Impact of disability and selected factors on the quality of life in the elderly in southeastern Poland - a cross-sectional study

Impact of disability and selected factors on the quality of life in the elderly in southeastern Poland - a cross-sectional study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Impact of disability and selected factors on the quality of life in the elderly in southeastern Poland - a cross-sectional study Agnieszka Sozańska, Bernard Sozański, Anna Wilmowska-Pietruszyńska, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6311301/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 11 Mar, 2026 Read the published version in BMC Public Health → Version 1 posted 14 You are reading this latest preprint version Abstract Background Population aging is associated with an increase in the prevalence of disabilities. Improving the quality of life (QoL) of the elderly has become an inevitable requirement of civilizational and social progress. The study aimed to analyse the relationships between areas of disability, QoL domains, and selected socio-demographic factors. Methods This was a cross-sectional study conducted in a representative population of people aged 65 and older living in southeastern Poland. The primary outcomes were the level of disability measured by the WHODAS 2.0 questionnaire and the level of QoL in the physical health, psychological, social relationships and environment domains measured by WHOQOL-Bref. Information on selected sociodemographic factors was also collected. Results A total of 3276 complete questionnaires were included in the analysis. The highest average level of disability was noted in the domain of Life activities: household (34.80), while the lowest QoL was in the physical domain (58.31). Women generally had lower QoL compared to men. The age of the research participants significantly affected lower QoL in the physical domain. Low education impacted lower QoL in the physical, social, and psychological domains. Single individuals generally had lower QoL in the psychological, social, and environment domains. Physical activity under 150 min./week and exercises significantly improved QoL in all domains. Conclusions Data on the relationship between QoL and functional disability are particularly important in the face of aging population and the related challenges for countries worldwide. The results of our study could serve as a reference point for formulating health and activation programs for the elderly to promote active and healthy aging. aged disability QoL WHODAS 2.0 WHOQL-Bref Background In recent years, there has been a steady increase in the number of older adults and people with disabilities in societies across Europe and the world. The main reasons are the rise in average life expectancy and the decline in birth rates [ 1 – 3 ]. This trend experienced a slight deceleration during the Covid-19 pandemic, however it still remains evident and ongoing [ 4 ]. In Poland, the percentage of people over 60 is expected to grow significantly, reaching 10.8 million by 2030 and 13.7 million by 2050, accounting for about 40% of the total population [ 5 ]. The prevalence of disability among the elderly in Europe is about 14.0%, with Poland being one of the countries with the highest disability rate [ 6 ]. Disability affects the quality of life (QoL) of older adults, influencing various aspects of their daily life, social integration, and overall well-being [ 7 – 9 ]. Research from different parts of the world indicates that disability limits the ability to perform complex and basic daily activities to various degrees and is often associated with older age, low income, low physical activity, multimorbidity, or depression [ 10 – 15 ]. Studies also highlight the role of factors such as gender and age, estimating that older women have a higher prevalence of disability than older men [ 16 ]. Disability among the elderly increases with age, particularly evident after the age of 80 [ 17 ]. Another factor significantly impairing the functioning of older adults is multimorbidity, occurring in nearly 70% of people aged 65 and older. Disability among the elderly leads to a significant increase in healthcare costs [ 18 – 19 ]. Older individuals with disabilities reduce their physical and utilitarian activity levels, consequently leading to social exclusion [ 11 , 20 – 22 ]. The assumptions of the International Classification of Functioning, Disability, and Health (ICF) can provide a framework for analysing the relationship between disability and QoL. In the ICF system, disability is defined as limitations in one or more components of the biopsychosocial model (body functions and structure, activity and participation, environmental factors, personal factors). These limitations, resulting from various sociodemographic or health factors, may also negatively impact the QoL [ 23 – 25 ]. Therefore, using tools built on ICF categories, such as WHODAS 2.0 for assessing disability levels in several domains, is crucial in analysing the impact of disability on QoL. ICF provides a robust framework for analysing the QoL of people with disabilities, offering a comprehensive, unified, and holistic approach. It emphasizes the importance of all aspects of an individual's life to fully understand and improve their health and well-being. Studies have shown that factors associated with a higher level of disability in older adults negatively affect their QoL, both directly and indirectly [ 26 – 29 ]. Limiting social participation, loss of mobility, and social interactions can adversely impact QoL [ 30 ]. As the global population ages, there is a growing need for population studies to clarify the complex interactions between health-related QoL and disability [ 31 ]. Due to the ongoing aging of societies around the world, it is necessary to increase the number of studies aimed at introducing systemic changes aimed at improving the functioning and quality of life of older people. A thorough understanding of the problems related to the functioning and disability of older people and their quality of life in relation to various socio-demographic and health-related factors is extremely important. This is of great importance for planning and implementing medical, care, social care and other support programs for older people. Therefore, our study aimed to analyse the relationships between the domains of disability measured by WHODAS 2.0 and QoL assessed by WHOQOL-Bref, as well as the impact of selected socio-demographic factors on the domains of QoL measured by WHOQOL-Bref. Methods Study design This is a cross-sectional survey conducted in a representative sample of older adults living in southeastern Poland in the Podkarpackie Voivodeship. Setting and procedures The study was conducted using the Random Route method among individuals aged 65 and older residing in the Podkarpackie Voivodeship in southeastern Poland. Participants were selected through a multi-stage cluster sampling method. The first clusters were chosen based on the region of residence and the size of the locality. Then, single clusters and individual households were randomly selected. The Podkarpackie Voivodeship was divided into 4 subregions [32], from which large, medium, and small towns and villages were randomly chosen. In each randomly selected town and village, an initial address was drawn. The interviewer began the survey from this address - the starting place. The next address was randomly selected by moving right from the first address, and subsequent addresses were chosen three numbers apart until the estimated number of interviews was achieved. Participants The study was conducted among individuals aged 65 and older living in the Podkarpackie community in southeastern Poland. Inclusion criteria for the study group were: age 65 and older, normal cognitive function (AMTS > 6 points), and informed consent to participate in the study. Exclusion criteria were: age below 65, cognitive impairment (AMTS ≤ 6 points), lack of informed consent, and being under institutional care. The Podkarpackie Voivodeship has 304,600 residents aged 60 and older [33]. Sample size assumptions included: 95% confidence level (0.95), maximum estimation error of 2%. It was assumed that the overall planned number of participants should be at least n = 3000. Eventually, a total of 3500 individuals were examined, and after checking the completeness of the collected data, 3276 questionnaires were included in the analysis. The age, gender and place of residence structure of the sample is consistent with the structure of the region from which it was taken (Supplementary table). Procedure The study was conducted using the Pen and Paper Interview method in 2021-2024. Interviews were carried out by properly prepared and trained interviewers at the place of residence of the elderly. Variables Information was collected on age, gender, place of residence, education, marital status, and monthly income per capita (PLN). Data was also collected on physical activity causing at least light fatigue (e.g., housework, gardening, brisk walking, sports) for at least 30 minutes a day (at least 150 minutes weekly), and physical exercises aimed at strengthening muscles and improving physical fitness and endurance, as well as social activities (participation in senior clubs, religious and cultural organizations, etc.). Older adults were asked about the diseases diagnosed by a doctor and compliant with ICD-10, pain occurrence (using the VAS scale 0-no pain, 10-unbearable pain), as well as height and weight measurements were taken. The primary outcomes analysed were the levels of disability measured by the WHODAS 2.0 questionnaire as well as the level of QoL in the physical health, psychological, social relationships, and environment domains measured by WHOQOL-Bref. Measurement To assess the disability of elderly participants, the WHODAS 2.0 version consisting of 36 questions was used. In order to evaluate QoL of the participants, the shortened version of WHOQOL-Bref was applied. Additionally, metric, socio-demographic, and health-related data were collected (as mentioned in the Variables section). World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0). The 36-item WHODAS 2.0 was used to assess the disability of the subjects. WHODAS 2.0 is a standardized uniform tool based on the International Classification of Functioning, Disability and Health (ICF) categories. This tool allowed for general disability assessment in six domains: Cognition (D1), Mobility (D2), Self-care (D3), Getting along (D4), Life activities – household (D5.1), Participation (D6). Life activities – work/school were not analysed in this study as most participants were no longer employed. The WHODAS 2.0 response scale is a 5-point scale, where: 1 = no problem, 2 = mild problem, 3 = moderate problem, 4 = severe problem, 5 = complete problem. Results were converted to a scale from 0 to 100. Disability levels for the entire community can be presented on a qualitative scale according to ICF, ranging from 0 to 4% (no disability), 5 to 24% (mild disability), 25 to 49% (moderate disability), 50 to 95% (severe disability), and 96 to 100% (extreme disability) [34]. In another study, we confirmed the high psychometric properties of WHODAS 2.0 in a survey of older adults in Poland [35]. WHOQOL-Bref WHOQOL-Bref was used to assess the QoL of participants. It consists of 26 questions and allows for the assessment in four domains: physical health, psychological, social relationships, and environment. Responses were rated on a five-point scale, indicating the level of difficulty or problem. Results were calculated according to user instructions on a scale from 0 to 100, where 0 = worst quality of life, and 100 = best quality of life [36]. The WHOQOL-Bref has been validated in the Polish population and is available for download from the WHO website [37]. Socio-demographic and health-related data were collected using a specially prepared interview questionnaire. The following variables were selected for analysis: age, gender, marital status, place of residence, education, physical activity, physical exercise, social participation, number of diagnosed chronic diseases, pain, height, and weight. Ethics approval The study was approved by the Bioethics Committee of the University of Rzeszow (Resolution No. 8/05/2021). All participants were informed about the purpose and principles of the study and were advised of their right to withdraw at any stage. Before the interview, participants signed an informed consent to take part in the study. Statistical methods The collected data were analysed using TIBCO Software Inc. (2017) Statistica (data analysis software system), version 13. Descriptive statistics measures were used for preliminary data analysis. The normality of distribution of measurable variables was assessed using the Shapiro-Wilk test. To compare the occurrence of differences in the distribution of particular variables in individual age groups, the Kruskal-Wallis test and the chi-square independence test were used. The direction and strength of the relationship between the level of disability and QoL were assessed using Spearman's rank correlation coefficient (due to the non-normal distribution of variables). Linear regression models were used to assess the impact of socio-demographic factors on the QoL of the subjects in specific domains. The significance level was set at p<0.05. Results The average age of the participants was 74.4 years. The majority of respondents were women (63.68%), urban residents (58.06%), living with a partner (58.33%), with primary education or lower (34.40%), and a monthly income per person in the range of 1001 - 2000 PLN. The percentage of women, rural residents, single individuals, and those with lower education levels was the lowest in the 65-74 age group and increased in the subsequent age groups. Nearly one-third of participants were physically active, almost 3 out of 10 exercised at least once a week. Slightly over 1 in 4 subjects reported being socially active. The percentage of physically active individuals, those performing physical exercises, and those socially active decreased with older age groups (Table 1). The average BMI value in the studied population was 27.60 kg·m -2 . The average number of diagnosed comorbidities was 4.73, while the average value of subjectively perceived pain on the VAS scale was 3.97. The average number of diseases and the subjectively perceived level of pain were the lowest in the 65-74 age group and increased in subsequent age groups. The situation was different for BMI. The highest average level of disability was noted in the domain Do5.1. Life activities: household (34.80), and the lowest in the Do3. Self-care domain (14.81). In terms of both the overall level of disability and the level of disability in individual domains, the average disability level was the lowest in the 65-74 age group and it increased in subsequent age groups. The highest average assessment of QoL was recorded for the social domain (68.50), and the lowest for the physical domain (58.31). Regarding all domains, the average QoL assessment was the highest in the 65-74 age group (Table 2). In the age group 65 - 74, the strongest significant correlation was noted between the level of disability in the domain of Do6. Participation and the QoL in the physical domain (-0.655). For the age groups 75-84 and 85 and older, the strongest significant correlation occurred between the level of disability in the domain of Do2. Mobility and the QoL in the physical domain (-0.635 and -0.731, respectively) (Table 3). On average, women had lower scores of self-assessment of QoL compared to men in the psychological (by 0.978 points), social (by 1,004 points) and environment (by 0.584 points) domains. Age of the subjects significantly affected QoL assessment only in the physical domain, with each additional year reducing it by an average of 1.229 points. Education significantly impacted QoL in the physical and social domains, where individuals with primary or lower education had the lowest QoL levels, and in the psychological domain, where those with secondary education had the highest, while those with primary or lower education had the lowest QoL levels. On average, single individuals rated their QoL lower than those in relationships in the psychological (1.338 points lower), social (1.712 points lower), and environment domains (0.829 points lower). Physical activity performed daily under 150 min./week significantly affected QoL in all domains, with those whose physical activity was no more than 150 min./week having QoL scores in the physical domain 2,382 points lower on average, in the psychological domain 1,229 points lower, in the social domain 0.986 points lower and in the environment domain 0.844 points lower than those whose physical activity was at least 150 min./week. Individuals who did not exercise had significantly lower QoL scores in each domain relative to those who exercised 4 or more times, with the largest average difference in the environmental domain (3.437 points) and the smallest in the physical domain (2.347 points). Socially inactive individuals generally rated their QoL lower across all domains compared to socially active ones. The largest average difference was in the psychological domain (2.590 points), and the smallest in the social domain (2.033 points). QoL scores in all domains decreased with each additional disease, with the physical domain decreasing by 1,250 points, the psychological domain by 1,003 points, the social domain by 0.439 points and the environment domain by 1,045 points. Subjective pain levels affected QoL scores only in the physical domain, where QoL scores in this domain decreased by an average of 0.156 points as pain levels increased by 1 point. QoL scores in all domains decreased with an increase in BMI, with an increase in BMI of 1 kg m -2 affecting a decrease in QoL scores in the physical domain by an average of 1.852 points, in the psychological domain by 0.301 points, in the social domain by 0.680 points and in the environment domain by 0.720 points (Table 4). Discussion As societies are aging, we decided to expand our knowledge of the relationship between various areas of disability and QoL, as well as the influence of different factors on the domains of QoL. We used tools recommended by WHO for this study. We have found that in the studied group of elderly people aged 65–74, the strongest relationship exists between the level of disability in the area Do6. Participation, measured by WHODAS 2.0, and QoL in the physical domain (-0.655). Participation in social life is linked to a better QoL, which is connected to good physical well-being. Older people may face environmental barriers precluding full participation in social activities, negatively impacting their health-related QoL [ 38 ]. Active participation in social life generates more physical activity and is closely linked to a sense of physical health in the physical dimension [ 39 , 40 ]. In addition, social factors such as community support and belonging enhance motivation and enjoyment of physical activity, which can lead to sustained participation and better QoL in the physical dimension [ 41 ]. Social groups have their own dynamics. The presence of active individuals in a group improves activity among group members [ 42 ]. Moreover, social activity can reduce feelings of isolation and loneliness, further encouraging physical activity [ 41 ]. In the age groups 75–84 and 85 and older, the strongest significant relationship was observed between the level of disability in the domain Do2. Mobility and QoL in the physical domain (-0.635 and − 0.731, respectively). Mobility is a crucial factor affecting the QoL for older adults, especially those aged 75 and older. Mobility limitations affect about 35% of people aged 70 and older, and most older adults over 85. Mobility restrictions are associated with increased risk of falls, hospitalization, and reduced QoL [ 43 , 44 ]. Maintaining physical fitness, especially the ability to walk safely, significantly contributes to better health perception and QoL in older age. Apart from efforts to maintain and improve the physical activity of older adults, implementing technological solutions for personal use and in social spaces is necessary to support the mobility of the elderly [ 45 , 46 ]. Our study confirmed that women generally had a lower QoL compared to men, particularly in the psychological, social, and environment domains. The tendency for older women to report lower psychological well-being compared to men is also confirmed by other research findings. Women achieve lower scores in self-acceptance, autonomy, having a purpose in life, and control the environment [ 47 ]. Studies indicate that women receive lower scores in mental health assessments and are more susceptible to experiencing psychological stress and symptoms of depression [ 48 – 50 ]. Older women are more sensitive to factors coming from social environment than men. Women who feel low social support more often report poor self-assessment of health status compared to men. Therefore, this suggests that social support is a significant factor affecting their overall well-being [ 51 ]. Other reasons for the poorer QoL in older women in social area may result from more frequent health problems, negatively affecting their ability to engage in social activities [ 52 , 53 ], or poorer economic conditions limiting participation in social life [ 54 ]. Moreover, social isolation, often associated with the loss of a spouse, may also contribute to poorer social QoL in older women [ 55 , 56 ]. The lower QoL of older women in the environment domain compared to men is also confirmed by other studies [ 57 ]. This situation particularly affects women living alone or with others (excluding a spouse) [ 58 ]. What is more, key factors, already mentioned, such as chronic illnesses and impairments in body functions and structures, are also crucial. These factors are particularly significant in the environment with poor accessibility for people with special needs [ 59 – 61 ]. Our results show that the age of the subjects significantly affected quality of life scores in the physical domain, where with each additional year, QoL scores in this domain decreased by an average of 1,229 points. This decrease can be attributed to the deterioration with age in muscle strength, physical and cognitive fitness of older people, the presence of chronic diseases, and more frequent psychological and emotional problems, leading to a worse perception of their health and living situation [ 62 – 66 ]. Studies have shown that maintaining higher levels of physical activity in older adults effectively improves physical fitness and the related QoL despite increasing age [ 65 , 66 ]. Our research has also confirmed the link between the level of education and QoL. Lower education was associated with the lower QoL for older adults in physical, social, and psychological domains. Studies performed by other authors confirm that a lower level of education is associated with poorer health parameters, more frequent disability, chronic diseases, and lower levels of physical activity, negatively affecting health-related QoL [ 67 – 69 ]. Education contributes to better social engagement, crucial for maintaining a higher quality of life. Higher education levels are associated with better social functioning and less social withdrawal [ 70 ] A lower level of education is linked to higher stress levels and lower subjective well-being. Research shows that older adults with lower education report higher levels of depression and cognitive stress, adversely affecting their psychological QoL [ 71 , 72 ]. Higher education is associated with better cognitive health and lower rates of cognitive decline, which also affects QoL in the psychological domain [ 73 ]. Our study results indicate that single individuals had, on average, lower scores in QoL assessments in psychological (by 1.338 points), social (by 1.712 points), and environment (by 0.829 points) domains compared to those living with a partner. Loneliness is associated with worse mental health, lower physical activity, fewer social interactions, and consequently, social isolation, all strongly correlated with lower QoL [ 74 – 77 ]. We confirmed in our study that maintaining an appropriate level of physical activity and regular exercise significantly influence the assessment of QoL. Older adults whose physical activity was less than 150 min/week had, on average, QoL scores in the physical domain 2,382 points lower, in the psychological domain 1,229 points lower, in the social domain 0.986 points lower and in the environment domain 0.844 points lower than those whose physical activity was at least 150 min./week. A similar situation occurred with exercising less than three times per week. The results strongly highlight the role of both overall physical activity and exercises in maintaining a higher QoL for older people. To achieve a significantly higher level of QoL, substantial engagement in physical activity is also required. Other authors' research confirms that regular physical activity is associated with better physical health outcomes, including reduced risk of numerous chronic diseases and cognitive and emotional disorders [ 78 ]. Better health provides opportunities to maintain stronger social bonds [ 79 ]. In our study, we demonstrated that socially inactive individuals generally had a lower QoL assessment across all domains compared to socially active individuals, with the average difference in each domain exceeding 2 points. Other researchers confirm the role of social activity in achieving higher QoL scores in various areas, including physical health, mental well-being, and social relationships [ 80 ]. Participation in social activities such as religious groups and formal group classes is positively associated with better overall QoL. The incidence of chronic diseases in the studied group was high (average 4.73 diseases). We confirmed that with each additional disease, there was a significant decrease in QoL across all domains. The subjectively perceived level of pain affected the QoL assessment in the physical domain, where the QoL decreased by an average of 0.156 points with a 1-point increase in pain level. Other studies also confirm a strong association between the occurrence of chronic diseases and lower satisfaction with life and its quality [ 81 ]. All the factors analysed above related to disability and QoL among older adults interact with each other. The findings observed in our study, as well as in studies performed by other authors related to significant levels of disability and low QoL in this social group, are concerning. Analysing the interaction between significant factors affecting QoL and undertaking initiatives aimed at optimally impacting the health and functioning of older adults using the biopsychosocial model promoted by WHO is crucial. Benefits and limitations The benefit of the study is the large representative sample of older adults living in southeastern Poland, as well as the use of measurement tools recommended by WHO. However, the type of study (cross-sectional study) does not allow for the assessment of cause-and-effect relationships. Conlusion Disability is linked to QoL. Physical exercise, social activity, the number of chronic diseases, and BMI were significantly associated with the perceived QoL in the studied population. Older adults who were physically and socially inactive had a lower QoL. The data regarding the relationship between QoL and functional disability are particularly important in the face of an aging population and related challenges for countries worldwide. The results of our study may serve as a reference point for formulating health and activation programs for older adults to promote active and healthy aging. Practical implications: In relation to the low QoL among older adults and its correlation with the factors identified in the study, the planning of social interventions should be taken into account: Actions that encourage and motivate broad participation of older adults in social life, physical activity, and the maintenance and development of social networks. Elimination of environmental barriers and increased accessibility to enable fuller participation of older adults. For people aged 75 and older, maintaining good mobility is particularly crucial, as it significantly relates to higher QoL, especially in the physical domain. Participation in educational and activation programs can increase social support and reduce feelings of loneliness, particularly among older women with lower education levels. Declarations Acknowledgements None. Data availability The data analysed in this manuscript are available from the corresponding author on reasonable request. Authors’ contributions AS contributed to the designing of the study, interpretation of the data, wrote the manuscript and led the writing of the paper. BS prepared the statistical analyses and interpretation of the data. AS, BS, AWS responsible for data collection. BS, AWS contributed to wrote the manuscript. AWP provided substantial feedback on the manuscript. All authors read and approved the final manuscript. Funding Funds for statutory research of the University of Rzeszów Ethics approval and consent to participate The research project was accepted by the Bioethics Committee of the University of Rzeszow (Resolution No. 8/05/2021). 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Sialino LD, van Oostrom SH, Wijnhoven HAH, Picavet S, Verschuren WMM, Visser M, et al. Sex differences in mental health among older adults: investigating time trends and possible risk groups with regard to age, educational level and ethnicity. Aging Ment Health. 2021;25:2355–64. Kinzl JF. Mental disorders in old age | Psychische Erkrankungen bei Frauen und Männern im Alter. Z Gerontol Geriatr. 2013;46:526–31. Caetano SC, Silva CM, Vettore MV. Gender differences in the association of perceived social support and social network with self-rated health status among older adults: A population-based study in Brazil. BMC Geriatr. 2013;13. Raczkiewicz D, Bejga P, Owoc J, Witczak M, Bojar I. Gender gap in health condition and quality of life at advanced age. Annals of Agricultural and Environmental Medicine. 2020;27:636–43. Kirchengast S, Haslinger B. Gender differences in health-related quality of life among healthy aged and old-aged austrians: Cross-sectional analysis. Gend Med. 2008;5:270–8. Llorens-Ortega R, Bertran-Noguer C, Juvinyà-Canals D, Garre-Olmo J, Bosch-Farré C. Influence of social determinants of health in the evolution of the quality of life of older adults in Europe: A comparative analysis between men and women. Humanit Soc Sci Commun. 2024;11. Streeter JL. Gender differences in widowhood in the short-run and long-run: Financial, emotional, and mental wellbeing. J Econ Ageing. 2020;17. De Groof S, Elchardus M. As long as you’re healthy and have your husband". An empirical analysis of the personal well-being of 75-year olds in Flanders | “Zolang ge maar gezond zijt en uwe man nog hebt”. Een empirische analyse van de welzijnservaring van 75-jarige Vlamingen. Tijdschr Gerontol Geriatr. 2005;36:47–59. Rollero C, Gattino S, De Piccoli N. A Gender Lens on Quality of Life: The Role of Sense of Community, Perceived Social Support, Self-Reported Health and Income. Soc Indic Res. 2014;116:887–98. Henning-Smith C. Quality of Life and Psychological Distress among Older Adults: The Role of Living Arrangements. Journal of Applied Gerontology. 2016;35:39–61. Cankovic S, Nikolic EA, Susnjevic S, Cankovic D, Radic I, Harhaji S. Environment and quality of life of older people. HealthMED. 2012;6:1815–20. Forster GK, Aarø LE, Alme MN, Hansen T, Nilsen TS, Vedaa Ø. Built Environment Accessibility and Disability as Predictors of Well-Being among Older Adults: A Norwegian Cross-Sectional Study. Int J Environ Res Public Health. 2023;20. Vitman Schorr A, Khalaila R. Aging in place and quality of life among the elderly in Europe: A moderated mediation model. Arch Gerontol Geriatr. 2018;77:196–204. Diaz-Caneja D, Campa FJ, Altuzarra O, Diez M, Lascurain-Aguirrebeña I, Santisteban L, et al. A compliant parallel manipulator for trunk rehabilitation after stroke. 2021. Zhao J, Han Z, Ding L, Wang P, He X, Lin L. The molecular mechanism of aging and the role in neurodegenerative diseases. Heliyon. 2024;10. Baum JI, Hawley AL, Børsheim E, Wolfe RR, Kim I-Y. The importance of branched-chain amino acids as components of dietary protein for successful aging. 2020. Ní Mhaoláin AM, Gallagher D, Connell HO, Chin AV, Bruce I, Hamilton F, et al. Subjective well-being amongst community-dwelling elders: What determines satisfaction with life? Findings from the Dublin Healthy Aging Study. Int Psychogeriatr. 2012;24:316–23. Lepsy E, Radwańska E, Żurek G, Żurek A, Kaczorowska A, Radajewska A, et al. Association of physical fitness with quality of life in community-dwelling older adults aged 80 and over in Poland: a cross-sectional study. BMC Geriatr. 2021;21. Fey J, Zimmermann J. Socioeconomic inequalities in functional health among very old adults in Germany. 2024. Chapman B, Duberstein P, Lyness JM. Personality traits, education, and health-related quality of life among older adult primary care patients. Journals of Gerontology - Series B Psychological Sciences and Social Sciences. 2007;62. Young CH, Guna L. Factors influencing health-related quality of life in the Korean seniors with lower education level: Focusing on physical activity types. Korean Journal of Adult Nursing. 2020;32:292–304. Lee E-KO, Lee J. Education, Functional Limitations, and Life Satisfaction Among Older Adults in South Korea. Educ Gerontol. 2013;39:514–26. Young CH, Guna L. Factors influencing health-related quality of life in the Korean seniors with lower education level: Focusing on physical activity types. Korean Journal of Adult Nursing. 2020;32:292–304. Celik SS, Celik Y, Hikmet N, Khan MM. Factors Affecting Life Satisfaction of Older Adults in Turkey. Int J Aging Hum Dev. 2018;87:392–414. Chow BC, Jiao J, Duong TV, Hassel H, Kwok TCY, Nguyen MH, et al. Health literacy mediates the relationships of cognitive and physical functions with health-related quality of life in older adults. Front Public Health. 2024;12. Sun X, Lucas H, Meng Q, Zhang Y. Associations between living arrangements and health-related quality of life of urban elderly people: A study from China. Quality of Life Research. 2011;20:359–69. Lim YM, Baek J, Lee S, Kim JS. Association between Loneliness and Depression among Community-Dwelling Older Women Living Alone in South Korea: The Mediating Effects of Subjective Physical Health, Resilience, and Social Support. Int J Environ Res Public Health. 2022;19. Tang C, Huang R, Wang Y, Zhou W. Relationship of depression and loneliness with quality of life in rural widowed elderly women living alone | 农村丧偶独居老年女性抑郁、孤独感与生活质量的关系. Journal of Central South University (Medical Sciences). 2023;48:1865–73. Ahadi B, Hassani B. Loneliness and Quality of Life in Older Adults: The Mediating Role of Depression. Ageing Int. 2021;46:337–50. Cunningham C, O’ Sullivan R, Caserotti P, Tully MA. Consequences of physical inactivity in older adults: A systematic review of reviews and meta-analyses. Scand J Med Sci Sports. 2020;30:816–27. Thompson C, Halcomb E, Masso M, Montgomery A. Ageing with chronic conditions and older persons’ experience of social connections: a qualitative descriptive study. Aust J Prim Health. 2024;30. Park HK, Chun SY, Choi Y, Lee SY, Kim SJ, Park E-C. Effects of social activity on health-related quality of life according to age and gender: An observational study. Health Qual Life Outcomes. 2015;13. Wister A V, Levasseur M, Griffith LE, Fyffe I. Estimating multiple morbidity disease burden among older persons: a convergent construct validity study to discriminate among six chronic illness measures, CCHS 2008/09. BMC Geriatr. 2015;15:12. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6311301","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":455339383,"identity":"abe12513-e75c-4506-8647-1819dad4da31","order_by":0,"name":"Agnieszka Sozańska","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA1UlEQVRIiWNgGAWjYBADAwb2BhDNDMINRGrhOQDTwkisFokEIrXw9x8+/OHnjjpj/plvzD4wVFgnNkg34tcicSMtwbD3zGEzids5xjMYzqQnNsgcJOCwGzwGCbxtB2wYgFoYGNsOJzZIJOLXIn/+jMHBv211NvI3zwC1/CNCi8GBHMNm3jZmM4MbPEAtDURoMbyRlsws23bY2PBMWjFDwrF04zZCfpE7f/jwx7dtdYbzjh/ezPChxlq2X7r5AF4tqCABiNkkSNAABWRoGQWjYBSMguENAJhKR4qtt2E4AAAAAElFTkSuQmCC","orcid":"","institution":"Rzeszów University","correspondingAuthor":true,"prefix":"","firstName":"Agnieszka","middleName":"","lastName":"Sozańska","suffix":""},{"id":455339387,"identity":"918a4ad9-5522-4aaa-9898-cebc7511d7d0","order_by":1,"name":"Bernard Sozański","email":"","orcid":"","institution":"Rzeszów University","correspondingAuthor":false,"prefix":"","firstName":"Bernard","middleName":"","lastName":"Sozański","suffix":""},{"id":455339388,"identity":"d98b1dcb-0b09-4348-aa3c-d5171e9ff469","order_by":2,"name":"Anna Wilmowska-Pietruszyńska","email":"","orcid":"","institution":"Lazarski University","correspondingAuthor":false,"prefix":"","firstName":"Anna","middleName":"","lastName":"Wilmowska-Pietruszyńska","suffix":""},{"id":455339389,"identity":"a9f669bd-4881-4331-b3ec-8390b542c3c9","order_by":3,"name":"Agnieszka Wiśniowska-Szurlej","email":"","orcid":"","institution":"Rzeszów University","correspondingAuthor":false,"prefix":"","firstName":"Agnieszka","middleName":"","lastName":"Wiśniowska-Szurlej","suffix":""}],"badges":[],"createdAt":"2025-03-26 10:23:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6311301/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6311301/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12889-026-26898-0","type":"published","date":"2026-03-11T15:58:46+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":104836087,"identity":"ddf51db4-017e-4c50-a7d0-273b1b11c097","added_by":"auto","created_at":"2026-03-17 17:51:09","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":485413,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6311301/v1/7eda5c0a-00a3-45f6-91f7-19c62d51e869.pdf"},{"id":82703334,"identity":"2eaa8079-65f1-41bf-8630-e700b21a3062","added_by":"auto","created_at":"2025-05-14 09:53:37","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":22127,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementarytable.docx","url":"https://assets-eu.researchsquare.com/files/rs-6311301/v1/09fc0ea88f5f6f807ec2191b.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Impact of disability and selected factors on the quality of life in the elderly in southeastern Poland - a cross-sectional study","fulltext":[{"header":"Background","content":"\u003cp\u003eIn recent years, there has been a steady increase in the number of older adults and people with disabilities in societies across Europe and the world. The main reasons are the rise in average life expectancy and the decline in birth rates [\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. This trend experienced a slight deceleration during the Covid-19 pandemic, however it still remains evident and ongoing [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. In Poland, the percentage of people over 60 is expected to grow significantly, reaching 10.8\u0026nbsp;million by 2030 and 13.7\u0026nbsp;million by 2050, accounting for about 40% of the total population [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe prevalence of disability among the elderly in Europe is about 14.0%, with Poland being one of the countries with the highest disability rate [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDisability affects the quality of life (QoL) of older adults, influencing various aspects of their daily life, social integration, and overall well-being [\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Research from different parts of the world indicates that disability limits the ability to perform complex and basic daily activities to various degrees and is often associated with older age, low income, low physical activity, multimorbidity, or depression [\u003cspan additionalcitationids=\"CR11 CR12 CR13 CR14\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Studies also highlight the role of factors such as gender and age, estimating that older women have a higher prevalence of disability than older men [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Disability among the elderly increases with age, particularly evident after the age of 80 [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAnother factor significantly impairing the functioning of older adults is multimorbidity, occurring in nearly 70% of people aged 65 and older. Disability among the elderly leads to a significant increase in healthcare costs [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Older individuals with disabilities reduce their physical and utilitarian activity levels, consequently leading to social exclusion [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan additionalcitationids=\"CR21\" citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe assumptions of the International Classification of Functioning, Disability, and Health (ICF) can provide a framework for analysing the relationship between disability and QoL. In the ICF system, disability is defined as limitations in one or more components of the biopsychosocial model (body functions and structure, activity and participation, environmental factors, personal factors). These limitations, resulting from various sociodemographic or health factors, may also negatively impact the QoL [\u003cspan additionalcitationids=\"CR24\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Therefore, using tools built on ICF categories, such as WHODAS 2.0 for assessing disability levels in several domains, is crucial in analysing the impact of disability on QoL. ICF provides a robust framework for analysing the QoL of people with disabilities, offering a comprehensive, unified, and holistic approach. It emphasizes the importance of all aspects of an individual's life to fully understand and improve their health and well-being.\u003c/p\u003e \u003cp\u003eStudies have shown that factors associated with a higher level of disability in older adults negatively affect their QoL, both directly and indirectly [\u003cspan additionalcitationids=\"CR27 CR28\" citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Limiting social participation, loss of mobility, and social interactions can adversely impact QoL [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. As the global population ages, there is a growing need for population studies to clarify the complex interactions between health-related QoL and disability [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDue to the ongoing aging of societies around the world, it is necessary to increase the number of studies aimed at introducing systemic changes aimed at improving the functioning and quality of life of older people. A thorough understanding of the problems related to the functioning and disability of older people and their quality of life in relation to various socio-demographic and health-related factors is extremely important. This is of great importance for planning and implementing medical, care, social care and other support programs for older people. Therefore, our study aimed to analyse the relationships between the domains of disability measured by WHODAS 2.0 and QoL assessed by WHOQOL-Bref, as well as the impact of selected socio-demographic factors on the domains of QoL measured by WHOQOL-Bref.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cem\u003eStudy design\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThis is a cross-sectional survey conducted in a representative sample of older adults living in southeastern Poland in the Podkarpackie Voivodeship.\u003c/p\u003e\n\u003cp\u003eSetting and procedures\u003c/p\u003e\n\u003cp\u003eThe study was conducted using the Random Route method among individuals aged 65 and older residing in the Podkarpackie Voivodeship in southeastern Poland. Participants were selected through a multi-stage cluster sampling method. The first clusters were chosen based on the region of residence and the size of the locality. Then, single clusters and individual households were randomly selected. The Podkarpackie Voivodeship was divided into 4 subregions\u0026nbsp;[32],\u0026nbsp;from which large, medium, and small towns and villages were randomly chosen. In each randomly selected town and village, an initial address was drawn. The interviewer began the survey from this address - the starting place. The next address was randomly selected by moving right from the first address, and subsequent addresses were chosen three numbers apart until the estimated number of interviews was achieved.\u003c/p\u003e\n\u003cp\u003eParticipants\u003c/p\u003e\n\u003cp\u003eThe study was conducted among individuals aged 65 and older living in the Podkarpackie community in southeastern Poland. Inclusion criteria for the study group were: age 65 and older, normal cognitive function (AMTS \u0026gt; 6 points), and informed consent to participate in the study. Exclusion criteria were: age below 65, cognitive impairment (AMTS ≤ 6 points), lack of informed consent, and being under institutional care.\u003c/p\u003e\n\u003cp\u003eThe Podkarpackie Voivodeship has 304,600 residents aged 60 and older\u0026nbsp;[33].\u0026nbsp;Sample size assumptions included: 95% confidence level (0.95), maximum estimation error of 2%. It was assumed that the overall planned number of participants should be at least n = 3000. Eventually, a total of 3500 individuals were examined, and after\u0026nbsp;checking the completeness of the collected data, 3276 questionnaires were included in the analysis.\u0026nbsp;The age, gender and place of residence structure of the sample is consistent with the structure of the region from which it was taken (Supplementary table).\u003c/p\u003e\n\u003cp\u003eProcedure\u003c/p\u003e\n\u003cp\u003eThe study was conducted using the Pen and Paper Interview method in 2021-2024. Interviews were carried out by properly prepared and trained interviewers at the place of residence of the elderly.\u003c/p\u003e\n\u003cp\u003eVariables\u003c/p\u003e\n\u003cp\u003eInformation was collected on age, gender, place of residence, education, marital status, and monthly income per capita (PLN). Data was also collected on physical activity causing at least light fatigue (e.g., housework, gardening, brisk walking, sports) for at least 30 minutes a day (at least 150 minutes weekly), and physical exercises aimed at strengthening muscles and improving physical fitness and endurance, as well as social activities (participation in senior clubs, religious and cultural organizations, etc.). Older adults were asked about the diseases diagnosed by a doctor and compliant with ICD-10, pain occurrence (using the VAS scale 0-no pain, 10-unbearable pain), as well as height and weight measurements were taken. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe primary outcomes analysed were the levels of disability measured by the WHODAS 2.0 questionnaire as well as the level of QoL in the physical health, psychological, social relationships, and environment domains measured by WHOQOL-Bref.\u003c/p\u003e\n\u003cp\u003eMeasurement\u003c/p\u003e\n\u003cp\u003eTo assess the disability of elderly participants, the WHODAS 2.0 version consisting of 36 questions was used. In order to evaluate QoL of the participants, the shortened version of WHOQOL-Bref was applied. Additionally, metric, socio-demographic, and health-related data were collected (as mentioned in the Variables section).\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003eWorld Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0).\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eThe 36-item WHODAS 2.0 was used to assess the disability of the subjects. WHODAS 2.0 is a standardized uniform tool based on the International Classification of Functioning, Disability and Health (ICF) categories. This tool allowed for general disability assessment in six domains: Cognition (D1), Mobility (D2), Self-care (D3), Getting along (D4), Life activities – household (D5.1), Participation (D6). Life activities – work/school were not analysed in this study as most participants were no longer employed. The WHODAS 2.0 response scale is a 5-point scale, where: 1 = no problem, 2 = mild problem, 3 = moderate problem, 4 = severe problem, 5 = complete problem. Results were converted to a scale from 0 to 100. Disability levels for the entire community can be presented on a qualitative scale according to ICF, ranging from 0 to 4% (no disability), 5 to 24% (mild disability), 25 to 49% (moderate disability), 50 to 95% (severe disability), and 96 to 100% (extreme disability)\u0026nbsp;[34].\u0026nbsp;In another study, we confirmed the high psychometric properties of WHODAS 2.0 in a survey of older adults in Poland [35].\u003c/p\u003e\n\u003col start=\"2\"\u003e\n \u003cli\u003eWHOQOL-Bref\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eWHOQOL-Bref was used to assess the QoL of participants. It consists of 26 questions and allows for the assessment in four domains: physical health, psychological, social relationships, and environment. Responses were rated on a five-point scale, indicating the level of difficulty or problem. Results were calculated according to user instructions on a scale from 0 to 100, where 0 = worst quality of life, and 100 = best quality of life\u0026nbsp;[36]. The WHOQOL-Bref has been validated in the Polish population and is available for download from the WHO website [37].\u003c/p\u003e\n\u003cp\u003eSocio-demographic and health-related data were collected using a specially prepared interview questionnaire. The following variables were selected for analysis: age, gender, marital status, place of residence, education, physical activity, physical exercise, social participation, number of diagnosed chronic diseases, pain, height, and weight.\u003c/p\u003e\n\u003cp\u003eEthics approval\u003c/p\u003e\n\u003cp\u003eThe study was approved by the Bioethics Committee of the University of Rzeszow (Resolution No. 8/05/2021). All participants were informed about the purpose and principles of the study and were advised of their right to withdraw at any stage. Before the interview, participants signed an informed consent to take part in the study.\u003c/p\u003e\n\u003cp\u003eStatistical methods\u003c/p\u003e\n\u003cp\u003eThe collected data were analysed using TIBCO Software Inc. (2017) Statistica (data analysis software system), version 13. Descriptive statistics measures were used for preliminary data analysis. The normality of distribution of measurable variables was assessed using the Shapiro-Wilk test. To compare the occurrence of differences in the distribution of particular variables in individual age groups, the Kruskal-Wallis test and the chi-square independence test were used. The direction and strength of the relationship between the level of disability and QoL were assessed using Spearman's rank correlation coefficient (due to the non-normal distribution of variables). Linear regression models were used to assess the impact of socio-demographic factors on the QoL of the subjects in specific domains. The significance level was set at p\u0026lt;0.05.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe average age of the participants was 74.4 years. The majority of respondents were women (63.68%), urban residents (58.06%), living with a partner (58.33%), with primary education or lower (34.40%), and a monthly income per person in the range of 1001 - 2000 PLN. The percentage of women, rural residents, single individuals, and those with lower education levels was the lowest in the 65-74 age group and increased in the subsequent age groups. Nearly one-third of participants were physically active, almost 3 out of 10 exercised at least once a week. Slightly over 1 in 4 subjects reported being socially active. The percentage of physically active individuals, those performing physical exercises, and those socially active decreased with older age groups (Table 1).\u003c/p\u003e\n\u003cp\u003eThe average BMI value in the studied population was 27.60 kg\u0026middot;m\u003csup\u003e-2\u003c/sup\u003e. The average number of diagnosed comorbidities was 4.73, while the average value of subjectively perceived pain on the VAS scale was 3.97. The average number of diseases and the subjectively perceived level of pain were the lowest in the 65-74 age group and increased in subsequent age groups. The situation was different for BMI.\u003c/p\u003e\n\u003cp\u003eThe highest average level of disability was noted in the domain Do5.1. Life activities: household (34.80), and the lowest in the Do3. Self-care domain (14.81). In terms of both the overall level of disability and the level of disability in individual domains, the average disability level was the lowest in the 65-74 age group and it increased in subsequent age groups.\u003c/p\u003e\n\u003cp\u003eThe highest average assessment of QoL was recorded for the social domain (68.50), and the lowest for the physical domain (58.31). Regarding all domains, the average QoL assessment was the highest in the 65-74 age group (Table 2).\u003c/p\u003e\n\u003cp\u003eIn the age group 65 - 74, the strongest significant correlation was noted between the level of disability in the domain of Do6. Participation and the QoL in the physical domain (-0.655). For the age groups 75-84 and 85 and older, the strongest significant correlation occurred between the level of disability in the domain of Do2. Mobility and the QoL in the physical domain (-0.635 and -0.731, respectively) (Table 3).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOn average, women had lower scores of self-assessment of QoL compared to men in the psychological (by 0.978 points), social (by 1,004 points) and environment (by 0.584 points) domains.\u003c/p\u003e\n\u003cp\u003eAge of the subjects significantly affected QoL assessment only in the physical domain, with each additional year reducing it by an average of 1.229 points.\u003c/p\u003e\n\u003cp\u003eEducation significantly impacted QoL in the physical and social domains, where individuals with primary or lower education had the lowest QoL levels, and in the psychological domain, where those with secondary education had the highest, while those with primary or lower education had the lowest QoL levels.\u003c/p\u003e\n\u003cp\u003eOn average,\u0026nbsp;single individuals rated their QoL lower than those in relationships in the psychological (1.338 points lower), social (1.712 points lower), and environment domains (0.829 points lower).\u003c/p\u003e\n\u003cp\u003ePhysical activity performed daily under 150 min./week significantly affected QoL in all domains, with those whose physical activity was no more than 150 min./week having QoL scores in the physical domain 2,382 points lower on average, in the psychological domain 1,229 points lower, in the social domain 0.986 points lower and in the environment domain 0.844 points lower than those whose physical activity was at least 150 min./week.\u003c/p\u003e\n\u003cp\u003eIndividuals who did not exercise had significantly lower QoL scores in each domain relative to those who exercised 4 or more times, with the largest average difference in the environmental domain (3.437 points) and the smallest in the physical domain (2.347 points).\u003c/p\u003e\n\u003cp\u003eSocially inactive individuals generally rated their QoL lower across all domains compared to socially active ones. The largest average difference was in the psychological domain (2.590 points), and the smallest in the social domain (2.033 points).\u003c/p\u003e\n\u003cp\u003eQoL scores in all domains decreased with each additional disease, with the physical domain decreasing by 1,250 points, the psychological domain by 1,003 points, the social domain by 0.439 points and the environment domain by 1,045 points.\u003c/p\u003e\n\u003cp\u003eSubjective pain levels affected QoL scores only in the physical domain, where QoL scores in this domain decreased by an average of 0.156 points as pain levels increased by 1 point.\u003c/p\u003e\n\u003cp\u003eQoL scores in all domains decreased with an increase in BMI, with an increase in BMI of 1 kg\u003cimg width=\"4\" height=\"21\" src=\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAAYAAAAgAgMAAABMV+HwAAAAAXNSR0IArs4c6QAAAAxQTFRFAAAAAAAAZrb//7ZmAhDZKgAAAAF0Uk5TAEDm2GYAAAAJcEhZcwAAFiUAABYlAUlSJPAAAAAZdEVYdFNvZnR3YXJlAE1pY3Jvc29mdCBPZmZpY2V/7TVxAAAAEklEQVQYV2NgIBqYNjBAECkAAGjuAiDhELezAAAAAElFTkSuQmCC\" alt=\"image\"\u003e\u003csup\u003e\u0026nbsp;\u003c/sup\u003em\u003csup\u003e-2\u0026nbsp;\u003c/sup\u003eaffecting a decrease in QoL scores in the physical domain by an average of 1.852 points, in the psychological domain by 0.301 points, in the social domain by 0.680 points and in the environment domain by 0.720 points (Table 4).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eAs societies are aging, we decided to expand our knowledge of the relationship between various areas of disability and QoL, as well as the influence of different factors on the domains of QoL. We used tools recommended by WHO for this study.\u003c/p\u003e \u003cp\u003eWe have found that in the studied group of elderly people aged 65\u0026ndash;74, the strongest relationship exists between the level of disability in the area Do6. Participation, measured by WHODAS 2.0, and QoL in the physical domain (-0.655). Participation in social life is linked to a better QoL, which is connected to good physical well-being. Older people may face environmental barriers precluding full participation in social activities, negatively impacting their health-related QoL [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. Active participation in social life generates more physical activity and is closely linked to a sense of physical health in the physical dimension [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. In addition, social factors such as community support and belonging enhance motivation and enjoyment of physical activity, which can lead to sustained participation and better QoL in the physical dimension [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. Social groups have their own dynamics. The presence of active individuals in a group improves activity among group members [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. Moreover, social activity can reduce feelings of isolation and loneliness, further encouraging physical activity [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn the age groups 75\u0026ndash;84 and 85 and older, the strongest significant relationship was observed between the level of disability in the domain Do2. Mobility and QoL in the physical domain (-0.635 and \u0026minus;\u0026thinsp;0.731, respectively). Mobility is a crucial factor affecting the QoL for older adults, especially those aged 75 and older. Mobility limitations affect about 35% of people aged 70 and older, and most older adults over 85. Mobility restrictions are associated with increased risk of falls, hospitalization, and reduced QoL [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]. Maintaining physical fitness, especially the ability to walk safely, significantly contributes to better health perception and QoL in older age. Apart from efforts to maintain and improve the physical activity of older adults, implementing technological solutions for personal use and in social spaces is necessary to support the mobility of the elderly [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOur study confirmed that women generally had a lower QoL compared to men, particularly in the psychological, social, and environment domains. The tendency for older women to report lower psychological well-being compared to men is also confirmed by other research findings. Women achieve lower scores in self-acceptance, autonomy, having a purpose in life, and control the environment [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]. Studies indicate that women receive lower scores in mental health assessments and are more susceptible to experiencing psychological stress and symptoms of depression [\u003cspan additionalcitationids=\"CR49\" citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOlder women are more sensitive to factors coming from social environment than men. Women who feel low social support more often report poor self-assessment of health status compared to men. Therefore, this suggests that social support is a significant factor affecting their overall well-being [\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e]. Other reasons for the poorer QoL in older women in social area may result from more frequent health problems, negatively affecting their ability to engage in social activities [\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e], or poorer economic conditions limiting participation in social life [\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e]. Moreover, social isolation, often associated with the loss of a spouse, may also contribute to poorer social QoL in older women [\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e, \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe lower QoL of older women in the environment domain compared to men is also confirmed by other studies [\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e]. This situation particularly affects women living alone or with others (excluding a spouse) [\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e]. What is more, key factors, already mentioned, such as chronic illnesses and impairments in body functions and structures, are also crucial. These factors are particularly significant in the environment with poor accessibility for people with special needs [\u003cspan additionalcitationids=\"CR60\" citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOur results show that the age of the subjects significantly affected quality of life scores in the physical domain, where with each additional year, QoL scores in this domain decreased by an average of 1,229 points. This decrease can be attributed to the deterioration with age in muscle strength, physical and cognitive fitness of older people, the presence of chronic diseases, and more frequent psychological and emotional problems, leading to a worse perception of their health and living situation [\u003cspan additionalcitationids=\"CR63 CR64 CR65\" citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e]. Studies have shown that maintaining higher levels of physical activity in older adults effectively improves physical fitness and the related QoL despite increasing age [\u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e, \u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOur research has also confirmed the link between the level of education and QoL. Lower education was associated with the lower QoL for older adults in physical, social, and psychological domains. Studies performed by other authors confirm that a lower level of education is associated with poorer health parameters, more frequent disability, chronic diseases, and lower levels of physical activity, negatively affecting health-related QoL [\u003cspan additionalcitationids=\"CR68\" citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e]. Education contributes to better social engagement, crucial for maintaining a higher quality of life. Higher education levels are associated with better social functioning and less social withdrawal [\u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e] A lower level of education is linked to higher stress levels and lower subjective well-being. Research shows that older adults with lower education report higher levels of depression and cognitive stress, adversely affecting their psychological QoL [\u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e, \u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e]. Higher education is associated with better cognitive health and lower rates of cognitive decline, which also affects QoL in the psychological domain [\u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOur study results indicate that single individuals had, on average, lower scores in QoL assessments in psychological (by 1.338 points), social (by 1.712 points), and environment (by 0.829 points) domains compared to those living with a partner. Loneliness is associated with worse mental health, lower physical activity, fewer social interactions, and consequently, social isolation, all strongly correlated with lower QoL [\u003cspan additionalcitationids=\"CR75 CR76\" citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR77\" class=\"CitationRef\"\u003e77\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWe confirmed in our study that maintaining an appropriate level of physical activity and regular exercise significantly influence the assessment of QoL. Older adults whose physical activity was less than 150 min/week had, on average, QoL scores in the physical domain 2,382 points lower, in the psychological domain 1,229 points lower, in the social domain 0.986 points lower and in the environment domain 0.844 points lower than those whose physical activity was at least 150 min./week. A similar situation occurred with exercising less than three times per week. The results strongly highlight the role of both overall physical activity and exercises in maintaining a higher QoL for older people. To achieve a significantly higher level of QoL, substantial engagement in physical activity is also required. Other authors' research confirms that regular physical activity is associated with better physical health outcomes, including reduced risk of numerous chronic diseases and cognitive and emotional disorders [\u003cspan citationid=\"CR78\" class=\"CitationRef\"\u003e78\u003c/span\u003e]. Better health provides opportunities to maintain stronger social bonds [\u003cspan citationid=\"CR79\" class=\"CitationRef\"\u003e79\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn our study, we demonstrated that socially inactive individuals generally had a lower QoL assessment across all domains compared to socially active individuals, with the average difference in each domain exceeding 2 points. Other researchers confirm the role of social activity in achieving higher QoL scores in various areas, including physical health, mental well-being, and social relationships [\u003cspan citationid=\"CR80\" class=\"CitationRef\"\u003e80\u003c/span\u003e]. Participation in social activities such as religious groups and formal group classes is positively associated with better overall QoL.\u003c/p\u003e \u003cp\u003eThe incidence of chronic diseases in the studied group was high (average 4.73 diseases). We confirmed that with each additional disease, there was a significant decrease in QoL across all domains. The subjectively perceived level of pain affected the QoL assessment in the physical domain, where the QoL decreased by an average of 0.156 points with a 1-point increase in pain level. Other studies also confirm a strong association between the occurrence of chronic diseases and lower satisfaction with life and its quality [\u003cspan citationid=\"CR81\" class=\"CitationRef\"\u003e81\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAll the factors analysed above related to disability and QoL among older adults interact with each other. The findings observed in our study, as well as in studies performed by other authors related to significant levels of disability and low QoL in this social group, are concerning. Analysing the interaction between significant factors affecting QoL and undertaking initiatives aimed at optimally impacting the health and functioning of older adults using the biopsychosocial model promoted by WHO is crucial.\u003c/p\u003e \u003cp\u003eBenefits and limitations\u003c/p\u003e \u003cp\u003eThe benefit of the study is the large representative sample of older adults living in southeastern Poland, as well as the use of measurement tools recommended by WHO. However, the type of study (cross-sectional study) does not allow for the assessment of cause-and-effect relationships.\u003c/p\u003e"},{"header":"Conlusion","content":"\u003cp\u003eDisability is linked to QoL. Physical exercise, social activity, the number of chronic diseases, and BMI were significantly associated with the perceived QoL in the studied population. Older adults who were physically and socially inactive had a lower QoL. The data regarding the relationship between QoL and functional disability are particularly important in the face of an aging population and related challenges for countries worldwide. The results of our study may serve as a reference point for formulating health and activation programs for older adults to promote active and healthy aging.\u003c/p\u003e \u003cp\u003ePractical implications:\u003c/p\u003e \u003cp\u003eIn relation to the low QoL among older adults and its correlation with the factors identified in the study, the planning of social interventions should be taken into account:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eActions that encourage and motivate broad participation of older adults in social life, physical activity, and the maintenance and development of social networks.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eElimination of environmental barriers and increased accessibility to enable fuller participation of older adults.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eFor people aged 75 and older, maintaining good mobility is particularly crucial, as it significantly relates to higher QoL, especially in the physical domain.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eParticipation in educational and activation programs can increase social support and reduce feelings of loneliness, particularly among older women with lower education levels.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data analysed in this manuscript are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAS contributed to the designing of the study, interpretation of the data, wrote the manuscript and led the writing of the paper. BS prepared the statistical analyses and interpretation of the data. AS, BS, AWS responsible for data collection. BS, AWS contributed to wrote the manuscript. AWP provided substantial feedback on the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFunds for statutory research of the University of Rzesz\u0026oacute;w\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe research project was accepted by the Bioethics Committee of the University of Rzeszow (Resolution No. 8/05/2021). In accordance with Declaration of Helsinki, the participants were provided with information about the aim and the course of the study and expressed their written and informed consent to participate. The persons were informed about the possibility of withdrawing from the study at any stage of the interview.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eEngland K, Azzopardi-Muscat N. Demographic trends and public health in Europe. Eur J Public Health. 2017;27:9\u0026ndash;13.\u003c/li\u003e\n\u003cli\u003eArredondo MT, Guill\u0026eacute;n S, Peinado I, Fico G. Scenarios for the interaction between personal health systems and chronic patients. 2011.\u003c/li\u003e\n\u003cli\u003eSilva I, Costa D, Silva TC, Veloso A. The aging workforce and human resource management: Challenges and recommendations. 2018.\u003c/li\u003e\n\u003cli\u003ePolizzi A, Zhang L, Timonin S, Gupta A, Dowd JB, Leon DA, et al. 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PLoS One. 2019;14.\u003c/li\u003e\n\u003cli\u003ePopek I, Rodin U. Functional ability self-assessment in elderly population | Samoprocjena funkcionalne sposobnosti osoba starije životne dobi. Acta Medica Croatica. 2018;72:125\u0026ndash;32.\u003c/li\u003e\n\u003cli\u003eWoldemariam S, Stein VK, Haider S, Dorner TE. Trends over time in the deficit of (instrumental) activities of daily living in the Austrian population aged 65 years and older: Results from the Austrian Health Interview Survey series. Wien Klin Wochenschr. 2024;136:488\u0026ndash;96.\u003c/li\u003e\n\u003cli\u003eChao S-F, Su C-Y, Chang M-F. Longitudinal mediation effects of activity meaning on the association between activity performance and quality of life among older adults with disabilities. BMC Geriatr. 2023;23.\u003c/li\u003e\n\u003cli\u003eFancourt D, Steptoe A. Comparison of physical and social risk-reducing factors for the development of disability in older adults: A population-based cohort study. J Epidemiol Community Health (1978). 2019;73:906\u0026ndash;12.\u003c/li\u003e\n\u003cli\u003eMarengoni A, Akugizibwe R, Vetrano DL, Roso-Llorach A, Onder G, Welmer A-K, et al. Patterns of multimorbidity and risk of disability in community-dwelling older persons. Aging Clin Exp Res. 2021;33:457\u0026ndash;62.\u003c/li\u003e\n\u003cli\u003eVirtuoso JS, Martins CA, Roza LB, Paulo TRS, Ribeiro MCL, Tribess S. Prevalence of disability and associated factors in the elderly | Preval\u0026ecirc;ncia de incapacidade funcional e fatores associados em idosos | La prevalencia de la discapacidad y los factores asociados en los ancianos. Texto e Contexto Enfermagem. 2015;24:521\u0026ndash;9.\u003c/li\u003e\n\u003cli\u003eBleijenberg N, Zuithoff NPA, Smith AK, de Wit NJ, Schuurmans MJ. Disability in the individual ADL, IADL, and mobility among older adults: A prospective cohort study. 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Aust J Prim Health. 2024;30.\u003c/li\u003e\n\u003cli\u003ePark HK, Chun SY, Choi Y, Lee SY, Kim SJ, Park E-C. Effects of social activity on health-related quality of life according to age and gender: An observational study. Health Qual Life Outcomes. 2015;13.\u003c/li\u003e\n\u003cli\u003eWister A V, Levasseur M, Griffith LE, Fyffe I. Estimating multiple morbidity disease burden among older persons: a convergent construct validity study to discriminate among six chronic illness measures, CCHS 2008/09. BMC Geriatr. 2015;15:12.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"aged, disability, QoL, WHODAS 2.0, WHOQL-Bref","lastPublishedDoi":"10.21203/rs.3.rs-6311301/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6311301/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003ePopulation aging is associated with an increase in the prevalence of disabilities. Improving the quality of life (QoL) of the elderly has become an inevitable requirement of civilizational and social progress. The study aimed to analyse the relationships between areas of disability, QoL domains, and selected socio-demographic factors.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis was a cross-sectional study conducted in a representative population of people aged 65 and older living in southeastern Poland. The primary outcomes were the level of disability measured by the WHODAS 2.0 questionnaire and the level of QoL in the physical health, psychological, social relationships and environment domains measured by WHOQOL-Bref. Information on selected sociodemographic factors was also collected.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA total of 3276 complete questionnaires were included in the analysis. The highest average level of disability was noted in the domain of Life activities: household (34.80), while the lowest QoL was in the physical domain (58.31). Women generally had lower QoL compared to men. The age of the research participants significantly affected lower QoL in the physical domain. Low education impacted lower QoL in the physical, social, and psychological domains. Single individuals generally had lower QoL in the psychological, social, and environment domains. Physical activity under 150 min./week and exercises significantly improved QoL in all domains.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eData on the relationship between QoL and functional disability are particularly important in the face of aging population and the related challenges for countries worldwide. The results of our study could serve as a reference point for formulating health and activation programs for the elderly to promote active and healthy aging.\u003c/p\u003e","manuscriptTitle":"Impact of disability and selected factors on the quality of life in the elderly in southeastern Poland - a cross-sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-14 09:53:14","doi":"10.21203/rs.3.rs-6311301/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-09-25T10:00:11+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-03T08:46:49+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-30T14:02:12+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-24T09:34:56+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-22T13:48:50+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"160446408489020647784187906461168070871","date":"2025-05-21T07:06:33+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"97821543694764407591340281464644856884","date":"2025-05-20T19:25:15+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"191935687773375006932614927182525958453","date":"2025-05-19T15:04:03+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"184453092278180395660489752577624889400","date":"2025-05-17T06:46:34+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-05-12T04:48:59+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-04-01T08:18:46+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-03-27T08:26:05+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-03-27T08:24:05+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2025-03-26T10:10:04+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b596ce49-ef93-4e3a-9723-d0776fbaccec","owner":[],"postedDate":"May 14th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-03-17T17:44:16+00:00","versionOfRecord":{"articleIdentity":"rs-6311301","link":"https://doi.org/10.1186/s12889-026-26898-0","journal":{"identity":"bmc-public-health","isVorOnly":false,"title":"BMC Public Health"},"publishedOn":"2026-03-11 15:58:46","publishedOnDateReadable":"March 11th, 2026"},"versionCreatedAt":"2025-05-14 09:53:14","video":"","vorDoi":"10.1186/s12889-026-26898-0","vorDoiUrl":"https://doi.org/10.1186/s12889-026-26898-0","workflowStages":[]},"version":"v1","identity":"rs-6311301","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6311301","identity":"rs-6311301","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}