Physical Activity,Functional Status,and Quality of Life Among Older Adults in India

Abstract

Introduction

Physical activity and social engagement protect older adults against functional decline and improve their quality of life. Physical inactivity poses an increased risk for noncommunicable diseases. Globally, one in four adults is physically inactive. Enhancing the physical activity of older adults is crucial not only for increasing their life expectancy but also for improving their functional status and quality of life.

Objective

This study aimed to evaluate the physical activity, functional status, and quality of life of older adults attending the medical outpatient department of a tertiary care hospital in Chennai, Tamil Nadu, India.

Methods

The study adopted a descriptive cross-sectional research design. A total of 100 female and male patients above 65 years of age with comorbid conditions attending the medical outpatient department participated in the study. The sociodemographic and clinical characteristics of these patients were assessed. In addition, the Rapid Assessment of Physical Activity, Katz Index of Independence in Activities of Daily Living, Lawton Instrumental Activities of Daily Living Scale, and Older People Quality of Life Questionnaire were used to measure the physical activity, functional status, and quality of life of patients. The data were analyzed using descriptive and inferential statistics.

Results

Among the participants, only 17% were active, and 35% were underactive for regular light activities. Approximately 81% did not perform any activity to improve their muscle strength or flexibility. In 56% of the participants, disability was present. The majority mentioned that they experienced difficulties in preparing food and shopping. Regarding the quality of life of the participants, the mean ± standard deviation score was 77.38 ± 9.03. Significant results were found in the domains of independence, control over life, and freedom. The overall quality of life was not related to leisure and activities, financial circumstances, the Instrumental Activities of Daily Living Scale score, the Rapid Assessment of Physical Activity 2 score, and the Rapid Assessment of Physical Activity 1 score. The quality of life was weakly related to emotional and psychological well-being, control over life, home and neighborhood, freedom, independence, and social relationships.

Conclusion

Limited physical activity and poor functional status impact the quality of life of older adults. Therefore, educational and physical interventions should be implemented at the hospital and community levels to improve the physical activity, functional status, and quality of life of older adults.

Keywords

quality of life aged frail elderly exercise activities of daily living functional status sedentary behavior

Introduction

The aging population is increasing in both developed and developing countries (Chang et al., 2019). The World Health Organization (WHO 2022) projected that by 2050, older adults will make up 80% of the population in low- and middle-income countries. In 2020, the number of people aged 60 years and above surpassed the number of children aged under 5 years. Additionally, the global proportion of the aging population doubled from 12% in 2015 to 22% in 2020 (WHO, 2022). It is estimated that the population aged 65 years and above in the United States of America will double from 40 million to 88 million by 2050 (Jarzebski et al., 2021). In India, people aged 60 years and above constitute 8.6% of the total population (WHO, 2023). As the aging population continues to live longer, it is important for them to enjoy a healthy life and a high health-related quality of life (HRQoL) during their extended years (Langhammer et al., 2018).

Healthy aging includes reaching a specific age, independently performing activities of daily living (ADLs), remaining free from chronic illnesses, experiencing a high quality of life (QoL), maintaining good well-being, engaging in physical activity, actively participating in social activities, having minimal or no disability, and experiencing only insignificant loss of intellectual or functional abilities (Zhang et al., 2024). Many factors, including genetics, exercise, a healthy diet, and a healthy lifestyle, influence healthy aging. Additionally, a positive attitude and mental well-being enhance the QoL in advancing years (Kassis et al., 2023). A recent systematic review has highlighted that health promotion/empowerment, lifelong person-centered interactions, and adaptation are crucial for healthy aging (Menassa et al., 2023). Moreover, it is essential to provide older adults with resources, build trusting relationships with healthcare providers, and identify and implement effective strategies and programs (Dev et al., 2020).

Literature Review

In older adults, physical activity improves their well-being, QoL, and mental health and delays the onset of dementia (Langhammer et al., 2018). The risk of noncommunicable diseases such as stroke, diabetes mellitus, cancer, and cardiovascular diseases can also be reduced with improved physical activity (Jakicic et al., 2019). Further, physical activity lowers body mass index (BMI) and improves overall health among older adults (Dhuli et al., 2022). However, a lack of physical activity increases the risk of many chronic illnesses. Factors such as age, marital status, sex, educational level, income, and the presence of health problems affect the physical activity levels of older people (An et al., 2020). Despite the well-documented effects of physical activity, the levels among older adults remain low (Boulton et al., 2018).

As people age, their physical activity and functional capacity decline due to loss of muscle mass, decreased range of motion, and diminished aerobic activity (Elam et al., 2021). Functional status refers to an individual's ability to perform ADLs across various aspects of life, including physical, intellectual, psychological, and spiritual functions (Idaiani & Indrawati, 2021). Activities of daily livings and instrumental ADL (IADLs) are measures used to assess the functional status of individuals (Edemekong et al., 2019). The QoL of individuals depends on their functional status. Factors such as age, the presence of comorbid conditions, depression, cognitive status, activity level, and social support influence functional status. In older adults, physical activity is strongly linked to functional status (Dombrowsky, 2017). When individuals need assistance with at least one ADL, it indicates a decline in functional status. This decline can lead to anxiety, a reduced sense of belonging, financial burden, and depression among older adults and their caregivers (Kwon et al., 2019).

Quality of life is an important indicator of subjective well-being, successful aging, happiness, and life satisfaction (Prati, 2022). Adequate social support, health-related knowledge, health-promoting behavior, and self-efficacy are determinants of a higher QoL among older adults (Feng et al., 2020). Currently, while the life expectancy among older adults has increased, comorbid conditions such as diabetes mellitus, hypertension, and heart failure have also become more prevalent. Therefore, HRQoL is considered an essential patient-reported outcome (Saqlain et al., 2021). With the growing older population, it is crucial to ensure that their physical activity, functional status, and QoL are maintained. Providing quality healthcare services and adequately addressing the needs of older people is essential to preserving their physical and mental health and their degree of independence (Ghenţa et al., 2022).

In the aging population, physical function is considered a significant predictor of QoL (Medhi et al., 2019). Earlier evidence shows that poor functional status leads to reduced HRQoL in older adults with chronic illnesses (Pei-Shan et al., 2020). According to Aung et al. (2022), the ability to perform ADLs is the most common determinant of HRQoL among adults. Moreover, the extent of independence in performing simple and complex activities determines the QoL of older people (Ćwirlej-Sozańska et al., 2020). Thus, maintaining physical activity and functional status is important for enabling older adults to perform self-care. A recent longitudinal survey conducted in India indicated that 27.39% of older adults had multimorbidities, and most of them did not engage in any moderate and vigorous physical activities. In another study, older adults who reported low levels of physical activity experienced more multimorbidities (Boro & Saikia, 2022).

To date, no studies have yet determined the relationship between physical activity, functional status, and QoL among older adults in Tamil Nadu, India. Furthermore, the authors observed that many older adults attending the outpatient department (OPD) of the data collection setting had limited physical activity, functional status, and QoL. Therefore, the authors decided to objectively measure these variables to obtain baseline data for designing interventions to improve the QoL of older people.

Methods

Approach

The study utilized a quantitative research approach.

Design

The study adopted a cross-sectional research design.

Setting

The study was conducted at the Medical Outpatient Department (OPD), `G' block, Sri Ramachandra Tertiary Care multi-specialty hospital, Chennai, Tamil Nadu, India. The hospital has 1,500 beds, 114 ICU beds, and 25 operating rooms, making it one of the largest private healthcare facilities in South Asia. Both male and female patients, along with their caregivers, visit the OPD for consultations. Older adult patients commonly visit the OPD to seek consultations for comorbid conditions, such as diabetes mellitus, hypertension, chronic obstructive pulmonary disease, tuberculosis, and osteoarthritis, as well as acute conditions, such as febrile illness, diarrhea, and fatigue.

Population

The study population included both male and female patients above 65 years of age attending the medical OPD of the target hospital.

Sample and Sample Size

The sample size was determined based on the physical activity variable outlined by Gomes et al. (2017). The calculation resulted in a sample size of 94, which was rounded up to 100 for an 80% confidence interval (CI).

Sampling Technique

Convenience sampling was used to select study participants.

Inclusion Criteria

The study included both male and female patients above 65 years of age with comorbid conditions such as diabetes mellitus, hypertension, and cardiovascular diseases attending the medical OPD.

Exclusion Criteria

The study excluded patients with known psychiatric illness and cognitive impairment, as they may not be able to provide appropriate responses.

Description and Interpretation of the Data Collection Tool

Part 1: Sociodemographic Variables

The sociodemographic variables evaluated included age, sex, marital status, educational level, employment status, family income, and family type.

Part 2: Clinical Variables

The clinical variables recorded included height, weight, and BMI.

Part 3: Rapid Assessment of Physical Activity

The Rapid Assessment of Physical Activity (RAPA) is a self-administered tool used to assess physical activity levels. It has two components and nine items. Seven items are included in RAPA 1 and two items in RAPA 2, with responses provided in a yes/no format. RAPA 1 measures overall physical activity, while RAPA 2 assesses strength and flexibility. The RAPA evaluates physical activity levels ranging from sedentary to vigorous activity and examines engagement in strength and flexibility training. For RAPA 1, the total possible score is 7. Individuals who score below 6 are considered to have suboptimal physical activity. For RAPA 2, strength and flexibility are scored separately, with scores assigned as 1 for strength training, 2 for flexibility training, and 3 for both. The r-value is 0.968 (Aktan et al., 2021).

Part 4: Functional Status

Part 4 of the data collection tool was divided into Parts A and B.

Part A: Katz Index of Independence in ADLs

The Katz Index of Independence in Activities of Daily Living is a semi-Guttman scale. The items of the scale are arranged in terms of difficulty in performing various functions. These functions include dressing, bathing, transferring, feeding, continence, and toileting. The adequacy of the performance of these six functions is measured by this scale. A high score of 6 indicates high independence, while a low score of 0 indicates high dependence.

Part B: Lawton IADL Scale

The Lawton IADL Scale assesses the ability of individuals to live independently in their own homes. Specifically, it evaluates their ability to shop, prepare food, use the telephone, take medications, do laundry, perform housekeeping tasks, manage finances, and use transportation. Each domain is scored, with a score of 0 indicating low functional ability and high dependence and a score of 8 showing high functional ability and independence.

Part 5: Older People Quality of Life Questionnaire

The Older People Quality of Life Questionnaire (OPQoL) consists of 35 items designed to evaluate QoL. Respondents indicate their level of agreement with each item using the following options: “strongly agree,” “agree,” “neither agree nor disagree,” “disagree,” and “strongly disagree.” Each option is scored from 1 to 5. The scale assesses various aspects of QoL, including health, independence, home and neighborhood, social relationships and participation, control over life and freedom, psychological and emotional well-being, financial circumstances, religion, and leisure activities. The total possible score ranges from 35 to 175. A score of 35 represents the worst possible QoL, while a score of 175 reflects the best possible QoL. Thus, a higher score indicates a better QoL.

Reliability of the Data Collection Tool

The Cronbach's alpha coefficient of the Lawton IADL Scale was 0.843. The test–retest reliability and interrater reliability of the Katz Index of Independence in ADLs were excellent (ICC = 0.999, 95% CI = 0.999–1.000). The internal consistency of the OPQoL was 0.78. For the RAPA, the sensitivity, specificity, and predictive value were 81%, 69%, and 77%, respectively.

Pilot Study

A pilot study was conducted with 10 patients at the medical OPD of the target hospital for 1 week. The study was deemed feasible, and no modifications were made during this pilot phase.

Ethical Considerations

The institutional ethics committee of Sri Ramachandra University granted ethical approval. Permission for data collection was obtained from the medical superintendent, nursing superintendent, and head of the general medicine department. The study purpose was explained to participants, who then signed a written informed consent form after having their queries answered. No participants were forced to participate in the study. Participants were informed that they could withdraw from the study at any time. All collected data were coded and stored in a password-protected file, with access limited only to the authors of the study.

Data Collection

The data were collected from March 7, 2022, to August 30, 2022, through patient interviews. The OPD register was checked, and patients who fulfilled the inclusion criteria and agreed to participate in the study were selected as study participants.

Data Analysis

The collected data were analyzed using descriptive and inferential statistics.

Results

The sociodemographic data of the participants are presented in Table 1. The mean ± standard deviation (SD) age of the participants was 71.30 ± 6.1 years. Among the participants, more than half were women; 81% were married; 61% completed primary school education; the majority were unemployed and had a low family income; and 38% belonged to a nuclear family.

Table 1.

Demographic and Clinical Characteristics of Older Adults (N = 100).

Demographic characteristics	Frequency/Mean ± SD	Percentage (%)
Age	71.30 ± 6.1
60–70	56	56
>70	44	44
Gender
Female	54	54
Male	46	46
Marital status
Married	81	81
Others	19	19
Education
College level	8	8
High school level	31	31
Primary school level	61	61
Employment status
Yes	19	19
No	81	81
Total family income
Upper lower	32	32
Lower middle	68	68
Type of family
Nuclear family	38	38
Others	62	62
Duration of illness
less than 6 months	13	13
6 months–1 year	9	9
1–2 years	33	33
More than 2 years	45	45
Weight (kg)	56.71 ± 10.03
Height (cm)	154.78 ± 6.13
BMI (kg/m²)	23.57 ± 3.35
Underweight	8	8
Normal	61	61
Overweight	26	26
Obese	5	5

Approximately 45% of the participants had comorbid conditions lasting for more than 2 years. The mean ± SD BMI was 23.57 ± 3.35 kg/m². The mean ± SD weight was 56.71 ± 10.03 kg, while the mean ± SD height was 154.78 ± 6.13 cm. Among the participants, 61% had normal weight.

Regarding physical activity, only 17% of the participants were active, while 35% were underactive for regular light activities. All participants were able to perform suboptimal aerobic activity. Approximately 81% did not perform any activity to improve their muscle strength or flexibility (Table 2).

Table 2.

Distribution of Physical Activity of Older Adults According to Rapid Assessment of Physical Activity (RAPA 1 and RAPA 2).

	Frequency	Percentage (%)
RAPA1
Sedentary	16	16
Underactive	25	25
Underactive for regular light activities	35	35
Underactive regular	7	7
Active	17	17
Overall Suboptimal Aerobic activity	100	100
RAPA2
No Activity to improve muscle strength or flexibility	81	81
Activity to improve strength	19	19
Activity to improve flexibility	0	0

The mean ± SD IADL score was 4.47 ± 1.93. No significant difference in the IADL score was found between the age groups (Table 3). In terms of specific IADLs, 91% and 74% of the participants experienced difficulties in preparing food and shopping, respectively. Some participants also reported difficulties in using transportation, using the telephone, taking own medications, performing housekeeping, doing laundry, and managing finances (Table 4).

Table 3.

Prevalence of IADL Level of Dependency among the Older Adults.

8-item IADL disability	Male (46)		Female (54)		Total (n = 100)
8-item IADL disability	60–70 years old (n = 23)	>70 years old (n = 23)	60–70 years old (n = 33)	>70 years old (n = 21)	Total (n = 100)
Dependent	12 (26.1)	11 (23.9)	17 (31)	9(16.6)	49
Independent	11 (23.9)	12 (26.1)	16 (29.6)	12(26.1)	51
IADL score (M ± SD)	4.52(1.83)	4.47 (1.99)	4.24 (2.10)	4.76(1.78)	4.47 (1.93)

Table 4.

Item-Wise IADL Level of Dependency among Older Adults.

8-item IADL level of dependency	Dependent	Independent
Ability to use telephone	31	69
Shopping	74	26
Food preparation	91	9
Housekeeping	47	53
Laundry	54	46
Mode of transportation	0	100
Responsibility for own medications	0	100
Ability to handle finances	56	44

Significant results were found in the QoL domains of independence, control over life, and freedom, with a mean ± SD score of 8.65 ± 1.43 (Table 5).

Table 5.

Various Domains of Quality of Life of Older Adults.

Domains of quality of life	Young old (n = 56)	Middle old (n = 44)	Total	F valueP value
Life overall domain (maximum score = 20)
Mean ± SD	8.39 ± 1.69	8.70 ± 1.23	8.53 ± 1.50	2.395 0.307
Median (25th–75th percentile)	8.0(8–9.75)	8(8–10)	8.0(8–10)
Range	4–12	5–13	4–13
Health and functioning domain (maximum score = 20)
Mean ± SD	9.21 ± 1.46	9.06 ± 1.46	9.15 ± 1.45	0.004 0.622
Median (25th–75th percentile)	9(8–10)	8.5(8–10)	9.0(8–10)
Range	6–13	6–12	6–13
Social relationships/leisure and social activities domain (maximum score = 25)
Mean ± SD	9.53 ± 2.34	10.06 ± 1.67	9.78 ± 2.08	7.177 0.222
Median (25th–75th percentile)	10(9–11)	10(10–11)	10.0(9–11)
Range	5–16	7–17	5–17
Independence, control over life, freedom (maximum score = 20)
Mean ± SD	8.33 ± 1.49	9.04 ± 1.25	8.65 ± 1.43	0.484 0.014**
Median (25th–75th percentile)	8(8–9)	9(8–10)	9.0(8–9.75)
Range	4–12	7–12	4–12
Home and neighbourhood (maximum score = 20)
Mean ± SD	7.85 ± 1.80	8.34 ± 1.32	8.07 ± 1.62	1.143 0.140
Median (25th–75th percentile)	8(7.25–9)	8(8–9)	8(8–9)
Range	4–11	4–11	4–11
Psychological and emotional well-being (maximum score = 20)
Mean ± SD	8.82 ± 1.83	8.59 ± 1.16	8.72 ± 1.57	4.913 0.469
Median (25th–75th percentile)	9(8–10)	9(8–9)	9.0(8–10)
Range	4–14	5–11	4–14
Financial circumstances (maximum score = 20)
Mean ± SD	10.85 ± 2.72	10.79 ± 2.30	10.83 ± 2.53	0.309 0.905
Median (25th–75th percentile)	11(9–13)	10.5(9–13)	11(9–13)
Range	4–17	6–15	4–17
Leisure and activities (maximum score = 30)
Mean ± SD	13.55 ± 2.80	13.77 ± 2.64	13.65 ± 2.72	0.000 0.691
Median (25th–75th percentile)	13(12–14.75)	13.5(12–15)	13(12–15)
Range	9–22	9–21	9–22
Overall quality of life
Mean ± SD	76.58 ± 10.32	78.38 ± 7.04	77.38 ± 9.03	1.375 0.326
Median (25th–75th percentile)	78(74–83)	79(72–83)	78.50(74–83)
Range	41–97	62–97	41–97
Poor QoL (Below mean)	47%
High QoL (Above mean)	53%

As shown in Table 6, the overall QoL was not related to leisure and activities, financial circumstances, the IADL score, the RAPA 2 score, and the RAPA 1 score. The QoL was weakly related to emotional and psychological well-being, control over life, home and neighborhood, freedom, independence, and social relationships.

Table 6.

Correlation Between Physical Function and Domains of Quality of Life.

Correlations
		QOL	Health	Social relationship	Independence	Neighbourhood	Psychological	Financial	Leisure	IADLA	RAPA2	RAPAI
QOL	Pearson Correlation	1
QOL	Sig. (2-tailed)
Health	Pearson Correlation	.271**	1
Health	Sig. (2-tailed)	.006
Social relationship	Pearson Correlation	.456**	.214*	1
Social relationship	Sig. (2-tailed)	.000	.033
Independence	Pearson Correlation	.429**	.282**	.584**	1
Independence	Sig. (2-tailed)	.000	.005	.000
Neighbourhood	Pearson Correlation	.447**	.239*	.531**	.546**	1
Neighbourhood	Sig. (2-tailed)	.000	.017	.000	.000
Psychological	Pearson Correlation	.281**	.283**	.509**	.531**	.325**	1
Psychological	Sig. (2-tailed)	.005	.004	.000	.000	.001
Financial	Pearson Correlation	.098	−.037	.230*	.100	.150	.370**	1
Financial	Sig. (2-tailed)	.334	.717	.021	.321	.136	.000
Leisure	Pearson Correlation	.095	−.083	.252*	.036	.129	.301**	.415**	1
Leisure	Sig. (2-tailed)	.347	.410	.011	.725	.200	.002	.000
IADLA	Pearson Correlation	−.038	.018	−.042	−.111	−.088	−.039	.115	.066	1
IADLA	Sig. (2-tailed)	.709	.861	.680	.270	.385	.698	.254	.514
RAPA2	Pearson Correlation	.169	−.103	.101	.012	−.068	.054	.063	.053	−.184	1
RAPA2	Sig. (2-tailed)	.093	.309	.319	.909	.499	.593	.534	.599	.066
RAPAI	Pearson Correlation	.097	−.160	−.017	.035	−.073	−.018	.076	.013	−.174	.763**	1
RAPAI	Sig. (2-tailed)	.337	.111	.865	.727	.473	.863	.454	.899	.084	.000

*Correlation is significant at the 0.05 level (two-tailed).

**Correlation is significant at the 0.01 level (two-tailed).

Discussion

Health-related QoL is influenced by various factors including physical activity, functional status, and living environment. Evidence shows that a positive HRQoL is strongly associated with physical activity and functional status among older people (Furtado et al., 2022). Older people exhibiting sedentary behaviors have an increased risk of developing diabetes mellitus and cardiovascular diseases (Sparling et al., 2015). For considerable health benefits, the WHO (2020) recommended 150–300 min of moderate-intensity aerobic physical activity throughout the week for individuals aged 65 years and above. Functional limitations and disabilities in older adults could be prevented by performing short-term exercise and regular aerobic activity (Stathi et al., 2022). Despite having numerous benefits, regular physical activity has not been effectively incorporated into healthcare practice (Izquierdo et al., 2021).

Regular physical activity enhances both physical and mental well-being, helping older people stay mobile and independent. Most older people do not meet the minimum physical activity levels needed to maintain health despite knowing the benefits of physical activity. Furthermore, sedentary lifestyles predominate older age, resulting in a premature onset of disease and frailty (McPhee et al., 2016). Notably, the prevalence of physical inactivity in adults aged 55 years and above is relatively low in 16 European countries. Likewise, in Sweden, the prevalence is shown to be 4.9%. On the contrary, the prevalence of physical inactivity in Portugal is higher at 29%. Various factors contribute to physical inactivity including memory loss, lack of social support, old age, limitations with physical activity, lack of sense of meaning in life, and depression (Gomes et al., 2017). Conversely, self-motivation, good perception of their own health, and self-motivation are linked to higher levels of physical activity in older adults (Notthoff et al., 2017).

The number of older adults engaging in muscle-strengthening exercise, aerobic conditioning, flexibility training, and balance training is substantially low. Additionally, many older adults are unaware of the suggested components of physical activity plans (Morey, 2019). Consistent with these findings, significantly few older adults in the current study were active, and most of them were underactive for regular light activities. Moreover, the majority of the older adults did not perform any activity to improve their muscle strength or flexibility. Despite these findings, it is suggested that functional status, physical activity, and QoL can be improved by attending senior social clubs (Stolarz et al., 2022). Physical recreation activities, such as yoga and tai-chi, as well as strength and resistance training are suggested (Taylor et al., 2021). Exercise interventions in older adults should be encouraged and performed under supervision to prevent functional and cognitive decline. Healthcare systems should systematically plan evidence-based exercise programs for older adults to promote healthy and dignified aging in both hospital and community settings (Izquierdo et al., 2021).

Older adults who regularly participate in social activities and maintain an active lifestyle have shown improvements in their QoL (Jin et al., 2023). Instrumental ADLs require engagement in social activities (Guo & Sapra, 2020). Evidence suggests that physical and cognitive functions are positively associated with functional status in IADLs (Clemmensen et al., 2020). Additionally, physical activity is associated with improved cognitive function; thus, active participation in physical activity is recommended to improve and maintain cognitive function (Jin et al., 2023). Regardless of knowing the benefits of physical and social activities on the QoL of older adults, most of the older adults in the present study experienced difficulties in preparing food and shopping. They also reported difficulties in using transportation, doing laundry, performing housekeeping, using the telephone, taking medications, and managing finances. In line with these findings, Burman et al. (2019) observed that older adults who received education lower than the primary level were women, were separated/widowed, belonged to a joint family, had a poor economic status, were depressed, and had multimorbidities had dependency for ADLs and IADLs. Therefore, intervention programs should be designed to improve the well-being, physical activity, functional status, and QoL of older people (Furtado et al., 2022).

The growing aging population poses unique challenges for older people, including various health problems, shifts in social structure, and limited access to healthcare facilities. These challenges can affect the QoL of older people (Rony et al., 2024). In this study, QoL was related to emotional and psychological well-being, home and neighborhood, autonomy, control over life, freedom, and social relationships. Similarly, another study indicated poor infrastructure, lack of healthcare facilities, and limited resources negatively affecting the HRQoL of older people (Saqlain et al., 2021). Additionally, Silva et al. (2019) identified a negative correlation of sedentary time with upper-limb flexibility and light physical activity. Krishnappa et al. (2021) found that older people from rural areas had a lower QoL irrespective of sex, educational level, and financial dependence. Klompstra et al. (2019) reported that a poorer ability to perform ADLs, higher symptom burden, and higher degree of depression was negatively associated with QoL. Therefore, it is essential to provide quality healthcare services to older people and adequately address their needs. When their needs are met, their degree of independence will increase, and their physical and mental health will improve (Ghenţa et al., 2022). Additionally, inequitable health resource distribution and inadequate support systems must be addressed to improve the QoL of older people (Krishnappa et al., 2021).

Considering the findings of the current study and other relevant studies, healthcare policies should be revised, and effective interventions should be implemented in clinical settings to address the needs of older adults, with a specific emphasis on equitable healthcare access, effective management of chronic comorbid conditions, and training of geriatric healthcare professionals (Rony et al., 2024). In outpatient settings, interprofessional teams including geriatricians, nurses, occupational therapists, social workers, speech therapists, physiotherapists, pharmacists, and dietitians could work together in interprofessional geriatric clinics to meet the healthcare needs of older adult patients.

Limitations

The study population was limited only to patients attending the OPD of a tertiary care hospital. Therefore, the study results are limited only to the study setting. Further studies with larger populations are needed to expand the generalizability of the findings. Another limitation is that the outcome measures were self-reported, which may be affected by recall and social desirability bias. Therefore, future studies are recommended to utilize objective measurements. As the study adopted a cross-sectional design, a true causal relationship could not be established. Future studies should assess the causal relationship between the study variables by using appropriate research designs. Lastly, the present study was conducted over a short period.

Nursing Implications

The study findings call for incorporating more physical activities into the lifestyles of sedentary or lightly active older adults to improve their HRQoL. Healthcare providers should provide personalized information tailored to the needs of older adults. Further, older adults should be supported in developing physical activity goals to improve their functional status and QoL. Healthcare providers should organize functional capacity screening programs and assist older adults in improving their ability to perform ADLs and preventing future complications. Older adults should also be assisted in identifying and managing chronic illnesses.

Recommendations

This study can be conducted with larger samples in different settings. A comparative study can be performed to compare physical activity, functional status, and QoL between home-based and hospital-admitted older adults.

Conclusion

Limited physical activity and poor functional status reduce the QoL of older adults. Therefore, educational and physical interventions should be implemented at the hospital and community levels to improve the physical activity, functional status, and QoL of older adults.

Footnotes

Acknowledgments

The authors acknowledge the study participants.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Ethical Considerations

Ethical approval was granted by the Institutional ethics committee (IEC/N/17/MAR/58/30). Permission for data collection was obtained from the medical superintendent, nursing superintendent, and head of the department of General medicine. The study purpose was explained to the study participants. Participants signed in the written informed consent form after getting their queries clarified. None of the participants were forced to participate in the study. Participants were told that they can withdraw their participation at any point of time. All the collected data collection instruments were coded and stored in a password-protected file. Only the investigators of the study have access to the data.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Judie Arulappan

References

Aktan

Ozalevli

Yalcinkaya

Alpaydin

AÖ

Sevinc

(2021). Validation of the Rapid Assessment of Physical Activity questionnaire in older patients with chronic obstructive pulmonary disease. Journal of Basic and Clinical Health Sciences, 5(3), 100–106. https://doi.org/10.30621/jbachs.917212

H. Y.

Chen

Wang

C. W.

Yang

H. F.

Huang

W. T.

Fan

S. Y.

(2020). The relationships between physical activity and life satisfaction and happiness among young, middle-aged, and older adults. International Journal of Environmental Research and Public Health, 17(13), 4817. https://doi.org/10.3390/ijerph17134817

Aung

T. N. N.

Moolphate

Koyanagi

Angkurawaranon

Supakankunti

Yuasa

Aung

M. N.

(2022). Determinants of health-related quality of life among community-dwelling Thai older adults in Chiang Mai, Northern Thailand. Risk Management and Healthcare Policy, 15(20), 1761–1774. https://doi.org/10.2147/RMHP.S370353

Boro

Saikia

(2022). Association of multi morbidity and physical activity among older adults in India: An analysis from the longitudinal ageing survey of India (2017–2018). BMJ Open, 12(5), e053989. https://doi.org/10.1136/bmjopen-2021-053989

Boulton

E. R.

Horne

Todd

(2018). Multiple influences on participating in physical activity in older age: Developing a social ecological approach. Health Expectations, 21(1), 239–248. https://doi.org/10.1111/hex.12608

Burman

Sembiah

Dasgupta

Paul

Pawar

Roy

(2019). Assessment of poor functional status and its predictors among the elderly in a rural area of West Bengal. Journal of Mid-Life Health, 10(3), 123. https://doi.org/10.4103/jmh.JMH_154_18

Chang

A. Y.

Skirbekk

V. F.

Tyrovolas

Kassebaum

N. J.

Dieleman

J. L.

(2019). Measuring population ageing: An analysis of the global burden of disease study 2017. The Lancet Public Health, 4(3), e159–e167. https://doi.org/10.1016/S2468-2667(19)30019-2

Clemmensen

F. K.

Hoffmann

Siersma

Sobol

Beyer

Andersen

B. B.

Frederiksen

K. S.

(2020). The role of physical and cognitive function in performance of activities of daily living in patients with mild-to-moderate Alzheimer’s disease-a cross-sectional study. BMC Geriatrics, 20, 1–9.

Ćwirlej-Sozańska

A. B.

Wiśniowska-Szurlej

Wilmowska-Pietruszyńska

, et al. (2020). Factors associated with disability and quality of life among the oldest-old living in community in Poland—a cross sectional study. Annals of Agricultural and Environmental Medicine, 27(4), 621–629. https://doi.org/10.26444/aaem/115020

10.

Dev

Zaslavsky

Cochrane

Eagen

Woods

N. F.

(2020). Healthy aging through the lens of community-based practitioners: A focus group study. BMC Geriatrics, 20(1), 1–10. https://doi.org/10.1186/s12877-020-01611-x

11.

Dhuli

Naureen

Medori

M. C.

Fioretti

Caruso

Perrone

M. A.

Bertelli

(2022). Physical activity for health. Journal of Preventive Medicine and Hygiene, 63(2 Suppl 3), E150. https://doi.org/10.15167/2421-4248/jpmh2022.63.2S3.2756

12.

Dombrowsky

T. A.

(2017). Relationship between engagement and level of functional status in older adults. SAGE Open Medicine, 5(5), 2050312117727998. https://doi.org/10.1177/2050312117727998

13.

Edemekong

P. F.

Bomgaars

Sukumaran

Levy

S. B.

(2019). Activities of daily living (Vol. 20). Treasure Island (FL): StatPearls Publishing; 2024 Jan. 2023 Jun 26.

14.

Elam

Aagaard

Slinde

Svantesson

Hulthén

Magnusson

P. S.

Bunketorp-Käll

(2021). The effects of ageing on functional capacity and stretch-shortening cycle muscle power. Journal of Physical Therapy Science, 33(3), 250–260. https://doi.org/10.1589/jpts.33.250

15.

Feng

Cramm

J. M.

Nieboer

A. P.

(2020). Social participation is an important health behaviour for health and quality of life among chronically ill older Chinese people. BMC Geriatrics, 20(24), 1–10. https://doi.org/10.1186/s12877-020-01713-6

16.

Furtado

G. E.

Vaz

Bovolini

Marques

Serra

Costa-Brito

A. R.

Vila-Chã

(2022). The impact of physical activity levels and functional fitness status on the quality of life perceived by older adults living in rural and urban areas: The Portuguese inland case. In Healthcare (vol. 10, No. 7, p. 1266). MDPI.

17.

Ghenţa

Matei

Mladen-Macovei

Stănescu

(2022). Quality of life of older persons: The role and challenges of social services providers. International Journal of Environmental Research and Public Health, 19(14), 8573. https://doi.org/10.3390/ijerph19148573

18.

Gomes

Figueiredo

Teixeira

Poveda

Paúl

Santos-Silva

Costa

(2017). Physical inactivity among older adults across Europe based on the SHARE database. Age and Ageing, 46(1), 71–77. https://doi.org/10.1093/ageing/afw165

19.

Guo

H. J.

Sapra

(2020). Instrumental activity of daily living (Vol. 14). Treasure Island (FL): StatPearls Publishing; 2024 Jan. 2022 Nov 14.

20.

Idaiani

Indrawati

(2021). Functional status in relation to depression among elderly individuals in Indonesia: A cross-sectional analysis of the Indonesian National Health Survey 2018 among elderly individuals. BMC Public Health, 21(1), 2332. https://doi.org/10.1186/s12889-021-12260-z

21.

Izquierdo

Duque

Morley

J. E.

(2021). Physical activity guidelines for older people: Knowledge gaps and future directions. The Lancet Healthy Longevity, 2(6), e380–e383. https://doi.org/10.1016/S2666-7568(21)00079-9

22.

Jakicic

J. M.

Kraus

W. E.

Powell

K. E.

Campbell

W. W.

Janz

K. F.

Troiano

R. P.

, … & 2018 Physical Activity Guidelines Advisory Committee (2019). Association between bout duration of physical activity and health: Systematic review. Medicine and Science in Sports and Exercise, 51(6), 1213. https://doi.org/10.1249/MSS.0000000000001933

23.

Jarzebski

M. P.

Elmqvist

Gasparatos

Fukushi

Eckersten

Haase

(2021). Ageing and population shrinking: Implications for sustainability in the urban century. NPJ Urban Sustainability, 1(1), 17. https://doi.org/10.1038/s42949-021-00023-z

24.

Jin

Hreha

Hong

(2023). Physical activity and functional status in older adults: Mediating effect of cognitive function. Alzheimer’s & Dementia, 19, e064406. https://doi.org/10.3389/fpubh.2023.1286530

25.

Kassis

Fichot

M. C.

Horcajada

M. N.

Horstman

A. M.

Duncan

Bergonzelli

Donato-Capel

(2023). Nutritional and lifestyle management of the aging journey: A narrative review. Frontiers in Nutrition, 9(9), 1087505. https://doi.org/10.3389/fnut.2022.1087505

26.

Klompstra

Ekdahl

A. W.

Krevers

Milberg

Eckerblad

(2019). Factors related to health-related quality of life in older people with multimorbidity and high health care consumption over a two-year period. BMC Geriatrics, 19(1), 1–8. https://doi.org/10.1186/s12877-019-1194-z

27.

Krishnappa

Gadicherla

Chidambaram

Murthy

N. S.

(2021). Quality of life (QOL) among older persons in an urban and rural area of Bangalore, South India. Journal of Family Medicine and Primary Care, 10(1), 272. https://doi.org/10.4103/jfmpc.jfmpc_1241_20

28.

Kwon

Park

E. C.

Kim

Choi

D. W.

Jang

S. I.

(2019). Depressive symptoms in individuals with family members requiring ADL assistance. Environmental Health and Preventive Medicine, 24(158), 1–10. https://doi.org/10.1186/s12199-018-0752-x

29.

Langhammer

Bergland

Rydwik

(2018). The importance of physical activity exercise among older people. BioMed Research International, 2018(15), 3–6. https://doi.org/10.1155/2018/7856823

30.

McPhee

J. S.

French

D. P.

Jackson

Nazroo

Pendleton

Degens

(2016). Physical activity in older age: Perspectives for healthy ageing and frailty. Biogerontology, 17(17), 567–580. https://doi.org/10.1007/s10522-016-9641-0

31.

Medhi

G. K.

Sarma

Pala

Bhattacharya

Bora

P. J.

Visi

(2019). Association between health related quality of life (HRQOL) and activity of daily living (ADL) among elderly in an urban setting of Assam, India. Journal of Family Medicine and Primary Care, 8(5), 1760. https://doi.org/10.4103/jfmpc.jfmpc_270_19

32.

Menassa

Stronks

Khatmi

Díaz

Z. M. R.

Espinola

O. P.

Gamba

Franco

O. H.

(2023). Concepts and definitions of healthy ageing: a systematic review and synthesis of theoretical models. EClinicalMedicine, 56(12). https://doi.org/10.1016/j.eclinm.2022.101821

33.

Morey

M. C.

(2019). Physical activity and exercise in older adults. UpToDate. Consulted 11 April 2015.

34.

Notthoff

Reisch

Gerstorf

(2017). Individual characteristics and physical activity in older adults: A systematic review. Gerontology, 5(5), 443–459. https://doi.org/10.1159/000475558

35.

Pei-Shan

L. I.

Hsieh

C. J.

Nae-Fang

M. I. A. O.

(2020). A study of physical activity, frailty, and health-related quality of life among community-dwelling older adults in Taiwan. Journal of Nursing Research, 28(6), e124. https://doi.org/10.1097/JNR.0000000000000402

36.

Prati

(2022). Correlates of quality of life, happiness and life satisfaction among European adults older than 50 years: A machine-learning approach. Archives of Gerontology and Geriatrics, 103(7), 104791. https://doi.org/10.1016/j.archger.2022.104791

37.

Rony

M. K. K.

Parvin

M. R.

Wahiduzzaman

Akter

Ullah

(2024). Challenges and advancements in the health-related quality of life of older people. Advances in Public Health, 2024(1), 8839631. https://doi.org/10.1155/2024/8839631

38.

Saqlain

Riaz

Ahmed

Kamran

Bilal

Ali

(2021). Predictors of health-related quality-of-life status among elderly patients with cardiovascular diseases. Value in Health Regional Issues, 24(24), 130–140. https://doi.org/10.1016/j.vhri.2020.11.003

39.

Silva

F. M.

Petrica

Serrano

Paulo

Ramalho

Lucas

Ferreira

J. P.

Duarte-Mendes

(2019). The sedentary time and physical activity levels on physical fitness in the elderly: A comparative cross sectional study. International Journal of Environmental Research and Public Health, 16(19), 1–11. https://doi.org/10.3390/ijerph16193697

40.

Sparling

P. B.

Howard

B. J.

Dunstan

D. W.

Owen

(2015). Recommendations for physical activity in older adults. BMJ, 350(21). https://doi.org/10.1136/bmj.h100

41.

Stathi

Greaves

C. J.

Thompson

J. L.

Withall

Ladlow

Taylor

Fox

K. R.

(2022). Effect of a physical activity and behaviour maintenance programme on functional mobility decline in older adults: The REACT (retirement in action) randomised controlled trial. The Lancet Public Health, 7(4), e316–e326. https://doi.org/10.1016/S2468-2667(22)00004-4

42.

Stolarz

Baszak

E. M.

Zawadka

Majcher

(2022). Functional status, quality of life, and physical activity of senior club members—A cross-sectional study. International Journal of Environmental Research and Public Health, 19(3). https://doi.org/10.3390/ijerph19031900

43.

Taylor

Walsh

Kwok

Pinheiro

M. B.

De Oliveira

J. S.

Hassett

Sherrington

(2021). A scoping review of physical activity interventions for older adults. International Journal of Behavioral Nutrition and Physical Activity, 18(1), 82. https://doi.org/10.1186/s12966-021-01140-9

44.

World Health Organization (2020). WHO guidelines on physical activity and sedentary behavior.

45.

World Health Organization (2022). https://www.who.int/news-room/fact-sheets/detail/ageing-and-health

46.

World Health Organization (2023). https://www.who.int/india/health-topics/ageing

47.

Zhang

(2024). Enhancing understanding of healthy aging based on time-varying dependencies among multidimensional health, life satisfaction, and health behaviors of older adults aged 60 years and over. BMC Public Health, 24(1), 192. https://doi.org/10.1186/s12889-024-17752-2