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A brief history of the Quality of Life: its use in medicine and in philosophy
This article traces the development of Quality of Life in medicine and philosophy in order to understand its current status and future potential.

Since the early 1970s, interest in the quality of life (QoL) concept has increased significantly in clinical practice and research. QoL has been of paramount importance for evaluating the quality and the outcomes of health care. Despite its importance, there is still no consensus on the definition or proper measurement of QoL. The purpose of this article is to analyze how QoL is being used in medicine and in philosophy to understand its current status.

The term QoL began to be used in the early 1960s following changes in the health and the demographic profiles of "late modern" societies. Traditionally, public health has been concerned, not to say preoccupied, with mortality. Public health frameworks in the first half of XX century were developed and articulated to help cope with the complex patterns of "premature" mortality, and, to a lesser extent, the incidence and prevalence of morbidity. In other words, medicine focused its attention on quantity of life.
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Academic Initiative
New Academic Project will Shed Light on Problems Posed by Aging Population

Home Renaissance Foundation is very proud to be the motivating force behind an academic endeavour that will look for ways to ensure the elderly are provided with good quality of life. As most elderly people would prefer to remain in their homes rather than enter into institutionalised care, it is appropriate for HRF to propel an effort that examines how this could be achieved. If the home is the elderly's preferred environment in which to continue developing as human beings and be looked after, then it is necessary to ensure that their house can be such a place through the appropriate training. On June 25, members of the research team organised a workshop in Campus Biomedico to present the study that was launched in November.

According to an OECD report, figures suggest that the 65+ population will reach 26% of the total population in OECD countries by 2050. The growth of the elderly demographic group will put added pressure on care services, a pressure that is already felt in the current imbalance between the need and supply of long-term caregivers.

In order to guide the policy-making process an international and interdisciplinary study will be carried out by a team of academics. The team will research quality of life from the elderly's perspective and by gathering data on the descriptions given by those working in caregiving in order to provide guidelines for policy and training reforms.

On June 25, at the University Campus Bio-Medico of Rome (UCBM) a one-day workshop on the quality of life of the elderly took place. The workshop was held in association with the Fundazione Alberto Sordi, Lexington College, Chicago and the Home Renaissance Foundation (HRF) and was an opportunity to analyse the initial stages of a research project launched last November. The three-stage research project is an in-depth study of geriatric care that aims to widen the pool of knowledge in this area of welfare, and improve the professional standards of caregivers.

Professor Maria Grazia de Marinis, Director of the Nursing Course at UCBM and head of the research team, described the need for this study: The issue of the aging demographic is one of great significance not only because of the consequences it has on the structure and composition of the population concerned, but also and especially because of its implications in healthcare and welfare. In this context, illness is no longer the sole concern for the elderly. Carrying out research, therefore, has become a priority in order to respond more comprehensively to the needs of the elderly.

Dr. Marta Bertolaso, Director of HRF and coordinator of the project for the UCBM, stressed the importance of the interdisciplinary character of this study, which allows a holistic approach to the problem and to the perspective of its practical outputs. The Institute of Philosophy of Scientific and Philosophical Action (FAST) of UCBM has been developing the anthropological and ethical aspects.

Societal context and need for solutions
There is an increasing share of older people in the population of OECD countries. According to OECD data, the 65+ population has increased from 9% in 1960 to 15% in 2006. This trend, which is expected to continue into the future, suggests that by 2050 26% of the total OECD population will be 65 or older. (OECD working papers no. 44). The significance of the growth of this demographic group is put into perspective when compared with statistics for other groups. In Italy, for example, by 2050 only 20% of the population will be 20 years old or younger.

In light of the increasing share of older people in the population, it is expected that the demand of long-term caregivers will also increase. At the moment, however, the supply of long-term caregivers does not meet the growing demand for their services. The foreseeable problems posed by the growth in the elderly population, the difficulty in the retention of formal caregivers and the decline in the supply of informal caregivers are such that the OECD has dedicated a report these specific issues. (OECD Working Papers no. 44)

Among the societal changes the OECD associates with a decline in the supply of family caregivers are declining fertility rates, a higher participation of women in the labour market, an increase in lone-elderly households and a rise in the educational attainments of the population. Many family care givers have also reported significant professional sacrifices such as lost income and benefits, including employer contributions to their retirement savings, as a result of turning down a promotion, reducing working hours and quitting work to dedicate more time to caregiving.

In addition to these trends, poor labour market conditions do not attract or retain long-term care workers. Caregiving is very mentally and physically demanding work, due in part to the long and irregular working hours, and with part-time and short-term employments as the norm, it does not provide stable working conditions. Many caregivers find that their work is not adequately recognised by families, care recipients, employers and other health care professionals.

The OECD links these poor working conditions to the frequency with which caregivers suffer from depression and other health problems. All these issues have been outlined in the OECD report as contributing factors to the unpopularity of caregiving despite the high demand for people engaged in this line of work.

The project as a response
The increasing share of the population aged 65+ and the shortage of long-term caregivers pose problems that will have a significant effect on policies in most Western countries. The research team propose that the first step towards adequate policy-making needs to be an in-depth study of the situation. It is only through a better understanding of the needs of those directly affected, the elderly and the caregivers, that any improvements to geriatric care can be made.

There are three main aims, or stages, to the research project. First of all, research must work towards finding an adequate definition for quality of life that can be applied to the elderly. Current conceptualizations suggest that quality of life for the elderly is exclusively bound to illness. Professor Marta Elvira, a member of the research team and head of the scientific committee for the 2011 Excellence in the Home Conference in London, organized by the Home Renaissance Foundation, gave a presentation at the workshop and argued to the contrary. In an interview she said, our studies show, that quality of life is directly related to your social relationships, even more so than to your health conditions. Obviously, at a certain age we all develop illnesses, but despite that, people have a preference for living with a sense of community.

The second aim of the project is to develop an understanding of caregivers jobs and their educational programme. A deeper knowledge and delineation of the competences required to provide quality care, adds Professor Elvira, will make caregiving a job that provides job satisfaction for the care giver themselves it will be a well-defined professionalised occupation, which is very much needed, given that this is the sector of the economy with the largest growth in upcoming years.

Based on the achievement of the first two aims, the third aim of the project is to develop human capital policies that will shape a suitable educational programme by which these competencies are fostered in caregivers. What the research team foresee as the ultimate result of the project is an interdisciplinary training that takes into account all the competences required to provide adequate quality of life.

Relevant and Innovative
Despite being one of the most used terms in bio-medical, psychological and social sciences literature, Quality of Life remains a multifaceted construct with various interpretations. Quality of Life is dependent on cultural perspectives and values, making an international and interdisciplinary approach to its definition necessary. As Professor Elvira explained, we need to learn from the different models. Doing an international, interdisciplinary study of how different health systems and different countries are approaching the issue can enrich the solutions that are available to this growing issue.

She continued, We do not have common approaches or common studies that can benefit from all the energies that are being put to this test so, firstly, there is a need for international research teams, and international data sets that can help us understand the issues. Secondly, there is a need for an interdisciplinary approach because this is not just an issue of healthcare. It is not a medical issue or an issue of illness. It is a social and global issue.

Apart from providing in depth knowledge of a new problem, the project, by its multidisciplinary nature, is taking a necessarily innovative approach towards finding solutions to the problem. Each of the stages of the project will add new knowledge to the field of international health care management by matching an accurate definition of geriatric care with the competences necessary to meet both the workers work satisfaction and the care recipients needs.

HRF, the impulse behind it all
In her interview, Prof Marta Elvira made it clear that the Home Renaissance Foundation was the impulse behind this academic endeavour. When talking about quality of life for the elderly, Prof Elvira stated, They define it more according to other variables: social relationships, knowledge-sharing, autonomy, of course, independence, ability to develop hobbies, the ability to continue growing as persons It is not so much society giving to them, but for them to still be able to contribute very much. What is more, older people's preference for home care rather than institutional care, as the OECD reports, affirms that the two are connected. For the elderly, then, the home is seen as a safe, comfortable environment where they can continue to develop as human beings while at the same time remaining in society.

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