Mary Kalfoss

The conceptualization and measurement of quality of life in older adults: a review of empirical studies published during 1994–2006

Instruments with acceptable measurement properties that support their application to older adults across a range of settings need to be identified. A narrative literature review of empirical studies investigating the conceptualization and measurement of quality of life (QoL) among older adults from 1994 to 2006 was performed. The review focused on evidence provided for conceptual frameworks, QoL definitions, types of measurements utilized and their psychometric properties. Two searches were conducted. The first search conducted in 2004 used Cinahl, Medline, PsycInfo, Embase and Cochrane databases. A supplemental search was conducted in December 2006, which included these bases from 2004 to 2006, and Sociological Abstracts and Anthropological literature base. The review included 47 papers. A total of 40 different measurements were applied in the studies, assessing most frequently functional status and symptoms. The most extensive psychometric evidence was documented for the SF-36. Although construct validity was reported in the majority of studies, minimal empirical evidence was given for other psychometric properties. Further, 87% of the studies lacked a conceptual framework and 55% did not report any methodological considerations related to older adults. Quality control standards, which can guide measurement assessment and subsequent data interpretation, are needed to enhance more consistent reporting of the psychometric properties of QoL instruments utilized. Future work on the development of common QoL assessment models that are both person-centered, causal and multidimensional based on collaborative efforts from professionals interested in QoL from the international gerontological research community are needed.

Quality of life model: predictors of quality of life among sick older adults.

The aim of this study was to explore how depressive symptoms, physical function, health satisfaction, age, and environmental conditions predict quality of life (QoL) in a conceptual model based on the Wilson and Cleary’s Model (WCM). A stratified sample by age, gender, and living area was drawn from the Norwegian population of older adults receiving community health care (mean age of 78.6 years, 94.4% living at home, 5.6% living in nursing homes). The study is part of a larger international study. Face-to-face interviews were conducted using the WHOQoL-Old, the WHOQoL-Bref Environment domain, the Geriatric Depression Scale, the Short Form SF-12, and sociodemographic and health questions. A path analysis (structural equation modeling) showed that the overall model provided empirical evidence for linkages in the WCM. QoL was manifested by significant direct effects of environmental conditions and health satisfaction. In addition, environmental conditions had indirect effects on QoL, in particular via depressive symptoms and health satisfaction. This model may help nurses in community health care to collect and assess information, to suggest suitable interventions, and to guide decision making.

Quality of life of older adults in Canada and Norway: Examining the Iowa model.

In this study, Glick and Tripp-Reimers (1996) Iowa model for gerontological nursing serves as a guiding framework for a descriptive exploratory study of quality of life (QOL) of older adults. Using secondary data, the authors explored whether the effects of health appraisal, morbidities, social support transitions (SST), and the environment on QOL would be partly mediated by cognitive developmental transitions (CDT). Data sets were available from studies with random samples of community-dwelling older adults from Canada (n = 202) and Norway (n = 490). The partly and fully mediated effects found suggest positive CDT in older age might be significantly enhanced by the presence of intimate ties, positive perceptions of ones health limitations, and residence in a healthy, safe, and resource-rich physical environment. These findings represent a novel attempt at testing complex linkages between aspects of elder, environment, and nursing concepts within the Iowa model warranting further research.

Reliability and validity of the Norwegian WHOQOL-OLD module

The aim of this study was to examine the validity and reliability of the Norwegian WHOQOL-OLD six-facet, 24-item module designed for assessing generic quality of life cross-culturally among the elderly. Using quota-stratified sampling defined on the basis of sex, age and geographical representation, 401 respondents were drawn from Statistics Norway and completed postal surveys. An additional 89 elderly completed personal interviews. Correlation and multivariate analyses partly confirmed the relevance of individual items and facets in both groups. All items correlated significantly higher with their original facets, although almost half of these items correlated with other facets in both groups. Multiple regression analysis of the module and two overall questions (dependent variables) showed that three facets made significant contributions to overall health, with Social Participation (B = 0.09) contributing most strongly in the postal-group. In the interview-group, only Social Participation (B = 0.20) was found to make a significant contribution, and this was in relation to overall health satisfaction. When the WHOQOL-BREF total score was considered as the dependent variable, different facets contributed significantly in both groups. Exploratory factor analysis of the WHOQOL-OLD in the combined group of both postal and interview samples, resulted in a five-factor solution (eigenvalues >1) explaining 65% of the cumulative variance in five of the six originally operationalized facets. The most conceptually clear facets were Death and Dying and Sensory Abilities. Further, confirmatory factor analyses in the combined group demonstrated a model with good fit, but with high covariance between the factors. Acceptable internal consistency was shown except for the Past, Present and Future Activities in both groups. Since construct validity was only partially confirmed, exploration of the scales conceptual validity needs further testing in Norwegian and international samples.

Important Issues to Quality of Life Among Norwegian Older Adults: An Exploratory Study

The increasing numbers of older people and higher expectations of a “good life” within societies, has lead to international interest in the enhancement of quality of life (QoL) among older adults. Understanding whether the same aspects of life are equally important to the life quality of subgroups of older people is important in helping health professionals plan social and health care policy and caring strategies. The purpose of this study was to describe the importance given to 38 areas of QoL among Norwegian older adults and to identify differences in importance ratings by age, gender, marital and health status. This exploratory study was conducted with 379 older adults (mean age 73.3 years, SD 6.9) consisting of two cohorts. The first cohort (n = 287) comprised of non-hospitalized participants, were recruited from two national senior organizations, two political senior organizations and a voluntary organization in Eastern Norway. Participants responded to a postal survey. The second cohort (n = 92) comprised of hospitalized and ambulatory patients, were recruited from three medical wards and one outpatient clinic at a county hospital in Eastern Norway. Data was collected by personal interviews and interview assisted. All importance ratings were found to reflect substantial areas of importance. Highest mean importance was assigned to activities of daily living, mobility, sensory abilities, health and home environment. Least important was sex life, adequate social help, chance to learn new skills, body image and appearance and free of dependence on medications and treatment. There were a number of significant mean group differences by age, gender, marital and health status. Sixteen of the items detected significant between- group differences. Future application of the importance questions could facilitate understanding and recognition of important issues in subgroups of older adults.

Quality of life in older Norwegian adults living at home: a cross-sectional survey

The term quality of life (QoL) has been used in nursing for several years despite having neither a common conceptual model nor a common definition. The Wilson and Cleary Model (WCM), defined in 1995, is used as a conceptual model to identify suitable variables important in planning nursing care in a study among Norwegian older adults. The objective of this study was to investigate how the relationships among depressive symptoms, physical function, health satisfaction, age and environment may predict QoL in a model based on the WCM. The overall model provides empirical evidence for linkages in the WCM. Results showed that QoL is likely to be influenced by the direct effects of environmental conditions, health satisfaction and age. In addition, environmental conditions and age had indirect effects on QoL, in particular via depressive symptoms. Environment had both a significant direct and an indirect effect on QoL. An indirect effect of environment on QoL was shown with depressive symptoms, physical function and perceived health as mediators. There was only a small amount of evidence for age predicting QoL. This model may help nurses and other health care workers to collect and assess information, to suggest suitable interventions and to guide decision making.

Coping and depression in chronically ill hospitalized elderly patients

The author hypothesized that depressive symptoms in chronically ill hospitalized elderly patients would be related not only to descriptive factors but also to appraisal and individual coping responses. Eighty elderly hospitalized medical inpatients (50-98 years) with chronic physical diseases who were not expected to die during hospitalization were assessed by the Ways of Coping Checklist and the Montgomery-Asberg Depression Rating Scale. No statistical significant relationships were found between illness variables, sociodemographic variables, or problem-focused coping scores and depressive symptoms. There were, however, modest but significant correlations between secondary appraisals of having to hold oneself back from the situation, emotion-focused coping scores (r=0.27;p=0.01), perceived mental health the year before admittance, and depressive symptoms. This study suggests that depressive symptoms in chronically ill hospitalized elderly patients reflect an underlying appraisal of having to hold back fr...

Cultural Frames, Qualities of Life, and the Aging Self:

We used the Self-Concept Enhancement Tactician (SCENT) model to explore whether older Norwegians and Canadians would tactically self-enhance on qualities considered significant within their cultures in their self-perceptions of aging. Qualities were measured using the WHOQOL-BREF and WHOQOL-OLD. Self-perceptions of aging were measured by the Attitudes to Aging Questionnaire. The study is a secondary analysis of data collected in a larger study; 393 older Norwegians and 202 older Canadians were included. The Norwegian and Canadian group self-enhanced their perceptions of psychosocial loss based on harmonious social relationships and being part of a larger social group. For self-perceptions of physical change, both groups self-enhanced on being self-sufficient and being part of a larger social group. Our findings suggest that Norwegians and Canadians are not highly individualistic people and also provide evidence of a bicultural self-perception of aging. Nurses should consider how cultural and individual perspectives affect the care priorities of older people.

Exploring the quality of life of depressed and nondepressed, home-dwelling, Norwegian adults.

AIM This study aims to explore how intimacy, physical and psychological health, loneliness, and attitudes to ageing at a time of loss affect the overall quality of life (QoL) of nondepressed and depressed older adults. METHOD This was a randomised, stratified, cross-sectional study with two subsamples: depressed (n=74; mean: 77.9 years; 65% female) and nondepressed (n=356; mean: 75.0 years; 55% female), and based on the Geriatric Depression Scale-15. RESULTS Physical health accounted for the greatest variance in overall QoL in the nondepressed group; psychological health, losses, and feelings of intimacy also made significant contributions. In the depressed group, intimacy made the strongest contribution, while psychological health came a close second. CONCLUSIONS Physical health, psychological health, and loss were important to the QoL of nondepressed older adults, while intimacy was important for QoL in both depressed and nondepressed older adults. For those who are depressed, feelings of intimacy, in the form of having opportunities to express and receive love, are especially relevant and should be assessed by health professionals when planning interventions.

Quality of life data in older adults: self-assessment vs interview

BACKGROUND AND PURPOSE There are obstacles for older people when reporting quality of life (QoL) in a survey format. The aim of this study was to explore the quality of data obtained on self-assessed QoL among older people with respect to modes of administration. METHOD AND RESULTS Approximately half of the QoL items showed significantly higher mean values in the mail sample than in the interview sample. Data suggest that there may be more vulnerability towards offering socially desirable answers. Problems with reduced energy and loss of memory affect both modes of administration. CONCLUSIONS This study demonstrates that investigating the mode of questionnaire administration among older people can be a valuable means by which to detect possible threats to data quality when interpreting QoL scores.