Ageing Society And Wellbeing Concerns

Nepal is rapidly transitioning into an ageing society due to increasing life expectancy and declining fertility rates, bringing with it a new wave of challenges. Rising demand for healthcare needs, the growing burden of multiple chronic conditions, and the need for strong geriatric care, social, and mental health support are pushing the country to rethink how it supports its older population. With rapid demographic changes and evolving traditional family structures and roles in Nepal, the quality of life for older people has become an increasingly pressing concern. 

Evidence suggests that the quality of life in later years—encompassing physical health, psychological well-being, social relationships, and environmental conditions—varies widely. The World Health Organization Quality of Life (WHOQOL) Group defines quality of life as the individual’s perception of their position in life in the context of their cultural and value system and in relation to their goals, expectations, standards, and concerns, which emphasises that quality of life is a subjective and multidimensional concept comprising physical health, psychological well-being, social relationships, and environmental conditions. Socioeconomic conditions, lifestyle characteristics, health status, access to and affordability of healthcare services, and social support strongly shape the quality of life of older people. Traditional family and community structures that once supported older people are gradually weakening in Nepali society due to urbanisation, migration of children, and changing household structures. As a result, many older people are becoming increasingly isolated, which further diminishes their quality of life. Despite its importance, this issue remains underexplored in Nepal, highlighting how sociodemographic, economic, and health-related factors shape the quality of life among older people.     

This study was conducted with 692 older people residing in Kamalamai Municipality, Sindhuli District, through face-to-face interviews using digital questionnaires to identify key factors influencing the quality of life among older people. 

Moderate quality of life 

The study found that the overall quality of life among older people was moderate, with a mean score of 27.6. Significant differences were observed across age groups, marital status, living arrangements, caste and ethnic groups, education levels, working status, economic source of living, state of economic dependency, receipt of social security allowance, wealth quintile, health status, instrumental activity of daily living (IADL), disability status, engagement in physical activity, and experiences of elder abuse. 

Older people aged 60-69, who were married, from Hill Caste, had at least secondary education, were currently working, had their own income, were not economically dependent, did not receive social security allowance, belonged to households with higher wealth, reported good health status, had high functioning in IADL, did not have a disability, engaged in physical activity, and experienced elder abuse, were found to have higher mean quality of life scores. However, no significant differences were observed in quality of life based on sex, family type, religion, health insurance, activity of daily living, and health risk behaviour such as smoking, tobacco use, and alcohol consumption. 

The study confirmed the positive relationship between education level and quality of life. Older people with some level of education—whether literate, basic, or secondary —reported a higher quality of life compared to those with no education. Education can increase happiness directly or indirectly through better employment opportunities, higher income, and a healthier lifestyle. 

Assessing the impact of economic factors on quality of life showed that older people who relied on income from their son or daughter or an old-age allowance reported lower quality of life. The results indicate that economic independence has a stronger impact on older people's perceptions of happiness and well-being. Similarly, the study showed that household wealth status is statistically significantly and positively associated with quality of life, indicating that higher household wealth status is associated with higher quality of life scores. Older people from the poorer, middle, richer, and richest household wealth status had a higher quality of life than those from the poorest households.

Health status and functional health—an individual's ability to perform activities of daily living—are key influencing factors of quality of life among older people. Self-reported health status had a significant impact on quality of life. Older people reporting fair or poor health had a lower quality of life than those with good health, but older people who performed activities of daily living independently had a lower quality of life than those with limitations in activities of daily living. This complex relationship provides an opportunity for further investigation. 

Health-related behaviours 

Health behaviours shape the health and quality of life of older people and can be positive or negative. Smoking, tobacco use, alcohol consumption, and physical inactivity are recognised as key health risk behaviours. Among health behaviour factors, physical activity was positively associated with quality of life, with older people who engaged in physical activity experiencing a higher quality of life than those who were inactive. However, the quality of life was lower among older people who smoked than among non-smokers, highlighting the need for further research to fully understand the underlying causes. 

One of the most concerning findings of this study is the negative impact of elder abuse on quality of life. Elder abuse refers to any intentional act or failure to act that causes harm or distress to an older person. Elder abuse includes physical, psychological, and financial abuse as well as sexual abuse and neglect. Older people who experienced elder abuse reported significantly lower quality of life, highlighting an often-overlooked issue in ageing research.  

The quality of life of older people in Nepal is shaped by a combination of education, source of income, household wealth status, health status, functional ability, and health-related behaviour. Factors such as education, source of income, household wealth status, and functional and physical activity can improve the quality of life among older people. In contrast, poor health status and elder abuse remain major threats to their quality of life. 

The findings suggest that targeted interventions, in relation to investment in education, economic security, and social protection, as well as the promotion of active lifestyles and the prevention of elder abuse, are essential to enhance the quality of life as a national priority.

(Thapa, PhD, is an associate professor of population studies at Tribhuvan University.)