Quality of Life of Healthy Older People:
Residential Setting and Social Comparison Processes
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Research Team:	Professor Graham Beaumont
	Dr Rachel Murrell
	Dr Pamela Kenealy
	Miss Joan Carter
Duration of Research:	November 1999 - December 2002
Contact:	Professor Graham Beaumont School of Psychology and Counselling University of Surrey Roehampton Whitelands College, West Hill London SW15 3SN Tel: +44 (0)208 780 4500 ext 5013 Fax: +44 (0)208 780 4501 Email: gbeaumont@rhn.org.uk
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Background

Previous quality of life (QoL) research with older people has generally focussed on 'pathological ageing'; studies have taken the view that decline in functioning is synonymous with ageing and this has resulted in the development of QoL instruments for use with older people that focus on health and physical functioning. However, a number of life-course theorists have emphasised that old age is a natural stage of the life span and that the meaning of QoL changes across the life span. Research has also indicated that functional capacity and health status are not prerequisites to a 'good' QoL in old age, but are relative to individual expectations and adaptability.

To date, there have been few attempts to deconstruct the psycho-social processes involved in constructing QoL perceptions, although several researchers suggest that social comparison processes are involved. Age has also been demonstrated to be an important socio-demographic variable in social comparison judgements; influencing both the type and frequency of comparisons that are made in order to evaluate QoL.

There has been little consideration of the effects of different residential settings on QoL perceptions in the healthy older people, although it has been suggested that more successful adaptation to age-related changes may be due to quality of residential environment. Within the last 20 years interesting contrasts have emerged within the social institutions of retirement and later life.

Using a person-centred approach, the study will examine the relationships between QoL in a residential setting (alone, with partner, with extended family, sheltered housing, in care) and social comparison processes in 192 healthy older people living in a London Borough. Health changes, cognitive functioning, ethnic origin and life events will also be monitored over a 16 month period to clarify the social and psychological variables which determine perceived QoL.

Aims and Objectives

The aims of the study, and related specific research questions are:

	To increase our understanding of the factors that contribute to QoL perceptions in healthy older people:
-	What are the factors that contribute to person-centred QoL perceptions in healthy older people? How do older people define their QoL, and what life areas are important to their QoL?
	To obtain a broader understanding of the factors that influence QoL perceptions among healthy older people:
-	Do the factors that contribute to QoL perceptions in old age differ as a function of ethnic origin, socio-economic status and disability status?
-	What are the effects of residential setting, social comparison strategies and autobiographical memory functioning on person-centred QoL in healthy older people?
-	Where individuals cannot remember their own past, do they perceive their present QoL as higher than those who can remember their past?
-	How do cognitive and emotional functioning affect QoL perceptions in healthy older people?
	To contribute to our understanding of the effects of positive and negative life changes on person-centred QoL perceptions in healthy older people:
-	What are the factors that contribute to positive and negative changes in perceptions of QoL?
-	How do significant life changes affect emotional functioning and perceived QoL of older people?
-	Do common factors such as cognitive and physical decline contribute to such changes, and are changes in QoL perceptions also affected by more subtle, personal life changes?
	To further develop and refine a theoretical model of the psychological and psychosocial processes involved in constructing QoL judgements:
-	Do psychosocial processes affect QoL judgements of healthy older people?
-	How do factors such as residential setting and autobiographical memory functioning influence the use of comparison processes in order to evaluate QoL in healthy older people?
-	Are the psychological and psychosocial processes involved in constructing QoL judgements unique to each population studied, or are there commonalties across populations that can assist in furthering our understanding of the processes used to judge QoL?

Study Design

The proposed study will examine QoL perceptions across a two-year period, in order to obtain further information on how positive and negative changes affect QoL among healthy older people. General mental ability and emotional functioning will be monitored, and information concerning socio-economic status and ethnic origin will be obtained for each participant.

The first research objective will be addressed through analysis of the five most important life areas nominated by each individual using the SEIQoL-DW, across the three test occasions. Given the quantity of information that will be obtained, analyses will also facilitate comparisons among residential groups, and by socio-economic status, ethnic origin, disability status, gender and age groups. The effect of residential setting and comparison strategy on person-centred QoL (second research objective) will be examined using a fixed factor between groups design. Residential setting has six levels (living in a residential home, living in sheltered housing, living with a partner or companion, living with extended family, living independently but widowed within the last five years, and having always lived independently as an older person). Social comparison strategy has four levels (comparison with 'better off' other, comparison with 'worse off' other; comparison with one's own past, and no comparison made). The effect of autobiographical memory on person centred QoL will be investigated using a one way analysis of variance. Factorial analyses will also be conducted to assess the effects of general cognitive and emotional functioning, socio-economic status, ethnic origin and disability status on person-centred QoL of healthy older people. It is also anticipated that changes in cognitive, emotional and disability status will permit analyses to be conducted among the following life change groupings; no change, moderate decline, substantial decline, and, where appropriate, moderate increase and substantial increase in functioning.

Policy Implications

The research will inform policy makers about the implications of residential status and special residential placements for perceived QoL; the particular needs that may have to be addressed to maximise QoL according to type of residence; and the account to be taken of individual cognitive variables in planning for QoL to be optimised. The factors that contribute to a Îgoodâ QoL should also become clearer, as will the interventions that can assist in optimising the perceived QoL of healthy older people. This will assist those responsible for the care of older people; public, private and voluntary bodies, health professionals, clinicians, carers and relatives; in improving the life experience of older people.