JMIR Publications

ABSTRACT

Background:

Existing literature highlights the influence of various individual factors (IF) and family factors (FF) on the quality of life (QOL) among older adults. However, previous studies have often focused on isolated factors or specific subgroups, thereby overlooking potential interactions and their impacts on outcomes. Additionally, there's a lack of studies exploring the mediating role of health risk (HR) and health services demand (HSD).

Objective:

This study aims to examine both direct and indirect pathways connecting IF and FF to the older adults’ QOL, using structural equation modeling (SEM).

Methods:

This study analyzed data from 8,600 elderly participants in the 2015 China Health and Retirement Longitudinal Study (CHARLS). SEM was used to examine the statistical significance of the association between individual and family factors and QOL, with mediation by HR and HSD. IF were determined based on education level, per capita disposable income, and endowment insurance. FF were established according to spouse satisfaction and children satisfaction. HR included physical activity, alcohol consumption, unhealthy sleep, and siesta. HSD was gauged by inpatient and outpatient service utilization. QOL was assessed using physical component summary (PCS) and mental component summary (MCS) scores.

Results:

Among the 8,600 participants, the majority (65.7%) were aged 60-70, with a near-equal distribution of males and females at around 50%. The average PCS score was 76.77, while the MCS score averaged 59.70. Both IF (β=0.165, P< .001) and FF (β=0.189, P< .001) had a direct positive effect on QOL. Furthermore, the indirect effects of IF (β=0.186, P< .001) and FF (β=0.211, P< .001) through HR and HSD were also significant. In the direct model, IF and FF had a greater impact on MCS (β=0.841) than on PCS (β=0.639). However, after including the two mediating factors, HR and HSD, the influence of IF and FF on MCS (β=0.739) became consistent with PCS (β=0.728). Subgroup analyses revealed that the direct effect of IF on QOL was significant in the 60-70 age group (β=0.151, P< .001) but not in those over 70 years old (β=0.122, P= .074). Comorbidity status significantly influenced the pathway from HR to HSD, with older adults having two or more chronic diseases (β=0.363) showing a greater impact compared to those with fewer than two chronic diseases (β=0.358).

Conclusions:

In the context of older Chinese adults, IF, like education, income, and endowment insurance, along with FF, such as satisfaction with a spouse and children, directly impact their QOL. Additionally, an equally significant proportion of influence is exerted through the mediating role of HR and HSD. Recognizing the interplay among these factors is crucial for targeted interventions to enhance the well-being of older adults in China.