The average age of the older adults is rising rapidly (1), and this is a big global challenge. Most developed and developing regions of the world are facing much rapid increase in older individuals of 65 years and above. By 2040, the world is projected to have 1.3 billion older adults who will account for 14% of the global population (2). This extraordinary upsurge in aging has brought numerous changes in the world, for example, exploration of risk and protective factors of their well-being, need for professionals who are specialized in geriatric care, and need for effective legislation focused on addressing the needs of this rapidly increasing aging population.

Like many social behaviors, aging is a culturally knitted phenomenon. Individuals living in different parts of the world pursue their own internalized cultural values with age (3). Personal characteristics, social relationships and interactions, cognition, and health status of older adults may not be manifested in exactly the same way across cultures. Cultural differences in health-related behaviors, psychological beliefs, and social participation have been proposed as possible mechanisms explaining health patterns of aging population (e.g., 4, 5). Empirical studies have been undertaken to compare health across nations/countries to assess how differences in macro-social and economic contexts shape individual health and well-being (e.g., 6, 7).

Like other parts of the world, a rapid increase in the aging population is a major challenge for both Pakistan and Canada. According to 2017 census, the individuals 65 years and above account for 4.48% of the total population in Pakistan (8). The number of individuals above 60 years is going to increase to 23.76 million in 2030 in Pakistan (9). Similarly, the older Canadians accounted for 12% in 2010 and will account for 23% in 2030 (10). Pakistan and Canada are two countries, diverse in terms of culture, and socioeconomic growth and development. Public policies and healthcare system in Pakistan are not conducive to the well-being of older adults. Older adults in general do not receive any financial support from the government. Legislation for elderly population is in its embryonic stage. The first major Senior Citizens Bill (2019) focuses on safeguarding fundamental rights of citizens (11). On the other hand, the government of Canada is presently focusing on the provision of a wide range of benefits to the older adults (12). Older adults are classified as a high-risk population in terms of health and quality of life (QoL). A core challenge due to this rapidly increasing high-risk aging population across Pakistan and Canada is to consider how to enhance their QoL. To achieve this goal, the United Nations has developed a research agenda for the twenty-first century to gain insights about the determinants of good QoL or healthy aging (13). The agenda focuses on the identification of interventions, curative measures, and rehabilitative models that can be used for gaining a better understanding about the processes and dynamics of aging in addition to the determinant factors and their roles (14). In terms of healthy aging, the constituents of a good life and correlates of a better QoL have remained crucial. Findings indicate that older adults in the developed regions (e.g., Canada) remain in good health for longer periods of time. A more detailed insight can be gained only through the assessment of cross-cultural differences in quality of life in terms of its biopsychosocial correlates. In the present study, the World Health Organization’s (WHO) definition of quality of life as an individual’s perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards, and concerns has been followed.

Initially, zero-order correlations were calculated among demographic variables, biopsychosocial factors, and QoL of older adults, separately on Pakistani and Canadian samples (see Annexure A). The results showed that all biopsychosocial variables and most of demographic variables had significant inter-correlations, which supported to run further statistical analyses.

Independent variables/predictors given in Tables 1 and 2 are health and lifestyle, self-efficacy, self-esteem, and social support, and dependent/outcome variables are quality of life total, psychological, and environmental features. Demographic variables are used as controlled variables in the analyses.

Table 1 shows that models 1 and 2 are significant, i.e., F₁ (7, 521) = 11.52, p <.001 and F₂ (11, 517) = 31.97, p <.001. For model 1, ΔR ² is 13%; for model 2, ΔR ² is 27%. Findings indicate that self-esteem (β = .30, p<.01), chronic illness (β = .22, p <.01), social support (β = .17, p <.01), health and lifestyle (β = .16, p <.01), and self-efficacy (β = .10, p <.05) significantly predicted 27% of variance in QoL of older adults in Pakistan, after controlling the impact of demographic variables.

Table 2 shows that models 1 and 2 are significant, i.e., F₁ (7, 432) = 4.94, p<.001 and F₁ (11, 428) = 83.65, p <.001. For model 1, ΔR ² was 7%; for model 2, it is 61%. Findings suggest that social support (β = .44, p<.01), self-efficacy (β = .24, p<.01), health and lifestyle (β = .16, p<.01), self-esteem (β = .15, p <.01), and chronic illness (β = .15, p <.01) significantly predict 61% variance in QoL of older adults in Canada by controlling the demographics.

In order to compare the group differences, independent sample t-test of was run.

Table 3 indicates that there are significant mean differences between older adults in Pakistan and Canada on QoL (t = −4.44, p ≤.001). Canadians scored higher on quality of life as compared to Pakistani older adults. Significant mean differences also appear between the groups with respect to health and lifestyle (t = −6.72, p ≤.000), self-efficacy (t = −2.11, p ≤.035), self-esteem (t = 2.46, p ≤.014), and social support (t = 4.86, p ≤.001). It is found that Canadian older adults have higher score on health and lifestyle and self-efficacy, whereas Pakistani older adults have higher scores on self-esteem and perceived social support. The Cohen’s d indicates low to moderate effect size of independent variable on dependent variable (ranges from.13 to.42). The values of Cohen’s d reflect that health and lifestyle, social support, and quality of life have more weight in one country than in another.

The study was carried out to assess predictive strength of biopsychosocial factors to predict quality of life of older adults in Pakistan and Canada. Hierarchical regression analyses were run to test the hypotheses based on the objectives of the study. Demographic variables were treated as controlled variables in the regression analyses, as zero-order correlation in the current study and the literature direct that demographic variables have a significant relationship with QoL of older adults (42). The results showed that chronic illness and health and lifestyle (biological factors) significantly predicted quality of life of the participants in both countries (see Tables 1 , 2 ). The findings of the present study are in line with the earlier studies, supporting the claim that poor lifestyle and presence of chronic diseases have a negative impact on QoL (e.g., 43). Literature indicates that experiencing biological health problems has a causal influence on QoL, self-esteem, and self-efficacy whereas satisfaction with biological aspects of health is one of the most significant predictors of QoL and emotional functioning among the older adults (44). Active lifestyle and taking part in social activities maximize physical abilities of older adults; they are able to structure their day-to-day routine, and their engagements with these activities help them in the replacement of their losses and is helpful to boost their QoL and well-being (45). Unhealthy lifestyle increases the probability of chronic illnesses in old age, which consequently impairs their perceptions about QoL. There is empirical evidence that older adults are primarily concerned with the physical aspects of their health, that is why healthy lifestyle and satisfaction with health have significant impact on their quality of life (44). The findings of the study have suggested that optimal level of physical health and consumption of healthy food, mobility, and regular exercise ensure better health and QoL of older individuals.

Self-efficacy and self-esteem (psychological factors) also appeared as significant predictors of QoL of older adults in Pakistan and Canada (see Tables 1 , 2 ). Results are in line with a number of studies that highlighted the importance of self-efficacy in relation to QoL of older adults (46). Self-efficacy embarks the belief and confidence in older adults that they can perform their day-to-day tasks without relying on others because it allows them to explore and exert control over their immediate environment (43), accomplish their life goals (47), and the excellence with which they are able to perform tasks related to their daily living (45). Self-efficacy has a great deal of relevance to adherence with different forms of healthcare guidelines (48).

Self-esteem as a significant positive predictor of QoL in older adults in the current study is consistent with the findings of previous studies (49) that support the auxiliary role self-esteem in the mental and physical health of older adults and the level of independence that they exhibit on a daily basis, social relations, and environmental domain of QoL. Promoting self-esteem of the older adults has positive impact on their motivation, encourage them to face the adversities of old age, and instill in them confidence and sense of control over their life (46). Self-esteem and self-efficacy encourage individuals who have even restricted residual physical abilities to participate in social activities (50) that will give a higher meaning and purpose to their life, which in turn can positively contribute towards their QoL.

Social support as a positive predictor of QoL of older adults in both countries is in accordance with the studies that have concluded that quality of life among the older adults is determined by the availability and non-availability of social support services to them, marked by personal relations and the kind of support available to them from friends and family (51). Social support not only serves as a source of emotional and physical support but is also a basis of promoting active engagement with the society and environment.

Although predictors of QoL in both countries are similar, the older adults in Canada scored significantly higher on health and lifestyle, self-efficacy, and overall quality of life, and the older adults in Pakistan scored higher on self-esteem and social support (see Table 3 ). Different contextual factors might be attributed to the higher scores of Canadian older adults on these variables. Canadian older adults are more aware of health-related behaviors, more knowledgeable about their health-related quality of life, have better access to healthcare services, income security, social networking, and excellent transportation (34, 52, 53). The Canadian economic and social systems provide more rights to the older adults in comparison to the Pakistani systems of governance. It is pertinent to note that the higher score of Canadian older adults on self-efficacy and quality of life in comparison to older adults in Pakistan validates the previous studies that reported higher scores of older adults in Canada on these variables in comparison to a number of other countries, for example, China, Japan, Brazil, USA, France, Germany, and India (54). We may conclude that better access to legal support and healthcare facilities and social support interventions inculcates high self-efficacy in Canadian older adults and supplements their healthy psychosocial and physical functioning.

Higher scores of older adults in Pakistan on self-esteem and social support could be attributed to close knitted social structure of Pakistan. Being a collectivistic society, the availability of social support from children, friends, and family for the older adults boosts their self-esteem (55). In Pakistan, children are expected to take care of their older parents and to fulfill their physical, psychological, social, and emotional needs. It is also marked for being a core cultural and religious obligation, which might account for the explanation of the higher scores of the Pakistani older adults on these factors. Pakistan is marked for being a collectivist society (56), in comparison to Canada, which is a highly individualistic society (57). This can possibly contribute towards the Canadian older adults, relying on the government and themselves for their socioeconomic and healthcare needs in comparison to Pakistani older adults, who mainly rely for support on their children and families. Results are consistent with (11, 58) that older adults in Pakistani generally score high on social support and self-esteem and family plays positive role in providing social support that has positive impact on the well-being of Pakistani older adults. Results are also in line with (59) that in collectivistic cultures, older adults have greater availability of social support to perform activities of daily living, and they have higher self-esteem.

On the basis of the results, we conclude that a significant amount of better QoL of older adults can be achieved through enhancing the biopsychosocial correlates of their QoL, both in Pakistan and Canada. Relatively higher scores of older adults in Pakistan on social support and self-esteem support the notion that the provision of social support promotes self-esteem of older adults that ensures their QoL. In countries like Pakistan, which is undergoing rapid social changes and where older adults do not have considerable awareness of their health and related factors and have limited access to government-assisted health facilities, social factors reflecting engagement of significant others, especially offspring and grandchildren, appeared to be more important in the better QoL of older adults. On the other hand, comparatively higher scores of the older adults in Canada on healthy lifestyle and behavior, self-efficacy, and QoL make it evident that older adults in Canada are more health conscious and have high-quality healthcare system. It seems that old-people-friendly legislation in Canada has inculcated self-confidence in them for the self-management of their health-related challenges, and this all has a considerable influence on their better QoL.

The original contributions presented in the study are included in the article/ Supplementary Material . Further inquiries can be directed to the corresponding author.

The studies involving humans were approved by Advanced Studies and Research Board of Government College University Lahore. The studies were conducted in accordance with the local legislation and institutional requirements. The participants provided their written informed consent to participate in this study.

SSB: Conceptualization, Data curation, Formal analysis, Methodology, Software, Supervision, Visualization, Writing – original draft, Writing – review & editing. ST: Conceptualization, Data curation, Investigation, Resources, Writing – review & editing. SC: Data curation, Validation, Visualization, Writing – review & editing. SAB: Methodology, Validation, Visualization, Writing – review & editing.