Subjective Quality of Life of Care-Dependent Older People in Five European Union Countries

  • Ene-Margit Tiit
  • Kai Saks

Ageing Europe faces a challenge of providing good care for older persons. Until recently there have been no universal standards for long-term care in the European Union (EU). Many national and European surveys indicate that health and social care for older people is primarily biomedically oriented and evaluates quality of care using health-related outcome measures (Carver, Chapman, Thomas, Stadnyk, & Rockwood, 1999; Garratt, Ruta, Abdalla, Buckingham, & Russell, 1993; Smit, 2000). Alternatively, recent research in the field of long-term care has clearly shown that quality of life (QoL) is a primary and meaningful outcome marker of care (Kane et al., 2003; Noelker & Harel, 2001). QoL can be evaluated using objective or subjective variables and indices (Lawton, 1991), but there is a growing consensus that the conceptualization and measurement of QoL in long-term care should be based primarily or exclusively on the resident’s subjective assessment of his or her QoL (Kane et al., 2003). It is now recognized that QoL extends beyond a strict medical discourse into areas as psychology, environmental studies, social work and so on (Smith, 2000). For people who need help in everyday life, the quality of care can significantly influence their QoL (see Chapter 5).

Research of QoL in long-term care is usually limited to one country, one care type or even one institution, and there is lack of comparative studies in this field. The main aim of the present study was to compare QoL of older people receiving long-term care—clients of home-based or institutional care-in different regions of EU: Estonia, United Kingdom, Sweden, Finland and Germany. Estonia is a “new” EU member and other four countries are “old” members. During the study Estonia had been a member of EU less than 2 years while others more than 10 years. Estonia differed from other project countries in several socio-economic areas. The mean life expectancy in Estonia was significantly lower (Estonia 71.8, UK 84.1, Sweden 86.3, Finland 81.4, Germany 82.3 years) (List of countries by life expectancy, 2005), general life satisfaction and happiness were poorer, security and state of repair of houses were more problematic and people were less satisfied with their homes, social life and health services (InfobaseEUROPE Database Record No. 7530, 2004).


European Union Mini Mental State Examination Environmental Domain Sheltered Housing Cognitive Performance Scale 
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  1. Antonovsky, A. (1993). The structure and properties of the sense of coherence scale. Social Science and Medicine, 36, 725–733.CrossRefPubMedGoogle Scholar
  2. Bowling, A., Banister, D., Sutton, S., Evans, O., & Windsor, J. (2002). A multidimensional model of the quality of life in older age. Aging & Mental Health, 6, 355–371.CrossRefGoogle Scholar
  3. Carver, D. J., Chapman, C. A., Thomas, V. S., Stadnyk, K. J., & Rockwood, K. (1999). Validity and reliability of the medical outcomes study short form-20 questionnaire as a measure of quality of life in elderly people living at home. Age & Ageing, 28, 169–174.CrossRefGoogle Scholar
  4. Eriksson, M., & Lindström, B. (2005). Validity of Antonovsky’s sense of coherence scale: a systematic review. Journal of Epidemiology and Community Health, 59, 460–466.CrossRefPubMedGoogle Scholar
  5. Folstein, M. F., Folstein, S. E., & McHugh, P. R. (1975). Mini-mental state: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198.CrossRefPubMedGoogle Scholar
  6. Garratt, A. M., Ruta, D. A., Abdalla, J. I., Buckingham, J. K., & Russell, I. T. (1993). The SF 36 health survey questionnaire: an outcome measure suitable for routine use within the NHS? British Medical Journal, 306, 1440–1444.CrossRefPubMedGoogle Scholar
  7. Hwang, H. F., Liang, W. M., Chiu, Y. N., & Lin, M. R. (2003). Suitability of the WHOQOL- BFER for community-dwelling older people in Taiwan. Age & Ageing, 32, 593–600.CrossRefGoogle Scholar
  8. InfobaseEUROPE Database Record No. 7530 (2004). Report on the quality of life in an enlarged European Union.
  9. Kane, R. A., Kling, K. C., Bershadsky, B., Kane, R. L., Giles, K., Degenholtz, H. B., Liu, J., & Cutler, L. J. (2003). Quality of life measures for nursing home residents. Journals of Gerontology Series A-Biological Sciences & Medical Sciences, 58, 3, 240–248.Google Scholar
  10. Lawton, M. P. (1991). A multidimensional view of quality of life in frail elders. In J. E. Birren, J. E. Lubben, J. C. Rowe, & D. E. Deutchman (Eds), The concept and measurement of quality of life in frail elders (pp. 3–27). San Diego: Academic Press.Google Scholar
  11. Little, R. J. A., & Rubin, D. (1987). Statistical analysis with missing data. New York: John Wiley.Google Scholar
  12. Morris, J., Fries, B. E., Mehr, D. R., Hawes, C., Phillips, C. D., & Mor, V. (1994). MDS Cognitive Performance Scale. Journal of Gerontology, 49, 3M, 174–182.Google Scholar
  13. Noelker, L. S., & Harel, Z. (2001). Humanizing long-term care: forging a link between quality of care and quality of life. In L. S. Noelker & Z. Harel (Eds), Linking quality of long-term care and quality of life (pp. 3–26). New York: Springer Publishing Company.Google Scholar
  14. Skevington, S. M., Lotfy, M., Oconnell, K., & The WHOQOL Group (2004). The World Health Organisation’s WHOQOL-Bref quality of life assessment: Psychometric properties and the results of the international field trial. A Report from the WHOQOL Group. Quality of Life Research, 13, 299–310.CrossRefPubMedGoogle Scholar
  15. Smith, A. E. (2000). Quality of life: a review. Education and Ageing, 15(3), 419–435.Google Scholar
  16. Teichmann, M., Murdvee, M., Saks, K. (2006). Spiritual Needs and Quality of Life in Estonia. Social Indicators Research, 76(1), 147–163.CrossRefGoogle Scholar
  17. Toothaker, L. E. (1992). Multiple comparison procedures. Sage University paper.Google Scholar
  18. von Heideken Wågert, P., Rönnmark, B., Rosendahl, E., Lundin-Olsson, L., Gustavsson, J. M. C., Nygren, B., Lundman, B., Norberg, A., & Gustafson, Y. (2005). Morale in the oldest old: Umeå 85+ study. Age & Aging, 34, 249–255.CrossRefGoogle Scholar
  19. WHOQOL group (1998). Development of the World Health Organization WHOQOL-BREF quality of life assessment. Psychological Medicine, 28, 551–558.Google Scholar
  20. Wong, E., Woo, J., Hui, E., & Ho, S. C. (2004). Explanation of the Philadelphia Geriatric Morale Scale as a subjective quality-of-life measure in elderly Hong Kong Chinese. Gerontologist, 44, 408–417.PubMedGoogle Scholar

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  • Ene-Margit Tiit
  • Kai Saks

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