Abstract
The purpose of this study was to investigate health-related quality of life (HRQOL) and functional ability among the least dependent elderly in residential care, and to compare them with information on the general population. A stratified systematic sample (n=1,587) was drawn from a one-day census of patients in all public residential homes in Finland on December 2, 1991. Sixty-nine per cent of residents in 1992 were able to participate (n=1,097) and 86% of them returned the questionnaire (n=948), of which n=795 were acceptable, the response rate being 72%. A postal survey was used for data collection. The personnel of residential homes were allowed to help residents complete the questionnaire, and 90% of respondents received such help. HRQOL was measured by the Nottingham Health Profile (NHP) and functional ability by a 14-item questionnaire. Finnish studies among the general population were used for comparisions. According to the NHP, the HRQOL appeared lower in institutional care and this was associated with the dependency level. Similarly, for most ADL items the general population had less restrictions than the least dependent residential care patients. In general, women expressed more difficulties in physical mobility and lack of energy than men. The longest stay elderly expressed better HRQOL. In multivariate models adjusted for age and gender those with poor vision had worse HRQOL in almost every dimension of NHP. Difficulties in speech were connected with emotional reactions and social isolation. Chronic illness limiting normal daily life predicted more problems in energy, pain, physical mobility, and emotional reactions. The married or widowed experienced less social isolation than single elderly. Higher education was related to better HRQOL in all NHP dimensions. Poorer perceived health was associated with lack of energy, pain, and emotional reactions. We conclude from these results that there are only a few clients in residential care whose HRQOL or functional ability compare with the non-institutionalized population.
Similar content being viewed by others
References
Aro S, Noro A. Deinstitutionalization of the elderly in Finland, 1981–91. (submitted 1995).
Health for all policy in Finland Copenhagen: WHO Regional Office for Europe, 1991.
Health for All by the Year 2000. The Finnish National Strategy Helsinki: Ministry of Social Affairs and Health, 1987.
Health for all by the year 2000. Revised strategy for co-operation. Publication series 1993: 9 Helsinki: Ministry of Social Affairs and Health, 1993.
Noro A, Lounamaa A. Koti laitoksessa. Hyvinvointikatsaus 1993: 30–33.
Meeberg GA. Quality of life: A concept analysis. J Adv Nurs 1993; 18: 32–38.
Browne JP, Boyle CA, McGee HM, et al. Individual quality of life in the healthy elderly. Qual Life Res 1994; 3: 235–244.
Patrick DL, Erickson P. Assessing health-related quality of life for clinical decision making. In: Walker SR, Rosser RM, eds. Quality of Life Assessment: Key Issues in the 1990s London: Kluwer Academic Publishers, 1993: 11–63.
Wilkin D, Hughes P. Residential care of elderly people. Ageing and Society 1987; 7: 175–201.
Nores T. Olemassaolokokemus. Naisvanhuspotilaan olemassaolokokemusta koskeva käsitteellinen ja empiirinen analyysi Turku: SHKS, 1993.
Clark P, Bowling A. Quality of everyday life in long stay institutions for the elderly. An observational study of long stay hospital and nursing home care. Soc Sci Med 1990; 30: 1201–1210.
McEwen J. The Nottingham Health Profile. In: Walker SR, Rosser RM, eds. Quality of Life Assessment. Key Issues in the 1990s. Bodmin: Kluwer Academic Publishers, 1993: 487.
Hunt SM, McEwen J. The development of a subjective health indicator. Soc Health and Illness 1980; 2: 231–246.
Hunt SM, McKenna SP, Williams J. Reliability of a population survey tool for measuring perceived health problems: a study of patients with osteoarthrosis. J Epidemiol Community Health 1981; 35: 297–300.
Hunt SM, McKenna SP, McEwen I, Backen EM, Williams J, Papp EA. A quantitative approach to perceived health status: A validation study. J Epidemiol Community Health 1980; 34: 281–286.
Hunt S, McKenna SP, McEven J, Williams J, Papp E. The Nottingham Health Profile: Subjective health status and medical consultations. Soc Sci Med 1981; 15A: 221–229.
Hunt S, McEven J, McKenna SP. Perceived health: Age and sex comparisons in a community. J Epidemiol Community Health 1984; 38: 156–160.
Hunt S. Subjective health indicators and health promotion. Health Promotion 1988; 3: 23–34.
McDowell I, Newell C. Measuring Health: A Guide to Rating Scales And Questionnaires USA: Oxford University Press, 1987.
Koivukangas P, Koivukangas J, Ohinmaa A, Kivelä S-L, Krause K. NHP—Koetun terveydentilan mittari tervey-denhuollon arviointitutkimuksiin. Sosiaalilääk Aikak 1992; 29: 229–235.
Hunt SM, McEwen I, McKenna SP. Perceived health and social inequalities. Effective Health Care 1985; 2: 151–160.
Hunt SM, Wiklund I. Cross-cultural variation in the weighting of health statements: a comparison of English and Swedish valuations. Health Policy 1987; 8: 227–235.
Erdman RAM, Passchier I. The Dutch version of the Nottingham Health Profile: Investigations and psychometric aspects. Psychological Reports 1993; 1027–1035.
Bucquet D, Condon S, Ritchie K. The French version of the Nottingham Health Profile. A comparison of items weights with those of the source version. Soc Sci Med 1990; 30: 829–835.
Thorsen H, McKenna SP, Gottschalk L. The Danish version of the Nottingham Health Profile: Its adaptation and reliability. Scan J Prim Health Care 1992.
Alonso I, Anto IM, Moreno C. Spanish version of the Nottingham Health Profile: Translation and preliminary validity. Am J Public Health 1990; 80: 704–708.
Koivukangas P, Ohinmaa A, Koivukangas J. Nottingham Health Profile (NHP) suomalainen versio. Saarijärvi: Stakes raportteja 187, Gummerus Oy, 1995.
Wolinsky FD, Callahan CM, Fitzgerald JF, Johnson RJ. The risk of nursing home placement and subsequent death among older adults. J Gerontol 1992; 47: S173-S182.
Vicente L, Wiley JA, Carrington RA. The risk of institutionalization before death. The Gerontologist 1979; 19: 361–367.
Greene VL, Ondrich JI. Risk factors for nursing home admissions and exits: A discrete-time hazard function approach. J Gerontol 1990; 45: S250-S258.
Branch LG, Jette AM. A prospective study of long-term care institutionalization among the aged. Am J Public Health 1982; 72: 1373–1379.
Wingard DL, Jones DW, Kaplan RM. Institutional care utilization by the elderly: A critical review. The Gerontologist 1987; 27: 156–163.
Heikkinen E, Arajärvi R-L, Jylhä M, Koskinen S, Pekurinen M, Pohjolainen P. Eläkeikäiset Tampereella. Haastattelututkimus 60–89-vuotiaiden tamperelaisten terveydentilasta, toimintakykyisyydestä, palvelujen käytöstä ja elintavoista. Tampere: Kansanterveystieteen julkaisuja M 65/81, 1981.
Jylhä M, Jokela J, Tolvanen E, et al. The Tampere longitudinal study on ageing. Description of the study. Basic results on health and functional ability. Scand J Soc Med 1992; 47(Suppl): 1–58.
Bucquet D, Curtis S. Socio-demographic variation in perceived illness and the use of primary care: The value of community survey data for primary care service planning. Soc Sci Med 1986; 23: 737–744.
Belsley DA, Kuh E, Welsch RE. Regression Diagnostics: Identifying Influential Data and Sources of Collinearity New York: John Wiley & Sons, 1980.
Aro S, Noro A, Byckling T, Häkkinen U, Salinto M, Kerppilä S. Aikuisväestön terveyspalvelujen käyttö ja terveydentila 1992 Jyväskylä: STAKES raportteja 120, Gummerus Oy, 1993.
Kane RL, Blewett LA. Quality assurance for a program of comprehensive care for older persons. Health Care Financing Review 1993; 14: 89–110.
Fillenbaum GG. Social context and self-assessment of health among the elderly. J Health Soc Behav 1979; 20: 45–51.
Foreman MD, Kleinpell R. Assessing the quality of life of elderly persons. Seminars in Oncology Nursing 1990; 6: 292–297.
Grimby A, Wiklund I. Health-related quality of life in old age. A study among 76-year-old Swedish urban citizens. Scand J Soc Med 1994; 22: 7–14.
Townsend P. The Last Refuge—a survey of residential institutions and Homes for the aged in England and Wales. London: Routledge & Kegan Paul, 1962.
Carabellese C, Appollonio I, Rozzini R, et al. Sensory impairment and quality of life in a community elderly population. J Am Geriatr Soc 1993; 41: 401–407.
Dugan E, Kivett VR. The importance of emotional and social isolation to loneliness among very old rural adults. The Gerontologist 1994; 34: 340–346.
Khullar KS, Reynolds BC. Quality of life and activity: A test of the activity versus disengagement theories. International Review of Modern Sociology 1990; 20: 33–68.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Noro, A., Aro, S. Health-related quality of life among the least dependent institutional elderly compared with the non-institutional elderly population. Qual Life Res 5, 355–366 (1996). https://doi.org/10.1007/BF00433920
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00433920