Measuring the quality of life of older persons: a model with implications for community and public health nursing

Predictors of change over time in satisfaction with outdoor activities ratings among long-term care services and supports recipients

OBJECTIVES

To identify predictors of change in older adults' satisfaction with outdoor activities ratings over the first two years of enrollment in long-term services and supports (LTSS).

METHODS

Self-rated satisfaction with outdoor activities (not at all satisfied to extremely satisfied) was the primary outcome of this secondary data analysis. Mixed-effects linear regression modeling with a backward elimination process was used for analyses.

RESULTS

In the final model (N = 453) older LTSS recipients at baseline had lower ratings of satisfaction with outdoor activities over time, whereas younger recipients had higher ratings over time. Those who moved into a residential facility at baseline had an increase in outdoor activity satisfaction ratings over time compared to older adults who received home and community-based services that had a decrease.

DISCUSSION

LTSS clinicians can use these findings to support older adults with decision-making around enrollment into LTSS, address preferences, and develop person-centered care interventions for outdoor activity.

Satisfaction With Outdoor Activities Among Northeastern U.S. Newly Enrolled Long-Term Services and Supports Recipients

Older adults receiving long-term services and supports (LTSS) experience barriers to outdoor activities and satisfaction ratings with such experiences are not well understood. Our study used cross-sectional data (n = 329) to (a) examine whether those new to LTSS were satisfied with their outdoor activities and (b) describe the characteristics and factors associated with satisfaction levels. Self-report of satisfaction with outdoor activities was the outcome variable. Multivariable linear regression modeling of the outcome was conducted. Fifty-nine percent were satisfied with their outdoor activities. More depressive symptoms (p < .001) and higher cognitive functioning (p = .011) were associated with lower ratings. Higher self-rated physical health (p = .009) and more independence with activities of daily living (p = .022) were associated with greater satisfaction. Findings suggest an unmet need among four in 10 new recipients of LTSS (41%) related to their outdoor activities. LTSS interdisciplinary teams can use these findings to inform their assessments, develop person-centered care plans, and address barriers.

Quality of Life and Mental Health Status of Japanese Older People Living in Chiang Mai, Thailand

This study aimed to establish the quality of life and mental health status among older Japanese people living in Chiang Mai, Thailand. We conducted a questionnaire survey among Japanese retired people aged 50 years or over who had been living in Thailand. The questionnaire covered socio-demographic variables including health status and ability to communicate in Thai. We measured mental health status using the Japanese version of the General Health Questionnaire-28 (GHQ-28) and quality of life using the Japanese version of EuroQOL-5D-3L. We explored the factors associated with poor mental health and quality of life using logistic regression analysis. In total, 96 (89.7%)participants provided complete responses. Overall, quality of life was generally good, although those with one or more chronic diseases reported significantly lower quality of life. Having one or more chronic diseases and being aged 70-79 were significantly associated with poorer mental health. In total, 21 (21.8%) respondents had a possible neurosis, which was defined as a total GHQ-28 score of more than 6. The logistic regression analysis showed a significant association between possible neurosis and the presence of chronic diseases (adjusted odds ratio: 11.7 1). Quality of life among older Japanese people living in Chiang Mai was generally good, but there was a high level of possible neurosis, especially among those with one or more chronic diseases.

Assessment of the Selected Health Factors by Polonia in the Greater Toronto Area in the Relation to Their Quality and Standard of Living

Quality of life constitutes an indicator of well-being, satisfaction or happiness resulting from one's existence. It is often referred to as a standard of living. In general, it is contentment with the fulfilment of one's needs. The main objective of the article is to describe the selected components of the living standards and quality of life within the Polish community of the Greater Toronto Area which includes four regions: Halton, Peel, York and Durham. The model of mutually affecting objective factors (standard of living) and subjective factors (quality of life) will be presented. The specific factors (demographic, social, cultural, economic, legal, educational, geographical and health-related) included in field studies among the respondents and based on assigned indices influencing the quality of life in the Polish community of the Greater Toronto Area, will be demonstrated. The major goal of the paper is to present an assessment of aspects related to health factors, both in terms of objective factors (standard of living) and subjective ones (quality of life) by Polonia living in the Greater Toronto Area. Results will be shown on the basis of the survey questionnaire completed by 583 respondents. The questions focused on, among other issues, access to the healthcare system, competence of medical staff and access to sports facilities. Respondents also evaluated their satisfaction with their general health, both physical and mental, as well as the possibility of practicing sports associated with healthy lifestyle.

Effects of Sahaj Samadhi meditation on heart rate variability and depressive symptoms in patients with late-life depression

BACKGROUND

Late-life depression (LLD) is a disabling disorder and antidepressants are ineffective in as many as 60% of cases. Converging evidence shows a strong correlation between LLD and subsequent risk of cardiovascular disease. There is a need for new, well-tolerated, non-pharmacological augmentation interventions that can treat depressive symptoms as well as improve heart rate variability (HRV), an important prognostic marker for development of subsequent cardiovascular disease. Meditation-based techniques are of interest based on positive findings in other samples.AimsWe aimed to assess the efficacy of Sahaj Samadhi meditation (SSM), an underevaluated, standardised and manualised meditation intervention, on HRV and depressive symptoms.

METHOD

Eighty-three men and women aged 60-85 years, with mild to moderate depression and receiving treatment as usual (TAU) were randomised to either the SSM or TAU arm. Those allocated to SSM attended 4 consecutive days of group meditation training, using personalised mantras followed by 11 weekly reinforcement sessions. HRV and Hamilton Rating Scale for Depression (HRSD; 17-item) score were measured at baseline and 12 weeks.

RESULTS

All time and frequency domain measures of HRV did not significantly change in either arm. However, there was significant improvement in the SSM arm, compared with TAU, on the HRSD (difference in mean, 2.66; 95% CI 0.26-5.05; P = 0.03).

CONCLUSIONS

Compared with TAU, SSM is associated with improvements in depressive symptoms but does not significantly improve HRV in patients with LLD. These results need to be replicated in subsequent studies incorporating a group-based, active control arm.Declaration of interestR.I.N. is the Director of Research and Health Promotion for the Art of Living Foundation, Canada and supervised the staff providing Sahaj Samadhi meditation. S.R. has received research funding from Satellite Healthcare for a mindfulness meditation trial in patients on haemodialysis. The remaining authors report no financial or other relationship relevant to the subject of this article.

Living with breathlessness: a systematic literature review and qualitative synthesis

What is the experience of people living with breathlessness due to medical conditions, those caring for them and those treating them, with regard to quality of life and the nature of clinical interactions?Electronic databases (Ovid MEDLINE, Embase, CINAHL Plus and PsycINFO) were searched (January 1987 to October 2017; English language), for qualitative studies exploring the experience of chronic breathlessness (patients, carers and clinicians). Two independent reviewers screened titles, abstracts and papers retrieved against inclusion criteria. Disagreements were resolved with a third reviewer. Primary qualitative data were extracted and synthesised using thematic synthesis.Inclusion and synthesis of 101 out of 2303 international papers produced four descriptive themes: 1) widespread effects of breathlessness; 2) coping; 3) help-seeking behaviour; and 4) clinicians' responsiveness to the symptom of breathlessness. The themes were combined to form the concept of "breathing space", to show how engaged coping and appropriate help-seeking (patient) and attention to symptom (clinician) helps maximise the patient's quality of living with breathlessness.Breathlessness has widespread impact on both patient and carer and affects breathing space. The degree of breathing space is influenced by interaction between the patient's coping style, their help-seeking behaviour and their clinician's responsiveness to breathlessness itself, in addition to managing the underlying disease.

Quality of Life of Older Adults in Canada and Brazil

In this study, we examined the factors contributing to quality of life (QOL) of older adults in regions of Canada and Brazil. The WHOQOL-BREF and a demographic data sheet were administered to random samples of 202 older adults from Canada and 288 from Brazil. Ratings on overall QOL and on the physical, psychological, and environmental domains were higher in the Canadian sample. Social domain scores were not significantly different. The authors found the same pattern of factors (health satisfaction, enough money, meaning in life, and opportunities for leisure activities) contributed to the variance of QOL in both countries, except for physical environment, which was significant in Brazil and not in Canada. Health satisfaction was the strongest contributor to QOL in both samples, and satisfaction with personal relationships was not significant in either country.

A training programme involving automatic self-transcending meditation in late-life depression: preliminary analysis of an ongoing randomised controlled trial

Late-life depression affects 2-6% of seniors aged 60 years and above. Patients are increasingly embracing non-pharmacological therapies, many of which have not been scientifically evaluated. This study aimed to evaluate a category of meditation, automatic self-transcending meditation (ASTM), in alleviating symptoms of depression when augmenting treatment as usual (NCT02149810). The preliminary results of an ongoing single-blind randomised controlled trial comparing a training programme involving ASTM with a wait-list control indicate that a 12-week ASTM programme may lead to significantly greater reductions in depression and anxiety severity. As such, ASTM may be an effective adjunctive therapy in the treatment of late-life depression.

DECLARATION OF INTEREST

R.I.N. is Director of Research and Health Promotion for the Art of Living Foundation, Canada and supervised the staff providing ASTM training.

COPYRIGHT AND USAGE

© The Royal College of Psychiatrists 2016. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence.

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.

A randomized controlled longitudinal naturalistic trial testing the effects of automatic self transcending meditation on heart rate variability in late life depression: study protocol

Background

The prevalence and socioeconomic cost of late life depression (LLD) is on the rise, while the response rate to antidepressant trials remains poor. Various mind-body therapies are being embraced by patients as they are considered safe and potentially effective, yet little is known regarding the effectiveness of such therapies to improve LLD symptoms. Among the mind-body therapies currently in practice, the results of our pilot study have shown that a particular meditation technique called Sahaj Samadhi Meditation, which belongs to the category of meditation termed automatic self-transcending meditation (ASTM) may have some promise in improving cardiovascular autonomic disturbances associated with LLD as well as ameliorating symptoms of depression and anxiety.

Methods/Design

Patients between the ages of 60 and 85 with LLD will be randomized either to ASTM plus treatment as usual (TAU) or TAU alone to assess changes in cardiovascular autonomic parameters, neuropsychological symptoms of depression and anxiety as well as quality of life. The instructional phase of the intervention consists of 4 consecutive days of meditation training, after which participants are encouraged to meditate twice daily for twenty minutes each time at home. The intervention also includes once weekly follow up sessions for the subsequent 11 weeks. The planned study has one and a half year recruitment period. Participants will be assessed at baseline and at 4, 8, 12 and 24 weeks post intervention.

Discussion

This study should provide a unique data source from a randomized, controlled, longitudinal trial to investigate the effects of a form of ASTM on cardiovascular autonomic and neuropsychological health in LLD.

Trial registration

Clinicaltrials.gov NCT02149810, date registered: 05/28/2014.

The important things in the life of older people: elderly women in social houses and home care

The purpose of the article is to analyze the aging experiences of elderly women in Estonia and the factors influencing them. The assessments of two groups using social services are compared-the elderly living in Tallinn's social houses and the elderly receiving care at home. From February to August 2011, a total of 80 elderly women were interviewed. Inhabitants of social houses find that their old age is satisfying more often (65% of the inhabitants of social houses and 40% of the people in home care). Many home care clients were convinced that it is best to spend old age among loved ones and in a familiar environment. Those living at home have many difficulties, which is why 20% of them are on a waiting list to go to a social house. Home services should include services with which the inhabitants of social houses are very satisfied.

Association between religiosity/spirituality and quality of life or depression among living-alone elderly in a South Korean city

INTRODUCTION

This study investigated the effects of religiosity and spirituality on quality of life and depression among older people.

METHODS

Two hundred and seventy-four solitary elderly people aged over 65 years living in Chuncheon city, South Korea were selected. Symptoms of depression were evaluated using the Short Geriatric Depression Scale-Korean version (SGDS-K) and quality of life was measured using Geriatric Quality of Life-Dementia (GQOL-D). We used the Duke Religion Index (DUREL) to assess religiosity and spirituality.

RESULTS

There was a significant correlation between scales of depression (SGDS-K), quality of life (GQOL-D), and scale of religiosity/spirituality (DUREL) in older people. Depressed people had a lower score GQOL-D than non-depressed people. Among the depressed, those believing in a religion had a higher GQOL-D score than the non-religious. Multiple regression analysis revealed that religiosity and spirituality had significant effects on depression and quality of life among the elderly. Interestingly, religiosity and spirituality were not related to depression and quality of life amongst Buddhists, but were related amongst Protestants and Catholics.

DISCUSSION

Religiosity and spirituality had significant effects on depression and on quality of life among the Korean elderly. However, there are different relationships between depression and religiosity, quality of life, and religiosity based on different religions. More research is needed to elucidate these findings.

Explaining quality of life of older people in the Netherlands using a multidimensional assessment of frailty

PURPOSE

Although frailty was originally a medical concept, nowadays more and more researchers are convinced of its multidimensional nature, including a psychological and social domain of frailty as well as a physical domain. The objective of this study was to test the hypothesis that the prediction of quality of life by physical frailty components is improved by adding psychological and social frailty components.

METHODS

This cross-sectional study was carried out with a sample of Dutch citizens. A total of 1,031 people aged 65 years and older completed a Web-based questionnaire containing the Tilburg Frailty Indicator for measuring physical, psychological, and social frailty, and the WHOQOL-BREF for measuring four quality of life domains (physical health, psychological, social relations, environmental).

RESULTS

The findings show that the prediction of all quality of life domains by eight physical components of frailty was improved after adding four psychological and three social frailty components. The psychological frailty component 'feeling down' significantly improved the prediction of all four quality of life domains, after controlling for the effects of background characteristics and all other frailty components.

CONCLUSION

This study emphasizes the importance of a multidimensional assessment of frailty in the prediction of quality of life in older people.

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.

Quality of life associated with adult day centers

The purpose of this study was to describe the quality of life (QOL) of current adult day center (ADC) clients and their family caregivers in one region of Canada. Semi-structured interviews were conducted with 10 ADC clients and 10 caregivers. Data analysis used a modified constant comparative method. The major categories relating to QOL that emerged in the analysis included Physical Health and Well-Being, Social Networks/Relationships, Aging in Place, Safety, Respite, Activation, Respect and Inclusion, and Adequate Health Care Services. These themes are consistent with those of other studies of QOL of older adults. It was evident that ADCs played an important role in maintaining and improving the QOL of both the older adults and caregivers participating in this study.

"Who do they think we are, anyway?": perceptions of and responses to poverty stigma

In this article, we report on qualitative findings pertaining to low-income people's perceptions of and responses to "poverty stigma," a key component of social exclusion with important implications for health and well-being. Our findings are drawn from a multimethod study designed to investigate experiences of social exclusion and social isolation among people living on low incomes. We conducted semistructured individual interviews (n = 59) and group interviews (total n = 34) with low-income residents of two large Canadian cities. Data were analyzed using thematic content analysis techniques. Participants overwhelmingly thought that other members of society tend to view them as a burden to society-as lazy, disregarding of opportunities, irresponsible, and opting for an easy life. Low-income people responded to perceived stigma with a variety of cognitive and behavioral strategies that reflected their efforts to reconcile their perceived "social" and "personal" identities. These strategies included confronting discrimination directly, disregarding responses from others, helping other low-income people, withdrawing and isolating themselves from others, engaging in processes of cognitive distancing, and concealing their financial situation.

Quality of life of older adults in Canada and Norway: examining the Iowa model

In this study, Glick and Tripp-Reimer's (1996) Iowa model for gerontological nursing serves as a guiding framework for a descriptive exploratory study of quality of life (QOL) of older adults. Using secondary data, the authors explored whether the effects of health appraisal, morbidities, social support transitions (SST), and the environment on QOL would be partly mediated by cognitive developmental transitions (CDT). Data sets were available from studies with random samples of community-dwelling older adults from Canada (n = 202) and Norway (n = 490). The partly and fully mediated effects found suggest positive CDT in older age might be significantly enhanced by the presence of intimate ties, positive perceptions of one's health limitations, and residence in a healthy, safe, and resource-rich physical environment. These findings represent a novel attempt at testing complex linkages between aspects of elder, environment, and nursing concepts within the Iowa model warranting further research.

Quality of life and health-related quality of life of adolescents with cerebral palsy

This study assessed quality of life (QOL) and health-related quality of life (HRQOL) of 203 adolescents with cerebral palsy (111 males, 92 females; mean age 16y [SD 1y 9mo]). Participants were classified using the Gross Motor Function Classification System (GMFCS), as Level I (n=60), Level II (n=33), Level III (n=28), Level IV (n=50), or Level V (n=32). QOL was assessed by self (66.5%) or by proxy (33.5%) with the Quality of Life Instrument for People With Developmental Disabilities, which asks about the importance and satisfaction associated with the QOL domains of Being, Belonging, and Becoming; HRQOL was captured through proxy reports with the Health Utilities Index, Mark 3 (HUI3), which characterizes health in terms of eight attributes, each having five or six ordered levels of function. GMFCS level was not a source of variation for QOL domain scores but was significantly associated with the eight HRQOL attributes and overall HUI3 utility scores (p<0.05). Some QOL domain scores varied significantly by type of respondent (self vs proxy; p<0.05). Overall HUI3 utility values were significantly but weakly correlated with QOL Instrument scores for Being (r=0.37), Belonging (r=0.17), Becoming (r=0.20), and Overall QOL (r=0.28), and thus explain up to 14% of the variance (r(2)). These findings suggest that although QOL and HRQOL are somewhat related conceptually, they are different constructs and need to be considered as separate dimensions of the lives of people with functional limitations.

Sexuality and quality of life

The purpose of this research was to explore the relationships between sexual activity and intimacy and quality of life (QOL) of older adults. The authors' research question was "To what extent do age, gender, marital status, health status, education, satisfaction with personal relationships, sexual activity, and satisfaction with intimacy explain older adults' ratings of QOL?" A secondary analysis was conducted using results from a cross-sectional survey. Data were available from a convenience sample of 426 individuals living in British Columbia, Canada, who volunteered to complete the questionnaire. Instruments included the WHOQOL-100, WHOQOL-OLD, and a demographic data sheet. It was found that the strongest contributors to the variance of overall QOL were satisfaction with personal relationships, followed by health status andsexual activity. Age, gender, marital status, and education were not significant. The implications for gerontological nurses include the need to support personal relationships for older adults, to encourage health promotion, and to ensure sexuality is discussed with older adults.

Hematologic disorders associated with human immunodeficiency virus and AIDS

Nurses encounter patients with human immunodeficiency virus infection at various stages of their infection and in a variety of settings. This article focuses on the most common hematologic disorders associated with human immunodeficiency virus infection and acquired immunodeficiency syndrome, which can precipitate complications and frequently accompany hospitalization. It is important for nurses to have a solid foundation as to the cause of these disorders, their impact on quality of life and outcomes, and management strategies.

Spirituality in Later Life: Effect on Quality of Life

The purpose of this study was to explore the effects of spirituality on quality of life (QOL) in older adults when age, gender, social support, and health status are controlled. A secondary analysis of data was conducted using results from a cross-sectional survey of older adults. Data were available from a convenience sample of 426 people living in British Columbia, Canada, who volunteered to complete the questionnaire. Instruments included the WHOQOL-100 and a demographic data sheet. The results show spirituality was not a significant factor contributing to QOL in this sample, and that the strongest predictors of overall QOL were social support and health satisfaction. Given difficulties in measuring spirituality and homogeneity of the sample, further research is warranted.

Predictors of quality of life in old age: A cross-validation study

A replication study was undertaken to validate a model of quality of life (QOL) generated in an earlier study on a random sample of 202 older adults. Pathways found to be significant were retested using QOL data from a convenience sample of 420 older adults. Using path analysis, we found that financial resources, health, and meaning in life directly and positively influenced QOL. Health, emotional support, and the physical environment indirectly affected QOL through purpose in life. All but one pathway were replicated, explaining 50.5% of the variance in QOL. Further explorations of the influence of spirituality, emotionally close ties, and opportunities for active engagement on QOL in older age are warranted.

Older people in Sweden with various degrees of present quality of life: their health, social support, everyday activities and sense of coherence

Public health policies in most European countries are concerned with how to keep older people living independently with a qualitatively good life in the community as long as possible. However, knowledge about what may characterise those seemingly 'healthy' older people is sparse. The aim of the study was to investigate the characteristics of a sample of people (75+) reporting various degrees of Quality of Life (QoL) with respect to QoL in different areas, as well as self-rated health, health problems, social support, everyday activities and sense of coherence. A postal questionnaire was sent out in spring 2001 to a randomly selected population-based sample (n= 600) in the southern parts of Sweden. A two-step cluster analysis was performed (n= 385, mean age 84.6, SD = 5.7) with 'present QoL' as clustering attribute. Three groups were disclosed, classified as high, intermediate and low present QoL, of which 33.8% could be regarded being at risk of low QoL. Those with low present QoL (18.4%) were the oldest and most vulnerable, a majority were women with 'poor or bad' self-rated health, high frequencies of health problems, low total QoL, low social support and sense of coherence and less physically active. Those with high present QoL (47.8%) reported more 'excellent or good' self-rated health, physical activity, satisfactory social support and higher sense of coherence and total QoL than the other two groups. Those with intermediate present QoL (33.8%) had more of 'poor or bad' self-rated health, more health problems were less physically active, had lower total QoL and sense of coherence, and less social support than those with high present QoL. The sample seemed to reflect the ageing process in that the respondents were at different stages of ageing. However, the fact that the level of social support, sense of coherence and self-rated health followed the same curve as QoL may indicate that some are more vulnerable to low present QoL given the same health and these should be targeted in preventive programmes since they report low QoL.

Self-reported health complaints and their prediction of overall and health-related quality of life among elderly people

OBJECTIVE

To describe and compare self-reported health complaints, overall and health-related quality of life and to investigate how health complaints, age, gender, marital status, living and dwelling conditions and socio-economy predicted overall and health-related quality of life.

DATA AND METHOD

A sample of 469 persons (aged 75-99) responded to a postal questionnaire. Multiple linear regression analysis was used to examine possible predictors.

RESULT

Self-reported health complaints such as pain, fatigue and mobility impairment significantly predicted low overall and health-related quality life. Women had significantly lower overall and health-related quality of life than men, and a significantly higher degree of self-reported health complaints. The regression models had more similarities than differences, implying that the overall quality of life instrument were sensitive to physical influences only supposed to be detected by health-related quality of life instruments. Several of the health complaints predicting low quality of life are amenable for being relieved by nursing care. In the care of older people nurses need to assess for several health complaints simultaneously and be aware of their possible interaction when outlining interventions. Nurses are able to facilitate early detection of health complaints negatively affecting quality of life by implementing more pro-active preventive work as well as a higher degree of thorough and systematic assessments. It also seems important to consider that older woman's and men's needs for high quality of life may differ.

Quality of life, life satisfaction and happiness in shift- and non-shiftworkers

OBJECTIVE

To investigate the quality of life, life satisfaction, happiness and demands of work in workers with different work schedules.

METHODS

The survey was carried out on professional workers in social care. Some were shiftworkers whose schedule included night shifts (N=311), some were shiftworkers without night shifts (N=207) and some were non-shiftworkers (N=1,210). Surveys were mailed and the response rate was 86%. For the purpose of this study several variables were selected from the Survey: The Quality of Life Profile, which measures importance, satisfaction, control and opportunities in nine domains of life plus measures of happiness, life satisfaction and demands of work.

RESULTS

While both groups of shiftworkers, compared to non-shiftworkers, reported needing more physical effort to complete their work, and reported 'being' more physically tired, no differences were found in reports of overall happiness, life satisfaction or total quality of life. However, night-shiftworkers reported greater percentage of time unhappy than the other two groups of workers. In analyses of the quality of life, night-shiftworkers were less satisfied with domains of spiritual 'being' and physical and community 'belonging' than day-shiftworkers and non-shiftworkers. They also reported having fewer opportunities to improve their physical 'being', leisure, and personal growth than the other two groups.

CONCLUSIONS

Quality of life in specific domains in night-shiftworkers was rated worse than in other groups of workers. Domain-based quality of life assessment gives more information regarding the particular needs of workers than overall or global measures of well-being.

Family carers of ICU survivors: a survey of the burden they experience

Intensive care unit (ICU) survivors may experience deterioration in their quality of life for months following their return home, with families assuming a caregiving role. The aim of this study was to measure the burden associated with caring for a family member who had been critically ill. The study also sought to describe the relationship between three factors (filial obligation, social support, self-efficacy) and caregiver burden. Seventy-one family carers, 51 females (72%) and 20 (28%) males of long-term intensive care patients completed a mailed survey, after signing an informed consent form. Although the vast majority of the caregivers were providing substantial number of hours of care each week, they scored lower than the midpoint on all caregiver burden inventory subscales. Filial obligation was found to be positively associated with caregiver burden; however, there was no association between social support, self-efficacy and caregiver burden. Male caregivers experienced significantly more burden than female caregivers. The findings suggest that an understanding of the factors that impact on caregiver burden of families of ICU survivors is only beginning to emerge.

Factor analytic properties of the Quality of Life Profile: examination of the nine subdomain Quality of Life Model

The Quality of Life Profile is a 54-item multidimensional measure of quality of life. The measure is based upon a theoretical approach that considers quality of life to include satisfaction with nine subdomains of functioning. To date, the factor structure of this 54-item collection has not been examined. To do so, an examination was made of the factor structure that emerged from an administration to 219 gay men, half of whom were HIV+. Analysis indicated that seven subdomains were clearly represented in seven of the 11 factors that emerged. One subdomain was fractured into two factors and one subdomain did not appear in the factor structure. Two minor factors appeared to represent issues that may be especially important to gay men living in the HIV era. The study provides insights into the structure of quality of life among gay men living in Ontario.

The reliability and validity of two health status measures for evaluating outcomes of home care nursing

The reliability, validity, and sensitivity of the Medical Outcome Study Short Form (SF-36) and the Quality of Life Profile: Senior Version (QOLPSV) for measuring outcomes of home care nursing were evaluated. Data were collected from 50 clients receiving home care nursing services. Twenty-two registered nurses and six registered practical nurses collected client and nursing data on each home visit. Client baseline and outcome measures were collected by two independent evaluators at admission and discharge from the home care service. Internal consistency reliability ranged from.76 to.94 for the eight subscales of the SF-36. Internal consistency reliability ranged from.47 to.82 for the nine subscales of the QOLPSV. The subscales of both instruments had minimal problems with missing responses. The SF-36 was found to be more sensitive than the QOLPSV to change over time. In addition, the subscales of the SF-36 were found to be more sensitive than the subscales of the QOLPSV to several of the nursing variables, such as intensity of the client's nursing condition and skill mix.

Quality of life domains in the healthy public: A trial investigation using attendants for an annual health checkup

A trial investigation of subjects gathered for annual health checkups was performed to detect domains of quality of life in the healthy public, and to explore the changes of their demographic characteristics for the possibility of engaging them in health service activities in the community. The eligible 1,096 subjects aged 30-79 years were investigated. The period of this survey was from September to December, 1997. The subjects were questioned using ten quality of life domains which were preliminarily prepared and had been assumed to be most important in the subjects' lives in relation to the order of priority, importance, and satisfaction levels. The first most important domain in both the male and female subjects' lives was personal health, followed by relationships with family, though the mean importance scores for their personal health and relationships with family were almost equivalent. The mean scores for work abruptly decreased in males over 60 years of age. Also, the first large and the second relatively small principal components were extracted through principal components analysis. The proposed ten domains of quality of life are most likely valid and reliable in terms of the results analyzed and the comparison with a referred study. Relationships with family is an effective cue for health service activities in the community, and the significance of work on quality of life in the healthy public will have to be taken into account separately, especially in males.