Abstract
Purpose/Hypothesis: Interest in patient-reported health care outcomes such as health related quality of life (HRQL) has increased dramatically over the past decade. Typically, HRQL has been conceptualized as having at least three domains: physical, psychological, and social functioning. Although research has attempted to identify factors that influence HRQL, few studies have simultaneously examined how various factors impact HRQL in the elderly. The purpose of this study was to develop and test a causal model to identify factors influencing HRQL. The constructs and observed variables hypothesized to influence HRQL included physiological well-being, housing satisfaction, socioeconomic status, religion/spirituality, age, gender, and marital status. Number of Subjects: Three hundred and sixty three (363) participants were drawn from a random sample of community dwelling elderly living in Tompkins County, NY (mean age, 74.9; SD, 8.5; range 60-103). Tompkins County is located in central NY, and home to a large university and mid-size college. Materials/Methods: This study was a non-experimental retrospective design using secondary survey data from the ‘Pathways to Quality Life’ study. Using confirmatory factor analysis, a measurement model of HRQL was tested and validated. The final HRQL model was defined by four constructs: general health perception, physical functioning, psychological functioning, and social functioning. Once this model was validated, structural equation modeling was used to test the full model examining factors influencing HRQL. Several goodness-of-fit indices were used to assess model fit. Modification indices were used to provide clues as to what changes would be appropriate to improve model fit. Respecifications to the model were based on theoretical rationale. Results: Greater levels of physiological well-being, increased frequency of attendance at religious events, and increased satisfaction with housing significantly influenced HRQL (p = .000, .006, .023, respectively). Socioeconomic status, age, gender, and marital status did not have a significant effect on HRQL. In addition, housing satisfaction had a significant direct effect on psychological functioning (p = .000) and social functioning (p = .000). Factors used to predict HRQL explained 38% of the variance in HRQL. Conclusions: Physiological well-being, housing satisfaction, and attendance at religious events appear to have a significant influence on HRQL. Further, the underlying concepts of HRQL are invariant to differences in demographics such as age, gender, and marital status. Clinical Relevance: The results of this study suggest that greater attention be considered to other domains that may be important to the adult population. These influencing factors may need to be accounted for when using HRQL instruments to study health outcomes in the elderly.
Published Version
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