Assessing selected quality of life factors of nursing home residents in Turkey

Abstract

As a result of improved public health and medical advances, not only has life expectancy among older people increased, but the importance of quality of life in terms of health in later life has also increased. The aim of this study was to investigate the relationship between socio-demographic factors, health-related behaviors, residents’ satisfaction, and functional disability levels among elderly people living in nursing homes in Turkey using the World Health Organization's Quality of Life-BREF (WHOQOL-BREF). Data regarding socio-demographic characteristics, chronic health problems, health-related behaviors (smoking, alcohol consumption, physical activity, etc.) were collected from the study group (N = 107) by a structured questionnaire during face-to-face interviews. Dependencies in activities of daily living (ADL) of the study group were also assessed using Katz's ADL index. The mean WHOQOL-BREF scores were significantly higher in participants who had independence in performing ADL (bathing, dressing, toileting, transfer, continence, feeding) (p < 0.0001, p < 0.0001, p < 0.0001, p < 0.001, p < 0.0001, and p < 0.001, respectively). It was found that WHOQOL-BREF scores were positively associated with having physical exercise habits and residents’ satisfaction with nursing homes; being dependent in dressing were significant predictors of in the study (R²: 0.38, p < 0.003, p < 0.0001, and p < 0.0001, respectively). Residents’ satisfaction from living nursing homes and participation in physical exercise were significant predictors of WHOQOL-BREF scores for those that participated in this study.

Introduction

Life expectancy for the elderly in developed and developing countries has increased due to improved public health and medical advances (Beaglehole and Bonita, 2004). For Turkey, the percentage of people in the population aged 60 years and over was 6.4% (3.2 million) in 1985 while the percentage increased to 8.4% (5.7 million) in 2000. The percentage was estimated to increase to approximately 9.5% by 2005 (7.4 million) in Turkey (Hacettepe Institute of Population Studies, 2003, Dönmez et al., 2005).

Advancing age is associated with an increase in the health conditions that can lead to disability (Dönmez et al., 2005). The elderly suffer from illness, handicaps and functional impairments that make them dependent on others to care and help them in their daily living (Hellström and Hallberg, 2000). About 25% of patients in nursing homes over the age of 65 in developed countries need the help of another person to perform ADL, such as bathing, dressing, eating, transferring, continence and toileting (Johnston, 2004). Arslan and Gokce-Kutsal (1999) reported that disability rate was 31.1% in elderly living in nursing homes in Turkey. Long-term care facilities consider the measurement of functional status in the elderly population, as a fundamental prerequisite when planning for social and healthcare services (Santos-Eggimann et al., 1999). A concept which is often perceived as being synonymous with functional ability is when elderly people experience diseases and impairments that threaten their quality of life (Santos-Eggimann et al., 1999, Carriere and Legare, 2000, Hellström and Hallberg, 2000, Johnston, 2004). The QoL for nursing home residents is a critical consideration in international healthcare policies and decisions. Thus the quality of life (in terms of health) for the aging populations in developed and developing countries continues to be an important public issue (Holtkamp et al., 2000). According to public health approaches, the main purpose of the health services for older people should be to minimize the impact of chronic disease, maintain their ability to live independently, and improve their QoL (Hellström and Hallberg, 2000, Holtkamp et al., 2000). When the World Health Organization (WHO) defined health as “a state of complete physical, mental and social well-being, not merely the absence of disease or infirmity”, it implied that the assessment of health and healthcare should not only include traditional measures of morbidity and mortality, but should also include a broader assessment of the quality of life (Saxena et al., 2001, Saxena et al., 2002). For this reason, the WHO created a new instrument called the WHOQOL-100 (World Health Organization Quality of Life) and its shorter version, the WHOQOL-BREF, in order to determine the status of QoL. The WHOQOL-BREF assessment was developed as a shorter version of the WHOQOL-100 for use in situations in which time is restricted or in which the burden on the respondent must be minimized (Jang et al., 2004). QoL is conceptualized as a generic, multidimensional construct that describes an individual's subjective perception of his or her physical and psychological health, as well as his or her social functioning, environment, and general life status (Jang et al., 2004, Kuehner and Buerger, 2005). However, most research on QoL in the elderly conducted thus far has been largely based on the relationship between the general health status and QoL in western populations from 14 developed (USA, UK, Spain, Australia, Israel, France, etc.) and developing (India, Zimbabwe, etc.) countries documented ADL, health status were highly significant correlations between QoL compared to other items (Saxena et al., 2001, Jang et al., 2004, Kuehner and Buerger, 2005). It has been found that social and cultural factors play an important role in people's perceptions of their health and QoL while race, ethnicity, and religion all impact the perceived satisfaction of care and QoL (Saxena et al., 2001, Saxena et al., 2002). The WHOQOL is the only QoL instrument that has been simultaneously developed in a wide range of cultures (Saxena et al., 2001). A qualitative study which was part of the European Union Frame Work 5 Program conducted during 2001–2002 used the WHOQOL-100 and focused on Turkish elderly. One result of this study indicated that the WHOQOL-100 was found to be too long. The WHOQOL-100 took too much time causing older Turkish adults to lose interest and concentration and they were unable to complete the entire survey. It was concluded that the shorter and clearer QOL instrument should be administered when conducting further research with older Turkish adults (Eser et al., 2005).

The WHOQOL-BREF is a cross-cultural measure that may be particularly useful for the measurements of QoL and disability levels across different areas (Saxena et al., 2001, Saxena et al., 2002). However, there is currently a lack of research using the WHOQOL-BREF and ADL assessments with residents of Turkish nursing homes.

Therefore, the purpose of this study was to determine the relationship between socio-demographic factors, health-related behaviors, residents’ satisfaction, and functional disability levels using the WHOQO-BREF and ADL assessments with residents of nursing homes in Turkey.