Abstract
Background The impact of disability, long term conditions, rurality, living alone, and being a carer on health has some evidence base. The extent to which a strong sense of coherence, a factor hypothesised to promote wellbeing, may moderate these associations is unknown. A model of physical, environmental and social factors on quality of life was tested, with particular emphasis on whether a strong sense of coherence (SoC) buffered these determinants of quality of life.Methods A cross sectional postal survey was undertaken of a random sample of 3,000 individuals over 65 years, across a rural population. Physical, environmental, and psychological variables were assessed against quality of life using ANOVA and a generalised linear model including the interaction effects of SoC.Results Of 1,547 responses, 1,471 were analysable and provided permission for research use. ANOVA demonstrated that age, gender, long-term condition / disability (LTC-D), living alone, >20 hours unpaid care for others per week, SoC, and loneliness, were associated with lower quality of life (p<0.01). There were strong correlations (p>0.01), between age and LTC-D, living alone, and poor SoC. Living alone was correlated with emotional and social loneliness; but those with higher SoC were less likely to experience loneliness. In an adjusted generalised linear model, significant associations with a lower quality of life were observed from: LTC-D, emotional loneliness and social loneliness (B= -0.44, -0.30, and -0.39, respectively, all p<0.001). The only interaction with SoC that was statistically significant (at p<0.05) was LTC-D. A stronger sense of coherence buffered the negative effects of long-term condition / disability on quality of life.Conclusions This study is novel in examining the relationship between the presence of a LTC-D and loneliness in an older rural population. The physical, environmental and social factors examined, identified long-term conditions / disability and loneliness to be the strongest factors associated with quality of life. SoC somewhat buffered the adverse effect of LTC-D on quality of life, but did not do so for loneliness. Future research to understand what could be done to improve quality of life in a rural context is warranted.
The Clay Paw Burial Rite of the Åland Islands and Central Russia: A Symbol in Action