Exploring quality of life

Questioning and measuring quality of life is important, as it helps us to understand what factors are associated with better or worsening quality of life.

One way of defining quality of life is by asking people what they think is important for their quality of life.

• The World Health Organisation tried to define and measure quality of life by asking people all around the world what they think is important for their quality of life.
• They identified six key life areas: social relationships, psychological wellbeing, level of independence, religion and spirituality, physical health and the environment.

However, defining and measuring quality of life in this way doesn’t account for differences in how important these things are across different people.

• Religion and spirituality might be very important for one person, but less important for someone else.

Another approach, the CASP-19 measure of quality of life, is based on the idea of human needs, and tries to overcome this problem.

Human needs and quality of life

Maslow’s theory of needs satisfaction suggests that all humans share a certain set of needs. These can be viewed as a hierarchy, with very basic needs such as food, water and safety at the bottom. Once these are met, then it is possible to pursue psychological needs such as relationships with others and self-esteem. The highest needs relate to self-fulfilment or achieving your full human potential.

This theory of human needs can be useful for thinking about quality of life.

• If we think that these needs are shared across all people, then we can define quality of life based around satisfaction of these needs.
• Things like physical health or living in a nice environment are not the same as quality of life, but are important because they help to fulfill our fundamental basic, psychological and self-fulfillment needs, which are the real basis for having good quality of life.

CASP-19 questionnaire

The idea that quality of life can be defined as the satisfaction of important human needs was used as the basis for the CASP-19 quality of life questionnaire. It was developed by Martin Hyde and his colleagues, working with a group of UK adults aged between 65 and 75.

• The questionnaire focussed on the higher psychological and self-fulfilment needs. Because of this, it is aimed at older adults living in developed countries, where it is assumed that basic needs such as food and shelter are generally met.

These higher needs were translated into four different domains of quality of life:

A large number of studies have used the CASP-19 questionnaire to explore what matters for quality of life in the over 50s. They have found that:

• Having good mental health, physical health and social relationships are more important for quality of life than wealth and social class (Layte, Sexton, & Savva, 2013).
• Feeling that you belong in your community is more important for quality of life than whether you stay in the same place as you age (Gilleard, Hyde, & Higgs, 2007).
• Dangerous or strenuous working conditions earlier in life can lead to lower quality of life after retirement (Platts et al., 2013).
• People aged 50 and over who report high quality of life are more likely to maintain good health and less likely to die over approximately a seven year period (Palgi, Shrira, & Zaslavsky, 2015; Steptoe & Wardle, 2012).

Take a look at the CASP questionnaire below and answer the following questions:

• Do you think this questionnaire captures what is important for your quality of life?
• Does it leave out anything that you think is important to your quality of life?
• Do you think the questionnaire captures what is important for quality of life in people from different countries or cultures? If not, why not?
• Are there any questions that you think do not work well as a measure of a person’s quality of life?

Note: The CASP questionnaire presented below is for discussion about quality of life rather than to complete as a questionnaire.

Source: Hyde, Wiggins, Higgs & Blane, 2003.

Eithne Sexton is a Research Fellow based in the Royal College of Surgeons in Ireland.