A Causal model of health-related quality of life among older persons with multimorbidity

Abstract

Multimorbidity negatively affects every aspect of quality of life among older persons (OP). Currently, there is an unclear understanding about the factors influencing the health-related quality of life (HRQOL) of OP with multimorbidity. This descriptive cross-sectional study aimed to test a causal model of HRQOL among OP with multimorbidity which synthesized from both Wilson and Cleary’s model of HRQOL and the literature. The sample included 410 Pakistani OP with multimorbidity, hospitalized in one of five Lahore public hospitals and selected using multi-stage sampling and proportionate stratified random sampling. Data were collected using a set of nine questionnaires, including the Demographic Data Form, the Six-CIT, the Barthel Index, the IADL, the GDS-15, the MSAS-SF, the VAS, the MSPSS, and the SF-36V2 Questionnaire, all of which were tested for reliability. Data analysis was done using descriptive statistics, Pearson’s product-moment correlation, and structural equation modeling.

The results illustrated that: 1. ADLs, social support, and perceived general health status were positively correlated with HRQOL at a high level, while symptom burden and depressive symptoms were negatively correlated with HRQOL at a high level (p < .01). 2. The modified final model of HRQOL fit with the empirical data (χ2 = 309.111, df = 73, p = 0.000, χ2/df = 4.234, CFI = 0.962, TLI = 0.937, RMSEA = 0.089, and SRMR = 0.052). The model explained 96.00% of the total variance in HRQOL. Social support had both positive direct and indirect effects on HRQOL via depressive symptoms, symptom burden, and ADLs (p < .01). ADLs had a positive direct effect on HRQOL(p < .01). Symptom burden had a negative indirect effect on HRQOL via ADLs (p < .01), and depressive symptoms had a negative indirect effect on HRQOL via symptom burden and ADLs (p < .01). Perceived general health status had no direct or indirect effect on HRQOL, but was affected by ADLs (p < .01). The results demonstrate that social support and activities of daily living are crucial factors affecting HRQOL. However, depressive symptoms and symptom burden also need reducing while enhancing social support and improving activities of daily living to attain optimum levels of HRQOL among OP with multimorbidity.