Quality of life (QOL) in older people with chronic illnesses will be investigated in terms of how it contributes to the valuation of life (VOL). VOL is the subjectively experienced worth of the person's present life, weighted by the multitude of positive and negative features in both the person and the environment. The research will extend existing research on health utility or health-state preferences by (a) using elders ages 70+; (b) investigating differences in VOL among those who are in versus those not in states of compromised health; (c) measuring the contributions of positive features of VOL as well as the traditional negative features. 180 subjects will be recruited from the residential and nursing-care sections of each of 2 components of the Teaching Nursing Home (The PGC and 5 retirement communities), and 99 from housing occupied by low-income elders with a majority of black occupants. They will be recruited to exclude the cognitively impaired but to represent a broad range of physical health. Standard interview-based assessment instruments will be used to measure QOL and psychological well-being plus new ones designed to measure VOL: Years of desired life under 4 hypothetical health conditions, a VOL scale, and an open-ended interview eliciting attitudes toward the future, present and future goals, and """"""""personal projects"""""""". Specific hypotheses and a structure model of psychological-well being and VOL based on Lawton's model of the good life will be tested. A """"""""positive path"""""""" and a """"""""negative path"""""""" are hypothesized to make independent contributions to psychological well-being and to VOL. A prospective cohort study will be performed on subgroups of subjects. The effect of health decline vs. health stability on Life Extending Treatment Preference will be tested on 200 subjects who survive for 12 months. Actual use of Life Extending Treatment will be determined for those who die, and QOL and VOL predictors of such use determined. No program income is expected.
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