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

social activities and retaining a role in society; and having enough money to meetbasic needs, participate in society, enjoy life and retain one’s independence andcontrol over life. Many of these themes are relevant to people in all age categories,while some are particular to people in their later years.72However, older people do not comprise a homogeneous group; it is not possible togeneralise about the concept of quality of life for older people, given the variety ofcircumstances in which older people may live their lives. Quality of life will differfor able older people and for older people who may suffer from a physical or mentaldisability. Old age is often accompanied by increasing ill-health and decliningphysical and mental ability. The goal of health interventions for older people maybe to minimise the negative affects of infirmity and improve the person’s qualityof daily life rather than effect a cure. Some older people are unable to remain intheir own home due to increased frailty and difficulty coping with activities of dailyliving, and so require residential care. A further distinction may, therefore, have tobe made between dependent older people who live at home and dependent olderpeople living in residential care, as quality of life domains may differ between thetwo settings. It is important to recognise this heterogeneity when consulting olderpeople about the quality of their lives. As Kane (2003c) notes, older people whodo not require long-term care may have different and higher expectations for theirquality of life than recipients of long-term care.A universal quality of life measurement instrument, the World Health OrganisationQuality of Life Survey (WHOQOL-100) has been developed by the World HealthOrganisation (WHO). This instrument is applicable to quality of life among all age groupsand in all settings. In order to ascertain the factors that contributed to quality of life,the WHO consulted focus groups comprised of health professionals, and membersof the general population who were ‘healthy’ and those who were in receipt of healthservices. Six quality of life domains emerged from the consultation process. Thedomains ranged from health-related factors such as physical, psychological and levelof independence factors, which include aspects such as pain and discomfort, mobilityand self-esteem, to social factors such as social relationships and spirituality. Theenvironment also emerged as an important contributor to quality of life. The domainsreflect the multidimensional and all-encompassing nature of quality of life. Theyalso reflect the difficulty of measuring the concept of quality of life. While it may berelatively easy to observe and measure physical or environmental features, it provesmore difficult to measure self-esteem or the level of social support of an individual.An abbreviated version of this instrument – the WHOQOL-BREF (The WHOQOLGroup, 1998) has also been developed which includes just four domains as follows:physical health, psychological health, social relationships and environment.Improving Quality of Life for Older People in Long-Stay Care Settings in Ireland