rater to evaluate the individual on a range of dimensions including bathing, dressing,
continence and feeding. ADLs have also been developed for individuals themselves to
complete and include questions such as, ‘Do you or would you have any difficulty:
washing down/cutting toenails/running to catch a bus/going up/down stairs?’ Measures
of functioning can either be administered on their own or as part of a more complex
assessment involving measures of subjective health status.
SUBJECTIVE HEALTH STATUS
Over recent years, measures of health status have increasingly opted for measures of
subjective health status, which all have one thing in common: they ask the individuals
themselves to rate their health. Some of these are referred to simply as subjective health
measures, others are referred to as either quality of life scales or health-related quality of
life scales. However, the literature in the area of subjective health status and quality
of life is plagued by two main questions: ‘What is quality of life?’ and ‘How should it be
measured?’
WHAT IS QUALITY OF LIFE?
Reports of a Medline search on the term ‘quality of life’ indicate a surge in its use from
40 citations (1966–74), to 1907 citations (1981–85), to 5078 citations (1986–90)
(Albrecht 1994). Quality of life is obviously in vogue. However, to date there exists no
consensus as to what it actually is. For example, it has been defined as ‘the value assigned
to duration of life as modified by the impairments, functional states, perceptions and
social opportunities that are influenced by disease, injury, treatment or policy’ (Patrick
and Ericson 1993), ‘a personal statement of the positivity or negativity of attributes that
characterise one’s life’ (Grant et al. 1990) and by the World Health Organization as ‘a
broad ranging concept affected in a complex way by the person’s physical health, psycho-
logical state, level of independence, social relationships and their relationship to
the salient features in their environment’ (WHOQoL Group 1993). Further, whilst some
researchers treat the concepts of quality of life as interchangeable, others argue that
they are separate (Bradley 2001).
Such problems with definition have resulted in a range of ways of operationalizing
quality of life. For example, following the discussions about an acceptable definition
of quality of life, the European Organisation for Research on Treatment of Cancer
operationalized quality of life in terms of ‘functional status, cancer and treatment
specific symptoms, psychological distress, social interaction, financial/economic impact,
perceived health status and overall quality of life’ (Aaronson et al. 1993). In line with
this, their measure consisted of items that reflected these different dimensions. Likewise,
the researchers who worked on the Rand Corporation health batteries operationalized
quality of life in terms of ‘physical functioning, social functioning, role limitations due
to physical problems, role limitations due to emotional problems, mental health, energy/
vitality, pain and general health perception’, which formed the basic dimensions of
MEASURING HEALTH STATUS 385