Introduction

Globally, human life expectancies have greatly improved with much progress happening in developing countries. It is projected that almost 80% of the world’s ageing population will be living in developing world [1]. The proportion of Africa’s older population is expected to increase from 5.1% in 2000 to 10.4% by 2050 [2, 3]. In sub-Saharan Africa, ageing population is taking place amidst challenges such as shortage of health infrastructure and services [4, 5]. This is worsened by the rise in non-communicable diseases such as cancer, cardiovascular diseases and several other later life health difficulties [6, 7]. Basing on the United Nations (UN) definition of older persons as those age 60 years and older [3], this study examines factors associated with physical health among older persons in rural Uganda.

Uganda’s population is largely characterized by young people. Nonetheless, the country’s older population is increasing steadily due to the high rate of survival and reduction in adult mortality [8, 9]. Estimated at 63 years, Uganda’s life expectancy has surpassed sub-Saharan Africa’s average of 60 years [9, 10]. The number of Uganda’s older persons age 60 years and above almost doubled between 1991 and 2002 (from 686,000 to 1.1 million persons)and increased to 1.6 million in 2014 [9]. Older persons constitute 4 percent of the total population [11]. The increase in ageing population is however against the backdrop of deterioration of social and family support systems that sustain the physical health and wellbeing of older persons [12]. For instance, rural-urban migration has drastically affected the care and support rendered to older persons [8]. Moreover, the existing social problems such as unemployment limit families’ capacities to support rural older persons’ healthcare [7, 8, 13].

Physical health dimension is one of the key indicators of people’s quality of life [14]. It includes activities of daily living, mobility status, fatigue; body pain, and sleep [15]. Poor physical health is the source of fear and discomfort among OPs thereby curtailing their productivity and reducing them to beggars and dependents [12]. Although research underscores the importance of physical health for OPs, this area remains understudied in Uganda [2, 11]. Existing literature about ageing population has mainly focused on loneliness [16], vulnerability of older adults [17], chronic poverty among elderly [18], nutritional status and functional ability of the elderly [19] and understanding the vulnerability of older adults [13]. Moreover, some of these studies used data covering a limited geographical scope and collected some years back. It is expected that the factors that influence physical health could have changed over time. Empirical evidence regarding factors influencing physical health among OPs is lacking. This research builds on earlier studies [13, 15, 17, 18] to bridge this knowledge gap. Using a recent empirical data from a wide geographical scope, we examine the factors influencing physical health of older persons in rural Uganda.

Materials and methods

This paper utilized data from a cross sectional study on determinants of quality of life of 912 older men and women age 60 years and above in rural Uganda; representing a response rate (RR) of 95%. RR was calculated using the fourth formula from those recommended by the American association for Public Opinion Research [20]. The data were collected from February to March, 2017. Before data collection, enumerators with minimum qualification of a Bachelor’s degree were identified and recruited from respective study districts. These were trained on various aspects including research ethics, how to conduct interviews, and administering a questionnaire. Each interview took 35–45 minutes on average. During interviews, we made sure that we did not include persons who were sick. Multi-stage stratified cluster sampling approach was used. Uganda was stratified into four major regions namely; central, eastern, northern and western regions. Using simple random sampling, one district was selected from each of the four regions. In each district, three sub-counties were selected using simple random sampling. Four villages were selected using simple random sampling from each of the selected sub-counties, providing a total of 12 villages per district and hence 48 villages in the whole of Uganda. Using a community leader, a list of households with older persons was generated per village. Thereafter, ten households were randomly selected and older persons from 480 households were interviewed using an interviewer-administered questionnaire.

Physical health indicators were adapted from the World Health Organization Quality of Life (WHOQOL-BREF instrument). The WHOQOL-BREF is a World Health organization instrument that measures physical health, psychological health, social relationships, and environment [15, 21].It consists of 26 items, 24 of which are divided into four domains: physical health, mental health, social relationships, and environment. This study adapted with modifications the indicators of physical health dimension of quality of life. The items under this dimension include activities of daily living, mobility status, fatigue; body pain, and sleep [15]. The WHOQOL-BREF was preferred because it is flexible and is used on people from different cultures.

Results and discussion

Descriptive characteristics of the older persons

Table 1 shows that the proportion of older persons reduced with advancement in age. The majority of the respondents (51%) were age 60–69 years. More than half of the respondents (57%) were females. Although five in every ten respondents (51%) were currently married, the level of widowhood was also noticeably high (40%). Regions were proportionately represented with central having the highest proportion (27%). More than a half (54%) had no formal education and 40% had primary education. The largest proportion (38%) of the respondents were affiliated to the Anglican faith, followed by Catholic (37%) and Muslims (13%); 69% were subsistence farmers by occupation. Over two-fifths (41%) were staying in permanent houses; 52% possessed radios; nearly three-quarters (73%) did not have mobile phones; 91% did not have electricity in for lighting in their houses; and 91% owned land for both agriculture and settlement. Majority of the respondents (76%) controlled their household resources and 74% lived with their children and grandchildren. Over half (56%) were not receiving financial support; 41% were getting healthcare support from their children; 48% travelled for 1–2 kilometers to reach the nearest health center; 97% were HIV sero negative; nearly three-quarters (74%) were engaging in physical activity; and 96% were using firewood as the main form of fuel for cooking. Respondents in the categories of physical health namely; good, fair and poor were equally represented (33%) as seen in Table 1.

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Table 1. Percent distribution of respondents by selected socio-demographic characteristics.

https://doi.org/10.1371/journal.pone.0209262.t001

Association between physical health and demographic and socio-economic factors

Table 2 presents chi-square test results for the association between physical health and selected demographic, socio-economic and social support factors. Religion, type of residential house, financial support, distance to the nearest health facility, HIV sero status and type of fuel for cooking were not significantly associated with physical health.

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Table 2. Percentages of older persons by selected factors affecting their physical health.

https://doi.org/10.1371/journal.pone.0209262.t002

The results show that the prevalence of self-reported poor physical health among older persons was highest among the oldest old age 80+ (59%; p < 0.001), women (37%; p<0.001), those living in central region (36%; p<0.001), those with no formal education (40%; p<0.001), widowed (40%; p<0.001), no occupation (56%; p<0.001), those with no radio set ownership (42%; p<0.001), no mobile phone (36%; p<0.001), no electricity for lighting in their houses (34%; p<0.001), no land ownership (47%; p = 0.004). Furthermore, self-reported poor physical health was highest among older persons whose children controlled their household assets (75%; p<0.001), those who were living alone (36%; p = 0.026), those whose healthcare was derived from their children (44%; p<0.001) and not doing physical activity (57%; p<0.001).

Predictors of physical health

Results of the ordered logistic regression model of factors influencing physical health of older persons are presented in Table 3. The results show that adjusting for other variables, the odds of good versus fair and poor physical health reduced with advancement in age. Compared to ages 60–69, the likelihood of having poor physical health was higher among older persons age 70–79 years (OR = 0.688; p = 0.026) and those age 80 years and older (OR = 0.349; p<0.001). The findings also show that male older persons had increased odds (OR = 11.549; p = 0.022) of having good physical health compared to their female counterparts. Living in eastern region was associated with good physical health (OR = 1.900; p = 0.001) compared to living in the central region. The Results further indicate that older persons who possessed a radio set were nearly two times more likely to have good physical health (OR = 1.928; p<0.001) compared to those who did not. Similarly, compared to the older persons whose household assets were controlled by their children, those who controlled their household assets were more likely to have good physical health (OR = 2.292; p = 0.008). Table 3 also shows that older persons whose healthcare support was derived from their spouses were more likely to have poor physical health (0.468; p = 0.001) compared to those who obtained healthcare support from their children. Older persons that engaged in physical activity were two times (OR = 2.375; p = <0.001) more likely to have good physical health than those who were not.

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Table 3. Results of ordered logistic regression of the predictors of physical health of older persons.

https://doi.org/10.1371/journal.pone.0209262.t003

Discussion

Our findings show that poor physical health was associated with advanced age especially among older persons age 80 years and older. This finding aligns with findings of studies done in Tanzania [26], Brazil [27], England [28], South Africa [29], Sweden [30] and other countries [31–35] which reveal that as people advance in age, they become frail and begin to experience frequent falls, functional complications and lead a dependency life in activities of daily living such as bathing, toileting, eating and walking.

This study found that male older persons were more likely to have good physical health compared to their female counterparts. Whereas our finding indicates that older male persons are more likely to be physically healthy than women, literature concerning mortality rates of older persons in Uganda is generally unavailable. However, available literature from Uganda National Population and Housing Census of 2014 indicates that the life expectancy for women in Uganda is higher (64.2 years) compared to 62.2 for men [9]. This contradicts our finding which seems to suggest that physical health may not be correlated with life expectancy. However, in conformity with this finding, previous research has shown that older women experience functional disabilities than men [27, 29]. This finding could also be attributed to gender imbalances in access to and control over socio-economic and political resources where men are more advantaged than women [31, 36, 37].

Regarding region, our findings indicate that older persons living in eastern region were more likely to have good physical health compared to those in central region. Regional disparities existing in OPs’ physical health could be resulting from cultural differences and life styles especially in diet and work status as well as disparities in the availability and accessibility to health services and healthcare support. This finding is in consonance with other studies [38–41] which show that the environment or context within which OPs live affects their health.

The odds of good physical health increased among older persons who owned a radio set. It could be argued that radios perhaps facilitate in dissemination of health information to the older persons since some of the programmes are educative in health matters. In addition, they address loneliness through entertainment. This finding aligns with previous studies which found that radio was one of the reliable sources of information in health related issues of older persons [42].

OPs whose assets were controlled by themselves or their spouses were more likely to have good physical health compared to their counterparts whose assets were controlled by their children. This could partly be because having control over assets leads to quicker decision making on matters relating to better health for the older person. This result is in agreement with previous studies [31, 43–46] which show that older persons who possess assets are more likely to generate incomes that facilitate access to healthcare and other social services that enhance their physical health [31, 43–46]. Similarly, older persons whose health care was supported by their children had poor physical health. Co-residence is currently rare making it difficult for children to provide quality care to their parents [47, 48]. Previous studies [8, 13, 18, 48–50] show that low healthcare support to the older persons by children results from family disruptions such as increasing rate of nuclear families education and rural-urban migration where children choose to live far away from their ageing parents with limited support.

The findings indicate that older persons who engaged in physical activity were more likely to have good physical health. In agreement with the previous studies [51–55], physical activity strengthens health status of older persons through decreased falls and morbidity. The major limitation of this study is that analysis relied on self-reported responses and not from anthropometric measures. Inadequate funding could not enable us to do objective analysis. Thus, the responses could have been under reported, over reported or misreported. Another limitation is that this study did not use complex survey analysis that would adjust for cluster sampling.

Conclusions

The odds of poor physical health were higher among; OPs of advanced age, females, those who lived in central region of the country, those who did not own a radio, those whose children controlled household assets and supported healthcare. Similarly, the OPs who did not engage in physical activity were more likely to have poor physical health. These findings have various policy implications, including creating an enabling environment and building capacities of older persons to remain in control of their household assets. Interventions focusing on deepening sensitization of older persons about importance of physical exercises could be a viable strategy for improving physical health of older persons.

Supporting information

Acknowledgments

This research was supported by the Consortium for Advanced Research Training in Africa (CARTA). CARTA (http://cartafrica.org/) is jointly led by the African Population and Health Research Center and the University of the Witwatersrand and funded by the Carnegie Corporation of New York (Grant No--B 8606.R02), Sida (Grant No:54100029), the DELTAS Africa Initiative (Grant No:107768/Z/15/Z). The DELTAS Africa Initiative is an independent funding scheme of the African Academy of Sciences (AAS)’s Alliance for Accelerating Excellence in Science in Africa (AESA) and supported by the New Partnership for Africa’s Development Planning and Coordinating Agency (NEPAD Agency) with funding from the Wellcome Trust (UK) (Grant No: 107768/Z/15/Z) and the UK government. The authors also thank the College of Business and Management Sciences, Makerere University (http://bams.mak.ac.ug/) for financial support. We also appreciate the Centre for Population and Applied Statistics (CPAS), Makerere University for providing space while writing this paper. The funders had no role in study design, data collection and analysis, decision to publish or preparation of this manuscript.