Quality of life (QOL) is a person's perception of how they are able to enjoy participating in physical, mental, social, and spiritual activities within the context of their own expectations and abilities; however, there is not a single definition of QOL (1). Maintaining a sense of purpose and meaningful engagement in activities that align with personal values is recognized as a fundamental contributor to both subjective wellbeing and objective health outcomes in older adults (2). It is critical for clinicians to take quality of life into account when establishing each patient’s goals of care and to use it as a guide for all care decisions.
When discussing QOL with patients, caregivers (both formal and informal), other health care personnel, and policy makers, health care professionals need to consciously avoid using language and assuming attitudes that suggest age bias, which negatively affects the patient's perception of what QOL could or should be.
General references
1. Costa DSJ, Mercieca-Bebber R, Rutherford C, et al. How is quality of life defined and assessed in published research?. Qual Life Res. 2021;30(8):2109-2121. doi:10.1007/s11136-021-02826-0
2. Steptoe A, Deaton A, Stone AA. Subjective wellbeing, health, and ageing. Lancet. 2015;385(9968):640-648. doi:10.1016/S0140-6736(13)61489-0
Health-Related Quality of Life
How health affects quality of life is variable and subjective. Health-related quality of life has multiple dimensions, and generally includes the following:
Absence or presence of distressing physical symptoms (eg, pain, dyspnea, nausea, constipation)
Quality of emotional well-being (eg, happiness, absence of anxiety)
Physical and cognitive functional status (eg, capacity to do activities of daily living and higher-order functions, such as pleasurable activities)
Nature and quality of close interpersonal relationships (eg, with family members and friends)
Ability to participate in and enjoy social activities
Degree of satisfaction with medical aspects of and financial arrangements for health care
Sexuality, body image, and intimacy
The interaction of these concepts has been suggested to increased quality of life in older adults (1).
Influences
Some of the factors that influence health-related quality of life (eg, reduced life expectancy, cognitive impairment, disability, chronic pain, functional status, dependency on caregivers) may be obvious in a patient to clinicians; however, some factors may not be, and clinicians may need to ask patients or their caregivers about other factors, especially social determinants of health (2). Social determinants of health (SDOH) are the conditions in the places where people live, learn, work, play, worship, and age that affect a wide range of health and quality of life risks and outcomes (3). Global health care initiatives reflect a growing recognition of how social and environmental factors impact health outcomes and quality of life in all people, including in older populations (4). The effect of one or more factors on quality of life cannot necessarily be predicted, and some factors that cannot be anticipated may have effects.
Perspectives on quality of life can change. For example, after the death of a spouse, a person's quality of life may change and affect care goals.
Health-related quality of life references
1. Marzo RR, Khanal P, Shrestha S, et al. Determinants of active aging and quality of life among older adults: systematic review. Front Public Health. 2023;11:1193789. Published 2023 Jun 26. doi:10.3389/fpubh.2023.1193789
2. World Health Organization (WHO). Social Determinants of Health. May 6, 2026. Accessed January 26, 20206.
3. U.S. Department of Health and Human Services: Office of Disease Prevention and Health Promotion. Social Determinants of Health and Older Adults. Accessed January 26, 2026.
4. Marmot M. Global action on social determinants of health. Bull World Health Organ. 2011;89(10):702. doi:10.2471/BLT.11.094862
Assessment of Quality of Life
Barriers to assessment
Assessing a patient's perspective on quality of life may be difficult for various reasons, including:
Quality of life is a subjective, individual experience, so the relative importance of various factors will vary between patients.
Quality of life is influenced by cultural factors that can impact a patient's values and preferences.
Patients may not discuss cultural and other personal factors, and even when they do, clinicians may not understand the impact of a particular factor.
Clinical methods of assessment are not always included or emphasized sufficiently in medical education, which tends to be focused on diagnosis and prolongation of life.
Quality of life assessment and communication must account for a patient's health literacy and fluency in the language spoken by the clinician.
Assessing the patient’s perspectives on quality of life takes time because it requires thoughtful conversation between patient and health care professional, and clinicians often do not have sufficient time during a typical clinical encounter.
Methods of assessment
Self-assessment methods are available for assessment of quality of life. One measure is self-rated health (SRH), also known as self-assessed health or self-perceived health, which is a single question in which people rate the current status of their own health on various scales that range from excellent to poor. SRH has been found to be associated with scores on measures of health-related quality of life and to be a reliable predictor of mortality (1, 2).
Wearable digital health technologies (smartwatches, fitness trackers, monitoring accessories [eg, glasses, rings], remote monitoring systems, and specialized medical devices) are providing increasingly valuable continuous, objective metrics that complement traditional self-reported quality of life assessments and enable more timely interventions (3). However, the technology must be user-friendly; cost, access, digital literacy, eyesight, hearing, manual dexterity, and ability to follow instructions for use are relevant factors.
Many methods of assessment are administered by a clinician. During assessment of quality of life, clinicians should not allow their own biases about the patient's health to inadvertently influence the patient's response. Determining a patient's preferences is usually possible. Many patients with dementia or cognitive impairment can make their preferences known when clinicians use simple explanations and questions; however, it is recommended to have family members present when discussing preferences of a patient with cognitive impairment.
Some of the most commonly used and well-validated patient-reported tools for assessing quality of life include the following:
EQ-5D (EuroQol [4]): This standardized instrument measures mobility, self-care, usual activities, pain/discomfort, and anxiety/depression (5). It can also be used to calculate quality-adjusted life-years for cost analysis to help evaluate health care interventions and policies.
SF-36 (Short Form Health Survey [6]): This tool consists of 36 questions evaluating physical, mental, and social health (eg, vitality, pain, physical function) (7). A physical component summary score and a mental component summary score are generated, which allows comparison within a selected population.
PROMIS (Patient Reported Outcomes Measurement Information System): PROMIS instruments consist of algorithm-generated patient questionnaires that gather and quantify health domains relevant to patients (eg, pain, fatigue, physical function, sleep disturbance, emotional distress, anxiety, cognitive function, depression, ability to participate in social roles) (8).
FACIT (Functional Assessment of Chronic Illness Therapy [9]): This collection of quality of life questionnaires for certain chronic conditions (eg, cancer, HIV, multiple sclerosis) can be used to help assess physical, social, emotional, and functional well-being.
WHOQOL-BREF (10): This tool is an abbreviated 26-item version of the World Health Organization (WHO) quality of life assessment, which includes physical/psychological health, social relationships, environment, overall quality of life and general health. These surveys have been validated internationally, translated into many languages, and successfully implemented in various clinical settings and patient populations.
These assessment tools can be administered serially to monitor quality of life of individual patients as their clinical course progresses, although there are not established guidelines for the frequency of these assessments. Some assessment tools (eg, PROMIS+Heart Failure-27 Profile v1.0 [8], the FACIT-Fatigue [11]) have disease- or condition-specific questionnaires that can assist in monitoring treatment responses and facilitate ongoing patient-centered goals of care discussions.
Assessment references
1. DeSalvo KB, Bloser N, Reynolds K, et al. Mortality prediction with a single general self-rated health question. A meta-analysis. J Gen Intern Med. 2006;21(3):267-275. doi:10.1111/j.1525-1497.2005.00291.x
2. Dumas SE, Dongchung TY, Sanderson ML, et al. A comparison of the four healthy days measures (HRQOL-4) with a single measure of self-rated general health in a population-based health survey in New York City. Health Qual Life Outcomes. 2020;18(1):315. Published 2020 Sep 24. doi:10.1186/s12955-020-01560-4
3. S Oliveira J, Sherrington C, R Y Zheng E, et al. Effect of interventions using physical activity trackers on physical activity in people aged 60 years and over: a systematic review and meta-analysis. Br J Sports Med. 2020;54(20):1188-1194. doi:10.1136/bjsports-2018-100324
4. EuroQol. EuroQol instruments. Accessed February 3, 2026.
5. Devlin NJ, Brooks R. EQ-5D and the EuroQol Group: Past, Present and Future. Appl Health Econ Health Policy. 2017;15(2):127-137. doi:10.1007/s40258-017-0310-5
6. RAND. 36-Item Short Form Survey (SF-36). Accessed February 3, 2026.
7. Ware JE Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992 Jun;30(6):473-83.
8. Health Measures. PROMIS. Accessed February 3, 2026.
9. FACIT. Measures & Searchable Library: Overview. Accessed February 3, 2026.
10. World Health Organization (WHO). WHOQOL: Measuring Quality of Life. Accessed February 3, 2026.
11. FACIT. Functional Assessment of Chronic Illness Therapy and Fatigue Scale. Accessed February 3, 2026.
