QUALITY OF LIFE, HEALTH, AND VALUATION OF LIFE BY ELDERS

老年慢性病患者的生活质量（QOL）将会下降

Quality of life (QOL) in older people with chronic illnesses will be investigated in terms of how it contributes to the valuation of life (VOL). VOL is the subjectively experienced worth of the person's present life, weighted by the multitude of positive and negative features in both the person and the environment. The research will extend existing research on health utility or healthy-state preferences by (a) using elders ages 70+; (b) investigating differences in VOL among those who are in versus those not in states of compromised health; (c) measuring the contributions of positive features of VOL as well as the traditional negative features. 400 subjects will be recruited from the Albert Einstein and Philadelphia Geriatric Center community: Discharged inpatients, outpatients, and nonpatients, stratified by gender, race, and socioeconomic status (5 Ss per cell). They will be recruited to exclude the cognitively impaired but to represent a broad range of physical health. Standard interviewed-based assessment instruments will be used to measure QOL and psychological well-being plus new ones designed to measure VOL: Years of desired life, a VOL scale, and an open-ended interview eliciting attitudes toward the future, present and future goals, and "personal projects." Specific hypotheses and a structural model of psychological well-being and VOL based on Lawton's model of the good life will be tested. A "positive path" and a "negative path" are hypothesized to make independent contributions to psychological well-being and to VOL. A prospective cohort study will be performed on subgroups of subjects. The effect of health decline vs. health stability on Life Extending Treatment Preferences will be tested on 160 subjects who survive for 24 months. Actual use of life extending treatment will be determined for those who die, and QOL and VOL predictors of such use determined.