Quality of life is another term used throughout this report. The WHO established a working party on quality of life using the following definition:
“Quality of life is defined as the individual's perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns. It is a broad ranging concept affected in a complex way by a person's physical health, psychological state, level of independence and their relationships to salient features of their environment” (WHOQOL Group, 1997)
This definition is very similar to the definition of subjective wellbeing used above, and the strong parallels between the two concepts have been highlighted (Camfield & Skevington, 2008). Research on wellbeing and quality of life have tended to exist in parallel silos with the wellbeing literature more focussed on measuring life satisfaction, and quality of life research more focussed on subjective assessments of health status. In recent years, however, definitions of quality of life and wellbeing have converged so that they are broadly interchangeable conceptually. As both terms continue to be used in the literature, both will be used in this review.
Similar to wellbeing, the concept of quality of life can encompass both individual subjective assessments of life quality, but also the objective and subjective life conditions and circumstances which influence a person’s quality of life (Brown, Bowling, & Flynn, 2004; Lawton, Winter, Kleban, & Ruckdeschel, 1999). Amartya Sen has emphasised the importance of assessing whether a person has the necessary capabilities or opportunities to lead the kind of life they value, particularly compared to others (Sen 1985a, b; Sen, 1999). These capabilities include being well-nourished, well-clothed, mobile, taking part in the life of the community. Wellbeing is thus not just about the achievement of specific positive outcomes, but whether the person has the freedom or opportunity to achieve those outcomes.
It is clear that definitions of wellbeing and quality of life are complex. Components include an individual’s assessment of their wellbeing and quality of life, including their overall satisfaction with life, happiness, autonomy and purpose in life. It also includes factors which contribute to those assessments of wellbeing, such as physical health, social relationships, financial security, and the quality of the home and neighbourhood. In measuring wellbeing, it is therefore important to include both people’s evaluations of their overall wellbeing or quality of life, and key life domains that both influence and are part of wellbeing.
In considering positive ageing, it is also important to take a life course approach. The life course has been defined as a sequence of age-related transitions that are embedded in social institutions and history (Bengston et al., 2012) and as such, lives are institutionally structured (Mortimer and Shanahan, 2003). Institutional contexts include the family, school, work and labour markets, church and government and these institutions define the normative pathways we take, the social roles we take on and the timing of key life transitions. These contexts also influence the psychological, behavioural and health related trajectories of individuals and groups as they age and move through them.
According to Bengston et al. (2012) there are five principles of the life course which are relevant to understanding health, wellbeing and positive ageing. The first is the principle of ‘linked lives’ whereby lives are embedded in relationships with people and are influenced by them. For example the plans of grandparents for retirement can change during times of economic hardship when adult children return home and need their support. The second principle relates to historical time and place. Historical events such as the Second World War, the Great Depression and the economic crises of the 1980s and 2008 create opportunities and constraints and ultimately influence the choices, behaviours and lives of individuals who live through them (Bengston et al. 2012). The third principle is the link between transitions, their timing and social contexts (Bengston and Allen, 1993; Elder, 1995). Historical events have influenced people’s lives in different ways depending on the age and stage they were at when the event occurred. This can lead to differences between cohorts in terms of demographic behaviour such as delaying marriage, occupational outcomes such as reduced job security and psychological wellbeing (Putney and Bengston, 2003). The fourth principle is agency; individuals are active agents in the construction of their lives who make choices within the context of their family background, stage in the life course, structural arrangements and historical conditions (Bengston et al., 2012). The fifth principle concerns the idea that ageing and human development are life-long processes and that relationships, events and behaviours of earlier stages have consequences for later life relationships, statuses and wellbeing (Roberts and Bengstons, 1996).
The concept of anindicator is also critical for monitoring positive ageing. Many definitions of indicators exist in the literature and are in use internationally, varying slightly depending on their intended use. In a policy context, an indicator provides a measure of the relative position in a specific area (e.g. health) of a given population sub-group, geographical area or time-point (Nardo et al., 2008). It thus allows identification of trends over time, and of problem areas that require improvement. This in turn informs priority setting and performance monitoring. The purpose of indicators therefore, is to help us to analyse and understand a system or outcome, compare it and improve it (Association of Public Health Observatories, 2008).
“A variable with characteristics of quality, quantity and time used to measure, directly or indirectly, changes in a situation…to appreciate the progress made in addressing it…and to assess the extent to which the objectives and targets of a programme are being attained” (World Health Organisation Centre for Health Development, 2004, p. 78).