The Quality of Life of Older Adults Living in an Urban Environment: Professional and Lay Perspectives

Influence of Neighborhood Characteristics on Physical Activity, Health, and Quality of Life of Older Adults: A Path Analysis

Background: As life expectancy and health expenditure consumed by older people increase, maintaining a better health and quality of life for older adults has become an important social issue. Research indicates that physical activity may help address this challenge. Moreover, it is believed that improved quality of life and health benefits from physical activity can be achieved through interventions in the neighborhood environments. However, existing knowledge has often been based on bivariate relationships between these factors, and few studies have formally examined the extent to which any association between neighborhood environments, health, and quality of life may be mediated by the level of physical activity. This paper aims to investigate the direct and indirect influence of neighborhood characteristics on the health and quality of life of older adults, taking into account physical activity behavior and socio-demographic characteristics in a more comprehensive framework. Methods: Data were collected using a survey among 363 older adults aged 60 years and over in China. A path analysis was used that derives all direct and indirect relationships between the variables. Results: Leisure-time physical activity levels played a mediating role in the relation between social capital and health as well as quality of life. Moreover, the study confirmed direct relationships between neighborhood characteristics such as neighborhood aesthetics and traffic safety and health as well as quality of life. However, the effect of neighborhood characteristics on health and quality of life through transport-related physical activity levels was not found. Conclusions: Leisure-time physical activity instead of transport-related physical activity should be considered a priority when developing interventions aiming to promote healthy aging. Additionally, neighborhood characteristics are important in promoting healthy aging, even though they have no or less impacts on older adults' health and quality of life through physical activity.

Perspectives on ageing: a qualitative study of the expectations, priorities, needs and values of older people from two Canadian provinces

BACKGROUND

Understanding the needs and values of older people is vital to build responsive policies, services and research agendas in this time of demographic transition. Older peoples' expectations and priorities for ageing, as well as their beliefs regarding challenges facing ageing societies, are multi-faceted and require regular updates as populations' age.

OBJECTIVE

To develop an understanding of self-perceptions of ageing and societal ageing among Canadian retirees of the education sector to define a meaningful health research agenda.

METHODS

We conducted four qualitative focus groups among 27 members of a Canadian retired educators' organisation. Data were analysed using an inductive thematic approach.

RESULTS

We identified four overarching themes: (1) vulnerability to health challenges despite a healthier generation, (2) maintaining health and social connection for optimal ageing, (3) strengthening person-centred healthcare for ageing societies and (4) mobilising a critical mass to enact change. Participants' preconceptions of ageing differed from their personal experiences. They prioritised maintaining health and social connections and felt that current healthcare practices disempowered them to manage and optimise their health. Although the sheer size of their demographic instilled optimism of their potential to garner positive change, participants felt they lacked mechanisms to contribute to developing solutions to address this transition.

CONCLUSION

Our findings suggest a need for health research that improves perceptions of ageing and supports health system transformations to deliver person-centred care. Opportunities exist to harness their activism to engage older people as partners in shaping solution-oriented research that can support planning for an ageing society.

Conflicting experiences of health and habitus in a poor urban neighbourhood: A Bourdieusian ethnography

An ethnographic study of health and wellbeing was undertaken in a deprived urban neighbourhood in the UK Midlands. Drawing on Bourdieu's concepts of habitus, capital and field, we discerned three different, even conflicting, ways of understanding and acting on health: (i) older adults discussed their wellbeing in relation to the local context or field, walking the dog, helping at the community centre and visiting the off licence, (ii) young professionals and students who lived in the neighbourhood were oriented towards leisure facilities, career opportunities and supermarkets outside of the neighbourhood, disdaining local facilities and (iii) community activists and carers discussed health in terms of providing for others but not themselves. Bourdieu is frequently used in medical sociology to highlight how poor people's lifestyle is constrained by their habitus; we suggest paying more attention to its both enabling and differentiating contradictions as well as the constraints it entails. Empirically and in terms of health promotion findings suggest that supposedly healthy activities, such as going to the gym, may also be a means of rejecting the local community; similarly, older people's pottering about in the neighbourhood, which is not usually recognised as a healthy activity, may enhance wellbeing in this context.

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.

Hearing the Voice of the Resident in Long-Term Care Facilities-An Internationally Based Approach to Assessing Quality of Life

OBJECTIVES

interRAI launched this study to introduce a set of standardized self-report measures through which residents of long-term care facilities (LTCFs) could describe their quality of life and services. This article reports on the international development effort, describing measures relative to privacy, food, security, comfort, autonomy, respect, staff responsiveness, relationships with staff, friendships, and activities. First, we evaluated these items individually and then combined them in summary scales. Second, we examined how the summary scales related to whether the residents did or did not say that the LTCFs in which they lived felt like home.

DESIGN

Cross-sectional self-report surveys by residents of LTCFs regarding their quality of life and services.

SETTING/PARTICIPANTS

Resident self-report data came from 16,017 individuals who resided in 355 LTCFs. Of this total, 7113 were from the Flanders region of Belgium, 5143 residents were from Canada, and 3358 residents were from the eastern and mid-western United States. Smaller data sets were collected from facilities in Australia (20), the Czech Republic (72), Estonia (103), Poland (118), and South Africa (87).

MEASUREMENTS

The interRAI Self-Report Quality of Life Survey for LTCFs was used to assess residents' quality of life and services. It includes 49 items. Each area of inquiry (eg, autonomy) is represented by multiple items; the item sets have been designed to elicit resident responses that could range from highly positive to highly negative. Each item has a 5-item response set that ranges from "never" to "always."

RESULTS

Typically, we scored individual items scored based on the 2 most positive categories: "sometimes" and "always." When these 2 categories were aggregated, among the more positive items were: being alone when wished (83%); decide what clothes to wear (85%); get needed services (87%); and treated with dignity by staff (88%). Areas with a less positive response included: staff knows resident's life story (30%); resident has enjoyable things to do on weekends (32%); resident has people to do things with (33%); and resident has friendly conversation with staff (45%). We identified 5 reliable scales; these scales were positively associated with the resident statement that the LTCF felt like home. Finally, international score standards were established for the items and scales.

CONCLUSIONS

This study establishes a set of standardized, self-report items and scales with which to assess the quality of life and services for residents in LTCFs. The study also demonstrates that these scales are significantly related to resident perception of the home-like quality of the facilities.

Exploring Subjective Well-being in Older Age by Using Participant-generated Word Clouds

Purpose of the study

Previous research has overlooked the heterogeneity in older adults' personal conceptions of subjective well-being (SWB), by not taking into account intradomain differences in the conceptions of SWB for different groups of older adults. The aim of this article is therefore to explore (a) older adults' own views on which aspects, categorized under domains, are important to their SWB and (b) which domains and aspects are important to older adults in different contexts and with different characteristics: to men and women, of different ages, and in different housing arrangements.

Design and methods

Sixty-six older adults (aged 65 and older) participated in our study. We asked the participants to freely nominate aspects of SWB that are important to them, using participant-generated word clouds as our exploratory, qualitative data collection method. The data were analyzed using qualitative inductive content analysis.

Results

We found 15 domains based on our participants' conceptions of SWB. The multidimensional domains of social life, activities, health, and space and place were most important to our participants. The domains and aspects were defined and prioritized differently by different groups of participants.

Implications

SWB should be studied as a multidimensional, individualized, and contextualized process to generate meaningful empirical information for researchers and policymakers.

Quality of urban life among older adults in the world major metropolises: a cross-cultural comparative study

The concept of quality of urban life (QoUL) can be interpreted quite differently across different cultures. Little evidence has shown that the measure of QoUL, which is based on Western culture, can be applied to populations cross-culturally. In the current study, we use data from the 2006 Assessing Happiness and Competitiveness of World Major Metropolises study to identify underlying factors associated with QoUL as well as assess the consistency of the QoUL measurement among adults, aged 60 and older, in ten world major metropolises (i.e. New York City, Toronto, London, Paris, Milan, Berlin, Stockholm, Beijing, Tokyo and Seoul). Exploratory factor analysis and multiple-group confirmatory factor analysis (CFA) are used to analyse the data. Findings of the study suggest that the measure of QoUL is sensitive to socio-cultural differences. Community factor and intrapersonal factor are two underlying structures that are related to QoUL among older adults in ten metropolises cross-culturally. Results from the CFA indicate that Toronto is comparable with Beijing, New York City, Paris, Milan and Stockholm in QoUL, while other cities are not. The results provide insights into the development of current urban policy and promotion of quality of life among older residents in major metropolitan areas. Future researchers should continue to explore the relationship between QoUL and socio-cultural differences within international urban settings, while remaining cautious when making cross-cultural comparisons.

Neighborhood resources and social participation among older adults: results from the VoisiNuage study

OBJECTIVE

This article examined the associations between proximity to selected locations considered to be conducive to social participation, and social participation itself, in urban-dwelling seniors.

METHODS

A sample of 520 older adults residing in the Montreal area provided reports of social participation and information about health, sociodemographic characteristics, social networks, and perceptions about features of their residential environment. Information about the distance between their home and five locations deemed to be conducive to social participation were obtained from a geographic information system.

RESULTS

Analyses showed a significant association between proximity to selected locations and social participation while accounting for individual characteristics and perceptions of neighborhood features (β = 0.37; SE = 0.17; p < 0.05).

DISCUSSION

Findings were consistent with contributions highlighting the impact of the built environment on seniors' health-related behavior. Future work would benefit from the use of longitudinal designs and examinations of social participation through alternate channels.

Components and determinants of quality of life in community-dwelling older adults

The objectives of this study are to detect the main components of global quality of life (QoL) of community-dwelling older adults from their own perspective and to identify determinants of health-related and global QoL in the same population. This is a cross-sectional study covering a representative sample of 1,106 community-dwelling adults aged 60 years and older residing in Spain. The survey collected information on QoL through a face-to-face interview asking for QoL components in free-format, as well as the completion of two QoL measures, the EQ-5D and the Personal Wellbeing Index. The most important QoL dimensions, according to the participants of this study, were health, family, and finances. Depression was the main determinant of both QoL indices, while functional independence and social support specifically influenced health-related and global QoL, respectively. Based on the perspective of the older adults as well as on statistical analysis, this work emphasizes the importance of health, family, and social support as areas of special interest in aging. There was a discrepancy when comparing findings related to the importance of financial status. Results also support that global and health-related QoL share some common determinants, but with different weights for functional independence and social support.

Identifying connections between the subjective experience of health and quality of life in old age

The importance of qualitative methods in quality of life (QoL) studies is being increasingly recognized. Whereas attention has mainly focused on the exploration of relevant domains, subjective well-being, and representations of health in aging, less consideration has been given to relations among different QoL domains. We aimed in this research to identify connections between subjective health and other relevant domains from the perspective of older adults. We identified four central categories: adaptation to the limits of health in aging; seeking a balance in subjective health and QoL in aging; sense of place in centers for older people; and health and family interrelated dimensions of QoL in old age. According to the participants, the family domain positively impacts health as a consequence of contacts, support, and accomplishments. It might also have a negative impact as a result of a relatives' death or severe disease. The qualitative QoL perspective contributes to capturing the multidimensionality of health, aging, and place.

Neighborhood Walkability: Older People’s Perspectives From Four Neighborhoods in Ottawa, Canada

This qualitative study examined older people’s walking experiences in 4 Ottawa neighborhoods. Seventy-five adults age 65 years and older who had lived in their neighborhoods for at least 2 yr participated in focus groups and individual interviews. Four themes were identified through data analysis: multidimensional personal meanings, navigating hostile walking environments, experiencing ambiguity, and getting around. Neighborhood walking was experienced within the continuum of personal and environmental change. Findings indicated that the concept of pedestrian connectivity must incorporate aspects of both intersection regulation and design to ensure relevance for an aging population. Participants called for more clarity about policies that affect pedestrian safety for older people. The overarching theme of getting around indicated that walkability assessments must consider how walking fits within an integrated transportation system and how accessible this system is for older people.

Living Long and Keeping Well: Elderly Canadians Account for Success in Aging

Senescence is a time of decline; yet many seniors remain active and engaged into very old age. How and why do some seniors live long and keep well? We report the responses to this question from a representative sample of 2,783 Canadian seniors.

Overall, seniors placed primary responsibility for their long lives on their own individual practices, citing keeping active and maintaining good nutrition as the major themes. Physical illness was less significant than the will to adapt to illness and avoid further physical decline as long as possible. Francophone and anglophone respondents differed in the frequency with which they mentioned many of the themes. Francophones focused on life quality and family, while anglophones focused on the self. Systematic gender differences were also identified. Many responses validate existing theories of successful aging, and indicate that Canadian seniors are well-informed, insightful participants in the process of growing old.

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.

Local environments and older people's health: Dimensions from a comparative qualitative study in Scotland

Based on the perspectives of older people themselves in three urban neighbourhoods in the Glasgow region of Scotland, this article explores the ways in which the local outdoor physical environment may support or challenge older people's health. Five dimensions are proposed: cleanliness; peacefulness; exercise facilitation; social interaction facilitation; and emotional boost. Consideration is also given to potential equality issues, arguing that such aspects of the local environment may disproportionately affect older people, and also that relevant environmental qualities vary between places. Greater equity and the improved well-being of older people may be achieved through planning and design consideration across sectors.

Do quality of life, participation and environment of older adults differ according to level of activity?

BACKGROUND

Activity limitation is one of the most frequent geriatric clinical syndromes that have significant individual and societal impacts. People living with activity limitations might have fewer opportunities to be satisfied with life or experience happiness, which can have a negative effect on their quality of life. Participation and environment are also important modifiable variables that influence community living and are targeted by health interventions. However, little is known about how quality of life, participation and environment differ according to activity level. This study examines if quality of life, participation (level and satisfaction) and perceived quality of the environment (facilitators or obstacles in the physical or social environment) of community-dwelling older adults differ according to level of activity.

METHODS

A cross-sectional design was used with a convenience sample of 156 older adults (mean age = 73.7; 76.9% women), living at home and having good cognitive functions, recruited according to three levels of activity limitations (none, slight to moderate and moderate to severe). Quality of life was estimated with the Quality of Life Index, participation with the Assessment of Life Habits and environment with the Measure of the Quality of the Environment. Analysis of variance (ANOVA) or Welch F-ratio indicated if the main variables differed according to activity level.

RESULTS

Quality of life and satisfaction with participation were greater with a higher activity level (p < 0.001). However, these differences were clinically significant only between participants without activity limitations and those with moderate to severe activity limitations. When activity level was more limited, participation level was further restricted (p < 0.001) and the physical environment was perceived as having more obstacles (p < 0.001). No differences were observed for facilitators in the physical and social environment or for obstacles in the social environment.

CONCLUSION

This study suggests that older adults' participation level and obstacles in the physical environment differ according to level of activity. Quality of life and satisfaction with participation also differ but only when activity level is sufficiently disrupted. The study suggests the importance of looking beyond activity when helping older adults live in the community.

Using an analytic framework to identify potential targets and strategies for ecologically based physical activity interventions in middle schools

The objective was to demonstrate the value of applying an ecological analytic framework to formative data in conjunction with ecological planning frameworks (e.g., intervention mapping) to ensure a high degree of ecological program integration as illustrated through a physical activity program for students in middle school. Eight focus groups were conducted with 38 students in four schools to examine student perceptions of who or what in their school made it easy or difficult for students to be physically active. Qualitative data were used to identify potential intervention targets according to the analytic framework. Frequency analysis revealed that most identified physical activity barriers/facilitators were associated with organization (59.4%) targets. Five different intervention strategies were identified, with organizational modification being most popular. Applying the analytic framework to formative data enabled us to identify potential targets, strategies, and activities for an ecologically based physical-activity-promotion program relevant to the priority population.

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.

What do Canadian seniors say supports their quality of life? Findings from a national participatory research study

BACKGROUND

A national project investigated seniors' perceptions of the influences upon their quality of life. The seven participating cities were Montreal, Quebec City, Ottawa, Toronto, Regina, Vancouver and Whitehorse. The project focussed on policy decisions affecting the quality of life of seniors. It was a participatory study in which seniors controlled the direction and shape of the project in each city.

METHODS

Focus groups and individual interviews with seniors and stakeholders. Data analysis used qualitative methods to see the world through the eyes of participants. Each project was committed to hearing the voices of seniors and their views on which issues were affecting the quality of their lives.

RESULTS

Across the seven cities, seniors highlighted access to information, health care, housing, income security, safety and security, social contacts and networks, and transportation as key issues that affect the quality of life of seniors in Canada.

CONCLUSIONS

The findings affirm the value of participatory activities that involve seniors working with other sectors as a productive policy-informing approach. The Seniors' Quality of Life projects demonstrate the conceptual power of the determinants of health perspective to understand seniors' quality of life issues. While seniors considered health care to be a continuing concern, they also recognized socio-economic issues as significantly affecting the quality of their lives.