ORIGINAL ARTICLES

QUALITY OF LIFE INDICATORS IN ELDERLY WITH CLUSTER C PERSONALITY DISORDERS

Iulia Echim1, Aurel Niretean2

Abstract: Background: Quality of life is an evaluative concept, the result of reporting living conditions and activities that make up human life to the needs, values and human aspirations. It refers both to the overall assessment of life and to the evaluation of various conditions and domains of life: environmental quality, quality of human work, quality of interpersonal relationships and quality of family life. Aims: To evaluate the impact of cluster C personality disorders on the subjective assessment of quality of life by a sample of elderly psychiatric patients and a control group. Methods: Using the WHOQoL -Bref quality of life questionnaire was assessed the group of 21 elderly patients with cluster C personality disorder and the control group, consisting of 10 elderly persons without personality disorder. Results: Overall, the assessment of quality of life in elderly patients with cluster C personality disorder showed us that 43% of cases this is neither good nor bad, while 90% of the elderly in the control group evaluated their quality of life as good. Conclusion: After analyzing the data, we can say that in elderly patients with cluster C personality disorder quality of life is lower than the quality of life of elderly people without personality disorder. Keywords: quality of life, cluster C personality disorder, elderly.

Rezumat: Introducere: Calitatea vieii este un concept evaluativ, fiind rezultanta raportrii condiiilor de via i a activitilor care compun viaa uman, la necesitile, valorile, aspiraiile umane. Se refer att la evaluarea global a vieii ct i la evaluarea diferitelor condiii sau sfere ale vieii: calitatea mediului ambiant, calitatea uman a muncii, calitatea relaiilor interpersonale, calitatea vieii de familie. Obiective: Evaluarea impactului tulburrilor de personalitate de cluster C asupra aprecierii subiective a calitii vieii cu ajutorul unui grup de pacieni psihiatrici vrstnici si un lot martor. Material i metod: Cu ajutorul chestionarului de calitatea a vieii WHOQoL- Bref a fost evaluat lotul de 21 de pacieni vrstnici cu tulburri de personalitate de cluster C precum i lotul martor, format din 10 pacieni vrstnici fr tulburri de personalitate. Rezultate: Per ansamblu, evaluarea calitii vieii pacienilor vrstnici cu tulburri de personalitate de cluster C ne-a artat c n 43% dintre cazuri aceasta este nici bun nici rea, n timp ce 90% dintre vrstnicii lotului martor i-au evaluat calitatea vieii ca fiind bun. Concluzii: n urma analizei datelor obinute, putem spune c, n cazul pacienilor vrstnici cu tulburare de personalitate de cluster C calitatea vieii este mai sczut dect a persoanelor vrstnice fr tulburri de personalitate. Cuvinte cheie: calitatea vieii, tulburri de personalitate de cluster C, vrstnici. satisfaction, happiness and fulfillment. If happiness is associated with a prevailing ethical perspective - what strategies must one adopt to maximize personal happiness -, quality of life is associated with a more socio-political perspective. Interest falls primarily on setting the objective factors which are responsible for the variation in quality of life, and the socio-political strategies of action to enhance the quality of life (2, 3). Many surveys have been devoted to the development of lifelong satisfaction of living. One of the most ambitious researches was made by Cameron (1975) on 6000 people aged between 4 and 99 years. His conclusion was that feelings of happiness, sadness and subjective well-being do not degrade with age, that pensioners do not have a lower satisfaction of life than younger people. Variability between individuals, instead,

BACKGROUND Quality of life is an evaluative concept, the result of reporting living conditions and activities that make up human life to the needs, values and human aspirations. It refers both to the overall assessment of life (how good/satisfying is the life of individuals, social groups and communities) and the evaluation of various conditions and domains of life such as environmental quality, quality of human work, quality of interpersonal relationships and quality of family life (1). Quality of life is resumption, from another perspective, for the concept of happiness. If happiness refers to the subjective state resulting from living one's life, quality of life refers to both the objective conditions under which human life is organized and also how each one is subjectively evaluating their own lives - state of
1

Rezident psychiatrist, Second Psychiytric Clinic Trgu Mure, 38,Gheorghe. Marinescu road, tel/fax: +0400-0265-211500, tel: +400-732515249; email: iulia.echim@yahoo.com 2 Professor Dr. University of Medecine and Pharmacy Trgu Mure, Department of Psychiatry, Head of Second Psychiytric Clinic Trgu Mure, 38,Gheorghe. Marinescu road, tel/fax. 0265-211500, email: aurelnirestean@yahoo.com Received August 29, 2011, Revised November 03, 2011, Accepted December 14, 2011.

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Iulia Echim, Aurel Niretean : Quality Of Life Indicators In Elderly With Cluster C Personality Disorders

appears to increase with aging (4). Aims: To evaluate the impact of cluster C personality disorders on the subjective assessment of quality of life by a sample of elderly psychiatric patients and a control group. METHODS We evaluated with the help of World Health Organization Quality of Life questionnaire (WHOQoLBREF): - A group of 21 elderly patients, average age 67 years old, including 14 women and 7 men, diagnosed with Cluster C personality disorder (avoidant personality disorder, dependent and obsessive-compulsive personality disorder) from the Psychiatric Clinic no.II Trgu Mure, recruited between 1 January 2009 and December 1, 2010. - A control group, consisting of 10 elderly persons (6 women and 4 men) without personality disorder- average age: 68 years old; Research data presented in this paper is organized in four domains: physical health, psychological health, social relationships, environment (personal life, living conditions), trying to capture as complete as possible the elements that describe quality of life. The information includes people's assessments of their own lives but also the contentment / satisfaction that they endeavor in . relation to living conditions. RESULTS Overall, the assessment of quality of life in elderly patients with cluster C personality disorders looks like this (Fig. 1):
How would you rate the quality of your life?
10%

14%

0%

33%

very good good

neighter good nor bad

bad very bad 43%

Figure 1. How would you rate the quality of your life? In the control group, 9 of 10 people evaluated their quality of life as good and 10% as neither good nor bad. 1. Living conditions In terms of living conditions: - home is the main element of support in living conditions (positive values prevail) - so that 66% patients were satisfied with their housing, 24% very satisfied, and in only 5% of cases dissatisfied; - the assessment of income remains in critical area - in 43% of cases, patients considered to have few money for daily needs and only 38% enough for daily needs; - people's expectations are heading towards a decent living, not towards recreational activities - recreation opportunities are limited for 66% of patients and in 29% of cases were evaluated as sufficient. The results obtained in the control group were: 50% of patients were very satisfied with their housing, 18

40% satisfied and 10% neither satisfied nor dissatisfied. As far as sufficient income for the daily needs: 2 people were completely satisfied with it, a person was mostly satisfied, 4 people were quite satisfied, and three people were too little satisfied with money for daily needs. Although the necessary financial opportunities for recreation come in second place even for the control group, 30% of respondents are mostly satisfied with these, 40% are fairly satisfied and 30% have fewer resources allocated to this sector of their lives. Environment plays an important role in living conditions. This was appreciated by elderly patients with cluster C personality disorder to be extremely healthy- 5% of cases; very healthy-19% of cases; quite healthy -61% of cases and in 5% of cases was assessed as not at all healthy. Percentages obtained in the control group are similar to those obtained from patients: 70% - the environment is quite healthy, 10% - very healthy, 20% . not so healthy. 2. Social environment The main elements of support are: - neighborhood relations (friends, neighbors, family). Patients were satisfied with social and personal relationships in the proportion of 52% cases, 24% were neither satisfied nor dissatisfied, 19% were dissatisfied with their relationships, and 5% of cases were very satisfied. As far as the support of friends: 14% of cases were very satisfied, 48% were satisfied, 33% were neither satisfied nor dissatisfied and 5% were dissatisfied. - assessing the quality of media information is also favorable- in 66% of cases it was considered quite available and in 29% of the cases was evaluated as mostly available. Also in this sector of life is included the assessment of the quality of public transport and accessibility to health services. Patients were satisfied with public transportation at a rate of 42%, 38% of cases were neither satisfied nor dissatisfied, 10% were dissatisfied and 10% were very dissatisfied. The results obtained in the control group were: 1. How satisfied are you with your personal and social relationships? - 90% - satisfied, 10% - dissatisfied 2. How satisfied are you with the help / support from friends? -70% - satisfied, 30% - neither satisfied nor dissatisfied 3. How available is information in your daily life? -40% - mostly, 30% - enough, 30% - less 4. How satisfied are you with the means of transportation? -10% - very satisfied, 40% - satisfied, 20% - neither satisfied nor dissatisfied, 30% -dissatisfied. 3. Personal life- the psychological domain and physical health As far as health status, elderly patients with cluster C personality disorders: 43% are dissatisfied (Fig. 2) and compared with last year, 33% of patients say it is almost the same as last year (Fig. 3). Also, an important place of this area is occupied by daily safety. Patients considered that they feel fairly safe in 81% of cases and less safe in 19% of cases. The results obtained after the assessment of life in elderly patients with personality disorder were: 24% of patients enjoy life a lot; 14% of cases enjoy life very much,

Romanian Journal of Psychiatry, vol. XIV, No.1, 2012 patients life is quite meaningful in 57% of cases, 19% extremely meaningful and in 19% of cases has little meaning. Health assessment in the control group was: 70% were satisfied with the current state of health, 10% were neither satisfied nor dissatisfied and 10% were dissatisfied. Compared to last year: 10% of cases- considered their health to be slightly better than last year, 50% of cases- almost the same as last year, 40% of cases- slightly worse than last year. Safety is an important aspect of daily life, 50% of the persons in the control group responded that they feel fairly safe, 30% - feel very safe, 20% - feel less safe. Regarding the appreciation of life in general: 6 people enjoy life very much, 2 people- enough and 2 people- a little; 20% - feel that life is extremely meaningful, 40% - that life is very meaningful, 20 % quite meaningful, 20% - responded that life has little meaning for them. should take into account the diversity of this vulnerable group. Meeting the various needs of elderly persons is done by appealing to a number of resources, whether human, material, economical, financial, legal, etc. Often, these resources are out of reach and access of older people, therefore, the involvement of family, relatives and people they know is essential for proper functioning of those who need them (7, 8). After analyzing the data, we can say that in elderly patients with cluster C personality disorder quality of life is lower than the quality of life of elderly people without personality disorder. In terms of current health status and the one compared to last year the results are undeniable in favor of the people in the control group. Since our study groups consist of people with very advanced age, is expected to be reported health problems (9), but health care services do not meet the level of population's health care needs. Quality housing is one of the indicators appreciated as positive by both patients and people of the control group, especially in relation to other aspects of life, but we must keep in mind that our samples included only those who have where to live, most being owners of the house. Environmental quality records also some correspondence between the two groups. Although there has been drastic reduction of industrial activity in the past decade, there hasn't been a significant change in the previous situation, partially because of the ever increasing number of vehicles and partially because of frequently occurring pollution events by negligence, all these imposing decisive action to halt the deterioration of living conditions, strict control over the factors of pollution, improving environmental education of the population. In relation to the availability of information, we can say that both patients and those in the control group consider it quite available, receiving an overall positive rating. The first group of indicators showing a lower quality of life includes the ones relating to material resources: assessment of income. Money for daily needs was considered as insufficient for many patients, and they were even fewer those for recreation / leisure. The value of the indicator for the quality of transportation was fairly similar in the two groups, being overall positive. Personal safety in the streets and housing, although an important element of quality of life had low ratings ? both in patients and people in the control group. The sense of personal insecurity is a powerful source of frustration for the population (10). The various sources of frustration are aggregated with others that can be maintained by the disharmonic structure of personality, so the indicator the state of contentment in daily life" shows that patients with personality disorder are more dissatisfied than people without this condition (9). Without a high expansion, changes recorded in the perceived quality of life, usually have negative significance. It is therefore perceived deterioration in quality of life and it is more pronounced for issues mainly related material conditions of existence (eg. income) Quality of life is ment to provide information for the development of social policy but contemporary sociopolitical context is an impediment to the reception and practical transposition of this approach giving it only a marginal role. 19

verydissatisfied

verysatisfied

satisfied

14%

0 %

14%
neither satisfiednor dissatisfied

29%

dissatisfied

verysatisfied satisfied dissatisfied

n eith er sa tisfiedno r d issatisfie d

43 %

verydissatisfied

Figure 2. How satisfied are you with your health?

14 % 24 %

0 %

much better than last year

29 %

little better than last year alm ost the same a s last year little w orse than last year

33 %

m uch worse than last year

Figure. 3. Compared to last year, how would you appreciate now your health in general? CONCLUSIONS Elderly population is a more vulnerable social group facing specific problems than other segments of society (5, 6). Securing the needs of the elderly population to ensure a decent living, covers a range of concerns, not only economical but also social and psychosocial, and developing programs and services for elderly people

Iulia Echim, Aurel Niretean : Quality Of Life Indicators In Elderly With Cluster C Personality Disorders

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6. Schneider EL. Aging in the Third Millennium. Science 1999;28: 7967. 7. Newson JT, Schulz R. Social support as a mediator in the relation between functional status and quality of life in older adults. Psychol Aging 1996;11: 34-44. 8. Rowe JW, Kahn RL. Successful aging. Gerontologist 1997;37: 43340. 9. Mrginean I, Blaa A. Calitatea vieii n Romnia, Ediia a II-a. Bucureti: Editura Expert, 2005, 146-187. 10. Nussbaum M., Sen A. The quality of life. UK, Oxford: Clarendon Press, 1993, 472.

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