Estonian Human Development Report

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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. 28 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- | 76
ents were satisfied or very satisfied with the personal qualities, attitudes and work ethic of the care providers. Nearly a tenth of the respondents complained, however, that the care worker had too little time and that they could not plan their own day. Dissatisfaction rates are high with regard to assistance related to several daily activities – a third of the respondents would like to have more help in caring for their teeth and mouth, moving around in their home and outside, putting on their clothes, eating and doing housework. Assistance related to participation in recreation activities is the cause of the most dissatisfaction, with half of the respondents who needed such assistance being dissatisfied with it. In planning and carrying out the provision of care, it is important to take into account the expectations and subjective needs of persons receiving the care in addition to the need to assist them with daily activities. Implementing the medical care model, currently still widespread in Estonia, leaves many opportunities for improving the patients’ quality of life unused. Putting into practice a socio-cultural model of care that takes into account the individual features, life story and preferences of every patient may improve even the quality of life of people whose health and ability to cope are beyond improvement. In conclusion, the quality of life of the elderly is lower in Estonia compared to other EU countries. The most significant factors that lower quality of life include the bad health of the elderly and the inadequate accessibility of support services. Meanwhile, the implementation of the model of aging while remaining active and successful has been relatively effective in Estonia. Many people who have reached retirement age but are well and able to cope continue working and can participate in suitable recreational activities if they wish. The lack of material means may limit participation to some extent, but is not the main reason for the low rate of participation in events among the elderly. Nearly half of the older population are cut off from social life due to health problems. Elderly people who require care and live at home are in the worst situation. Reserves that can be used to improve the quality of life of the elderly consist of the enhancement of the availability and quality of both health care and nursing care services. Looking into the future, the most successful strategy for improving the quality of life of the elderly would be the improvement of the general state of health of the population, which would allow people to retain their self sufficiency into an advanced age. This should be combined References 1. Ainsaar M., Kutsar, D., Harro M. (eds) (2005) Euroopa Sotsiaaluuringu 2004 Eesti raport. [European Social Survey 2004: the Estonian Report] Tallinn: National Institute for Health Development. 2. Baltes, P. B., Baltes, M. M. (1990). Successful aging: Perspectives from behavioral sciences. New York: Cambridge University Press. 3. Bowling A., Gabriel Z. (2007) Lay theories of quality of life in older age. Aging & Society, 27: 827–848. 4. Health status indicators from the EU-SILC survey. http://epp. eurostat.ec.europa.eu/portal/page?_pageid=1073,60136085&_ dad=portal&_schema=PORTAL&p_product_code=HLTH_ STATUS_SILC_BASE. 23.10.2008 5. National Health Interview Surveys 2004. http://epp.eurostat. ec.europa.eu/extraction/retrieve/en/theme3/hlth/hlth_1s_ spa?Output. 10.09.2008. Figure 3.6.3. Subjective quality of life of the elderly living in care institutions in five European countries 90 80 70 60 50 40 30 20 10 0 Finland Sweden ESTONIA United Kingdom Source: CareKeys 2003–2006 (Saks & Tiit 2008). Germany Psychological Physical Social Environmental Figure 3.6.4. Subjective quality of life of the elderly receiving care/nursing services at home in five European countries 90 80 70 60 50 40 30 20 10 0 Finland Sweden ESTONIA United Kingdom Source: CareKeys 2003–2006 (Saks & Tiit 2008). Germany Psychological Physical Social Environmental with a reduction in age-based social alienation in all areas of life. In the near future, however, the key factor will be the improvement of the care provided to the elderly, which will also improve the quality of life of people belonging to the middle-aged and younger generation as they are currently bearing the great burden related to providing care for many ailing elderly people. 6. Pieper, R., Vaarama, M. The concept of care-related quality of life. (2008) (eds) M. Vaarama, R. Pieper, A. Sixsmith., Care related quality of life in old age. Concepts, models, and empirical findings. New York: Springer: 65–101. 7. Saks, K., Allev, R., Soots, A., Kõiv, K., Kolk, H., Paju, I., Jaanson, K., Schneider, G. (2001). Eakate tervishoid ja hoolekanne Eestis. [Health Care and Welfare Services of the Elderly], Tartu: Tartumaa Trükikoda. 8. Saks, K. (ed.) (2006) Hooldusest sõltuv elukvaliteet, hoolduse kvaliteet ja hoolduse juhtimise kvaliteet. [Quality of Life Dependent on Care, the Quality of Care and the Quality of Care Management], Tartu: Tartu University Press. 9. Saks, K., Leibur, J. (2008). Hooldusravi audit 2006-2007. [Care Audit 2006-2007], Lege Artis, 7: 19–21. 10. Saks, K., Tiit, E-M. 2008 Subjective quality of life of care-dependent older people in five European Union countries (eds) M. Vaarama, R. 77 |
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Estonian Human Development Report
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Estonian Human Development Report T
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4.2. Ethnic differentiations in sat
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Preface This year, the Estonian Hum
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CHAPTER 1 Estonian Human Developmen
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Figure 1.1.3. Life expectancy in co
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Figure 1.2.2. Life expectancy at bi
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to reality. The greatest inaccuracy
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Figure 1.2.9. Internal migration ev
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12. Marksoo, A. 1992. “Dynamics o
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Table 1.3.1. PISA 2006 study result
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Table 1.3.2. Number of students in
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Table 6.2.1. Objective and subjecti
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Figure 6.2.4. Relationship between
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Figure 6.2.7. Difference between th
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Figure 6.3.1. GDP, government secto
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Figure 6.3.3. Employed 15-74-year-o
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Figure 6.3.8. Percentage of social
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References 1. Aaviksoo, A., G. Paat
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Figure 6.4.1. Labour market flexibi
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Figure 6.4.3. Creations of jobs ind
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Figure 6.4.5. Public expenditures o
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Figure 6.4.6. Ratio of the particip
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6.5. Cities as development engines
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Table 6.5.2. Existence of developme
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have been underfinanced or are not
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Table 7.1. Factors that favour and
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Table 7.2. Potential economic devel
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Authors Chapter 1 Ene-Margit Tiit,
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Margit Keller (PhD) is a Senior Res
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Special prizes Estonian Human Devel
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Estonian Human Development Report H
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Estonian Human Development Report H
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Honorable mentions Estonian Human D
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Estonian Human Development Report P
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Estonian Human Development Report A
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