Grewal Ini, Lewis Jane, Flynn Terry, Brown Jackie, Bond John, Coast Joanna
National Centre for Social Research, UK.
Soc Sci Med. 2006 Apr;62(8):1891-901. doi: 10.1016/j.socscimed.2005.08.023. Epub 2005 Sep 15.
Current UK policy with respect to the provision of health and social care for older people suggests that greater integration is required. Economists' attempts to assist resource allocation decisions, however, are very health focused, with concentration on the use of health-related quality of life measures. This paper reports an attempt to determine attributes for a new index clearly focusing on quality of life for older people rather than health or other influences on quality of life. In-depth interviews were conducted with 40 purposively selected informants aged 65 and over in private households to explore their views about what is important to them in terms of quality of life. Data were analysed using Framework qualitative analysis. Initial discussions tended to concentrate upon factors influencing quality of life including activities, relationships, health, wealth and surroundings. Further probing and analysis suggested five conceptual attributes: attachment, role, enjoyment, security and control. The data also suggested that the quality of informants' lives was limited by the loss of ability to pursue these attributes. So, for example, it is not poor health in itself, which reduces quality of life, but the influence of that poor health upon each informant's ability to, say, be independent, that is important. Amartya Sen's work on functioning and capability is particularly pertinent here. Using this work, it is possible to interpret the five conceptual attributes as a set of functionings-important for older people in the UK in the 21st century-but noting that it is the capacity to achieve these functionings that appears to be of importance. This suggests that further development of this measure should focus on an index of capability rather than preference-based utility.
英国当前针对老年人提供健康和社会护理的政策表明，需要实现更大程度的整合。然而，经济学家在协助资源分配决策时，非常侧重于健康方面，主要关注与健康相关的生活质量衡量指标的运用。本文报告了一项旨在确定一个新指数属性的尝试，该指数明确聚焦于老年人的生活质量，而非健康状况或其他对生活质量的影响因素。研究人员对40名年龄在65岁及以上、从私人家庭中经过有目的挑选的受访者进行了深入访谈，以探讨他们对于生活质量中对自己重要之事的看法。采用框架定性分析法对数据进行了分析。初步讨论往往集中在影响生活质量的因素上，包括活动、人际关系、健康、财富和环境。进一步的探究和分析提出了五个概念属性：依恋、角色、享受、安全感和掌控感。数据还表明，受访者的生活质量因追求这些属性的能力丧失而受到限制。例如，降低生活质量的并非健康状况本身，而是健康不佳对每个受访者诸如保持独立能力等方面的影响，这才是重要的。阿玛蒂亚·森关于功能和能力的研究在此尤为相关。运用这项研究成果，可以将这五个概念属性解读为一组功能——对21世纪英国的老年人而言至关重要——但要注意，实现这些功能的能力似乎才是关键所在。这表明该衡量指标的进一步发展应聚焦于能力指数，而非基于偏好的效用。
