A Causal Model of Health-related Quality of Life Among Pakistani Older Persons with Multimorbidity (HRQL-OPM)

•Geriatric multimorbidity is a globally health concern that impact all dimensions of HRQOL.•Wilson and Cleary's (1995) model of HRQOL provide a base of study variables.•Causal model identified factors which are directly or indirectly related to HRQOL.•SEM highlighted two supportive factors directly related to HRQOL are ADLs and social support while symptom burden, social support and depressive symptoms had indirect associations with HRQOL. Poor health-related quality of life (HRQOL) is common among older persons (OP) with multimorbidity. A model is proposed to examine how different factors influence HRQL-OPM. Participants included 410 hospitalized OP ≥ 60 years with multimorbidity. Structural equation modeling assessed hypothesized relationships between factors and HRQOL. Activities of daily living (ADLs) and social support were directly related to HRQOL, while symptom burden, social support and depressive symptoms had indirect associations with HRQOL via ADLs as a mediator. Model fit was excellent (CMIN/DF = 4.23; TLI = 0.93; CFI = 0.96; RMSEA = 0.08). Achieving optimum HRQL-OPM requires alleviating depressive symptoms and symptom burden while enhancing social support and improving ADLs. Ultimately, ADLs and social support determines an individual's level of HRQOL. Findings suggest the need to understand what kind of ADLs and ways of social support are required by those coping with multimorbidity.