Abstract
Instruments with acceptable measurement properties that support their application to older adults across a range of settings need to be identified. A narrative literature review of empirical studies investigating the conceptualization and measurement of quality of life (QoL) among older adults from 1994 to 2006 was performed. The review focused on evidence provided for conceptual frameworks, QoL definitions, types of measurements utilized and their psychometric properties. Two searches were conducted. The first search conducted in 2004 used Cinahl, Medline, PsycInfo, Embase and Cochrane databases. A supplemental search was conducted in December 2006, which included these bases from 2004 to 2006, and Sociological Abstracts and Anthropological literature base. The review included 47 papers. A total of 40 different measurements were applied in the studies, assessing most frequently functional status and symptoms. The most extensive psychometric evidence was documented for the SF-36. Although construct validity was reported in the majority of studies, minimal empirical evidence was given for other psychometric properties. Further, 87% of the studies lacked a conceptual framework and 55% did not report any methodological considerations related to older adults. Quality control standards, which can guide measurement assessment and subsequent data interpretation, are needed to enhance more consistent reporting of the psychometric properties of QoL instruments utilized. Future work on the development of common QoL assessment models that are both person-centered, causal and multidimensional based on collaborative efforts from professionals interested in QoL from the international gerontological research community are needed.
Similar content being viewed by others
References
Akifusa S, Soh I, Ansai T, Hamasaki T, Takata Y, Yohida A, Fukuhara M, Sonoki K, Takehara T (2005) Relationship of number of remaining teeth to health-related quality of life in community-dwelling elderly. Gerodontology 22(2):91–97
Altman DG (1999) Practical statistics for medical research. Chapman & Hall, London
Andersson M, Halberg IR, Edberg K (2006) The final period of life in elderly people in Sweden: factors associated with QoL. Int J Palliat Nurs 12(6):286–293
Andresen EM (2000) Criteria for assessing the tools of disability outcomes research. Arch Phys Med Rehabil 81(12 Suppl 2):15–20
Andresen EM, Meyers AR (2000) Health-related quality of life outcomes measures. Arch Phys Med Rehabil 81(2):30–45
Andrews F, Withey SB (eds) (1976) Social indicators of well-being: americans’ perceptions of life quality. Plenum, New York
Assantachai P, Maranetra N (2003) Nationwide survey of the health status and quality of life of elderly Thais attending clubs for the elderly. J Med Assoc Thai 86(10):938–946
Beaumont JG, Kenealy PM (2004) Quality of life perceptions and social comparisons in healthy old age. Ageing Soc 24(5):755–769
Berkman B (1999) Standardized screening of elderly patients’ needs for social work assessment in primary care: use of the SF-36. Health Soc Work 24(1):9–16
Berlowitz DR (1995) Health-related quality of life of nursing home residents: differences in patient and provider perceptions. J Am Geriatr Soc 43(7):799–802
Borders TF (2004) Factors associated with health-related quality of life among an older population in a largely rural western region. J Rural Health 20(1):67–75
Borglin G, Jakobsson U, Edberg AK, Hallberg IR (2005) Self-reported health complaints and their prediction of overall and health-related quality of life among elderly people. Int J Nurs Stud 42(2):147–158
Bowling A (2001a) Measuring disease: a review of disease specific quality of life measurement scales. 2nd edn., Open University Press, Philadelphia
Bowling A (2001b) Research methods in health: investigating health and health services. 2nd edn., University Press, Philadelphia
Bowling A (2005) Ageing well: quality of life in old age. Open University Press, Maidenhead
Bowling A, Banister D, Sutton S, Evans O, Windsor J (2002) A multidimensional model of the quality of life in older age. Aging Ment Health 6(4):355–371
Bowling A, Gabriel Z, Dykes J, Dowding LM, Evans O, Fleissig A, Banister D, Sutton S (2003) Let’s ask them: a national survey of definitions of quality of life and its enhancement among people aged 65 and over. Int J Aging Hum Dev 56(4):269–306
Bowling A, Ebrahim SS (eds) (2005) Handbook of health research methods: investigation, measurement and analysis. Open University Press, Maidenhead
Brand CA, Jones CT, Lowe AJ, Nielsen DA, Roberts CA, King BL, Campbell DA (2004) A transitional care service for elderly chronic disease patients at risk of readmission. Aust Health Rev 28(3):275–284
Brazier JE, Walters SJ, Nicholl JP, Kohler B (1996) Using the SF-36 and EuroQoL on an elderly population. Qual Life Res 5(2):195–204
Brown J, Bowling A, Flyn T (2004) Models of QoL: a taxonomy, overview and systematic review of the literature, European Forum on Population Ageing Research
Buck D, Jacoby A, Massey A, Ford G (2000) Evaluation of measures used to assess quality of life after stroke. Stroke 31(8):2004–2010
Burns R, Nichols LO, Martindale-Adams J, Graney MJ (2000) Interdisciplinary geriatric primary care evaluation and management: two-year outcomes. J Am Geriatr Soc 48(1):8–13
Byles J (1999) Over the hill and picking up speed: older women of the Australian longitudinal study on women’s health. Aust J Ageing 18(3):55–62
Byles JE, Tavener M, O’Connell RL, Nair BR, Higginbotham NH, Jackson CL, McKernon ME, Francis L, Heller RF, Newbury JW, Marley JE, Goodger BG (2004) Randomised controlled trial of health assessments for older Australian veterans and war widows. Med J of Aust 181(4):186–190
Byles J, Young A, Furuya H, Parkinson L (2006) A drink to healthy aging: the association between older women’s use of alcohol and their health-related quality of life. J Am Geriatr Soc 54(9):1341–1347
Calman KC (1987) Definitions and dimensions of quality of life. In: Aaronson NK , Beckmann JH (eds) The quality of life of cancer patients. Raven, New York
Campbell A, Converse PE, Rodgers WJ (eds) (1976) The quality of American life: perceptions, evaluations, and satisfactions. Russell Sage, New York
Chang AA, Heskett KM, Davidson TM (2006) Searching the literature using medical subject headings versus text word with PubMed. Laryngoscope 116(2):336–340
Chinn PL, Kramer MK (eds) (1999) Theory and nursing: integrated knowledge development. Mosby, St Louis
Craig JV, Smyth RL (eds) (2002) The evidence-based practice manual for nurses. Churchill Livingstone, London
Cummins RA (1997) Assessing quality of life for people with disabilities. In: Brown R (ed) Quality of Life for people with disabilities: models, research and practice. 2nd edn., Stanley Thornes, Cheltenham, pp 116–150
De Korte J, Sprangers MAG, Mombers FMC, Bos JD (2004) Quality of life in patients with psoriasis: a systematic literature review. J Invest Dermatol Symp 9(2):140–147
De Leo D, Diekstra RF, Lonnqvist J, Trabucchi M, Cleiren MH, Frisoni GB, Dello BM, Haltunen A, Zucchetto M, Rozzini R, Grigoletto F, Sampaio-Faria J (1998) LEIPAD, an internationally applicable instrument to assess quality of life in the elderly. Behav Med 24(1):17–27
Dempster M, Donnelly M (2000) How well do elderly people complete individualised quality of life measures: an exploratory study. Qual Life Res 9(4):269–375
Deyo RA, Diehr P, Patrick DL (1991) Reproducibility and responsiveness of health status measures. Statistics and strategies for evaluation. Control Clin Trials 12(4 Suppl):142–158
Ellingson T, Conn VS (2000) Exercise and quality of life in elderly individuals. J Gerontol Nurs 26(3):17–25
Erikson EH, Erikson JM (eds) (1997) The life cycle completed. Norton, New York
Ettema TP, Droes RM, de Lange J, Mellenbergh GJ, Ribbe MW (2005) A review of quality of life instruments used in dementia. Qual Life Res 14(3):675–686
Farquhar M (1995) Elderly people’s definitions of quality of life. Soc Sci Med 41(10):1439–1446
Fayers PM, Machin D (eds) (2007) Quality of life: the assessment, analysis and interpretation of patient-reported outcomes. Wiley, Chichester
Feldman PH, Peng TR, Murtaugh CM, Kelleher C, Donelson SM, McCann ME, Putnam ME (2004) A randomized intervention to improve heart failure outcomes in community-based home health care. Home Health Care Serv Q 23(1):1–23
Ferrans CE, Zerwic JJ, Wilbur JE, Larson JL (2005) Conceptual model of health-related quality of life. J Nurs Scholar 37(4):336–342
Finkel SI, Richter EM, Clary CM (1999) Comparative efficacy and safety of sertraline versus nortriptyline in major depression in patients 70 and older. Int Psychogeriatr 11(1):85–99
Fitzpatrick R, Davey C, Buxton MJ, Jones DR (1998) Evaluating patient-based outcome measures for use in clinical trials. Health Technol Assess 2(14):1–74
Flanagan JC (1978) A research approach to improving our quality of life. Am Psychol 33(2):138–147
Fletcher AE, Dickinson EJ, Philp I (1992) Review: audit measures: quality of life instruments for everyday use with elderly patients. Age Ageing 21(2):142–150
Fletcher AE, Price GM, Ng ES, Stirling SL, Bulpitt CJ, Breeze E, Nunes M, Jones DA, Latif A, Fasey NM, Vickers MR, Tulloch AJ (2004) Population-based multidimensional assessment of older people in UK general practice: a cluster-randomised factorial trial. Lancet 364(9446):1667–1677
Fors S, Thorslund M, Parker MG (2006) Do actions speak louder than words? Self-assessed and performance-based measures of physical and visual function among old people. Eur J Ageing 3(1):15–21
Fries NJ (1983) Toward an understanding of patient outcome measurement. Arthritis Rheum 26(6):697
Fry PS (2001) Predictors of health-related quality of life perspectives, self-esteem, and life satisfactions of older adults following spousal loss: an 18-month follow-up study of widows and widowers. Gerontologist 41(6):787–798
Frytak JR (2000) Assessment of quality of life in older adults. In: Kane RL, Kane RA, Eells M. Assessing older persons: measures, meaning, and practical applications. Oxford University Press, Oxford, pp 200–236
Gagnon AJ, Schein C, McVey L, Bergman H (1999) Randomized controlled trial of nurse case management of frail older people. J Am Geriatr Soc 47(9):1118–1124
Gault LV, Shultz M, Davies K (2002) Variations in medical subject headings (MeSH) mapping: from the natural language of patron terms to the controlled vocabulary of mapped lists. J Med Libr Assoc 90(2):173–180
George LK, Bearon LB (eds) (1980) Quality of life in older persons: meaning and measurement. Human Sciences Press, New York
Gerritsen DL, Steverink N, Ooms ME, Ribbe MW (2004) Finding a useful conceptual basis for enhancing the quality of life of nursing home residents. Qual Life Res 13(3):611–624
Gilhooly M, Gilhooly K, Bowling A (2005) Quality of life measuring and measurement. In: Walker A (ed) Understanding quality of life in old age. Open University Press, Maidenhead, pp 14–26
Gill TM, Feinstein AR (1994) A critical appraisal of the quality of quality-of-life measurements. JAMA 272(8):619–626
Grimby A, Wiklund I (1994) Health-related quality of life in old age. A study among 76-year-old Swedish urban citizens. Scand J Soc Med 22(1):7–14
Grotle M, Brox JI, Vollestad NK (2005) Functional status and disability questionnaires: what do they assess? A systematic review of back-specific outcome questionnaires. Spine 30(1):130–140
Grundy EE (2006) Ageing and vulnerable elderly people: European perspectives. Ageing Soc 26(1):105–134
Grundy E, Bowling A (1999) Enhancing the quality of extended life years. Identification of the oldest old with a very good and very poor quality of life. Aging Ment Health 3(3):199–212
Guyatt GH, Jaeschke F, Patrick D (1996) Measurement in clinical trials: choosing the right approach. In: Spilker B (ed) Quality of life and pharmacoeconomics in clinical trials. 2 edn., Lippincott-Raven, Philadelphia
Hallett KS, Todd AL (1998) Separate but equal? A system comparison study of Medline’s controlled vocabulary MeSH. Bull Med Libr Assoc 86(4):491–495
Hanlon JT, Weinberger M, Samsa GP, Schmader KE, Uttech KM, Lewis IK, Cowper PA, Landsman PB, Cohen HJ, Feussner JR (1996) A randomized, controlled trial of a clinical pharmacist intervention to improve inappropriate prescribing in elderly outpatients with polypharmacy. Am J Med 100(4):428–437
Haywood KL, Garratt AM, Schmidt LJ, Mackintosh A, Fitzpatrick R (2004) Health status and quality of life in older people: a review, National Centre for Health Outcomes Development, Oxford
Haywood KL, Garratt AM, Fitzpatrick R (2005a) Older people specific health status and quality of life: a structured review of self-assessed instruments. J Eval Clin Pract 11(4):315–327
Haywood KL, Garratt AM, Fitzpatrick R (2005b) Quality of life in older people: a structured review of generic self-assessed health instruments. Qual Life Res 14(7):1651–1668
Haywood KL, Garratt AM, Fitzpatrick R (2006) Quality of life in older people: a structured review of self-assessed health instruments. Expert Rev Pharmacoecon Outcom Res 2(6):181–194
Hellstrom Y, Andersson M, Hallberg IR (2004a) Quality of life among older people in Sweden receiving help from informal and/or formal helpers at home or in special accommodation. Health Soc Care Community 12(6):504–516
Hellstrom Y, Persson G, Hallberg IR (2004b) Quality of life and symptoms among older people living at home. J Adv Nurs 48(6):584–593
Hendry F, McVittie C (2004) Is quality of life a healthy concept? Measuring and understanding life experiences of older people. Qual Health Res 14(7):961–975
Higgs P, Hyde M, Wiggins R, Blane B (2003) Researching quality of life in early old age the importance of the sociological dimension. Soc Policy Adm 37(3):239–252
Hughes C, Hwang B (1996) Attempts to conceptualize and measure quality of life. In: Schalock RL (ed) Quality of life, vol 1. Conceptualization and measurement. American Association on Mental Retardation, Washington, pp 51–62
Hyland ME (1992) A reformulation of quality of life for medical science. Qual Life Res 1(4):267–272
Jenkins KR (2002) Activity and health-related quality of life in continuing care retirement communities. Res Aging 24(1):124–149
Jenuwine ES, Floyd JA (2004) Comparison of medical subject headings and text–word searches in MEDLINE to retrieve studies on sleep in healthy individuals. J Med Libr Assoc 92(3):349–353
Kane RL, Kane RA, Eells M (2002) Assessing older persons: measures, meaning, and practical applications. Oxford University Press, Oxford
Kempen GI, Ormel J, Brilman EI, Relyveld J (1997) Adaptive responses among Dutch elderly: the impact of eight chronic medical conditions on health-related quality of life. Am J Public Health 87(1):38–44
Kempen GI, Brilman EI, Ranchor AV, Ormel J (1999) Morbidity and quality of life and the moderating effects of level of education in the elderly. Soc Sci Med 49(1):143–149
Krause N (2004) Lifetime trauma, emotional support, and life satisfaction among older adults. Gerontologist 44(5):615–623
Kumar P, Zehr KJ, Chang A, Cameron DE, Baumgartner WA (1995) Quality of life in octogenarians after open heart surgery. Chest 108(4):919–926
Laake K (2003) Geriatri i praksis (Geriatrics in practice). 4th edn., Gyldendal Akademisk, Oslo
Lee TW, Ko IS, Lee KJ (2006) Health promotion behaviours and quality of life among community-dwelling elderly in Korea: a cross-sectional survey. Int J Nurs Stud 43(3):293–300
Liu-Ambrose TY, Khan KM, Eng JJ, Lord SR, Lentle B, McKay HA (2005) Both resistance and agility training reduce back pain and improve health-related quality of life in older women with low bone mass. Osteoporos Int 16(11):1321–1329
Livingston G, Watkin V, Manela M, Rosser R, Katona C (1998) Quality of life in older people. Aging Ment Health 2(1):20–23
MacRae PG, Asplund LA, Schnelle JF, Ouslander JG, Abrahamse A, Morris C (1996) A walking program for nursing home residents: effects on walk endurance, physical activity, mobility, and quality of life. J Am Geriatr Soc 44(2):175–180
Maslow AH (1954) Motivation and personality. Harper and Row, New York
McDowell I, Jenkinson C (1996) Development standards for health measures. J Health Serv Res Policy 1(4):238–246
McFall SL (2000) Outcomes of a small group educational intervention for urinary incontinence: health-related quality of life. J Aging Health 12(3):301–317
McHorney CA (1996) Measuring and monitoring general health status in elderly persons: practical and methodological issues in using the SF-36 Health Survey. Gerontologist 36(5):571–583
McHugh GJ, Havill JH, Armistead SH, Ullal RR, Fayers TM (1997) Follow up of elderly patients after cardiac surgery and intensive care unit admission, 1991 to 1995. N Z Med J 110(1056):432–435
Moons P (2004) Why call it health-related quality of life when you mean perceived health status? Eur J Cardiovasc Nurs 3(4):275–277
Nelson ME, Layne JE, Bernstein MJ, Nuernberger A, Castaneda C, Kaliton D, Hausdorff J, Judge JO, Buchner DM, Roubenoff R, Fiatarone Singh MA (2004) The effects of multidimensional home-based exercise on functional performance in elderly people. J Gerontol Biol Sci Med Sci 59(2):154–160
Nesbitt BJ, Heidrich SM (2000) Sense of coherence and illness appraisal in older women’s quality of life. Res Nurs Health 23(1):25–34
Nilsson M, Ekman S, Sarvimaki A (1998) Ageing with joy or resigning to old age: older people’s experiences of the quality of life in old age. Health Care Later Life 3(2):94–110
Noro A, Aro S (1996) Health-related quality of life among the least dependent institutional elderly compared with the non-institutional elderly population. Qual Life Res 5(3):355–366
Nunnally J, Bernstein IH (eds) (1994) Psychometric theory. 3rd edn., McGraw-Hill, New York
O’Boyle CA (1997) Measuring the quality of later life. Philos Trans R Soc Lond B Biol Sci 352(1363):1871–1879
Østby L (2004) Den norske eldrebølgen: ikke blant Europas største, men dyrt kan det bli (The Norwegian old age wave: not the largest in Europe, but potentially expensive). Samfunnspeilet 18(1):2–8
Parse RR (2003) The lived experience of feeling very tired: a study using the Parse research method. Nurs Sci Q 16(4):319–325
Patrick DL, Chiang YP (2000) Measurement of health outcomes in treatment effectiveness evaluations: conceptual and methodological challenges. Med Care 38(9 Suppl):14–25
Peek MK (2004) Reliability and validity of the SF-36 among older Mexican Americans. Gerontologist 44(3):418
Pfisterer M, Buser P, Osswald S, Allemann U, Amann W, Angehrn W, Eeckhout E, Erne P, Estlinbaum W, Kuster G, Moccetti T, Naegeli B, Rickenbacher P, Trial of Invasive versus Medical therapy in Elderly patients (TIME) Investigators (2003) Outcome of elderly patients with chronic symptomatic coronary artery disease with an invasive vs optimized medical treatment strategy: one-year results of the randomized TIME trial. JAMA 289(9):1117–1123
Polit D, Beck C (eds) (2004) Nursing research: principles and methods. 7th edn, Lippincott Williams and Wilkins, Philadelphia
Power M, Bullinger M, Harper A (1999) The World Health Organization WHOQoL-100: tests of the universality of quality of life in 15 different cultural groups worldwide. Health Psychol 18(5):495–505
Power M, Quinn K, Schmidt S (2005) Development of the WHOQoL-old module. Qual Life Res 14(10):2197–2214
Reeves BC, Harper RA, Russell WB (2004) Enhanced low vision rehabilitation for people with age related macular degeneration: a randomised controlled trial. Br J Ophthalmol 88(11):1443–1449
Repetto L, Comandini D, Mammoliti S (2001) Life expectancy, comorbidity and quality of life: the treatment equation in the older cancer patients. Crit Rev Oncol Hematol 37(2):147–152
Rodriguez-Manas L, Guillen F, Caballero JC, Tobares N, Sempere R (1996) A comparison of the efficacy, tolerability and effect on quality of life of nisoldipine CC and enalapril in elderly patients with mild-to-moderate hypertension. Acta Ther 22(2–4):89–106
Sarvimaki A, Stenbock-Hult B (2000) Quality of life in old age described as a sense of well-being, meaning and value. J Adv Nurs 32(4):1025–1033
Scientific Advisory Committee of the Medical Outcomes Trust (2002) Assessing health status and quality-of-life instruments: attributes and review criteria. Qual Life Res 11(3):193–205
Sirgy MJ, Michalos AC, Ferriss AL, Easterlin RA, Pavot W, Patrick D (2006) The quality-of-life (QoL) research movement: past, present, and future. Soc Indic Res 76(3):343–366
Stenzelius K, Westergren A, Thorneman G, Hallberg IR (2005) Patterns of health complaints among people 75+ in relation to quality of life and need of help. Arch Gerontol Geriatr 40(1):85–102
Streiner DL, Norman GR (eds) (2003) Health measurement scales: a practical guide to their development and use. 3rd edn., Oxford University Press, Oxford
Streiner DL, Norman GR (2006) “Precision” and “accuracy”: two terms that are neither. J Clin Epidemiol 59(4):327–330
Taylor SJ, Bogdan R (1990) Quality of life and the individual’s perspective. In: Schalock R, Begab MJ (eds) Quality of life: perspectives and issues. American Asscoiation on Mental Retardation, Washington, pp 27–40
Terwee CB, Dekker FW, Wiersinga WM, Prummel MF, Bossuyt PM (2003) On assessing responsiveness of health-related quality of life instruments: guidelines for instrument evaluation. Qual Life Res 12(4):349–362
Terwee CB, Bot SDM, de Boer MR, van der Windt DAWM, Knol DL, Dekker J, Bouter LM, de Vet HCW (2007) Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol 60(1):34–42
Tidermark J, Ponzer S, Carlsson P, Soderqvist A, Brismar K, Tengstrand B, Cederholm T (2004) Effects of protein-rich supplementation and nandrolone in lean elderly women with femoral neck fractures. Clin Nutr 23(4):587–596
U.S. Department of Health and Human Services Food and Drug Administration, Center for Devices and Radiological Health (CDRH) (2006) Guidance for industry patient-reported outcome measures: use in medical product development to support labeling claims. Health and quality of life outcome
Varma S, McElnay JC, Hughes CM, Passmore AP, Varma M (1999) Pharmaceutical care of patients with congestive heart failure: interventions and outcomes. Pharmacotherapy 19(7):860–869
Walker A (2005a) Growing older in Europe. Open University Press, Maidenhead
Walker A (2005b) Understanding quality of life in old age. Open University Press, Maidenhead
Walker A (2005c) A European perspective on quality of life in old age. Eur J Ageing 2(1):12
White F (1967) Improved medical care statistics and the health services system. Public Health Rep 82(10):847
Wilson IB, Cleary PD (1995) Linking clinical variables with health-related quality of life. A conceptual model of patient outcomes. JAMA 273(1):59–65
World health Organization (2000) Social development and ageing: crisis or opportunity? Geneva
Acknowledgments
We are grateful for the financial support from Diakonova University College, Department of Nursing Research. We want to express our gratitude to Librarian Jenny Owe, Diakonova University College, for library assistance and the EJA’s anonymous referees.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Halvorsrud, L., Kalfoss, M. The conceptualization and measurement of quality of life in older adults: a review of empirical studies published during 1994–2006. Eur J Ageing 4, 229–246 (2007). https://doi.org/10.1007/s10433-007-0063-3
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10433-007-0063-3