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Quality of Life Among Older People in the UK and Taiwan

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Quality of Life Among Older People in the UK and Taiwan Quality of Life among Older People in the UK and Taiwan By Chih-Ping Lucia Li A THESIS SUBMITTED IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY In THE DEPARTMENT OF INFORMATION STUDIES THE FACULTY OF SOCIAL SCIENCES THE UNIVERSITY OF SHEFFIELD 151 June 2009 © CHIH-PING LUCIA LI, 2009 ABSTRACT This research is a cross-national comparison of longitudinal studies, designed to compare the quality of life, to identify the physical, mental, social, environmental factors contributing to quality of life, and predict the relationship between quality of life and mortality in old age. Although previous research has suggested that health, functional ability, psychological well-being, social relationships, socioeconomic status, and environmental conditions can affect quality of life among older people, little research has compared quality of life in old age across Asia-Western countries. The overall aim of this study was to compare the factors affecting quality of life among older people in the UK and Taiwan. Data were derived from the 1989 and 1993 waves of two nationally-representative samples of older people: the Nottingham Longitudinal Study of Activity and Ageing (NLSAA) in the UK, and the Survey of Health and Living Status of the Elderly in Taiwan. Data from the two studies were harmonised to ensure their comparability for the statistical analyses, and life satisfaction was used as a measure of quality of life. Secondary analysis was performed on the harmonised data sets containing data from 690 (1989) and 410 (1993) NLSAA participants and 1,438 (1989) and 1,003 (1993) SHLSET participants. Factors related to physical (e.g., self-rated health, perceived health relative to peers, specific diseases) and mental health (e.g., loneliness, depression), social factors (e.g., attending religious groups, having a TV or radio, having friends), demographic characteristics (e.g., age, gender, marital status, income), and life satisfaction (as a measure of quality of life) were examined using Mann­ Whitney tests, chi-square tests, stepwise multiple regression, and logistic regression. The association between quality of life and mortality was assessed using Cox proportional hazards regression models. Cluster analysis was used to examine the patterns among older people in terms of life satisfaction, and the relationship of these clusters with mortality was assessed. The results of this research suggested that the sample of older people from the UK had higher life satisfaction scores than their peers in Taiwan; however, this difference did not remain in the multivariate analyses. The analyses also identified that self-rated health, mental health (loneliness and depression), income satisfaction, and using a walking aid were common predictors affecting quality of life in the two countries. The results from Chapter 5 showed that the study location variable had an interactional effect with particular variables on life satisfaction between the two countries, i.e., people in the UK who were married, had excellent self-rated health, smoked, had heart, stomach, dizziness, high blood pressure or walking problems, used a walking aid, and those with high level of depression. People in these groups in the UK tended to report a high level of life satisfaction compared with their counterparts in Taiwan. Older people in Taiwan without friends had lower life satisfaction than their counterparts who had no friends in the UK. Survival analyses showed that life satisfaction is associated with mortality in the two countries, especially older people who reported positive feelings in life satisfaction tended to have a decreased risk of mortality. Life satisfaction had a less persistent effect on mortality for the sample of older people in Taiwan, suggesting that other factors explain the relationship with mortality in older people in Taiwan, or that they are more resilient. However, in the UK people who had higher life satisfaction scores had improved survival, independent of demographic, physical and mental health, and social engagement. There was no relationship between change in life satisfaction (1989-1993) and mortality. Finally, patterns of life satisfaction were related to mortality - older people with patterns of higher life satisfaction within cluster were more likely to live longer. Statistically significant differences were found between most the of factors of life satisfaction in the two countries. For instance, older people in Taiwan tended to live with someone, suggesting that the extended families are more in Taiwan than the UK. While some of the differences found, such as depression and loneliness, may be due to cultural variations, further research is required to identify further predictors of life satisfaction. Finally, the term 'life satisfaction' is one component of quality of life, and life satisfaction was used as a measure of quality of life in the research. This comparative research described and explained the differences and similarities in quality of life among older people living in two different cultures and societies. To conclude, a common data set is a unique opportunity to identify the factors affecting quality of life and to compare quality of life between the UK and Taiwan for increasing our understanding of older people. 11 ACKNOWLEDGMENTS Thank you, Lord Jesus Christ, for all the pains and dark you have borne for me; for all the benefits and blessings you have given me; Merciful friends, brothers and sisters may I know you more clearly, lover more dearly, and follow you more nearly, day by day. - Prayer of Saint Richard of Chichester I wish to express my gratitude to Dr. Peter Bath, my supervisor, for valuable comments and criticisms, for reading the draft of thesis and making a number of helpful suggestions. He also provided me with the skills and experiences necessary to succeed in future academic and work endeavours, and I am truly indebted to his for this. His expertise and background were also especially invaluable to me. I would like to acknowledgment of permission to use the data set of the Nottingham Longitudinal Study ofActivity and Ageing (NLSAA) in the UK. NLSAA was initiated with a foundation grant from the Grand Charity. Additional support for the study was provided by I kip the Aged, PPP Charitable Trust and Trent Regional Health authority. This research also utilised the data set from the Survey of Health and Living Status of the Elderly in Taiwan, provide by the Bureau of Health Promotion, Department of Health, Taiwan, R.O.C. I would like to give a special thank to Miss Sue-Hwa Chou for all your love and kindness throughout these years. Thank you very much for helping to make my dream come true. I also wish to acknowledge Mr. Paul Fenn and Mr. Andrew Stones for solving computer problems and Mr. Tim Nadin, Mrs. Julie Priestley, Miss Wendy Hardman, and Mrs. Christine Shaw for helping to help with general administration problems in this research. I received invaluable direction from various individuals in preparing this thesis. I wish to extend very special thanks to Sue-llwa Chou, Li-Li Wei, Lin-Lin Wei, Dr. Kevin White, Jhy-Yi Chen, Pin-Ling Chang, Chia-Wei Chu, Te-Tzu Han, Te-lIiang Han, Jin III Tan, Ming Li, Hung-Yang Lin, Dr. Zapopan Muela Meza, Dr. Kendra Albright, Jacqueline MacDonald, Simon Read, Theocharis Stavroulakis, Juliet Harland, Joel Minion, and Bonnie Raught. Lastly, I wish to acknowledge my dearest mother A-Chun Lin, my dearest husband Dr. Byron Gong, and my brother Chih-Shiang Lee. Their patience, support, constant encouragement, and much love are essential for the completion of this research. lV CONTENTS ABSTRACT ............................................................................................................................. i ACKNOWLEDGMENTS ...................................................................................................... iii CONTENTS ............................................................................................................................ v LIST OF TABLES .................................................................................................................. xi LIST OF FIGURES ............................................................................................................... xv LIST OF ABBREVIATIONS .............................................................................................. xvi Chapter 1 Introduction .......................................................................................................... 1 1.1 Introduction ...................................................................................................... 1 1.2 Ageing population in the world ....................................................................... 2 1.3 Comparative research: developed versus developing countries ...................... 3 1.4 Comparison of the UK and Taiwan ................................................................. 4 1.4.1 IIistorical perspective ................................................................................. 4 1.4.2 Ageing population in the UK and Taiwan ................................................. 6 1.4.3 llealth services ........................................................................................... 8 1.4.4 Social support systems ............................................................................. 11 1.4.5 Lifestyle of older people .......................................................................... 13 1.4.6 Overview
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