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Involving older people in research to examine quality of life in residential aged care

Edwards, Helen E., Courtney, Mary D., & O'Reilly, Maria T. (2003) Involving older people in research to examine quality of life in residential aged care. Quality in Ageing: Policy, practice and research, 4(4), pp. 38-43.

Abstract

Introduction Residential care in Australia has long been subsidised by Federal Government funds, and since the mid 1980’s, the Australian Government has introduced and refined strategies for assessing quality in residential care facilities, eventually evolving into a mandatory accreditation system (Gray, 2001). Implicit in such systems is the understanding that the ultimate outcome of these standards should be improved resident quality of life (QoL). However, it cannot necessarily be assumed that receipt of good quality clinical care results in heightened life quality. The exact aspects of QoL that are important to residents must thus be understood so that residential care providers and clinicians can target them.
Quality of life is not easily defined, it means different things to different people, and as such is equally difficult to measure (Arnold, 1991; Ball et al, 2000; Bury & Holme, 1993; Byrne & MacLean, 1997; Courtney et al, 2003; Guse & Masesar, 1999; McDowell & Newell, 1996). However, it is largely agreed that the construct comprises both objective and subjective elements (Arnold, 1991; Ball et al, 2000; Bury & Holme, 1993; Byrne & MacLean, 1997; Fletcher et al, 1992; Guse & Masesar, 1999; McDowell & Newell, 1996), and recent research concedes that the subjective elements (i.e. the person’s own perceptions) are paramount (WHOQOL Group, 1993).
Much research into QoL has emerged from the health related quality of life (HRQoL) field, so there has been a tendency for substantial emphasis to be placed on health status as an indicator of QoL (McDowell & Newell, 1996). As people age, health and physical functioning tend to deteriorate, but despite such changes, older people have been found to score more highly on psychological aspects of QoL and may rate their overall QoL more highly than their younger counterparts (Frytak, 2000). Thus, traditional HRQoL scales are not always appropriate for the older population (Courtney et al, 2003). Moreover, the nature of residential care presents further paradoxes for the researcher; residents are physically frailer than even the general older population and institutional life is markedly different to life at home (Bury & Holme, 1993; Byrne & MacLean, 1997; Cohn & Sugar, 1991; Coons et al, 1996; Fiveash, 1998; Guse & Masesar, 1999; Kane, 2001), thus different factors become important for the maintenance of optimal QoL (Kane, 2001). Furthermore, resident perceptions of their own QoL have been found to differ markedly from the perceptions of staff and researchers (Ball et al, 2000; Byrne & MacLean, 1997; Cohn & Sugar, 1991; Fletcher et al, 1992; Kane, 2001; Rai et al, 1995). It is being increasingly acknowledged that such concepts as autonomy, control and choice are important for resident QoL (Ball et al, 2000; Byrne & MacLean, 1997; Coons et al, 1996; Harrington et al, 1999; Kane, 2000; Kane, 2001; Kane & Kane, 2000). The above suggests that, as much as possible, research into resident QoL should be conducted from the residents’ perspective. This paper discusses a study that used focus groups to develop insights into QoL issues for aged care facility residents. These insights could then be used to help determine an appropriate QoL measure for use in a later study. Method Focus groups use a structured interview process utilising open-ended questions to determine the feelings and opinions of small groups of participants about a specific topic (Krueger, 1994). In total, eight focus groups were conducted, each containing 4-12 participants; all occurred within residential facilities from the same aged care provider in and around the Brisbane metropolitan area. Residents were asked about their perceptions of quality of life, including factors which enhance and impede QoL outcomes.
Results Subsequent to content analysis, a number of themes were identified; each is described briefly below.Circumstances Residents largely stated that their circumstances were beyond their control, particularly in regards to the decision to move into residential care in the first place. Most agreed that while their surroundings might be quite comfortable, they still did not equate to being at home. However, most participants also expressed a desire not to be a "burden" on family and friends, which somewhat offset any dissatisfaction with their circumstances. Also present was a well-articulated determination to make the most of their situations. Thus most stated that they had adjusted to the move and were quite happy where they were, although some expressed ongoing dissatisfaction with their circumstances.

Impact and interest:

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ID Code: 9499
Item Type: Journal Article
Additional URLs:
Keywords: Residential aged care, research
ISSN: 1471-7794
Subjects: Australian and New Zealand Standard Research Classification > MEDICAL AND HEALTH SCIENCES (110000) > NURSING (111000) > Aged Care Nursing (111001)
Divisions: Current > Research Centres > Centre for Health Research
Current > QUT Faculties and Divisions > Faculty of Health
Current > Institutes > Institute of Health and Biomedical Innovation
Copyright Owner: Copyright 2003 Pavilion Publishing
Copyright Statement: Reproduced in accordance with the copyright policy of the publisher.
Deposited On: 14 Sep 2007
Last Modified: 09 Jun 2010 22:45

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