Estonian Human Development Report

Figure 3.6.2. Subjective quality of life of the elderly in
Tallinn and Helsinki (%)
Does not feel lonely*
Wants to live*
Makes plans for the
future*
Feels needed
Is satisfied with life*
* – statistically reliable difference
Source: TALSINKI study 2004.
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0 20 40 60 80 100
satisfied with the local governments’ efforts was somewhat
larger (16–20%) than that of satisfied respondents.
According to the study of well-being conducted in the
neighbouring cities of Tallinn and Helsinki (Talsinki 2004),
the subjective quality of life of the elderly living in Tallinn
is significantly lower than that of the elderly living in Helsinki
(Figure 3.6.2.). The only area where no difference was
identified was the respondents’ perceived indispensability
to others, but the elderly in Tallinn reported a greater sense
of loneliness, a lesser will to live, fewer plans for the future
and remarkably lower satisfaction with life. These indicators
were apparently not influenced by the fact that a considerably
smaller percentage of the elderly live alone in Tallinn than in
Helsinki (36% in Tallinn compared to 67% in Helsinki).
The lower quality of life of Estonia’s elderly population
is a result of worse health (52% of respondents in
Tallinn considered themselves ill or very ill compared to
29% in Helsinki), but also significantly worse access to formal
services (4% of all respondents used such services in
Tallinn, while 35% of respondents were able to do so in
Helsinki). The availability of help from family or friends/
acquaintances is similar in both cities (nearly 80% of
respondents can receive help if they need it).
Quality of life of the elderly
with care needs
70
72
In the case of elderly people with care needs it is possible
to differentiate between the quality of life in general and
the quality of life dependent on care. The aim of care is to
improve people’s quality of life as much as possible in their
situation by adjusting their environment, helping and supporting
them. It is possible to relieve many coping problems
caused by illnesses or age with care, although it is not possible
to fully compensate for irreversible losses. Due to this, the
key dimensions of quality of life in terms of providing care
are those that can be affected through care. The four carerelated
dimensions of quality of life include the environment
and resources, functional abilities, social identity and social
relations, and psychological well-being (Pieper & Vaarama
42
Helsinki
51
66
Tallinn
76
90
84
88
2008). On the subjective level, these four dimensions correspond
with safety and convenience, the feeling of control, satisfaction
with life, and emotional well-being. The provision of
care must help the recipients in their activities of daily living,
support the self-sufficiency of people depending on care as
well as their social relations, and give emotional support.
The quality of life of elderly people using home care services
is affected most by serious illnesses, problems related
to daily activities and housekeeping, difficulties related to
their dwelling and living environment, their limited access
to social life as well as their passive lifestyle and absence of
close friends (Vaarama & Tiit, 2008). The quality of life of
people receiving home care is better if they are positively
disposed to the process of aging and are satisfied with the
services provided to them. The feeling of security and control
over their situation and the care services are important
to people receiving home care. The quality of life of elderly
people in care institutions is affected positively not only by
their satisfaction with the rendered services and the people
who assist them, but also by the opportunity to take
part in making decisions related to their care and the planning
of their daily life, as well as the opportunity to fill their
free time with meaningful and interesting activities. The
involvement of family and friends in the treatment process
also improves the quality of life of people living in care
institutions. In the case of people dependent on care, the
significance of different dimensions with regard to general
well-being changes somewhat, with food and issues related
to meals as well as the ability to leave their room becoming
especially important (Saks et al. 2008).
The EU research project CareKeys studies the quality of
life of elderly people receiving care services with the aim of
clarifying the connections between care and quality of life.
The study revealed that the quality of life of the elderly living
in Estonian care hospitals and care homes as measured
with the short version of the World Health Organization
Quality of Life Questionnaire (WHOQOL Group 1998) was
just a little lower than, but comparable to, that of the elderly
living in similar institutions in other countries (Figure
3.6.3.). The subjective quality of life of people who receive
care services at home, however, is considerably lower, even
compared to the Estonian elderly living in care institutions
(Figure 3.6.4.; Saks & Tiit 2008). Some of the elderly in need
of care would prefer to stay in a care institution, but are unable
to do so due to financial constraints.
The quality of life of people depending on care is significantly
affected by their satisfaction with the services they
receive. In Estonian (health) care institutions, the patients’
satisfaction with care is generally high according to the Care
Keys study () and the Care Audit (Saks & Leibur 2008). However,
seven per cent of the respondents were dissatisfied with
the care they received and three per cent were very dissatisfied.
A higher percentage of respondents (15%) were dissatisfied
with the fact that the personnel providing them with care
do not have enough time for them and do not give them sufficient
information. Respondents were also dissatisfied with
being denied the opportunity to plan their own day as well as
with having little to do and having difficulty getting outside.
They were also critical of their lack of access to health care
services. However, the respondents were generally satisfied
with the assistance related to their daily activities and with
the care institutions as a whole (Saks & Leibur 2008).
Only a small number of home care service users (5%)
were dissatisfied with the care provided as a whole. Respond-
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