Quality of Life Research

, Volume 23, Issue 5, pp 1593–1602 | Cite as

Quality of life and related factors: a questionnaire survey of older people living alone in Mainland China

  • Yu ChenEmail author
  • Allan Hicks
  • Alison E. While



There is a growing population of older people living alone within the context of dramatic population ageing and changing living arrangements. However, little is known about the quality of life (QoL) of older people living alone in Mainland China. This study aimed to investigate QoL and its related factors among Chinese older people who live alone.


A stratified random cluster sample of 521 community-dwelling older people living alone in Shanghai completed a structured questionnaire through face-to-face interviews. QoL was measured using the Older People’s Quality of Life Questionnaire. Other data collected included self-rated health, physical health, cognitive function, depression, functional ability, loneliness, social support, physical activity, health services satisfaction, satisfaction with overall dwelling conditions and socio-demographic variables.


Older people living alone in Mainland China rated social relationships and financial circumstances as sources of low satisfaction within their QoL. Multiway analysis of variance showed that satisfaction with overall dwelling conditions, self-rated health, functional ability, depression, economic level, social support, loneliness, previous occupation and health services satisfaction were independently related to QoL, accounting for 68.8 % of the variance. Depression and previous occupation had an interaction effect upon QoL.


This study identified nine factors influencing the QoL of older people living alone in Mainland China. Interventions to increase satisfaction with dwelling conditions, improve economic level, social support and functional ability, decrease loneliness and depression and improve health services satisfaction appear to be important for enhancing their QoL.


Quality of life Related factors Living alone Older people China 



The authors would like to thank Professor Yan Hu and Professor Hai-ou Xia for their translation of the OPQOL and Mr. Peter Milligan for his advice on statistical analysis. We thank data collectors for their assistance in data collection and the older people for their participating in this study. The authors would also like to thank China Scholarship Council, King’s College London and Fudan University for their financial support.


  1. 1.
    United Nations. (2009). World population ageing 2009. New York: United Nations.Google Scholar
  2. 2.
    United Nations. (2001). World population ageing: 1950–2050. New York: United Nations.Google Scholar
  3. 3.
    World Health Organization. (2008). WHO global report on falls prevention in older age. Geneva: World Health Organization.Google Scholar
  4. 4.
    Rolls, L., Seymour, J. E., Froggatt, K. A., & Hanratty, B. (2010). Older people living along at the end of life in the UK: Research and policy challenges. Palliative Medicine, 25(6), 650–657.PubMedCrossRefGoogle Scholar
  5. 5.
    Casey, B., & Yamada, A. (2002). Getting older, getting poorer? A study of the earnings, pensions, assets and living arrangements of older people in nine countries. OECD labour market and social policy occasional papers, no. 60, OECD Publishing. Accessed March 24, 2013.
  6. 6.
    Chou, K. L., & Chi, I. (2000). Comparison between elderly Chinese living alone and those living with others. Journal of Gerontological Social Work, 33(4), 51–66.CrossRefGoogle Scholar
  7. 7.
    Lee, J. J. (2005). An exploratory study on the quality of life of older Chinese people living alone in Hong Kong. Social Indicators Research, 71(1–3), 335–361.Google Scholar
  8. 8.
    Lin, P. C., Yen, M. F., & Fetzer, S. J. (2008). Quality of life in elders living alone in Taiwan. Journal of Clinical Nursing, 17(12), 1610–1617.PubMedCrossRefGoogle Scholar
  9. 9.
    World Health Organization. (1977). Prevention of mental disorders in the elderly. Copenhagen: World Health Organization.Google Scholar
  10. 10.
    Bowling, A. (2009). The psychometric properties of the Older People’s Quality of Life Questionnaire, compared with CASP-19 and the WHOQOL-OLD. Current Gerontology and Geriatrics Research. doi: 10.1155/2009/298950.PubMedCentralPubMedGoogle Scholar
  11. 11.
    World Health Organization. (2002). Active ageing. A policy framework. Geneva: World Health Organization.Google Scholar
  12. 12.
    Yahaya, N., Abdullah, S. S., Momtaz, Y. A., & Hamid, T. A. (2010). Quality of life of older Malaysians living alone. Educational Gerontology, 36(10–11), 893–906.CrossRefGoogle Scholar
  13. 13.
    Bilotta, C., Bowling, A., Nicolini, P., Case, A., & Vergani, C. (2012). Quality of life in older outpatients living alone in the community in Italy. Health and Social Care in the Community, 20(1), 32–41.PubMedCrossRefGoogle Scholar
  14. 14.
    The WHOQOL Group. (1995). The World Health Organization quality of life assessment (WHOQOL): Position paper from the World Health Organization. Social Science and Medicine, 41(10), 1403–1409.CrossRefGoogle Scholar
  15. 15.
    Chen, Z. L., & Chen, X. B. (2006). Discussion on situation of the ageing in Shanghai and its countermeasures. Chinese Health Service Management, 22(11), 671–673.Google Scholar
  16. 16.
    Zhang, L. (2010). Shanghai coming to grip with its aging population problems. EAI background brief, no. 517. Accessed August 30, 2013.
  17. 17.
    Gerontological Society of Shanghai. (2011). 2010 Shanghai monitored statistical information on population of the elderly & development of old age program. Accessed August 30, 2013.
  18. 18.
    National Bureau of Statistics of China. (2011). Major figures of the sixth national population census. Accessed August 30, 2013.
  19. 19.
    Newton, R. R., & Rudestam, K. E. (1999). Your statistical consultant: Answers to your data analysis questions. California: Sage.Google Scholar
  20. 20.
    Pfeiffer, E. (1975). A Short Portable Mental Status Questionnaire for the assessment of organic brain deficit in elderly patients. Journal of American Geriatric Society, 23(10), 433–441.Google Scholar
  21. 21.
    Chen, Y., Hicks, A., & While, A. E. (2013). Validity and reliability of the modified Chinese version of the Older People’s Quality of Life Questionnaire (OPQOL) in older people living alone in China. International Journal of Older People Nursing. doi: 10.1111/opn.12042.
  22. 22.
    Chen, Y., Hicks, A., & While, A. E. (2013). Quality of life of older people in China: A systematic review. Reviews in Clinical Gerontology, 23(1), 88–100.CrossRefGoogle Scholar
  23. 23.
    Sheikh, J. L., & Yesavage, J. A. (1986). Geriatric Depression Scale (GDS): Recent evidence and development of a shorter version. Clinical Gerontologist, 5(1–2), 165–173.Google Scholar
  24. 24.
    Boey, K. W. (2000). The use of GDS-15 among the older adults in Beijing. Clinical Gerontologist, 21(2), 49–60.CrossRefGoogle Scholar
  25. 25.
    Lawton, M. P., & Brody, E. M. (1969). Assessment of older people: Self-maintaining and instrumental activities of daily living. The Gerontologist, 9(3), 179–186.PubMedCrossRefGoogle Scholar
  26. 26.
    Russell, D. W. (1996). UCLA Loneliness Scale (version 3): Reliability, validity, and factor structure. Journal of Personality Assessment, 66(1), 20–40.PubMedCrossRefGoogle Scholar
  27. 27.
    Xiao, S. Y. (1999). The Social Support Rate Scale. In X. D. Ma, X. L. Wang, & H. Ma (Eds.), The handbook of Mental Health Rating Scales (pp. 127–131). Beijing: Chinese Mental Health Journal Press.Google Scholar
  28. 28.
    Haskell, W. L., Lee, I. M., Pate, R. R., Powell, K. E., Blair, S. N., Franklin, B. A., et al. (2007). Physical activity and public health: Updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Medicine and Science in Sports and Exercise, 39(8), 1423–1434.PubMedCrossRefGoogle Scholar
  29. 29.
    Polit, D. F., & Beck, C. T. (2012). Nursing research: Generating and assessing evidence for nursing practice (9th ed.). Philadelphia: Lippincott Williams & Wilkins.Google Scholar
  30. 30.
    Tabachnick, B. G., & Fidell, L. S. (2001). Using multivariate statistics (4th ed.). New York: Allyn and Bacon.Google Scholar
  31. 31.
    Zhong, R. Y. (2004). An analysis of the living condition of the elders living alone in Shanghai and the policy related. Journal of Social Science, 8, 66–70.Google Scholar
  32. 32.
    Tong, H. M., Lai, D. W. L., Zeng, Q., & Xu, W. Y. (2011). Effects of social exclusion on depressive symptoms: Elderly Chinese living alone in Shanghai. China. Journal of Cross-Cultural Gerontology, 26(4), 349–364.CrossRefGoogle Scholar
  33. 33.
    Phillips, D. R., Siu, O. L., Yeh, A. G. O., & Cheng, K. H. C. (2005). The impacts of dwelling conditions on older persons’ psychological well-being in Hong Kong: The mediating role of residential satisfaction. Social Science and Medicine, 60(12), 2785–2797.PubMedCrossRefGoogle Scholar
  34. 34.
    Michalos, A. C., Zumbo, B. D., & Hubley, A. (2000). Health and the quality of life. Social Indicators Research, 51(3), 245–286.CrossRefGoogle Scholar
  35. 35.
    Lee, T. W., Ko, I. S., & Lee, K. J. (2006). Health promotion behaviors and quality of life among community-dwelling elderly in Korea: A cross-sectional survey. International Journal of Nursing Studies, 43(3), 293–300.PubMedCrossRefGoogle Scholar
  36. 36.
    Zhang, J. P., Huang, H. S., Ye, M., & Zeng, H. (2008). Factors influencing the subjective well being (SWB) in a sample of older adults in an economically depressed area of China. Archives of Gerontology and Geriatrics, 46(3), 335–347.PubMedCrossRefGoogle Scholar
  37. 37.
    Paskulin, L., Vianna, L., & Molzahn, A. E. (2009). Factors associated with quality of life of Brazilian older adults. International Nursing Review, 56(1), 109–115.PubMedCrossRefGoogle Scholar
  38. 38.
    Jia, S. M., Feng, Z. Y., Hu, Y., & Wang, J. Q. (2004). Survey of the living quality and its effect factors for the aged people in urban community of Shanghai city. Journal of Nurses Training, 19(5), 420–423.Google Scholar
  39. 39.
    Zhou, B., Chen, K., Wang, J. F., Wang, H., Zhang, S. S., & Zheng, W. J. (2011). Quality of life and related factors in the older rural and urban Chinese populations in Zhejiang Province. Journal of Applied Gerontology, 30(2), 199–225.CrossRefGoogle Scholar
  40. 40.
    Cai, T. J. (2004). Self-rated life satisfaction and its determinants among Chinese elderly females living alone. Chinese Journal of Population Science, S1, 70–74.Google Scholar
  41. 41.
    Deng, J. L., Hu, J. M., Wu, W. L., Dong, B. R., & Wu, H. M. (2010). Subjective well-being, social support, and age-related functioning among the very old in China. International Journal of Geriatric Psychiatry, 25(7), 697–703.PubMedCrossRefGoogle Scholar
  42. 42.
    Huang, J. Q., Chen, Q. E., & Shu, X. F. (2005). A study on the relationship between quality of life and social support of elder in community. Chinese Journal of Behavioral Medicine Science, 14(8), 725–726.Google Scholar
  43. 43.
    Xiao, S. Y. (1994). The theoretical basis and applications of Social Support Rate Scale. Journal of Clinical Psychiatry, 4(2), 98–100.Google Scholar
  44. 44.
    Fratiglioni, L., Wang, H. X., Ericsson, K., Maytan, M., & Winblad, B. (2000). Influence of social network on occurrence of dementia: A community-based longitudinal study. The Lancet, 355(9212), 1315–1319.CrossRefGoogle Scholar
  45. 45.
    Lauder, W., Sharkey, S., & Mummery, K. (2004). A community survey of loneliness. Journal of Advanced Nursing, 46(1), 88–94.PubMedCrossRefGoogle Scholar
  46. 46.
    Victor, C., Scambler, S., Bond, J., & Bowling, A. (2000). Being alone in later life: Loneliness, social isolation and living alone. Reviews in Clinical Gerontology, 10(4), 407–417.CrossRefGoogle Scholar
  47. 47.
    Ruggeri, M., Nose, M., Bonetto, C., Cristofalo, D., Lasalvia, A., Salvi, G., et al. (2005). Changes and predictors of change in objective and subjective quality of life: Multiwave follow-up study in community psychiatric practice. The British Journal of Psychiatry, 187, 121–130.PubMedCrossRefGoogle Scholar
  48. 48.
    Joseph, C., & Nichols, S. (2007). Patient satisfaction and quality of life among persons attending chronic disease clinics in South Trinidad, West Indies. The West Indian Medical Journal, 56(2), 108–114.PubMedCrossRefGoogle Scholar
  49. 49.
    Brett, C. E., Gow, A. J., Corley, J., Pattie, A., Starr, J. M., & Deary, I. J. (2012). Psychosocial factors and health as determinants of quality of life in community-dwelling older adults. Quality of Life Research, 21(3), 505–516.PubMedCrossRefGoogle Scholar
  50. 50.
    Chachamovich, E., Fleck, M., Laidlaw, K., & Power, M. (2008). Impact of major depression and subsyndromal symptoms on quality of life and attitudes towards aging in an international sample of older adults. The Gerontologist, 48(5), 593–602.PubMedCrossRefGoogle Scholar
  51. 51.
    Chou, K. L., & Chi, I. (1999). Determinants of life satisfaction in Hong Kong Chinese elderly: A longitudinal study. Aging & Mental Health, 3(4), 328–335.CrossRefGoogle Scholar
  52. 52.
    Chen, Y., Hicks, A., & While, A. E. (2012). Depression and related factors in older people in China: A systematic review. Reviews in Clinical Gerontology, 22(1), 52–67.CrossRefGoogle Scholar
  53. 53.
    Ning, H. D., Luo, C. S., Zhang, Q. X., Zhu, Y. H., Wu, S. Y., Liang, H. Y., et al. (1999). An epidemiological study on quality of life among elderly population in Shenzhen. Chinese Journal of Prevention and Control of Chronic Non-communicable Diseases, 7(4), 1–5.Google Scholar
  54. 54.
    Qian, Z. C., & Zhou, M. (2004). Social support and quality of life: China’s oldest-old. Accessed September 13, 2012.

Copyright information

© Springer Science+Business Media Dordrecht 2013

Authors and Affiliations

  1. 1.Fudan UniversityShanghaiP.R.China
  2. 2.King’s CollegeLondonUnited Kingdom

Personalised recommendations