Revised methods of measuring quality of life in old age shows that wellbeing is driven by psychological and social factors such as independence and social interaction, rather than income, education or home ownership.
Increasing numbers of older people, demands on health and social care services, and higher expectations for ‘a good life’ have led to a greater interest in improving and measuring quality of life in older age.
Until recently most measures of quality of life have been based on the opinions of outside ‘expert’ opinion. However, if the expert-led measures of quality of life don’t measure the right things, policymakers may end up making the wrong policy interventions.
Since 1999, Professor Ann Bowling and colleagues have been formulating a new measure of quality of life based on the priorities of older people, using in-depth interviews to gain an idea of the factors contributing to older people’s wellbeing. The project included face-to-face interviews with over 1000 people aged 65 and older, conducted over an eight-year period.
The research indicates that the main drivers of quality of life in older age are psychological (social comparison and expectations, an optimistic or pessimistic outlook on life); health (good health and mobility, physical functioning); social (social participation and support); and neighbourhood social capital (local facilities and sense of security).
These factors contributes far more to perceived quality of life than objective indicators of material circumstances, such as actual level of income, education, home ownership, or social class.
Two other factors - the subjective perception of having an adequate income, and of retaining independence and control over one’s life – were added as quality of life indicators, as a result of survey responses and qualitative interviews.
- Most measures of quality of life in old age have been based on external ‘expert’ opinion and may not have been measuring the right factors, instead focusing on ‘objective’ measures such as income and financial security
- There are a number of drivers for quality of life in old age, including social comparison, personal expectations, having good health and mobility, and feeling safe in the community
- Survey respondents emphasised the importance of living in a neighbourly and safe area, and having good local facilities to promote friendly and helpful relationship with other people, including neighbours
- Regular contact with sons and daughters was important to most respondents for enjoyment, help and security. Contact with grandchildren (and being able to play and go out with them) was seen as important to playing a reciprocal role, and to feel useful and valued
- Many respondents referred to the importance of having social or voluntary activities to ‘keep busy’ – to stop them worrying, feeling alone, or dwelling on the past
Policy relevance and implications
- There is a need to work harder, and in partnership with local people, to promote local communities with good facilities – including health care and access to transport, opportunities for social participation and networking, and environments which are perceived to be safe
- Local policies are needed to do more to prevent loneliness and social isolation in older age, especially when people have limited mobility – for instance, initiatives to help them build new support networks, including teaching computer/email skills
- More initiatives to promote mobility and independence outside hospitals are needed, in the community where people live. Prevention of further loss of mobility, and maintenance of independence, should be part of education in medical schools and information to the public
- There is a gap between fear of crime and actual crime figures. Well-known planning and policing strategies to enhance perceived and actual neighbourhood safety should be implemented more widely
- Access to good and convenient public transport are important to older people’s quality of life, their sense of freedom and independence, and is emphasised as an important factor by respondents.