Life satisfaction among elderly patients in Nepal: Associations with nutritional and mental well-being

Background: Nepal's demography is aging rapidly, yet few studies to date have examined how this has affected the health and well-being of the elderly, defined as those above 60years in Nepal's Senior Citizen Act (2006). Our study, abbreviated NepEldQOLII, aims to assess perceived life satisfaction, and evaluate its relationship with nutritional health and mental well-being among the burgeoning Nepalese elderly population. Methods: A cross-sectional survey among 289 Nepalese elderly, aged ≥60years, attending an outpatient clinic of a hospital in Kathmandu, Nepal was conducted. Nutritional status, depression, and life satisfaction were assessed by a mini-nutritional assessment scale (range: 0-14), a geriatric depression scale (range: 0-15), and a satisfaction with life scale (range: 5-35), respectively. Mediation analyses, adjusted for age, sex, marital status, and family type, were used to assess mediating relationships between nutritional and mental wellbeing with life satisfaction as the outcome. Results: Approximately 21% of the participants were dissatisfied with their life. Life satisfaction was positively associated with being married, high family income, involvement in active earning, and a high nutritional score. Conversely, life satisfaction was inversely associated with living in a nuclear (as opposed to joint) family, the perception of having worse health than peers, the perception of being ignored/hated due to old age, and a higher depression score. In mediation analyses, both nutrition (β=0.48, bias-corrected and accelerated (BCa) 95% CI: 0.27, 0.69) and depression (β=-0.87, BCa 95% CI: -1.01, -0.74) had significant direct associations with life satisfaction. Furthermore, both nutrition (β=0.30, BCa 95% CI: 0.13, 0.49) and depression (β=-0.07, BCa 95% CI: -0.14, -0.03) mediate each other's association with life satisfaction. Nutritional score mediated 7% of the total association between depression and life satisfaction; depression mediated 38% of the total association between nutrition and life satisfaction. Conclusions: Life satisfaction shows a pattern of decline as nutritional and mental health status decrease. Both depression and under-nutrition had a significant association with life satisfaction. The pathway by which nutrition affects life satisfaction is influenced by depression as a mediator. Moreover, nutritional status explained a small portion of the relationship between depression and life satisfaction. These observed preliminary findings should be confirmed in future longitudinal studies.