Assessing the Quality of Life of the Ilocano Older Adults During COVID-19 Pandemic: A Cross-Sectional Study on the Association Between Health-Promoting Behaviors and Quality of Life, and the Moderating Effect of Socio-Demographic Profile.

The COVID-19 pandemic has affected the lives of people across ages, with older adults identified as a vulnerable group. This vulnerability has been magnified by circumstantial indications of ageism emerging at different levels. Crucial at this point is the practice of healthy lifestyle behaviors to maintain functional independence and to improve the quality of life of these susceptible individuals. This study generally aims to comprehensively evaluate the quality of life among Ilocano older adults amidst the COVID-19 pandemic, exploring the relationship between their health-promoting behaviors and quality of life, while considering the moderating influence of socio-demographic factors. A total of 383 community-dwelling older adults from Ilocos Norte aged 60-93 y/o (M 69.68, SD = 7.13) without cognitive impairment, and who can verbally communicate were recruited through stratified random sampling from February to March 2022. Data measures used were the Ilocano translated socio-demographic questionnaire, the Health-Promoting Lifestyle II(HPLP) for HPB, and the World Health Organization Quality of Life -BREF for QOL. The translation process followed the WHO protocol. Reliability and validity testing were done and established. A Mini-Cog test was administered to validate subject inclusion. Data were obtained face-to-face with full observance of health and safety protocol. The Statistical Package for Social Science (SPSS) v.28.0 was used for the descriptive and inferential analysis of study data. Diagnostic testing like outlier screening and distribution checking were conducted prior to data analysis. Tests of normality were conducted prior to the regression analysis. Ilocano older adults (IOA) generally have a high level of HPBs (M = 2.91, SD 0.49) and average perception of QOL (M = 3.37, SD = 0.46) regardless of their demographic profile. However, the physical activity subscale was reported to be low. An analysis of variance (ANOVA) with the Scheffe post hoc test revealed statistically significant differences in the HPB scores of the IOA according to age, civil status, and educational attainment and a significant difference in the perceived QOL of the IOA when classified according to their health status. The Pearson R correlation test revealed a positive (r = .467, p < .01 level of significance) and a moderate magnitude of correlation (.4 < $\left(r\right)<.69)$ between HPBs and QOL. Multiple linear regression tests with a stepwise method revealed physical activity ( $\beta$ = .205, p = .001), nutrition ( $\beta$ = -.242, p = .001), and spiritual growth ( $\beta$ = .205, p = .008) influence the quality of life of Ilocano older adults. They explained 25% of the variance of QOL while other subscales of HPB explained 26% of it (adjusted R²⁼.251, R² change = .263), significant at p < 0.05. Moderation analysis showed age and health status to have an effect on the relationship between HPB and QOL with a p-value of .000 and .001 respectively. This study showed that HPBs are positively associated with the QOL of IOA. Physical activity, nutrition, and spiritual growth affect the QOL perception while age and health status were found to influence the association. The practice of HPB must be encouraged with a focus on increased physical activity engagement, proper nutrition, and religious practices that foster spiritual growth for this identified vulnerable group. The findings of this study have offered a lucid description of the current HPB practice and QOL perceptions of the IOA and have posed the fundamental basis for possibly proposing health policy reforms and implementing health-promoting interventions that will lead to the lifelong well-being of the IOA during the pandemic and are sustained after the health crisis.