The increasing number of older people, with higher expectations of ‘a good life’within society and with their high demands for health and social care, has led to international interest in the enhancement, and measurement, of quality of life (QoL) in older age. UK Government policy is also concerned with enabling older people to maintain their independence and active contribution to society and, in effect, to add quality to years of life. QoL has thus become commonly used as an endpoint in the evaluation of public policy (eg in the assessment of outcomes of health and social care). This indicates that a multifaceted perspective of QoL is required, with a shift away from single-domain approaches that focus only on single areas of life (eg physical health and/or functioning, mental health, social support, life satisfaction, and well-being) towards one that also reflects the views of the population concerned.

A measure of QoL requires a definition of the concept. QoL theoretically encompasses the individual’s physical health, psycho-social well-being and functioning, independence, control over life, material circumstances, and external environment. It is a concept that is dependent on the perceptions of individuals, and is likely to be mediated by cognitive factors (Bowling, 2005a, b). It reflects macro, societal, as well as micro, individual, influences, and it is a collection of objective and subjective dimensions which interact (Lawton, 1991). Lawton (1982, 1983a, b) developed a popular model and proposed that well-being in older people may be represented by behavioural and social competence (eg measured by indicators of health, cognition, time use, and social behaviour), perceived QoL (measured by the individual’s subjective evaluation of each domain of life), psychological well-being (measured by indicators of mental health, cognitive judgements of life satisfaction, positive-negative emotions) and the external, objective (physical) environment (housing and economic indicators). He thus developed a quadripartite concept of the ‘good life’for older people (Lawton, 1983a), which he later changed to ‘quality of life’as the preferred overall term, accounting for all of life. However, there is no consensus within or between disciplines about conceptual definitions or measurement of QoL.