Abstract / Summary
Abstract Background: Population ageing is accelerating in urban Pakistan, where the family remains the main source of care for older people. Yet family support has rarely been measured as a health determinant in this setting. This study examined the associations between family support, health outcomes and the management of geriatric conditions among older adults in Lahore. Methods: A cross-sectional survey of 325 adults aged 60 years and older was conducted between June and December 2025 in households, community settings, religious gatherings and residential care facilities across the four zones of Lahore. An interviewer-administered questionnaire assessed functional ability and work history, social support and caregiving, health status, and emotional and psychological impact (Cronbach’s α = 0.800). Analyses comprised descriptive statistics, chi-square tests, exploratory factor analysis, structural equation modelling (SEM) and binary logistic regression. Results: Factor analysis yielded 14 dimensions across the four domains (KMO 0.724–0.847; Bartlett’s test p < 0.001; 60.5–61.6% of variance explained). In the SEM, health status was associated with functional ability (B = 1.10, SE = 0.165, p < 0.001) and emotional and psychological state (B = 0.95, SE = 0.156, p < 0.001); its association with social support and caregiving was weaker (B = 0.22, SE = 0.126, p = 0.081). Lack of social support and loneliness was the most frequently reported concern of later life (24.3%). Feeling isolated (OR = 1.97), feeling that others did not wish to talk (OR = 1.55), higher education (OR = 1.74) and part-time or voluntary work (OR = 1.51) were associated with higher odds of naming loneliness as the principal concern, whereas living with family (OR = 0.59), frequent family communication (OR = 0.66) and visual difficulty (OR = 0.58) were associated with lower odds. The model correctly classified 84.6% of cases. Over half (53.5%) had delayed medical care because of cost. Conclusions: Functional independence and emotional wellbeing were the strongest correlates of health in later life, and co-residence and regular communication with family were associated with lower odds of loneliness. Family-centred geriatric policy, together with financial protection for older people’s healthcare, is warranted in urban Pakistan.