Quality of Life and Person-Centered Care for Older People, 1st ed. 2020

This book explores the meaning of quality of life in care for older persons and introduces the reader to their main concerns when receiving care. Based on qualitative research, it pays particular attention to the needs and requirements of older people, considering their individual family situations, social circumstances, values and lifestyles. Person-centred care is a way of providing nursing care that puts older people and their families at the core of all decisions, seeing each person as an individual, and working together to develop appropriate solutions.

Following an introduction to the concept of quality of life in old age, the book reviews essential findings from worldwide research into the experiences of older people with regard to nursing care and the impact of these experiences on their quality of life. It investigates health promotion, care provided in nursing homes and assisted living facilities, and palliative care. Each chapter includes a brief introduction to the respective field of nursing care and the problems it has to deal with, concluding with a discussion of their implications for nursing practice in the respective field of care. In closing, the evidence from qualitative research is discussed in relation to current gerontological theories.

1. Introduction

Ageing societies

Why quality of life matters

Activity fields in the care for older persons

Outline of the book

After a short description of the demographic transition resulting in ageing societies worldwide, the introduction will elucidate the relevance of quality of life in old age, introduce the reader to the concept of person-centered care, describe the activity fields in nursing where such care should be provided, and gives an outline of the book.

2. Quality of life in old age - a concept analysis

Quality of life – confusion about a concept

Quality of life as satisfying life conditions

Quality of life as general well-being

Quality of life – a comparison of theoretical approaches

Conclusion and implications for practice

Despite its widespread use the concept of quality of life in old age is far from being well defined. Based on an extensive literature research this chapter attempts to clarify the confusion about the concept. It introduces the reader to four basic meanings of quality of life that will be encountered in the literature. A comparison of these meanings and their theoretical background will result in a suggestion for a definition that is meaningful in the context of care for older persons. The definition of quality of life as a multidimensional fulfilment of human life will provide a template for the subsequent chapters of this book where the experiences of older persons with various activity fields of care will be analysed and evaluated with regard to their impact on older persons' quality of life.

Health promotion – definition and approaches

Health promotion from the perspective of older adults

Quality of life and health promotion – recommendations for the implementation of programs

4. Quality of life and the care seeking process of older persons

Care dependency – a definition

Care seeking as a process in response to care dependency – theoretical considerations

Care seeking as perceived by older persons and their families – evidence from qualitative research

Quality of life concerns in the care seeking process – implications for care consultations

Even if older persons strive to remain active and promote their health, they may become afflicted by ailments resulting in age related functional limitations and care dependency. Nurses should support their care seeking process by advice and counselling. Older persons anticipate emerging care dependency to impact on their quality of life. Hence, quality of life concerns will influence their care seeking process. After a short introduction to the concepts of care dependency and care seeking this chapter will explore how older persons confront their emerging care dependency as described by qualitative research. Their perspective will be complemented by findings from studies about the experience of care consultants who should support older persons in their care seeking process and have to react to their attitudes and expectations in their consultations. As receiving care is expected to be associated with a loss of quality of life, older adults may be inclined to deny emerging care dependency. This in turn may result in unmet needs. Based on the experience of care consultants the chapter finally provides suggestions to facilitate counselling in way that increases acceptance of care dependency

Quality of life and the experience of staying in a nursing home

Nursing homes – a heterogeneous concept

The experience of staying in a nursing home – findings from qualitative research

Receiving care

Establishing social contacts and shaping one’s own life

Worldwide nursing homes have been established as institutions to provide care for older persons who have lost the ability to care for themselves and do not find sufficient support among their families. Due to various cultural backgrounds and economic conditions these facilities may look despite their similar function quite different. Becoming institutionalized requires a move and has a strong impact on an older person’s quality of life.  This chapter will summarize qualitative studies about the experience of older persons who move into nursing homes. These studies demonstrate the negative impact of institutionalized care on all dimensions of quality of life. Despite this negative outlook on nursing homes which remind several researchers to total institutions the final part of this chapter will show ways to improve quality of life in this setting that can be derived from qualitative studies.

5. Quality of life and the experience of staying in assisted living

Assisted Living in the context of living and care facilities for older persons

Dealing with emerging care dependency

Establishing social contacts and shaping one’s own life

Assisted living – an alternative to nursing homes?

Quality of life in assisted living – implications for practice

Assisted living was established as an alternative to nursing homes. It aimed to avoid the negative aspects of institutionalisation. The proliferation of these facilities in Western countries since the eighties of the last century resulted in a variety of institutions that sometimes share only few characteristics with the original concept After an overview of the various kinds of facilities that operate under the label of assisted living, this chapter explores the experience of residents in these facilities based on a summary of qualitative research. Also here the focus is on how these facilities deal with emerging care dependency, promote social contacts and support residents in shaping their life. This allows contrasting experiences made in assisted living with experience made in nursing homes in order to answer the question of whether assisted living is able to achieve its original aim and to meet the requirements of quality of life in a better way than nursing homes.

7. Quality of life at the end of life

The process of dying according to Kübler-Ross

Hospice care

The experience care at the end of life in different settings

Quality of life in the process of dying – implications for clinical practice

The process of dying is the final stage of life that renders older persons vulnerable and helpless. In this final stage quality of life may change its meaning but not its importance. The process of dying came into the focus of research through the work of Elisabeth Kübler-Ross. Dissatisfied with standard treatment of dying persons in medical care settings Cecil Saunders established hospice care in the UK from where the idea spread to other countries. Since these ground-breaking investigations and approaches qualitative research has advanced the knowledge about the process of dying and the care needed. After a short introduction to the theory of Kübler-Ross and the concept of hospice care, this chapter will summarize findings about the process of dying as identified by latest qualitative research. It then investigates how settings where older persons die (i.e. hospital, nursing home, hospice) may shape the experience of this process. Considering the meaning of quality of life in this process the chapter will finally identify ways of care that may facilitate quality of life as it matters for those who are dying.

8. Quality of life in the context of gerontological theories

Ageing as a psycho-social problem

Ageing as a process of disengagement

Active and successful ageing

Criticism of successful ageing from a Foucauldian perspective

Alternative approaches

Conclusion:  Person-centered care for older adults from a multiplicity of perspectives

The final chapter will turn to the broader theoretical context of ageing. Since long gerontologists have discussed the issue of good ageing and they suggested a variety of solutions. Their theories, however, were developed with regard to the social changes in industrial societies that also had an impact on the traditional role of older persons. They were intended to show ways how older persons could adapt to these changes, and they implicitly or explicitly refer to an idea about quality of life in old age. They are, however, not concerned about the role and function of nursing care in this regard. This chapter therefore will relate theories about good ageing as proposed by gerontologist to the findings about older persons’ experiences with the various fields of care as described in the previous chapter. It starts with ideas about ageing that emerged after World War 2 and conceived it as problematic phenomenon as in the work of the French philosopher Jean Amery. It then turns to the competing theories of disengagement and active ageing that were both developed at the same time to show alternatives to such perceptions. The idea of successful ageing enhanced the perspective of active ageing, but critical gerontologist started to criticise it from a Foucauldian perspective.  They suggest alternative approaches like the theory of selection, optimization and compensation by Baltes, Erikson’s stages of psychosocial developments or Tornstam’s theory of gerotranscendence. All these theories will be investigated regarding their contribution to a way of care for older persons that promotes quality of life. Ageing as a multifaceted and variable phenomenon cannot be sufficiently described by a single theory. Several theoretical approaches are needed to provide an understanding of the role of nurses in promoting quality of life in old age. Person-centered care goes beyond a single theory. Placing the individual right in the center of care requires making deliberate use of gerontological theories in order to decide which theoretical framework may provide adequate guidance for care in a specific situation.

Thomas Boggatz was born in 1962 in Germany and finished his training as a male nurse in 1992. He studied Nursing Education at the Institute of Health and Nursing Science at the Charité, Berlin, Germany, from where he graduated in 2003 as a nurse educator.

From 2005 to 2008, he worked in Egypt to establish a training centre for geriatric care and a home care service in Greater Cairo. In 2010, he received a doctorate in Nursing Science from the Charité, Berlin, Germany, for a thesis about care dependency and care seeking attitudes among older people in Egypt.

He has been teaching nursing science at the University of Applied Sciences in Salzburg, Austria and is currently a lecturer at the Faculty of Nursing Science at the Philosophical-Theological University Vallendar. He conducted research about quality of life in care settings for older persons and has published a number or research articles, particularly on the topic of geriatric nursing care and quality of life.

Relates available evidence from qualitative research to current gerontological theories to provide evidence-based guidelines for the person-centred care of ageing adults

Offers a valuable guide for all practicing nurses, student nurses and healthcare professionals working with older adults

Illustrates the need for person-centred care in various professional care settings from health promotion to palliative care

Written by a respected expert in the field