Quality of Life in Older Adults
Ramona Lucas Carrasco, Institut de l'Envelliment, Universitat Autonoma de Barcelona, Barcelona, Spain

Ageing is a global phenomenon. This is the result of sociodemographic changes and an extended life span achieved during the last century, mainly through improvements in sanitation and public health. By the year 2025, elderly people will make up more than 20% of the total world population. Recent studies have found that morbidity is compressed into fewer years in later life. From a public health perspective it is important to help older people to maintain their independence and their active contribution to society. Also, it is important that elderly respond successfully to the physical, psychological and social challenges they face. In recent years there has been a major interest in the study of quality of life in older age.

Most of the quality of life measures were developed for younger adults. One issue about quality of life in elderly people is to know if questionnaires developed for use in younger adult populations might be used in older populations. Another issue if there are specific areas of quality of life that may be more important in older adults and that should supplement a generic adult questionnaire.

Although there is not an agreed quality of life definition for the elder population, investigators and older people living in the community have associated quality of life with good health, both physical and psychological; beliefs, aspirations, morale and self-esteem; intimacy; functional ability, autonomy and independence; good social relationships with family, friends and neighbors; good home and neighborhood (good facilities in the community including transport). Also associated with quality of life are activities/hobbies; social participation, social networks, social support and voluntary activities; adequate level of income; external environment; perceived control over life, expectations of life, social values and level of adaptation and safety. Specific facets found by the WHOQOL-OLD Group, such as sensory abilities; intimacy; past, present and futures activities; and eath and dying have been less often explored mentioned.

As elderly people are heterogeneous, some populations deserve further investigation. For example, people living in residencies / nursing homes emphasize other components, such as opportunities for recreation, common interests, attitudes from professionals, need of adaptation, food choice and participation in the decision making process. Also, quality of life in people with cognitive impairment / dementia deserve special attention.

Who should evaluate quality of life? There are two approaches to the evaluation of QOL: subjective and objective. Subjective QOL is made by the own person and is influenced by the individual's personal values, previous experiences in life and the importance assigned to various domains of QOL. People without cognitive impairment should evaluate their own quality of life. Objective QOL is evaluated by external observers, such as family / professionals in cognitively impaired elderly.

Information of quality of life is useful for health and social professionals with the objective to plan actions according to the population's needs and to evaluate the impact of these actions. Provision of services at different levels of care / rehabilitation can reduce the burden of the most common elderly conditions and enhance patients' quality of life. But also, older people might and should contribute to maintain and to improve their quality of life through preventive measures that have been proven to be effective. The aim of this century is to add quality of life to years of life.