Social aspects of quality of life of disabled elderly in social facilities In gerontology, experts discuss the fact that the ``disabled process'' in its form includes interactions closely tied to cultural norms and the socio-economic status of the individual (e.g. attitudes, emotions, stigma, availability or lack of various services, accessibility, etc.) In addition to differences between genders, ethnic origin and economic status, social indicators are also among the significant factors related to the degree of disability, because they influence quality of life in old age. If we want to understand this problem, we have to focus on the fact that disability is a kind of intersection between the individual and his environment, at the same time perceive the potential of the therapeutic environment to maintain or increase the quality of life of seniors.

The quality of life of immobile seniors can decrease as a result of several types of social risks (e.g. loneliness, isolation), or increase as a result of those activities that support their social integration. Disability can arise at any time due to various causes and affects each of us at a certain stage of life. Even in the case of seniors, we can examine in more detail the quality of life, which is reflected in many social aspects (such as social isolation, interpersonal relationships or relationships with the environment, a sense of usefulness, social literacy, etc.).

Quality of life is a concept that currently reflects the interest of experts in helping professions in the well-lived life of clients in given conditions in cooperation with their limitations. Leaving aside the relative number of definitions to begin with, it is necessary to clarify the term "quality". Based on a loose interpretation of the Latin word "qualis" (what?), it is possible to understand the quality of life as what characterizes the life of an individual compared to the life of other individuals. (Kováč, 2004) In the professional literature, more complicated and complex definitions and reflections on various aspects of this phenomenon are added to the mentioned term. Čornaničová (2007 p. 28) offers an outline of four basic trends in the conceptualization of quality of life:

  • A) Sociological-economic: they focus on the material conditions of the life of society, social groups, regions, families and individual households, their basis is the calculation of certain parameters of the standard of living, standard of living and way of life of the monitored subjects.
  • B) Psychological: they are based on the theory of feeling the quality of life as subjective individual satisfaction or dissatisfaction in one's life and its individual areas based on one's own ideas, expectations and beliefs. Subjective perception includes the conditions, circumstances and social relations in which a person lives his life.
  • C) Applied with an emphasis on the medical and social fields: they are primarily focused on the management of intervention in specific health or social crisis situations of the individual and the family and on the measurement of the achieved results. We mainly focus on practical possibilities and areas of support for the quality of life of the client, who is in a specific life situation.
  • D) Synthesizing – theoretical and practical. They determine a kind of synthesizing model of quality of life, which is based on the assumption that quality of life areas participate in quality of life, as well as internal components in each of the mentioned areas.

Tokárová (2002) defines quality of life as a "complex category that includes social, biological, psychological conditions of life and its indicators are: physical well-being, material well-being and the quality of interpersonal relationships, social and civic activities, personal development, self-realization, recreation". "A reflection of the quality of life is the overall life satisfaction, which is the result of a person's relationship with his environment" (Frk, 2002 p. 436).

It is the task of interdisciplinary branches to define the quality of life of older people, establish its indicators and solve its theoretical and practical issues. Solving this aspect therefore requires the synthesis of several points of view, many knowledge and scientific approaches of various scientific disciplines. Based on these facts, the theory of social work plays a very important role. Research on social indicators and well-being, especially in the area of ​​work, family life and leisure activities, was conditioned by the creation of the welfare state. (Erickson 1974, In: Katschnig, 1997)

To evaluate and measure the quality of life of a citizen, Džuk (2004) compiled the main dimensions, namely: a) objective living conditions, b) subjective prosperity and satisfaction, c) personal values and aspirations. In the mentioned dimensions, it monitors the psychological, material, social and emotional aspects of life, development and activities. The content of the indicators is obtained either by the respondents' statements (subjective attitudes, evaluations) or by the use of objective data (collected by various institutions). The categories on the basis of which social indicators are grouped are called life domains, while the parameters of these domains are determined inductively or deductively, confirmed on the basis of theory and subsequently tested or empirically discovered and connected to theory. Zatura, Goodheart (In: Oliver et al., 1996) highlighted the usefulness of measuring the quality of life for the social environment. Based on their opinions, a good life is determined by social norms, laws and ways that help to achieve and maintain the quality of life. They define social indicators as social factors that guide individual behavior and are an aspect for evaluating where we are and where we are heading with regard to our values ​​and goals. (Džuka, 2004)

When looking for aspects of quality of life for seniors, we must take into account that the most important factors are its indicators or indicators. We understand by them certain qualitative-quantitative characteristics of social processes that contain individual aspects of the social development of individuals or social groups. We agree with the statement of Hrozenská (2008) that the quality of an individual's life cannot be determined independently of him. An objective description of living conditions, a person's functioning and their state of health are important, but not sufficient. If we want to take the quality of life as a measure relating to a person as an individual, we must also take into account the subjective aspect with all the complications that are a person's social health. The author therefore presents several models of the quality of life QoL (Quality or Life):

  1. Lenhart's model of quality of life – covers personal satisfaction, functional status, resources and possibilities at one's disposal.
  2. Bigelow model - emphasizes that the perception of quality of life goes beyond the clinical approach that measures the level of psychological abilities (eg, survival, cognitive processes) by including the ability to respond to environmental challenges.
  3. Two-dimensional comfort model – Hrozenská (2008) explains this concept in the words of Kolcabu, who introduces the concept of comfort as a positive criterion of nursing care. For Kolcaba, comfort means satisfying basic human needs, relief, comfort and transcendence resulting from a specific health situation.
  4. Three-dimensional model for measuring results in rehabilitation - the author refers to Testa et al., who introduced a term that includes various areas related to physical, functional, psychological and social health of a person in relation to quality of life as a criterion for the purposes of therapeutic decision-making and care planning.

Kováč adds that "the term quality of life is a multi-level and multi-dimensional phenomenon in which a more or less integrative approach prevails." (Kováč, 2003 p. 90)

However, the quality of life model cannot be explained only from a social point of view, because the quality of life depends on a wide variety of factors and the search for individual values in a person's life. (Balogová, 2005)

WHO QOL projects

The World Health Organization defined the quality of life by how a person perceives his position in life in the context of the culture in which he lives in relation to his goals, expectations, lifestyle and interests." (WHO, 1996) created the WHOQOL group (World Health Organization Duality of Life Group) in the early nineties and created standardized questionnaires for measuring quality of life. Thus, WHO not only defined the quality of life, but also developed questionnaires in basic and modified form to measure the quality of life of seniors. Such versions are, for example:

  • WHOQOL-100 (World Health Organization Quality of Life Assessment)
  • WHOQOL-BREF – shortened version
  • WHOQOL-OLD – special module for the elderly. (WHO, 1996)

The WHOQOL-OLD questionnaire is a standardized questionnaire created as part of the World Health Organization project: "Measuring the quality of life of seniors and its relationship to healthy aging: WHOQOL-OLD". The project ran from 2001 to 2004 and involved 23 research centers from 4 continents.

On behalf of the Slovak Republic, the Prague Psychiatric Center took part in the mentioned research project, which conducted research on the quality of life from a sample of the elderly population of Prague. The aim of the project was to create an instrument for measuring the quality of life in old age for both healthy and sick elderly population. The basis was already existing quality of life questionnaires of the World Health Organization. "The WHOQOL-OLD instrument is not intended for independent use, but only as an additional module to the WHOQOL-100 or WHOQOL-BREF quality of life questionnaires, which is a shortened version of the WHOQOL-100" (Dragomerická, Prajsová, 2009 p. 15).

In connection with old age, the concept of quality of life appears quite often, but the subject of research tends to be life satisfaction, the proof of which is that there are not many conducted researches on the topic of quality of life in old age. Also for these reasons, the WHOQOL-OLD international research team developed an instrument for measuring the quality of life in older people. The instrument consists of six domains: sensory functioning, independence, fulfillment, social involvement, attitudes toward death and dying, and close relationships. Each mentioned area (domain) contains 4 items, so the questionnaire has 24 items, which are evaluated on a five-point Likert scale. The questionnaire contains a total of 100 items and is denoted by the abbreviation WHOQOL-100. The WHOQOL-BREF questionnaire is an abbreviated version of this questionnaire, while taking into account the examined persons (long-term patients, seniors, persons with medical disabilities, etc.). It consists of four domains (containing 24 questions) and two questions aimed at assessing quality of life and health satisfaction: physical condition (the domain also includes 4 questions related to independence), survival (the domain also includes a question focused on spirituality), social relationships and environment. All aspects are subsequently operationalized into individual items. (Dragomerická, Prajsová, 2009)

Implementation of the research problem

Our research plan was constructed as a system of comparison of age groups: client group 60-75 years old, client group 75-85 years old, client group 90 years and older. The basic research set (or population) consisted of 300 immobile seniors, mapped on the territory of the Slovak Republic. The collection of empirical data was carried out in the period from July 2014 to the end of February 2015 through randomly selected social organizations from eight regions of the Slovak Republic. We selected respondents by random selection, the task of each collaborating center was to obtain data from a population of at least 40 people.

The collection of research data was organized in cooperation with organizations that provide health or social care for seniors, or provide recreational and educational activities for them. We did not include some respondents in our research due to the incomprehensibility of the filled-in data. We selected the respondents by random quota selection, we approached them through a standard procedure. We investigated the quality of life of immobile seniors primarily in social facilities in the territory of the Slovak Republic. We actually managed to collect data from 225 respondents, we continued to work with this sample in our research. In solving our research problem, a quantitative approach to research methodology was implemented.

Thus, the sample research group represented 225 respondents, while the number of respondents in individual social facilities in the regions of Slovakia was in an institutional environment (N=200) and the control group consisted of 25 clients in a home environment (N=25). In this work, we represent the results of a population sample (N=225) of clients. In a more detailed investigation of the issue, we focused on the differences in the perception of independence, fulfillment and social inclusion between seniors living at home and seniors in social facilities. The starting point of the mentioned research methodology was a structure that contained basic socio-demographic characteristics.

The task of the respondents was to use a 5-point Likert scale to evaluate their level of agreement or disagreement with the given statement. The principle of measurement is the assignment of numbers to feelings, experiences, etc., while the respondent expresses their subjective satisfaction with individual areas on the scale. In general, questionnaires are among the most frequently used techniques in research. They are used in the social sciences for mass and rapid ascertainment of facts, opinions, attitudes, preferences, values, motives, needs, interests, etc.

Processing the research problem

We processed the results through logical analysis and appropriate generalization. We evaluated the significance of differences (verification of hypotheses) using quantitative statistical methods using methods of descriptive statistics, reliability tests, parametric and non-parametric testing. To assess the factor analysis, we applied Kaiser-Meyer-Olkin (KMO) sample measurement as well as Bartlett's test of sphericity. We used the Shepiro-Wilk W-test to determine the normality of the distribution of both groups in the subtests of functional fitness, domains of quality of life, life in the presence and selected somatic indicators. Research in the social sciences means a systematic and thoroughly planned activity, which is guided by an effort to answer research questions and contribute to the development of the given field, while the social sciences emphasize empirical data when acquiring knowledge.

Interpretation of research results

GRAPH 1: Correlation of perceptions of intimacy in relation to gender and status

GRAPH 2: Correlation of attitude towards death in relation to age and fulfillment dimension

GRAPH 3: Correlation of survival, social involvement in relation to the environment

GRAPH 4: Correlation of independence, fulfillment and social inclusion in relation to the environment.

Discussion

In the research part of the work, we discovered that the quality of life of immobile old people depends not only on the level of their physical health and psychological functioning, but also on their social experience in the environment. The survey was carried out in social facilities on the territory of the Slovak Republic. The data collection took place between June 2014 and February 2015. We processed the obtained results in the IBM SPSS Statistics 22 program (Statistical Package for Social Sciences), which is currently the best software for statistical data processing in the social sciences. The reliability of all domains of the WHO QOL OLD and WHO QOL BREF questionnaires was very good to excellent. Slight differences in numbers can be attributed to the smaller population sample. From the interpretation of our results, we can see that all domains had a good measure of sampling-adequacy (Kaiser-Meyer-Olkin criterion is > 0.5). Bartlet's test of nullity of the covariance matrix was rejected for all domains, which is favorable. The share of the original variability of the items contained in the created domain can be seen in the Total variance explained table. From the results, we can see that the domains contained a sufficiently high proportion of variability - higher than 70%).

In our work, we set goals for the given topic, for which we formulated six hypotheses. All hypotheses were measured by statistical methods at a significance level of 5%.

The first hypothesis of our research related to the idea that there are differences in the perception of the function of the senses among seniors, and we hypothesized that the elderly experience more problems. In the mentioned hypothesis, we used ANOVA variance analysis of the dependent variable Function of the senses with the factor Age with an established contract in the sense of our hypothesis. From our results, it can be seen that the function of the senses as reported by pensioners does not depend statistically significantly on age. The stated hypothesis was not supported.

The second hypothesis related to the opinion that there are differences in the perception of intimacy between seniors according to gender and status, while we assumed that married and cohabiting seniors have higher scores in the intimacy dimension. For this assumption, we worked with ANOVA analysis of variance of the dependent variable Intimacy with the factors Gender and Status and with post-hoc tests corrected according to Bonferroni. The condition factor was found to be statistically significant. For example, we can see that the married status has an average score of 1.04 points higher in the perception of intimacy than the widowed. Also, being with a partner has a 0.98 point higher score than being divorced. And finally, married status has a 1.22 point higher score than divorced. The mentioned hypothesis was therefore supported.

The third hypothesis was based on the idea that there are differences in attitudes towards death among seniors, and we hypothesized that these attitudes are influenced by age and the dimension of fulfillment. In this case, we reprocessed the results based on the above assumption by ANOVA analysis of variance of the dependent variable Attitude towards death with the factor Age and the covariate Fulfillment with post-hoc tests corrected according to Bonferroni. A significant effect of the Fulfillment domain on Attitude towards death was shown. However, age did not have a significant effect on the attitude towards death. This hypothesis was supported.

The fourth hypothesis was based on the idea that there are differences in the perception of physical health among seniors, and we hypothesized that the elderly experience more problems. In this case, we used the analysis of variance ANOVA of the dependent variable Health with the factor Age with an introduced contract in the sense of the hypothesis. Physical health as reported by our pensioners did not depend statistically significantly on age. The stated hypothesis was not supported.

The fifth hypothesis defined the opinion that there are differences in experience, social involvement and environment between seniors living at home and seniors in social facilities. In the mentioned case, Hotelling's multivariate t-test was used in the work with the domains Survival, Social InvolvementQ and Environment. The set of domains Survival, Social involvementQ and Environment depended statistically significantly on the housing factor. The mentioned hypothesis was also supported. From the interpretation of the results, we can see that this influence causes that seniors living in a social facility have an average of 0.83 points higher scores in the social involvementQ domain than seniors living at home.

The last hypothesis led to the opinion that there are differences in the perception of independence, fulfillment and social inclusion between seniors living at home and seniors in social facilities. To obtain the results for the mentioned hypothesis, we used Hotelling's multivariate t-test with the domains Independence, Fulfillment and Social involvement. In the results, we can see that this effect causes seniors living in a social facility to have an average of 2.06 points lower scores in the fulfillment domain and 0.98 points lower scores in the social engagement domain. This hypothesis was supported. The set of domains Independence, Fulfillment and Social involvement depended statistically significantly on the housing factor.

Some of the results obtained from our research are compared with the research of other authors' research works, further available professional literature, or supplemented with our own commentary. For comparison, e.g. we can state (Ležovič, 2011) that the quality of life decreases with age and the strongest relationship of the quality of life is the subjective assessment of one's own health. According to the author, 57% of respondents expressed their dissatisfaction and 41% satisfaction with their health, while only 3% of seniors were very satisfied with their health status and quality of life. Farský and Solárová (2010) also investigated the quality of life of seniors living in a social care facility using the standardized WHOQOL-BREF questionnaire on a sample of 40 respondents. Their results show that the respondents had the biggest deficit in the area of ​​health. We are convinced that the strongest emotional support for old people lies in doing good for others. It is these deeds that fill them with a sense of usefulness and meaningfulness of life and can be the subject of their volunteer activities. The conclusions from our research show that the quality of life of immobile seniors living in a social facility is poor. The authors state similar conclusions (Farský, Žiaková, Ondrejka, 2005 p. 235) that the quality of life of seniors living in community facilities is not optimal, it requires further investigation and efforts to provide care that will bring the expected improvement in quality of life. The current state of health could directly influence the answers of the seniors. We can also consider the current family and social background as an important factor that affects the assessment of the quality of life of immobile seniors.

Conclusion

Philosophical understanding of the quality of life of seniors in a social environment is starting to become an increasingly discussed term even at the academic level. For non-profit organizations, the so-called "Disruptions" of social support can result in clients being excluded from participation in their lives. As part of the social process, the situation of seniors in the social environment is often worsened due to their health handicap. The lack of mobility of immobile seniors as clients of social work can also be determined from the point of view of the influence of some social factors.

The results of our research show that as a result of the changed state of health, contact with the social environment is significantly limited, social ties are disrupted, etc. The quality of life of these people is also significantly threatened by this. The degree of self-sufficiency, physical and mental activity, coping with illness, emotionality, social and spiritual aspects are most often absent in elderly people with limited mobility. To ensure the maximum quality of life of seniors with disabilities, it is very important to preserve their dignity and social well-being, which should not be reduced just because of their disability.

The interest of our company is that the older generation builds positive attitudes towards the observance of social norms. We must eliminate the causes and conditions of aging and old age in the form of preventive activities and a comprehensive approach, it is important to build a functional system of social and material support for seniors in families in order to prevent the relegation of seniors to the margins of society. In this work, we propose assistance to a group of immobile elderly people who are trying to reintegrate into society. The work discusses the basic features of the aging process, the position of immobile seniors in society, but also the opinions of seniors living in the territory of the Slovak Republic. We approached the respondents in the environment in which they experience their daily life ritual. Their answers largely confirmed the opinions of many experts on the quality of life of the senior population. The respondents had a different opinion depending on the degree of their awareness of current issues of social assistance, nevertheless they are aware of their specific problem, which is posed to Slovak society by the absence of balanced care and, ultimately, in their integration into society.

Author: Mgr. Zita Tomová The author is a doctoral student at the University of Health and Social Work of St. Elizabeth List of bibliographic references

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