Quality of life among older people. Their experience, need of help, health, social support, everyday activities and sense of coherence
Abstract: The overall aim of this thesis was to investigate QoL and Health-Related QoL (HRQoL) among people aged 75 years and over in relation to socio-demographic variables, need of ADL help, various degrees of present QoL, self-rated health (SRH), health complaints, everyday activities, social support and sense of coherence (SOC). A further aim was to test a QoL scale and to illuminate older people's experience of QoL. Data were collected by questionnaires sent to a population-based sample and by an interview study. Study I comprised 469 people (83.2, SD 5.7). In study II 1,093 people (82.7, SD 5.3) participated, whilst study III comprised of 385 people (84.6, SD 5.7). Eleven people aged 80 years and over participated in an interview study (Paper IV). Quantitative data were analysed by descriptive, comparative, correlation statistics and by a two-step cluster analysis, multiple linear regression and factor analyses. The qualitative data were analysed inspired by the hermeneutic phenomenological method. Health complaints such as pain, fatigue and mobility impairment (Paper I) predicted low QoL and HRQoL. Reporting fair and poor SRH, not spending time outdoors and being nervous and/or worried also proved to predict low QoL whilst SOC and social support positively influenced QoL (Paper III). Women reported more health complaints (Paper I) and were more vulnerable in terms of having lower QoL and HRQoL than men (Papers I?II). The same vulnerability in terms of low QoL and HRQoL was found among those in need of ADL help in comparison with those not needing such help. Those needing ADL help as well as women additionally had lower scores in several of the separate QoL areas (Paper II). The construct and cross-validation of the QoL instrument showed that eight out of ten primordial QoL areas were replicated. The instrument differentiated between those in need of ADL help and not, as well as between gender (Paper II). In paper III, three groups, high, intermediate and low present QoL were identified through cluster analysis. Half of the sample were at risk or had low present QoL. The most notable differences were found between those with high (47.8%) and low (18.4%) present QoL, especially in terms of total QoL, SRH, health complaints, social support, physical activities and SOC. The oldest most vulnerable people constituted those with low present QoL, whereas those with high present QoL shared several features with ?successful ageing?, excellent or good SRH, physical activity, low frequencies of health complaints, high total QoL and SOC. Those with intermediate present QoL (33.8%) differed from those with high present QoL in various ways but were less exposed in several respects than those with low present QoL (Paper III). The interviews (Paper IV) revealed that QoL in old age meant a preserved self and meaning in existence. How QoL was valued depended on the meaning the people attached to the areas of importance for their QoL. Their ability to adapt was also found to be important for how they evaluated their QoL. Areas not generally included when measuring QoL quantitatively, such as the meaning of home and philosophy of life, became discernible. Health complaints such as pain mobility impairment, fatigue and being nervous and/or worried as well as reporting fair and poor SRH together with not spending time outdoors had a negative influence on QoL, However, social support and SOC had the opposite influence on QoL among older people. Women and those dependent on ADL help reported lower total QoL as well as HRQoL but also lower scores in QoL areas outside health and physical functioning. The tested QoL instrument were reasonably stable and differentiated between being and not being in need of help as well as between women. Within the group of independent seemingly healthy older people, there was a group reporting low to very low present QoL. The lower present QoL could be a manifestation of the ageing process but perhaps also of less adaptive resources. QoL in old age meant a preserved ?self? and ?meaning? in existence. Areas not generally included in QoL measures were included in the older people's evaluation of their QoL.
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