What Is Quality of Life, Anyway?
Quality of life (QOL): You may have seen this term or heard your doctor use it during your visits, especially when making recommendations for your treatment. But just what is quality of life—what does it really mean for your health and happiness, and how do you measure it?
What Determines Quality of Life?
It turns out, quality of life isn’t that easy to define, says Dana Simpler, M.D., a board-certified internist with Mercy Medical Center in Baltimore. Even the Centers for Disease Control and Prevention (CDC) says QOL is pretty subjective.
Benjamin Bring, D.O., a board-certified family medicine physician at OhioHealth’s Dublin Methodist Hospital, says QOL can be different for everyone, depending on where they live and what’s important in their particular culture.
QOL, in simplistic terms, can be viewed as how happy you are with your life as a whole, which includes your health, job, family, and relationships.
“[QOL considers] all aspects related to the positives and negatives of a person’s life,” Bring says. These aspects could include:
- The status of your current health
- Whether you have any chronic conditions, such as hypertension, diabetes, MS, arthritis, or psoriasis
- Your access to safe and stable housing
- Where you live, and with whom
- What you do for work
- What you eat and your access to affordable, nutritious food
- How connected you are with your culture, values, and/or spirituality
Any of these factors can support or interfere with your ability to do the activities you want or need to do, which can affect how you feel about your quality of life.
For example, people with chronic diseases and people in the LGBTQ community tend to have lower QOL than others. While the reasons aren’t fully understood yet, researchers suggest this may be because of certain factors (such as the financial strains of treating a chronic disease, or experiences of discrimination, respectively) that can affect well‑being.
What Is Health-Related Quality of Life (HRQOL)?
In the 1980s, the term “health-related quality of life,” or “HRQOL,” was born. People often use the terms “QOL” and “HRQOL” interchangeably. However, according to the CDC, health-related quality of life specifically refers to the aspects of overall quality of life that can affect a person’s physical and mental health.
A healthy diet, regular exercise, and good sleep are all important contributors to a good health-related quality of life, which is why you should talk to your doctors about these issues and their impact on your HRQOL whenever you see them, Bring says.
Doctors may use questionnaires to help them evaluate your HRQOL, as well. Some questions they may ask include “Does your health limit you in activities such as carrying groceries, climbing several flights of stairs, or walking more than a mile?” or “How often during the past four weeks has your physical health or emotional problems interfered with your social activities, such as visiting with friends or relatives?”
Throughout the COVID-19 pandemic, HRQOL has become a big issue, Bring says. “We saw a dramatic increase in individuals suffering from depression and anxiety, which adversely affects their mental health,” he says. “Sometimes, when mental health isn’t optimized, it can also affect your physical health.”
For instance, when people are depressed or anxious, they may not eat right, exercise regularly, or get adequate restful sleep—all things that can lower your HRQOL, Bring says. Furthermore, the way some people deal with stress, such as by turning to alcohol, smoking, or drugs, can further lower HRQOL.
Making Health Decisions Related to QOL
Quality of life should be part of the equation in any treatment decision. When discussing possible treatments for a chronic condition, ask your doctors about how the treatment they’re recommending could affect your QOL, Simpler says.
For example, your doctor may recommend a medication that could decrease symptoms such as pain or impaired mobility—which would generally increase QOL. But what if that drug carried with it side effects, like constant nausea, that could decrease QOL?
You should consider possible side effects of any treatment and how those side effects could affect your daily activities and the goals you set for yourself. You and your doctor can weigh the benefits and the drawbacks to your daily living.
Ideally, treatment for a chronic condition should decrease symptoms without causing any side effects, but sometimes treatment is limited and a compromise is needed. That’s why knowing your personal goals for QOL is important to help with making treatment decisions.
How to Improve Your QOL
Simpler says there are “pillars of health” within your control that can help you improve your quality of life and overall sense of well‑being. She and Bring recommend the following approaches.
Aim to Get the Best Sleep You Can
“Many people have disturbed sleep for many reasons,” Simpler says. “You need to make sure you have good sleep hygiene.” Try these tips for getting quality sleep:
- Give yourself quiet relaxation time before going to sleep. “Don’t go directly from the treadmill to the bed,” Simpler says. Plan for some wind-down time first. Taking a warm bath or engaging in relaxation exercises might help. In general, it’s better to exercise in the morning rather than around bedtime because all the adrenaline you get with exercise may make it difficult for you to fall asleep.
- Set the scene for better sleep. Use your bed only for sleeping and sex. Keep your bedroom cool, quiet, and dark. Try to avoid anything with a screen within 30 minutes of falling asleep.
- Skip the late-day naps. Napping generally doesn’t interfere with nighttime sleep as long as you nap before 2 p.m. and limit it to no more than 30 minutes.
- Watch what you eat and drink. Avoid caffeine later in the day, or about six hours before bedtime, as caffeine can take hours to wear off. Alcohol may make you sleepy at first, but also it can disrupt your sleep as the hours pass, waking you up throughout the night. And a heavy meal close to bedtime can make you uncomfortable and lose sleep.
“Anytime you’re stressed, it’s going to aggravate a medical condition,” Simpler says. “Stress suppresses your immune system and makes it harder for your body to heal and repair itself.” To manage stress, try these tips:
- Resolve worries before you hop into bed. If you wake up in the middle of the night, it may help to write down your worries or stressors. Write down what’s weighing on your mind and then set those thoughts aside until morning.
- Get organized. Set priorities and learn to say no. “Try not to take on more than you can handle,” Simpler says. “We all have constraints regarding what we can and can’t do.”
- Seek counseling. “If you have trauma in your life that’s never been resolved, speaking to a professional can help,” Simpler says.
- Try relaxation techniques. Some find that strategies such as meditation, deep breathing, or other similar mindfulness exercises work well for them, Simpler says.
Eat Healthy Food
In general, a healthy diet includes fresh fruits and vegetables, lean meats and poultry, fish, low-fat dairy, healthy fats, nuts, seeds, and whole grains. “Try to increase whole foods in your diet while decreasing processed foods, junk foods, and fast foods,” Bring says.
Be careful to also avoid fad diets like juicing or diets that completely eliminate a certain food, because these can lead to nutritional deficiencies. If you have questions about what diet is right for you, or want to make changes to your diet, talk to your doctor.
Any type of regular movement that you enjoy can help improve your quality of life. Combining cardiovascular exercise and resistance training is ideal, Bring says. If you have a chronic condition that limits your mobility or ability to exercise, talk to your doctor or a physical therapist about modifications you can make so that you’re able to reap the benefits of exercise. For example, swimming may be a good form of exercise for those with arthritis.
Aim to do moderate exercise five to six days a week, Bring says. Consider getting a gym membership, taking a yoga class, or setting up regular walking dates with a friend.
Team Up with Your Doctors
Doctors can guide you as you work to achieve your personal health goals and improve your quality of life with a chronic disease. If you work with your doctors to slow down the progression of your chronic condition, your QOL will improve, Bring says.
And while your health is a significant factor in your quality of life, it's generally not the only one. Pay attention to other aspects of your life—like having meaningful relationships, a job you like, and low stress levels—to help improve your overall well‑being and satisfaction with your life.
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