Association between multimorbidity and quality of life among older adults in community-dwelling of Uttar Pradesh, India


  • Himanshu . Department of Development Studies, International Institute for Population Sciences, Mumbai, Maharashtra, India
  • P. Arokiasamy Department of Development Studies, International Institute for Population Sciences, Mumbai, Maharashtra, India
  • Y. Selvamani Department of Development Studies, International Institute for Population Sciences, Mumbai, Maharashtra, India



Quality of life, Older adults, Chronic diseases, Multimorbidity, Uttar Pradesh, WHOQoL-BREF


Background: Increasing longevity with the coexistence of chronic multimorbidity makes the elderly population vulnerable to functional limitation, disability and more frequent hospitalization, resulting deterioration in the quality of life (QoL). The present study examines the association between chronic multimorbidity and QoL among the older population in Varanasi, India.

Methods: A cross-sectional data of 500 individuals in the Varanasi district of Uttar Pradesh, India aged 50+ years were collected using a multistage simple random sampling procedure from November 2017 to May 2018. Multimorbidity variable was generated using eight self-reported chronic conditions. WHOQOL-BREF was utilised to assess the QoL of the study participants. Descriptive analysis was performed to assess the mean QoL score pattern, whereas multivariate linear regression analysis examines the association between multimorbidity and QoL.

Results: The mean age of respondents was 64 [±10.7] years, and 49% were female. Eighteen percent of study participants had multimorbidity (2+). The mean QoL score was 70, which decreased with age and was found higher among males (73). Multivariable regression analysis shows that demographic and lifestyle risk factors are significantly associated with QoL.  Elderly with multimorbidity (β=-4.42; 95% CI=-7.18: -1.66) and physical inactivity (β=-4.65; 95% CI=-6.9: -2.3) was significantly associated with reduced QoL.

Conclusions: Multimorbidity along with demographic and lifestyle factors are significantly associated with QoL. Healthcare programmes need to focus multimorbidity while promoting healthy and risk-free lifestyle to control modifiable risk factors. For their day-to-day needs, government assistance is necessary for the most economically dependent older population.


Raj D, Swain PK, Pedgaonkar SP. A study on quality of life satisfaction and physical health of elderly people in Varanasi: An urban area of Uttar Pradesh, India. Int J Med Sci Publ Health. 2014;3(5):616-20.

Arokiasamy P. India's escalating burden of non-communicable diseases. The lancet global health. 2018;6(12):e1262-3.

Fortin M, Dubois MF, Hudon C, Soubhi H, Almirall J. Multimorbidity and quality of life: a closer look. Health and quality of life outcomes. 2007;5(1):1-8.

Pati S, Agrawal S, Swain S, Lee JT, Vellakkal S, Hussain MA, et al. Non communicable disease multimorbidity and associated health care utilization and expenditures in India: cross-sectional study. BMC health services research. 2014;14(1):1-9.

Arokiasamy P, Uttamacharya U, Jain K, Biritwum RB, Yawson AE, Wu F, et al. The impact of multimorbidity on adult physical and mental health in low-and middle-income countries: what does the study on global ageing and adult health (SAGE) reveal? BMC medicine. 2015;13(1):1-6.

Aiden H. Multimorbidity. Understanding the Challenge; 2018.

Barnett K, Mercer SW, Norbury M, Watt G, Wyke S, Guthrie B. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet. 2012;380(9836):37-43.

Zhou B, Chen K, Wang J, Wang H, Zhang S, Zheng W. Quality of life and related factors in the older rural and urban Chinese populations in Zhejiang province. J Applied Gerontology. 2011;30(2):199-225.

Singh JK, Ray SK, Basu AK. A Study of Quality of Life of Elderly People in the Tangra Area of Kolkata. InGlobal Public Health Conference. 2014;2014:240.

Dasgupta A, Pan T, Paul B, Bandopadhyay L, Mandal S. Quality of life of elderly people in a rural area of West Bengal: A community-based study. Med J. 2018;11(6):527.

Shah VR, Christian DS, Prajapati AC, Patel MM, Sonaliya KN. Quality of life among elderly population residing in urban field practice area of a tertiary care institute of Ahmedabad city, Gujarat. J Family Med Primary Care. 2017;6(1):101.

Thadathil SE, Jose R, Varghese S. Assessment of domain wise quality of life among elderly population using WHO-BREF scale and its determinants in a rural setting of Kerala. Int J Curr Med Appl Sci. 2015;7(1):43-6.

Registrar General and Census Commissioner of India. District Census Handbook Varanasi. New Deli; 2011.

Whoqol Group. Measuring quality of life. Geneva: The World Health Organization; 1997:1-3. Available at: handle/10665/63482. Accessed on 1 January 2017.

World Health Organization T. Global recommendations on physical activity for health. World Health Organization; 2010.

Pati S, Swain S, Hussain MA, van den Akker M, Metsemakers J, Knottnerus JA, et al. Prevalence and outcomes of multimorbidity in South Asia: a systematic review. BMJ Open. 2015;5(10):e007235.

Kumar D, Shankar H. Prevalence of Chronic Diseases and Quality of Life among Elderly People of Rural Varanasi. Int J Contemporary Med Res. 2018;5(7):G1-5.

Uddin MA, Soivong P, Lasuka D, Juntasopeepun P. Factors related to quality of life among older adults in Bangladesh: A cross sectional survey. Nursing Health Sci. 2017;19(4):518-24.

Nagarani SKR. A study on quality of life of elderly population in Mettupalayam, a rural area of Tamilnadu. Natl J Res Community Med. 2012;1:123-77.

Barua A, Mangesh R, Kumar HH, Saajan M. Assessment of the domains of quality of life in the geriatric population. Indian J Psychiatry. 2005;47(3):157.

Canbaz S, Sünter AT, Dabak S, Pekşen Y. The prevalence of chronic diseases and quality of life in elderly people in Samsun. Turkish J Med Sci. 2003;33(5):335-40.

Mini GK, Thankappan KR. Pattern, correlates and implications of non-communicable disease multimorbidity among older adults in selected Indian states: a cross-sectional study. BMJ open. 2017;7(3):e013529.

Jackson SE, Hackett RA, Steptoe A. Associations between age discrimination and health and wellbeing: cross-sectional and prospective analysis of the English longitudinal study of ageing. Lancet Public Health. 2019;4(4):e200-8.

Bao J, Chua KC, Prina M, Prince M. Multimorbidity and care dependence in older adults: a longitudinal analysis of findings from the 10/66 study. BMC public health. 2019;19(1):1-0.

Kshatri JS, Palo SK, Bhoi T, Barik SR, Pati S. Associations of multimorbidity on frailty and dependence among an elderly rural population: Findings from the AHSETS study. Mechanisms Ageing Development. 2020;192:111384.

Figueira HA, Figueira JA, Mello D, Dantas EH. Quality of life throughout ageing. Acta medica lituanica. 2008;15(3).

Ibrahim TM, Namir GA, Tariq SA, Nazar PS. Quality of life and morbidity pattern of Geriatric population in Erbil City. Middle East J Age Ageing. 2010;7:233-50.

Qadri SS, Ahluwalia SK, Ganai AM, Bali SP, Wani FA, Bashir H. An epidemiological study on quality of life among rural elderly population of Northern India. Int J Med Sci Public Health. 2013;2(3):514-22.

Ulloa BF, Møller V, Sousa-Poza A. How does subjective well-being evolve with age? A literature review. J Population Ageing. 2013;6(3):227-46.

Mondal NA, Kannaujiya AK, Ali B. Quality of Life of Elderly in Rural Murshidabad (West Bengal). Social Science Spectrum. 2020;5(1):42-9.

Garin N, Olaya B, Moneta MV, Miret M, Lobo A, Ayuso-Mateos JL, et al. Impact of multimorbidity on disability and quality of life in the Spanish older population. PloS one. 2014;9(11):e111498.

Vitorino LM, Paskulin LM, Vianna LA. Quality of life among older adults resident in long-stay care facilities. Revista latino-americana de enfermagem. 2012;20:1186-95.

Mini GK. Socioeconomic and demographic diversity in the health status of elderly people in a transitional society, Kerala, India. J Biosocial Sci. 2009;41(4):457-67.

Singh L, Arokiasamy P, Singh PK, Rai RK. Determinants of gender differences in self-rated health among older population: evidence from India. Sage Open. 2013;3(2):2158244013487914.

Vagetti GC, Barbosa VC, Moreira NB, Oliveira VD, Mazzardo O, Campos WD. Association between physical activity and quality of life in the elderly: a systematic review, 2000-2012. Brazilian J Psychiatry. 2014;36:76-88.

Holzer BM, Siebenhuener K, Bopp M, Minder CE. Evidence-based design recommendations for prevalence studies on multimorbidity: improving comparability of estimates. Population health metrics. 2017;15(1):1-9.

Diederichs C, Berger K, Bartels DB. The measurement of multiple chronic diseases - a systematic review on existing multimorbidity indices. J Gerontology Series A: Biomed Sci Med Sci. 2011;66(3):301-11.

Johnston MC, Crilly M, Black C, Prescott GJ, Mercer SW. Defining and measuring multimorbidity: a systematic review of systematic reviews. European J Public Health. 2019;29(1):182-9.

Violan C, Foguet-Boreu Q, Flores-Mateo G, Salisbury C, Blom J, Freitag M, et al. Prevalence, determinants and patterns of multimorbidity in primary care: a systematic review of observational studies. PloS one. 2014;9(7):e102149.

Guisado-Clavero M, Roso-Llorach A, López-Jimenez T, Pons-Vigués M, Foguet-Boreu Q, Muñoz MA, et al. Multimorbidity patterns in the elderly: a prospective cohort study with cluster analysis. BMC Geriatrics. 2018;18(1).




How to Cite

., H., Arokiasamy, P., & Selvamani, Y. (2022). Association between multimorbidity and quality of life among older adults in community-dwelling of Uttar Pradesh, India. International Journal Of Community Medicine And Public Health, 9(8), 3197–3208.



Original Research Articles