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Quality of Life in the Elderly
Quality of life often depends on health and health care. However, health care practitioners, especially when establishing therapeutic objectives, may underemphasize its importance to patients.
How health affects quality of life is variable and subjective. Health-related quality of life has multiple dimensions, including the following:
Absence of distressing physical symptoms (eg, pain, dyspnea, nausea, constipation)
Emotional well-being (eg, happiness, absence of anxiety)
Functional status (eg, capacity to do activities of daily living and higher-order functions, such as pleasurable activities)
Quality of close interpersonal relationships (eg, with family members)
Participation in and enjoyment of social activities
Satisfaction with medical and financial aspects of treatments
Sexuality, body image, and intimacy
Some of the factors that influence health-related quality of life (eg, institutionalization, reduced life expectancy, cognitive impairment, disability, chronic pain, social isolation, functional status) may be obvious to health care practitioners. Practitioners may need to ask about others, especially social determinants of health (ie, the social, economic, and political conditions that people experience from birth to death and the systems put in place to prevent illness and treat it when it occurs). Other important factors include the nature and quality of close relationships, cultural influences, religion, personal values, and previous experiences with health care. However, how factors affect quality of life cannot necessarily be predicted, and some factors that cannot be anticipated may have effects.
Also, perspectives on quality of life can change. For example, after a stroke that caused severe disability, patients may choose treatment (eg, life-saving surgery) to sustain a quality of life that they would have considered poor or even unacceptable before the stroke.
Assessing patients’ perspectives on quality of life may be difficult for the following reasons:
Such an assessment is not always taught or emphasized sufficiently in traditional medical education.
Quality of life is subjective, so decision models cannot be applied to individual patients.
Assessing the patient’s perspectives on quality of life takes time because it requires thoughtful conversation between patient and health care practitioner.
Quality of life is best assessed by a direct interview with patients. During assessment, practitioners should be careful not to reveal their own biases. Determining a patient's preferences is usually possible; even patients with mild dementia or cognitive impairment can make their preferences known when practitioners use simple explanations and questions. Having family members present when discussing preferences of a patient with cognitive impairment is recommended.
Instruments that measure health-related quality of life can be useful in research studies for assessing group trends but tend not to be useful clinically for assessing individual patients.
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