Chapter 2

Literature Review
Relationships between Quality of Life (QoL), its psychological health and social consequences like life

satisfaction and helping attitude among old age people have been widely reported and recognized in the

previous literature.

2. Quality of Life

2.1 Meaning and Measurement of Quality of Life (QoL)

The dictionary definition of ‘quality’ is ‘grade of goodness’ (Chambers

Twentieth Century Dictionary 1961). Mendola and Pelligrini (1979) defined quality of

life (QoL) as ‘the individual’s achievement of a satisfactory social situation within the

limits of perceived physical capacity’. Shin and Johnson (1978) defined QoL as ‘the

possession of resources necessary to the satisfaction of individual needs, wants and

desires, participation in activities enabling personal development and self

actualisation and satisfactory comparison between oneself and others’. More

recently, the World Health Organization Quality of Life Group (1993) defined QoL as

including the individual’s perception of his or her position in life in the context of the

culture and value systems in which they live and in relation to goals.

The factors and processes relevant to QoL identified across the previous

studies can be usefully summarized within Renwick and Brown’s (1996) framework

which consists of three primary dimensions of QoL termed ‘being’, ‘belonging’ and

‘becoming’. ‘Being’ refers to the physical, psychological and spiritual aspects of QoL;

‘belonging’ is concerned with the adequacy of an individual’s interpersonal

relationships and their physical, social and community environments; while

‘becoming’ encompasses personal aspirations regarding purposeful activity,

instrumental activity, leisure pursuits and personal growth (Nolan et al. 2001).

2.2 Inequalities in quality of life

sometimes, also race/ethnicity without necessarily looking at how these factors interact

(Arber and Ginn 1991). However, feminist writers have stressed the importance of analysing

the interaction between class, race and gender (Calasanti and Slevin 2001). In particular,

marital status is an example of gendered power relations that differentiate both men and

women across their lifecourse and have an effect on QoL. lot is already known about the

effects of marital status on health and mortality for both men and women (Welin et al. 1985;

Lillard and Waite 1995). However there has been little research that has looked at how these

dynamics might affect QoL in older ages.

2.3 The Environments of Ageing

In its broadest sense, the term ‘environment’ encompasses the microenvironments that

constitute the home, through to macro meanings of the urban and the rural. Rather than

treating ‘environment’ simply as a backdrop to human activity and agency, in these four

studies a notion of environment was adopted which allowed exploration of person–

environment interactions? This approach parallels the work of other scholars who have

researched older people’s interactions with their homes and neighbourhoods and theorized

the role of person–place interaction across the lifecourse and in society generally (for

example, Rowles 1978, 2000; Lawton 1980; Bourdieu 1984; Laws 1984; Rubenstein 1989;

Lefebvre 1991). Environment is never experienced as unitary or monolithic, but as a series of

settings where people experience their day-to-day lives. It can be conceived, perceived and

lived (Lefebvre 1994) as segmented, insofar as people’s capacity for moving around allows

them to enact different sets of behaviors’ in different categories of place.

2.4 Family and Economic Roles

Individuals undertake a variety of social and economic roles over the lifecourse,

including those of spouse, parent, grandparent, carer and paid worker. Combining family and
economic roles brings benefits and costs to individuals and families at all stages of life. Older

people’s QoL is also a function of the role they play within the family. Family links and

intergenerational solidarity may be crucial in contributing to many older people’s well-being

and for the avoidance of social exclusion. In Bowling’s (1995) investigation of QoL,

relationships with family and relatives were named as the most important aspect, well ahead

of anything else. These relationships encompass emotional, practical and financial support as

well as feelings of reciprocal obligation. Intergenerational exchanges work in both directions

(Quereshi and Walker 1989; Aldous 1995). Older people can usually rely on care from their

children, but where both parents are working or where family breakdown has occurred,

grandparents may be expected to care for grandchildren or to contribute to their support in

financial or emotional terms. The consequences of family breakdown and particularly the loss

of contact with grandchildren can be severe for the physical and emotional health of

grandparents (Kruk 1995).

2.5 Social Participation

Social participation is recognized as a major constituent part of QoL (Bowling 1995).

However, the social forms in which people find themselves do not remain static but

constantly change. This has been as true for later life as it has been for other parts of the

lifecourse which have been affected by social changes such as the rise of consumerism,

contraception and divorce. The present experience of later life is contextualized by retirement

at younger ages as well as the expectation of a longer period of (healthy) post-working life

more than was the case with previous cohorts. It is also the case that the people who are

entering retirement are more similar to the rest of the population in terms of their experiences

and motivations than may have been the case in the past (Hirsch 2000). This combination of

factors suggests at the very least that QoL needs to be seen in terms of cohort or generation.

As cohorts eventually die out, they are replaced by newer cohorts who have had different
‘generational’ experiences to those that had preceded them (Ryder 1985; Gilleard and Higgs

2002).While there has been considerable discussion about the existence of a ‘welfare

generation’ that grew up and benefited from an expanding public sector (Hills 1995), less has

been written about the effect of the ‘sixties’ generation entering retirement. The difference

between the two generations and their expectations become more, rather than less, important

once later life is reached.

That QoL is not assessed in these terms is apparent from the way that it is traditionally

studied. Generally, QoL is reduced to proxies or to individualized scales (Hyde et al. 2003).

In particular, QoL in older populations is often reduced to health or social contact. Bowling

(1997) points out that it is no longer possible to measure QoL simply as a medical outcome.

However, using other simple proxies such as income get us little further, particularly when

we are trying to understand the unequal structuring of QoL. Instead, we need to examine how

the various social structures such as class, gender and ethnicity interplay to enable (or

restrict) older people to engage with the opportunities available to them in general. In the

same way that it is no longer acceptable to see health-related QoL only in terms of survival or

cure, this can apply to QoL more generally. In other words, QoL needs to be seen as an

expanding concept rather than a restricted one. In contemporary society that may mean a

focus on leisure pursuits (Midwinter 1992; Scase and Scales 2000) and foreign travel

(Burnett 1991).

2.6 Positive Perceptions

Positive aging perception has been found to positively influence life satisfaction

(Barker, O’Hanlon, McGee, Hickey, & Conroy, 2007) as well as an individual’s ability to

cope with the many and varied challenges that present with older age (Sadegh Moghadam et

al., 2016; Yaghoobzadeh et al., 2017). A positive perception of aging has been associated

with improved mental health, decreased mortality rates, and increased general well-being.
People who report positive aging perception are also more likely to report a better quality of

life.

The concept of healthy aging, and what influences this construct, has been a focus in

academic fields interested in gerontology (e.g., nursing, psychology, medicine, social work)

(Officer et al., 2016). Given that aging perception plays a fundamental role in healthy aging

(Zanjari, Sharifian Sani, Hosseini Chavoshi, Rafiey, & Mohammadi Shahboulaghi, 2016),

understanding the factors that affect it has important implications for professionals that work

with older populations (Sadegh Moghadam et al., 2016). The field of gerontological nursing

in particular has emphasized the importance of positive aging perception for healthy aging

(Buys, Aird, & Miller, 2012). Studies that have been conducted in this area have identified a

broad range of factors affecting aging perception, which include hearing (Gygi & Shafiro,

2013; Musaiger, D’Souza, & Al-Roomi, 2013), the use of religion as a coping strategy

(Heydari-Fard, Bagheri-Nesami, Shirvani, & Mohammadpour, 2014), sociability (Buys et al.,

2012; Heydari-Fard et al., 2014), perceived aging discrimination (Han & Richardson, 2015),

the presence of physical pain (Buys et al., 2012), gender (Musaiger et al., 2013), and the

ability to pursue lifelong learning (Fernández-Ballesteros et al., 2013).

Among the factors found to affect aging perception, an individual’s hopefulness is

argued to be the most influential (Bergin & Walsh, 2005). Erikson’s theory of development

suggests that hope develops in infancy provided that sufficient care and nurturing is provided

by caregivers (Erikson, Erikson, & Kivnick, 1994). Bergin and Walsh (2005) suggest that

hope is defined by dichotomous conceptualizations that include adaptive hope (e.g., hope as a

productive coping skill) and maladaptive hope (e.g., hope as a nonproductive coping skill).

Recently, researchers have been interested in the concept of hope among elderly

populations (Gunzelmann, Beutel, Kliem, & Brahler, 2016; Haugan, Utvaer, & Moksnes,

2013). The nurse–patient interaction, in particular, has been found to influence hope in
patients who have unimpaired cognitive functioning (Haugan, Moksnes, & Espnes, 2013).

This positive nurse–patient relationship has been found to enhance the self-worth of elders,

which has been associated with increased life satisfaction (Haugan, 2014). Hope has been

identified as an important factor that may inspire the elderly to maintain their overall health,

especially those who are searching for new love (Warren-Jeanpiere, Dillaway, Hamilton,

Young, & Goparaju, 2014).

A substantial portion of the peer-reviewed literature also describes the influence of

life satisfaction and helping attitude on aging perception (Kalfoss, 2017; Kunna, San

Sebastian, & Williams, 2017; Park, Kim, & Park, 2014). Such findings suggest that the level

of life satisfaction diminishes in the elderly if they are facing economic hardship. An

outcome of this interaction is that aging perception is also reduced (Kolosnitsyna, Khorkina,

& Dorzhiev, 2017). More research is needed to investigate how life satisfaction and helping

attitude affect aging perception directly (Sadegh Moghadam et al., 2016).

Aging perception is affected by multiple variables; however, hope, life satisfaction,

and helping attitude have had a particularly strong focus in the literature (Nilsson, Sarvimaki,

& Ekman, 2000; Sadegh Moghadam et al., 2016). Understanding and identifying the

relationship between these three factors will help nurses and other health care providers to

facilitate essential care to elders for their physical and mental well-being (Sadegh Moghadam

et al., 2016). The purpose of the present study is to design and test a hypothetical model to

evaluate the possible direct and indirect relationships between hope, life satisfaction, and

helping attitude with aging +perception.

2.7 Quality of Life & Helping Attitude

Nickell (1998) defined helping attitude as the beliefs, feelings and behaviours related

to helping people. Altruism, often used as a synonym for helping behaviour, can be defined

as actions or behaviours that are intended to benefit another person (Snyder, Lopez
&Pedrotti, 2011) Helping attitude or behaviour is an established noble behaviour in many

cultures and is an important feature of many religions throughout the world. Seligman and

Csikszentmihalyi (2000) consider altruism to be an important process which fosters the

collective well-being of the society.

Ageing affects different people differently. The definition of successful ageing

includes physical, functional, psychological and social health (Phelan EA, 2004). It is a myth

that physical deterioration and illness is part of the ageing process and that older adults

become more intolerant and conservative in old age (McInnes A, 2004). Most elderly are fit

and live active and independent lives. Older people in Asia prefer staying with families rather

than living alone and they consider having no filial children as bad (Chong AML, Hsu HC,

2006-2007). Living with or close to family members helps provide psychological, social and

physical needs and because most Asian countries are not welfare states this bond is

maintained however due to various reasons the family support towards the elderly is waning

(Cheng ST, 2007) and coupled with the loss of spouse and the inability to care for self, there

has been an increase in the admissions of the elderly into institutional care facilities. This

pattern of living arrangement has caused social implications for the older adults.

Feeling older does not necessarily mean the individual will feel bad. It has been

shown that older people have a positive attitude in aspects of development and adaptation in

older age and they believe that ageing has positive features including growth and

development (Ceremnych J, 2006).

It has been suggested that as one age negative emotions are experienced less

frequently and intensely hence ageing experience rated by older people are more

positive(Mather M, 2005). Attitudes relevant to healthy ageing is greatly influenced by

traditions, religious and cultural beliefs(Kickbusch I, Moberg DO, 2005). When an

individual has unfavorable attitude towards ageing they experience negative outcomes (Mock
SE, 2011). Negative attitude towards ageing has been linked to detrimental psychological,

physical and health outcomes for older adults and may influence the choices they are likely to

make in regards to the levels of activity, independence and control that they have over their

lives including rejecting medical help. In the western society there is a negative impression

towards ageing which indirectly influences the older adults attitude towards ageing(Levy BR,

Laidlaw K, 2002-2007) whereas studies have shown that there are more positive ageing

attitudes in Asians as compared to western cultures(Levy B, Langer E 1994).

Attitude, perception and belief of the elderly towards themselves affect the quality of

life and sleep quality of the elderly. The psychosocial component of the AAQ scale values the

close relationships with members of the community and involvement in activities. Poor social

relationships has also been linked with poor sleep quality (Friedman EM, Hayney MS, 2005)

and it affects the quality of life(Mudey A, Ambekar S, 2011). Environment which is an

important component of the WHOQOL-BREF is strongly associated with quality of life in

respect to social interaction, activity involvement, independence and psychological wellbeing

(Hwang HF, Lawton MP 2001-2003). Hence it is not surprising to find that increase in the

quality of life and positive sleep quality was associated with a positive attitude towards

ageing.

Although musculoskeletal pain, education and marriage were not found to be

statistically significant in the regression analysis, poor physical state and deficits in functional

autonomy have been shown to be a deterrent to affective social functioning which is

important for successful ageing. Lack of education which can lead to poor paying jobs which

is in turn a reason for financial insecurity can be a reason for poor attitude towards ageing as

well. Studies have shown that older woman are comfortable maintaining an independent

lifestyle and own ability to care for themselves and that they perceive marriage as costly to
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