Quality of Life of Seniors

Needs of Seniors

The aging of the population is associated with an increasing demand for services to seniors. This is occurring at a time of fiscal restraint when service providers are being encouraged to rationalize their activities. An idea which is gaining increasing acceptance is to address the quality of life of clients as an essential part of service delivery. More germane to public health practice is the interest in quality of life as a key concept in health promotion practice. The literature supports a distinction between normal, optimal, and pathological aging and epidemiological studies clearly identify factors such as life-style and social support as predictive of health. These factors may be considered as quality of life components.

The Quality of Life of Seniors Project

The Health Promotion and the Elderly Working Group of the North York Community Health Promotion Research Unit (NYCHPRU), a cooperative venture of the Centre for Health Promotion, University of Toronto and the North York Public Health Department, undertook the task of developing an approach towards assessing the quality of life of seniors living in the community. NYCHPRU is funded through a system-linked research grant from the Ministry of Health.

Development of the Quality of Life Profile: Seniors Version (QOLPSV) began with a series of twelve group meetings where seniors were asked: What does the term "Quality of Life" mean to you? and What are some areas of concern to seniors? These comments were collected and reviewed and developed into items for a self-report survey instrument. The draft instrument was reviewed by professionals and piloted by public health nurses with a number of seniors both in groups and during home visits. It consists of 111 items; 12 items in each of the first six sub-domains and 13 in the last three. The respondent provides ratings for each item both Importance and Enjoyment.

Validation Study

A validation study* was carried out with 205 seniors. We found the measure to be reliable and valid. We observed that seniors were concerned with specific areas related to their quality of life. For example, relatively low quality of life scores were reported for the areas of Practical, Leisure, and Growth Becoming, and specific items related to purpose and meaning, social relationships, and community involvement. We also found an association between quality of life and health status.

Implications for Public Health and Health Promotion Practice

The quality of life model and instrumentation can be used for a variety of purposes including assessment, program evaluation, planning, and stimulation of discussion for community action. These activities can have an individual or community-level focus.

More specifically, one application of a quality of life assessment is to use it directly in determining health and service needs. For example, in the validation study, relatively low quality of life scores were reported for the areas of Practical, Leisure, and Growth Becoming. These findings suggest priority areas among these respondents which could be addressed in the groups conducted by health departments. On the other hand, the relatively high scores of other items (e.g., personal safety or maintaining personal hygiene) suggested that although these areas should probably not be ignored by public health professionals, there is probably less need for focus.

Another application is to use it as a means of evaluating the impact of programs. If one of the goals of programs is to improve quality of life of seniors to whom its programs are directed, the measure should be an appropriate and important way to evaluate whether these programs have made a difference in people's lives.

Examples of Items in the Quality of Life Profile: Seniors Version

Respondent Rates Each Item for Importance and Enjoyment

Development of Short and Brief Versions of the QOLPSV

Short (56 item) and Brief (27 item) versions of the QOLPSV were developed and validated. These measures show strong evidence of reliability and validity and it appears that the two additional versions may be especially useful for research and screening purposes respectively. The Brief Version, for example, is currently being used as part of an evaluation of a wellness project in Southwestern Ontario and a home care program in Eastern Ontario.

Conclusion

The value of quality of life assessment is that it provides a conceptual framework for addressing health promotion goals. Our conceptualization of quality of life, because of its congruence with these current health promotion principles and goals, offers a highly appropriate framework through which such activities can be addressed. Since these principles and goals reflect widely-held values in the health field, it is also very likely that our conceptualization is highly appropriate to address the goals of a wide range of health programs and services.

Quality of life may be conceived as either a desired outcome of health promotion practice, or as a determinant of health among seniors, that is, differentiating between pathological, normal and optimal functioning among seniors. In either case, the focus upon, and assessment of quality of life appears to be a fertile area for public health planning and practice.

*Results of the validation study were published in:

Raphael, D., Smith, T., Brown, I., & Renwick, R. (1995). Development and properties of the short and brief versions of the Quality of Life Profile: Seniors Version. International Journal of Health Sciences 6, 161–168.

(reprints may be ordered from the publications page).