The Functional Quality of Life (fQOL)-Model
A New Basis for Quality of Life-Enhancing Interventions in Old Age
Abstract
Quality of life (QOL) is increasingly being suggested as a crucial outcome variable for interventions that aim to maintain or improve health and psychological resources in old age. Currently, two main approaches to measuring QOL can be distinguished: (1) the sQOL approach which measures an individual’s subjective evaluation of his or her overall life situation and QOL; (2) the oQOL approach that infers QOL of an individual from the outside, e.g., via measurement of health impairments. Both approaches, however, are problematic: In the first case, a large majority of individuals report relatively high levels of sQOL that are sometimes in stark contrast to observable impairments (known as the well-being paradox; Staudinger, 2000). This suggests that improving impaired resources does not necessarily lead to improved sQOL (although there may be positive effects on the autonomy of these individuals). The second approach is problematic because improved oQOL leads only to an increase in self-reported overall sQOL under very rare conditions – and one cannot assume that an increase in resources necessarily has led or will lead to higher levels of sQOL. Therefore, we propose a new, functional quality of life (fQOL) approach to determine quality of life. It combines the existing approaches by linking the subjective representations of objectively measurable resources to their functional value for pursuing individually meaningful activities and goals. From this model, fQOL-improving interventions as well as methods to evaluate the effectiveness of QOL-interventions can be derived.
References
1994). Maintenance and rehabilitation of independence in old age: An intervention program for staff. Psychology and Aging, 9, 179–188.
(1991). Theoretische Grundlagen [
(Theoretical foundations ]. In A. Abele P. BeckerEds., Wohlbefinden (pp. 13–49). Weinheim: Juventa.2005). Das Heidelberger Instrument zur Erfassung von Lebensqualität bei Demenz (H.I.L.DE.) Dimensionen von Lebensqualität und deren Operationalisierung [
(The Heidelberg Instrument to Measure Quality of Life in Dementia ]. Zeitschrift für Gerontologie und Geriatrie, 38, 108–121.in press ). The equilibrium dynamics of meaning. Perspectives on Psychological Science.2005). Clinical practice guidelines and quality of care for older patients with multiple comorbid diseases. Journal of the American Medical Association, 294, 716–724.
(2007). Konzepte positiver Entwicklung [
(Concepts of positive development ]. In J. Brandstädter U. LindenbergerEds., Entwicklungspsychologie der Lebensspanne (pp. 681–723). Stuttgart: Kohlhammer.1990). Tenacious goal pursuit and flexible goal adjustment: Explication and age-related analysis of assimilative and accomodative strategies of coping. Psychology and Aging, 5, 58–67.
(2004). Models of quality of life. A taxonomy and systematic review of the literature. Report commissioned by European Forum on Population Ageing Research/Quality of Life, University of Sheffield (Prof. Alan Walker).
(1998). SF-36. Fragebogen zum Gesundheitszustand. Handanweisung [
(Health status questionnaire manual ]. Göttingen: Hogrefe.1984). Quality of life in cancer patients: A hypothesis. Journal of Medical Ethics, 10, 124–127.
(2011). Effectiveness of a lifestyle intervention in promoting the well-being of independently living older people: Results of the Well Elderly 2 Randomized Controlled Trial. Journal of Epidemiology and Community Health. doi 10.1136/jech.2009.099754.
(1985). The Satisfaction with Life Scale. Journal of Personality Assessment, 49, 71–75.
(1999). Subjective well-being: Three decades of progress. Psychological Bulletin, 125, 276–302.
(2006). Developmental changes in personal goal orientation from young to late adulthood: From striving for gains to maintenance and prevention of losses. Psychology and Aging, 21, 664–78.
(2005). A review of quality of life instruments used in dementia. Quality of Life Research, 14, 675–686.
(1996). Die “Skala zur Lebensbewertung”: Empirische Skalenkonstruktion und erste Befunde zu Reliabilität, Stabilität und Validität [
(The “Life Evaluation Scale”: Empirical scale construction and first results on reliability, stability, and validity ]. Zeitschrift für Differentielle und Diagnostische Psychologie, 17, 141–153.1999). A three-stage model of coping with loss and trauma: Lessons from patients suffering from severe and chronic disease. In A. Maercker M. Schützwohl Z. SolomonEds., Posttraumatic stress disorder: A lifespan developmental perspective (pp. 43–78). Seattle, WA: Hogrefe & Huber.
(2002). Quality of life measurement: Bibliographic study of patient assessed health outcome measures. British Medical Journal, 324, 1417–1421.
(1999). The Assessment of Quality of Life (AQoL) instrument: A psychometric measure of health-related quality of life. Quality of Life Research, 8, 209–224.
(1991). Psychometrische Testung der “Münchner Lebensqualitäts Dimensionen Liste (MLDL)” [
(Psychometric measures of “Munich Quality of Life Dimensions List” ]. In M. Bullinger M. Ludwig N. v.Eds., Lebensqualität bei kardiovaskulären Erkrankungen (pp. 73–90). Göttingen: Hogrefe.2002). Das Zufriedenheitsparadox in der Lebensqualitätsforschung. Wovon hängt unser Wohlbefinden ab? [
(The satisfaction paradox in quality-of-life research: What does our well-being depend on? ]. Psychotherapie, Psychosomatik, Medizinische Psychologie, 52, 141–150.1996). A new short form Individual Quality Of Life Measure (SEIQoL-DW): Application in a cohort of individuals with HIV/AIDS. British Medical Journal, 313(7048), 29–33.
(2005). EQ-5D concepts and methods: A developmental history. New York: Springer.
(2000). Measuring the outcomes of care in older people: A noncritical review of patient-based measures. I. General health status and quality of life instruments. Reviews in Clinical Gerontology, 10, 33–42.
(1984). Stress, appraisal, and coping. New York: Springer.
(2010). Psychologische Grundlagen der Gerontologie [
(Psychological foundations of gerontology ]. Stuttgart: Kohlhammer.2012). How psychology as a discipline can profit from focusing psychological research on the individual. European Psychologist, 17, 28–33.
(2009). The 3-phase model of dyadic adaptation to dementia: Why it might sometimes be better to be worse. European Journal of Aging, 6, 291–301.
(2005). Physical activity and psychological well-being in advanced age: A meta-analysis of intervention studies. Psychology and Aging, 20, 272–284.
(2003). Development of a common instrument for quality of life. In A. Nosikov C. I. GudexEds., EUROHIS: Developing Common Instruments for Health Surveys (pp. 145–164). Amsterdam: IOS.
(2005). Development of the WHOQOL-Old module. Quality of Life Research, 14, 2197–2214.
(1999). Das Konstrukt Lebensqualität: Metaanalytische Validierung und die Entwicklung eines modularen Erhebungssystems [
(The quality of life construct: Metaanalytical validation and development of a modular assessment system ]. Nervenarzt, 70, 41–53.2007). Individual quality of life: Can it be accounted for by psychological or subjective well-being? Social Indicators Research, 82, 443–461.
(2003). Übereinstimmungen und Unterschiede in der selbst- und fremdeingeschätzten Gesundheit bei extrem Hochaltrigen [
(Similarities and differences between self-rated and proxy-rated health in extreme old age ]. Zeitschrift für Gerontologie und Geriatrie, 36, 429–436.1999). Emotion and control: A life-span perspective. In K. W. Schaie M. P. LawtonEds., Annual review of gerontology and geriatrics (Vol. 17, pp. 185–205). New York: Springer.
(1999). Annual review of gerontology and geriatrics, Vol.18: Focus on interventions research with older adults. New York: Springer.
(1999). Integrating response shift into health-related quality of life research: A theoretical model. Social Science and Medicine, 48, 1507–1515.
(2000). Many reasons speak against it, yet many people feel good: The paradox of subjective well-being. Psychologische Rundschau, 51, 185–197.
(1995). The World Health Organization Quality of Life assessment (WHOQOL). Position paper from the World Health Organization. Social Science and Medicine, 41, 1403–1409.
. (2000). Zur Veränderung des Alterns heute und morgen – Beiträge der Interventionsgerontologie [
(On the modification of aging today and tomorrow – Contributions of intervention gerontology ]. Zeitschrift für Gerontologie und Geriatrie, 33(Suppl. 1), I/85–I/89.2005). Gerontologie [
(Gerontology ]. Stuttgart: Kohlhammer.2004). Aging in context across the adult life: Integrating physical and social research perspectives. In H.-W. Wahl R. Scheidt P. WindleyEds., Annual review of gerontology and geriatrics (pp. 1–33). New York: Springer.
(