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What Disabled Seniors Want: Dignity And Control

Quality of life for disabled elderly people is most closely tied to two factors: a sense of dignity and a sense of control, according to a study by researchers at the San Francisco VA Medical Center and the University of California, San Francisco.

"By 'control,' these elders mean a sense of autonomy in their activities of daily living," said lead author Jennifer King, MD, who was a medical student at the UCSF School of Medicine at the time of the study. "Because of disability, not all of them are able do to all activities on their own, but they want to feel they have some say in how those activities progress throughout the day."

The two factors were singled out as important by members of all ethnic groups in the study, which was based on a series of qualitative interviews with 62 disabled elders. The ethnic groups represented included white, African American, Latino and Chinese American. When asked to rate the quality of their own lives on a five-point scale that ranged from "excellent" to "poor," 87 percent of the elders responded "fair to very good," which was in the middle of the scale.

"These folks are not doing badly," said senior investigator Alexander Smith, MD, MPH, a palliative medicine doctor at SFVAMC. "Their quality of life, as they rate it, is definitely higher than some might assume it would be for older people with disabilities."

The study participants were all recruited from the On Lok Lifeways program in San Francisco. The day program provides social, health, nutrition, rehabilitation and other services to older adults who meet Medicaid requirements for residence in a nursing home but wish to remain in their own homes.

"One of the limitations of this study is that we only looked at older adults in On Lok, which is a model program for the entire country," said Smith, who is also a Greenwall Faculty Scholar in Bioethics and an assistant professor of medicine in the Division of Geriatrics at UCSF. "It could be that their high quality of life is simply a reflection of the dignity and sense of control they get as participants in the program—or it could be that we, as younger people, have preconceived notions about what it's like to live with late-life disability. That's something that future research needs to tease out."

"As the number of elders from diverse backgrounds with late life disability increases, we need to learn how to assess their quality of life, and develop an assessment scale that will adequately reflect what they tell us is important," said King. "With those tools, we can then create interventions to improve their quality of life."

To learn more about helping keep or regain quality of life, read Anxiety & Aging: How To Meet The Challenge and Can Physical Therapy Help Your Aging Parent? You Bet!