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Neighborhood environment and quality of life of older adults in eastern Nepal: findings from a cross-sectional study
Quality of life (QoL) is a subjective measure reflecting individuals’ evaluations based on their personal goals and values.
Neighborhood environment and quality of life of older adults in eastern Nepal: findings from a cross-sectional study
Introduction
Quality of life (QoL) is a subjective measure reflecting individuals’ evaluations based on their personal goals and values. While global research shows the role of neighborhood factors like ethnic diversity and socio-cultural dynamics on QoL, these are unexplored in the Nepali context. Therefore, this study examined the relationship between neighborhood environment and QoL among Nepali older adults in eastern Nepal.
Methods
This cross-sectional study involved 847 non-institutionalized older adults (aged ≥ 60 years) from two districts in eastern Nepal. QoL was evaluated using the 13-item brief Older People’s Quality of Life questionnaire, where a mean score of < 3 indicated low/poor QoL. The neighborhood environment, conceptualized across three domains (demographic, socio-cultural, and built environment), included ethnic diversity, connections with family, friends, and neighbors, cultural ties, residential stability, and rurality. Their association with QoL was examined using multivariable logistic regression.
Results
Around 20% of older adults reported poor QoL. Higher ethnic diversity (adjusted Odds Ratio [aOR] = 0.12, 95% confidence interval [CI]: 0.04–0.36), moderate contact with family and relatives (aOR = 0.26, CI: 0.11–0.61), and high contact with neighbors (aOR = 0.09, CI: 0.03–0.21) were associated with lower odds of poor QoL. Conversely, high contact with friends (aOR = 2.29, CI: 1.30–4.04) and unstable residence (OR = 6.25, CI: 2.03–19.23) increased the odds of poor QoL. Additionally, among the covariates, chronic disease, tobacco use, unemployment, and lack of education were also significantly associated with poor QoL.
Conclusion
Overall, the demographic environment, socio-cultural factors, and the built environment of the neighborhood influence QoL. Therefore, diversifying the neighborhood’s ethnic composition, promoting social connections such as frequent contact with family, relatives, and neighbors, and ensuring residential stability can enhance the QoL of older adults.
Peer Review reports
Introduction
Quality of life (QoL) is a subjective assessment based on the goals and standards individuals set for their lives, covering aspects such as physical and psychosocial health, as well as social relations, and is driven by their cultural and value systems [1]. Globally, increased life expectancy brought many opportunities; however, when coupled with sensory loss, chronic conditions, disability-adjusted life years, and poor QoL, it can impede the progression to healthy and successful aging [2, 3]. The global prevalence of successful aging has been modest, ranging from 10 to 47%, highlighting the need to enhance older adults’ QoL [4]. The significance of QoL among older adults in Nepal is also growing, propelled by the increasing aging population attributed to the rising life expectancy with improved healthcare access [5]. Notably, the proportion of adults aged 65 years and older has significantly risen, reaching 6.9% in 2021, up from 5.3% in 2011, and more than doubling since 1981, when it was 3.3% [5, 6].
In general, and especially among older adults, QoL is associated with various chronic morbidities [3, 7], mental health problems [8], and goes beyond traditional health measures to embrace a holistic view of well-being, incorporating physical, mental, social, cultural, and emotional aspects [9]. The enhancement of subjective well-being during the aging process is crucial for safeguarding the health and overall well-being of older adults [10].
Older adults’ QoL is a multidimensional construct influenced by various factors at both macro and micro levels. Macro factors include social and environmental aspects, while micro factors involve individual characteristics [9]. Bronfenbrenner’s Ecological Systems theory [11] highlights the impact of an individual’s surroundings, emphasizing interconnected systems. This theory highlights how the socio-cultural environment influences the alignment between individuals and their surroundings through four layers of systems, i.e., microsystem, mesosystem, exosystem, and macrosystem [11, 12]. The microsystem encompasses neighborhood in which an individual lives and interacts directly with the environment, which includes factors like personal characteristics, behavioral attitudes, neighborhood demographics, relationships, and community support influencing an older adult’s well-being. The mesosystem focuses on interactions within the neighborhood, such as interaction with social networks and friends, while the exosystem includes service accessibility, covering healthcare, infrastructures, and others. The macrosystem encompasses cultural and societal values shaping perceptions of aging in the community. These four components of Bronfenbrenner’s Ecological Systems theory collectively shed light on the substantial influence of the neighborhood environment on the aging process [12], incorporating physical, socio-cultural, economic, and environmental characteristics [13]. Examining the factors influencing the QoL of older adults in Nepal entails exploring the various dimensions of these neighborhood environments [9].
In the context of the neighborhood, the ethnic diversity of older adults plays a crucial role in determining their well-being [14, 15]. While ethnic enclaves may offer social support to older individuals, they can also contribute to racial/ethnic segregation, which negatively impacts the health and wellbeing of older adults [13]. Nepal, a multi-ethnic and diverse nation with 142 ethnic groups, each having its own cultural traditions, languages, and histories [6], experiences the formation of ethnic enclaves, particularly among historically marginalized groups like the Indigenous, Madheshi, Janajatis, and Dalits (the latter considered lower untouchable caste as termed in Nepal’s national policy called Muluki Ain of Nepal, 1854 AD). The formation of distinct social communities is intricately linked to the nation’s social structure, reflecting issues of identity, resource allocation, political representation, and stemming from historical discrimination and marginalization [16].
The socio-cultural environment in Nepal significantly influences the well-being of older adults, shaped by factors like connections with family, friends, and neighbors. Additionally, cultural bonds manifest through involvement in each other’s social events and rituals, and the acceptance and celebration of each other’s festivals play a significant role. Traditional values, including filial piety, emphasize the crucial roles of adult children, particularly sons and daughters-in-law, in caring for older parents within multigenerational households [17]. Previous studies in Nepal highlight the substantial impact of social support from spouses, family, and neighbors on the QoL of older adults [18,19,20]. Changing societal dynamics, including internal (rural-to-urban) migration and high rates of international migration, are reshaping traditional family structures from multigenerational to nuclear or smaller families. This transformation is slowly altering the nature of familial support, resulting in older adults living in skip-generational households, alone or in old-aged homes [21,22,23]. Considering the evolving dynamics of family structure in Nepali society, revisiting the association between social connections and QoL is timely and important.
The built environment of the neighborhood plays a crucial role in shaping the well-being of older adults. Access to essential services such as healthcare, grocery stores, and community centers is vital for their QoL [24,25,26]. Age-friendly infrastructure in the community contributes to active living, fostering a healthy aging process [24]. The neighborhood’s design, including factors like population density, diversity, accessibility and proximity to essential resources, is a pivotal factor in enhancing the overall QoL for older adults [12, 27]. Additionally, given that older adults frequently reside in the same area for extended periods and depend on community resources for social support [12], residential stability in the neighborhood has been associated with their improved psychosocial well-being [26].
Prior studies have quantified the QoL and identified socio-demographic covariates associated with QoL among Nepali older adults [8, 28,29,30,31,32]. However, despite the potential roles of neighborhood factors in determining QoL, there is a paucity of research specifically focused on investigating the role of neighborhood environment on QoL of older adults in Nepal. This study aimed to fill this gap by exploring the association between neighborhood environments and the QoL of Nepali older adults. To achieve this aim, a conceptual model was developed (Fig. 1) based on a comprehensive literature review [11, 14, 26, 33]. This model illustrates the intricate relationship between the neighborhood environment and the QoL of older adults.
BMC Geriatrics, https://doi.org/10.1186/s12877-024-05278-6