Exploring the construction of quality of life in older people

Abstract

Ageing populations and the unique challenges they pose are characteristic of the accelerating demographic transition evident in both developed and developing countries. In South Africa the elderly population is also increasing dramatically. There is a disproportionate distribution of older persons per ethnic group, with white older people representing the largest group of older South Africans (21%, proportional to ethnic group). The influx of the baby boomer generation will inevitably lead to an exponential increase in the numbers of white older people within the next two decades. Regardless of integration policies in post-apartheid South Africa, 90% of all residential care facilities are still occupied solely by white older people. Such facilities are described as buildings or other structures used primarily for the purposes of providing accommodation and of providing a 24-hour service to older persons. The increasingly larger segment of white older people holds considerable implications for the future of these facilities since more individuals will turn to this living arrangement. The Older Persons Act of South Africa was inaugurated by the government in 2006 and its key objectives are aligned with the recommendations of the Madrid International Plan of Action on Ageing (2002). Amongst many other objectives, the Older Persons Act emphasises practices that enhance the wellbeing and quality of life (QoL) of all older persons. However, the reigning circumstances in most residential care facilities have been described as challenging. A national audit of residential care facilities in 2010 indicated a need for psychosocial interventions since the QoL of residents was found to be undefined and unspecific. The purpose of the study was to explore the construction of QoL, from the perspective of the older people living in residential care facilities. A purposive sample of 54 participants (male, n=10; female, n=44) with ages ranging between 62 and 95 years was drawn. The participants were able to communicate congruently and understood the research purpose. Participants resided in four similar facilities situated in urban areas in two South African provinces. A multiple-context inquiry was conducted to gather rich data and collateral information. The study made use of interviews, focus groups, journals, and the Mmogo-method® to collect qualitative data. Interpretative Phenomenological Analysis (IPA) and visual analysis methods were used to analyse the data. Interactive Qualitative Analysis (IQA) was conducted with 19 participants, resulting in a conceptual model of QoL. Member-checking was performed by the participants. Ethical approval was granted by the Ethics Committee of the North-West University (Potchefstroom Campus), as part of a larger project, namely “An exploration of enabling contexts (05K14)”. The findings revealed that the nature of QoL is informed by spiritual worldviews, interpersonal contexts and the maintained ability of older people to regulate aspects of their own lives. The nature of QoL was also revealed as transitional throughout the ageing process and that the dimensions of QoL may be found on a continuum. Six domains were elicited in the construction of QoL, namely spirituality, health, relationships, meaningfulness, autonomy and sense of place. Each domain presented with certain contributors and inhibitors influencing the older person’s ability to experience QoL. Findings revealed the strengths of older people to deal with adversities associated with later life. The inhibitors of QoL are emphasised for the attention of policy makers, the managers of residential care facilities, care givers and family members. The study provided insight into the causal influences between the domains of QoL. A conceptual model with systemic properties is proposed. The theoretical implications of this systems model are that QoL domains are mutually informing and exercise a particular influence on the relational states of older people. It is hoped that new knowledge in the area of QoL might direct future research efforts and put resources channeled to residential care facilities to better use.