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Quality of life

an individual’s perception of their position in life in the context of the cultural and value systems in which they live and in relation to their goals, expectations, standards and concerns

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Quality of life

  1. 1. Dr. Dalia El-Shafei Assist.Prof., Community Medicine Department, Zagazig University http://www.slideshare.net/daliaelshafei
  2. 2. LEARNING OBJECTIVES: 1) Define quality of life. 2) Identify component of quality of life. 3) Understand and calculate measures of quality of life.
  3. 3. DEFINITION OF QOL WHO : “an individual’s perception of their position in life in the context of the cultural and value systems in which they live and in relation to their goals, expectations, standards and concerns”. The degree of well being, satisfaction and standardized living. A feeling, function and future of happiness, health and hope. With increase life expectancy all over the world, the aim of health services is to make these added life years of good quality.
  4. 4. COMPONENT OF QUALITY OF LIFE • Energy & Mobility / Activities of daily living / Work capacityPhysical Health • Feelings, fear, depression / Self-esteem / Thinking, learning, memory and concentration.Psychological • Religion/ Personal internal powerSpirituality • Personal relationships / Social support / Role in the family, profession and social groups of friends& relativesSocial Relations • Physical, chemical & biological (pollution, noise, traffic, and climate) / Transport/ home environmentEnvironment
  5. 5. ASSESSMENT OF QUALITY OF LIFE Questionnaire, tests and /or instruments which must be: Valid Accurate Adequate Reliable
  6. 6. IMPORTANCE OF ASSESSMENT OF HEALTH RELATED QOL (SCOPE OF APPLICATION) Assess effect of community medicine programs after health policy changes. Measuring the burden of disease for estimating the degree of morbidity & mortality (economic evaluation assist decision makers). Assess patient satisfaction after clinical treatment. Assess quality of life of handicapped.
  7. 7. INSTRUMENTS FOR ASSESSMENT OF HEALTH RELATED QUALITY OF LIFE Quality adjusted life years (QALYs) Disability adjusted life years (DALYs)
  8. 8. QUALITY ADJUSTED LIFE YEARS (QALYS) Any year lived with less than optimal health = less than one Utility: is the patient's perception (opinion) of his/her QOL along a line starting from 0 to 1 (indifference from death & life) (1 = the best life). 1 year in perfect health = 1year x 1 utility =1 QALY It’s used in economic evaluation especially cost utility analysis. Assess years lived with high quality of health without disability or premature death.
  9. 9. Example: For 2 years bed ridden (utility = 0.5) QALY = 2 x 0.5 = 1 year
  10. 10. DISABILITY ADJUSTED LIFE YEARS (DALYS) WHO considered DALYs as a measure of the global burden of disease. It is the international quantitative indicator of burden of disease as it sums the years lost (YLL) because of premature mortality and years lived with disability (YLD) adjusted for the severity of the disability. DALY= YLL+YLD
  11. 11. CALCULATION OF TOTAL DALY FOR A DISEASE IN POPULATION YLL • No. of deaths X years lost from expectancy YLD • No. of cases X disability % X average duration of disability till cure or death. DALY • YLL + YLD (+ YLL after death from disability).
  12. 12. Example for understanding “DALY” calculation: In 16 years old adolescents: due to accident 100 deaths (consider life expectancy = 60 years) 70 with disability divided into: 60 with disability 25% for 4 years till cure 10 with disability 30% for 3 years then died YLL= No. of deaths x years lost from expectancy =100 x (60-16)= 4400 years YLD= No. of cases x disability percent x average duration of disability till cure or death = (60 x 25/100 x 4 = 60 years) + (10 x 30/100 x 3 = 9 years) DALY = YLL + YLD DALY = 4400+60+ 9= 4469 years (+ YLL after death from disability = 10 x (60-19) = 410 years) DALY =4400+60+ 9+410= 4879 years
  13. 13. RELATION BETWEEN QALY & DALY QALY assess years lived with high quality. DALY assess years lost of healthy life. They are completing each other
  14. 14. A man live for 50 years with blindness (since birth) & utility of blindness = 0.45. Considering life expectancy =80 years, calculate QALY& DALY. QALY = years x utility = 50 x 0.45 = 22.5 years DALY = YLL+YLD YLL = years lost from expectancy = 80 – 50 = 30 years YLD = disability (1- utility) x years = (1- 0.45) x 50 = 0.55 x 50 = 27.5 years DALY = 30 + 27.5 = 57.5 years DALY + QALY = 57.5 +22.5= 80 years

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