Structural equation model of the relationship between functional ability, mental health, and quality of life in older adults living alone

Abstract

Aims: Living alone, a reality in an increasing number of older adults recently, is a risk factor for low quality of life. This study identified the predictors of quality of life in older adults living alone based on mental health and the International Classification of Functioning, Disability, and Health.

Methods: This secondary data analysis used information from the 2018 Assessing the Requirements of Customized Health Care and Daily Living Support Services survey (N = 1,022), collected from adults aged ≥ 65 living alone in Siheung City, South Korea, from August to October 2018. The exogenous variables were body functions (hand grip strength, timed "up and go" test score, and body mass index), daily living activities (Korean Instrumental Activities of the Daily Living Scale), social activity participation (social activity engagement, neighbor contacts, and family contacts), and participation in economic activity (frequency). The endogenous variables were mental health (Geriatric Depression Scale Short Form-Korean Version and UCLA Loneliness Scale) and quality of life (EuroQoL-5 Dimension-3 Level and EuroQoL-Visual Analog Scale).

Results: After modifying the hypothetical model, which had failed to satisfy the recommended fitness level, the (modified) model had good fitness indices Q (CMIN / df) 2.90, GFI 1, AGFI 1, RMSEA 0.04, CFI 0.90 and PCFI 0.53. Of the nine pathways of the modified model, five were statistically significant. Quality of life was affected by body functions, daily living activities, social activity participation, and mental health. These variables explained 68.2% of the factors affecting quality of life.

Conclusions: By highlighting the role of mental health, this model provides a useful framework for improving the quality of life of older adults who live alone and function at various levels in the community. Focusing on advancing mental health through body functions, daily living activities, and social activity participation can improve quality of life.

Fig 1. Hypothetical model.

x1 Hand grip strength; x2 Timed up and go score; x3 Body mass index; x4 Korean instrumental activities of daily living; x5 Social activity participation frequency; x6 Number of neighbor contacts; x7 Number of family contacts; x8 Economic activity participation frequency; y1 Geriatric Depression Scale Short Form-Korean; y2 Revised UCLA Loneliness Scale-version 3; y3 Euro Quality of Life-5 Dimension index; y4 Euro Quality of Life Visual Analogue Scale.

Fig 2. Path diagram of the modified model.

*p < .05, ** p < .01, *** p < .001; x1 Hand grip strength; x2 Timed up and go score; x3 Body mass index; x4 Korean instrumental activities of daily living; x5 Social activity participation frequency; x6 Number of neighbor contacts; x7 Number of family contacts; x8 Economic activity participation frequency; y1 Geriatric Depression Scale Short Form-Korean; y2 Revised UCLA Loneliness Scale-version 3; y3 Euro Quality of Life-5 Dimension index; y4 Euro Quality of Life Visual Analogue Scale; e1-12 Measurement error in the Observed variables of x1-8 and y1-4; d1 Structural error in the Endogenous variable of Mental Health; d2 Structural error in the Endogenous variable of Quality of Life.