Quality of life among older adults: a proposed conceptual model




Low, Gail

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The purpose of this study was to develop and test a model of Quality of Life (QOL) of older adults in which overall QOL was the dependent variable and financial resources, perceived health and Activities of Daily Living (ADL) performance, emotional support, meaning and purpose in life, and the older adult's surrounding physical and home environment were the independent variables. It was hypothesized that each of these independent variables would have a significant and positive effect upon overall QOL, and meaning and purpose in life were expected to mediate the effects of perceived health upon overall QOL. To address the hypotheses being posed in this study. a secondary analysis was undertaken of two cross-sectional data sets. namely the Canadian WHOQOL-OLD Group 2004 Field trial (data set 1: n = 202) and the WHOQOL-OLD Group 2002 Pilot study (data set 2: n = 420). At the bivariate level, in data set 1, all six independent variables were found to be significantly and positively associated with overall QOL. In the multiple regression analysis, the pattern of findings for all eight predictors indicated the hypothesized model was not likely to fit data set 1. In particular. the non-significant direct effects of ADL performance. emotional support, and the physical and home environment indicated either that they are not related to QOL or their relationship is mediated by another variable. The non-significant direct effect of purpose in life did not provide preliminary evidence of its mediating role in relation to the remaining predictors. The fit and modification indices arising from the path analysis of data set I gave rise to an alternate model wherein financial resources, perceived health, and meaning in life had a significant and positive direct effect upon overall QOL. Purpose in life partially mediated the effect of perceived health, and meaning and purpose in life also played significant mediating roles in relation to emotional support and the surrounding physical environment. and a structural path was added from purpose to meaning. In a second path analysis. the post-hoc model arising from data set 1 was evaluated using an independent sample of older adults (data set 2) but yielded poor Adjusted Goodness of Fit and Root Mean Square Error of Approximation indices. Points of disparity arising from the path analysis of data set 2 were the added structural paths from ADL performance, emotional support, purpose in life, and the surrounding physical and home environment to overall QOL itself. Additionally, meaning in life did not mediate the effect of the surrounding physical environment. The empirical support received in this validation phase of analysis for all six hypotheses highlighted the sample-dependent nature of post-hoc models and drew attention to the limitations of this study. including that of sample size discrepancies between data sets 1 and 2 and convenience sampling bias for data set 2. The nursing practice implications of this study closely align with the Canadian Gerontological Nurses Association (1996) practice mandate. Specifically, the findings of this study imply that collaborative clinical practice, in which the sharing of expertise contributes to comprehensive and informed assessment. planning and intervention aimed at enhancing and promoting QOL among chronically ill older adults, would be valuable.



quality of life, older people, social conditions