The Relative Contribution of Health Status and Quality of Life Domains in Subjective Health in Old Age

To analyze the influence of different health status dimensions and quality of life (QoL) domains on older adults’ subjective health, and to assess the role that residential satisfaction plays in these relationships. A QoL survey was conducted on a representative sample of the community-dwelling older adult population in Madrid province (Spain). Logistic regression models were applied to studying: the health status dimensions associated with satisfaction with health; the relationship between satisfaction with health and other QoL domains; and, the influence of these domains on satisfaction with life. Sociodemographic and residential characteristics were included in all the models. The determinants of satisfaction with health in the first model were: mobility, usual activities, morbidity, and satisfaction with neighborhood. QoL domains associated with health were: leisure activities, neighborhood, and finances. Satisfaction with life was explained by these three domains, along with age, family and health. In sum, leisure, neighborhood, and finances showed a positive effect on satisfaction with health and with life.     

Dimensions of mental health: Life satisfaction,positive affect,anxiety and depression

Psychological well-being and psychological distress are often regarded as distinct, if not orthogonal dimensions of mental health. Based on analyses in this paper, we consider the distinction misleading. Four dimensions seem worth measuring in general population surveys: life satisfaction, positive affect, anxiety and depression. Furthermore, one of the well-being dimensions, life satisfaction, is quite strongly correlated with a distress dimension, depression. A person is unlikely to be both satisfied with life and depressed, but may be satisfied and anxious. The paper is based on convergent validity (exploratory and confirmatory factor analyses) and divergent validity assessments of a range of widely used measures, which were included in the Victorian Quality of Life Panel Survey, 1987.     

Determinants of Health and the Quality of Life in the Bella Coola Valley

The aim of this investigation is to obtain some baseline self-reported data on the health status and overall quality of life of all residents of the Bella Coola Valley of British Columbia aged 17 years or older, and to measure the impact of a set of designated health determinants on their health and quality of life. In the period from August to November 2001, a variety of procedures were used to ensure that all eligible residents of the Valley received a copy of our questionnaire, and 687 useable questionnaires were obtained for our working dataset. Health status was measured by SF-36 and the U.S. Centers for Disease Control healthy days items. Thirty-one items were used to measure the Provincial Health Officer’s designated determinants of health in four clusters, namely, biological, social and economic, health behaviours and health services determinants. Quality of life was measured by satisfaction levels in 13 specific domains of life (e.g., family, financial security), four global items (e.g., happiness, life satisfaction) and one global Subjective Well-Being Index. Besides obtaining baseline figures on all our measures for the Valley, we made some comparisons among our figures and those from other areas, e.g., Prince George, BC. Most of the measures indicated that the health status and quality of life of Bella Coola Valley residents were lower than those of Prince George residents. For the sample as a whole, SF-36 scores on the eight dimensions ran from 82.3 (physical functioning) to 50.0 (social functioning), with a mean of 62.7. Residents in the Valley averaged 6.5 days in the past 30 in which their health was physically not good, 5.5 days when it was mentally not good and 4.1 days when their health limited their usual daily activities. Eleven percent of respondents described their general health as “excellent” and another 27% said it was “very good”. On a 7-point scale from 1=very dissatisfied to 7=very satisfied, respondents had average life satisfaction and satisfaction with the overall quality of life scores of 5.5. For specific domains of life, the lowest mean level of satisfaction was reported for federal and provincial government officials (3.3) and the highest was reported for living partners and personal safety around home (5.8). Regarding bivariate relations, each of the eight dimensions of SF-36 was significantly correlated with a single item measure of general health, and five of the eight were significantly correlated with the number of good health days. Happiness and the Subjective Well-Being Index were positively but moderately correlated with six of the eight dimensions, and life satisfaction was positively correlated with five. Age was negatively related to general health, but positively related to life satisfaction. Not being of aboriginal descent was positively related to all of the four global health indicators and to the Subjective Well-Being Index. Education was positively related to the four global health measures but not to the three global quality of life measures. The Social Support and Good Family Indexes were positively related to all seven global measures. There was a positive correlation between six of the seven global measures and the frequency with which respondents participated in activities sponsored by voluntary organizations. Frequency of smoking was negatively associated with every global dependent variable except the Physical Health Index. Frequency of skipping meals was negatively associated and average hours of sleep per night was positively associated with all seven global measures. Turning to multivariate relationships, the four clusters of health determinants explained from 12% (SF-36 Mental Health Index) to 24% (general health) of the variance in the dependent global health variables, and from 20% (happiness) to 26% (Subjective Well-Being Index) of the variance in the dependent global quality of life variables. Adding domain satisfaction scores to the total set of predictors allowed us to explain from 20% (SF-36 Mental health Index) to 29% (general health) of the variance in the dependent global health variables, and from 39% (happiness) to 62% (life satisfaction) in the dependent global quality of life variables. By including measures of social support and good family relationships in our set of health determinants, we practically guaranteed that the latter would be relatively strongly predictive of global quality of life.     

Life Satisfaction as a Distinguishing Indicator of College Student Functioning: Further Validation of the Two-Continua Model of Mental Health

The two-continua model of mental health contends that both psychological distress and psychological well-being make related-yet-distinct contributions to our understanding of human health and its relations with other quality of life outcomes. Using self-reported somatization, depression, and anxiety symptoms as indicators of psychological distress and self-reported life satisfaction as an indicator of psychological well-being, the present study classified participants into one of four mental-health-status groups—mentally healthy, mentally unhealthy, symptomatic yet content, or asymptomatic yet discontent—and investigated between-group differences across three key indicators of college student functioning: academic achievement, interpersonal connectedness, and physical health. Findings provide further validation for the two-continua model of mental health among college students, showing that, when considered in conjunction with clinical symptoms, life satisfaction serves as a distinguishing indicator of college students functioning across academic, social, and physical health domains—as well as a strong predictor of the absence or presence of clinical symptoms and comorbidity. Implications for theory, practice, and future research are discussed.     

Healthy Days,Health Satisfaction and Satisfaction with the Overall Quality of Life

In this note we report results of 6 surveysusing the United States Centers for DiseaseControl and Prevention indicators of healthstatus, taken from the Behavioral Risk FactorSurveillance System. Generally speaking, wefound that the CDC healthy days variables couldplay a useful role in survey research aimed atassessing the impact of measured health statuson people's satisfaction with their own healthand with the overall quality of their lives.More precisely, using stepwise regressions wefound: (1) The three healthy days variablesexplained from 16 to 27 percent of the variancein General Health scores. The limited activitydays variable remained as a significantpredictor in only one of the six regressionsand the not good physical health days variablewas most influential in every sample. (2) Thethree healthy days variables explained from 19to 32 percent of the variance in healthsatisfaction scores, and the not good physicalhealth days variable was again most influentialin every sample. (3) The three healthy daysvariables explained from 12 to 39 percent ofthe variance in quality-of-life satisfactionscores, with the not good mental healthvariable most influential in every sample. (4)The four CDC variables together explained from40 to 55 percent of the variance in healthsatisfaction scores, with the General Healthvariable always dominating the set ofpredictors by a fairly wide margin. (5) Thefour CDC variables together explained from 17to 28 percent of the variance inquality-of-life satisfaction scores, with theGeneral Health variable most influential inthree samples and the not good mental healthvariable most influential in the other three.(6) When the four CDC variables plus the healthsatisfaction variable were used as potentialpredictors, we were able to explain from 29 to40 percent of the variance in quality-of-lifesatisfaction scores. In every sample, theGeneral Health and limited activity daysvariables had no significant impact. (7) Usingstructural equation modeling, we found GeneralHealth does not have a direct effect onsatisfaction with the overall quality of lifebut rather only an indirect effect throughhealth satisfaction. The General Health, notgood physical health, and not good mentalhealth days variables account for 51% of thevariation in health satisfaction, and healthsatisfaction, not good physical health and notgood mental health days variables account for30% of the variation in satisfaction with theoverall quality of life.     

Good Health is Not the Same as a Good Life: Survey Results from Brandon,Manitoba

The aim of this investigation was to obtain some baseline self-reported data on the health status and overall quality of life of a sample of residents of the city of Brandon, Manitoba aged 18 years or older, and to measure the impact of a set of designated health determinants, comparison standards and satisfaction with diverse domains of life on their health and quality of life. In May and June 2010, 2,500 households from the city of Brandon, Manitoba were randomly selected to receive a mailed out questionnaire and 518 useable, completed questionnaires were returned. Baseline health status data were obtained using the 8 SF-36 dimensions of health and 13 items from the United States Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System. Determinants of health and overall quality of life included measures of socializing activities, a Good Neighbourhood Index, Social Support Index, Community Health Index, a measure of free-time exercise levels, health-related behaviours, use of drugs, health care issues, a set of domain-specific quality of life items, a set of measures concerning criminal victimization, worries and behaviours concerning victimization and the basic postulates of Multiple Discrepancies Theory. Overall life assessment, dependent variables included Average Health, happiness, a single item measure of satisfaction with life as a whole, a single item measure of satisfaction with the overall quality of life, the Satisfaction With Life Scale, Contentment with Life Assessment Scale and a Subjective Wellbeing Index. Using multiple regression, we explained as much as 75% of the variance in Subjective Wellbeing scores and as little as 45% in happiness scores. Four clusters of health determinants explained from 20% (Happiness) to 44% (Average Health) of the variance in the dependent variables. Adding comparison standards and domain satisfaction scores to the set of health determinants increased our total explanatory power by only 2% points for Average Health (from 44 to 46%), but more than doubled our explanatory power for Happiness (from 20 to 45%) and for satisfaction with the overall quality of life (from 31 to 67%). As well, our explanatory power for the single item of Life Satisfaction increased from 34 to 66%, for the Satisfaction With Life Scale from 39 to 74%, for the Contentment With Life Assessment Scale from 36 to 60%, and for Subjective Wellbeing from 42 to 75%. This provided very clear evidence that self-perceived good health is not equivalent to perceived quality of life, confirming evidence reported in our earlier studies. The three most important take-home messages from this investigation are (1) in assessing the relative influence of any alleged determinants of health and the quality of life, different sets of alleged determinants will appear to be more or less influential for different dependent variables. Therefore, (2) researchers should use diverse sets of determinants and dependent variables and (3) it is a big mistake to use measures of health status as if they were measures of the perceived quality of life.     

American High School Students’ Perceptions of Determinants of Life Satisfaction

Life satisfaction can be assessed either globally or with regard to satisfaction with specific domains of life. The latter multidimensional approach presumes science has delineated with confidence the specific domains most relevant to evaluating whether the criteria for a good life have been met. This paper shares results of a qualitative study of the perceived determinants of life satisfaction among 30 high school students who were diverse in terms of mental health; 6–10 participants were classified as complete mental health, vulnerable, symptomatic but content, or troubled at two time points separated by a year. Thematic analyses of transcribed individual interviews suggested eight themes that capture the domains of life adolescents perceive influence their happiness. These themes are compared and contrasted to domains included in existing multi-dimensional measures of youth life satisfaction. The factors likely to be particularly salient to students with different levels of mental health are noted.

     

Life Satisfaction and Suicide among High School Adolescents

Relationships between perceived life satisfaction, poor mental health, suicide ideation and suicide behaviors were examined in a statewide sample of 13 to 18 year old public high school students (n = 4,758) using the self-report CDC Youth Risk Behavior Survey (YRBS). Adjusted logistic regression analyses and multivariate models constructed separately (via SUDAAN), revealed that poor mental health (past 30 days), poor mental/physical health (past 30 days) serious suicide consideration (past 12 months), planning for suicide (past 12 months), attempted suicide (past 12 months) and suicide attempt requiring medical care (past 12 months) were significantly related to reduced life satisfaction. Also, differences across gender and race were demonstrated. Measures of life satisfaction as a component of comprehensive assessments of adolescent mental health, suicide ideation and suicide behavior in fieldwork, research, and program-evaluation efforts should be considered.     

Materialism and Satisfaction with Over-All Quality Of Life and Eight Life Domains

Previous research has shown that materialism relates negatively to satisfaction with many life domains. The present study broadens this body of research by examining the relationship between three dimensions of materialism and eight quality of life (QOL) domains in a large, diverse sample of U.S. respondents. Two hypotheses were tested: First, overall measures of materialism and satisfaction with QOL were thought to be inversely related. Second, the three dimensions of materialism and QOL domains were hypothesized to be negatively correlated. Results show that overall materialism and its happiness dimension were consistently negatively related to all eight measures of QOL. Materialism’s centrality and success dimensions were negatively correlated with seven and six of the eight QOL domains, respectively. Findings are discussed in light of Humanistic and Organismic theories, and other implications are considered.     

An Exploratory Study on the Quality of Life of older Chinese People Living alone in Hong Kong

This study successfully interviewed 109 randomly selected Chinese people aged 60 and over living alone in two public housing estates in an urban area of Hong Kong. The results show that mental health status, number of days staying in hospital, life satisfaction, age, and self-esteem are significant factors in predicting the life quality of older Chinese respondents living alone. The explanatory power of this model is 56.4. The results of this study are consistent with previous findings reported in the west and in Hong Kong. A subgroup analysis of those older Chinese respondents living alone who have offspring also living in Hong Kong shows that belief in childrens’ support in old age, good walking ability, and better self-reported health status via life satisfaction as the mediating variable, better self-reported health status and satisfactory self-reported financial status via self-esteem as the mediating variable, are crucial predictors of quality of life. This model explains 64.2% of the variance in quality of life from a subset of the predictor variables.     

An Exploratory Study on the Quality of Life of older Chinese People Living alone in Hong Kong

This study successfully interviewed 109 randomly selected Chinese people aged 60 and over living alone in two public housing estates in an urban area of Hong Kong. The results show that mental health status, number of days staying in hospital, life satisfaction, age, and self-esteem are significant factors in predicting the life quality of older Chinese respondents living alone. The explanatory power of this model is 56.4. The results of this study are consistent with previous findings reported in the west and in Hong Kong. A subgroup analysis of those older Chinese respondents living alone who have offspring also living in Hong Kong shows that belief in childrens support in old age, good walking ability, and better self-reported health status via life satisfaction as the mediating variable, better self-reported health status and satisfactory self-reported financial status via self-esteem as the mediating variable, are crucial predictors of quality of life. This model explains 64.2% of the variance in quality of life from a subset of the predictor variables.     

Health and Other Aspects of the Quality of Life of Older People

Celebrating the United Nations' International Year of Older Persons, in September 1999 a survey research project was undertaken throughout the Northern Interior Health Region (NIHR) of British Columbia. A total of 875 people completed 23-page questionnaires, the average age of the respondents was 69 and the range ran from 55 to 95 years. Responses to the SF-36 questionnaire indicated that for male respondents aged 55–64, the mean score for the 8 dimensions was 74.4. This mean was practically identical to that of the United States norm for such people (74.5) and lower than that for the United Kingdom (77.4). For male respondents aged 65 and older, the mean was 68.3. This was numerically higher but again practically the same as that of the norm for the United States (68.1). For females aged 55–64, the mean score for 8 dimensions was 73. This was superior to that of the United States norm of (70.6) for such people and lower than that for the United Kingdom (74.6). For female respondents aged 65 and older, the mean score was 65.4. This was practically identical to that of the United States (65.5).Comparing 18 average figures for our respondents on satisfaction with specific domains of life (e.g., financial security, health, friendships) and life as a whole with those of average adults in Prince George in November 1999, we found that in all but two cases the older people's scores were higher. Only in the cases of satisfaction with health and overall happiness were older people's scores lower, and the differences were not statistically significant.Eleven percent of our respondents reported that they had been a victim of a crime in the last year, compared to 38% in our 1997 adult victimization survey. Older people had a more benign view than ordinary adults of the growth of crime in their neighbourhood and city, although exactly 64% of both groups thought that crime had increased in Canada. Although older people had a more optimistic view than other adults of the increase in crime in their neighbourhoods, fewer of the former than the latter felt safe out at night. Nevertheless, compared to adults surveyed in 1997, the behaviour of respondents in our survey of older people was not as constrained by concerns of criminal victimization.Two or three of the 8 SF-36 health dimensions explained 37% of the variation in life satisfaction scores, 34% of variation in happiness scores, 34% in satisfaction with the overall quality of life scores and 22% in satisfaction with one's overall standard of living. In every case, Mental Health was the dimension that had the greatest impact on our four dependent variables.When all of our potential predictors were entered into a regression equation simultaneously, we found that they could explain 60% of the variance in life satisfaction scores, 44% in happiness scores, 58% in satisfaction with the overall quality of life scores and 59% in satisfaction with one's overall standard of living scores.     

Living Arrangements and Quality of Life Among Chinese Canadian Elders

This paper examines the role of living arrangements in thequality of life of community-dwelling Chinese elders (aged 65 andover) currently residing in Vancouver and Victoria, BritishColumbia. Data are based on a random sample of 830 persons[response rate = 71.5%], who were interviewed in their homes inthe language of their choice in 1995–96. Three dimensions ofquality of life – satisfaction, well-being and social support –are examined for married men and women [living with spouse alonevs. living intergenerationally] and widowed women [living alonevs. living intergenerationally]. Few differences are found formarried persons, especially women; for widows, living alonesignificantly reduces quality of life in a number of areas.Regression analyses indicate that living arrangements are not asignificant predictor of life satisfaction or well-being formarried men and women. For widows, living arrangements determinewell-being but not life satisfaction.Overall, age, health status, and social support (havingfriends/confidante) are better predictors of quality of life forelderly Chinese Canadians than are living arrangements. Findingshighlight the importance of: empirically distinguishing maritalstatus and living arrangements in studying the quality of life ofelders; not homogenizing Chinese Canadian seniors with regard toliving arrangements; and focussing on Chinese elderly widows wholive alone as a group at risk of low well-being.     

Long-term effects of back extensor strengthening exercises on quality of life in women with osteoporosis

The aim of the present study was to evaluate the long-term effect of back extensor strengthening exercises on health-related quality of life (QOL) in women with osteoporosis. In this randomized clinical trial, 183 women with osteoporosis were treated with pharmacotherapy and weight-bearing and balance-training exercises. The case group additionally performed back extensor exercises at home. Patients filled out the Persian version of the Short Form (SF-36) QOL questionnaire at baseline and 6 months post treatment. At the end, all physical and mental parameters of the SF-36 questionnaire improved significantly in the case group, except for one subscale of mental health, compared to the control group. In the control group, only some physical health dimensions (bodily pain, role limitation, physical function, vitality), and mental health status as a mental health subscale improved. In conclusion, considering a major impact of back extensor exercises on improving QOL in women with osteoporosis over the long term, these exercises should be prescribed in routine management of these patients.     

Health,Quality of Care and Quality of Life: A Case of Frail Older Adults

This study explores the relationship between health, quality of care of geriatric case management and quality of life for the purpose of furthering the understanding of the relationship between quality of life and geriatric case management. Using survey data from a group of frail older adults, this study assesses the relative merit of two mediation hypotheses: one considering health as a mediator for quality of care of geriatric case management and quality of life, and the other considering quality of care of geriatric case management as a mediator for health and quality of life. The study findings show that quality of care of geriatric case management, measured by client satisfaction, was not a mediator between health and quality of life (measured by life satisfaction). There was a significant positive association between quality of care of geriatric case management and quality of life. Although the significant association between quality of care of geriatric case management and quality of life could not be mediated by either self-rated health or self-reported physical activity levels, it was completely mediated by health satisfaction. These findings provided preliminary empirical evidence to support a significant relationship between quality of care of geriatric case management and quality of life.     

Trajectory of Life Satisfaction and its Relationship with Subjective Economic Status and Successful Aging

The aim of the study was to explore the relationship between subjective economic status and indicators of successful aging to life satisfaction trajectories among the elderly in Taiwan. Data were from the four waves of “Survey of Health and Living Status of the Elderly in Taiwan”. Hierarchical linear modeling was conducted. Subjective economic status was measured by childhood economic status and time-varying economic satisfaction. Time-varying physical, mental, and social successful aging variables and demographics were also used to describe the trajectory of life satisfaction. Life satisfaction showed a slightly decreasing but generally stationary trend across time. The concurrent economic satisfaction was associated with life satisfaction trajectory, but childhood economic status was not significant. The time-varying depressive symptoms, cognitive function and social support were related to the life satisfaction trajectory. Policy on the elderly should take particular account of the economic security, mental health, and social support of the elderly.     

Comparing Self-Rated Health, Satisfaction and Quality of Life Scores Between Diabetics and Others Living in The Bella Coola Valley

Objective: To investigate the relative effect that diabetes has on self-rated health, satisfaction with various specific domains of life, and satisfaction with quality of life operationalized as happiness, satisfaction with life as a whole, and satisfaction with overall quality of life. Design: Mixed methods – mailed survey and chart review. Study Population: All people aged 17 years or older, residing in the Bella Coola Valley in September 2001 and having a chart at the Bella Coola Medical Clinic. Main outcome measures: Self-rated health, self-rated stress, rating of self-care received, global life satisfaction (Life as whole; Overall standard of living; Overall quality of life; and Overall happiness); and satisfaction with various domains of life. Results: A total of 968 useable surveys were returned for a response rate of 56 (968/1734). Age was negatively related to General Health, but positively related to Life Satisfaction. Not being of Aboriginal descent was positively related to all of the four global health indicators and to Subjective Well-Being. After accounting for age, race, and weight, we found that diabetics report significantly poorer self-rated health, and lower satisfaction with health scores compared to people without diabetes. Participants with diabetes who were the least compliant with their treatment regimens rated their current health significantly lower than those who were the most compliant. People with diabetes were, however, no more likely to be unhappy or dissatisfied with their lives as a whole or with the overall quality of their lives compared to people without diabetes. Among people with diabetes, however, those who used insulin did report significantly less satisfaction with the overall quality of their lives than those who didn’t use insulin. Conclusion: Diabetics understand they have poorer health than others, but they do not have poorer global life satisfaction scores. This may explain why it is difficult to get diabetics to adopt behaviours which may lower their quality of life – e.g., diet plans, lose weight, engage in exercise programs, or take medications.     

Does National Income Inequality Affect Individuals’ Quality of Life in Europe? Inequality,Happiness, Finances,and Health

This paper analyses the effect of income inequality on Europeans’ quality of life, specifically on their overall well-being (happiness, life satisfaction), on their financial quality of life (satisfaction with standard of living, affordability of goods and services, subjective poverty), and on their health (self-rated health, satisfaction with health). The simple bivariate correlations of inequality with overall well-being, financial quality of life, and health are negative. But this is misleading because of the confounding effect of a key omitted variable, national economic development (GDP per capita): Unequal societies are on average much poorer (r = 0.46) and so disadvantaged because of that. We analyse the multi-level European Quality of Life survey conducted in 2003 including national-level data on inequality (Gini coefficient) and economic development (GDP) and individual-level data on overall well-being, financial quality of life, and health. The individual cases are from representative samples of 28 European countries. Our variance-components multi-level models controlling for known individual-level predictors show that national per capita GDP increases subjective well-being, financial quality of life, and health. Net of that, the national level of inequality, as measured by the Gini coefficient, has no statistically significant effect, suggesting that income inequality does not reduce well-being, financial quality of life, or health in advanced societies. These result all imply that directing policies and resources towards inequality reduction is unlikely to benefit the general public in advanced societies.