Determinants of Quality of Life Among Elderly in a Social Care Center: Emphasis on Sleep

Introduction

Aging is a natural and inevitable phase in human development, marked by progressive physical, psychological, and social changes that often result in gradual decline. According to the World Health Organization,¹ individuals aged 60 years and above are classified as elderly. This phase of life presents challenges such as reduced adaptability to stress, decreased biological and cognitive function, and diminished social interaction, all of which may significantly affect an individual’s quality of life (QoL).² However, aging should not be viewed solely as a period of decline; with adequate health care, social support, and targeted interventions, many older adults are able to maintain independence, resilience, and a sense of well-being. Thus, understanding the multidimensional impact of aging is essential for developing strategies that promote active aging and improve QoL among the elderly population.

In Indonesia, caring for the elderly has traditionally been considered a familial responsibility, deeply rooted in cultural values of parental respect and intergenerational support. However, changes in family dynamics, rapid urbanization, and increasing work demands have shifted this paradigm, resulting in a growing number of elderlies being placed in nursing homes or social care centers.³ While these institutions provide essential health and social services, the transition to institutional living often comes at a psychosocial cost. Many elderly residents report feelings of loneliness, abandonment, and diminished self-worth, particularly when the decision to institutionalize is made without their full consent or participation.⁴ Such experiences not only affect emotional well-being but can also significantly lower overall quality of life, underscoring the need for more person-centered and family-inclusive approaches in elderly care.

Quality of life among institutionalized elderly is influenced by multiple factors, including physical health, mental well-being, and social connectedness. Social support is recognized as a critical determinant of well-being in later life, offering emotional, informational, and practical assistance that helps older adults maintain autonomy and cope with daily challenges.⁵ A lack of meaningful interaction can lead to isolation, depression, and poor QoL among residents in social care facilities.⁶ Studies have suggested that social support can buffer the negative impact of institutionalization. When elderly individuals receive consistent support from family, peers, and the broader community, their sense of purpose and emotional resilience improves. Moreover, opportunities for interaction, recreation, and companionship can significantly enhance their perception of life satisfaction and reduce psychological distress.⁷

A preliminary exploration at Tresna Werdha Budi Mulia 2 Social Care Center in Jakarta revealed that residents often felt bored, lonely, and disconnected due to the limited variety of daily activities and minimal opportunities for meaningful interaction. These psychosocial challenges illustrate how institutional living can restrict autonomy and reduce the sense of purpose among the elderly, which in turn may negatively influence their overall quality of life. Motivated by these observations, the present study seeks to examine in greater depth the role of social support—both from peers within the institution and from family members or staff—in shaping the well-being of elderly individuals residing in social care centers. In this context, the research is directed toward understanding whether, and to what extent, the presence, quality, and consistency of social support can enhance different dimensions of quality of life, including physical health, psychological well-being, and social connectedness. By positioning social support as a central variable, the study aims to provide a clearer picture of how interpersonal and institutional relationships contribute to the lived experiences of older adults in care facilities.

Methods

This study employed a cross-sectional design using a non-probability purposive sampling technique to recruit elderly individuals residing in Tresna Werdha Budi Mulia 2 Social Care Center, West Jakarta. Participants were selected based on specific inclusion and exclusion criteria to ensure the appropriateness of the sample for the research objectives. Data collection was conducted in August 2022 at Tresna Werdha Budi Mulia 2 Social Care Center, Cengkareng, West Jakarta. The inclusion criteria were as follows: (a) elderly individuals who had been residing in the care center for more than one month, (b) aged 50 years or older, and (c) not experiencing severe illness, dementia, hearing impairment, psychological disorders, or decreased consciousness. The exclusion criteria included: (a) individuals with communication disorders, and (b) elderly residents who were unwilling to participate as respondents.

Data collection utilized three main instruments. First, demographic data were collected using a standardized questionnaire from the World Health Organization. Second, social support was measured using a researcher-developed questionnaire (Section B), which was tested for validity and reliability through a pilot study involving 30 elderly residents at Tresna Werdha Budi Mulia 2 Social Care Center in Cengkareng. Third, the WHOQOL-BREF questionnaire (Section C) was used to assess quality of life across four domains: physical, psychological, social, and environmental. Quality of life scores were categorized into three levels: low (<33), moderate (≥33 and <67), and high (≥67). Additionally, the Quality-of-Life Index: Generic Version-III was used to support and compare WHOQOL-BREF findings. Data analysis consisted of univariate and bivariate methods. Univariate analysis was conducted to describe demographic variables such as age, gender, education, marital status, and employment. Bivariate analysis using simple linear regression was applied to examine the influence of physical, psychological, social, and environmental factors on the quality of life.

The Participant Information Sheet (PIS) and informed consent were verbally administered by the research team, as most participants were older adults and some had visual impairments. Following a detailed verbal explanation and confirmation of comprehension, participants who voluntarily agreed to take part provided their written signatures on the consent form. This procedure was reviewed and approved by the institutional ethics committee to ensure inclusivity, accessibility, and full understanding among all participants.

Results

Discussion

Quality of life is defined as an individual’s perception of their position in life, in the context of their goals, expectations, and social and cultural values.² It is a broad, multidimensional concept that includes subjective evaluations of both positive and negative aspects of life.⁵ Among the elderly population, QoL is influenced by several interrelated factors, such as physical health, psychological well-being, social support, and environmental conditions. In addition, the World Health Organization highlights that QoL is not only related to the absence of disease but also encompasses overall well-being, independence, social relationships, and spiritual aspects. It is a dynamic construct that can change over time due to shifts in health status, life roles, or socioeconomic circumstances. As such, measuring QoL provides a comprehensive indicator of an individual’s overall health and serves as an essential outcome in evaluating the effectiveness of healthcare interventions and social policies.

In this study, the majority of elderly residents in the social care center demonstrated relatively good social support, adequate nutritional intake, and active engagement in disease prevention activities. However, despite these positive behaviors, the overall QoL scores were still found to be moderate or even low in many cases. This finding is consistent with previous revealed that 68.4% of older adults in their study had poor QoL.⁵ The discrepancy between favorable health-related behaviors and low QoL highlights that objective indicators do not necessarily guarantee subjective well-being. Factors such as loneliness, declining physical capacity, loss of independence, or unmet emotional needs may influence how older adults perceive their quality of life.⁸ Thus, QoL assessment should be viewed holistically, incorporating both behavioral measures and individual perceptions to capture the true well-being of the elderly.⁹

One striking finding in this study was that sleep behavior showed a significant association with quality of life (p = 0.002). Poor sleep has long been associated with diminished cognitive function, mood disorders, and lower life satisfaction among older adults. Although 99% of the elderly participants reported “fair” sleep quality, their overall QoL scores remained in the moderate or low range. This suggests that even slight disturbances in sleep may have a substantial impact on perceived well-being. Tucker et al emphasized through a systematic review and meta-analysis that poor nutritional status and poor sleep were both linked with reduced QoL in institutionalized older adults, reinforcing the role of fundamental daily behaviors in shaping long-term well-being.¹⁰ Similarly, Tatineny et al underscored that sleep architecture changed with age and was often accompanied by insomnia, fragmented sleep, and increased sleep latency, all of which contributed to daytime dysfunction.¹¹ These disruptions can lead to irritability, fatigue, cognitive decline, and social withdrawal, thus deteriorating QoL. Furthermore, Gothe et al found that sleep quality was deeply intertwined with physical activity and psychosocial well-being.¹² In their study, better sleep was associated with more consistent physical activity, fewer depressive symptoms, and stronger social support—factors that, collectively, predicted higher QoL in community-dwelling older adults.

Contrary to expectations, this study found no significant association between medication adherence and QoL (p = 0.491), despite the high rate (97.4%) of non-adherence. One possible explanation is the structured nature of medication administration in institutional settings, where the standardized delivery of prescribed drugs reduces the variability typically caused by individual adherence behaviors. This finding also underscores the multifactorial complexity of chronic illness management among older adults, suggesting that pharmacological treatment alone may not be sufficient to enhance overall well-being. Psychosocial aspects, environmental support, and the presence of comorbidities likely play a more prominent role in shaping QoL than adherence in isolation. Therefore, interventions aimed at improving QoL in elderly populations should adopt a holistic approach that integrates medical, psychological, and social dimensions rather than focusing solely on medication compliance. Nutritional intake also did not show a significant relationship with QoL (p = 0.445), despite 97.3% of participants reporting adequate food intake. While nutrition remains essential for physical health, Tucker et al found that its effects on QoL may have been moderated by the emotional context of mealtimes and individual autonomy in food choices.¹⁰ In institutional settings where food provision is standardized, the absence of choice and emotional connection to food may reduce its impact on subjective well-being.

Sleep quality again emerged as a central determinant of QoL in older adults. A study by Almondes et al comparing pre-pandemic and pandemic sleep patterns among the elderly revealed that disruptions in sleep habits were associated with increased anxiety and social isolation, leading to lower QoL scores.¹³ These findings reinforce the notion that psychological and environmental stability play a critical role in maintaining sleep quality and, by extension, life satisfaction in late adulthood. Disease prevention behavior and physical activity were also not significantly correlated with QoL in this study, possibly due to age-related functional limitations and fear of injury. Physical activity among the elderly often declines due to mobility issues or chronic pain, which may prevent it from translating into perceived improvements in life quality unless accompanied by psychosocial support and autonomy.¹⁴

In addition, a cross-sectional study found that poor sleep quality was significantly associated with reduced QoL in retired elderly individuals, particularly in domains related to emotional role functioning and general health perception.¹⁵ Other findings highlight the critical role of sleep as a determinant of both physical and psychological well-being in later life.¹⁶ Sleep disturbances not only contribute to fatigue and impaired cognitive function but may also exacerbate feelings of anxiety, depression, and social withdrawal, all of which negatively affect QoL. This suggests that interventions targeting sleep quality—such as sleep hygiene education, relaxation techniques, or supportive environmental modifications—could indirectly enhance broader aspects of life satisfaction and health-related outcomes among the elderly.

Given the demonstrated relationship between sleep and QoL, improving sleep behavior should be recognized as a central pillar in geriatric care planning. Simple, non-pharmacological interventions such as sleep hygiene education, optimizing light and noise levels in care environments, and establishing individualized bedtime routines have been shown to produce meaningful improvements in sleep outcomes in institutional settings.¹⁷ Beyond their clinical benefits, such interventions are cost-effective and minimally invasive, making them especially suitable for adoption in resource-limited care homes. Incorporating sleep-focused programs into routine geriatric care not only addresses sleep disturbances directly but also has the potential to indirectly enhance emotional well-being, cognitive function, and overall QoL in older adults. Finally, this study underscores the need for a paradigm shift in evaluating and enhancing the quality of life among older adults in social care institutions. Moving beyond traditional health metrics, a more holistic approach should integrate psychological comfort, environmental tranquility, and consistent social connection—factors in which sleep quality often acts as a mediator. Future studies may explore how sleep interventions interact with other domains such as emotional support, social participation, and cognitive functioning to enhance QoL in late life.

Conclusion

This study identified sleep behavior as the only statistically significant determinant of quality of life among elderly individuals residing in a social care center. Despite the majority of participants demonstrating adequate medication adherence, nutritional intake, disease prevention behavior, and physical activity, these factors did not show a significant association with their overall QoL. This suggests that subjective factors, particularly those related to rest and psychological well-being, may hold greater weight in determining the perceived quality of life in late adulthood.

The findings are consistent with international research, including a meta-analysis by Sella et al. (2023), which highlighted sleep quality as a crucial contributor to emotional, psychological, and functional health among older adults. In care institutions, where autonomy and social interaction may already be limited, disrupted or poor-quality sleep can exacerbate feelings of fatigue, anxiety, and dissatisfaction. Therefore, sleep should be considered not only a physiological necessity but also a central component of person-centered care for the elderly.

It is recommended that social care facilities integrate sleep-promoting interventions into their routine services, such as sleep hygiene education, calming night-time environments, and individualized bedtime schedules. Furthermore, future research should explore how improving sleep interacts with other psychosocial dimensions to holistically elevate quality of life. Policymakers and practitioners must recognize that addressing sleep quality could serve as a cost-effective and impactful strategy in enhancing the well-being of aging populations, particularly those in institutionalized settings.