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Measuring Quality of Life - Joint Debate Slides
- 1. Measuring Quality of Life Tuesday 10 th May 2011 www.ilcuk.org.uk
- 4. Quality of Life in older age A. Bowling, D. Banister, P. Stenner, H. Titheridge, K. Sproston, T. McFarquhar
- 5. To measure QoL in people 65+ in Britain To develop & test new ‘bottom up’ measure of QoL (OPQOL) Aims of Studies
- 7. 15 ‘Oldest’ Countries Sources: Carl Haub, 2006 World Population Data Sheet . % age 65+
- 14. Social relationships - neighbours & family: “ Four doors down the man called me to give me broad beans. When I did not put my washing line up he came round to see if there was any problem. The lady two doors down does my eye drops three times a week. They are all very good.” “ The quality of my life now is my family - my children and grandchildren. My life surrounds them. I go at weekends, they visit every week. Sometimes I have the younger grandchild staying overnight… I’m there if they need me.”
- 23. WHOQOL-OLD Total Score (2 new samples only) Ethnibus ONS % % ≤ 69 Lowest possible QoL 2 4 70-79 23 11 80-89 58 24 90-99 15 40 100-120 Highest possible QoL 2 27 Cronbach’s alpha 0.42 0.85 Scale range 24-120 (24 x 5-point response scales 1-5; - reversed so positive=better & summed)
- 34. Delivering wider measures of national well-being and quality of life – Paul Allin, Programme Director
- 38. How to measure national well-being? Stiglitz measurement framework: Economic Measures , e.g. Net national income per household Distribution of wealth, income, disposable income Effects of tax and benefits on distribution Human capital and growth rate Environmental Measures , e.g. Stocks of natural resources and depletion rates Indicators of climate change Quality of Life e.g. Health: life expectancy, expected disability free life years, Indicators of family life e.g. Single parent households Problem indicators e.g. Crime rate, Children in care, drugs, imprisonment rate Subjective wellbeing
- 39. Well-being New Economy Resources Environment Well-being Green Growth Quality Growth
- 48. Living arrangements of Europeans aged 60+ and 80+ by region. Source: Analysis of ESS 2002/4. North : DK, Fin, Norw, Swe; West : Aust, Belg, Ger, Neths, UK; East : CzR, Est, Hung, Pol, SlovK, Sloven, Ukr; South : Gre, Port, Esp.
- 50. Country groupings North West South East Sweden Norway Finland Denmark Germany Belgium UK Austria Netherlands Portugal Greece Spain Poland Slovenia Slovakia Hungary Ukraine Estonia Czech Republic N=3621 N=5867 N=3857 N=4786
- 51. Happiness among unmarried older women by European region: results from ordinal logistic models (Higher =happier), 2002-4 Analysis of European Social Survey; models control for age, widowhood indicator, long term illness & Whether living alone or with others. ( ) results from models not including social ties. North West South East Low education 1.27 (1.17) 1.19 (1.15) 0.76 (0.73) 1.10 (1.02) Low income 0.75 (0.74) 0.86 (0.87) 0.94 (0.81) 0.53** (0.45**) Moderate social ties 0.76 0.69** 0.62 0.92 Low social ties 0.41** 0.56** 0.34** 0.48** Least social ties 0.08** 0.19** 0.45** 0.24** N 840 1664 1055 1507
- 52. Associations between living arrangements and happiness (higher=better) by region; ref. group=living alone : results from analysis of ESS 2002-4. ***P<.001, *P<0.05 Controlling for age, education, income, social meetings, social activities, long term illness, availability of confidante, widowhood. Men Women Spouse only Spouse+others Others only Spouse only Spouse+others Others only North 2.59*** 3.36*** 0.73 1.94*** 1.86* 1.09 West 2.11*** 1.82* 1.34 2.11*** 2.69*** 2.06*** East 1.04 1.09 0.60 1.81* 1.50 1.36* South 1.61 1.47 1.10 1.77* 1.82* 2.08*
- 55. Life satisfaction Look forward to each day Life has meaning Look back with happiness Full of opportunities Future looks good Optimistic about future Feel prepared for my future Happiness Enjoyed life Well-being Factor 1 Factor 2 Factor 3 Factor 4 Best fitting/invariant well-being model
- 56. Well-being country level comparison
- 57. Depression country level comparison
- 61. Measuring Quality of Life Tuesday 10th May 2011 www.ilcuk.org.uk
Notes de l'éditeur
- Theory –e.g. Most measures of social support (eg having a close confiding relationship) and affiliation (involvement in community life, attending clubs) are associated with health status and wellbeing. Friendship is protective whether directly or via a buffer to stress is still debated. There is policy concern about how to encourage people to maintain their social networks throughout life, and promotion of social capital – the neighbourhood resources that enable people to network and participate – thus find supportive relationships. Putnam’s studies in Italy and the US showed that the rise and fall in social capital almost exactly reflects trends in income distribution, showing how income has a direct impact on the social fabric of society. Hence studies of QoL need to be multidimensional and aware that the concept is complex, multidimensional, and that dimensions can inter-relate.
- Qol domains overlap CASP based on theory of human need and satisfaction WHOQOL –OLD mainly consists of WHOQOL with items judged by focus groups to me missing (e.g. on functioning)
- Except for Japan, the world’s 15 oldest countries are all in Europe. The U.S. population is relatively “young” by European standards, with less than 13 percent age 65 or older, ranking as the 38 th oldest country. The aging of the baby-boom generation in the United States will push the proportion of older Americans to 20 percent by 2030; it will still be lower than in most Western European countries. The older share of the population is expected to more than double between 2000 and 2030 in Asia and Latin America and the Caribbean. Aging is occurring more slowly in sub-Saharan Africa, where relatively high birth rates are keeping the population “young.” Ageing Fastest increase in the ‘oldest old’ Population by age, UK, 1984, 2009 and 2034 The population of the UK is ageing. Over the last 25 years the percentage of the population aged 65 and over increased from 15 per cent in 1984 to 16 per cent in 2009, an increase of 1.7 million people. Over the same period, the percentage of the population aged under 16 decreased from 21 per cent to 19 per cent. This trend is projected to continue. By 2034, 23 per cent of the population is projected to be aged 65 and over compared to 18 per cent aged under 16. The fastest population increase has been in the number of those aged 85 and over, the “oldest old”. In 1984, there were around 660,000 people in the UK aged 85 and over. Since then the numbers have more than doubled reaching 1.4 million in 2009. By 2034 the number of people aged 85 and over is projected to be 2.5 times larger than in 2009, reaching 3.5 million and accounting for 5 per cent of the total population. As a result of these increases in the number of older people, the median age of the UK population is increasing. Over the past 25 years the median age increased from 35 years in 1984 to 39 years in 2009. It is projected to continue to increase over the next 25 years rising to 42 by 2034.
- Wb includes happiness, positive and negative affect Caspe based on maslows needs satisfaction – feel in control of friendships but doesn’t inform on quality or if they exist to the satisfaction of respondent
- & 7-point QoL self-rating scale 77% r/r; ; 80 re-interviewed in-depth
- MD Multi-dimensional
- Green – not in most scales except caspe control
- The OPQOL was conceptually grounded in lay views from the baseline QoL Survey, integrated with theory from a synthesis of the literature. First, older people’s responses to open-ended questioning about the ‘good things’ that gave life quality were examined. These were categorised into main themes by two researchers, independently. These were, in order of magnitude: social relationships (mentioned by 81%), social roles and activities (60%), solo activities (48%), health (44%), psychological outlook and well-being (38%), home and neighbourhood (37%), financial circumstances (33%), and independence (27%). Smaller numbers mentioned various other things. These responses were consistent with older people’s views about what took quality away from life. Poor health was most often mentioned as the thing that took ‘quality away’ from their lives (by 50%). Other commonly mentioned things that took quality away from life were home and neighbourhood (30%), financial circumstances (23%), psychological outlook (17%). Having health, followed by better finances (i.e. having enough/more money), were the two most frequently mentioned things that respondents said would improve the quality of their own lives. The sub-scale domains in the OPQOL reflected this common core of main constituents of quality of life. The common sub-themes are listed in (Bowling 2007). The pool of actual verbatim responses was examined next by two researchers, again independently, to inform the inclusion of the items within each sub-scale. The main reasons given by people, at survey and in-depth interview, to explain the importance of these themes to their QoL were categorized, by two independent coders, as: freedom to do the things they wanted to do without restriction (whether in the home or socially); pleasure, enjoyment and satisfaction with life; mental harmony; social attachment - having access to companionship, intimacy, love, social contact and involvement, help; social roles; and feeling secure. These cut across the main themes (Bowling & Gabriel, in press). The responses which were selected for inclusion in OPQOL represented the most commonly occurring sub-themes within each theme. The verbatim responses formed an initial pool of over 100 different statements, or attitudes. After reading and comparing the items, overlapping statements were deleted to leave 51 items. The revised items were first mailed to QoL Survey sample members in 2006 and 60% 179 of the respondents invited to participate returned the completed questionnaires). They were asked to complete the items, report any difficulties they had with it, and to make any other comments about it. Psychometric tests for item redundancy, reliability and validity, led to the removal of redundant items (over-high correlations), items with high missing data, items where the Cronbach’s alpha of the scale improved with their removal, items which did not correlate with the overall scale score or a self-rated global QoL item. Exploratory factor analysis was used to explore the dimensions underlying the questionnaire,
- Sample ages: Ethnibus: 91% aged 65<75, 9% 75+ ONS Omnibus: 55% aged 65<75 , 45% 75+ QoL sample (follow-up): 17% aged 65<75 , 83% 75+ & 52-54% female Multivariable analyses controlled for age & sex. NB: patterns shown in results unaffected by age, sex, SES At baseline QoL 999 sample = 96% white British: baseline; 33% aged 75+]
- Bear in mind Ethnibus= younger and QoL fup=older –same patterns when analysed by age within each sample 1. I enjoy my life overall 2. I am happy much of the time 3. I look forward to things 4. Life gets me down
- All sample differences remain when controlling for their age differences Almost three-quarters (73%) of the Ethnibus sample scored in the worst two OPQOL categories indicating poor QoL, compared with 45% of the older QoL follow-up respondents, and 12% of ONS Omnibus respondents. Chinese people reported better QoL than other ethnic groups. Cronbach’s alphas all exceeded threshold criteria for acceptability of alpha (0.70+): α: 0.748 (Ethnibus survey), α: 0.876 (ONS Omnibus survey), α: 0.901 (QoL follow-up survey). Cronbach’s alphas for the OPQOL in the three samples satisfied the α: 0.70<0.90 threshold for internal consistency: α: 0.748 (Ethnibus survey), α: 0.876 (ONS Omnibus survey), α: 0.901 (QoL follow-up survey). The CASPE-19 and the WHOQOL-OLD both satisfied the threshold for Cronbach’s alpha in the ONS sample (α: 0.866 and α: 0.849 respectively), but not in Ethnibus (α: 0.553 and α: 0.415 respectively).
- Differences remain when we compare age groups
- Lends support top self management programs re chronic disease which build self-efficacy The mean sd for those with walking disabilities: Able to walk 400 yards-some diff. Unable without help/at all Mean sd Mean sd OPQOLTOT Ethnibus 116.595 (11.490) 109.310 (9.514) ONS new sample 139.037 (13.015) 122.724 (12.134) No of supporters x OPQOL tot 0-2 supporters 3+ supporters mean (sd) OPQOL TOTAL score Ethnibus 113.643 (9.742) 114.961 (11.140) ONS new sample 129.010 (14.836)*** 136.289 (13.653)
- P10’s club provided assistance: those with poor eye sight employed SOC by optimizing their attendance at the club, where they met friends, and compensated for poor eye sight with binoculars/bowling against string:
- The OPQOL performed well in national population and ethnically diverse samples of older people, reflecting its multi-dimensionality, the item-generation by older people themselves, and piloting with ethnically diverse focus groups. It is of potential value in the evaluation of interventions which have a multidimensional impact on people.
- The 4 questions on the IHS The HIS would cover 4 overall questions on subjective well-being covering evaluative, experience and eudemonic accounts allowing for overall monitoring of SWB in the UK and at the sub-national level This will be supplemented with domain specific and detailed questions asked regularly on our Opinions survey, which is a monthly survey with a random sample of around 1000 adults responding each moth