Health-related Quality of Life: Expanding a Conceptual Framework to Include Older Adults Who Receive Long-term Services and Supports

Abstract

For older adults receiving long-term services and supports (LTSS), health-related quality of life (HRQoL) has emerged as a critical construct to examine because of its focus on components of well-being, which are affected by progressive changes in health status, health care, and social support. HRQoL is a health-focused quality of life (QOL) concept that encompasses aspects of QOL that affect health such as function, physical, and emotional health. Examining existing theoretical constructs and indicators of HRQoL among LTSS recipients led us to posit a revised conceptual framework for studying HRQoL among LTSS recipients. We adapted the Wilson and Cleary HRQoL model by expanding function to specifically include cognition, adding behavior and LTSS environmental characteristics in order to create a more robust HRQoL conceptual framework for older adults receiving LTSS. This refined conceptual model allows for the measurement of a mix of structural, process, and outcome measures. Continued development of a multidimensional conceptual framework with specific HRQoL measures that account for the unique characteristics of older adults receiving LTSS will contribute significantly to LTSS research, policy, and planning efforts.

Factors Associated With Changes in Perceived Quality of Life Among Elderly Recipients of Long-Term Services and Supports

“…The framework that guided this study, reported in an earlier paper 17 , was an adaptation of the Wilson & Cleary HRQoL conceptual model. 11 Briefly, this model describes relationships between and among multiple HRQoL domains including biological and physiological factors, symptom status, physical functional status, general health perceptions, social support and overall quality of life.…”

“…12,13,15,16 HRQoL is now recognized as a complex construct, encompassing multiple domains, including biological and physiological factors, symptom status, physical and cognitive functional status, general health perceptions, emotional status, social support and overall quality of life. 17 …”

Longitudinal Changes in Nursing Home Resident–Reported Quality of Life

“…The Donabedian framework, while useful for understanding the sequence of how a particular health care setting affects individual outcomes, does not incorporate individual characteristics as predictors of outcomes and is not specifically developed for long-term care (LTC) settings. A conceptual model developed by Zubritsky et al (2013) focuses on health-related QOL for persons in LTC. The model views QOL as multidimensional and influenced by the characteristics of both individual and the environment.…”

Multiple Chronic Conditions and Hospitalizations Among Recipients of Long-Term Services and Supports

“…A secondary data analysis was conducted using an extant data set from a National Institute on Aging-funded longitudinal observational cohort study entitled, Health Related Quality of Life: Elders in Long Term Care (HRQoL), R01AG025524 , hereafter referred to as the “parent study” (Naylor et al, 2016; Zubritsky et al, 2013). …”