Age categories differences in subjective quality of life of women with physical disabilities

The World Health Organization (WHO) reports that there are more than one billion people with a disability globally, and of this between 110 million and 190 million adults experience significant difficulties in functioning (1). Disability disproportionately affects women, older people, and poor people. Women and girls with a disability are likely to experience “double discrimination”, which includes gender-based violence, abuse and marginalization. As a result, women with a disability often face additional disadvantages when compared with men with a disability and women without a disability (1). Individuals with disabilities, like all people, have varied and dynamic feelings and thoughts about their lives which contribute to their quality of life (QoL) (2).

In many countries, women with disabilities face barriers to social integration, employment and productivity, healthcare, and adequate access to community resources and support services, all of which significantly decrease their QoL (3). Being a woman and having a disability often results in double discrimination and consideration as a second-class citizen (4). Research also reveals that the health-related quality of life of women with disabilities is related to their educational level, marital status, type of residence, cause of acquired disability and disability of a spouse. Activities of daily life, self-esteem and health-promoting behaviours are significant predictors to explain the quality of life in disabled women (5). In Tate et al. (6) women with traumatic conditions (amputation, spinal cord injury) reported poorer physical functioning and well-being, whereas women in the nontraumatic (post-polio, breast cancer) group reported poorer health status. Age is another important factor that can negatively influence the QoL of a person with a disability, such as through an increasing incidence of pain (7, 8). The research objective of the current study was thus to identify any age-based differences in the subjective quality of life of women with physical disabilities through assessing their satisfaction with various quality of life domains (physical health and independence level, psychological health and spirituality, social relations, environment) and an overall quality of life assessment.

Almost all of the youngest group of women with PDs (1929 years) were single (96.2%) and still studying (88.7%), while for daily movement the majority used an electric or manual wheelchair (39.6%). Women in the age category of 30-44 years had mostly finished higher education (48.0%), were single (56.0%), employed (44.0%) and for daily movement also used a wheelchair (60.0%). The older age category of women with PDs (45-59 years) mostly had a university level of education (54.1%), were married (54.2%), employed full-time (70.8%), and one third used a wheelchair (33.3%). All women with PDs in the oldest age category (60+ years) were pensioners or invalid pensioners (100%) and widows (57.1%), more than half of them had a higher education level (51.4%) and used other CTs (74.3%) for daily movement (Table 1).

Analysis of the mean point scores in QoLDs shows the highest satisfaction with the social relations domain in all groups of women with PDs, no matter what age category (Table 2). The mean point scores also show a high level of satisfaction with the domain physical health/IL for all four groups of women with PDs, coming in second place after the social relations domain. The results of the Wilcoxon Signed Rank test revealed the highest satisfaction with the social relations domain in the three older age categories of women with PDs (30-44, 45-59 and over 60), and in these women significant differences were found between the social relations domain (as the leading domain with regard to satisfaction) and the physical health/IL domain (as the second-placed domain), although this was not the case for the youngest women with PDs. Because there were no significant differences between the first two domains for the younger women, the results of the present study can confirm that 19-29 yr-old women with PDs are equally satisfied with the social relations and the physical health/ IL domains (Table 3).

On the other hand, the highest levels of dissatisfaction were reported for the psychological health/S and environment domains for all age groups of women with PDs (Table 2). More specifically, the youngest group of women (19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29) and women aged 45-59 expressed the highest dissatisfaction in their lives with regard to psychological health/S. The 3044 yr-old women and the oldest group (60+ years) showed the highest dissatisfaction with the environment domain, with the highest mean point scores among all the analysed QoLDs. However, the Wilcoxon Signed Rank test revealed different results. While the group of 19-29 yr-old women showed the highest dissatisfaction with psychological health/S, because there were significant differences (Z=-2.091, p=0.037) between this domain and the environment domain, the three older age groups all reported the highest dissatisfaction with both the psychological health/S and environment domains, although significant differences were not found between these two areas (Table 3).

The satisfaction with QoLDs among four age categories of women with PDs revealed significant differences in two domains, those of physical health/IL (Chi=9.91, p=0.019) and the environment (Chi=16.2, p=0.001) (Table 2). The highest satisfaction with the domain physical health/IL from among all the age categories of women with PDs was expressed by the youngest women (2.213±0.513 mean points). Similar results were found with regard to the differences in satisfaction with the environment domain, when the highest satisfaction with this was again expressed by the youngest women with PDs (2.370±0.490 mean points). With regard to the analyses of overall QoL, the results of the present study revealed significant differences among the four groups of women with PDs according to age (Chi=8.05, p=0.045) (Table 2). Specifically, the highest overall QoL was reported by the youngest group of women with PDs (2.350±0.429 mean points).

Application of the Mann Whitney U test did not reveal any significant differences in QoLDs’ satisfaction nor in overall QoL between the following two age groups of women with PDs: 30-44 versus 45-59, 30-44 versus 60+. and 4559. versus 60+. Moreover, the youngest women with PDs (19-29 yrs) reported significantly higher satisfaction with the physical health/IL and environment domains, as well as significantly higher overall QoL, compared to the three older groups (Table 4).

Measuring the quality of life of adults with disabilities is multi-dimensional and must go beyond health-related quality of life measurement tools (12). The objective of the present study was to identify any differences based on age in the subjective quality of life of women with physical disabilities, by measuring satisfaction with the WHO quality of life domains and an overall quality of life assessment. The highest satisfaction with the domain of social relations was found in the three older groups of women with PDs (30-44, 45-59 and over 60), while for the women aged 19-29 two domains had equal highest satisfaction, namely social relations and physical health/IL. On the other hand, the group of 19-29 yr-old women show the highest dissatisfaction with psychological health/S, while the three older groups expressed the highest dissatisfaction for two domains, psychological health/S and environment. In Tate et al. (6), women with traumatic conditions (amputation, spinal cord injury) reported significantly lower physical functioning and physical wellbeing compared with women with nontraumatic conditions (breast cancer and post-polio). Women with nontraumatic conditions, however, reported significantly lower levels of well-being with respect to their health status during the previous year compared with their traumatic condition counterparts (6). Our results partially correspond with the results of Nemček’s (13) study, when both groups of people with physical disabilities and deaf and hard of hearing people were the most satisfied with social relations in their lives, while the highest dissatisfaction was reported for the domain psychological health/spirituality (14). Women with disabilities experience the double impact of being female and disabled. As women, they have greater risks of psychosocial health problems than men, and compared to women in general those with disabilities report higher rates of depression and stress (15). One study found that feeling depressed or anxious and experiencing major depression in the past 12 months was a serious problem among younger women with more severe disabilities (16). At especially high risk are those women with physical disabilities who are limited by pain, lack of social support, and/or have experience with recent abuse (17). The highest levels of depression and anxiety were discovered for those women suffering back pain and the lowest for headache (18). Earlier authors thus recommend that stress management interventions for women with physical disabilities should consider incorporating components addressing pain, social support, and abuse (17). Other authors suggest that women with physical disabilities may also benefit from a self-esteem group intervention, which has been shown to provide significant improvements to psychological health by increasing self-esteem and self-efficacy, and decreasing depression (19).

In the present study no significant differences were found in S-QoL between the women aged 30-44and 45-59, 3044 and over 60, nor between those aged 45-59 and over 60. Young women with physical disabilities aged 19-29, as reported in Ladecká, Nemček and Harčaríková (20), had significantly lower levels of physical and psychological health compared to young men with physical disabilities in the same age category. On the other hand, a study that examined elderly people who were deaf and hard of hearing found significant differences between men and women in changes in the QoL domains of sensory abilities, social participation and intimacy, with women reporting significant improvements in these (21).

With advancing age the S-QoL is expected to decrease in all populations, based on the different health statuses (22, 23). However, the results of the present study did not confirm decreasing S-QoL along with rising age in women with PDs, although the highest overall QoL was reported by the youngest age category of women (19-29 yrs), while the three older age groups (30-44, 45-59 and over 60 yrs.) expressed similar levels of S-QoL. Ellert, Lampert and Ravens-Sieberer (24) found that with increasing age the quality of life for both men and women decreased in the physical dimensions, while increasing in the mental health ones. On the other hand, Brenes et al. (25) indicated that worse psychological health is associated with higher levels of disability, and that different effects are seen according to age. Older adults with any symptoms that negatively affect their psychological health tend to report higher levels of disability than younger adults. Harris et al. (26) reported significant gaps in service provision in the community, and stated that more work was needed on such issues to examine the short- and long-term effects on maturation and ageing, reproductive and sexual health, mental health and life satisfaction in girls and women with PDs. With regard to the results of the present study, S-QoL decreases in the physical dimension as age increases. Barker et al. (27) revealed that the poorer quality of life of people with PDs compared people without PDs is associated with secondary impairments, activity limitations and restrictions on participation in daily activities, but not with neurological level, age, or time since injury (27). For example, body weight control, as a part of the physical health as well as psychological health domains, is indeed a problem among women with disabilities in middle age, with 42% of women with three or more limitations being overweight (16). Hypertension increases substantially with age and severity of impairment, which may be related to the physical and emotional stress associated with living with a disability (16). The social relation domain in the present study remains relatively stable for all age groups of women with PDs, staying the most satisfying domain, while the psychological health/S domain stays as one of the least satisfying domains.

The findings of this study confirm that there are differences in S-QoL in some QoLDs as well as in an overall QoL among the four age groups of women with PDs. Significant differences were revealed between the youngest age women and the three older age group in terms of satisfaction with the domains of physical health/IL, environment and overall QoL. The women aged 19-29 showed significantly higher levels of satisfaction with the physical health/IL and environment domains and significantly higher levels of overall QoL compared to the older women. There were no significant differences found in S-QoL among the other three older age groups. The results further revealed the highest satisfaction in the three older age groups of women was with the social relations domain, while the 19-29 yr-old women were equally satisfied with the social relations and physical health/IL domains. For the youngest women the highest dissatisfaction was reported for the psychological health/S domain, while the three older groups where least satisfied with the psychological health/S and environment domains. However, the existing research on age-related differences in S-QoL in people with various kinds of disabilities is very limited. It is thus necessary to continue this line of research, and also to explore the ways in which psychological health increases as an integral part of S-QoL in women with PDs. It is also is necessary to focus on the QoL indicators that make up the environment domain and search for ways to enhance these and thus improve the lives of women with PDs.