Care-related quality of life in old age

Promoting quality of life is a central theme in recent ageing policies, but what quality of life means in concrete terms for people in different stages of old age is rather unclear. This study presents a multi-dimensional model of care-related quality of life (crQoL) and, based on analyses of three Finnish cross-sectional datasets from the years 2004–2007, examines the distinctions between dimensions of QoL by age and gender, with a special focus on older home care clients. Correlation analyses (Pearson) and stepwise linear regression were applied to analyse variation in QoL by age group and the association between QoL and perceived quality of home care. The results suggest that individual QoL and the priorities of (physical, psychical, social, and environmental) dimensions in the assessment of QoL by older persons vary considerably and exhibit distinct profiles in different stages of ageing. In addition, four dimensions for good care corresponding to the crQoL model were identified and their empirical relevance demonstrated. From the perspective of older people in need of help, home care is not just about giving them the instrumental help they need to perform their daily activities, but rather about giving responsive care that reflects their personal preferences or their view on a “good life”, and treats them with dignity and respect. The criteria for the evaluation of quality of home care should reflect these insights, and policy measures should take these differences into account.     

Profiles of functioning as predictors of mortality in old age: The advantage of a configurative approach

This study proposes the concept of functioning profile, by which one's status is summarized across essential functioning domains, and validates its efficiency in predicting mortality. The study analyzed data of two cohorts of community-dwelling Israelis aged 75 and over, nationally sampled in 1989 (N = 1200) and 1999 (N = 421), respectively. Eight groups with differential profiles reflected higher versus lower levels of functioning in three domains: physical (activities of daily living), cognitive (Orientation-Memory-Concentration test = OMC) and affective (depressive symptoms). The analyses predicted mortality within 4 years, adjusting for sociodemographic and health variables. Relative to the optimal profile, most functioning profiles represented groups having elevated mortality risks of considerable consistency across cohorts. Physical functioning was the most predictive component in the profiles, but its combinations with cognitive and affective functioning produced unique contributions to mortality prediction. The study suggests that the functioning profile, representing a person-centered configurative approach (i.e., one that considers the person's combined standing on key factors), is a useful concept for delineating risk groups in late life and evaluating risk factors in predicting mortality.     

Meaning in life in three samples of elderly persons with high cognitive functioning.

The study examined the relationships between meaning in life and cognitive functioning in three elderly samples. The participants in Sample I were 78 persons aged 82-87, in Sample II 182 persons aged 83-92, and in Sample III 299 persons aged 65-69. The samples took part in interviews and cognitive tests in 1996-1997. Several interview questions together with the Sense of Coherence questionnaire were used to study the degree and content of meaning in life. Cognitive functioning was measured by Digit Span, Digit Symbol, and Word Fluency in Sample I and Mini-D in Samples II and III. Each sample was divided into the group of persons with high cognitive functioning (including those whose results in cognitive tests fell in the top third of their age cohort) and the comparison group (including the rest of the sample). The analysis showed no difference between the groups in the degree of meaning in life in any of the three samples. The content of meaning in life differed in the two groups: human relationships were reported as a reason for meaning in life and a source of strength in life more often by the persons with high cognitive functioning than by the comparison group. Moreover, those with high cognitive functioning reported that they had taken up a new activity (especially one involving social interests) that gave a sense of meaning in life after retirement more often than the comparison group. Death had positive meaning for the majority of the participants and the groups did not differ in meaning of death. The interactions between the various measures of meaning in life showed that having a sense of coherence and zest for life were factors related to the sense of meaningfulness in life. Meaning of death was not related to other measures.     

A European perspective on quality of life in old age

This article focuses on the scientific study of quality of life in old age and summarises, on the one hand, what we know and, on the other, what further research is needed. It consists of three main parts, with an extended introduction charting the recent evolution of a European perspective on ageing. First of all, it emphasises the amorphous, multidimensional and complex nature of quality of life and the high level of inconsistency between scientists in their approach to this subject. Secondly, the article summarises the main areas of consensus about quality of life in old age—its dynamic multifaceted nature, the combination of life course and immediate influences, the similarities and differences in the factors determining quality of life between younger and older people, the most common associations with quality of life and the likely variations between groups, and the powerful role of subjective self-assessment. Thirdly, the main research priorities and gaps in knowledge are outlined, together with the key methodological issues which must be tackled if comparative, interdisciplinary research on quality of life is to develop further. The main sources for the article are two European Framework Programme projects—the one a small five-country comparison and the other a large multidimensional project which, among other things, has been developing recommendations for research on quality of life in old age and included an extensive literature review on this topic. The article also draws on the recently completed UK Growing Older Programme of research on extending quality of life. This article was previously published with DOI s10433-005-0015-8, which was mistakenly created twice and has therefore been replaced by the current DOI. I would like to thank very warmly the following for their help with this paper: Ann Bowling, Joe Cook, Rocio Fernández-Ballesteros, the EJA’s anonymous referees, and all of the participants in the FORUM project quality of life workshops.     

A European perspective on quality of life in old age

This article focuses on the scientific study of quality of life in old age and summarises, on the one hand, what we know and, on the other, what further research is needed. It consists of three main parts, with an extended introduction charting the recent evolution of a European perspective on ageing. First of all, it emphasises the amorphous, multidimensional and complex nature of quality of life and the high level of inconsistency between scientists in their approach to this subject. Secondly, the article summarises the main areas of consensus about quality of life in old age—its dynamic multifaceted nature, the combination of life course and immediate influences, the similarities and differences in the factors determining quality of life between younger and older people, the most common associations with quality of life and the likely variations between groups, and the powerful role of subjective self-assessment. Thirdly, the main research priorities and gaps in knowledge are outlined, together with the key methodological issues which must be tackled if comparative, interdisciplinary research on quality of life is to develop further. The main sources for the article are two European Framework Programme projects—the one a small five-country comparison and the other a large multidimensional project which, among other things, has been developing recommendations for research on quality of life in old age and included an extensive literature review on this topic. The article also draws on the recently completed UK Growing Older Programme of research on extending quality of life. This article was previously published with DOI s10433-005-0015-8, which was mistakenly created twice and has therefore been replaced by the current DOI. I would like to thank very warmly the following for their help with this paper: Ann Bowling, Joe Cook, Rocio Fernández-Ballesteros, the EJA’s anonymous referees, and all of the participants in the FORUM project quality of life workshops.     

Morbidity and physical functioning in old age: differences according to living area

OBJECTIVES: To describe differences in morbidity and functional status according to living area. DESIGN: Community‐based survey. SETTING: A community‐based prospective cohort, the Kungsholmen‐Nordanstig Project. PARTICIPANTS: Adults aged 75 and older living in an urban area of central Stockholm (n=1,222) and in the rural community of Nordanstig in northern Sweden (n=919). MEASUREMENTS: Physicians clinically examined all participants using the same standardized protocols in both living areas; trained nurses directly assessed disability. RESULTS: Cardiovascular disease was the most common disorder in both living areas (39.9% in the urban area and 45.2% in the rural area). There were great area differences in the prevalence of stroke (7.4% and 14.0%), diabetes mellitus 6.3% and 16.1%), and Parkinson's disease (1.0% and 3.7%). It was more common to have two or more diseases than no diseases in the rural area than in the urban area (odds ratio=1.9, 95% confidence interval=1.4–2.4). Significant living area differences (urban vs rural) in population attributable risk (PAR) was found for disability due to stroke (5.6 vs 32.2), diabetes mellitus (1.2 vs 6.1), fractures (1.4 vs 10.7), and hearing impairment (8.7 vs 22.0). CONCLUSION: Differences were found in disability, morbidity, and disease patterns according to living area. The rural elderly population was more disabled and had more diseases than the urban elderly population, despite being slightly younger than the urban cohort. There were significant area differences in the PAR of how specific chronic conditions influenced the risk of disability.     

Joannes Stobaios, "On old age": an important source for the history of gerontology

Literary and medical writers have written about elderly people—their health, constitution, and treatment—since the dawn of history. The dramatic demographic changes that have taken place within industrial nations in recent times have certainly imparted this theme with a heretofore-unknown explosiveness.
Joannes Stobaios' (5th c.) three chapters "On old age" have long been largely unappreciated in the history of gerontology and geriatrics. This late Ancient author collected numerous citations from other, earlier authors who lived between 800 BCE and 400 CE and brought them together thematically in an anthology of monumental scope. The work contains the only versions—albeit sometimes fragmentary—of many texts now otherwise lost. This is also true for the gerontological writings; Stobaios proved that, as early as the end of the Ancient period, an appreciable corpus of relevant texts existed, of which only very little—excepting Cicero's well-known text "On old age" ( Cato maior de senectute )—survived into the modern period. These texts reveal that the question as to whether old age is a burden or a joy is ancient and evidently insoluble. This article presents the gerontological aspects of Stobaios' work and places them in their historical context. This will demonstrate that Stobaios was also a defender of seniority who made clear the value, as well as the tasks and ethical duties, of this phase of life. From the Ancients' perspective, this was not a medical but a moral obligation.     

Meaning of quality of life for older adults: Importance of human functioning components

This study explored the perceptions and lived experience of community-dwelling older adults about their quality of life (QOL) in regards to personal factors, social participation and environment. A qualitative design was used to extend existing work on QOL focusing on human functioning components and advanced QOL conceptualization. Based on a semi-structured interview guide, two individual in-depth interviews were conducted with 18 participants (aged 63–92; 12 women) having various levels of ability and QOL. Personal factors, such as health, inner life and behavioral abilities, were found to be essential for QOL. Being occupied and doing activities associated with good health habits are also important. Accomplishment of social roles is, for the majority of participants, more significant than daily activities. The physical and social environment must be adapted to the person's needs and preferences. Participants’ perceptions differed only slightly according to their ability and QOL levels. Findings show the critical role of adaptation to disabilities and aging for better QOL. A sense of control over one's own life also has beneficial effects. These results point up the importance of considering perceptions about personal factors, social participation and environmental factors in older adults’ QOL. Other theoretical as well as methodological implications for further QOL study are highlighted.     

Cognitive functioning in the last year of life as a function of age, gender, and race.

Research has shown that many factors affect cognitive functioning. In this study cognitive functioning was analyzed using proxy reports concerning 17,135 decedents included in the 1993 National Followback Mortality Study conducted for the National Center for Health Statistics. These responses form a representative sample of all U.S. residents over age 15 who died in 1993 (except for those in South Dakota, which did not participate). Decedents had more difficulty understanding where they were than remembering what year it was or in recognizing family members. Logistic regression models found that age, gender, and race were the most important predictors of these basic cognitive functions. Although increasing age was associated with more cognitive difficulties, men had fewer deficits than women and Black Americans tended to have fewer deficits than White Americans. Possible reasons for these findings are discussed as well as some general implications for health service provision.