Defense Date


Document Type


Degree Name

Doctor of Philosophy


Health Related Sciences

First Advisor

Dr. Daniel L. Riddle


Interest in patient-reported health care outcomes such as health related quality of life (HRQL) has increased dramatically over the past two decades. Typically, HRQL has been conceptualized as having at least three domains: physical, psychological, and social functioning. Although research has attempted to identify factors that influence HRQL,few studies have simultaneously examined how various factors impact HRQL in the elderly. The purpose of this study was to develop and test a causal model to identify factors influencing HRQL. The constructs and observed variables hypothesized to influence HRQL included medical burden, housing satisfaction, socioeconomic status,religion/spirituality, age, gender, and marital status.Three hundred and sixty three (363) participants were drawn from a random sample of community dwelling elderly living in Tompkins County, NY (mean age, 74.9; SD, 8.5; range 60-103). Tompkins County is located in central NY, and home to a large university and mid-size college.This study was a non-experimental retrospective design using secondary survey data from the "Pathways to Life Quality" study. Using confirmatory factor analysis, a measurement model of HRQL was tested and validated. The final HRQL model was defined by four constructs: general health perception, physical functioning, psychological functioning, and social functioning. Once this model was validated, structural equation modeling was used to test the full model examining factors influencing HRQL. Several goodness-of-fit indices were used to assess model fit. Modification indices were used to provide clues as to what changes would be appropriate to improve model fit. Respecifications to the model were based on theoretical rationale.Greater levels of medical burden, increased frequency of attendance at religious events, and increased satisfaction with housing significantly influenced HRQL (pThe results of this study suggest that there are other constructs and variables particularly salient and that directly influence HRQL in older community dwelling adults. These variables and constructs should be accounted for when conducting randomized clinical trials and cohort studies examining HRQL outcomes in older adults.


© The Author

Is Part Of

VCU University Archives

Is Part Of

VCU Theses and Dissertations

Date of Submission