Quality of Life

Medical advances during the past century have dramatically increased average life span and changed the [Page 489]course of illness during older age. Many illnesses previously considered to be terminal are now treated as chronic conditions. As people live longer with chronic illnesses, quality of life has become an increasingly important issue to older adults and researchers alike. The current emphasis on quality of life during later life has shifted the focus of geriatric health care from increasing the quantity of years to increasing the quality of years. Despite increased knowledge of disease causes, healthy lifestyle changes, and successful treatment options, there is scant evidence that rapid advances in science and medicine have resulted in improved quality of life for elder adults. This entry reviews the emergence of quality of life as a concept and major goal of health and social policy, explores its meaning and measurement, details a new approach to assessment, and suggests possible directions for future research.

Historically, quality of life has been a concern of the humanities, religion, philosophy, sociology, medical science, and social gerontology. Although the concept existed earlier, quality of life did not receive significant attention until after World War II. In 1948, the World Health Organization (WHO) expanded its definition of health to include “health as a state of complete physical, mental, and social well-being.” Simultaneously, dramatic social inequities and health disparities across Western societies captured the attention of researchers. Concerns about quality of life and poverty during older age gave rise to reform movements, Social Security, and the policy initiatives of the 1960s' “War on Poverty” in the United States.

Although not defined, quality of life was identified as a goal during the mid-1960s in theReport of the President's Commission on National Goals in the United States. The term was used primarily in reference to objective social indicators such as number of households with telephones, material wealth, divorce rates, and crime statistics. Following the political and social upheavals of the 1960s, emphasis shifted from objective indicators to subjective dimensions of quality of life such as personal freedom, enjoyment, and caring. It was argued that quality of life is a state of mind rather than a state of health or wealth. Because people respond to subjective impressions, their feelings and perceptions need to be considered when assessing quality of life.

The increasing use of the termquality of life in the popular press of the 1960s was followed by its use in medical research. The term first appeared in academic literature in theInternational Encyclopedia of Social Sciences in 1968 and inIndex Medicus during the mid-1970s. As interest in this topic grew over the subsequent 30 years, numerous health-related instruments were developed as medical research shifted its focus from mortality and morbidity to the broader impact of chronic disease on quality of life.

Although there is a burgeoning research literature devoted to the measurement of quality of life, a precise definition remains elusive. Despite this limitation, a consensus has emerged that quality of life is multidimensional in nature and must include both objective and subjective dimensions. Current researchers often cite the WHO's definition of quality of life as an individual's self-perception of his or her position in life in the context of that individual's own culture and value systems. Quality of life measures are increasingly used to evaluate the value of medical and social services, assess life course changes, and distinguish disadvantaged population groups. Consequently, our understanding of the relationship between specific therapeutic interventions and quality of life across the life span has increased.

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