Health-related restrictions of choices and choosing: implications for quality of life and clinical interventions.
BACKGROUND
The process of "accessing choices and choosing among them" (c-c) has been proposed as a model for understanding, evaluating, and assisting a patient's management of quality of life. If desired choices are freely accessible, and the act of choosing is efficient and unconstrained, then the outcome is optimized quality of life. The c-c model fits many clinical situations where improved quality of life is a goal, and interventions may be aimed at relieving health-related restrictions of the patient's desired activities.


OBJECTIVE
To determine the impact of health restrictions of choices and choosing on indicators and outcomes reflecting quality of life.


METHODS
Secondary analysis of a community-based health survey of three ethnic groups, 65 years and older (n = 2,130), repeated after 18 months, with mortality over 6 years.


RESULTS
Complaints of health restrictions of desired activities accounted for about half the variance of all determinants of a quality of life proxy indicator, and had a high frequency. Such complaints also predicted declines in mood and function, higher death rates, and increased service use.


CONCLUSIONS
Clinical trials are warranted of the efficacy for quality of life improvement of interventions that focus on the relief of health-induced restrictions of desired activities.
Columbia University Department of Psychiatry, Stroud Center for Study of Quality of Life, New York, NY, USA;
Barry J
BJ
Gurland
Huai
H
Cheng
Mathew S
MS
Maurer