What exactly is Quality of Life? Because we live in an aging

What exactly is Quality of Life?

Because we live in an aging culture that has a high life expectancy, quality of life (QOL) has become an increasingly important component of healthy aging. Indeed, some individuals consider that improving QOL is more essential than increasing years of life (8). Scientists who are interested in studying quality of life encounter a significant difficulty when seeking to define QOL. This difficulty arises from the fact that quality of life belongs to a very broad research field that encompasses a wide set of constructs that cover a extensive range of domains including physical health, mental health, social relations and environmental dimension (9).

In attempt to give a framework in which the term quality of life can be understood and manipulated many scientists have presented their own definitions of quality of life (QOL). In the year 1983 Lawton et al. provided a definition of quality of life that was all-encompassing, precise, and surprisingly relevant to the modern world; however, it was too general (25). He referred to it as the “good life” and described the components that it included: “behavior competence, psychological well-being, perceived quality of life, and [the] objective environment” (25). Lately a more specific definition than Lawton’s was provided by Katschnig et al., he declared that quality of life is “a loosely related body of work on psychological well-being, social and emotional functioning, health status, functional performance, life satisfaction, social support, and standard of living, whereby normative, objective, and subjective indicators of physical, social and emotional functioning are all used” (26). In the past days till know there were a big range of prominent and worldwide acknowledged scientist and researcher groups researcher groups around them who tried to provide a definition for the term quality of life. As a bright verity of QOL definition was proposed by different researcher teams the World Health Organization (WHO), in an effort to supply researchers with a comprehensive understanding of what quality of life (QOL) is, reported that “Quality of life is the individual’s perception of their position in life in the context of culture and value systems in which they live and in relation to their goals, expectations, standards, and concerns” (27). However, it does not explain how so many different factors that are mentioned within the definition of quality of life relate to each other in order to form a framework in which the term quality of life can be understood and manipulated. As shown by the numerous definitions presented above, the field does not have a QOL definition that is accepted universally.

As a result scientists, who are conducting study on quality of life need to keep in mind that QOL is a multidimensional construct, and that the particular domain, that is being investigated can change based on the instrument that is being used to evaluate it as well as the population that is being studied (9)(10). Quality of life discussion has tremendous practical implications, so it is necessary to deal with the difficulties of defining this multifarious construct (10). The way we define quality of life affects the way we govern, educate, treat and parent, because all of these efforts seek to improve people’s lives (9)(11). In the past decade, Lord Kelvin said that “What is not defined cannot be measured. What is not measured cannot be improved. What is not improved is always degraded” (24). Few features of the QOL definition have been agreed upon so far. All academics believe that the definition of quality of life (QOL) should incorporate both multidimensionality as well as subjectivity (8).

As the quality of life (QOL) is composed of several dimensions, various measurement methods are available. One of the measurement methods, the WHOQOL-BREF, encompasses social,functional or environmental, psychological, and physical aspects of a person’s opinion of their quality of life, all of which are influenced by their health state.

Physical Health

The physical health domain in WHOQOL-BREF primarily focuses on individuals’ physical activity, among other physical health-related factors like the individual’s dependence on medical aids and substances, their mobility, if they are in discomfort due to pain or any other health issue, their sleep and rest schedules and the work capacity that they take up (48). Physical activity is a majorly significant factor affecting physical health since it increases one’s duration of living and helps people have better lives. Activities of daily living (AODs) improve one’s life by reducing the risk of numerous diseases like hypertension and diabetes by strengthening the heart and muscles (50). The activities also improve emotional and mental functioning and boost one’s relationships with others. The release of stress-relieving and mood-enhancing hormones is prompted by aerobic exercise, promoting a feeling of well-being and alleviating stress (50). In addition, the repetitive muscular contractions that take place in almost all forms of physical activity have been shown to raise levels of the feel-good chemical serotonin in the brain, which helps fight off unfavorable emotions (50). Aerobic exercise, of any intensity from moderate to extreme, is beneficial to both performance and libido. Blood flow to the brain is increased by physical activity, which may assist in preserving brain function (49). In addition, it encourages healthy lung function, a trait shared by individuals whose memory and mental sharpness stay intact as they age. Assessment of the physical health of individuals is therefore crucial as it proves vital to all aspects of a human being’s life.

Psychological Health

The psychological state of an individual is used in measuring their quality of life since the psychological aspect of an individual affects how they act, feel, and think. Psychological health also assists in determining how people make choices, handle stress, and relate to others (51). Psychological well-being is essential to everyone’s life, from childhood to adulthood and adolescence. Factors that the WHOQOL-BREF looks at while assessing one’s psychological health include one’s bodily image of themselves, negative and positive attitudes and feelings, self-esteem, personal beliefs like religion and spirituality, and cognitive abilities like concentration, memory, thinking, and learning (49). Bodily appearance and image: If one’s bodily image of themselves is negative, they may acquire eating disorders, anxiety, depression, or even body dysmorphia (49). Negative attitudes and emotions of despair and helplessness may generate chronic stress, which can harm the immune system, disturb the bodily hormonal balance, and deplete the brain chemicals necessary for happiness. Chronic stress can also weaken the body’s ability to heal from illness. On the other side, having positive sentiments and attitudes may help a person become more resilient since they provide the individual with the emotional resources necessary for coping (51). People with a poor sense of self-esteem are more likely to suffer from depressive symptoms, making self-esteem an essential component of psychological health. Inadequate levels of self-esteem have been linked to suicidal ideation in teenagers, in addition to despair and anxiety. Individuals’ belief systems, such as their religion or spirituality, impact how they think and feel about other people, as well as themselves, their lives, and the world in which they live. The beliefs determine the sort of individuals one aspires to be and the kind of life one hopes to lead. Cognitive deficiencies are symptoms of several ailments that influence mental health, including affective disorders like depression and bipolar disorder and psychological problems like schizophrenia (49). When determining a person’s quality of life, it therefore is crucial to include their cognitive ability and other elements of their psychological condition.

Social Relationships

Health habits, physical health, mental health, and mortality risk are all influenced by social ties. Social relationships also impact the mental health of an individual. Thus, the WHOQOL-BREF takes the individuals’ social relationships as an important aspect of their quality of life. Factors that are examined since they affect an individual’s social relationships include their social support, sexual activity, and personal relationships. Sexual activity releases oxytocin within the brain, an essential hormone in building trust and social bonding; therefore, people who are more sexually active tend to have better-rooted social relationships. Social support and personal relationships are vital in lowering an individual’s distress and cardiovascular risks like hypertension and diabetes (50). Social support systems and personal relationships also assist in maintaining an excellent life-long mental state among individuals.

Environmental Factors

Lastly, the WHOQOL-BREF assesses Individuals’ environmental aspects to obtain a better insight into the workings of the person’s life so that the individual’s quality of life can be better assessed. The WHOQOR-BREF considers these factors by asking the individual to comment on their financial well-being and resources since they indicate one’s way of life, the person’s physical safety, security and freedom, home environment, the opportunities that the individual has to obtain new skills and information, the individual’s participation in recreational opportunities and leisure activities, the environmental challenges that the individual faces and their transport systems and capabilities (48). The individual’s environment directly affects their healthcare access, health status, and risks they may be prone to. Therefore, one must look into one’s functional environment in assessing QOL (52).

Impact of COVID 19 on Quality of Life

The COVID-19 pandemic has brought a wide range of issues, some of which are not directly connected to the virus, but are instead caused by the lockdown measures, that have been implemented globally. Even though the lockdown might be required in order to keep the virus under control, its effects, which range from physiological to mental, as well as its impact on social relations and the environment of the people, have not been observed deeply (55). Some studies have reported about negative impacts of lockdown measures at almost all four basic quality of life dimensions and their facets (Figure 1.) (53)(54).

Sleep issues, sadness, and worry psychologically affect 3–4 out of every 10 COVID 19 survivors. COVID-19 had a large effect on engaging in physical exercise as well (53). Both ill and healthy people were aware of the decline in physical activity as the epidemic spread. Assume that the epidemic restricted people’s ability to participate in sports. In such a situation, it is clear that the inability to access training facilities and the anxiety associated with exercising outside influenced QOL (52). The observed reduction in athletic activities was substantially attributed to the closure of fitness centers and the end of club activities. Changes in work habits and routines brought on by the lockdown greatly impacted employment status and job performance. In addition, the economic downturn drove numerous businesses, eateries, and recreation areas to adjust and reduce their workforces, often to the point where workers were only partly compensated for their jobs or even let off (52). Empirical studies find, that the impact of this crisis on the economies of the world will most likely continue to be felt for several years after it has passed. The current crisis has had among other things enormous damaging effects at the economic systems in the world. 

While no segment of the population will stay unaffected by the COVID-19 pandemic, the elderly are likely to bear the burden of the consequences. According to the early data, approximately 70 percent of deaths caused by COVID-19 occur in people who are 65 years old or older (55). Whether a person is young and healthy or old and fragile, COVID 19 negatively impacts QOL and continues to do so.

Long-term care facility

Nursing Home

The decision to move an elderly person from their previous residence into a facility, that provides long-term care, can be motivated by a number of different factors (15). The major causes for making such a choice are typically deteriorating health, the inability to care for oneself, the passing of a spouse or a member of the family, or a combination of these circumstances (16). The term long-term care facility refers to a broad category, that includes many different types of establishments (12)(8). Nursing homes are perhaps the most well-known type, but there are also other types like: assisted living facilities and alternative types of nursing homes(16)(17).

People who are elderly and sometimes also disabled have the option of residing in nursing homes as a form of housing (16)(11). During the Middle Ages, these kinds of housing options developed from poor houses, which were establishments that offered both food and a place to sleep to people who were unable to care for themselves and who lacked a source of income (20)(12). They were run either by religious institutions or by nonprofit organizations (17).

In the 20th century, there was a growing awareness that people living in these types of housing facilities require more than just a place to eat and a roof over their heads (14). Residential facilities for the elderly began to offer assistance in daily living activities. During the same time period, it became clear that there was a need for specialized medical and nursing services (20). As a consequence of the occurrence of this trend, countries started passing laws to guarantee the care of elderly people (12). As a result, nursing homes can be understood as residential facilities that offer both personal care and nursing care to their residents (12)(17). 

However, some countries differentiate such facilities based on the level of care they aim to provide. In the United Kingdome, for instance, there is a distinction between care homes (personal) and care homes (nursing )(16). The primary types of care that are provided by care homes (personal) are personal care and social.   The majority of the staff consists of people who provide care assistance (20). Care in the fields of medicine and nursing is only provided up to a certain point, beyond which patients must ask help from external district nurses or general practitioners. Residents who need more intensive nursing care must consider relocating to care homes (nursing) where nurse practitioners are on duty around-the-clock (17). In Holland, a comparable distinction exists. Residential care homes are typically reserved for elderly patients with less severe conditions. Nursing homes provide accommodations for people who are physically or mentally disabled and require ongoing medical care and monitoring (17). In some countries, such as Germany, there is no distinction between personal care homes and nursing care homes. Instead, all types of residents, including those who would be treated differently in the United Kingdom or Holland, are included in facilities that are collectively referred to as nursing homes (17).

Assisted Living

It would not be accurate to talk about long-term care facilities without also discussing the possible options to nursing homes that have become available in certain countries since the late ‘80s (17). Assisted living is probably the most well-known possible option. It emerged as a reaction to growing criticism of nursing homes that had an emphasis on medical care and were organized similar to hospitals (16)(17). This type of nursing home was criticized for having a hospital-like environment. They were accused of having strict rules for the residents and taking away their privacy, freedom, and individual way of life. In contrast the goal of assisted living facilities is to provide residents with as much autonomy and privacy as possible within a setting that feels like home(17)

Alternatives to Nursing Home

Not only did the criticism of nursing homes lead to the rise of assisted living, which did not follow the same rules as nursing homes, but it also led to a lot of other changes (21). People also tried to change the culture of the nursing home from the inside (23). The greatest example is The Eden AlternativeTM, which was made by an American geriatrician named Dr. Bill Thomas. He redesigned a nursing home to make it feel more like a home (20). The Eden design included bringing plants, animals, and children into the nursing home to keep the residents from being bored or lonely and to help them have a “life worth living” (21). Caring became more important than getting medical treatment. The residents were in charge of making decisions, and by interacting with plants, animals, and children, they should be able to give care and also get it (23).

Nursing Homes in the course of COVID-19 pandemic

Short overview on COVID-19 cases in selected Europena Union countries

Various SARS-CoV-2 outbreaks have been documented in nursing home facilities across the globe since the start of the ongoing pandemic.. These outbreaks have affected both the residents and the care employees at the facilities (28).

In nursing home facilities across the United States of America, it was estimated that COVID-19 was responsible for 35,000 deaths that were documented, a statistic that is equivalent to 42% of the total number of deaths caused by the novel coronavirus (28)(31). As for January 2022 similar information on the percentage of COVID-19 deaths that occurred in nursing homes in comparison to the total number of SARS-CoV-2 deaths was also recorded in a variety of countries in Europe, including Austria (44 %), Belgium (50.8 %), Germany (29%), the Netherlands (52%) and France (42%) (Table 1) (42). In order to more effectively manage the COVID-19 pandemic as well as any other epidemics that may occur in the future, it is essential to detect and address any potential inefficiencies that may be related to nursing home practices (37)(32).

Nursing Home residents as most-at-risk group

Since the beginning of the pandemic, experts have advised that the elderly population should be protected from the virus. This is because the elderly population has a greater chance of having a more intense form of the disease, which might further contribute to an increase in mortality rate (31). According to the findings of several studies, an age greater than 65 years was related with a substantially increased risk of serious and critical symptoms, disease progression, and death; more specifically, males were much more likely to be at risk for adverse health outcomes (28)(33)(38).

It has been shown that number of risk factors such as diabetes mellitus Type II, cardiovascular disease, chronic pulmonary disease, cerebrovascular disease, dementia, and malignant disease independently increase the risk of poor COVID-19 evolution and death (Figure 2.) (38)(34). Since most people who live in a nursing home have more than one comorbidity, it is likely that a SARS-CoV-2 infection would have serious effects (37). Consequently, it is of the greatest priority to create a strategy that would prevent people in this population group from being infected with COVID-19(35).

Another possible reason for the high infection rate in nursing homes is that the people who live there often have disability, which can make it hard for them to do things like wash their hands well or wearing a mask (30). One study that looked at the degree of disability among nursing home residents with diabetes discovered that the average number of underlying comorbidities was 3, with dementia, hypertension and ischemic heart disease being the most common (31). About half of the residents (62%) were unable to feed themselves, 51% had speaking difficulty, and 89% needed at least a wheeled walking frame or the assistance of one caregiver to walk (33). Because of this, it is anticipated that the prolonged duration of the physical contact between these residents and the facility staff will increase the risk of infection for both. According to previous epidemic studies (e.g. Middle East respiratory syndrome coronavirus in 2012), nursing homes have a high rate of outbreaks due to the large numbers of residents who share the same supplies of water, meals, air, and accommodations (28)(29). In addition, this problem was further aggravated by the fact that only a small staff of caretakers were responsible for a large number of residents(28).

It is possible that the number of outbreaks that occur in nursing homes could be reduced, as could their severity, if protocols were established and put into place that would address these issues. In addition, training programs should be organized for all care workers.

Nursing Homes and the European Center for Disease Prevention and Control

Throughout the COVID-19 pandemic, residents of care homes realized that they were not just the most vulnerable group but perhaps the individuals with the lowest protection. In the event of natural catastrophes inside nursing home facilities, one of the factors that contributed to the shocking findings all over the world, was indeed a limited availability of official rules and standards (40).   At a later time after the global COVID-19 outbreak, some of institutional organs responsible for issuing such guidelines released a list of instructions for this specific reason.

 The European Center for Disease Prevention and Control (ECDC) is the organization in charge for establishing these kind of rules throughout the European Union . After the first wave of the novel coronavirus was over the ECDC issued a research report regarding the surveillance of SARS-CoV-2 in nursing home facilities (39). The report describes the primary concerns that need to be addressed in nursing homes in order to prevent some more decline in estimation of the disease risk that is placed on these facilities. One of the main reasons for a high COVID-19 outbreak rate inside nursing home facilities was staff members working even though they were infectious (41). Poorly trained staff, working in multiple facilities and  lack of safety devices as well as limited testing ( done only on symptomatic individuals ) were some of the other factors that contributed to the spread of the disease (39).

The European Center for Disease Prevention and Control recommended the establishment of a screening system for all people living in nursing home facilities. The screening system involves the regular assessment of the novel coronavirus symptoms as well as periodic testing programs. The recommendation applies also for the stuff members who are responsible for the care of the residents. When a confirmed COVID-19 case is detected, infection control procedures should be activated as soon as possible (40). Every care facility should gather institution-based data, preferably with the help of a comprehensive electronic system that tracks and keeps a record of the health conditions of both residents and staff. Updates to the responsible health authorities is crucial; therefore, daily data reports should be made to the municipal, regional, state – wide, and European Union designated institutional organs (39). The European Center for Disease Prevention and Control also emphasized the significance of taking preventative measures, such as wearing a face mask, isolation of infected people, and also more attention should be paid to hygiene recommendations (39).

Method and materials

Study design and sample

A descriptive approach was taken in the design of this study. The quality of life was the variable that was researched. The subjects of this research were all geriatric patients residing in the nursing home “Seniorenresidenz Dahlem” in Berlin, Germany. There were a total of 116 people participating.  The study was conducted between April 7, 2021 and May 29, 2021. The method of sampling that is being used in this investigation is total sampling. The following were the inclusion criteria for the study: the participant needed to be at least 65 years old, they needed to agree on a voluntary basis to take part in the research. It was required to pass a Standardized Mini Mental Test with a score of at least 24. It was also necessary to be a resident of the nursing home for at least two years as well as to speak and understand German. Out of a total of 116 older adults, 6 didn’t want to take part in the study, 5 had MMSE test scores under 24, 4 had lived in the nursing home for less than two years as well as 3 had troubles to communicate. These people were excluded from the study. The last 98 people who met the study’s criteria for participation formed the final sample.

At the facility “Seniorenresidenz Dahlem” where the research was performed, the older adults lived in a three storey housing complex with rooms for 1, 2, or maximum 3 people. At the time of the study, there were 24 caregivers, 3 doctors, 6 physiotherapists, and 2 ergo therapists employed in the nursing home. Routine examinations (e.g. blood pressure measuring, glucose level examination, eating habits etc.) and some treatments (e.g. decubitus care, insulin administration etc.) of the older adults living in the nursing home were performed in-house. If there was an emergency or if further investigations were needed, the residents got send to the hospital. The nursing home has a small botanical garden where older people can take walks or plant spices. There was also a big lobby with a large TV screen where they could spend their free time and socialize. Throughout the course of the study conduction the nursing home was closed for the general public. The Federal Ministry of Health in Germany obliged all long facilities nursing homes to close their doors for visitors throughout the pandemic. Communication via telephone or video calls were the only options to stay in contact with the relatives and friends from outside the nursing home facility.

Data collection forms

The steps performed by collecting the data can be summarized as followed:  the participants were informed about the objectives of the study and the informed consent was obtained; data form about the participants was completed; the Mini-Mental State Examination was conducted; the German Version of WHOQOL-BREF questionnaire was filled; the Brief Resilience Scale was calculated.

The data form about the participants: This form has 5 questions about the age, gender, family status, presence of chronic diseases, passed COVID-19 infection.

The Mini-Mental Status Exam (MMSE) is a cognitive screening tool that measures cognitive function quickly and objectively(43). It can be used to find out if someone has cognitive problems are as well as to keep track of how their intellect change over time. The MMSE tests several domains of cognition such as: “orientation, repetition, verbal recall, attention and calculation, language and visual construction”(43). Total MMSE scores range from 0 to 30. Scores of 28 to 30 indicate normal cognitive status, scores of 24 to 27 indicate mild cognitive impairment, and scores below 23 indicate that dementia may be present(43).

The WHOQOL-BREF is an instrument that measures both the quality of life of individuals as well as populations. It is a simplified shorter representation of its longer counterpart, the WHOQOL-100. Both were issued in 1995 by the World Health Organization (WHO)(44).  The WHOQOL-BREF is a self-administered  survey form with 26 questions about how the person feels about their health and well-being in the last two weeks(44). On a 1–5 Likert scale, 1 means “disagree” or “not at all,” and 5 means “completely agree” or “extremely.” Physical and psychological health, social relationships and the environment are the four domains  that the WHOQOL-BREF covers(45). Additionally, there are also two distinct questions that specifically ask about the respondent’s overall perception of both their quality of life and their state of health(44).

The Brief Resilience Scale was developed in order to evaluate an individual’s self-perceived potential to recover or to keep moving after facing stressful situations in once life. The scale was developed to evaluate a singular construct of resilience which includes items that are worded in both a positive and negative manner. The range of possible score is from 1 (indicating low resilience) to 5 ( indicating high resilience)(46).

Data analysis

The package IBM SPSS Statistics 22. 0 program was used to analyze the collected data. In descriptive statistics, for both categorical and continuous variables, calculations were made to determine the number, the percentage, the mean, the standard deviation, as well as the minimum and maximum values. The values of Shapiro Wilks, skewness, and kurtosis were applied in order to ascertain whether or not the data linked to the normal distribution. Additionally, the Pearson correlation coefficient was chosen in order to investigate the link between two quantitative variables that followed the normal distribution. It was determined, through the use of multiple linear regression analysis, which factors are connected with the various domains of quality of life, including the physical, psychological, social, and environmental. Significant in terms of quality of life is a p-value of less than 0.05. Physical, psychological, social, and environmental dimensions had internal consistency coefficients of.67,.77,.60, and.75.

Results

Characteristics of the geriatric patients at the nursing home Seniorenresidenz Dahlem,

The results depicted in Table 1. show the demographic characteristics of the participants who took part in the study. The findings of the research with a total of 98 survey participants were based on the outcome of a data analysis. The average age of the study participants is 72 years old, with a standard deviation of 6.53 years. The majority of them were male (57.1%) and the mean MMSE score was 26,4 (SD 2,1). According to the data about the past history of COVID-19 infection, the significant proportion of the elderly (64,6%) suffered from the novel coronavirus. About the history of chronic diseases, it can be said, that the vast majority of people surveyed (92,3%) confirmed having at least one chronic health condition.

Distribution of the mean BRS and WHOQOL-BREF scores

The mean BRS score was 19.15+/-1.82 (14-21). The mean scores on the physical dimension, mental dimension, social relations dimension, and environmental dimension of WHOQOL-BREF-TR 61,37+/-12,06 (16,76-81,34), 66,17+/-14,42 (32,29-100.00), 55,61+/-17,85 (7,41-100,00), 65,64+/-11,23 (36,40-95,87).

Correlation between Age, MMSE, BRS, and WHOQOL-BREF

There was a moderately negative correlation among the age and the mean scores on the mental as well as the environmental dimension of the WHOQOL-BREF (p <0.05), and there was a positive correlation between the Mini-Mental State Examination (MMSE) and the mean scores on all dimensions WHOQOL-BREF-TR (p<0.01). Both of these correlations were significant. The BRS and WHOQOL-BREF dimensions did not show any statistically significant correlation.

The factors affecting quality of life

Male gender (b: -.044), history of chronic disease (b: -.235), and MMSE score (b:.386) all had a significant effect on QOL physical dimension scores (R2=0.352, p0.01). Both age (b: -.214) as well as MMSE score (b:.353) had a significant impact on mental dimension scores (R2=0.363, p<0.01). The MMSE score (b:.276) had a big impact on the social relations dimension. Last but not least, MMSE score (b:.295) had a significant impact on the environmental dimension (R2=0.352,p<0.01).

DISCUSSION

The World Health Organization write, a person’s body will go through a number of changes as they get older including hearing loss, obstructive pulmonary disease, refractive errors as well as a decline in musculoskeletal function. This is just a fraction of the physiological modifications, not to mention the mental changes, which goes hand in hand with aging. As it was shown in several studies the older age does influence the quality of life dimensions (41)(45)(9). In accordance with this study it could be said, that this factum is to some extend also reflected in the sample group of this survey. In the table you can see, that the age (b: -.214) significantly affect scores on the mental dimension (R2=0.363, p<0.01), which contribute to the changes in overall quality of life.

As reported by the results of this research, the quality of life (QOL) of the geriatric residents at the nursing home facility Residenz Dahlem was  slightly more than moderate in accordance to their scores in WHOQOL-BREF on the four basic dimensions:  physical , mental , social relations and environmental. While the SARS-CoV-2 pandemic had the greatest impact on the social and physical dimensions of QOL, the mental and environmental dimensions were the littelst affected. Emotional connection, which can be achieved through friendship or familial relationships, satisfies a fundamental human demand and has significant positive effects on the social quality of life. The restrictive measures for prevention of uncontrolled novel coronavirus spread drastically reduced the possibility to establish or to strength these emotional ties. During the time this study was conducted the German government released a set of corona measures, which obliged all the nursing facility residents to go in to self-isolation. Visits from family members or friends were strictly forbidden. All the socializing activities offered by the nursing home were canceled. The residents didn’t have the possibility to make new friends while playing board games together, participating at craft workshops or singing in a choir. Each resident was strictly instructed to stay at his private room all day long for undefined period of time. The norms of interaction, especially those used to express trust,  empathy, and respect (hugging, shaking hands, physical comforting) have been radically changed as a result of the physical distancing regulations that have been implemented to limit the spread of COVID-19. In point of fact, research has shown that having a strong social support system, which is provided through social interaction, is one of the most essential factors in terms of adaptability to stressors in the wake of catastrophic events like COVID-19 pandemic. If this social support system is disturbed the necessary emotional and physical resources can not be provided in a sufficient extend(47). This state of affairs can lead to a markable decrease in social quality of life, which is also reflected in the results of this study. As can be seen in TABEL the drop of the calculated score at the nursing home facility Seniorenresidenz Dahlem is more prominent at the level of the social quality of life domain.

The connection between the importance of active lifestyle and the quality of life in elderly people has been a subject of extensive research and become more important facing the challenges of the COVID-19 pandemic. The time when personal freedom was severely restricted, and confinement was ordered by the government it raised consequently questions about possible negative effects on the quality of life especially in the most vulnerable groups, elderly people. Since the ability to carry out day-to-day activities was cramped as well as the degree of contentment experienced by that means was on its lowest point and the knowledge that these elements are incorporated in the physical quality of life domains. The negative effects on this domain is something to expect. A line of studies as well as the current research came up with the same results and described a markable decline of the score at the level of the physical quality of life domain.

As per the findings of this research, the mental and environmental quality of life scores of elderly, living in the nursing facility the study was conducted, are at their top level in comparison to the other two domains. The satisfaction with life in both physical and mental sense as well as general levels of one’s own contentment, are the topics that are covered by the mental component of the scale. Equally there are several factors incorporate in the environmental QOL dimension including overall satisfaction with one’s surroundings, a sense of security, and the ability to meet one’s physical as well as mental needs. There is a good chance that the older adults who participated in the current study were able to meet their physical as well as mental needs thanks to the activities and care services offered in the nursing home facility Seniorenresidenz Dahlem where the research was carried out. Such additional activities and care services encountered following practices: cognitive stimulation with the help of special designed applications, maintaining regular sleep-wake cycle, providing mental support by caregivers. Moreover, regular one-to-one visiting schedules of isolated geriatric residents by the employees of the nursing facility were organized. On top of that the relatives of the residents were animated to use electronic devises and to keep in touch in a regular manner with the isolated people. It was emphasized to use especially applications for video calling on big screens. It is possible, that as a result, the scores of QOL on the mental and environmental dimensions were high.