Quality of life (QOL) is the degree to which a person is healthy, comfortable, and able to participate in or enjoy life events. It is critical for health care practitioners to take quality of life into account when establishing each patient’s goals of care and to use it as a guide for all care decisions.
When discussing QOL with patients, caregivers (both formal and informal), other health care personnel, and policy makers, practitioners need to consciously avoid using age bias Aging Geriatrics refers to medical care for older adults, an age group that is not easy to define precisely. Gerontology is the study of aging, including biologic, sociologic, and psychologic changes... read more that negatively impacts the patient's perception of what QOL could or should be.
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, reduced life expectancy, cognitive impairment, disability, chronic pain, social isolation, functional status, dependency on caregivers) 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 professional's ability to deliver timely and appropriate care. A social history helps members... read more . Social determinants of health (SDOH) are the conditions in the places where people live, learn, work, and play that affect a wide range of health and quality of life risks and outcomes.
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 the death of a spouse a person's quality of life may change, impacting care goals.
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, which tends to be focused on diagnosis and prolongation of life.
Quality of life is a subjective, individual experience, 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, and there often is not enough time allotted for these in-depth conversations during traditional fee-for-service–based health care delivery models.
Method
People can assess their own quality of life or more specifically their own health. Also known as self-assessed health or self-perceived health, self-rated health (SRH) refers to a single-item health measure in which people rate the current status of their health on a scale ranging from excellent to poor. SRH has been proved a reliable predictor of mortality and disability by a series of national and international analyses (1 Assessment reference Quality of life (QOL) is the degree to which a person is healthy, comfortable, and able to participate in or enjoy life events. It is critical for health care practitioners to take quality of... read more ).
During assessment, practitioners should be careful not to reveal their own biases. Determining a patient's preferences is usually possible; even patients with 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.
Assessment reference
1. Wu S, Wang R, Zhao Y, et al: The relationship between self-rated health and objective health status: A population-based study. BMC Public Health 13:320, 2013. doi: 10.1186/1471-2458-13-320
