My name is Eithne Sexton, and I work as a research fellow at The Irish Longitudinal Study on Ageing, and also the Healthy and Positive Ageing Initiative. Advances in health care and living standards mean that we can all expect to live substantially longer lives than previous generations. But those additional years will not mean that much if we do not enjoy a good quality of life as we age. In other words, we hope that as years are added to our lives, life can also be added to those years. But what do they really mean when we talk about good quality of life? Do we mean having good physical health, having enough money, living in a nice neighbourhood?
All of these things could be important to quality of life, but that importance might be different for different people and at different stages of people’s lives. So we see news headlines all the time talking about quality of life– which country or city has the highest or lowest, new drugs or treatments that boost quality of life. And all of the research studies described in these headlines use the words “quality of life,” but are actually talking about different things. So some use a definition of quality of life that includes characteristics of countries, such as average incomes, life expectancy, even hours of sunshine.
Others refer to different characteristics of people like how in control of their lives people feel, their sense of meaning in life, their social participation, even things like their culture and religion. And some use quite narrow definitions which focus largely on people’s physical health and their function or their ability to do everyday activities. And in fact, definitions of quality of life that focus on physical health tend to be very common, particularly when we are talking about the benefits of new drugs or other health care interventions. But is physical health or function really the same thing as quality of life? It’s undoubtedly important, particularly for someone who has just had a stroke or some other major illness.
Maintaining or improving function may be critical for the quality of their lives. But we also know that lots of people who have poor physical health see themselves as having a good quality of life. The two researchers called Albrecht and Devlieger interviewed 150 people with moderate or severe disabilities– individuals that most people would say have poor quality of life. But in fact, over half of those people said that they saw themselves as having good or excellent quality of life.
So the research has found that many people with disabilities were able to adapt and redefine their quality of life in different ways– finding new ways of doing things that were important to them, shifting their attention to the new activities and goals that were more doable, and focusing on the positive aspects of their lives. And just as people often assume that people with disabilities have a poorer quality of life, we can sometimes make the same assumption about ageing– that just because health tends to decline with age, the quality of life does as well. However, studies from around the world show that older people tend to report similar or even better quality of life relative to younger people.
We also know from The Irish Longitudinal Study on Ageing that as we age, disability tends to have less of an affect on our quality of life. So for people who are in their 50s, having one or more difficulties with activities of daily living, such as getting dressed or doing household chores, is associated with a 19% lower score on quality of life. But for people and their 70s and older, there’s only about a 12% difference. Of course, it’s not always easy to adapt to declining physical health, and adaptation may require things like access to good quality health care and support from family and friends.
But the key point is that there is no one set of circumstances that necessarily equates to good or bad quality of life. Nobody can judge whether your quality of life is good or bad except you. So if quality of life is completely personal and subjective, does that mean that quality of life is the same thing as being happy or satisfied with your life? It is certainly important, but it may not be the full picture. Many people think that quality of life is also about having meaning and purpose in your life, and feeling as though you can make a contribution to your community and society. So being happy may not be all there is to quality of life.
So to sum up, we’ve talked about a few things that quality of life is not. It is not the same as physical health, and it is not necessarily the same thing as happiness. So how can we come up with a way of defining quality of life that deals with these complexities and also fits with how people think and feel about their quality of life, particularly at older ages? In the comments below, we’d like you tell us what you think it means to have a good quality of life.