The term quality of life (QoL) has been used in nursing for several years despite having neither a common conceptual model nor a common definition. The Wilson and Cleary Model (WCM), defined in 1995, is used as a conceptual model to identify suitable variables important in planning nursing care in a study among Norwegian older adults. The objective of this study was to investigate how the relationships among depressive symptoms, physical function, health satisfaction, age and environment may predict QoL in a model based on the WCM. The overall model provides empirical evidence for linkages in the WCM. Results showed that QoL is likely to be influenced by the direct effects of environmental conditions, health satisfaction and age. In addition, environmental conditions and age had indirect effects on QoL, in particular via depressive symptoms. Environment had both a significant direct and an indirect effect on QoL. An indirect effect of environment on QoL was shown with depressive symptoms, physical function and perceived health as mediators. There was only a small amount of evidence for age predicting QoL. This model may help nurses and other health care workers to collect and assess information, to suggest suitable interventions and to guide decision making.
AikenLSStephenG (1991) Multiple Regression: Testing and Interpreting Interactions. Newbury Park, CA: Sage Publications.
2.
al WindiAElmfeldtDTibblinGSvardsuddK (1999) The influence of sociodemographic characteristics on wellbeing and symptoms in a Swedish community. Results from a postal questionnaire survey. Scand J Prim Health Care17: 201–209.
3.
AltmanDG (1999) Practical Statistics for Medical Research. London: Chapman & Hall.
4.
Amos (2006) Version 6.0 SPSS Inc, Chicago, IL.
5.
BaronRMKennyDA (1986) The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. J Pers Soc Psychol51: 1173–1182.
6.
BentlerPM (1990) Comparative fit indexes in structural models. Psychol Bull107: 238–246.
7.
BirrenJESchaieKW (2006) Handbook of the psychology of aging6th edAmsterdam/Boston: Elsevier Academic Press.
8.
BorglinGJakobssonUEdbergAHallbergIR (2006) Older people in Sweden with various degrees of present quality of life: Their health, social support, everyday activities and sense of coherence. Health Soc Care Comm14: 136–146.
9.
BowlingA (2001) Measuring Disease: A Review of Disease Specific Quality of Life Measurement Scales2nd edPhiladelphia, PA: Open University Press.
10.
BowlingA (2005) Ageing Well: Quality of Life in Old Age. Maidenhead UK: Open University Press.
11.
BowlingAGabrielZDykesJDowdingLMEvansOFleissig (2003) Let's ask them: A national survey of definitions of quality of life and its enhancement among people aged 65 and over. Int J Aging Hum Dev56: 269–306.
12.
BrownJBowlingAFlynT (2004) Models of QoL: A Taxonomy, Overview and Systematic Review of the Literature. Bristol, UK: European Forum on Population Ageing Research.
13.
BrowneMWCudeckR (1993) Alternative ways of assessing model fit. BollenKALongJCTesting structural equation models. Newbury Park, CA: Sage Publications445–455.
14.
BuonoMDUrciuoliODe LeoD (1998) Quality of life and longevity: A study of centenarians. Age Ageing27: 207–216.
15.
ByrneB (2001) Structural Equation Modeling with AMOS: Basic Concepts, Applications, and Programming. Mahwah, NJ: Lawrence Erlbaum Associates.
16.
CarrAJGibsonBRobinsonPG (2001) Measuring quality of life: Is quality of life determined by expectations or experience? First in a series of five articles. BMJ19: 1240–1243.
17.
CourtneyM (2003) Quality of life measures for residents of aged care facilities: A literature review. Australas J Ageing22: 58–64.
18.
D'AthPKatonaPMullanEEvansSKatonaC (1994) Screening, detection and management of depression in elderly primary care attenders. I: the acceptability and performance of the 15 item Geriatric Depression Scale (GDS15) and the development of short versions. Fam Pract11: 260–266.
19.
de JongePOrmelJSlaetsJPKempenGIRanchorAVvan JaarsveldCH (2004) Depressive symptoms in elderly patients predict poor adjustment after somatic events. Am J Geriatr Psychiatry12: 57–64.
20.
De LeoDDiekstraRFLonnqvistJTrabucchiMCleirenMHFrisoniGB (1998) LEIPAD, an internationally applicable instrument to assess quality of life in the elderly. Behav Med24: 17–27.
21.
DempsterMDonnellyM (2000) How well do elderly people complete individualised quality of life measures: An exploratory study. Qual Life Res9: 269–375.
22.
EngedalK (2003) Etter 70 er alt trist og leit (After 70 everything is sad and gloomy). Tidsskr Nor Laegeforen123: 1653–1656.
23.
FarquharM (1995) Elderly people's definitions of quality of life. Soc Sci Med41: 1439–1446.
24.
FayersPMMachinD (2007) Quality of Life: The Assessment, Analysis and Interpretation of Patient-Reported Outcomes. Chichester: John Wiley & Sons, Ltd.
25.
Fernandez-BallesterosR (1998) Quality of life: The differential conditions. Psychometrika2: 57–65.
26.
FieldA (2005) Discovering Statistics using SPSS: (and Sex, Drugs and Rock 'n 'Roll). London: Sage Publications.
27.
FokSKChairSYLopezV (2005) Sense of coherence, coping and quality of life following a critical illness. J Adv Nurs49: 173–181.
28.
GandekBWareJEAaronsonNKApoloneGBjornerJBBrazierJE (1998) Cross-validation of item selection and scoring for the SF-12 Health Survey in nine countries: results from the IQOLA Project. International Quality of Life Assessment. J Clin Epidemiol51: 1171–1178.
29.
GillTMFeinsteinAR (1994) A critical appraisal of the quality of quality-of-life measurements. JAMA272: 619–626.
30.
GrundyEBowlingA (1999) Enhancing the quality of extended life years. Identification of the oldest old with a very good and very poor quality of life. Aging Ment Health3: 199–212.
31.
HaaseJEBradenCJ (1998) Guidelines for achieving clarity of concepts related to quality of life. KingCRHindsPSQuality of Life: From Nursing and Patient Perspectives: Theory, Research, Practice. Boston, MA: Jones and Barlett54–74.
32.
HalvorsrudLKalfossM (2007) The conceptualization and measurement of quality of life in older adults: A review of empirical studies published during 1994–2006. EJA4: 229–246.
33.
HalvorsrudLKalfossMDisethÅ (2008) Reliability and validity of the Norwegian WHOQOL-OLD module. Scand J Caring Sci22: 292–305.
34.
HansenTMoumTShapiroA (2007) Relational and individual well-being among cohabitors and married individuals in midlife. Recent trends from Norway. J Fam Issu28: 910–933.
35.
HaugTTMykletunADahlAA (2004) The association between anxiety, depression, and somatic symptoms in a large population: the HUNT-II study. Psychosom Med66: 845–851.
36.
HawthorneGElliottP (2005) Imputing cross-sectional missing data: Comparison of common techniques. Aust NZ J Psychiatry39: 583–590.
37.
HaywoodKLGarrattAMSchmidtLJMackintoshAFitzpatrickR (2004) Health Status and Quality of Life in Older People: A Review. Oxford: National Centre for Health Outcomes Development.
38.
HellströmYAnderssonMHallbergIR (2004a) Quality of life among older people in Sweden receiving help from informal and/or formal helpers at home or in special accommodation. Health Soc Care Community12: 504–516.
39.
HellströmYHallbergIR (2001) Perspectives of elderly people receiving home help on health, care and quality of life. Health Soc Care Community9: 61–71.
40.
HellströmYPerssonGHallbergIR (2004b) Quality of life and symptoms among older people living at home. J Adv Nurs48: 584–593.
41.
HeoSMoserDKRiegelBHallLAChristmanN (2005) Testing a published model of health-related quality of life in heart failure. J Card Fail11: 372–379.
42.
HoferSBenzerWAlberHRuttmannEKoppMSchusslerG (2005) Determinants of health-related quality of life in coronary artery disease patients: A prospective study generating a structural equation model. Psychosomatics3: 212–223.
43.
HuLTBentlerPM (1995) Evaluating model fit. HoyleRHStructural Equation Modeling: Concepts, Issues, and Applications. Thousand Oaks, CA: Sage Publications76–99.
44.
IdlerEL (1993) Age differences in self-assessments of health: Age changes, cohort differences, or survivorship?. J Gerontol48: 289–300.
45.
IdlerELHudsonSVLeventhalH (1999) The meanings of self-ratings of health: A qualitative and quantitative approach. Res Aging21: 458–476.
46.
IwarssonSWahlH-WNygrenCOswaldFSixsmithASixsmithJ (2007) Importance of the home environment for healthy aging: Conceptual and methodological background for the European ENABLE-AGE project. The Gerontologist47: 78–84.
47.
JakobssonUHallbergIRWestergrenA (2004) Overall and health related quality of life among the oldest old in pain. Qual Life Res13: 125–136.
48.
JohnsonMLBengtsonVLColemanPGKirkwoodTBL (2005) The Cambridge Handbook of Age and Ageing. Cambridge UK: Cambridge University Press.
49.
KingCRHindsPS (1998) Quality of Life: From Nursing and Patient Perspectives: Theory, Research, Practice. Boston, MA: Jones and Barlett.
50.
LinMWolfSLHwangHGongSChenC (2007) A randomized, controlled trial of fall prevention programs and quality of life in older fallers. J Am Geriatr Soc55: 499–506.
51.
MichalosACHubleyAZumboBDHemingwayD (2001) Health and other aspects of the quality of life of older people. Soc Ind Res54: 239–274.
52.
MooreBSNewsomeJAPayneLPTiansawadS (1993) Nursing research: Quality of life and perceived health in the elderly. J Gerontol Nurs19: 7–14.
53.
Moore-HarrisonTSpeerEMJohnsonFTCressME (2008) The effects of aerobic training and nutrition education on functional performance in low socioeconomic older adults. J Ger Phys Therapy31: 18–23.
54.
NaumannVJByrneGJA (2004) WHOQOL-BREF as a measure of quality of life in older patients with depression. Int Psychogeriatr16: 159–173.
55.
NesbittBJHeidrichSM (2000) Sense of coherence and illness appraisal in older women's quality of life. Res Nurs Health23: 25–34.
56.
NetuveliGBlaneDB (2008) Quality of life in older ages. Br Med Bull85: 113–126.
57.
NetuveliGWigginsRDHildonZMontgomerySMBlaneD (2006) Quality of life at older ages: Evidence from the English longitudinal study of aging (wave 1). J Epidemiol Community Health60: 357–363.
58.
NoroAAroS (1996) Health-related quality of life among the least dependent institutional elderly compared with the non-institutional elderly population. Qual Life Res5: 355–366.
PaskulinLMGMolzahnA (2007) Quality of life of older adults in Canada and Brazil. West J Nurs Res29: 10–26.
65.
PearlJ (2000) Causality: Models, Reasoning, and Inference. Cambridge: Cambridge University Press.
66.
PowerMQuinnKSchmidtS (2005) Development of the WHOQOL-Old module. Qual Life Res14: 2197–2214.
67.
Preacher K and Leonardelli GJ (2003) Calculation for the Sobel test: An interactive calculation tool for mediation. Available at: http://www.people.ku.edu/~preacher/sobel/sobel.htm (accessed 22 April 2009).
68.
PuentesW (2004) Cognitive therapy integrated with life review techniques: an eclectic treatment approach for affective symptoms in older adults. J Clin Nurs13: 84–89.
69.
PutsMTShekaryNWiddershovenGHeldensJLipsPDeegDJ (2007) What does quality of life mean to older frail and non-frail community-dwelling adults in the Netherlands?. Qual Life Res16: 263–277.
70.
RaphaelDBrownIRenwickRCavaMWeirNHeathcoteK (1995) The quality of life of seniors living in the community: A conceptualization with implications for public health practice. Can J Pub Health86: 228–233.
71.
ReevesBCHarperRARussellWB (2004) Enhanced low vision rehabilitation for people with age related macular degeneration: A randomised controlled trial. Br J Ophthalmol88: 1443–1449.
72.
RussoACesariMOnderGZamboniVBarillaroCPahorM (2007) Depression and physical function: results from the aging and longevity study in the Sirente geographic area (ilSIRENTE Study). J Geriatr Psych Neur20: 131–137.
73.
SarvimakiAStenbock-HultB (2000) Quality of life in old age described as a sense of well-being, meaning and value. J Adv Nurs32: 1025–1033.
74.
SkevingtonSMSartoriusNAmirM (2004) Developing methods for assessing quality of life in different cultural settings. The history of the WHOQOL instruments. Soc Psychiatry Psychiatr Epidemiol39: 1–8.
SobelME (1982) Asymptotic Intervals for Indirect Effects in Structural Equations Models, Sociological Methodology. San Francisco, CA: Jossey-Bass290–312.
77.
SousaKH (1999) Description of a health-related quality of life conceptual model. Outcomes Manag Nurs Pract3: 78–82.
78.
SousaKHChenFF (2002) A theoretical approach to measuring quality of life. J Nurs Meas10: 47–58.
79.
SousaKHKwokOM (2006) Putting Wilson and Cleary to the test: Analysis of a HRQOL conceptual model using structural equation modeling. Qual Life Res15: 725–737.
80.
SPSS (2006) Version 14.0.2. SPSS Inc, Chicago, lL.
81.
TabachnickBGFidellLS (2007) Using Multivariate Statistics5th ednNew York: Harper Collins.
82.
The WHOQOL GroupThe World Health Organization Quality of Life assessment (WHOQOL): Position paper from the World Health Organization. Soc Sci Med199541: 1403–1409.
83.
The WHOQOL Group (1996) WHOQOL-BREF introduction, administration, scoring and generic version of the assessment. Field Trial Version. Mental Health, World Health Organization.
84.
The WHOQOL GroupWHOQOL: development and general psychometric properties. Soc Sci Med199846: 1569–1585.
85.
The WHOQOL-OLD Group (2005) The WHOQOL-OLD Manual. Copenhagen: World Health Organization group (WHO/EURO).
86.
UlvikBNygårdOHanestadBRWentzel-LarsenTWahlAK (2008) Associations between disease severity, coping and dimensions of health-related quality of life in patients admitted for elective coronary angiography – a cross sectional study. Health Qual Life Outcomes6: 1–12.
87.
UnruhMLNewmanABLariveBAmandaDMMiskulinDCGreeneT (2008) The influence of age on changes in health-related quality of life over three years in a cohort undergoing hemodialysis. J Am Geriatr Soc56: 1608–1617.
88.
WahlAKRustoenTHanestadBRLerdalAMoumT (2004) Quality of life in the general Norwegian population, measured by the Quality of Life Scale (QOLS-N). Qual Life Res13: 1001–1009.
89.
WalkerA (2005) Quality of Life in Old Age in Europe. Maidenhead: Open University Press.
90.
WareJEJrKosinskiMKellerSD (1996) A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care34: 220–233.
91.
Ware JE Jr, Kosinski M, Turner-Bowker DM, Gandek B and Keller SD (2002) How to Score: Version 2 of the SF-12 Health (with a Supplement Documenting Version 1). Health Assessment Lab, Lincoln, RI, Quality Metric Incorporated and Boston MA, Boston.
92.
WaternauxCM (1976) Asymptotic distribution of the sample roots for a nonnormal population. Biometrika63: 639–645.
93.
WettergrenLBjorkholmMAxdorphULangius-EklofA (2004) Determinants of health-related quality of life in long-term survivors of Hodgkin's lymphoma. Qual Life Res13: 1369–1379.
94.
WilhelmsonKAndersssonCWaernMAllebeckP (2007) Elderly people's perspectives on quality of life. Ageing Soc25: 585–600.
95.
WilsonIBClearyPD (1995) Linking clinical variables with health-related quality of life. A conceptual model of patient outcomes. JAMA273: 59–65.
96.
YesavageJABrinkTLRoseTLLumOHuangVAdeyM (1982) Development and validation of a geriatric depression screening scale: A preliminary report. J Psychiatr Res17: 37–49.
