than those with moderately sized social engagement [12]. Quality of life is dependent on cognitive functioning, so if there is an impairment in mental abilities, the elderly are less likely to sustain a healthy lifestyle [13] Understanding the complex interplay of physical, social, and cognitive factors is crucial in assessing the needs of older individuals in care [14]. By investigating these dynamics, we can inform the development of tailored healthcare interventions and policies that aim to optimize the QoL for elderly citizens in nursing homes.

Therefore, the main goal of this study is to investigate the assessment of quality of life (QOL) in elderly individuals residing in nursing homes, providing valuable insight to guide future healthcare initiatives.

Methodology

This cross-sectional study aimed to assess the quality of life (QoL) among male and female older adults aged 60 and above, residing in long-term care facilities for more than three months. The sample size comprised 260 participants selected through convenience sampling.

Exclusion criteria included cognitive impairment (defined as a score < 23 on the Mini-Mental Scale), severe medical conditions, physical limitations, communication barriers, severe pain, recent surgery, acute illness, or psychiatric disorders.

The WHO’s QoL scale was employed for the evaluation of participants' perceptions of their quality of life during structured interviews. Participants rated their QoL on a scale from 1 to 7, with higher scores indicating better QoL (7: delighted, 6: pleased, 5: satisfied, 4: mixed, 3: dissatisfied, 2: unhappy, 1: terrible) [15]. The Mini-Mental Scale was employed for assessing cognitive abilities, with scores ranging from 0 to 30, categorizing participants into severity levels [16]. BMI was calculated by integrating weight measurements obtained from a digital healthcare scale and height measurements from tape measurements.

Ethical approval was obtained from the Institutional Review Board of the University of Management and Technology. Moreover, all participants provided informed consent before participation. Data collection involved administering questionnaires, conducting cognitive assessments using the Mini-Mental Scale, and obtaining BMI measurements.

Researchers conducted interviews and assessments at various nursing homes, including Happy Homes, Rahimoon Welfare Foundation Old Homes, Fountain House, Affiat Old Age Homes, and Bahria Old Age Homes in Lahore, over two months. Data entry and analysis were performed using the Statistical Package for Social Sciences (SPSS) version 22, utilizing descriptive statistics such as frequency distribution, mean, and standard deviation, along with pie charts and correlation analysis to explore relationships between variables.

Results

The study's demographic analysis revealed that the majority of participants were aged between 60 to 75 years (190 participants, 73.1%), married (196 participants, 75.4%) and had predominantly undergraduate education (175 participants, 67.3%). Additionally, the sample consisted of 144 male participants (55.4%) and 116 female participants (44.6%).

Regarding their stay in nursing homes, a considerable proportion had been residing for up to 6 months (117 participants, 45.0%). In terms of BMI and cognitive function, the findings indicated that 140 participants were overweight (53.8%), while 111 had a normal BMI (42.7%), and 9 were underweight (3.5%). Furthermore, the majority showed no cognitive impairment on the Mini-Mental Scale (201 participants, 77.3%), while 54 participants had mild cognitive impairment (20.8%), and 5 had severe cognitive impairment (1.9%) (Table 1).

Table 1. Descriptive Statistics of Demographics.

The analysis revealed strong positive correlations between Quality of Life (QOL) and Mini-Mental Scale Score (Table 2), which implies that participants with higher Mini-Mental scores had more satisfactory QoL. The correlation analysis unveiled a noteworthy negative correlation between BMI and quality of life (QoL), with a Pearson correlation coefficient of -0.224 (p < 0.01) (Table 2). This finding signifies that as BMI increased, QoL tended to decrease among elderly residents in nursing homes.

Table 2. Correlation between QOL and Mini-Mental State Score, BMI and QOL, and BMI and Mini-Mental State score.

These findings suggest potential effects on the quality of life in nursing home residents, particularly focusing on BMI and Cognition.

Discussion

This study assessed the Quality of Life (QoL) of individuals in nursing homes, and the findings highlight that individuals with a low QoL either had impaired Cognition or high BMI. As far as cognition is concerned, this study shows a definite effect of Cognition impairment on QoL similar to the one conducted previously [17]. Additionally, limitation in the movements of two obese case subjects from a nursing home was also reported, which signifies the inability an active lifestyle leading to relatively poor QoL. The focus of the study was to observe, based on the quality of life of geriatrics in old homes with no comorbidities, the possible effects of other factors on residents towards the sustainment of their quality of life [18].

A correlation of 0.459 between the Mini-mental score and QoL was observed. This result means that there was a positive correlation between these variables, suggesting that if the mental abilities of the residents are intact, then it will help them achieve a better life quality. As implied by this study, most individuals (77.3%) at the retirement homes exhibited no cognitive impairment, so their quality of life was relatively good. These results are opposite to the results of the study conducted previously, as it shows a higher percentage of residents with cognitive impairment and a lower percentage of residents with normal MMS examination scores [19].

The difference can be due to the overall facilities of the nursing homes and mental health care provision. However, the BMI factor was also under consideration, which appeared to have influenced the QoL with the Pearson Correlation of -0.224 (p < = 0.01). As the results revealed, approximately 53.8% of residents with high BMI had also compromised their quality of life, due to a lack of self-care and dynamic participation in ADLs.

Moreover, the study also pointed out a non-significant negative correlation of -0.088(p > 0.158) between BMI and the mini-mental scale, indicating that a person's mental abilities cannot be affected by weight even if they are living in residential homes. Although all the factors that impacted the Quality of life of older residents of nursing homes were apparent, the fact that there is a background of emotional distress that leads to the lack of active self-care cannot be denied. The study also highlights the relationship between depression and social aspects of quality of life [20].

However, it can also be assumed that QoL somehow also reflects the ambiance provided by care homes to its residents. The long-term homes included in this study had a well-balanced environment for the residents that included regular medical check-ups, counseling, and availability of modern facilities, which can be an element in the relatively good quality of life of most residents than often presumed in standard long-term care home settings.

Limitations and Recommendations

Recommendations

Researchers should explore the effectiveness of various exercise programs and social engagement initiatives in enhancing the quality of life (QoL) among elderly individuals in nursing homes.

Further investigation into the impact of the physical environment of nursing homes, including accessibility to continuous medical and physical care, is warranted to better understand its influence on residents' well-being.

Limitations

The study's narrow focus on assessing QoL in elderly nursing home residents using only two variables, BMI and cognition, limits the comprehensive understanding of factors influencing their well-being.

Relying solely on self-reported data for QoL assessment may introduce biases such as social desirability bias and subjective interpretation, potentially impacting the accuracy of study outcomes.

Conclusion

In conclusion, our study sheds light on the intricate relationship between BMI, cognitive function, and quality of life (QoL) among elderly residents in nursing homes. We found that individuals with better cognitive function and lower BMI generally reported higher QoL compared to those with impaired cognition and higher BMI. These findings emphasize the importance of managing both cognitive health and weight management to improve the QoL of elderly nursing home residents. Future interventions should focus on tailored strategies to promote healthy aging and enhance QoL in this population.

References

1. Ko H, Park YH, Cho B, Lim KC, Chang SJ, Yi YM, et al. Gender differences in health status, quality of life, and community service needs of older adults living alone. Arch Gerontol Geriatr [Internet]. 2019;83:239-45. doi: https://doi.org/10.1016/j.archger.2019.05.009

2. Cordes T, Schoene D, Kemmler W, Wollesen B. Chair-Based exercise interventions for nursing home residents: A systematic review. J Am Med Dir Assoc [Internet]. 2021;22(4):733-40. doi: https://doi.org/10.1016/j.jamda.2020.09.042

3. Chen P, Cai H, Bai W, Su Z, Tang YL, Ungvari GS, et al. Global prevalence of mild cognitive impairment among older adults living in nursing homes: a meta-analysis and systematic review of epidemiological surveys. Transl Psychiatry [Internet]. 2023 Mar 11;13(1):88. doi: https://doi.org/10.1038/s41398-023-02361-1

4. Branco de Oliveira L da SSC, Souza EC, Rodrigues RAS, Fett CA, Piva AB. The effects of physical activity on anxiety, depression, and quality of life in elderly people living in the community. Trends Psychiatry Psychother [Internet]. 2019;41(1):36-42. doi: https://doi.org/10.1590/2237-6089-2017-0129

5. Li J, Xu X, Sun J, Cai W, Qin T, Wu M, et al. Activities of daily living, life orientation, and health-related quality of life among older people in nursing homes: a national cross-sectional study in China. Qual Life Res [Internet]. 2020;29(11):2949-60. doi: https://doi.org/10.1007/s11136-020-02571-w

6. Heydari J, Khani S, Shahhosseini Z. Health-related quality of life of elderly living in nursing home and homes in a district of Iran: Implications for policy makers. Indian J Sci Technol [Internet]. 2012;5(5):1-6. doi: https://doi.org/10.17485/ijst/2012/v5i5.24

7. Hjaltadóttir I, Gústafsdóttir M. Quality of life in nursing homes: perception of physically frail elderly residents. Scand J Caring Sci [Internet]. 2007;21(1):48-55. doi: https://doi.org/10.1111/j.1471-6712.2007.00434.x

8. Figueira HA, Figueira OA, Figueira AA, Figueira JA, Polo-Ledesma RE, Lyra da Silva CR, et al. Impact of physical activity on anxiety, depression, stress and quality of life of the older people in Brazil. Int J Environ Res Public Health [Internet]. 2023;20(2):1-11. doi: https://doi.org/10.3390/ijerph20021127

9. Tew CW, Ong SP, Yap PLK, Lim AYC, Luo N, Koh GCH, et al. Quality of Life, person-centred care and lived experiences of nursing home residents in a developed urban Asian country: a cross-sectional study. Jour Nursing Home Res [Internet]. 2021;7:1-8. doi: http://dx.doi.org/10.14283/jnhrs.2021.1

10. López-García E, Banegas Banegas JR, Gutiérrez-Fisac JL, Gzaciani Pérez-Regadera A, Díez- Gañán L, Rodríguez-Artalejo F. Relation between body weight and health-related quality of life among the elderly in Spain. Int J Obes Relat Metab Disord [Internet]. 2003;27(6):701-9. doi: https://doi.org/10.1038/sj.ijo.0802275

11. Alomari E, Steinke C. Quality of life in assisted living facilities for seniors: A descriptive exploratory study. Nurs Open [Internet]. 2024 Mar;11(3):e2084. doi: https://doi.org/10.1002/nop2.2084

12. Dodds L, Brayne C, Siette J. Associations between social networks, cognitive function, and quality of life among older adults in long-term care. BMC Geriatr [Internet]. 2024;24(1):1-12. doi: https://doi.org/10.1186/s12877-024-04794-9

13. Chang HK, Gil CR, Kim HJ, Bea HJ. Factors affecting quality of life among the elderly in long-term care hospitals. J Nurs Res [Internet]. 2021 Feb;29(1):e134. doi: https://doi.org/10.1097/jnr.0000000000000413

14. Böhner ES, Spek B, Joling KJ, Zwaagstra Y, Gerridzen IJ. Factors associated with ADL dependence in nursing home residents with Korsakoff’s Syndrome and other alcohol-related disorders: An explorative cross-sectional study. J Clin Med [Internet]. 2023 Mar 11;12(6):2-10. doi: https://doi.org/10.3390/jcm12062181

15. Verdugo MÁ, Gómez LE, Arias B, Schalock RL. The Integral Quality of Life Scale: Development, Validation, and Use. In Michalos AC, editor. Social Indicators Research Series vol 41 [Internet]. Dordrech: Springer; 2010. p. 47-60. doi: https://doi.org/10.1007/978-90-481-9650-0_4

16. Vertesi A, Lever JA, Molloy DW, Sanderson B, Tuttle I, Pokoradi L, et al. Standardized mini-mental state examination. Use and interpretation. Can Fam Physician [Internet]. 2001 Oct;47:2018-23. Available from: https://pubmed.ncbi.nlm.nih.gov/11723596/

17. Hussenoeder FS, Conrad I, Roehr S, Fuchs A, Pentzek M, Bickel H, et al. Mild cognitive impairment and quality of life in the oldest old: a closer look. Qual Life Res [Internet]. 2020;29(6):1675-83. doi: https://doi.org/10.1007/s11136-020-02425-5

18. Sabol VK, Kennerly SM, Alderden J, Horn SD, Yap TL. Insight into the movement behaviors of nursing home residents living with obesity: A report of two cases. Wound Manag Prev [Internet]. 2020 May;66(5):18-29. doi: https://doi.org/10.25270/wmp.2020.5.1829

19. Akter N, Banu B, Chowdhury SH, Islam KR, Tabassum TT, Hossain SM. Astute exploration of collective mental health events among the residents of elderly care homes. Heliyon [Internet]. 2023 Jul 8;9(7):e18117. doi: https://doi.org/10.1016/j.heliyon.2023.e18117

20. Polat Ü, Bayrak Kahraman B, Kaynak İ, Görgülü Ü. Relationship among health-related quality of life, depression, and awareness of home care services in elderly patients. Geriatr Gerontol Int [Internet]. 2016;16(11):1211-9. doi: https://doi.org/10.1111/ggi.12618