Social service homes in the context of the quality of life of seniors
In the period of aging, the quality of life of seniors declines in the area of both physical and psychological health. Quality of life is a broader perspective on a person's health, understood not only in physical terms but also through emotional states and the ability to manage everyday activities (Goppoldová, Dragomirecká, Motlová, Hájek, 2005). Major changes in seniors' lives occur when they are placed in a social services institution for various reasons, in most cases due to social need, either voluntarily or involuntarily (Határ, 2005). Entry into a social services facility is strongly influenced by the senior's health condition, psychological factors, family background, social status, and so on. It is a turning point in the life of an older person and brings certain risks with it. (Hegy, 2004).
Because aging and problems related to it directly or indirectly affect all of us, we decided to focus on this issue. The steadily rising average life expectancy is leading us toward paying more attention to the quality of life of seniors in homes for social services.
Aim of the survey and research questions
The goal of our survey was to determine the quality of life of seniors and to identify the level of satisfaction of seniors with quality of life in homes for social services in Slovakia and Austria.
Through research questions, we wanted to find out:
- What is the quality of life of seniors in homes for social services in Slovakia?
- What is the quality of life of seniors in homes for social services in Austria?
- In which quality-of-life domain do seniors achieve the lowest scores?
- In which quality-of-life domain do seniors achieve the highest scores?
Research methodology
We conducted the survey in homes for social services in Slovakia and Austria. The Slovak Republic was represented by two senior facilities in the Košice self-governing region: PATRIA in the village of Drienovec and Juraj Schopper Institution in Čučma. Austria was represented by Hilfswerk Wiental in Pressbaum and the senior facility RENNWEG in Vienna.
To determine seniors' quality of life, we used the World Health Organization international questionnaire WHOQOL-OLD (Dragomerická, Prajsová, 2009). The first part of the questionnaire collected demographic information such as age and gender. The second part contained 24 questions that provided responses in six domains of quality of life. The Sensory Functioning domain was formed from questions 1, 2, 10, and 20. The Autonomy domain was mapped by questions 3, 4, 5, and 11. The Fulfillment domain comprised questions 12, 13, 15, and 19. Social Participation was assessed by responses to questions 14, 16, 17, and 18. The Death and Dying domain was represented by questions 6, 7, 8, and 9. The final domain, Intimacy, was formed from responses to questions 21, 22, 23, and 24.
Each of the above-mentioned domains was formed by scoring individual responses to four questions. Scoring for each domain was as follows: not at all = 1 point, a little = 2 points, moderately = 3 points, very = 4 points, maximally = 5 points. From the opposite end of the Likert scale, we reverse-scored the questions phrased oppositely: questions 1, 2, 6, 7, 8, 9, and 10. In analyzing the results of both questionnaires, we summed the individual scores for each question in each facility and then created crude scores for each domain. Survey evaluation was carried out through analysis, synthesis, and comparison of the results. By using descriptive statistics, we obtained average scores for the Slovak Republic and Austria.
The sample consisted of 76 (100%) seniors, of which 37 (49%) were in Slovakia, including 20 seniors from J. Schoppera and 17 from PATRIA. In Austria, a total of 39 (51%) seniors participated, including 20 in Vienna and 19 in Pressbaum.
Interpretation of findings
Through the survey, we examined the quality of life of seniors in social service facilities and obtained the following findings.
Table 1 Average values of quality-of-life indicators of the WHOQOL-OLD questionnaire
Source: Own processing
Figure 1 Average values of quality-of-life indicators of the WHOQOL-OLD questionnaire
Source: Own processing
Through questions within the domain "Sensory Functioning," we examined the effect of sensory decline on daily life, the impact of senses on participation in different activities, communication in society, and the functioning of seniors' senses. From the table and graph, it is clear that no significant differences were found in the "Sensory Functioning" domain, although seniors in Slovak facilities recorded slightly higher scores.
More marked differences are seen in evaluating the "Autonomy" domain, where we investigated to what extent seniors can decide on their own matters, their future, the extent to which their decisions are respected, and whether they are allowed to engage in activities of interest to them. Respondents in Slovakia scored 2.70 and seniors in Austria scored 3.31. This means Slovak respondents' answers ranged from 2.54 to 2.91, indicating that in most cases they responded with moderately or a little. Austrian respondents answered in the range of 2.83 to 3.76, from which we can infer that a larger part of respondents answered mostly moderately or very. In this area, based on our survey results, we can infer that quality of life is perceived as better among respondents in the Austrian facilities we contacted.
We observe similar results in the "Fulfillment" domain, where the average response values in Slovakia were 2.81 and in Austria 3.71. In the "Fulfillment" domain, we asked questions focused on satisfaction with their possibilities, sense of recognition, achievements in life, and satisfaction with things. Slovak seniors' responses ranged from 2.08 to 3.04, indicating that in most cases responses were mostly moderately or a little. For seniors in Austrian facilities, response range was from 3.49 to 4.02, which suggests they answered mainly very and moderately. Here too, we can interpret that quality of life in the "Fulfillment" domain is higher among seniors in Austrian facilities. They are therefore satisfied with their possibilities in life to still achieve something, receive the recognition they deserve, be satisfied with what they have achieved in life, and with things they can look forward to.
In the domain "Social Participation" we also reached comparable results in the previous two cases. In this domain, we asked about the amount of activities, opportunities for participation, satisfaction with social events, and leisure time use. Respondents in Slovak facilities achieved an average score of 2.67, while seniors in Austrian facilities achieved 3.58. As Slovak responses ranged from 2.56 to 2.84, we can state that most answers were moderately or a little. For Austrian respondents, the characteristic range was 3.24 to 3.76. These seniors most often answered moderately, very, and in some cases maximally. This means these participants have sufficient activities each day, are satisfied with their activities, with opportunities to participate in social life, and with opportunities to spend free time.
In the "Death and Dying" domain, we examined whether seniors experience fear of death, dying, and pain during dying, as well as fears of losing control in connection with death. The average score for Slovak seniors was 2.67, while for Austrian seniors it was 3.09. Responses from Slovak facilities ranged from 2.27 to 2.93. This means the most frequent responses were moderate and very. From this, we can infer that seniors are afraid of death, fear dying, and fear pain during dying. For respondents living in Austria, responses ranged from 2.30 to 3.62, as these respondents generally answered the death-related questions with moderate.
The final domain was Intimacy, in which we assessed how important friendship is to seniors, whether they feel loved, whether they have the opportunity to love someone, and whether they have enough love in their lives. Even in this domain, higher scores were recorded among seniors from Austria (3.99), whereas respondents from Slovakia scored lower, i.e., 3.36. The differences between both respondent groups were not especially large; in most cases, seniors answered moderately or very. We assume that those seniors in our sample were generally satisfied with this life area and felt enough love and friendship in their lives.
Discussion
In the survey focused on determining the quality of life of seniors, Slovak respondents recorded the lowest score in "Death and Dying" at only 2.67. This domain was also the weakest in the Austrian respondent sample. Austrian seniors achieved an average score of 3.09, from which it follows that both sample groups lag behind results reported by Dragomerická and Prajsová (2009) for a Prague population over 60 years old, and the level of our respondents is below average with slightly reduced quality of life. Slovak respondents achieved the same score in "Social Participation" as in "Death and Dying," meaning that people generally fear dying for reasons also identified by Vránová (2013) in her master's thesis titled Fear of Death in Seniors. The author concluded that older people fear most that they will die in hospitals and in hospices. As additional fear phenomena of dying, respondents mentioned fear of pain during dying, fear of losing self-sufficiency, fear of loss of dignity, and fear of losing loved ones. In her study, the author stated that there is a statistically significant negative correlation between perceived social support and anxiety about dying. Similar findings were also found by Sušinková (2016), who in her study found that the least favorable environment for seniors to spend their last moments is an institutional hospital environment, as this option was reported by 20% of respondents. Therefore, 27.50% of respondents would accept the alternative of a home environment, which is linked to a sense of safety and the presence of family members.
The "Social Participation" domain in Slovak facilities had an average score of 2.67, where questions were aimed at identifying a senior's satisfaction with their abilities and opportunities to participate in social activities. In our view, this domain is strongly influenced by the opportunities for leisure activities provided by the facilities as well as by seniors' functional abilities. Hudáková, Pavelková, and Fertáľová (2010) also confirmed this, finding that functional limitations in seniors lead to difficulties in performing social roles. The low level of the "Social Participation" domain was also mentioned by Dimunová, Dankulincová, and Stropkaiová (2013), who conducted research in the Košice self-governing region with a sample of 100 respondents, 50 of whom lived in institutions of social care and 50 in a home environment. The study was conducted using the Fliesstein test of cognitive functions and the WHOQOL-OLD questionnaire. The aim of their research was to determine and compare the quality of life of seniors in home and institutional environments. After analysis, they reached the clear conclusion that the quality of life of seniors in institutions of social care is not optimal. Another study from the Košice self-governing region was conducted by Soósová and Gajdošová (2014), whose goal was to determine the quality of life of seniors. The exploratory sample comprised hospitalized respondents in the Military University Hospital in Košice. Their study confirmed that seniors living in the Košice self-governing region have quality-of-life values at the lower edge of the normal interval. One option for increasing the quality of life of seniors is also humanoid robots, as pointed out by recent research in senior care. As reported by Štefková and Dimunová (2015), effects documented by video monitoring over several months showed positive effects on improving seniors' mood, which led to active communication and reduced anxiety.
We also cannot forget that comparing the Austrian sample of 39 respondents (100%) were from two facilities. The first was the Hilfswerk Wiental institution in Pressbaum, with 20 (51%) seniors receiving 24-hour home nursing care in their own home environment, and 19 (49%) respondents were seniors from RENNWEG in Vienna. When comparing these two facilities, we found that the quality of life of seniors receiving nursing care at home was higher in almost all quality-of-life domains than that of seniors in institutional care. Similar findings were reported by Tabaková and Bušová (2007), who examined satisfaction with provided nursing care in the home environment among 67 ADOS clients. We also encounter similar results in the work of Dimunová, Dankulincová, Veselská, and Stropkaiová (2013), who in research comparing quality of life in seniors living at home and in social care institutions found higher quality of life in the "Social Participation" domain among seniors living in social care facilities than among those living at home. After thorough analysis of our results, we concluded that seniors in Austria, both those living in social care institutions and those in home settings, rate quality of life higher compared with seniors in Slovakia.
Conclusion
On the basis of the survey results, it is clear that quality of life is shaped by multiple aspects and it is important to recognize that this area of research requires increased attention. Evaluation of quality of life becomes the outcome of interest in providing nursing care (Raková, 2010, p. 300) and at the same time provides insight for development in social care. Aging is a phenomenon that brings with it health, social, and economic changes that largely determine quality of life for both the individual and society as a whole. Therefore, it is very important to create conditions for comprehensive, multidisciplinary care with regard to the environment in which seniors live, and to give individuals the opportunity to age healthily and lead an active and meaningful life in old age (Zamboriová, Simočková, Potočeková, 2007, p. 676).
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