Factors associated with quality of life among older persons in urban and rural settings: a cross-sectional population-based study

Abstract Introduction Quality of life (QoL) is a core aspect of healthy ageing, reflecting the ability of older persons to adapt and maintain well-being in later life. Urban–rural differences pose distinct challenges, with urban areas facing overcrowding and high costs, whereas rural areas lack healthcare and infrastructure, necessitating targeted public health strategies. This study identified factors associated with QoL among older Malaysians, with analyses stratified by urban and rural areas. Methods This cross-sectional study analysed data from the National Health and Morbidity Survey 2018: Elderly Health, involving 3,977 community-dwelling older Malaysians aged 60 years and above. QoL was measured using the Control, Autonomy, Self-Realisation, and Pleasure (CASP-19) scale. Independent variables included sociodemographic characteristics, physical activity, chronic disease, dementia, depression, ADL/IADL limitations, sensory and urinary problems, abuse or neglect, and social support. Descriptive statistics profiled respondents, and stratified complex sample linear regressions identified associated factors. Missing data were handled using multiple imputation, incorporating survey weights. STATA version 16 was used for analysis. Results Urban older persons had a higher mean QoL than rural counterparts (46.1 vs. 45.2). In both areas, depression (urban: β = − 7.13, p < 0.001; rural: β = − 6.17, p < 0.001), hearing disability (urban: β = − 3.83, p < 0.001; rural: β = − 2.29, p < 0.001), ADL limitations (urban: β = − 1.50, p = 0.010; rural: β = − 1.25, p = 0.042), and IADL limitations (urban: β = − 1.24, p < 0.001; rural: β = − 1.68, p < 0.001), and lower levels of social support (urban: β = -1.82, p = 0.002; rural: β = -2.41, p < 0.001) were associated with lower QoL. Urban-specific factors were tertiary education (β = 2.77, p = 0.001) and physical activity (β = 1.37, p = 0.001). Rural-specific factors included higher income (β = 2.43, p < 0.001) and vision disability (β = − 2.63, p < 0.001). Conclusion This study provides insights into factors associated with QoL among older persons, distinguishing shared factors from those specific to urban and rural areas. Depression, hearing disability, functional ability, and social support were associated with QoL. However, the effects of income, education, and physical activity differed across urban and rural areas, underscoring the need for locally tailored interventions. Trial registration number NMRR ID-25-00097-EZT. 19th February 2025.