This study presents results from eleven nursing homes in Germany about HRQOL from the resident’s perspective, which according to Kane et al. denotes the “gold standard” . Measuring HRQOL provides an outstanding insight towards approaches that may lead to an improved quality of care . HRQOL was measured in six dimension of the NHP.
As a main result of our study we found that care dependency of the nursing home residents does not influence HRQOL of the residents, except for the domain “Sleep”. Here, residents with a high care dependency, compared to those with a low care dependency, had a significantly lower HRQOL (mean score: high care dependency 32.8 vs. low care dependency 15.3, p = 0.02). This can be explained by the fact that high care dependency residents are in more need of care compared to other residents. Nurses, for example, have to check the residents during night for incontinence problems or to change positions to avoid pressures ulcer, which results in disturbed sleep.
All other HRQOL domains (“Energy”, “Pain”, Emotional Reaction”, Social Isolation” and “Physical Mobility”) both in the univariate and in the regression analysis showed no significant results in relation to care dependency. Therefore HRQOL in our setting does not seem to be influenced by the degree of care dependency which is comparable with the other studies in similar contexts [28, 29]. It is worthy of note that the evaluation of HRQOL from the perspective of relatives, nurses or physicians does not necessary agree with the residents’ perspective [28–30], which shows the importance of this specific feature. This is particularly important for elder people and their perception of getting older in a permanently developing environment. Thus, standards and values in this group of people are of great importance for the assessment of HRQOL . Moreover, aspects of a ”good“ or “normal” HRQOL might therefore be subject to change in the various periods of elderly people’s life compared to other patient groups .
Taking this into account the reasonable HRQOL in our setting is understandable. Almost all HRQOL scores were below fifty from a possible 100, the maximum was not reached. A literature search revealed results of adults discharged from hospitals to their own homes in Switzerland who had an even lower HRQOL in the domains “Emotional Reaction” (79.8) and “Social Isolation” (87.2)  compared to our results (“Emotional Reaction” mean score: 19.2 and “Social Isolation” mean score: 22.4 ). Another study on hip fracture patients in all six domains of the NHP showed a lower HRQOL than our setting one week after hospital admission. . This could be explained by the aforementioned aging process and also the process of moving into a nursing home which is usually not based upon an abrupt decision but rather as a result of severe and acute problems associated with a hospital admission.
Becoming aware of an increasing age goes alongside with cognitive and emotional adaptation processes resulting in a recalibration of individual goals and beliefs. In addition to internal standards and values, conceptualization and reconsidering of quality of life is also a part of the adaptation process [35, 36]. As a consequence, HRQOL in our setting can be better compared to studies in acute settings.
The highest reduction of HRQOL was seen in the domains “Physical Mobility” (mean score 53.5) indicating clearly the residents’ physical limitations. This is of course not surprising, as most nursing home residents prior to nursing home admission suffer from several chronic diseases leading to substantial physical dependency, which then becomes a predictor for admission to a nursing home [37, 38]. However, the efforts made by residents to remain mobile use a lot of their energy, which is clearly reflected in the mean score of the domain “Energy” (43.7). In our study, more than fifty-two percent of the residents state that they “run out of energy”. One measure to improve this situation is to adapt exercise programmes which have already proven their effectiveness in other studies [39, 40].
HRQOL was independent from the care dependency in the domains “Pain”, “Social Isolation”, “Emotional Reaction”, and “Sleep” with all mean scores being less than twenty five points. With respect to gender differences we only found a significantly lower HRQOL in women compared to men in the domain “Pain” (mean score 29.5 vs. 14.9, p = 0.011), which is confirmed by other studies [41, 42]. An explanation might be that individuals who consider themselves more masculine and less sensitive to pain show higher pain thresholds and tolerances .
Out of all residents (n = 553) agreeing to participate only 41.4% could be included in the NHP analysis, which has already been discussed in detail . In addition to the sample size of our study it cannot be regarded as representative. This is mainly due to the fact that the drop out was not by random but by systematic conditions (residents declined to participate, data administration not possible, cognitive impairment). Moreover the sample was drawn in Berlin and Brandenburg (only two out of sixteen federal German states), so it can’t be representative for nursing home residents “in general”. Finally the residents were surveyed at the time of admission which also might have influenced their response. For the survey we chose the instrument NHP owing to the dichotomized response scale with a completion time of about 10 minutes. The high number of missing answers in the item “I’m in pain when going up and down stairs or steps” (n = 22, 18.3%) can be attributed to the use of elevators, to living on ground floors or to not being applicable to the resident’s situation.