Adding Quality to Quantity:
Older People's Views on their Quality of Life
and its Enhancement
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Background

The concept of quality of life spans a wide range of disciplines and topics (from the quality of the last year of life to the quality of life in urban environments), and is measured using an equally wide range of subjective and objective indicators. Most disciplines, in both the social and medical sciences, have based their concepts on experts' opinions, rather than those of lay people. In addition, a pragmatic approach prevails in the literature, and clarification of the concept of quality of life is typically by-passed with reference to its abstract nature. Too often, measurement scales of quality of life, and their scoring systems, rely too heavily on the literature and on psychometric properties in their validation process - and lose sight of their meaning and relevance to the people they will be applied to. More recently-developed individualised measures which permit respondents to select their own domains of quality of life, and to weight these items, are highly complex and unsuitable for use in large scale studies.

The promotion of quality of life in older age is attracting increasing policy interests. While for some people old age will be a time of increasing dependency and loss of control, for others it will be a period of personal fulfilment. Old age contains many opportunities for positive change and productive functioning, and should not be confused with illness. However, population ageing is regarded as a problem by governments in relation to increasing burdens on pensions, health and social welfare provisions. At the same time, the hypothesised future compression of morbidity and disability into a shorter period of life is leading to more positive perspectives of healthy ageing as normal. However, most socio-psychological theory on quality of life has not been underpinned by empirical data, and there is little data on how the dynamics of quality of life change with the process of ageing, nor of the roles of assimilative and accommodative coping behaviour.

This research will address the issues of defining and measuring quality of life in older age, and is based on the perspective that people themselves are the best judges of the quality in their lives, and how it can be extended. The research will explore older people's perceptions of quality of life, their views on how their quality of life can be practically improved, and how it changes over time. This will also contribute to methodological development in relation to measuring these concepts in evaluations of multi-agency policy.

Study Design

The study is based on both quantitative survey and qualitative interview methods. The survey will generate older people's conceptual categories of QoL, their priorities in relation to these, and their views on how quality of life can be extended. Information will also be collected on people's attitudes and circumstances. The vehicle for the survey is the national Omnibus Survey mounted by the Office of National Statistics (ONS). This is a national population survey, based on interviewing a random sample of adults in their own homes. A sample of approximately 1760 people aged 65 and over is aimed for, at four stages throughout the year in four quarterly Omnibus Surveys (to generate enough numbers and to avoid a seasonal bias). A small sub-sample of eighty of these survey respondents, and 20 of their carers, will also be selected for future in-depth follow-up. The qualitative methods will use an open-ended check list to explore the concepts of interest in the context of a life history approach.

Aims and Objectives

The research proposed here will investigate older people's own views of quality of life, the factors that affect it in both good and bad ways, and how these change over time.

The aims of the proposed study of quality of life (QoL) are:

	To contribute to the development of a conceptual framework and body of knowledge on quality of life and its enhancement in older age.
-	This will be grounded in older people's views of factors which constitute and extend quality of life.
	To provide strong, rigorously collected empirical data which will also be used for a critique of the content validity of existing measures of quality of life.
-	This will contribute to the methodological development of an improved instrument for use in descriptive surveys (eg. of the 'social temperature') and in the assessment of outcomes in multi-agency policy and service evaluation.
	To provide rigorously collected data which will be of value to older people and to public policy makers by suggesting ways in which the quality of older people's lives can be improved.

The objectives are:

	To obtain population norms of, and rich insights into, older people's definitions and descriptions of what QoL means to them, how the different areas are prioritised, perceptions of what increases and decreases quality in their lives, how quality can be extended, and to explore the dynamics of changes in QoL.
	To ascertain whether, and to what extent, these perceptions of QoL are inter-related with other perceptual domains, social and structural characteristics of people and their circumstances.

Policy implications

There is international interest in the improvement of quality of life in old age. This is partly due to the increasing numbers of older people and higher expectations of society. There is public policy interest in the potential for reducing public expenditure by enabling older people to retain their independence, and to enhance their perceived quality of life, rather than fostering dependency.

The information obtained on quality of life will be used to make practical suggestions for the extension of quality of life in older age. This will address public policy makers' concerns about how to prolong independence in older age, how to empower older people to maintain an active role in society, and to promote more effectively the well-being of future generations. The research will also be used for the development of empirically based measurement scales for measuring the broader QoL outcomes of multi-agency policy and services.