The conceptualization and measurement of quality of life in older adults: a review of empirical studies published during 1994-2006

Enhancing the quality of life for physical therapists: insights from a cross-sectional study

Background

Physical Therapy profession is known for its demanding physical requirements. This increases the risk of attrition and work-related accidents and disorders that affect physical therapists' quality of life and work performance. This study aimed to evaluate the effect of physical activity level and other contributing factors on quality of life of physical therapists.

Methods

A cross-sectional study was conducted among practicing physical therapists (n = 258). The International Physical Activity Questionnaires-Short Form was used to measure physical activity levels and the World Health Organization Quality of Life Questionnaire short form was used to measure the quality of life among physical therapists. Data was collected through a self-administered online survey using Microsoft Forms.

Results

The eligible participants were 258 out of 297. The highest percentage of physical therapists had a moderate physical activity level (45.35%) and the median for overall quality of life score was 63.27(52.73-73.59). There was a significant positive correlation between physical activity and age with overall quality of life score (rs = 0.41, p < 0.001; rs = 0.13, p < 0.036) respectively and a significant negative correlation between body mass index and overall quality of life score (rs = -0.13, p < 0.04).

Conclusion

The results obtained revealed that physical therapists mostly have moderate physical activity level and relatively good perceived quality of Life. Furthermore, our study identified significant correlations between physical activity, age, body mass index, and the overall quality of life among practicing physical therapists.

The Impact of Physical Activity Levels and Functional Fitness Status on the Quality of Life Perceived by Older Adults Living in Rural and Urban Areas: The Portuguese Inland Case

Health-related quality of life (HRQoL) is influenced by several factors, such as living place, physical activity (PA), and functional fitness levels. Evidence shows that functional fitness and PA levels are strongly associated with positive HRQoL, especially in the older population. However, the impact of the living place has not been investigated as an influencing variable in this context. Therefore, this study aimed to investigate the relationship between the HRQoL, PA, and functional fitness of older adults living in rural and urban areas of Portugal. A cross-sectional study was performed with community-dwelling adults aged 65 years and over (n = 261) living in the city of Guarda. The participants were assessed for sociodemographic, anthropometric, clinical health, HRQoL, PA levels, and functional fitness status. The results showed that rural residents presented higher scores of HRQoL and functional fitness than older individuals living in urban areas. Regression models showed that functional fitness variables influence the HRQoL overall score and mental and physical subcomponents of HRQoL, regardless of the living place. In contrast, PA levels only influenced the HRQoL score in rural residents. The findings suggest that intervention programs to improve the physical health, quality of life, and well-being of the older population need to consider the country’s different geographical areas.

Evaluation of the psychometric properties of the Swiss French version of the Older People's Quality of Life questionnaire (OPQOL-35-SF)

Background

The proportion of the world population aged over 65 years is increasing in the world population. Quality of life is an important factor in the biopsychosocial management of older patients. The Older People’s Quality of Life-35 (OPQOL-35) questionnaire was developed specifically for assessment of the quality of life of older people. The aim of this study is to evaluate the psychometric properties of a Swiss French version of the OPQOL-35 questionnaire (OPQOL-35-SF).

Methods

Forward–backward procedure was used to translate the original questionnaire from English into Swiss French. A sample of older people then completed the questionnaire. Construct validity of the OPQOL-35-SF was evaluated by comparing the results with those from three other questionnaires [World Health Organisation Quality of Life in older people questionnaire (WHOQOL-OLD), Control, Autonomy, Self-realization, Pleasure in 12 questions (CASP-12), and EuroQol-5-dimensions-5-levels (EQ-5D-5L)] and two visual analogue scales (health and quality of life). The structure of the OPQOL-35-SF questionnaire was assessed using exploratory and confirmatory factor analysis. To evaluate the reliability the OPQOL-35-SF questionnaire was completed a second time after 7–23 days.

Results

A total of 264 older people completed all the questionnaires at the first session, and 262 completed the OPQOL-35-SF again at the second session. Mean age of participants was 76.8 (standard deviation (SD) = 7.1) years. The majority of participants were women (73.9%). The Kaiser–Meyer–Olkin Measure of Sampling Adequacy (KMO) was 0.86 and Bartlett’s test of sphericity was significant (p < 0.001). The result of Exploratory Factor Analysis (EFA) revealed 8 factors with eigenvalues greater than one, which explained 58% of the observed variance. All items had an acceptable loading (< 0.30) in at least one factor. The convergent validity presented low to moderate correlations (rho: 0.384–0.663). Internal consistency was good (Cronbach’s alpha 0.875 for test and 0.902 for retest). Test–retest reliability presented an intra-class correlation coefficient, two-way random effects, absolute agreement, single rater (ICC_2.1) of 0.83 [95% confidence interval (CI) 0.78–0.87].

Conclusions

The Swiss French version of the OPQOL-35 questionnaire shows good psychometric properties, which permit its use in clinical practice or research. A supplementary sample would be necessary for a better distribution of the items in the different factors.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12955-022-01950-w.

Exploring Interrelations Between Person-Centred Care and Quality of Life Following a Transition into Long-Term Residential Care: A Meta-Ethnography

BACKGROUND AND OBJECTIVES

Globally, a culture change in long-term residential care (LTRC) moving towards person-centred care (PCC) has occurred in an attempt to improve resident quality of life (QoL). However, a clear understanding of how different aspects contributing to a PCC approach are interrelated with resident QoL is still lacking. This review explores interrelating aspects between PCC and QoL in LTRC using qualitative synthesis.

RESEARCH DESIGN AND METHODS

Ten relevant primary studies were identified from a search of interdisciplinary research databases providing qualitative information. Studies were critically reviewed for key themes and concepts by the research team. We used a meta-ethnography approach to inductively interpret findings across multiple studies and reinterpreted the information using a constructivist approach.

RESULTS

We identified 5 second order constructs sharing commonalities suggesting interrelations between PCC and QoL: (1) Maintaining dignity, autonomy and independence. (2) Knowing the whole person. (3) Creating a 'homelike' environment. (4) Establishing a caring culture. (5) Integrating families and nurturing internal and external relationships. Synthesis translation led to the following third order constructs: (1) Personalising care within routines (2) Optimising resident environments (3) Giving residents a voice.

DISCUSSION AND IMPLICATIONS

There are many interrelating aspects of PCC and QoL following a permanent transition into LTRC, but successful implementation of PCC, which enhances QoL presents challenges due to organisational routines and constraints. However, by prioritising resident voices to include their needs and preferences in care, QoL can be supported following a transition into LTRC.

One slope does not fit all: longitudinal trajectories of quality of life in older adulthood

PURPOSE

Maintaining or improving quality of life (QoL) in later life has become a major policy objective. Yet we currently know little about how QoL develops at older ages. The few studies that have modelled QoL change across time for older adults have used 'averaged' trajectories. However, this ignores the variations in the way QoL develops between groups of older adults.

METHODS

We took a theoretically informed 'capabilities approach' to measuring QoL. We used four waves of data, covering 6 years, from the New Zealand Health, Work and Retirement Study (NZHWR) (N = 3223) to explore whether distinct QoL trajectories existed. NZHWR is a nationally representative longitudinal study of community-dwelling adults aged 50 + in New Zealand. Growth mixture modelling was applied to identify trajectories over time and multinomial regressions were calculated to test baseline differences in demographic variables (including age, gender, ethnicity, education and economic living standards).

RESULTS

We found five QoL trajectories: (1) high and stable (51.94%); (2) average and declining (22.74%); (3) low and increasing (9.62%); (4) low and declining (10.61%); (5) low and stable (5.09%). Several differences across profiles in baseline demographic factors were identified, with economic living standards differentiating between all profiles.

CONCLUSIONS

The trajectory profiles demonstrate that both maintaining and even improving QoL in later life is possible. This has implications for our capacity to develop nuanced policies for diverse groups of older adults.

Fear of Falling Among Community-Dwelling Older Adults with Heart Disease: Findings from an International Mobility in Aging Study (IMIAS)

Background: Older adults with heart disease (HD) are more likely to report a higher prevalence of falls compared to those without HD. A knowledge gap currently exists regarding the factors associated with fear of falling (FOF) among older adults with HD. Therefore, this study aimed to estimate FOF and identify factors associated with FOF among older adults with HD. Methods: Data came from a secondary analysis of the International Mobility in Aging Study (IMIAS) baseline (2012) data. FOF was measured using the Falls Efficacy Scale-International (FES-I). Stepwise linear regression was used to identify factors associated with FOF. Results: A total of 429 participants identified themselves as having heart disease diagnosed by their physician (mean age 69.5 ± 2.9). Older adults with HD reported on average (25.6) higher FOF than those without HD. For older adults with HD, FES-I increased significantly by 1.3, 1.0, and 0.6 points, when the Short Physical Performance Battery, the Leganes Cognitive Test, and QOL total scores decreased by one point. FES-I also significantly increased by 3.2 when income was insufficient compared to sufficient or very sufficient income. Discussion: FOF is multifactorial, and our findings provide a base for developing future management rehabilitation intervention programs aimed at decreasing FOF among older adults with HD.

Perceived Physical Functioning and Gait Speed as Mediators in the Association Between Fear of Falling and Quality of Life in Old Age

Preserving Quality of Life (QoL) in old age gains in importance, but Fear of Falling (FoF) considerably limits QoL. The aim of our study was to understand how physical mediators may translate FoF to QoL. At Time 1, FoF, subjective leg strength, balance, QoL, and objective gait speed were assessed. QoL was reassessed after 6 months, at Time 2 (n = 125). A sequential mediation analysis examined whether the relationship between FoF and QoL could be mediated by leg strength, balance, and gait speed. FoF was directly associated with QoL (β = -.27; 95% CI [-0.007, -0.001]) as well as indirectly via leg strength, balance, and gait speed (specific sequential indirect effect: β = -.03; 95% CI [-0.06, -0.001]; R² = .40 in QoL; controlled for age, QoL at Time 1). An intervention approach could be to address FoF and foster physical functioning and gait speed to maintain QoL.

A systematic review on the influence of fear of falling on quality of life in older people: is there a role for falls?

Maintaining or improving quality of life (QoL) is a key outcome of clinical interventions in older people. Fear of falling (FoF) is associated with activity restriction as well as with poorer physical and cognitive functions and may be an important contributor to a diminished QoL. The objectives of this systematic review were to determine i) the effect of FoF on QoL in older people, ii) whether the association between these two constructs depends on the use of specific conceptualizations and measurement instruments, and iii) the role of fall events as mediating factor in this relationship. Four electronic databases (PubMed, EMBASE, CINAHL, and Cochrane Library) were searched from their inceptions to February 2018. Thirty mostly cross-sectional studies in nearly 30.000 people (weighted mean age 75.6 years (SD =6.1); 73% women) were included. FoF was associated with QoL in most studies, and this association appeared to be independent of the conceptualization of FoF. Moreover, this relationship was independent of falls people experienced which seemed to have a lower impact. FoF should be considered not only as by-product of falls and targeted interventions in parts different from those to reduce falls are likely required. Studies are needed showing that reducing FoF will lead to increased QoL.

What does quality of life mean to older adults? A thematic synthesis

BACKGROUND

Consideration of older adults' quality of life (QoL) is becoming increasingly important in the evaluation, quality improvement and allocation of health and social care services. While numerous definitions and theories of QoL have been proposed, an overall synthesis of the perspective of older adults themselves is lacking.

METHODS

Qualitative studies were identified in PubMed, Ebsco/Psycinfo and Ebsco/CINAHL, through a search on 28 November 2018. Articles needed to meet all of the following criteria: (i) focus on perceptions of QoL, (ii) older adults living at home as main participants, (iii) use of qualitative methodology, (iv) conducted in a Western country and (v) published in English (vi) not focused on specific patient groups. A thematic synthesis was conducted of the selected studies, using the complete 'findings/results' sections from the papers.

RESULTS

We included 48 qualitative studies representing the views of more than 3,400 older adults living at home in 11 Western countries. The QoL aspects identified in the synthesis were categorized into nine QoL domains: autonomy, role and activity, health perception, relationships, attitude and adaptation, emotional comfort, spirituality, home and neighbourhood, and financial security. The results showed that although different domains can be distinguished, these are also strongly connected.

CONCLUSION

QoL can be expressed in a number of domains and related subthemes that are important for older adults living at home. The findings further support that the concept of QoL should be seen as a dynamic web of intertwined domains.

Quality of life and subjective health status according to handgrip strength in the elderly: a cross-sectional study

OBJECTIVES

The purpose of this cross-sectional study was to examine potential associations between handgrip strength and health-related quality of life, or subjective health status, in the elderly.

METHOD

We performed secondary data analysis on 2377 elderly individuals aged >65 years. Raw data from the Korea National Health and Nutrition Examination Survey VI (2014-2015), were drawn from a representative national sample.

RESULTS

Of those aged ≥65 years or older, 25.4% had low handgrip strength. After adjusting for confounding variables, the odds ratios of elderly individuals with low handgrip strength were 1.30 (95% confidence interval [CI]: 1.00-1.69) for mobility, 2.18 (95% CI: 1.47-3.22) for self-care, 1.70 (95% CI: 1.30-2.23) for usual activities, 1.30 (95% CI: 1.01-1.67) for pain/discomfort, 1.03 (95% CI: 0.74-1.44) for anxiety/depression, 1.44 (95% CI: 1.10-1.87) for the EQ-5D index, and 1.37 (95% CI: 1.08-1.73) for subjective health status.

CONCLUSION

Health-related quality of life and subjective health status differ according to handgrip strength. Therefore, handgrip strength should be addressed to improve quality of life in elderly individuals. Elderly individuals require exercise education and adequate nutritional intake to increase handgrip strength.

Quality of Life in Australian Adults Aged 50 Years and Over: Data Using the Schedule for the Evaluation of Individual Quality of Life (SEIQOL-DW)

OBJECTIVES

This study explored unique and personal domains associated with quality of life (QOL) in 153 mid-aged and older Australian adults over age 50, using an innovative measure of individualized QOL, the Schedule for the Evaluation of Individual Quality of Life (SEIQOL-DW).

METHODS

Demographic measures as well as the SEIQOL-DW were administered. The qualitative responses on this scale were analyzed by Leximancer, a text analysis program that extracts semantic meaning and relational information automatically from text.

RESULTS

For the sample as a whole, the most important QOL domain was found to be Relationships, followed by Family, Health, Activities, Community, Security, Beliefs, Independence and finally Wellbeing. When the sample was broken down into age bands for analysis, the most important domain theme was Family (50-59 year olds), Relationships (60-69 year olds), Relationships (70-79 year olds), and Health (80+ year olds).

CONCLUSIONS

The wide range of concepts elicited in each domain via Leximancer underscores the argument for analyzing QOL in an individualized way, as it was clear from these concepts that different domains had unique meanings to each person.

CLINICAL IMPLICATIONS

Understanding QOL at the level of which domains in an individual are important to QOL in later life is critical to providing services to both healthy aged as well as those with health and mental health needs. The SEIQOL-DW affords clinicians a unique tool with which to describe an individual's unique and relevant quality of life areas, and affords a way to measure change in these areas as a result of interventions.

Quality of life, demoralization syndrome and health-related lifestyle in cardiac transplant recipients - a longitudinal study in Taiwan

BACKGROUND

Quality of life is an outcome indicator after health care treatment, and the factors that affect quality of life change over time after heart transplantation. As such, quality of life as related to heart transplantation warrants further investigation.

AIMS

The purposes of this study were to compare different post-transplant times of cardiac transplant recipients in terms of their quality of life, demoralization syndrome and health-related lifestyle and to identify the predictors of quality of life in Taiwan.

METHODS

This longitudinal study, which used convenience sampling, was conducted in one medical center. Participants were divided into three groups (1, 2 and 3) based on post-transplant time. Four questionnaires, that is, demographic, quality of life, including a physical and mental component summary (PCS and MCS), demoralization and health-related lifestyle, were used to collect data at baseline and at three, six and 12 months. Hierarchical regression was used to identify the predictors of quality of life.

RESULTS

There were 99 participants, who were divided into three groups: Group 1 ( n = 31), Group 2 ( n = 29) and Group 3 ( n = 39). The majority of participants were male, with a mean age of 53.68 years. In each group, fewer than half had good quality of life, and one-third had demoralization syndrome. Demoralization syndrome combined with post-transplant time, age, use of mechanical circulatory support during hospitalization and stress status accounted for 35.2% of PCS for all participants. Further, demoralization syndrome combined with age and religion accounted for 40.3% of MCS for all participants.

CONCLUSIONS

The results indicated that quality of life, demoralization syndrome and health-related lifestyle were correlated over time. Demoralization was an independent predictor of quality of life.

Feeling good in old age: factors explaining health-related quality of life

Background

Sustained growth in longevity raises questions as to why some individuals report a good quality of life in older ages, while others seem to suffer more markedly the effects of natural deterioration. Health-related quality of life (HRQL) is mediated by several easily measurable factors, including socio-demographics, morbidity, functional status and lifestyles. This study seeks to further our knowledge of these factors in order to outline a profile of the population at greater risk of poor ageing, and to identify those attributes that might be modified during younger stages of the life course.

Methods

We use nationally representative data for Catalonia (Spain) to explain the HRQL of the population aged 80-plus. Cross-sectional data from 2011 to 2016 were provided by an official face-to-face survey. HRQL was measured using EQ-VAS – the EuroQol-5D visual analogue scale – which summarizes current self-perceived health. Multivariate linear regression was used to identify variables influencing the EQ-VAS score.

Results

Sociodemographic factors, including being older, female, poorly educated and belonging to a low social class, were related with poor HRQL at advanced ages. The presence of severe mobility problems, pain/discomfort, and anxiety/depression were highly correlated to the HRQL of the elderly, while problems of self-care and with usual activities had a weaker association.

Conclusions

Encouraging the young to stay in education, as well as to adopt healthier lifestyles across the lifespan, might ensure better HRQL when individuals reach old age. More multidisciplinary research is required to understand the multifaceted nature of quality of life in the oldest-old population.

Need for Comprehensive Health Care Quality Measures for Older Adults

Research indicates that older adults receive only about half of their recommended care, with varying quality and limited attention to social issues impacting their health through the most commonly used quality measures. Additionally, many existing measures neglect to address nonclinical social determinants of health. Evidence of the need for more comprehensive measures for seniors is growing. The primary purpose of this article, which is supported by a limited review of literature, is to describe gaps among current quality measures in addressing certain nonclinical needs of older adults, including key social determinants of health. In doing so, the authors describe their position on the need for expanded measures to incorporate these factors to improve care and quality of life. The authors conducted a limited review of the literature to inform this article, focusing specifically on selected measures for older adults rather than a broader systematic review of all measures. Most research identified was related to clinical practice guidelines rather than quality measures of care as applied to older adults. Furthermore, the literature reviewed reflected limited evidence of efforts to tailor quality measures for the unique social needs of older adults, confirming a potential gap in this area. A growing need exists for improved quality measures specifically designed to help providers address the unique social needs of older adults. Filling this gap will improve overall understanding of seniors and help them to achieve optimal health and successful aging.

Health Related Quality of Life in Iranian Elderly Citizens: A Systematic Review and Meta-Analysis

BACKGROUND

The ever-growing elderly population of Iran and their physical and mental consequences put emphasis on the necessity of determining the quality of life (QoL) in this social group. This systematic review and meta-analysis aimed to estimate the mean score of QoL in Iranian elderly citizens.

METHODS

Twenty-one articles that were indexed in Iranian (MagIran and Iran Medex) and international (Scientific Information Database, Google Scholars, Science Direct, PubMed, ProQuest, Scopus) databases were selected. The articles have used the Short Form Health Survey (SF-36) to measure QoL in Iranian elderly. The collected data were analyzed using a random effects model, while heterogeneity of the studies was measured by I2 index. The data analysis was performed by STATA.

RESULTS

The sample size of the 21 articles was 5318 and the mean score of QoL in the healthy and sick elderly citizens was 53.8 (CI 95%: 49.4-58.2) and 50.6 (CI 95%: 38.4-62.9) respectively. In addition, there was no significant relationship between the score of QoL and the year of publication of the articles. (P=0.748).

CONCLUSION

Given that QoL of the studied elderly was almost at an average level, there is a need to codify and implement comprehensive programs through effective training programs toward improving QoL of the elderly.

[Subjective theories on quality of life and health in old age : An explorative study with nursing home residents and their nursing personnel]

BACKGROUND

The terms "quality of life" and "health" are often used interchangeably even though there are indications to suggest that they are distinct constructs. Nevertheless, studies which would help to understand the difference between these constructs on the level of subjective theories of nursing home residents are lacking. Because nursing personnel can essentially contribute to the quality of life of residents, the comparison of subjective theories from residents and from nursing personnel can help to detect and understand potential discrepancies.

MATERIAL AND METHODS

Semi-structured interviews were conducted with 31 pairs of residents and their nursing personnel. Based on the approach of Fliege and Filipp (2000) one half of the respondents answered the questions using the term "quality of life" and the other half using the term "health". In addition, quality of life and health had to be rated on a visual analogue scale (VAS), whereby residents rated themselves and nurses rated the corresponding resident. Data were analyzed using qualitative content analysis in a team-based approach. Following a mixed methods approach the deductively developed main categories and the inductively developed subcategories were quantified and statistically analyzed together with the VAS ratings.

RESULTS AND CONCLUSION

Quality of life was more strongly associated with psychological, social and environmental aspects, whereas health more strongly evoked thoughts on physical functioning. This effect was stronger in nursing personnel, which can be explained by their role concept. In future scientific studies the terms should be used accurately, as they elicit different associations. The term "quality of life" seems to be more suitable to adequately reflect the adaptability of elderly people.

Quality-of-life assessment in dementia: the use of DEMQOL and DEMQOL-Proxy total scores

PURPOSE

There is a need to determine whether health-related quality-of-life (HRQL) assessments in dementia capture what is important, to form a coherent basis for guiding research and clinical and policy decisions. This study investigated structural validity of HRQL assessments made using the DEMQOL system, with particular interest in studying domains that might be central to HRQL, and the external validity of these HRQL measurements.

METHODS

HRQL of people with dementia was evaluated by 868 self-reports (DEMQOL) and 909 proxy reports (DEMQOL-Proxy) at a community memory service. Exploratory and confirmatory factor analyses (EFA and CFA) were conducted using bifactor models to investigate domains that might be central to general HRQL. Reliability of the general and specific factors measured by the bifactor models was examined using omega (ω) and omega hierarchical (ω h) coefficients. Multiple-indicators multiple-causes models were used to explore the external validity of these HRQL measurements in terms of their associations with other clinical assessments.

RESULTS

Bifactor models showed adequate goodness of fit, supporting HRQL in dementia as a general construct that underlies a diverse range of health indicators. At the same time, additional factors were necessary to explain residual covariation of items within specific health domains identified from the literature. Based on these models, DEMQOL and DEMQOL-Proxy overall total scores showed excellent reliability (ω h > 0.8). After accounting for common variance due to a general factor, subscale scores were less reliable (ω h < 0.7) for informing on individual differences in specific HRQL domains. Depression was more strongly associated with general HRQL based on DEMQOL than on DEMQOL-Proxy (-0.55 vs -0.22). Cognitive impairment had no reliable association with general HRQL based on DEMQOL or DEMQOL-Proxy.

CONCLUSIONS

The tenability of a bifactor model of HRQL in dementia suggests that it is possible to retain theoretical focus on the assessment of a general phenomenon, while exploring variation in specific HRQL domains for insights on what may lie at the 'heart' of HRQL for people with dementia. These data suggest that DEMQOL and DEMQOL-Proxy total scores are likely to be accurate measures of individual differences in HRQL, but that subscale scores should not be used. No specific domain was solely responsible for general HRQL at dementia diagnosis. Better HRQL was moderately associated with less depressive symptoms, but this was less apparent based on informant reports. HRQL was not associated with severity of cognitive impairment.

The European Portuguese WHOQOL-OLD module and the new facet Family/Family life: reliability and validity studies

PURPOSE

The aim of this study was to examine the psychometric properties of the European Portuguese version of the World Health Organization Quality of Life-Older Adults Module (WHOQOL-OLD). The European Portuguese WHOQOL-OLD includes a new identified facet, Family/Family life.

METHODS

A convenience sample of older adults was recruited (N = 921). The assessment protocol included demographics, self-perceived health, depressive symptoms (GDS-30), cognitive function (ACE-R), daily life activities (IAFAI), health status (SF-12) and QoL (WHOQOL-Bref, EUROHIS-QOL-8 and WHOQOL-OLD).

RESULTS

The internal consistency was excellent for the total 24-item WHOQOL-OLD original version and also for the final 28-item European Portuguese WHOQOL-OLD version. The test-retest reliability for total scores was good. The construct validity of the European Portuguese WHOQOL-OLD was supported in the correlation matrix analysis. The results indicated good convergent/divergent validity. The WHOQOL-OLD scores differentiated groups of older adults who were healthy/unhealthy and without/mild/severe depressive symptoms. The new facet, Family/Family life, presented evidence of good reliability and validity parameters.

CONCLUSION

Comparatively to international studies, the European Portuguese WHOQOL-OLD version showed similar and/or better psychometric properties. The new facet, Family/Family life, introduces cross-cultural specificity to the study of QoL of older adults and generally improves the psychometric robustness of the WHOQOL-OLD.

Quality of life in old age - a concept analysis

AIM

To identify existing definitions of quality of life in old age and to determine the most suitable for evaluating outcomes of nursing care for older adults.

BACKGROUND

Promoting quality of life is a central concern of nursing care for older persons. There is, however, a lack of clarity about the meaning of this concept. Attributes of quality of life are often confused with those factors influencing them.

DESIGN

Concept analysis according to Walker and Avant.

METHOD

A search was carried out in the databases MEDLINE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO(®) and Gerolit for the years 1992-2013. Excerpts dealing with definitions, antecedents, consequences and empirical referents of the concept were compiled.

RESULTS

Three basic concepts for quality of life were identified: satisfying life conditions, subjective general well-being and subjective fulfilment of dimensions of human life.

DISCUSSION

Satisfying life conditions are antecedent to the other concepts. It is not suitable to view such conditions as an outcome of nursing care for older adults because an outcome has to be a consequence. General well-being is likely to remain stable over time and changing conditions due to adaptation taking place. Fulfilment of dimensions of human life as a multidimensional inner state may be more sensitive to changing conditions.

CONCLUSION

Fulfilment of dimensions of human life is the most suitable definition of quality of life in old age as an outcome of nursing care. Studies are needed to decide whether it is responsive to changing circumstances.

IMPLICATIONS FOR PRACTICE

Fulfilment of dimensions of human life should be assessed to provide care that meets the needs of clients.

Psychological well-being in individuals with mild cognitive impairment

OBJECTIVES

Cognitive impairments associated with aging and dementia are major sources of burden, deterioration in life quality, and reduced psychological well-being (PWB). Preventative measures to both reduce incident disease and improve PWB in those afflicted are increasingly targeting individuals with mild cognitive impairment (MCI) at early disease stage. However, there is very limited information regarding the relationships between early cognitive changes and memory concern, and life quality and PWB in adults with MCI; furthermore, PWB outcomes are too commonly overlooked in intervention trials. The purpose of this study was therefore to empirically test a theoretical model of PWB in MCI in order to inform clinical intervention.

METHODS

Baseline data from a convenience sample of 100 community-dwelling adults diagnosed with MCI enrolled in the Study of Mental Activity and Regular Training (SMART) trial were collected. A series of regression analyses were performed to develop a reduced model, then hierarchical regression with the Baron Kenny test of mediation derived the final three-tiered model of PWB.

RESULTS

Significant predictors of PWB were subjective memory concern, cognitive function, evaluations of quality of life, and negative affect, with a final model explaining 61% of the variance of PWB in MCI.

DISCUSSION

Our empirical findings support a theoretical tiered model of PWB in MCI and contribute to an understanding of the way in which early subtle cognitive deficits impact upon PWB. Multiple targets and entry points for clinical intervention were identified. These include improving the cognitive difficulties associated with MCI. Additionally, these highlight the importance of reducing memory concern, addressing low mood, and suggest that improving a person's quality of life may attenuate the negative effects of depression and anxiety on PWB in this cohort.

Attitudes to aging mediate the relationship between older peoples' subjective health and quality of life in 20 countries

BACKGROUND

With ever-increasing life expectancy globally, it is imperative to build knowledge of how older peoples' views of their own aging, considering their health-related circumstances, affect quality of life for practitioners and policy-makers alike. Based on our literature review, we wanted to determine whether older adults' attitudes toward their own aging would partly mediate the effect of their health satisfaction ratings upon their quality of life. Furthermore, would these attitudes mediate the relationship between health satisfaction and quality of life in the same way when we account for older adults' country of origin, and their age and gender?

METHODS

This was a secondary analysis of cross-sectional survey data collected in 20 countries taking part in the 2003 WHOQOL-OLD Field study. The study sample consisted of 4593 adults whom were, on average, 72.10 years of age (range = 60 to 100 years of age); 42.8% were female. The WHOQOL-BREF measured quality of life and health satisfaction. The Attitudes to Aging Questionnaire measured participants' attitudes toward physical change, psychosocial loss, and psychological growth. All items in both questionnaires were measured on a 5-point Likert scale. Questionnaire responses were analyzed using multilevel modeling and path analysis.

RESULTS

All three attitudes to aging partly mediated the relationship between health satisfaction and physical, psychological, social, environmental, and global quality of life. These partial mediations manifested in the same way across all 20 country samples, regardless of age or gender. Attitudes toward physical change were the strongest mediator of health satisfaction upon global and domain-specific quality of life, followed by psychosocial loss and psychosocial growth.

CONCLUSIONS

Our study is the first cross-cultural study with a large sample to show that quality of life judgements, between 60 to 100 years of age, are a product of older men's and women's perceptions of health-related circumstances, and attitudes toward physical and psychosocial aspects of the aging self. A prospective study of the linkages between older peoples' subjective views of health and attitudes toward the aging self over time using multiple subjective measures of health is warranted. Understanding these linkages may help practitioners and policy makers consider strategies to enhance quality of life.

Effects of exercise on health-related quality of life and fear of falling in home-dwelling older women

This randomized, controlled trial evaluated the effects of exercise on health-related quality of life (HRQoL) and fear of falling (FoF) among 149 home-dwelling older women. The 12-mo exercise program was intended to reduce the risk of falls and fractures. HRQoL was assessed by the RAND-36 Survey, and FoF, with a visual analog scale, at baseline, 12 mo, and 24 mo. On all RAND-36 scales, the scores indicated better health and well-being. The exercise had hardly any effect on HRQoL; only the general health score improved slightly compared with controls at 12 mo (p = .019), but this gain was lost at 24 mo. FoF decreased in both groups during the intervention with no between-groups difference at 12 or 24 mo. In conclusion, despite beneficial physiological changes, the exercise intervention showed rather limited effects on HRQoL and FoF among relatively high-functioning older women. This modest result may be partly because of insufficient responsiveness of the assessment instruments used.

Aerobic versus resistance training effects on health-related quality of life, body composition, and function of older adults

This study aimed to investigate the effects of training on health-related quality of life (HRQoL), body composition, and function in older adults. Fifty participants were randomized into aerobic training (AT--70%-80% HR reserve), resistance training (RT--80% 1RM), or controls. They had HRQoL, body composition, and function assessed before and after 8 months. Training groups reduced body fat, increased performance in the stair ascent, 8-ft up-and-go and sit-to-stand five-times tests, and improved their physical component score (PCS; p ≤ .03). AT increased performance in the 6MWT test, and improved general and mental health (MH) domains when compared to controls (p < .01). Finally, changes in stair ascent were associated with changes in bodily pain, MH, and mental component score (p ≤ .04), while changes in handgrip strength were associated with changes in physical role and MH (p = .03). AT and RT were effective interventions for decreasing body fat and improving functionality and the PCS in older adults.

Is collective efficacy age graded? The development and evaluation of a new measure of collective efficacy for older adults

Objectives. Community processes are key determinants of older adults' ability to age in place, but existing scales measuring these constructs may not provide accurate, unbiased measurements among older adults because they were designed with the concerns of child-rearing respondents in mind. This study examines the properties of a new theory-based measure of collective efficacy (CE) that accounts for the perspectives of older residents. Methods. Data come from the population-based Chicago Neighborhood Organization, Aging and Health study (N = 1,151), which surveyed adults aged 65 to 95. Using descriptive statistics, correlations, and factor analysis, we explored the acceptability, reliability, and validity of the new measure. Results. Principal component analysis indicated that the new scale measures a single latent factor. It had good internal consistency reliability, was highly correlated with the original scale, and was similarly associated with neighborhood exchange and disorder, self-rated health, mobility, and loneliness. The new scale also showed less age-differentiated nonresponse compared to the original scale. Discussion. The older adult CE scale has reliability and validity equivalent to that of the existing measure but benefits from a more developed theoretical grounding and reduced likelihood of age-related differential nonresponse.

Reliability and Validity of the Dementia Quality of Life Measure in Nursing Home Residents

The purpose of this study was to test the reliability and validity of the Dementia Quality of Life (DQOL) in a sample of 486 residents from 12 nursing homes in the greater Baltimore area. There was some evidence of validity of the DQOL based on confirmatory factor analysis and Rasch model testing and criterion-related validity. Reliability of the DQOL was somewhat supported in this study based on internal consistency and test—retest reliability. Alpha coefficients and R2 estimations were generally low across all of the subscales. Despite these findings, the subscale scores remained consistent over a 12-month period. The use of the single-item question about QOL may not be an accurate reflection of QOL among nursing home residents. These findings provide additional information about the psychometric properties of the DQOL and offer some recommendations for revisions in the measure to optimally measure QOL in nursing home residents.

The use of social services by community-dwelling older persons who are at risk of institutionalization: a survey

The use of community-based social services additionally to regular home help services to support older persons at risk of institutionalization was studied. Structured interviews were held with 292 persons, who specifically pointed out that they prefer to remain independently at home. Bivariate and multivariate logistic regression models were developed to study the association between social service use and personal, health-related and wellbeing characteristics. 195 respondents indicated that they made use of at least one social service (68%). Only three services (individual care, social-cultural activities and restaurant facilities), out of nine, were used regularly. Those who lived in a sheltered environment or were supported by informal caregivers or who visited day care had a significantly higher probability of using these services. More attention should be given to the nature and accessibility of community-based social services in order to have distinctive added value in enabling older persons to age in place.

Quality of life among Norwegian older adults: focus group results

Fundamental to the nursing profession is understanding what issues are important to quality of life (QoL) for older adults. The aim of this study was to explore issues of importance to older adults and to compare findings with Lawton's theoretical QoL conceptualization. Five focus groups were conducted with healthy and hospitalized adults and health professionals. Many valued aspects of human existence were found to affect QoL, and results lend empirical support to many of the themes appearing under Lawton's four sectors. Results indicate the need for multidimensional assessments of QoL among older adults related to health, psychological, personal competency, social, environmental, and spiritual indicators. Issues related to time use, happiness, cognitive functioning, self-concept, coping with change, social functioning, self-determination, altruistic activity, living conditions, security, and technological aids should also be considered in future assessments of QoL. Research is needed to explore the relevancy of these issues in future assessments of QoL among older adults.

Older adult loneliness: myths and realities

The focus in this paper is on the social domain of quality of life, and more particularly loneliness. The empirical literature on older adult loneliness is reviewed, thereby challenging three often-held assumptions that figure prominently in public debates on loneliness. The first assumption that loneliness is a problem specifically for older people finds only partial support. Loneliness is common only among the very old. The second assumption is that people in individualistic societies are most lonely. Contrary to this belief, findings show that older adults in northern European countries tend to be less lonely than those in the more familialistic southern European countries. The scarce data on Central and Eastern Europe suggest a high prevalence of older adult loneliness in those countries. The third assumption that loneliness has increased over the past decades finds no support. Loneliness levels have decreased, albeit slightly. The review notes the persistence of ageist attitudes, and underscores the importance of considering people's frame of reference and normative orientation in analyses of loneliness.

Measuring the impact of increased exercise on quality of life in older adults: the UQQoL, a new instrument

The University of Queensland Quality of Life instrument (UQQoL) was developed to provide a quantitative measure sensitive to the impact of increased exercise on the quality of life (QoL) of older individuals. This paper describes the development and testing of the UQQoL including an exploratory study of focus group interviews with 18 participants aged 65 and over, item development and selection, and instrument piloting with groups of older adults undergoing high-intensity training. The SF-36, another established QoL tool, was also administered at the same time points for comparative purposes. The UQQoL displayed good convergent validity with selected SF-36 domains. A significant change in QoL following training was found, complementing functional improvements. This change was not detected by the SF-36. While broader testing is required, the UQQoL appears to be a reliable instrument sensitive to the change in QoL experienced by healthy community-dwelling older adults following resistance exercise.