Archives of Gerontology and Geriatrics 74 (2018) 39–43

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Archives of Gerontology and Geriatrics

journal homepage: www.elsevier.com/locate/archger

Depression, functional disability and quality of life among Nigerian older T

adults: Prevalences and relationships
⁎
Christopher Olusanjo Akosilea,d, , Ukamaka Gloria Mgbeojedoa, Fatai Adesina Marufa,
Emmanuel Chiebuka Okoyea, Ifeanyi Chuka Umeonwukab, Adesola Ogunniyic
a
Department of Medical Rehabilitation, College of Health Sciences, Nnamdi Azikiwe University, Nnewi Campus, Anambra State, Nigeria
b
Department of Medical Rehabilitation, College of Medical Sciences, University of Maiduguri, Borno State, Nigeria
c
Neurology Unit, Department of Medicine, College of Medicine, University of Ibadan/University College Hospital, Ibadan, Oyo State, Nigeria
d
Department of Physiology, College of Medicine and Health Sciences, Afe Babalola University, Ado-Ekiti, Ekiti State, Nigeria

A R T I C L E I N F O A B S T R A C T

Keywords: Background: Ageing is associated with increased morbidity, depression and decline in function. These may
Depression consequently impair the quality of life (QoL) of older adults.
Functional disability Purpose: This study was used to investigate the prevalence of functional disability, depression, and level of
Frailty quality of life of older adults residing in Uyo metropolis and its environs, Nigeria.
Quality of life
Method: This cross sectional survey involved 206 (116 females and 90 males) older adults with mean age of
Older adults
69.8 ± 6.7. The World Health Organization Quality of Life-OLD, Functional status Questionnaire (FSQ) and
Geriatric Depression Scale (GDS) were used to measure quality of life, functional disability and depression
respectively. Data was analysed using frequency counts and percentages and Spearman rank-order correlation
coefficient, at 0.05 alpha level.
Results: 45.5% of participants had depression, and at least 30% had functional disability in at least one domain,
but their quality of life was fairly good (> 60.0%) across all domains. Significant correlation existed between
depression scores and individual quality of life and functional disability domains and between overall QoL and
each functional disability domain (p < 0.001).
Conclusions: Depression and functional disability were quite prevalent among sampled older adults but their
QOL was not too severely affected. Since the constructs were interrelated, it seems interventions targeted at
depression and functional status may invariably enhance the quality of life of the older adults.

1. Introduction
Ageing is a natural process of life and is usually fraught with higher
possibility of suffering from multiple health disorders. Old age in many
developing countries is thought to begin at the point when active
contribution is no longer possible (McGuire, Ford, & Umed, 2006). This
point is roughly equivalent to the ages of 60 to 65 years, which often
are the retirement ages in most countries (Jagger, Spiers, & Clarke,
2007; WHO, 2003). The World Health Organization (WHO), reported
the older adult population to be more than 600 million globally and this
is estimated to double by the year 2025 and rise to 2 billion by 2050
(Lutz, Sanderson, & Scherbov, 2008). In Nigeria, the aged 65 years and
above make up about 3.4% of the total population according to the
2006 population census (Nigeria Population Commission (NPC, 2009)).
The prevalence of disability in ageing is unknown but available esti-
mates suggest that about 29–48% of adults with functional disability
had the onset occurring at 65 years and above (Verbrugge & Yang,
2002).
Many individuals with advancing age, are vulnerable to a decline in
physical functioning and find themselves unable to undertake normal
daily tasks that they used to take for granted (de Paula et al., 2015;
Fiksenbaum et al., 2005; Greenglass, Fiksenbaum, & Eaton, 2006;
Ibrahim et al., 2013). Functional disabilities are defined in terms of
higher-level instrumental activities of daily living (IADL) and basic
activities of daily living tasks and these may include shopping for
groceries and personal items, bathing, climbing stairs, or taking a bus or
train by oneself (Jefferson, Paul, Ozonoff, & Cohen, 2006; Jette, 2003).
Functional disability in the elderly encompasses an acquired difficulty
in performing basic everyday tasks or more complex tasks needed for
everyday living (Alves, Leite, & Machado, 2008). It is an important
health indicator in the elderly and can hamper quality of life (QoL) of
the individual and cause heavy social impact with long term

⁎
Corresponding author at: Medical Rehabilitation Department, Nnamdi Azikwe University, Nnewi Campus, Anambra State, Nigeria.
E-mail address: coakosile@yahoo.com (C.O. Akosile).

http://dx.doi.org/10.1016/j.archger.2017.08.011
Received 6 July 2017; Received in revised form 22 August 2017; Accepted 26 August 2017
Available online 06 September 2017
0167-4943/ © 2017 Elsevier B.V. All rights reserved.
C.O. Akosile et al.
institutionalization and medical care (Guralnik, Fried, & Salive, 1996).
Functional disability has been shown to affect the subjective well-being
of the individual, and has been associated with increased morbidity and
mortality (Jagger et al., 2007). Several studies have identified risk
factors for functional disability, of which increasing age was the most
frequent risk factor. (Dunlop, Manheim, Sohn, Liu, & Chang, 2002; Tas
et al., 2007). Also, socio-economic factors such as lack of schooling and
living in a rental housing have also been implicated as risk factors for
incidence of functional disability (Chiu, Chen , Huang & Mau, 2004;
Grundy & Glaser, 2000).
Depression is a common mental disorder characterized by sadness,
loss of interest in activities and by decreased energy. It is differentiated
from normal mood changes by the extent of its severity, the symptoms
and the duration of the disorder (WHO, 2011). Depression is a debili-
tating and globally common illness with a prevalence that increases
with age (Gureje, Ademola, & Olley, 2008; Stordal, Mykletun, & Dahl,
2003), affecting an estimated 350 million people worldwide (WHO,
2012). It has been identified as one of the more prevalent issues in older
adults, which often affects their quality of life (Miedzianowski, 2015)
and is projected to become the third leading cause of disability world-
wide by 2020 (WHO, 2008). Empirical evidence generally supports the
hypothesis that functional disability may increase the risk of depression
(Chiu et al., 2005; Gayman, Turner, & Cui, 2008) and the worse the
depressive symptoms, the more serious the functional disability (Bruce,
2001; Harris, Cook, & Victor, 2003).
Depression increases risk of morbidity in diverse populations
(Diener & Micaela, 2011; Anand, 2014) and has been reported to ne-
gatively impact upon a person’s psychological well-being and the
ability to physically function normally (Assis, de Paula, Assis,
Moraes, & Malloy-Diniz, 2014; Bombin et al., 2012; de Paula & Malloy-
Diniz, 2013; Park, Jun, & Park, 2014; Tomita & Burns, 2013; Wang, van
Belle, Kukull, & Larson, 2002; Zahodne, Devanand, & Stern, 2013). It
also adversely affects the quality of life of the individual (Ibrahim et al.,
2013; Damron-Rodriguez & Carmel, 2014).
It is also worth noting that both depressive symptoms and functional
disability are dynamic and progressive processes, linked with the con-
sequences of underlying co-morbid chronic conditions often associated
with ageing (Anand, 2014; Chen et al., 2011; Rosso, Eaton, & Wallace,
2011). Depressive symptoms and disorders are frequent causes of
emotional and physical suffering and are associated with elevated risks
of disability in diverse areas of functioning and impaired quality of life,
leading to increased risk for death among older adults (Blazer, 2003;
Blazer, Hybels, & Pieper, 2001; Gureje, Kola, Afolabi, & Olley, 2008b).
The loss of independence that functional disability connotes for older
adults is a common cause of life dissatisfaction for them. Other than
health problems and functional impairments, to which most elderly
persons are vulnerable, ageing in Nigeria may predispose them to some
social and economic problems (Gureje et al., 2008b) that may further
complicate their quality of life.
Some previous studies predominantly from Europe and Asia
have explored relationships between variable pairs among QoL,
functional disability and depression in older adults (de Paula
et al., 2015; Grover & Malhotra, 2015; Khaje-Bishak, Payahoot,
Pourghasen, & AsqhariJafarabadi, 2014; Netuveli & Blane, 2008;
Onunkwor et al., 2016), However, literature on the relationship of
functional disability, depression and QoL of older adults in Nigeria and
other African countries is still rather sparse. It is hoped that this study
will provide some further evidence to guide health policy and practice
as it concerns the studied variables among older adults in various
African populations.
2. Methodology
Ethical approval was obtained from the Ethical Review Committee
of University of Uyo Teaching Hospital (UUTH), Uyo, Akwa-Ibom State.
Participants for this community-based cross-sectional survey were two
40
Archives of Gerontology and Geriatrics 74 (2018) 39–43
hundred and six (116 women, 90 men) volunteering older adults (aged
65 years and above) who were consecutively recruited from Uyo me-
tropolis and environs in Akwa-Ibom State Nigeria. Uyo metropolis in-
cludes Aka, Itiam, Offot, Anua-offot, Oku, and Etoi. Uyo environs in-
clude Nsukara, Ibesikpo, Itu, and Nsit-ibom. The communities in the
study location were extensively covered. Big orthodox churches in these
communities were purposively selected because they were more likely
to have congregations with greater proportion of older adults. Some of
the older adults were also recruited at their homes, market stalls, and
institutions (hospitals, schools) where they perform post-retirement
contract or volunteer services. Administrators of the churches and in-
stitutions gave permission and provided conducive atmospheres. All
participants were informed about the purpose and procedures of the
study, and gave verbal or written informed consent (as applicable de-
pending on the level of literacy). The test instruments were interviewer-
administered on individual participant.
The Geriatric Depression Scale (GDS) was used to assess depression.
The 15-item instrument developed by Sheikh and Yesavage (1986) has
been tested and used extensively with the older population (Greenberg,
2007). A scoring grid accompanies the GDS. One point is given for each
respondent’s answer that matches those on the grid. Each question is
scored as either 0 or 1 point.Scores of 0–4 are considered normal; 5–8
indicate mild depression; 9–11 indicate moderate depression; and
12–15 indicate severe depression.
The Functional Status Questionnaire (FSQ) was used to assess
functional disability. This 34-iteminstrument was designed as a clinical
tool to screen for functional disability and to monitor change in func-
tion. It has four core domains related to activities of daily living (ADL),
aside the assessment of both basic and instrumental ADL themselves.
Items 11, 13, 15, 17, 18, 25, 28 are scored in reverse. A “warning zone”
was devised to help clinicians interprete individual FSQ domain scores.
Scale scores that fall within the warning zone represent important
functional disabilities, while scores that fall above the warning zone
range represent little or no functional limitation, that is, a lower score
indicates greater functional disability.
The World Health Organization Quality of Life-OLD (WHOQoL-
OLD) questionnaire, a 24-item self- report that is divided into six do-
mains was used to assess quality of life. Answers are based on a 5-point
Likert response scale with items 1, 2, 6, 7, 8, 9, 10 being scored in
reverse. Each domain consists of 4 items and thus generates in-
dependent scores ranging from 4 to 20 points. The sum of the 6 domains
scores (converted into a 0–100 scale) resulted in the overall score of the
instrument. Higher scores represent better quality of life in the facets.
Information on participants’ demographic such as age, gender, level
of education, marital status was obtained via oral interview. Data was
analysed with the Statistical Package for Social Sciences (SPSS)-version
16 using frequency counts and percentages, range, mean and standard
deviation and Spearman rank order correlation coefficient (for testing
the correlation among the variables). The level of significance was set at
p < 0.05.
3. Results
Two hundred and six older adults (90 males, 116 females), with a
mean age of 69.78 ± 6.69 years (range = 60–98 years) participated in
the study. The mean ages of male and female participants
(70.19 ± 6.64 years versus 69.47 ± 6.75 years) were similar
(t = 0.769, p = 0.443). Forty-seven percent of the participants were
married and lived with their spouses, and nearly 60% of respondents
had at least a secondary school level education and about half of the
study population was occupationally active(Table 1). The prevalence of
depression was 49.5% and at least 30% of participants had functional
disability in one domain or the other with social activity being the
domain most affected (Table 2), and quality of life was generally fairly
good (scores > 60) across domains though lowest in the intimacy do-
main (Table 3). Depression had significant but inverse correlation with
C.O. Akosile et al. Archives of Gerontology and Geriatrics 74 (2018) 39–43

Table 1 Table 4
Demographic profile of study participants. Correlation between participants’ level of depression and individual domains of quality of
life and functional disability.
Parameters Class n(%) X2 p
Variables class rho-value p-value
Gender Male 90(43.7) 3.28 0.07
Female 116 (56.3) WHOQOL Intimacy −0.432 0.0001*
Past, present & future activities −0.535 < 0.0001*
Marital status Single 20 (10.0) 169.29 < 0.0001
Sensory ability −0.532 < 0.0001*
Married 109 (53.0)
Death & dying −0.238 0.001*
Widowed 54 (26.0)
Autonomy −0.466 < 0.0001*
Separated 12 (6.0)
Social participation −0.441 < 0.0001*
Divorced 11 (5.0)
FSQ Basic activities of daily living −0.705 < 0.0001*
Educational Nil formal 24 (11.7) 43.86 < 0.0001
Instrumental ADL −0.608 < 0.0001*
Primary 60 (29.1)
Mental health −0.633 < 0.0001*
Secondary 36 (17.5)
Work performance −0.563 < 0.0001*
Tertiary 86 (41.7)
Social activities −0.625 < 0.0001*
Occupation Active 103 (50.0) Quality of interactions −0.542 < 0.0001*
Inactive 103(50.0)
Key: ADL = Activities of daily living; WHOQOL: world health organization quality of life;
n = frequency%: percentage. FSQ: functional status questionnaire.
Active = Individuals with active employment, made up of civil servants, farmers and * indicates significance at p < 0.05
traders.
Inactive = Retirees from the public service and private companies, farmers and traders.
Table 5
Correlation between participants’ overall score of quality of life and domains of
Table 2 Functional Status Questionnaire (FSQ).
Proportion of participants in different depression categories and with functional dis-
ability. Variables class rho-value p-value

Variable class frequency percentage FSQ Basic activities of daily living 0.604 < 0.0001*
Instrumental activities of daily living 0.554 < 0.0001*
Depression Normal 104 50.5 Mental health 0.579 < 0.0001*
Mild 58 28.2 Work performance 0.487 < 0.0001*
Moderate 32 15.5 Social activity 0.641 < 0.0001*
Severe 12 5.8 Quality of interactions 0.605 < 0.0001*
Functional disability Basic ADL 67 32.5
* indicates significance at p < 0.05.
Instrumental ADL 81 39.3
Mental health 72 35.0
Work performance 77 37.4 recession may precipitate depression. Poverty, poor access to health
Social activity 88 42.7 care and medical comorbidity had been reported as risk factors for
Quality of interactions 63 30.6
depression (Anand, 2014; Blazer, 2003). All the occupationally inactive
were retirees from public and private organizations while majority from
Table 3
the occupationally active group were artisans and traders. Declining
Participants’ mean and standard deviation scores for domains of quality of life. national economic resources has led to early retirement (when most are
still responsible for their children) for most individuals who now form
Variabla Class mean Standard deviation the older adult group. Abysmal and irregular payment of terminal/re-
Quality of life Sensory ability 78.28 19.43
tirement benefits and pensions coupled with reduced healthcare
Death & dying 67.96 21.29 funding, amidst growing incidence of non-communicable diseases may
Intimacy 63.47 22.31 jointly be contributing to higher prevalence of depression than what
Past, present, future activities 65.53 19.63 previously obtained in the country in the present study. Prevalence of
Autonomy 67.14 18.86
depression is reportedly common in sub-Saharan Africa (Tomlinson,
Social participation 65.85 16.41
Swartz, Kruger, & Gureje, 2006) and so the story may not be so different
in the other nations.
all QoL (r = −0.238–−0.535; p < 0.001) and FSQ Prevalence estimates of functional disability in basic ADL and
(r = −0.542–−0.705; p < 0.001) domains except in the death and Instrumental ADL were found to be about 30% and 40% respectively.
dying domain of quality of life, where though significant, the correla- These values were much higher than the respective 3% and 9.1% for
tion was weak (Table 4). Quality of life had moderate to fairly strong both constructs by Gureje, Ogunniyi, Kola, and Afolabi, 2006a in a
significant correlation (r = 0.432–0.641; p < 0.001) with the domains study conducted among Yoruba-speaking older adults from the South-
of FSQ (Table 5). west and North-central regions. Functional disability in the other FSQ
domains of this study were within the same 30%- 40% range. Other
authors using a different instrument had reported about 47% in dif-
4. Discussion ferent domains among an American population (Ostchega, Harris,
Hirsch, Parsons, & Kington, 2000). While variations in study instru-
The prevalence of depression among the older adults in our study ments may have contributed to differences across studies, the fact that
was 49.5%. Other studies have reported 14.5% for an African American our study population and that of the American study were from urban
population (Baiyewu et al., 2007); 12% for a Greek population areas may also have contributed to these higher values. Gureje,
(Papadopoulos et al., 2005); 27.4%, 23.7% and 15.6% for Indian, Ogunniyi, Kola, and Afolabi, 2006b found the trend of functional dis-
Mexican and Russian population respectively (Anand, 2014); 19% and ability tends to increase from rural through semi-urban to urban areas.
21.4% for South-eastern and South-western Nigerian populations re- A study involving participants from rural and semi-urban communities
spectively (Baiyewu et al., 2007; Uwakwe, 2000). Aside possible cul- in South-eastern Nigeria however reported about 65% of them being
tural influences, reduced self-worth from loss of economic power (as- dependent in physical functioning. (Akosile et al., 2014a).
sociated now with most Nigerian older adults) due to a severe national

41
C.O. Akosile et al.
Participants’ QoL scores were generally not too severely affected
across domains and could be regarded as fair. The scores were similar to
the mean and median scores of 68.2 and 68.8 reported by Mwanyangala
et al. (2010) among Tanzanian older adults. Akosile et al. (2014b) had
however found lower but not poor mean scores among a population
from South-eastern Nigeria. The instrument for the Akosile et al.
(2014b) study was different to the one used in the Tanzanian and
present study and its participants were also older. Previous authors
have generally reported poorer QoL with increasing age (Gureje et al.,
2008a; Mwanyangala et al., 2010)
Significant correlations were found between depression and do-
mains of functional disability. Some authors have hypothesized that
functional disability may increase risk of depression (Assis et al., 2014;
Bombin et al., 2012; Gayman et al., 2008; Park et al., 2014; Tomita and
Burns, 2013; Zahodne et al., 2013; de Paula and Malloy-Diniz, 2013).
Gureje et al. (2007) reported the rate of major depressive disorders to
be higher among older adults with functional disability while Geerlings,
Beekman, Deeg, Twisk, and Van-Tilburg, 2001 found statistically sig-
nificant correlation between depression and functional limitations. It is
thought that the impact of depression on functional disability may
partly be due to the reduced physical activity and social interactions of
depressed people (Pennix et al., 1999). Additionally, Blando (2011)
reported that a positive affect and participation in pleasurable activities
are associated with more positive self-ratings of health and improved
quality of life…
Significant correlation was also found between all functional dis-
ability domains and quality of life. Gureje et al. (2006a) had similarly
also reported that disability in activities of daily living or in instru-
mental activities of daily living was associated with poorer quality of
life in all of the four domains of the WHOQoL-Bref. Akosile et al.
(2014b) also found lowered QoL (particularly in the physical health
component) in a group of older adults majorly dependent in physical
function.
Findings in this study showed that depression correlated negatively
with quality of life. This finding is similar to previous reports (Gureje,
Kola, & Afolabi, 2007; Ibrahim et al., 2013) which showed that people
with depression had impaired quality of life. According to reports from
Carmel, Shrira, and Shmotkin, 2013 the overall will to live concept as it
relates to life satisfaction (quality) reflects the outcome of the thinking
process that considers quality, meaningfulness, and worthiness of living
and has been found to be strongly associated with mental health.
Certain limitations to the present study ought to be noted. This
study involved a convenience sample of volunteers who responded to
our invitation. Participants’ recruitment was done irrespective of the
presence or absence of medical co-morbidities among participants. The
contributions of co-morbidities (if present) to the obtained values and
actual true values for the population could therefore not be ascertained.
The cross-sectional design nature of the study also did not allow us to
determine the direction of causality and findings were only reported
based on observed associations and should thus be interpreted with
caution.
5. Conclusion
Depression and functional disability were quite prevalent in this
sample of older adult but their quality of life was fairly good.
Significant correlations exist between depression and each of the
functional disability and quality of life domains and also between
functional disability domains and overall quality of life. The high pre-
valence of depression and functional disability in the population is
worrisome and suggest the need for routine investigation of the con-
struct by relevant professionals. Healthcare professionals should also
devise interventions to address the problems and policies should be put
in place to minimize their development so as to enhance the quality of
life of the older adults. This might require legislative and executive
42
Archives of Gerontology and Geriatrics 74 (2018) 39–43
actions to provide social security and accessible and affordable
healthcare for the group.
Conflict of interest
The authors declare no conflict of interest.
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