Quality of life: Everyone wants it, but what is it?

What exactly does "quality of life" mean? IESE's Marta Elvira and her coauthors analyze the term's widespread use, stressing the need for everyone to define their concepts.

"Quality of life" was once a term largely used by health-care professionals; now everyone from economists and advertising executives care about it.

For companies hoping to attract highly educated workers, being able to offer potential employees good "quality of life" is becoming increasingly important.

But what does it mean, and how can businesses, as well as physicians, help to improve it, if nobody can clearly define what it is?

An article by IESE's Marta Elvira, written with Barbara Barcaccia, Giuseppe Esposito, Maria Matarese, Marta Bertolaso and Maria Grazia De Marinis for Europe's Journal of Psychology, tries to pin down this elusive concept.

The authors analyze how "quality of life" has been interpreted and defined for research purposes over the past two decades, and they consider the difficulties involved in measuring it.

A matter of life and death

As medical advances have helped to increase longevity, our focus has shifted from the quantity to the quality of life.

While scientists may resort to rating scales to measure pain, or scoring systems to quantify disabilities, the authors believe that trying to measure "quality of life" this way may be going too far.

"Quality of life" is subjective and multidimensional, encompassing positive and negative features of life. It's a dynamic condition that responds to life events: A job loss, illness or other upheavals can change one's definition of "quality of life" rather quickly and dramatically.

Even though measuring it is difficult, clarity is extremely important, especially for medical practitioners, who often take "quality of life" into account when considering whether life-sustaining medical intervention should be withheld for severely disabled or ill patients. As such, coming up with a distinct definition is ethically important, and not just a case of splitting hairs.

The search for a definition

An analysis of scientific papers over the past 20 years shows that a precise, clear and shared definition is a long way off. Often researchers don't even attempt to define the concept, using it instead as an indicator. Among the observations made about "quality of life" is that it encompasses:

• life satisfaction, which is subjective and may fluctuate.
• multidimensional factors that include everything from physical health, psychological state, level of independence, family, education, wealth, religious beliefs, a sense of optimism, local services and transport, employment, social relationships, housing and the environment.
• cultural perspectives, values, personal expectations and goals of what we want from life.
• not just the absence of disease but the presence of physical, mental and social well-being. The authors stress the need for multidisciplinary medical teams who can develop a perspective on psychosocial needs and not just physical care.
• our interpretation of facts and events, which helps to explain why some disabled people can report an excellent "quality of life" while others can't.
• our level of acceptance of our current condition, and our ability to regulate negative thoughts and emotions about that condition.

Subjectivity appears to be fundamental to our understanding of "quality of life." The authors also urge that other variables not strictly related to physical health, such as spiritual and social health, should be assessed in the future.

As it stands, the confusion over what "quality of life" means does little to help professionals in any field, and could have serious ethical consequences.