Quality of Life for Frail Older Persons Living in Taichung, Taiwan

Yi-Chen Lin¹, Merilyn Annells²
School of Nursing and Midwifery, La Trobe University, Australia^{1, 2}
Department of Nursing, Central Taiwan University of Science and Technology, Taiwan¹
ylin6474@yahoo.com.tw¹

Introduction

In 2006, reflecting the worldwide trend for an ageing population, 2.23 million people were over 65 years old in Taiwan (9.8% of the population). At any age, quality of life (QOL) with its subjective and multidimensional elements is a major concern for a person. In Taiwan, little is known about QOL for frail older persons, especially from their perspective. This study primarily aimed to develop a substantive grounded theory to guide facilitation of optimal QOL for frail older persons in Taiwan.

Sample

Incidents and situations pertaining to QOL concerning 28 older persons aged 65 and over who required assistance with activities of daily living within a city in the middle of Taiwan - 9 living in a nursing home, 10 in a senior citizens' home and 9 in private housing.

Methods

This study applied grounded theory method to identify the core basic psychosocial process (BSP) and to develop a grounded substantive theory concerning the research focus and aim. Guided by theoretical sampling until saturation, data were collected via individual, semi-structured interviews. Constant comparative data analysis was applied with use of Strauss & Corbin's paradigm model and conditional/consequential matrix. This analysis involved open, axial and selective coding with the extensive writing of memos and the application of theoretical sensitivity.

Findings

The BSP, as the core category is 'The process of frail older persons seeking to maintain QOL in Taichung, Taiwan'. The substantive theory encapsulates four associated main categories:

QOL in the foreground
Psychological adjustment
Direct action
Level of QOL

There are 22 subcategories with associated properties. Entwined in the theory are variables relevant to the QOL of older persons in Taiwan. The substantive grounded theory as an explanatory schema, can be summarised in a diagram (as illustrated), in a table according to the paradigm model (as illustrated), as a story-line (handout available proximally), or extended in explanation with illuminating quotes from data as presented in the full report of the research.

**Table 1:** The Substantive Grounded Theory According to the Basic Psycho-Social Process Construction Model
The Basic Psycho-Social Process Construction Model	Elements of the Substantive Grounded Theory
Causal conditions	Subjectivity about QOL
	Concern about QOL
	Causes impacting on QOL
Phenomenon	The process of frail older persons seeking to maintain QOL in Taichung, Taiwan
Broad situational context	Frail older persons in a range of care situations in Taiwan
Intervening conditions	Satisfaction with care-giving
	Satisfaction to the decision of care placement
	Discussing QOL issues
	The impact on QOL
	Usefulness of psychological adjustment & direct action
Action/interaction strategies	Psychological adjustment
	Cognitive strategies
	Self-reliance strategies
	Evasive strategies
	Emotive strategies
	Direct action
	Physical maintenance
	Solo activities
	Interactive participation activities
	Adjustment making
	Maximizing independence
	Contact with people
	Mutual benefit actions
	Doing good to others
Consequences	Quantitative level of QOL (upper, middle, lower)
	Qualitative level of QOL (good aspect, bad aspect)

Diagram 1: The Process of frail older persons seeking to maintain QOL in Taichung, Taiwan

Note: * These broken-lined arrows indicate potential variation in the degree of 'Usefilness of psychological adjustment and direct action'

Conclusion

The theory can guide multidisciplinary QOL-focussed assessment, intervention and evaluation not only for frail older persons living in Taiwan but also globally for frail elderly from a Chinese culture - and possibly could transcend cultural barriers.

References

Directorate-General of Budget, Accounting and Statistics, Executive Yuan, R.O.C. (2006). National statistics. Retrieved March 24, 2006, from http://sowf.moi.gov.tw/stat/month/m1-06.xls

Leung, K.-K., Wu, E.-C., Lue, B.-H., & Tang, L.-Y. (2004). The use of focus groups in evaluating quality of life components among elderly Chinese people. Quality of Life Research, 13(1), 179-190.

Noll, H.-H. (2000). Social Indicators and Social Reporting: The International Experience. Retrieved September 13, 2004, from http://www.ccsd.ca/noll1.html

Strauss, A., & Corbin, J. (1990). Basics of qualitative research: grounded theory procedures and techniques. Newbury Park: SAGE Publications Ltd.

Strauss, A. and J. Corbin (1998). Basics of qualitative research: Techniques and procedures for developing grounded theory. Thousand Oaks, SAGE Publications Inc.

The WHOQOL Group. (1998). The World Health Organization Quality of Life Assessment (WHOQOL): development and general psychometric properties. Social Science & Medicine, 46(12), 1569-1585.