Predictors of quality of life in older people living at home and in institutions

Background and aims: Health-related quality of life (QOL) is considered to be the key goal for health promotion in older people. The aim of this study was to describe the correlates of QOL in home-dwelling and institutionalized elderly. Methods: One hundred and fifty-two elderly residents of long-term care homes and 160 community-dwelling elderly participated in the study. Assessment included demographic and social variables, health status, nutritional state, physical and cognitive function. Physical activity (PA) was assessed by two PA questionnaires: the Seven Day Recall PA Questionnaire and the Stanford Usual Activity Questionnaire. QOL was assessed with the Euroqol 5D questionnaire. Results: Depression was the most powerful predictor of QOL in both community-dwelling and institutionalized elderly. Complaints associated with the musculoskeletal system in community-dwelling elders and manifestations of atherosclerosis and cardiovascular diseases in institutionalized elders were the most important concomitant diseases. Regular participation in PA, preventing obesity and maintaining an adequate level of physical and cognitive function, contributed more to overall QOL in community-dwellers than in older and frailer institutionalized elderly adults. Conclusions: The relative contribution of functional and medical comorbidities, as well as health-promoting behaviors to QOL, may be different in community-dwelling and institutionalized elders. Physical and cognitive function deficits, overweight/obesity, and lack of regular PA are among primary predictors of decreased QOL in home-dwelling elders. In institutionalized subjects, these functional/behavioral data seem to be of lesser importance, the role of concomitant diseases becoming dominant.