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

Human needs may also provide part of the foundation for quality of life and thiscan be an important influence on the theory and practice of measurement (Bowling,2004; Raphael, 1996; Sirgy, 1986; Browne et al., 1997). A.H. Maslow’s A Theoryof Human Motivation (1970) outlines a needs-based approach to measuring qualityof life that adopts a hierarchical stance. At the bottom of the hierarchy are basicneeds which are physiological, followed by safety and security needs. These needsare deemed to be essential for human survival and it is not until they have beenfully satisfied that an individual will seek to fulfil higher level needs. When thephysiological and safety needs have been gratified, then love, affection andbelongingness needs will emerge. These include the need for affectionaterelationships, for example with family and friends. When this need is satisfied,the individual will strive to fulfil esteem needs which include a feeling of selfrespectand self-confidence and the gaining of the respect of others. Finally,Maslow maintains that even if all of these are met, an individual will not be atpeace until they have fulfilled the need for self-actualisation, i.e. ‘the individualis doing what h/she, individually, is fitted for’ (Maslow, 1970). In other words,the individual must be able to realise and express his full potential, whateverthe circumstances; what Sen (1993) might describe as maximising capabilities.The consideration of quality of life in terms of human needs provides a usefulframework for understanding the interplay of objective and subjective componentsof quality of life and why people’s perceptions of quality of life may change overtime. Bowling (2004) believes that the objective approach to measuring qualityof life is fundamentally a needs-based approach (which assumes that individualshave basic needs) and the satisfaction of these needs determines an individual’swell-being. Therefore, as a society becomes more affluent and basic needs (e.g.physiological, comfort, safety and security) are met, subjective indicators of qualityof life may grow in importance (Gentile, 2001). Therefore, quality of life may bemore accurately measured or defined as an individual’s evaluation of their perceivedwell-being or satisfaction with life.693.4 Assessing Quality of Life for People with DementiaA particular challenge arises in the measurement of the quality of life of people withdementia. Any framework adopted for measuring the quality of life of residents musttake account of the needs and limitations of people suffering from dementia(Lawton, 2001). It is often assumed that dementia patients are incapable of