Quality of life
Investigators
Ann Bowling, University College London
David Banister, University of Oxford
Paul Stenner, University of Brighton
Kerry Sproston, National Centre for Social Research
Helena Titheridge, University College London
Team
Mr Charlie Clerke, Enfield PCT
Chris Bain, Age Concern England
Background
At the time of the project, there were more people aged in their 70s and 80s, and with increased life expectancy, than ever before.
Increasing social expectations, and concerns about the policy implications of the ageing population, have led to interest in improving older people’s health, independence, activity, social and economic opportunities and participation, thereby their active contribution to society, and, in effect, adding quality to extended years.
Assessment of the effectiveness of public policy in this area required the use of relevant and valid measurement instruments, based on a sound conceptual model and with relevance to older people.
Aims and objectives
The aims of the project were:
Test a new measure of Older People's Quality of Life (OPQOL)
The robustness of the causal model under-pinning it as people age
Thereby providing detailed information on the dynamic links between influences on quality of life (QoL), the process of active ageing and the outcome of self-assessed QoL.
Design
Three vehicles were used:
A national Omnibus Survey to test the reliability and validity of the OPQOL. This was a rolling survey of adults aged 16+, based on a stratified random sample of postcodes across Britain. People aged 65 and over, who are representative of older people living at home in Britain were sifted and interviewed face-to-face at home.
The Ethnibus face-to-face home interview survey was used to assess whether the OPQOL is psychometrically sound among ethnically diverse populations. The questionnaire and its domains were initially assessed with three focus groups reflecting ethnic diversity. People aged 65 and over, were sifted and interviewed face-to-face at home.
In order to test the reliability and validity of the measure dynamically as people age, the OPQOL was administered in a postal follow-up of our QoL Survey respondents (1999/2000 baseline survey funded by ESRC Growing Older Programme), with further qualitative follow-up of a sub-sample.
Policy implications
Our research was intended to be of value to policy makers across sectors and academics. A key policy and practical implication is the testing of the psychometric properties of the Older People’s Quality of Life Questionnaire (OPQOL).
Product development
The product development opportunity, and end-product of the research, therefore, is the fully tested, multidimensional measurement tool, appropriate for use in the evaluation of multi-sector policy on ageing, and in descriptive research monitoring QoL in older age.
Other policy and practice implications of the research
The research also examined older people’s perceptions, and self-assessments, of active ageing, and associations with quality of life. Comparisons were made with existing definitions and policy agendas.
Older people’s perceptions have been neglected in the policy and academic literature. There is an expectation in the policy literature that active ageing can be promoted by health promotion and physical activity prescriptions, while the theoretical literature indicates that self-efficacy may be a mediating variable between activity interventions and QoL.
The role of self-efficacy in ‘active ageing’ requires examination longitudinally, and has implications for chronic disease management programmes for those who are ill or frail (ie supporting self-efficacy training) as well as for exercise prescriptions (ie motivating feedback to promote self-efficacy). We explored whether self-efficacy is associated with ‘activity’ in older age groups (using both lay and published definitions), and thereby to enhanced QoL, dynamically. Active ageing has also been defined in terms of social participation.
At baseline, using multi-level modelling, we found that area affluence, respondents' perceptions of neighbourliness of the area, and ratings of facilities, independently influenced respondents' levels of social activity; social activity, in turn, was associated with enhanced QoL.
If the associations hold longitudinally, the policy implication is that strategies that aim to promote the social activity element of active ageing, and thereby enhanced QoL, need to ensure that local infrastructures include facilities which older people feel include them, and designs which aim to enhance perceived 'neighbourliness'.
Non-academic involvement
We liaised closely with our non-academic partners, who include Age Concern England, management and policy representation, and older people themselves.
We worked with the NDA programme to maximise the impact of the study, and were pro-active in the dissemination of the results to stakeholders across policy sectors.