Hindawi

Journal of Aging Research

Volume 2018, Article ID 4086294, 7 pages
https://doi.org/10.1155/2018/4086294

Research Article
The Impact of Quality of Life on the Health of Older
People from a Multidimensional Perspective

1
Luis Miguel Rondón Garcı́a and Jose Manuel Ramı́rez Navarrro2
1
Faculty of Social Work, University of Granada, Granada, Spain
2
Faculty of Social Studies, University of Málaga, Málaga, Spain

Correspondence should be addressed to Luis Miguel Rondón Garcı́a; [email protected]

Received 4 November 2017; Revised 2 April 2018; Accepted 19 April 2018; Published 16 May 2018

Academic Editor: Antonello Lorenzini

Copyright © 2018 Luis Miguel Rondón Garcı́a and Jose Manuel Ramı́rez Navarrro. This is an open access article distributed under
the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium,
provided the original work is properly cited.
Background. This research analyzes the impact of quality of life as a metavariable that conditions the health and social welfare of
the elderly. The sample of this study is composed of 500 people, randomly selected from the major day centers for the elderly in the
province of Granada (Spain). Method. For the inferential analysis, we used the CUBRECAVI questionnaire, which is a multi-
dimensional scale of health and quality of life, along with the Katz and Garcı́a measure questionnaires, which are also applied to
quality of life. Through the technique of the interview, we have distributed the participants into two groups: experimental and
control. Results and Conclusions. Once the tests have been completed, we have concluded from the meta-analysis and validation
tests that the participants have a good perception of their quality of life, considering health, leisure, environmental quality,
functional capacity, level of satisfaction, social support, social networks, and positive social interactions as the determinants of
their well-being, although social contact reduces as the age advances. We conclude that multidimensional evaluation is an effective
tool to evaluate the quality of life and the objective and subjective health of the elderly. These variables can be related to the
improvement of health and well-being.

1. Introduction [7–13]. We add social networks, which are a fundamental

element to understand this analysis, as they are an important
The World Health Organization [1] defined quality of life as vector of the quality of life.
an “individual perception of his or her living situation, However, for a general approach to the state of health
understood in a cultural context, value system and in re- from the quality of life perspective, it is necessary to
lation to the objectives, expectations and standards of a given consider more precise questions, and it is, therefore, im-
society” (p. 2). From this perspective, health-related quality portant to distinguish health from life satisfaction, which
of life includes areas such as physical health, psychological involves complacency with the life of the present and past
state, level of independence of the person, personal re- experiences. In this sense, many gerontologists claim that
lationships, beliefs in a particular context or the natural older people who successfully age are those who feel happy
environment, social support, and perceived social support and satisfied with their past and present and enjoy positive
[2–6]. social relationships and contacts. This concept also refers to
The different discursive approaches have recognized the a subjective dimension of welfare, to an adequate capacity
importance of implementing health measures from a mul- to adapt to, accept, and recognize the environment, in
tidimensional perspective. This means that while analyzing order to have a better perception of health and welfare. It is
the quality of life, factors such as the various social con- about explaining how people experience their lives, their
ditions and social, cultural, and psychological networks that cognitive assessment, their emotional reactions, and their
exist within the different study groups should be considered adaptation to life.
2 Journal of Aging Research

As we have already mentioned, quality of life and life daily life in relation to real needs are the factors that con-
satisfaction are different concepts, but at the same time, they dition health [26].
are complementary. Life satisfaction represents an indicator To finish with, we conclude that no clear consensus exists
of quality of life, a specific part of it, since it focuses on moral, over the definition of quality of life in elderly to develop the
cognitive, and affective aspects, on the tasks carried out concept based on all its extent for further evaluation from
independently, and on satisfaction with social support re- a psychological, cultural, or social point of view. In fact,
ceived and, in general, is related to life expectancy [14, 15]. instead, there is a wide variety of terminology that includes
On the contrary, quality of life is more closely linked to a satisfying life, subjective and psychological welfare, per-
factors strictly related to health [16]. To put it more accu- sonal development, and other elements that many authors
rately and pragmatically, many older people relate quality of consider synonymous with a satisfying life and welfare.
life to the ability to be independent in their daily activities. These authors found some approaches to the three di-
This is the reason why it is so important to take into account mensions of the concept proposed by Borthwick-Duffy [27]
the improving self-esteem, satisfaction with functioning, by adding a fourth dimension that seems key to our study:
a sense of independence in daily life tasks, and a sense of the satisfaction experienced by people in their living con-
participation, which are important components of the whole ditions, the combination of subjective and objective ele-
structure that makes up the standards of quality of life of the ments along with the sensations they experience, according
elderly. to their scale of values, personal expectations, and aspira-
From this perspective, it is common in professional tions held by all elderly people.
practice to measure the quality of life according to signs of From the above analysis, it is evident that the quality of
satisfactory living. More recently, the cultural context, the life, in addition to being multidimensional, must take into
meaning of life for a person from a quality of life perspective, account the person’s life experience, how they feel, and how
has been introduced. This shows that quality of life, in they interpret their lives [28]. These factors, along with good
addition to being multidimensional, must take into account habits, social support, and relationships, significantly affect
the person’s life experience and how they feel and interpret health.
their life in relation to other people involved. This idea Finally, and as a synthesis, the ability to evaluate and
becomes more relevant in people who suffer from dementia, learn about these elements allows us to manage health and
who need to foster their empowerment, so that they can disease and to identify those factors that can affect. It also
express how they feel and their needs, when more specific improves the quality of life of older people from an integral
stimulation is required for them. point of view, that is, from a medical, psychological, and
It is worth mentioning that, in recent decades, research is social perspective. It is a multifaceted, interdisciplinary,
related to health, quality of life, and gerontology as linked holistic approach, focused on the person searching for new
subjective health with psychological welfare beyond the support strategies for the care and improvement of the
absence of disease [17–19]. The Gwozdz and Sousa-Poza health of the elderly, from an interdisciplinary point of view.
study [20] shows that happy people can live longer, and this This approach is beginning to be implemented in clinical
idea envisions interesting research prospects for the future. practice in some projects of care for dependent and in-
Previous research has already highlighted the relationship dependent elderly people. In summary, the main objective of
between the age evolution and happiness in the elderly this research is to analyze the quality of life and the per-
[21–24]. In this sense, and in line with our main research ception of health of the elderly from a multidimensional
objective, professionals must look beyond the aspects related perspective. The following objectives are pursued:
to the health of older people, that is, how to restore psy-
(i) To assess health in general, from a subjective and
chological and social crisis, as this leads to acceptance of
objective point of view
the ageing process. Results of White’s study assessed “life
experiences, describing personality, past traumas, social (ii) To assess functional, recreational, and leisure skills
support, and level of activity, along with physical and (iii) To analyze life satisfaction, taking into account the
psychological health, influencing levels of happiness and social contacts and networks, and other social
satisfaction in the elderly” (p. 54). These findings explain the variables
need to review the variables involved in success or satis- (iv) To determine the relationship between the variables
faction with life, such as psychological and physical health, described above and how they complement each
level of activity, and social support. The combination of other
these factors can give a sense of usefulness and a positive
feeling in the review or balance of life in the elderly.
Other specific factors should also be considered when 2. Materials and Methods
analyzing life satisfaction in people with reduced capacity or
dependency. In these specific cases, social, physical, and According to data from the National Institute of Statistics
economic aspects interact with each other as a combination [29] for the year 2017, the total population over 65 years of
that determines the optimal quality of life [25]. Especially the age in Granada in 2017 is 47,257 (20.48%). Based on these
feeling of loneliness, the degree of self-care capacity, the data, the sample group is made up of 510 people, selected at
feeling of concern, the scarcity of financial resources to random from the municipal population census, from five
manage personal independence, and the basic activities of social centers for the elderly in the province of Granada
Journal of Aging Research 3

(Spain). This type of random sampling is suitable for this Table 1: Internal consistency of the CUBRECAVI tool.
type of research, since all people in the universe have the Variable N Alpha
same probability of being chosen, discarding those who, due
Health 857 0.61
to their dementia or disability, could not collaborate in the Social integration 341 0.22
survey. Leisure and activities 862 0.66
The selection of participants was coordinated with the Functional capacities 509 0.81
help of a technical team. Each of the interviewers chose Environmental quality 893 0.73
a center to conduct the random questionnaires, selected
from the available list of the Health and Social Services. The
surveys have been thorough and were conducted from associations between the scores obtained and measures of
January to May 2017. In order to improve effectiveness, four the explanatory or independent variables, as explained be-
months elapsed between the first evaluation and second low. Finally, a multivariate descriptive analysis was carried
evaluation, with the time needed for a rigorous analysis of out with the sample studied.
the results obtained in the two groups studied. Before For the analysis of inferential statistics, descriptive re-
starting, a pilot study was carried out to adapt the items or sults and sociodemographic variables were initially analyzed.
questions to the characteristics of this sector of the pop- Later, we studied both the magnitude and the significance of
ulation. In both cases, the sample had sociodemographic and the association between the dependent variables and each of
health characteristics similar to those of social center users, the independent variables (Mantel–Haenszel chi square) in
with representative quotas by sex and age, and an age range both the experimental and control groups. The magnitude of
of 60 to 85 years for both genders. The experimental group the associations is expressed with odds ratios and the dif-
was composed of 250 people, and the control group was ferences in percentages, as well as their reliable intervals. In
composed of 260 people. contrast to the hypotheses of the quantitative variables,
The applied research design has been a longitudinal techniques such as Student’s and analysis of variance were
panel design. In the first part of the empirical research, the used if the necessary conditions were met. In order to
statistical tool SPSS version 22 was used for the inferential identify independent risk factors, multivariate analysis
analysis, based on the data obtained from the validated techniques and nonconditional logistic regression with bi-
questionnaire CUBRECAVI [30], which is a reliable and nary dependent variables and Cox regression were per-
valid scale for multidimensional measurement of health and formed. All these, as indicated, are performed with the SPSS
quality of life. It is a validated questionnaire that has the statistical tool.
psychometric guarantees of reliability and internal consis-
tency and is very appropriate to our research objectives. It is 3. Results
easy to complete, of short duration (approximately 20
minutes), and measures the following areas related to quality In the descriptive results of the sociodemographic variables,
of life: health (subjective, objective, and psychic), social we found that the percentage of men is slightly higher than
integration, functional capacities, activity and leisure, en- that of women, which represents 43.6%. In terms of age, all
vironmental quality, life satisfaction, education, income, and of them are older adults aged between 60 and 70, with 43% of
social and health services. By means of individual and group the sample being between 60 and 70 years old, compared to
interviews, we have arranged the participants into two 57% between 70 and 87 years old. The socioeconomic level of
groups: experimental and control. In order to analyze the the participants is medium low, with an average income
reliability of the CUBRECAVI scale, the Cronbach alpha ranging from 500 to 600€ per month, although they are
index was applied to the main variables that made up the within the national average. No significant differences have
questionnaire: health, integration, activity and leisure, been found in gender dimensions or educational levels,
functional capacities, and environmental quality. Sub- although age is significant. Hence, the older the person, the
sequently, a regression analysis was conducted, based on the greater the deterioration in the quality of life.
responses to the CUBRECAVI questionnaire, in the ex- As soon as the sociodemographic data were identified,
perimental and control groups. This was followed by we examined the specific components of quality of life which
a comprehensive statistical analysis of the most significant are most relevant for the older participants in the study of
variables related to social relations, health, and quality of life. both groups. First, in Table 1, we began to analyze the in-
This analysis involved social contacts, frequency, social ternal consistency of each of the scales indicated by
networking, and cohabitation with family members. The CUBRECAVI to measure the reliability of this tool. For this
questionnaires included sociodemographic data, social purpose, the Cronbach alpha index has been calculated for
support OARS, daily activities, health-related quality of life the subvariables: health, social integration, leisure and ac-
scales (QL-Index), and the Garcia scale [31, 32]. These scales tivities, functional capacities, and environmental quality. As
were designed to assess the frequency and degree of satis- the scales have only one item, an index of the five scales
faction with the social contact received from different indicated above has been calculated.
sources in relation to quality of life. This study also tested the The previous results indicate that the scale used in our
reliability of the questionnaire, its criteria, and its structural research (CUBRECAVI) allows us to predict a subjective
validity, already demonstrated by the authors who validated criterion of quality of life, that is, whether the subject is
the tool. The correlative analysis showed significant positive satisfied with life. As explained at the beginning of this
4 Journal of Aging Research

Table 2: Regression analysis of experimental and control groups.

Environmental group Control group
Variable
Beta T Signification Beta T Signification
Health 0.32 5.25 0.001 0.39 2.79 0.001
Functional capacities 0.02 0.11 0.0021 0.19 2.07 0.031
Leisure and activities 0.15 2.89 0.002 0.19 2.09 0.033
Environmental quality 0.9 2.08 0.0026 0.9 0.91 0.02
Income −0.9 1.45 NS −0.02 −0.29 NS
Note: variance explained of the experimental group: 25%; variance explained of the control group: 25%; NS � no significance.

document, satisfaction with life is related to quality of life, Therefore, we understand that the elderly consider
although specific aspects of each of these concepts are transcendental, for their lives, having the capacity to carry
measured. According to the data in Table 1, the internal out the basic activities of daily life, but also having sufficient
consistency indices are moderate (between 0.81 and 0.61) in physical capacities to allow them access to leisure and spare
all the subvariables (health, leisure and activities, environ- time, in an suitable environmental context. In simple terms,
mental quality, and functional capacities), with the excep- this is interpreted as the need to be able to carry out their
tion of the social integration that it is low (0.22). personal autonomy and community participation in the
Once the reliability of the scale has been verified, in environment, or the natural environment, close to their
Table 2, we proceed to apply the regression analysis with the reference nuclei, taking into account the limitations of age.
five variables indicated by CUBRECAVI and analyzed in our After all, being well, being able to do the basics for oneself,
questionnaires already indicated in the table. and enjoying spare time are priority aspects in this stage of
In the multiple regression process, the aim is to describe life because they make it possible to feel more empowered
the impact of the quantitative factors applied on the and better. For obvious reasons, the connotations of these
CUBRECAVI scale on the dependent variable proposed in elements are direct with the state of health because they
our study on quality of life, which in turn is related to the influence the fact of feeling better and, consequently, of
health of older people, which, as we have explained in the being better, of the perception one has of one’s health and
initial introduction, usually have multiple causes. In this quality of life.
specific case, health and quality of life phenomena relate to To complement the results of the previous analysis
several independent factors or variables that influence a pri- obtained in the factors determined by the scale CUBRE-
ori, such as health, functional capacities, leisure and activities, CAVI, a new element has been introduced, which in our
environmental quality, and income. For this reason, multi- opinion may be of interest for the purpose of this study. We
variate analysis analyzes the five variables simultaneously, are referring to the effects that social contacts and social
relating them to the impact on the quality of life of the elderly, relations have on the quality of life of the elderly and, of
in order to know how they can affect. It is a question of finding course, also on their health situation. To this end, we have
out from a statistical research whether they are in any way taken into account what has been published in the latest
related to each other, so it is possible that they can be research and articles in the area of geriatrics and gerontology
mathematically related. In order to achieve this purpose, we that places contact, its duration, frequency, and interactions
calculate the regression line in Table 2, where we represent the as a crucial axis in the health and illness binomial. Thus, in
results of this parametric test with the two groups studied: Table 3, we show the multivariate analysis of nonconditional
Once the regression analysis was carried out, as shown in logistic regression in the same subjects, with both models, in
Table 2, which differentiates the results of the experimental relation to the independent variable called social contact.
and control groups, we concluded that health, leisure, ac- Three specific aspects or dimensions are calculated: the
tivity, and environmental quality are the significant variables association between the duration of visits, weekly contacts,
with the greatest influence on older people in both groups. In and cohabitation as explanatory subvariables. The data are
detail, in the experimental group, four of the five variables intended to determine whether or not the probability of
established by CUBRECAVI have been validated as de- these variables occurring will influence the quality of life and
terminants, with the exception of income. These values health of the elderly and whether they are a complement to
represent 25% of the total variance in the experimental the variables studied in the table above. The strength of
group. In the control group, the same thing happens as in the association is expressed in odds ratios.
previous case, and only the income variable is not significant, If we compare the variables set out in Table 3 in the
where the variance represents 31% of the total. results of both groups, we find some differences in the scores
The results of the two groups have in common the obtained. First, in the control group, we find negative as-
importance given to leisure, spare time, health, and the in- sociations in the coexistence subvariable, when contact with
fluence of these factors on the quality of life. However, the children occurs (HR 0.99), and positive association when it is
participants in the control group attach more importance to with other family members (HR 1.28). HR stands for the
functional skills and leisure activities. In contrast, in the hazard ratio. Also, as reflected in the odds ratio data, they are
experimental group, they value environmental conditions negative when the number of visits per week is increased.
more. These differences, nevertheless, are minimal. Specifically, the association is more negative when the visits
Journal of Aging Research 5

Table 3: Logistic regression analysis of the association size of the network and social contacts in both groups.
Environmental group (model 1) Control group (model 2)
Variable 95% CI of HR 95% CI of HR
P Hazard ratio P Hazard ratio
Lower limit Upper limit Lower limit Upper limit
Coexistence
Alone (basal) 1 1
Spouse 0.211 1.068 0.806 1.434 0.325 1.089 0.794 1.387
Son/daughter 0.019 1.289 0.989 1.68 0.389 0.995 0.791 1.335
Siblings 0.003 1.335 1.119 1.988 0.169 1.1 0.833 1.469
Other people 0.008 1.499 1.108 1.995 0.048 1.285 0.886 1.893
Contacts and weekly visits
>5 (basal) 1 1
2–4 per week 0.499 1.401 0.799 1.132 0.428 0.824 0.659 1.089
1-2 per week 0.599 1.048 0.795 1.244 0.11 1.08 0.88 1.386
0 0.24 1.22 0.78 1.249 0.229 0.795 0.495 1.081
Times to visit the social network
>1-2 day (basal) 1 1
2–5 per week 0.699 1.024 0.842 1.203 0.504 1.079 0.765 1.109
1-2 per week 0.297 1.097 0.865 1.259 0.069 1.182 0.895 1.34
0 0.1 1.123 0.889 1.295 0.897 0.924 0.828 1.829
Note: model 1 was adjusted by sociodemographic variables in the experimental group; model 2 was adjusted by sociodemographic variables in the control
group; 95% CI of HR � confidence interval for b.

are more frequent than two per week (HR 0.82) but also As for the variable related to the contacts made with
when there are no visits at all (HR 0.79). On the contrary, different people during the week, although they are valued as
1 or 2 contacts with people per week are positive for this important in general, it seems that they are more positive
group (HO 1.08). We can conclude from these data that the when they are of a medium frequency but not intense. The
ideal is to have visitors, but not too many, given that elderly ideal is between 2 and 4 contacts per week in the experi-
value quality more than quantity. mental group (HR 1.401). In this respect, the two groups do
Secondly, in the experimental group, there is a positive not agree on this point, and the number of contacts per week
association with the quality of life and health of the elderly, is more important for the experimental group. The common
in the variables called coexistence and contacts, but also with point, or coincidence, occurs when considering two average
divergences from the previous group. In the case of contacts, contacts per week as the average of positive contacts for
both the length of time they last and the frequency or quality of life.
number of times they occur influence this model. That is to We insist once again that social relationships depend on
say, the longer and more frequent the visits, the better the several factors as determinants of quality of life. For this
association or dependency. Hence, we can consider that the reason, in addition to coexistence and contacts, the length of
experimental group does value the frequency and number of time these contacts last is also important. According to these
social interactions and not so much their quality as the other results, as for the number of visits, the opposite occurs when
group does. the visits decrease to none per week, which is a negative
Specifically, by analyzing each of the three dimensions of association in the experimental group. When they increase,
contact in experimental and control duality, the differences in that is, between 2 and 5 visits per week (control group HR
scores are minimal. It is interesting to observe results in 1.024), it is considered a positive element in the perception
common, in the variable related to coexistence. In particular, of quality of life. In the control group, the scores are slightly
this relationship is more positive, with second-degree relatives lower, peaking at 1.182 in 1 to 2 visits per week. Conse-
and other persons outside the primary group, than with those quently, the higher the number of visits, the better the
closest to them, such as the spouse or children. That is to say, quality of life. That is, having visitors or contacts is an
other members than the direct family provide a more positive important predictor as well, with a clear positive association
relationship in the elderly of both groups, with an even greater with the dependent variables.
incidence in the control group. We can conclude, then, that in
this study, the incidence of the contact subvariable is clearly 4. Discussion
a determinant of the quality of life of the experimental group
with an HR between 1.04 and 1.40, and a 95% confidence Data from multivariate analysis show that the determinants
Interval, compared to the control group with an HR between indicated in the variables analyzed above, if added together,
0.79 and 1.08. In any case, in both groups, it is closer to the are considered as a metavariable measure of health and
value 1 when the contacts range from 1 to 2 per week. This quality of life. If we take into account the regression analysis,
means that older people who have social contacts are more they influence according to their number or frequency and
likely to improve their quality of life when they have weekly the relationship that social contact has with the elderly
contacts with others, regardless of kinship. person; in fact, living with close relatives is less valued than
6 Journal of Aging Research

living with other people. In addition, contacts are influenced a predictor of physical fitness, which is associated with
not only by how long they last but also by their influence or psychological conditions such as life satisfaction, self-
importance. It is not important to have contact with many esteem, functional skills, activities, participation, and so-
different people, but it is important to have contact with cial interaction.
those who provide a sense of comfort, who are chosen by the
older person, who are not imposed, and, above all, who last
long enough to be able to interact, talk, and share common
Conflicts of Interest
topics of conversation. The authors declare that they have no conflicts of interest.
As a final summary, we conclude that there is a positive
and significant association between the variables described.
Therefore, the validity of these scales is confirmed as References
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