Influences on Health Related Quality of Life in Community Dwelling Adults Aged 60 Years and Over

Abstract

INFLUENCES ON HEALTH RELATED QUALITY OF LIFE IN COMMUNITY DWELLING ADULTS AGED 60 YEARS AND OVER By Hilary Beth Greenberger, P.T., M.S., OCS A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy at Virginia Commonwealth University. Virginia Commonwealth University, 2006 Daniel Riddle, P.T., Ph.D., FAPTA, Department of Physical Therapy Interest in patient-reported health care outcomes such as health related quality of life (HRQL) has increased dramatically over the past two decades. 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 xii influence HRQL included medical burden, housing satisfaction, socioeconomic status, religiodspirituality, age, gender, and marital status. 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. This study was a non-experimental retrospective design using secondary survey data from .the Pathways to Life Quality 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. Greater levels of medical burden, increased frequency of attendance at religious events, and increased satisfaction with housing significantly influenced HRQL (p < .001, p =.005, p < ,001, respectively). Socioeconomic status, age, gender, and marital status did not have a significant effect on HRQL. However, in an a posteriori analysis, greater ease in meeting monthly payments was associated with higher levels of HRQL. Age was indirectly associated with HRQL through its relationship with medical burden. When financial abilities and age were included in the full model, 46% of the variance in HRQL