Cristina Giudici: University “La Sapienza”, Rome.
In the context of the European debate on ageing, a central question is the evolution of health status of population and in particular the trade-off between quantity and quality of life: is the increase of the individual length of life accompanied by an increase in the quality of life? And what do we mean by ‘quality’ of years lived?
The quality of life may be defined as a multi-dimensional phenomenon which covers various aspects of life; it is a complex process in which different elements of the past and the present individual story interact, including economic and social factors, such as professional situation, family relations etc (Wiggins et al., 2004; Walker, 2005). Thus, in the literature on health and social sciences, the quality of life is generally defined in terms of functional status, disability and perceived health (Fernandez-Ballesteros, 1998; Walker, 2005; Verbrugge, 1995; Beaumont et Kenealy, 2004, Robine, 2005). In the present study health is synonymous with ability vs. disability.
From a political point of view governments are strongly interested in forecasting the need regarding elderly assistance, showing a growing attention to prevention of functional problems and dependency. From this perspective active ageing policies are implemented in most European countries in order to create a ‘society for all ages’. In this context the international plan of action on ageing (Madrid 2002) is a reference point for governments.
The main aim of this study is to highlight the relationship between activity, in the sense of social participation, and health among the aged. The relation is reciprocal and bidirectional: bad health impedes social participation, but isolation could have a negative effect on health, especially on mental health.
2. The Conceptual Framework
The present study has been carried out within the conceptual framework provided by the World Health Organisation called International Classification of Functioning (ICF).
The ICF is a classification of health and health related domains that describe body functions and structures, activities and participation. It is a tool of classification aimed at describing the health status of individuals integrated in the society. According to this framework, an impairment concerning body functions or structure could lead to an activity limitation, which could lead to a restriction in social participation. All these elements influence perceived and real health conditions and are influenced by several environmental and personal factors.
Figure 1: Interaction of concepts — ICF 2001
From this perspective, health is seen in a social and cultural context, in which one can observe a reciprocal influence between health status, individual activity and social participation.
In particular, the ICF proposes a detailed list of ‘normal’ social activities, divided in nine groups: Learning &Applying Knowledge; General Tasks and Demands; Communication; Movement; Self Care; Domestic Life Areas; Interpersonal Interactions; Major Life Areas; Community, Social & Civic Life. All these factors, linked to social participation, are strongly influenced by environmental factors (technologies, services, policies, support and relationships, etc.) which can facilitate or obstacolate social participation (i.e. a person with a physical impairment living in an well equipped area could have a normal social activity and participation).
A great deal of literature can be found on the use of this framework, especially concerning the part of the pattern that goes from the impairment to the restriction of participation (Désesquelles 2002), but some studies also indicate the reverse process Laditka (2003).
3. Data and methodology
The study is carried out on data drawn from the French survey on handicap, incapacity and physical and psychological dependency (HID). It is a longitudinal survey with two waves: a first phase, started in 1998, consisted of interviewing people in social and care institutions on the basis of a questionnaire (15000 individuals were interviewed). The questionnaire is structured in ten modules, from impairments to social participation, including activity limitation. The same questionnaire was proposed to people living at home in 1999 (16500 individuals). Two years later the same individuals were interviewed a second time both in institutions and at home.
The first wave of the HID survey is representative of the entire French population, whereas the second one is representative of the evolution of individual situations.
The variables considered in the analysis refer to physical, sensory and cognitive functional limitation (disability), as far as to activity limitation and participation restriction: from a physical point of view we refer to the capacity of the individual to use his hands and fingers without problems; concerning mental health, variables refer to the temporal and spatial orientation: if individuals can remember what time of the day it is and if they can find their way home; sensory functional limitation refers to the capacity of the individual to see closely, to hear or to speak. Concerning the activity limitation the reference is to the so called Activities of Daily Living (ADL) i.e. getting washed, getting dressed, eating pre-cooked foods, going to bathroom, getting out of the bed or up of a chair.
For each of these questions the possible answers are grouped in four categories: no problem; some difficulties; great difficulties; help needed. Even if the first situation is the most frequent one, in this study we adopted a restrictive definition of disability, considering disabled people which have great difficulties or which need help in each field.
Thus, activity limitation and physical, sensory and mental disability were synthesised: i.e., individuals are “limited” in their daily life if they need help or have great difficulties in at least one of the five ADL areas. As far as mental health is concerned individuals are “disabled” if they have not good temporal or spatial orientation (i.e. if they have frequent or permanent lack of orientation in at least one or the two considered domains), etc.
As far as social participation is concerned, the variables entering the analysis are marital life (it does not necessarily mean marriage, but life together with a partner); the existence and availability of social and family contacts; social position (employees, manager, executives); information on whether or not they have lived through a dramatic experience in the last two years were also considered (this is usually the death of a relative); association life (whether or not the individual is member of at least one association); holiday (whether or not the individual goes on holiday at least one week per year).
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Tags: ability/disability, active ageing, activity and health, elderly assistance, mental health, quality of life, social participation