Improving Quality of Life for Older People in Long-Stay Care ...

In a study of quality of life in nursing homes in the USA, Kane treated residents’own reports as the gold standard for quality of life because, in her view, quality oflife is inherently subjective (Kane, 2003b). However, she does not advocate theexclusive use of subjective measures as they may be subject to bias (Kane, 2003c).Self-report measures of quality of life may have to be treated with some degreeof caution for a number of reasons: residents may be reluctant to criticise nursinghome facilities or staff upon which they are dependent (Kane, 2003c; Raphael,1996; Clark and Bowling, 1990; Bowling et al., 1991; Bowling and Formby, 1992;Cohn and Sugar, 1991); they may not wish to appear ungrateful or unappreciativeof the service offered; residents who have been in the home for some period oftime may become desensitised to their conditions or lack knowledge about whatconstitutes an acceptable standard of quality of life and view their conditions asadequate (Kane, 2003c); and Lawton (1983) points to the fact that the tendency ofpeople to assert their satisfaction may be accentuated in older people. Therefore,objective views on a resident’s quality of life may also need to be garnered fromstaff, family or the direct observation of researchers.68A discrepancy between appraisals of quality of life may occur due to differingagendas and perspectives. Cohn and Sugar (1991) found clear differences in theways in which nursing home residents, staff and families defined quality of life.They suggest that groups tended to define quality of life in terms of domains thatvalidated their roles (Cohn and Sugar, 1991). It may be that salience is also a factor,with groups emphasising those areas for which they hold responsibility or withwhich they are most familiar. While medical experts judge quality of life basedon physical and functional impediments of a person, the individual concerned willconsider other aspects of life when evaluating their quality of life (Bond and Corner,2004; Gentile, 1991).Berglund and Ericsson (2003) conducted a study to compare meanings of quality oflife as defined by older people and geriatric staff. Their results revealed a variationbetween what the two groups judged to be important for quality of life. Geriatric staffover-emphasised two of the categories – health and social network. The older peopleplaced more emphasis on subjective factors such as ‘being appreciated’ and ‘living agood life’. The authors feel that this evidence underscores the importance of includingthe views and opinions of older people in care planning. This is a view supported byKane (2003b; 2003c) and Tester et al. (2004). Therefore, subjective indicators areneeded in the setting of policy goals, based on what people need and want. Objectiveindicators alone do not provide sufficient information. Haas (1999b) recognises theimportance of objective indicators of quality of life but believes that they should beused to complement subjective indicators which are a more direct measure.Improving Quality of Life for Older People in Long-Stay Care Settings in Ireland