What drives older women's perceptions of health-related quality of life?

Background Age-related differences in the way ratings of health related quality of life (HRQL) are produced are poorly understood, especially for older women. Objective To examine age differences in critical dimensions of HRQL among older women using structural equation modelling. We hypothesized that physical, mental and social health domains would exert weaker total effects on HRQL among older middle-aged versus much older women. Methods A model of HRQL was developed and confirmatory factor analysis (CFA) was used to test the structure of the model across two samples of community-dwelling women aged 55 years and older. The relationships between the constructs and the relative magnitude of direct and indirect effects on HRQL were evaluated in a series of path models, with women younger and older than age 70 tested separately. Results The CFA model of HRQL showed excellent fit in both the national and verification samples (RMSEA 0.04 and 0.02 respectively). In the path model, the total effects of physical, mental and social health on general perceptions of HRQL were greater and more significant in middle-aged versus older women (beta coefficients 0.810, 0.277, 0.266, all P < 0.05 versus, 0.700, 0.189, and 0.057, P < 0.05 for physical and mental health only respectively). Conclusion This HRQL model suggests different opportunities for intervention among older women to improve the outcomes along the path to HRQL.