Dr Tracey McDonald AM PhD
Long Term Care Quality of Life Scale
MEASURING & MANAGING LIFE QUALITY IN LONG TERM CARE CONTEXTS
Introduction
In Australia and other developed economies, we are living the dream of our ancestors who built efficient sanitation systems, a clean water supply, set up public education, introduced safe workplaces, law and order and so much more. As a result, we are living longer and healthier lives than ever before.
Of course, this also means that the time we spend as adults is far longer than the time spent being young and dependent on our parents. These lifespan changes also affect the way we manage our responsibilities to ourselves and others as we all age.
As we plan for a longer life we have to admit that there will be times when getting through the day will involve asking for and accepting help and support from others. We will also assist other people who need help. If appropriate help is available when and as required, we can expect a reasonable quality of life, especially during those late-life years. The quality of life I refer to here is not 'quality of lifestyle' although lifestyle may be a factor in the quality of life we experience.
Life quality is an overall subjective feeling of well-being that links to happiness, morale and self-confidence. People can experience a good quality of life despite having health issues or physical function limitations. Equally, someone living their life in a way that others might reject, does not mean they are not content.
The idea of 'quality of life' has been around for over 100 years and has informed the way we organise our lives, work and relationships into a balanced existence while getting through life’s challenges. These days most people want to improve the quality of our life rather than just the length of it.
Quality of Life
There are many ways in which quality of life has been defined and measured for various purposes.
In the health environment, researchers have looked at the effect of disease and disability on quality of life and designed assessment scales to objectively monitor that effect. These scales, designed for people with specific medical conditions and treatments, are grouped under health-related quality of Life (HR-QoL) scales.
Other scales measure satisfaction with life and monitor our capacity to be self-sufficient and independent. These scales are tested and validated for people of certain ages, gender, culture, language and cognitive ability as well as particular health problems or disabilities. It is therefore important for you to know how the scale used in your case was validated in order to see if it is relevant to you and your situation. If a scale developed for a particular disease is applied to someone who does not have that problem, it is not a valid use of that scale and the results ae uncertain.
Very few HR-QoL scales were researched using older people in their 70s and 80s and beyond and most excluded people living with dementia or other symptoms of cognitive decline. It is rare that these scales acknowledge the person's emotional response to their circumstances and surroundings.