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Quality of Life in Older People

By

Richard W. Besdine

, MD, Warren Alpert Medical School of Brown University

Last full review/revision Apr 2019| Content last modified Sep 2019
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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.

Health-Related Quality of Life

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)

  • Physical and cognitive 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, friends)

  • Participation in and enjoyment of social activities

  • Satisfaction with medical and financial aspects of treatments

  • Sexuality, body image, and intimacy

Influences

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 Introduction to Social Issues in Older Adults Social issues influence an older person’s risk and experience of illness as well as a health care practitioner’s ability to deliver timely and appropriate care. A social history helps members... read more (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.

Assessment of Quality of Life

Barriers to assessment

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.

Method

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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