in Quality of Life
Among People Aged 75 and Over
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The Government has proposed to 'tackle fundamental
inequalities' by concentrating 'attention and resources on the
areas most affected by air pollution, poverty, low wages .. which
can make people ill in both body and mind'. However, as yet older
people have not had the attention they deserve in this policy.
Health inequalities across socio-economic groups
are well established among people of middle age but there is far
less information for older people, especially those aged 75 and
over. This is the fastest-growing age group of the older population
and the group with the highest health and social service use.
Research so far shows that there are some socio-economic differences
in mortality and in long-term illness persisting into very old
age and suggests that the patterns of influential socio-economic
factors may differ by gender. Hitherto there has been no research
which looks at self-reported quality of life (QoL) as the outcome
in relation to socio-economic factors.
Chronic health problems are known to be a source
of depression and poor QoL. Social support may attenuate adverse
effects of these health problems but the evidence on this is mixed.
We will address whether inequalities in disease, disability and
health contribute to socio-economic variations in inequalities
of QoL; also whether social support either ameliorates or exacerbates
Policy interventions can be aimed at individuals
or communities. It is hypothesised that characteristics of the
area might have an influence on QoL over and above that arising
from individual circumstances. It is also possible that the impact
of individual circumstances may differ according to the characteristics
of the area.
Aims and Objectives
The aim is to investigate differences in quality
of life (and various dimensions thereof) of older people by their
socio-economic circumstances in late and mid life; and to identify
the features which account for socio-economic variations thereby
informing appropriate intervention strategies.
The objectives are:
To investigate differentials in QoL by socio-economic
factors among people aged 75 and over living in the community;
and to assess whether gender and age are additional sources
of variations in QoL.
||To identify personal factors which
contribute to differentials in QoL, in particular morbidity,
level of social contact and social support, and availability
of help including informal care and health and social services.
||To investigate the interaction of
personal and area measures of deprivation on QoL.
||To examine whether social class
during mid life is associated with QoL in old age; and to
investigate whether socio-economic circumstances experienced
in old age modify any observed association with mid life measures.
The project uses data collected as part of a cluster-
randomised trial of the means of assessment and care of people
aged 75 and over in the community. In 23 general practices patients
took part in detailed QoL interviews and subsequently had assessments
of their health which identified both clinical and social needs.
Three well-established QoL instruments were used: the Sickness
Impact Profile; the Philadelphia Geriatric Morale Scale; and the
Medical Outcomes Study 36-item short-form survey. To reduce the
burden on participants practices were randomised to receive one
of three versions of the questionnaires. Some dimensions are common
to all versions, the rest being divided between them. The socio-economic
measures include standard items such as current housing tenure,
and central heating together with perceptions of material deprivation
such as financial problems. The assessment covers self-reports
of problems which warrant further clinical assessment, such as
severe symptoms, problems of hearing and sight, difficulties with
activities of daily living, incontinence, depression, memory problems.
The QoL interview includes detailed information on use of health
and social services in the previous month, and information on
levels of informal caring (frequency of help, relationship of
the informal carer). Social support is measured by frequency of
contact with friends, neighbours or relatives outside the household,
and availability of a close confidante.
Each participant is classified according to various
characteristics of the enumeration district in which they live,
such as the Carstairs deprivation score and density of occupation.
The area characteristics are linked to the individual's circumstances
using Geographical Information Systems methods.
Multivariate statistical methods will be used and
clustering allowed for. The interpretation will take into account
the possibility of health selection.
The information on prevalence of poor QoL in subgroups
is an essential starting point in deciding whether to take forward
health inequalities among older people as a public health issue
of importance. The subsequent modelling of explanatory and mediating
factors, particularly those which are amenable to action (e.g.
social support, care services, and community regeneration) will
contribute evidence to assist in deciding on appropriate points
of intervention to improve QoL. In particular, the availability
of area-level characteristics is pertinent to the Government's
proposals for healthy neighbourhoods and Health Action Zones and
to the Department of Health's Health Inequalities programme.