Aging with burden: multimorbidity, depression and quality of life in older adults residing in long-term care facilities in South Africa

BACKGROUND: Population ageing has become an immediate global imperative, with older adults disproportionately afflicted by multimorbidity, a complex interplay of co-existing chronic diseases that erodes health-related quality of life (HRQoL). Multimorbidity is associated with impairments in physical and mental functioning, which undermine older adults' autonomy and contributes to declines in HRQoL. However, vital data that explore these relationships remain absent for older populations residing in long-term care facilities (LTCFs) across sub-Saharan Africa. This study examines multimorbidity prevalence in LTCF residing older adults and its associations with depression, HRQoL outcomes and physical activity. METHODS: A cross-sectional study among 396 older adults from 17 randomly selected South African LTCFs employed the Geriatric Depression Scale, EQ-5D-3 L, and Weighted Functional Comorbidity Index. Descriptive statistics, correlation analyses and TwoStep cluster analysis elucidated multimorbidity patterns. RESULTS: Multimorbidity affected 76.77% of participants, with variation across four distinct clusters. The Cardiovascular-Respiratory cluster comprised 33.8% predominance. Multimorbidity was significantly predicted by poorer HRQoL and increasing age, χ²(140, n = 396) = 228.19, p < .001. Depression prevalence reached 35.10%, with higher scores associated with greater multimorbidity burden (ρ = 0.28, p < .01) and reduced HRQoL. An inverse correlation between the Weighted Functional Comorbidity Index and EQ-5D-3 L scores (ρ = -0.33, p < .001) reflected multimorbidity's negative impact on HRQoL. Multimorbidity was inversely associated with Short Physical Performance Battery scores, lower physical activity, and directly to waist-to-hip ratios. CONCLUSION: Advancing age is strongly associated with an increased burden of multimorbidity, which is intricately linked to depressive symptoms, diminished HRQoL, reduced muscular strength, central adiposity, and physical inactivity. These findings highlight the urgent need for integrated interventions in institutionalised older adults in sub-Saharan Africa and should inform policy reform aimed at strengthening long-term care and healthy ageing strategies.