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 MannWhitney
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.