A report by Garavan, Winder and McGee (2001) Health and Social Services for Older People, Consulting Older People on Health and Social Services: A Survey of Use, Experiences and Needs concluded within its findings that older women viewed that they had a low quality of life.
Stuart-Hamilton (2000) states that an element within the ageing concept is that men for varying reasons die at a greater rate than women after the age of 70 and that therefore it could be concluded that the ageing experience could be a longer process for women.
The elderly population in Ireland is increasing in that according to Connell & Pringle (2004) the projected population of older women in 2021 is expected to be between 375,000 and 389,000 which would indicate a rise of over 50 per cent from that in 2002.
“Ageing can be defined as the process of progressive change in the biological, psychological and social structure of individuals …aged 60 or over” (Stein and Moritz, 1999;4).
According to Greenstein (2006) social research is abstract in general in that the concepts are not easily measured because of the subjectivity of the topics and that a way of gaining a vague measure within the research is to ask the participants their level of satisfaction or dis-satisfaction in relation to the sub-themes.
Ageing has a direct biological decline and because of this quality of life has been regarded to be directly linked by the health of the person versus ill-health. But health being defined by the World Health Organisation cited in (Bond and Corner, 2004:2) ” as a state of complete physical, mental and social wellbeing” have resulted in the concept that quality of life is much more complex and varied depending on other factors rather than being traditionally associated solely with health (Bond and Corner, 2004).
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Definition of Quality of Life
Quality of life is not scientifically measureable in that it is very subjective to the individual depending on their experiences of ageing and that the terms well-being and life satisfaction are often used as a means of gaining an insight into the degree a person views that they are experiencing quality of life (Vincent, Phillipson and Downs, 2006).
Research has shown that quality of life is subjective to the person, Abrams (1973) cited in (Bond and Corner, 2004:4) defines quality of life “as the degree of satisfaction or dissatisfaction felt by people with various aspects of their lives”.
This literature review will act as a base for a thesis that will explore the views of older women in Cavan as to the factors that contribute to quality of life.
The definition of what is quality of life is not easily determined and many authors offer different domains as the priority but in fact the priority will be subjective to what the individual older person measures as the most important aspect to them (Nay and Garratt, 2009).
There has been much focus on what is quality of life in recent years in terms of social policies that have in turn directed service provision and providing care that is impacting positively on a person’s quality of life according to Vincent et al (2006).
Quality of life according to Nay and Garratt (2009) typically measures general health, physical, cognitive, sexual and emotional functioning while also measuring the happiness of the person but it is subjective to the person in that what one person views as important may differ from another person. Factors such as employment, social networks, social activities, self-identity, financial security and cognitive and physical function are considered to impact on quality of life (Renwick et al (2003) cited in Nay and Garratt, 2009).
Also that quality of life in relation to older people is often used as an assessment measure of whether a service is supporting the needs of its clients in that it is not just a measure of quantity of life but that the life has quality within it so that the outcomes of supports or services are impacting positively on quality of life (Nay and Garratt, 2009).
That measurement of quality of life is sometimes measured within one domain such as general health while others measure cover several domains. But in general the largest measurement of quality of life is the concept that it is directly connected to the health of the person and their satisfaction regarding their health (Nay and Garratt, 2009). Therefore “Health Related Quality of Life” is a term that is often used by service providers as a directive for their care provision (Nay and Garratt, 2009:352).
Focusing quality of life within the domains of general health can create what is called the “disability paradox” in that older people rather than viewing their decline in health as an indicator of low quality of life that the expectation of inevitable physical and health decline has resulted in other factors such as social networks and their overall well-being as the domains used to measure their view of quality of life and that it is presumptuous to view that general health is the sole measure of quality of life (Carr and Higginson, (2001) cited in Nay and Garratt, 2009:353).
According to Vincent et al (2006) people will view health, social networks and standard of living as important factors within their lives but that the importance of the factors will vary as the person proceeds along their life course.
Research sources have shown the complexity in defining the key factors within quality of life and the initial reading by the researcher highlighted that the many elements could be loosely grouped within three sub-themes in relation to quality of life: (1) physical factors – general health and physical mobility, (2) economic factors – income, and standard of living and (3) social structure factors – social networks, cultural environment but further reading has emphasised that even though these concepts are applicable that expanding them further will allow greater exploration and description.
In that according to Stuart-Hamilton (2000) that focusing on a narrow of domains could result in some domains appearing more important within the research than they possibly are.
That domains such as health, income, and environment have an impact on a person’s life satisfaction in general and are all inter-related but that the personality of the person will also impact on the how they measure their life satisfaction (Stuart-Hamilton, 2000).
Walker (2005) suggests that as quality of life has no distinct key factors that most research focuses on health, environment, employment and relationships. That the environment has within it the physical, social, cultural and economic elements that can either enhance or reduce quality of life. Health has within it general health and the physical, mental and emotional health of the person. Employment covers income and can be related to the wealth of the person.
The key concepts with regard to quality of life as suggested by Hughes (1990) cited in Bond and Corner (2004) are:
(1) Physical environmental factors which include quality of accommodation, access to public services such as shops, transport and other public services such as libraries and other leisure outlets.
(2) Social environmental factors which include family members, social networks, the level of support obtainable from family and social networks and the levels of leisure activities that the person is involved in.
(3) Socio-economic factors which include the general standard of living, the income available to the person and other means of wealth.
(4) Cultural factors which include the age, class, gender and religious leaning of the person.
(5) Health factors which include general health, mental well-being of the person and physical mobility.
(6) Personality factors which include whether the person is an optimist or pessimist, will all impact on the subjectivity by the person on their measure of life satisfaction.
(7) Autonomy factors which include the degree that a person has the capability to make their own decisions.
(8) Satisfaction subjective to the individual – the level of satisfaction over all the areas of their life that they judge as important.
There is no definitive on what factors contribute to quality of life, therefore (Arnold (1991); McDowell & Newell (1996) cited in Nay and Garratt 2009:355) suggest that the measurement of quality of life should include
“objective indices such as economic circumstances and housing, those that measure subjective aspects such as morale, happiness and life satisfaction and those that contain both objective and subjective components, such as health related quality of life”
But according to Bond and Corner (2004) the subjective and objective aspects are interrelated an illustration of this being in that the objective element of health related quality of life could be subjectively not important to the older person who as of yet has not experienced any health issues that they view as impacting on their quality of life.
There is a view according to Stuart-Hamilton (2000) within society that the busier the life of an older person the more quality of life that they have. That the subjective measure of life satisfaction can be directly linked to the activities that an older person participates in that give a meaning to their life can be directly linked to one of the theories of ageing – Activity Theory (Bond and Corner, 2004). That an indicator of life satisfaction can be the degree that an older person maintains activities within their community, in that the more activities indicate higher levels of life satisfaction. Bond and Corner (2004) disagree and agree with elements of this theory in that they state that although social networks and activities can maintain and support physical and mental health such as reducing depression that ageing has a biological element that can impact on health and reduces an older persons social network as confidantes become ill or eventually die and that it is wrong to expect an older person to engage in levels of activities to the degree that they did when they were much younger. Stuart-Hamilton (2000) suggests the concept that engaging in activities for the sake of them does not allow the older person the ability to make their own choices and that within the provision of services for older people that by assuming that any activity is better than none could be directly linked to the application of Disengagement theory whereby it is believed that the older person accepts that death is eventual and therefore prepares for death by choosing to dis-engage from society and that also it has a function of reinforcing the expected process of ageing in Western Society.
Personality:
And its link to health:
One element within a person’s personality is that it will relate to their choices with regard to their lifestyle such as diet, exercise all which can aid the life expectancy of a person but what if the person’s personality has within it a negative outlook will this impact on how they view the ageing process and the biological decline and that rather than trying to improve their physical well-being by a healthier lifestyle that they approach death and illness as unavoidable and then reduce their activities and disengage from society (Stuart-Hamilton, 2000).
Link between psychological well-being and personality and health:
Research has shown a link between physical well-being and mental well-being in that according to Whitbourne (1987) cited in Stuart-Hamilton (2000) people that exercised and had levels of what they measured as physical well-being had a general feeling of overall well-being but therefore could it be said that people that have a poor physical well-being are more less satisfied with life (Stuart-Hamilton, 2000).
Personality:
Preference for lifestyle link:
That the personality of a person whether they are an introvert or extrovert will also impact on the lifestyle they choose in that if they are an introvert it will probably follow that as they are older that they will not seek out social activities (Stuart-Hamilton, 2000).
Disengagement theory Cumming and Henry, (1961) as cited in Stuart-Hamilton, (2000) suggest that as people get older that they automatically start to disengage from society in degrees as if in preparation for death and this is also supported by society in that the structures have come to expect this disengagement. This disengagement according to Stuart-Hamilton (2000) can be as a result of many factors such as illness, loss of family members, low income that does not provide for activities and also their personality type in that what if they are introvert or extrovert and that disengagement theory has been criticised for the overall image that older people are cutting ties with society in preparation for inevitable death. According to Maddox (1970) cited in Stuart-Hamilton, (2000) this disengagement may simply be a an aspect of the person’s personality and that it is not an element of ageing at all. Merriman (1984) cited in Stuart-Hamilton (2000) also criticises disengagement theory and states that ageing policies within many countries encourage that older people have an high profile within their community.
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Activity theory was proposed as a way of combating disengagement theory according to Stuart-Hamilton (2000) in that it was proposed that the more activities that an older person engaged in the better their life satisfaction. But this does not allow for choices for the older person and what if their personality is such that enforced activities is wrong (Stuart-Hamilton, 2000).
Issues related to measuring Quality of Life
There are issues relating to the measurement of quality of life in that the domains are both subjective and objective. The “objective indices, such as economic circumstances and housing; those that measure purely subjective aspects, such as morale, happiness, and life satisfaction; and those that contain both objective and subjective components, such as Health Related Quality of Life measures” (Arnold, (1991) cited in Nay and Garratt, 2009:355).
Vincent et al (2006) agrees that there are both objective and subjective domains but unlike Nay and Garratt (2009) attributes social factors within the objective domains by stating that the number of social networks that a person has is objectively measureable but that the quality of these social networks is a subjective element. Likewise Vincent et al (2006) states that health although measureable in terms of whether an illness was present and therefore objectively measureable that the domain is also subjective in that the importance of health to quality of life will depend on what the individual views health to be.
The view by Vincent et al (2006) that the meaning of what is health is subjectively defined by the individual is illustrated by the “disability paradox” as per (Carr and Higginson, (2001) cited in Nay and Garratt, 2009:353). In that older people rather than viewing their decline in health as an indicator of low quality of life in that the expectation of inevitable physical and health decline have resulted in other factors such as social networks as the domains used to measure their view of quality of life and that it is therefore presumptuous to view that general health is the sole measure of quality of life (Nay and Garratt, 2009). Anderson & Bury (1988) cited in Vincent et al (2006) state that people can adjust to illness and develop coping skills so that the illness no longer factors as a significant domain to the person and this would therefore affect the measurement of health within quality of life research. Health and physical functioning as an objective measure in the domains of quality of life are mentioned continually and can in its simplest form according to Nay and Garratt (2009) be that if a person has a condition or range of illnesses be considered to have a low quality of life. But what if the adjustments suggested by Anderson & Bury (1988) cited in Vincent et al (2006) were accommodations such as medication or lifestyle changes and were to adjust how the illness impacts on the person could it then be considered that although the health status remains the same but that the accommodations have resulted in the meaning of what is health to not be defined by illness or physical functioning. Therefore in relation to this research the aim is to explore the subjectivity of what the participant views as health and if any accommodations have impacted on the meaning of what is health.
Economic factors such as standard of living are objectively measured according to Nay and Garratt (2009) in that income can be an indicator of a standard of living but according to Vincent et al (2006) this objective measure has to be balanced by the subjective measure of what is the expectation of a standard of living and according to Stuart Hamilton (2000) will be directly linked to past experiences of standard of living in that if a person has in the past had a particular standard of living the subjective measure will be linked to whether the same standard of living was expected by the person or not. Therefore in relation to this research with regard to economic factors as a domain within quality of life previous standard of living and expectations of standard of living as an older person and direct experience will be explored.
According to Vincent et al (2006) quality of life has no scientific measurement that can define the exact objective degree of quality of life because there are so many variations of what is quality of life. That the experience of life may support or contradict what the objective measure describes as quality of life.
Qualitative and Quantitative Methods:
Quantitative methods are often the means of gaining information regarding what is quality of life but using quantitative methods will not allow for the subjectivity of individual experiences and their views on quality of life. That using structured questionnaires still conform to the researcher’s view of quality of life and does not allow for the exploration of the views of the older person. That these approaches do not allow for the “symbolic nature and meaning of life to the individual (Vincent et al, 2006:158). Taking the view that as the person proceeds along the life course that their view of life will remain the same.
Stuart Hamilton (2000) suggests that the life course?????
Another challenge in relation to measuring quality of life and with particular reference to older people is that there can be such differences between each person in that as they age the experience in relation to physical, social, emotional, sexual and cognitive functioning is not as homogenous an experience and that these differing experiences will impact on what factors are key to quality of life (Stewart et al (1996) cited in Nay and Garratt, 2009).
The setting that the older person lives within will impact greatly on the factors that are viewed as contributors to quality of life in that if a person is living within a residential unit that this group orientated setting will have different routines and rules in comparison to an older person living within community in general, and that for those within a residential setting that research has shown that “dignity, self-determination and participation and accommodation of resident needs” were considered to be the factors that impacted on quality of life (Nay and Garratt, 2009:357).
That measurement of quality of life needs to consider the domains that are considered contributors within quality of life and that how the research is conducted in that the way that questions are asked can create a bias. As already stated biological decline is a natural aspect of ageing therefore if an indicator of quality of life were to be considered the level of physical functioning it would be inappropriate to ask the participant if they were physically able to do as much and for as long as they used to when they were younger and that this would not be a realistic indicator of quality of life according to Nay and Garratt, (2009).
Measurement tools are World Health Organisation Quality of Life Instrument (whoqol) (Skevington et al 2004), cited in Nay and Garratt, 2009.
Conclusion
This literature review has explored the concept of quality of life and that the factors that are considered to contribute to quality of life are varied and can contain subjective and objective components and that older people in order to measure quality of life should not be viewed as a homogenous group.
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