Syeda Iffat Nasir[i]


DOI: 10.36283/pjr.zu.12.1/016


Background and Objective: Aging is influenced by culture, individual experiences, and socio-demographic characteristics along with societal expectations. Cognitive functioning and activity level in geriatric population may alter their participation in daily life activities thus this study aims to explore the required physical and social activities for cognitive alertness among Pakistani Geriatric population.

Methodology: An observation based study of 169 aging individuals who performed on MoCA for cognitive functioning and interviewed on IPAQ for duration of physical activity in everyday life.

Results: It is an observational study, conducted among the geriatric population of different areas of Pakistan. A total number of 169 individuals participated out of which 59 % were males and 40 % were females with a majority of the population 74% falling between 65-75 years of age. It was found that 59% of the male and only 19% of the female had 22 score on MoCA for cognitive functioning and these individuals were practicing physical activities such as brisk walk for 3 days a week for more than 40 minutes and are involve at least once a week in social activities.

Conclusion: The research finding concluded that physical activities and social gathering both has impact on cognitive function of geriatric population to participate actively in daily activities.


Aging is an ongoing process that occurs throughout the lifespan. The age group of 65+ years may usually be denoted as old age as agreed by the United Nations.1As the rest of the world is experiencing an increase in life span, likewise Pakistan is experiencing an upward thrust in its aged population and is ranked as 6th maximum populous country in the world17,18.

Aging successfully is multifaceted and multidimensional principle, encompassing the avoidance of disability and disease, the preservation of high cognitive and physical function, and continuous engagement in societal and productive activities19. Moreover, it is a socially constructed phenomenon that is influenced by cultural and societal expectations, individual experiences as well as socio-demographic characteristics. The term “Successful Aging” is a substantial concept, to define as the standards of aging. Overall understood from a holistic point of view that may refer to the capacity to maintain good physical health, while also referring to the social adaptation and psychological processes in later life20. Lifestyle is a defining characteristic of social existence and a key idea in social gerontology. It is regarded as each the reason and effect and is used as an assembled, to explicate preferences, as modes of living, and as a trademark of social standing20.

Healthy aging means a healthy lifestyle. In Pakistan, most of our people follow a collective society standard where grandparents live with their children and grandchildren. In families where cultural norms still prevail, it is considered as the chance to care for older persons a privilege. But at times, taking care leads to the dependency over the family members for even minor chores and for a person living independent life throughout; this might affect the well-being and life-satisfaction. It is even important for the elderly population to feel a productive member of a society to avoid all the mental and health related problems in this age of life. The role of elderly often includes dissolving family matter and to solve issues among them with their wisdom and experience. They often play a role a caretaker for their grandchildren so that the mother of a child gets encouraged and open a way for them to enter in the market and do have jobs. Elderly also volunteers in activities relating to their worship places17.

The aging research shows that life style plays an important part, it depends on it as it is a gerontological field. It promotes healthy and successful life style and also the opposite, it is often determined as a critical concept as it directs towards gerontology’s neglect to transform aging experiences and determinants of health with relation to society and environment. Being social is also important for geriatric age group. It can be in form of joining old age citizen club to participate in activities or to visit park and form a friendship. For elderly people, friendship plays a very important role as it provides psychological calmness and wellbeing. The support they get from family member as well as from society and friends results in good physical condition and also helps in cognitive development. The absence may result in isolation, loneliness and irritation that leads to decline in health. Societal isolation leads to low psychological maintenance and poor health growth22.

Cognition refers to a scale of mental processes correlate to the acquisition, storage, control, and recover of information. It promotes many daily life chores in health or disease throughout the lifespan2. Aging successfully is multifaceted and multidimensional principle, encompassing the avoidance of disability and disease, the preservation of high cognitive and physical function, and continuous engagement in societal and productive activities22.

In 1998, World Health Organization made a report which estimated that 6% of our US population was over 60, with a likelihood of magnifying twice by 20255. As of 2019, nearly 15 million people in Pakistan are aged over 60 which is seven percent of the country’s total population.6. One of the studies published in the year 2021 reports that individuals of age 65 years and above is 4.4% for Pakistan. Over the last 50 years, in Pakistan the population aged 65 years and above grew substantially from 3.8 to 4.4 % rising at an increasing annual rate that reached a maximum of 1.16% in 2021. Therefore, the shared statistics describes that the geriatric population of Pakistan is increasing but with activity limitation and participation restriction due to inactivelifestyle7.

Population getting older brings about profound consequences as social, health and economic problems. GAWI that stands for Global Age Watch Index analyzes the records across the world to estimate and monitor important components of the socio-economic wellbeing of geriatric population globally. GAWI considers health status, employment, income security, education, and enabling environments. Pakistan’s rank became ninety- two out of ninety-six in 2015 and eighty-one in the domain of enabling societies which is quite low. It clearly suggests that Pakistan needs to overcome this worsening state to cope with prevailing populace structure17,18.

Hamer and Chida studied meta-analysis on risk of neurodegenerative disease plus physical activity that involved 16 prospective studies of 163,797 participants without dementia. Among those members who were physically active, there was a 28% decrease in risk of dementia and a 45% decrease in Alzheimer’s disease11,12. Another meta- analysis of 15 prospective researches shows that 38% of individuals reduced the risk of cognitive decline those who are physically active   (mostly older adults). The evidence from cross-sectional and prospective research shows that physically active lifestyle decrease the risk of cognitive impairment in future life13.

With ageing, there is reduced cognitive functions and low quality of life2,3. As suggested by several studies, this decline in quality of life and cognitive activities can be related to the age-related changes that include biological, physical and lack of cognitive activities. 4World health organization (WHO) along with several studies shows positive impact on cognitive function by physical activities.8-10Exercises, mainly aerobics provide maintenance for cognitive function that ultimately results in good health and healthy aging for adults11,12. Moreover, the studies for the relation of physical activity and self- regulation function shows that self-regulation acts majorly in determining the health maintenance of aging adults aging adults and its effects on physical activity, in preference to the influence of the physical activity on self-regulation. Self-regulation is a factor that effects the mental and physical health of older adults and physical activity behavior14. This study aims to explore the required physical and social activities for Pakistani elderly population to stay cognitively alert for better quality of life.


Study setting

Data collected from different cities of Pakistan.

Target population

Geriatric population.

Study design

Study is cross sectional in nature.

Sampling technique

Non probability, convenience sampling technique.

Study period

6-8 months.

Sample size

Open EPI software was used to calculate the sample size. The confidence interval is 95% and 5% the margin of error. Sample size of n=169 was calculated by using formula.

Sample size n = [DEFF*Np (1-p)]/ [(d2/Z21-α/2*(N-1)+p*(1-p)]

Inclusion criteria

Both male and female with age above 65 years.

Exclusion criteria

Individuals above 65 years of age with bedridden conditions

Data Analysis

The SPSS (Statistical Package for Social Sciences) software version 20 to enter and analyze data. Participants’ demographic variables will be presented with standard deviation, frequency and mean, while their responses will be evaluated using frequency and percentage.

Data collection tool

  1. The Montreal Cognitive Assessment Test (MoCA) is a screening test for cognitive impairment and is used to measure cognitive ability. Language, memory, direction, computations, conceptual thinking, executive functions, attention and focus, as well as visual constructive skills are all examined by MoCA. The test takes approximately 10 minutes and is conducted by the examiner. The overall number of points on the questionnaire is 30, and the score ranging above 22 is healthy cognition.
  2. The IPAQ (International Physical Activity Questionnaire) is used in geriatric population (aged 65 years and above) to assess activity levels. The IPAQ-E is a self-reported questionnaire that assesses the duration (hours per day) and frequency (days per week) of several types of physical activity over the previous seven days. Activities are divided into three groups by the IPAQ: high-intensity, moderate-intensity, and walking exercise. Each activity category’s total number of hours and days is analyzed.

Data Collection Procedure

The data collection is based on informed consent. After seeking permission, the questionnaire were filled out based on interview and performance. Following the completion of the sample, the findings were analyzed.

Ethical Considerations

Ethical consideration was taken by the participants through written and verbal consent before starting the data collection. All the information of the participants are kept anonymous under investigator’s supervision.


The demographic details showed that majority of the sample population was between the age range of 65-75 whereas only 23% was above 75 years (Table 1A) and female population is almost 40% of the sample in Table 1B.

Table1A Indicating the age range in the sample

Table 1B Male Vs Female participation

It was evaluated that 34% of the male geriatric population scored in the range of 22- 23 indicative health cognition for occupational performance whereas only 13% of the females fall in the range of healthy cognition at MOCA in Table 2.

Table 2 Gender with respect to MOCA

Both male and female together makes 47% of the sample that scored healthy cognition score on MOCA, when compared to their physical activity at IPAQ it reflected almost 81% of healthy cognition walks maximum 50 minutes a day whereas only 9% who walks above 50 minutes also scored the same score as that of individual who walked 50 minutes in Table 3.

Table 3 Walking Time with respect to MOCA

Another amazing finding was explored that besides the physical activity geriatric population scoring healthy cognition also have social gathering on regular basis minimum once in a month. Table 4 mentioned that 34 % of the health cognitive individuals have minimum once in a week social gathering whereas almost 4% have twice in a month in Table 4.

Table 4 Social Gatherings


The present investigation evaluated the relationship between activity level and cognitive functioning. WHO also emphasizes upon a positive impact on cognitive functioning by physical activities is estimated8,10. The findings support the hypothesis that there is a link between activity level and cognitive functioning, as proposed in this study. The data show link between participation in daily life activities and cognition level in Pakistani geriatric population.

The total percentage of older men i.e. 59.4% and 40.2% of older women participated in the study with 74% of the total population that lies between age ranges of 65 to 75. A total of 164 older adults in the current study were found to spend around 100 minutes on moderate physical activity. Most of the geriatric population in Pakistan is not involved in physical activities and spend most of their time sitting. In this study, time spend while sitting is calculated to be around 600-900 minutes per day for 3.5%, 300-600 minutes per day for 30% and around 65.9% spends around 300 minutes while sitting. Our culture promotes the idea of looking after the geriatric population in every aspect possible that somehow leads to independency in daily life activities.

However, it is credible to say that being cognitively active leads towards physically active35. The decline in cognitive functioning can also be explained by less physical activity as the person grows or as year’s passes, by evaluating cognitive functioning. Moreover, some studies resulted in no relationship between physical activity and cognitive stimulation in aged people. Sabia, S. et al., in the study, concludes that growing age leads towards less physical activity and is more reclined towards dementia diagnosis and sometimes this decline in physical activity can also be an early symptom of dementia31.

Another important component of this study is that it includes co-founding factors such social gatherings which is very significant in Asian culture and is one of the main occupational performance component. These factors influence the cognitive functioning in older adults. The study conducted by Jennings et al., founds that in comparison to non-caregiving grandparents; caregiving grandparents have better cognitive function, and this association does not differ by gender32.

Moreover, geriatric population have fewer close contacts and participate less frequently in social gatherings than the adult population in general. Furthermore, they also experience increased feelings of loneliness. One of the study conducted by Toepoel V. however, shows that lowbrow activities might increase satisfaction with life and social integration. Therefore, it may be appropriate to stimulate older people to participate often in lowbrow activities like music events, visit to parks and cinema33.

However, 34% of total participants with health cognitive score involves in social gatherings once a week and 30% get involved twice a week; which shows that get-together and socializing is also an important factor for the maintenance of healthy cognition. Some studies have reported that cognitive functioning declines with age and also the older population is at a risk of cognition related issues. Physical activity has been indicated as a way to push health within the elderly, similarly on encourage the maintenance of functional capacity, and acts within the prevention and control of varied diseases. Physical activity is that the foremost effective treatment for aging. Given the well-established benefits of physical activity for health and well-being across the life course. Here could be a transparent trend evident publically health across both the developed and increasing developing world that exercise and physical activity interventions are adopted as methods of improving the physical health and well-being of the population. During this context, physical activity is broadly needed as bodily movement that lands up in energy conservation for the performance of routine tasks the first aim of this study was to seem at the effect of physical activity on cognitive functioning among older adults in our research because of large sample size most of all the geriatric population is representing moderate cognitive and low physical activity level. Positive physical effects of accelerating physical activity there’s a growing body of evidence indicating cognitive elderly people. Therefore, our research concluded the ratio of moderate cognitive impairment in Pakistani males is higher than females. This shows the positively weak correlation between activity level and cognition so it is estimated that high sample size and cognitive functional measurements are required in future.


These findings in this study may serve as recommendation to the geriatric population for healthy cognition status. Aging can be active and occupational performance may be maintained with minimum 50 minute regular walk and once in a week socialization. Whether living in shelter houses or with family physical activities will keep their participation intact not only for their own living but also as healthy member of family who contribute best in his roles and responsibility. Pakistan government has introduce many policies to protect geriatric population rights , it must also focus on provision of such facilities in the environment such as park, senior citizen clubs at union council levels so the aging population should  not be burden on the society and can live fully.


  1. World Health Organization. Retrieved2016-04-04.
  2. Hedden and J. D. E. Gabrieli, “Insights into the ageing mind: a view from cognitive neuroscience,” Nature Reviews. Neuroscience, vol. 5, no. 2, pp. 87– 96, 2004.
  3. C. V. Miranda, S. M. Soares, and P. A. B. Silva, “Qualidade de vida e fatoresassociadosemidosos de um Centro de Referência àPessoa Idosa,” Ciência&SaúdeColetiva,vol. 21, no. 11, pp. 3533–3544, 2016.
  4. Puciato, M. Rozpara, and Z. Borysiuk, “Physical activity as adeterminant of quality of life in working-age people in Wrocław, Poland,” International Journal of Environmental Research and Public Health, vol. 15, no. 4, p. 623, 2018.
  5. International Data base IDB. International Programs centre,Population division, US Bureau of Census2004.
  6. R Sabzwari Department of family medicine, the Aga khan University Hospital, Karachi, Pakistan. G. Azhar Reynolds Institute on Aging, University of Arkansas for Medical Sciences, 4301 West Markham Street, Little Rock, AR 72205,USA
  7. Pakistan Population aged 65 years and above, 1960-2020 -knoema.com
  8. Mandolesi, A. Polverino, S. Montuori et al., “Effects of physicalexercise on cognitive functioning and wellbeing: biological and psychological benefits,” Frontiers in Psychology, vol. 9, p. 509, 2018.
  9. Phillips, “Lifestyle modulators of neuroplasticity: how physical activity, mental engagement, and diet promote cognitive health during aging,” Neural Plasticity, vol. 2017, Article ID 3589271, 2017.
  10. S. Falck, G. J. Landry, J. R. Best, J. C. Davis, B. K. Chiu, and T. Liu- Ambrose, “Cross-sectional relationships of physical activity and sedentary behavior with cognitive function in older adults with probable mildcognitive impairment,” Physical Therapy, vol. 97, no. 10, pp. 975–984,2017.
  11. Phillips, “Lifestyle modulators of neuroplasticity: how physical activity, mental engagement, and diet promote cognitive health during aging,” Neural Plasticity, vol. 2017, Article ID 3589271, 2017.
  12. S. Falck, G. J. Landry, J. R. Best, J. C. Davis, B. K. Chiu, and T. Liu- Ambrose, “Cross-sectional relationships of physical activity and sedentary behavior with cognitive function in older adults with probable mildcognitive impairment,” Physical Therapy, vol. 97, no. 10, pp. 975–984,2017.
  13. Effects of Exercise on Cognitive Performance in Older Adults: ANarrative Review of the Evidence, Possible Biological Mechanisms, and Recommendations
  14. Ingold M, Tulliani N, Chan CC, Liu KP. Cognitive function of olderadults engaging in physical activity. BMC geriatrics. 2020Dec;20(1):1-3.
  15. Ingold M, Tulliani N, Chan CC, Liu KP. Cognitive function of olderadults engaging in physical activity. BMC geriatrics. 2020Dec;20(1):1-3.
  16. Chang Fu 1 , Zhen Li 2 and Zongfu Mao 1, (2018) ‘Association between Social Activities and Cognitive Function among the Elderly in China: A Cross-Sectional Study’, International Journal of Environmental Research and Public Health, 15(231), pp.9-11.
  17. Blog, P. (2021). Ageing in Pakistan: A Curse or Blessing? – PIDEBlog.
  18. Country ageing data | Data | Global Age Watch Index 2015.
  19. Rowe J, Kahn R. Successful aging. National library of medicine(NIH).
  20. Urtamo A, Jyväkorpi SK, Strandberg TE. Definitions of successful ageing: A brief review of a multidimensional concept. Acta Biomed. 2019;90(2): 359- 363.
  21. Hendricks J, Hatch LR. Seventeen – Lifestyle and Aging. Handbook of Aging and the Social Sciences. 2006;301-319.
  22. Blieszner R, Ogletree AM, Adams RG. Friendship in Later Life: A Researcg Agenda. Innovation in Aging. 2019 Mar 30; 3 (1):1-18
  23. A Chaudhry, H Aniol, C Shegos,2020.
  24. Joseph Michael Northey, Nicolas Cherbuin, Kate Louise Pumpa, Disa Jane Smee, Ben Rattray Year: 2017 Container: British Journal of Sports Medicine Volume: 52 Issue: 3 Page:154-160.
  25. Lianne M. J. Sanders, Tibor Hortobágyi, Sacha la Bastide-van Gemert,Eddy.
  26. van der Zee, Marieke J. G. van Heuvelen Year: 2019 Container: PLOS ONE Volume: 14 Issue: 1 Page: e0210036.
  27. Paola Zaninotto, G David Batty, Michael Allerhand, Ian J Deary Year: 2018 Container: Journal of Epidemiology and Community Health Volume: 72 Issue: 8 Page:685-694.
  28. Yoon D, Lee J, Song W. Effects of Resistance Exercise Training on Cognitive Function and Physical Performance in Cognitive Frailty: A Randomized Controlled Trial. The journal of nutrition, health & aging. 2018;22(8):944-951.
  29. Flatt Year: 2012 Container: Frontiers in Genetics Volume: 3
  30. Terry Fulmer, Molly L. Tanenbaum, Persis Commissariat, Elyse Kupperman, Rachel N. Baek, Jeffrey S. Gonzalez, Nicole Brandt, Rachel Flurie, Jennifer Heaney, Christopher Kline, Linda Carroll, Jane Upton, Patrícia Cardoso Buchain, Adriana Dias Barbosa Vizzotto, AlexandraMartini de Oliveira, Tania C. T. Ferraz Alves, Quirino Cordeiro, Lorenzo Cohen, M. Kay Garcia, Amy Jo Marcano-Reik, Siqin Ye, Anthony J. Wheeler, Scott DeBerard, Josh Allen, Akihisa Mitani, Akihisa Mitani, Elizabeth R. Pulgaron,Rex A. Wright, Deborah J. Wiebe Year: 2013 Container: Encyclopedia of Behavioral Medicine Page:22-24.
  31. Relationship between physical activity and cognitive functioning among older Indian adult [Internet]. Nature.com.
  32. Sabia, S. et al. Physical activity, cognitive decline, and risk of dementia: 28- year follow-up of Whitehall II cohort study. BMJ 357, 1–12(2017).
  33. Jennings EA, Farrell MT, Kobayashi LC. Grandchild caregiving and cognitive health among grandparents in rural South Africa. Journal of Aging and Health. 2021Oct;33(9):661-73.
  34. Toepoel V. Cultural participation of older adults: Investigating the contribution of lowbrow and highbrow activities to social integration and satisfaction withlife.
  35. Lautenschlager N, Almeida O. Physical activity and cognition in old age. Current Opinion in Psychiatry. 2006;19(2):190-193.
  36. Bhayana R, Agrawal K, Aggarwal M, Devgon R, Kar R. Sahayak: An Application for Social and Physical Well-Being for the Elderly. InIndiaHCI’20: Proceedings of the 11th Indian Conference on Human-Computer Interaction 2020 Nov 5 (pp. 124-129).


The Ziauddin University is on the list of I4OA (https://i4oa.org/) & I4OC (https://i4oc.org/).
This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0). https://creativecommons.org/licenses/by/4.0/
Conflict of Interest: The author (s) have no conflict.

[i] Ex. Rehabilitation programs analyst in Ministry of health and Ministry of transportation Canada (0000-0003-4592-3012)