I have read with great interest the paper by Wagle et al. dealing with factors affecting health-related quality of life (QOL) among 362 older adults after the earthquake in Nepal. ^{Reference Wagle, Amnatsatsue and Adhikari1} Questionnaires were applied to measure posttraumatic stress disorder (PTSD) and depression, functional ability, and social support. A multiple linear regression analysis was adopted for the analysis, and standardized regression coefficients of functional status, PTSD, chronic disease, social support, injury, and age for predicting QOL were 0.295, -0.225, -0.168, 0.120, -0.104, and -0.116, respectively. I have 2 concerns about the study.

First, Hashmi et al. reported the prevalence of psychological morbidity among survivors of the northern Pakistan earthquake. ^{Reference Hashmi, Petraro and Rizzo2} About half of the survivors had symptoms of PTSD, and more than three-fourths exhibited symptoms of an anxiety disorder at 6 months after the incident. This report presents the significance of health status monitoring for survivors, and a long-term follow-up of survivors might be needed to verify the change of health effects by an earthquake.

Second, Nunnerley et al. conducted a review to evaluate QOL and participation outcomes of individuals with earthquake-related physical injury. ^{Reference Nunnerley, Dunn and McPherson3} Injured earthquake survivors in developing countries experienced diminished participation and reduced QOL, and functional consequences by the injury and the environmental impact from the earthquake should be simultaneously included for the assessment of QOL after an earthquake.

Finally, keeping QOL of older adults after an earthquake should be considered. Recovery of QOL after an earthquake in older adults might be more difficult than that of younger adults, and maintaining the level of QOL, including physical activity, should be supported to avoid deterioration of health status. ^{Reference Moriyama, Urabe and Onoda4}