Abstract

Background: The World Health Organisation defines Healthy Ageing as “the process of developing and maintaining the functional ability that enables well-being in older age”. Functional ability means being capable of doing things that people value, including meeting basic needs, being able to learn and make decisions, being mobile, building and maintaining relationships, and making a contribution to society.

Objectives: Supporting ageing populations to live healthier, longer lives is of benefit both to the individual and to reducing the costs associated with health and social care services. Increasingly, it is recognised that in order to measure a healthier life it is necessary to extend beyond health outcomes and functional ability onto the capability of older people to live a life that they themselves value. In effect, to adopt Sen’s capability approach to measure a worthwhile life. Such measures include the Adult Social Care Outcomes Toolkit (ASCOT), the ICEpop CAPability measure for Older people (ICECAP-O) and the Living Standard Capability for Elders (LSCAPE). These measures share the multiple dimensions that older people are known to value: attachment/social integration; contribution/role; security; control/restriction; and enjoyment. These contrast with the measures of functional ability that are used to assess the need for care services, such as, instrumental activities of daily living (IADLs) and activities of daily living (ADLs).

Methods: This paper addresses the factors that influence older peoples’ capabilities to live a worthwhile life using a battery of questions contained in the HAGIS (Healthy Ageing in Scotland) pilot survey. The HAGIS survey collected data from 1000 Scots aged 50+ during 2016-17. It included the Living Standards Capabilities for Elders: LSCAPE-6 (15) question battery, ADLs, IADLs and both socio-demographic and health-related variables. Our analyses examined the relationship between these capabilities, ADLS and IADLS and adjusting for socio-demographic and health variables including perceived general and mental health and cognitive ageing.

Results: The results find that capability is negatively affected by increasing difficulties in activities of daily living (ADLs and IADLs), marital status and deprivation. Of the health variables, those who reported poorer mental health were more likely to have reduced capabilities. This study is the first to explore the effect of functional capacity (ADLs and IADLs) on the capability to live a worthwhile life in older people in Scotland using LSCAPE. This will add to existing literature on the evaluation of well-being as measured by ASCOT and ICEPOP-O.