Functional Status, Social Support and Quality of Life as Determinants of Successful Aging

Research Article

Gerontol Geriatr Res. 2020; 6(1): 1041.

Functional Status, Social Support and Quality of Life as Determinants of Successful Aging

Sharma R*

Department of Psychology, University of Delhi, India

*Corresponding author: Ritu Sharma, Department of Psychology, University of Delhi, Aditi Mahavidyalya, Delhi, India

Received: January 02, 2020; Accepted: January 27, 2020; Published: February 03, 2020


Introduction: Older people 65+ constitute 4.8% of total population being characterized by frailty, socio-economic dependence, widowhood, abuse, poverty, loneliness, depression and chronic ailments. This study aims to explore the relation among functional status, and social support and QOL of community dwelling older people to understand factors contributing to successful aging.

Methods: In this cross-sectional study, random sample of 1016 senior citizens of all socio-economic status were collected from Delhi (India). The quantitative assessment was done on indicators of functional status, physical activity and quality of life by using scales of ADL, IADL, QOL, LTA and social support.

Results: Older people (80+) were significantly different on ADL, IADL, QOL GDS at p<0.05. Living arrangement, education and SES affect IADL and QOL, and LTA (p<0.05). Regression analysis showed significant relation of IADL with age, education, depression, economic independence, social activities, social support and depression.

Conclusion: Modifiable variables such as age, education, living arrangement, marital status and socio-economic status negatively influence the functional status. Independence in IADL, LTA and social support can improve the quality of life of senior citizens.

Impact: Deterioration in health with age and dependence arise the need for long term care services in community. Maintenance of good health can help in dealing with abuse and improve QOL. In the absence of family support or caregiver burnout, a community based long term care system can be a solution to support community dwelling older people.

Keywords: Quality of life; Healthy aging; Active aging; Social support; Depression


The loss of function and development of disability in old age are dynamic bio-social phenomenon that relate to the individual’s physiological and psychological conditions in the milieu of their socioeconomic position, cultural norms and broader environmental contexts. Aging raises a host of fascinating issues that have come into focus due to the increasing share of older people in Indian society [1]. Functional status is the ability of an individual to perform activities to meet daily challenges and keep one-self healthy both physically and psychologically [2]. It seems to be a matter of least concern for all those who are invariably leading an independent life. However, people who are aged, disabled or suffering from chronic ailments face challenges to perform activities of daily living such as getting up from the bed, taking shower, preparing a meal, watering plant, recollecting memories or taking medicines [3,4]. There is a need to understand the meaning of functionality from the perspective of the most heterogeneous group i.e. older adults. It is not only a matter of physical restrictions it also includes the emotional and psychological pressure an individual bears to cope up with his inability to perform the activities of daily living [5]. Therefore, functional status refers to the capacity of an individual to remain psychologically and physically healthy, to work independently, to deal with different life stressors and cope with day to day problems [6,7].

Old age is an age of which people are most fearful because of the degeneration process within the body, slow speed of recovery and psycho-social losses [8]. The process of degeneration, wear and tear within the body in the absence of a healthy lifestyle makes the body vulnerable to various types of diseases and frailties. It often results in limited or complete dependence in later years of life [9]. Psychological and social losses associated with age makes the situation worse. Therefore, there are several aspects which altogether decide the functional status such as independence in Activities of Daily Living (ADL), and Instrumental Activities of Daily Living (IADL), chronic ailments, BMI, hearing and vision, perceived health, cognitive status, mental health, social support, life satisfaction, Leisure Time Activity (LTA), self-rated mental health, Quality of Life (QOL) and happiness. Functional status makes a person psychologically, physically, emotionally and spiritually sound to make better decisions, to deal with the environmental situations, to participate constructively to the society and capacitates the achieving of satisfaction and everlasting state of happiness. A large number of older adults specifically in underdeveloped countries where the government is unable to provide social security, medical insurances, safety, security to hugenumber of senior citizens, suffer/ undergo a life that is more or less contingent at the mercy of their children and relatives.

In the context of Indian older adults, a survey of historical context is important to construe their physical, psychological, financial and social condition. After partition large number of people entered as refugees and settled in various parts of Delhi and NCR in 1947. They had nothing much in their hands apart from trauma and nightmares. They established themselves in varying but surely tough ways and developed means to earn their bread and butter. At present, many of them are earning through small shops and financially not much strong. In the absence of medical insurances, the diseases become huge burden on children and ultimately reason for elder abuse. Several studies show that disability, dependence make older adults vulnerable to abuses [10,11]. Therefore, the functional status which could be the key for their happiness and quality of life is the concern of present research. Can older adults attain the quality of life through active life style? Can activities of daily living, instrumental activities of daily living, leisure-time activities which are indicators of functional status related to quality of life? Is there any relationship between functional status and quality of life or they are independent of each other? What is the role of social support in establishing quality of life of older adults? What restricts the functional status of older adults in society and how it can be improved are few areas explored in this research.


• Older people who are active and capable of living independently have a better quality of life as compared to those who need assistance to perform daily chores.

• Older people with limited or complete dependence need social support to improve their quality of life.


• To assess the functional status of older people on the following parameters of functionality ADL, IADL, QOL, LTA and Social Support (SS).

• To explore the relationship between physical independence, mental health and social support on quality of life.

• To give practical and workable solutions to bring QOL in the lives of older adults.



Independent Variables: Age, gender, living arrangement, marital status, education, Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL), Leisure Time Activities (LTA), social support.

Dependent Variable: Quality of Life (QOL).


A sample of 1016 older people with age of 60 years and above and residing in the National Capital Region (NCR) of Delhi was taken. The random stratified sampling method was used to select sample from Delhi. To take the sample from all socio-economic areas, three different localities namely, Ambedkar nagar, a slum area; Rohini, inhabited mostly by middle-class families; and South Delhi, where per capita income is relatively high were chosen. The sample was taken from the areas.

Distribution of the population

Distribution of population based on age, gender, marital status, living arrangement, and education. The age was categorized into five groups-Young-Old (60-65 years), Old (65-70 years) and Old-Old (71- 75 years), Older-Old (76-80) and Oldest-Old (81+). The population was divided based on gender namely male and female. The whole population was categorized into three groups illiterate, primary/ secondary and graduate and above based on education. The marital status was categorized as married-with-spouse-living, married-butwidowed and alone/never-married.

Procedure of Data collection

The prospective sample was defined from the voters’ list and subjects were identified by random sampling with reasonable scope in case of absence and death of the identified subject. A voter list was taken from the constituency office of the respective areas and every 10th house was approached for data collection. An informed consent was taken from the elderly person before the collection of data about the objectives of the study, its methodology, advantages and disadvantages besides giving them the option to refuse to participate. Two separate teams were made- one comprising of doctors and the other of psychologists and they took the data on the prescribed formats independently. Both the trams collected data on different times and shared the list of participants with the other team. Other team followed the details and approached the participants for the remaining part of the data. Initially the data of collected from the sample of 1180 but it had reduced to 1016 because some people had either died, or shifted to some other place or showed their disinterest in providing information. The questionnaires were short and not time-consuming and all administered at one time in a single sitting. To avoid making the assessment process tiring and monotonous, the questionnaires were administered in an informal setting. To prevent the person from becoming overwhelmed by the numbers of questions in the assessment procedure, an effort was made to elicit the needed information during the conversation itself.


Barthel’s index of activities of daily living: This tool is to assess activities of daily living; it uses ten variables describing ADL and mobility. The scale was introduced in 1965, and yielded a score of 0-100 by Mahoney FI & Barthel DW (1965). The Barthel index has demonstrated high inter-rater reliability (0.95) and test retest reliability (0.89) as well as high correlations (0.74-0.8) with other measures of physical disability.

Lawton’s instrumental activities of daily living: The Lawton Instrumental Activities of Daily Living Scale (IADL) is an appropriate instrument to assess independent living skills. These skills are considered more complex than the basic activities of daily living as measured by the Katz Index of ADLs. The instrument is most useful for identifying how a person is functioning at present and for identifying improvement or deterioration over time. There are 8 domains of function measured with the Lawton IADL scale. Historically, women were scored on all 8 areas of function; men were not scored in the domains of food preparation, housekeeping, laundering. Inter-rater reliability was established at 0.85.

Leisure Activities Record: It was developed by Van Willigen and Chadha (1990) to assess the activities the elderly undertaken to occupy their time. The record has a list of 23 activities that the elderly could usually do during their leisure time. These activities were divided into four categories: cultural, social, solitary and physical.

Social Support Network Schedule: This tool was developed by Van Willigen and Chadha in 1991 to understand the social linking of elderly people with their neighbours, friends, and family. A list of 20 items included with two categories of response option as ‘Yes’ or ‘No’. The response of ‘Yes’ means elderly is socially active and ‘No’ indicates a socially inactive person. A score of 2 is given to the response of ‘Yes’ and 1 is given to the response of ‘No’.

WHOQOL-BREF: The WHOQOL-BREF was derived from data collected using the WHOQOL-100. It produces scores for four domains related to the quality of life: physical health, psychological, social relationships and environment. It also includes one facet on the overall quality of life and general health. There are 26 questions range from ‘Never’-5, ‘Seldom’=4, ‘Quiet often’=3, ‘Very often’=2, ‘Always’=1 [12].

MMSE Test: The Mini-Mental State Examination (MMSE) or Folstein test is a 30-point questionnaire that is used extensively in clinical and research settings to measure cognitive impairment. It is commonly used in medicine and allied health to screen for dementia. Any score of 24 or more (out of 30) indicates a normal cognition. Below this, scores can indicate severe (≤9 points), moderate (10-18 points) or mild (19-23 points) cognitive impairment.

Other Information Includes

Demographic Details: such as the person’s name, age, gender, and contact address.

Socio-Economic Status: Person’s educational level, marital status, current living arrangement, occupation (if any), monthly income, and sources of income.

Family History: Numbers of children and the availability of caretakers.

Results & Analysis

Quality of Life (QOL) is the general well-being of individuals and societies, outlining negative and positive features of life; it depicts happiness and overall satisfaction. It is very difficult to measure the quality of life because of its subjective nature. The functional status seriously affects QOL. In the present research functionality had been assessed by ADL, IADL, MMSE, LTA and the influence of age, gender, marital status, education, living arrangement, and socio-economic status also studied on these variables of functionality.

Of the 1016 subjects included in the study, 523 (51.5%) were females and 493 (48.5%) were males. The mean age of our study subjects is 67.86 years (+7.52). The population studied has a higher number of females and most individuals studied are young-old (60- 64 years). Females are significantly low in IADL, QOL (p>0.01).

Older people who are married and living with their spouse are 62.4% and 37% are widowed. 36.3% are living alone and the largest numbers of people who are living alone (59.2%) belong to the age group of 80+ followed by senior citizens living alone. It reflects that most of the widowed population (94.7%) is living alone.

52.7% population of older people is illiterate and 87.8% is not working only 12.2% is currently working. 17.9% chose to leave work because of ill health 23.4% of older people are out of the formal work sector. It seems to be a lack of good health and stereotypes are the major reason behind the non-working status. It has a significant impact on the social and financial status of older citizens in society Table 1.