Gereç ve Yöntem: Tanımlayıcı ve ilişki arayıcı tipte yürütülen araştırmanın evrenini, Türkiye’nin bir ilinde bulunan huzurevinde yaşayan 104 birey oluşturdu. Veriler; Tanıtıcı Özellikler Formu ve Yaşlılarda Yaşam Kalitesi Ölçeği kullanılarak toplanıldı. Araştırmadan elde edilen veriler SPSS 23 paket programıyla değerlendirildi.

Bulgular: Çalışmaya katılan yaşlı bireylerin; %26’ sı 65-69 yaş aralığında, %51.9’u erkek, %81.7’si 0-5 yıldır huzurevinde yaşamakta, %32.7’si kendisini kimsesiz/yalnız hissetmekte, %64.4’ü huzurevinde kendi isteğiyle bulunmakta, %51’si ise ziyaretçisinin ara sıra gelmekte olduğunu belirtmektedir. Ayrıca yaşlılarda yaşam kalitesi ölçeği; vücudunda ağrı/hassasiyet hissetmeyen (20.96±6.88) ve kendisini kimsesiz/yalnız hissetmeyen (20.21±7.90) katılımcılarda anlamlı derecede daha yüksek bulunmuştur.

Sonuç: Bulgular, huzurevlerinde yaşayan yaşlı bireylerin yaşam kalitesinin fiziksel rahatsızlıklar (ağrı) ve duygusal faktörler (yalnızlık) tarafından anlamlı şekilde etkilendiğini göstermektedir. Fiziksel konforun artırılması ve duygusal desteğin güçlendirilmesi, kurumsal bakım ortamlarında yaşam memnuniyetini ve genel iyilik halini artırabilir.

Quality of life is a condition that reflects the balance between an individual’s expectations and actual life experiences ⁴. Functional capacity, health status, psychological condition, personal beliefs, life goals, expectations, norms, and concerns affect an individual's quality of life ⁵. In older individuals, in addition to chronic, physical, and mental illnesses, factors such as gender, age, low economic status, irregular medication use, low education level, pain, physical disabilities, lack of social security, inability to access healthcare services, and social isolation negatively impact both their health and quality of life ^6-8.

Nursing is a health discipline that aims to protect and improve the health of individuals, families and society; to improve and support life functions when there is a physical, mental or social deterioration in health status ⁹. Nurses support elderly individuals to meet their physical care needs, cope with emotional difficulties, maintain their self-sufficiency, adapt to the limitations they experience and maintain their sense of self-worth. The aim of services for elderly individuals is to support their quality of life and to contribute to their independent and active life as much as possible ¹⁰. The aim of this study is to investigate the effect of physical and emotional well-being on the quality of life of elderly individuals living in nursing homes. Additional objectives include to increase the awareness of health professionals providing services to the elderly living in nursing homes, to guide nursing home staff in services to improve the quality of life for the elderly and to provide an up-to-date contribution to the literature. The study aims to address the following research questions regarding older individuals residing in nursing homes:

1. What are their sociodemographic characteristics?
2. Is there a difference between their sociodemographic characteristics and quality of life?
3. What is the level of their quality of life?

Study Design: This study was conducted using a descriptive and correlational design.

Place and Duration of the Study: The study was initially planned to include a total of 188 older individuals residing in the Kahramanmaraş Nursing Home for Elderly Care and Rehabilitation Center and the Şehit Hakan Duygal Nursing Home for Elderly Care and Rehabilitation Center in the central district of Onikişubat between July 10, 2022, and December 30, 2022. However, due to delays in obtaining institutional permissions, the study could not be conducted within the specified period. By the time the necessary institutional approvals were obtained, the Kahramanmaraş earthquakes occurred on February 6, leading to the closure of the elderly care and rehabilitation center. After the disaster, 188 elderly individuals returned to the facility in June 2024. Ethics committee approval for the study was updated accordingly.

Population and Sample of the Study: The study population consists of elderly individuals (188 elderly individuals) residing in nursing homes between July and October 2024. The sample includes elderly individuals who resided in the nursing home during this period and met the inclusion criteria. The inclusion criteria are as follows: volunteered to participate, spoke Turkish, resided in a nursing home, and had no communication or cognitive impairment. No specific sampling method was used; instead, all elderly individuals who met the inclusion criteria were included. A total of 188 elderly individuals resided in the nursing home during the two-month study period. However, following the Kahramanmaraş earthquake on February 6, 76 elderly individuals were diagnosed with dementia or Alzheimer's disease by a physician and 8 elderly individuals refused to participate in the study and were excluded. Among the remaining residents, those who did not have visual, auditory, or psychological impairment and agreed to participate were included. The total number of individuals included in the studay became104. A demographic information form and the Quality of Life in the Elderly Scale were used to collect data. Both instruments were administered through face-to-face interviews conducted by the researcher. The completion of the forms took approximately 15-20 minutes.

Data Collection Tools
Demographic information form: The demographic information form prepared by the researchers consisted of 20 questions aimed at identifying participants’ socio-demographic characteristics, chronic diseases, length of stay in the nursing home, medication use, friendships, visitor status, and level of dependence in daily activities.

Quality of Life Scale in Older People: The CASP-19 scale was developed by Hyde et al. to measure the quality of life of older adults. The scale consists of 19 items, four sub-dimensions (control, autonomy, pleasure, and self-realization), and follows a four-point Likert type ¹¹. The Turkish validity and reliability study, conducted by Türkoğlu and Adıbelli (2014), led to the removal of six items, refining the scale into a 13-item, two-sub-dimension measure with a four-point Likert format (Never: 0 – Always: 3). The Autonomy and Satisfaction Perception sub-dimension consists of items 3, 5, 6, 7, 8, 9, 10, 11, 12, and 13, while the Perceived Constraint sub-dimension consists of items 1, 2, and 4. The items in the perceived constraint sub-dimension are reverse coded. The total score obtained from the scale ranges between 0 and 39, with higher scores indicating better quality of life. The Cronbach’s alpha coefficients for the sub-dimensions and the total scale were found to be 0.93, 0.75, and 0.91, respectively ⁴. In this study, the Cronbach’s alpha coefficients were found to be 0.85, 0.70, and 0.80, respectively.”

Data collection: The study data were collected by the researchers by face-to-face interviews in a separate room using the form and scale. The completion time was approximately 15–20 minutes. The purpose of the study was explained to the participants in detail, and it was stated that the study was conducted with institutional permission and ethical committee approval. Additionally, the data were collected after obtaining informed voluntary consent forms and verbal consent from the participants.

Data Analysis: The data obtained from the study were analyzed using the Statistical Package for the Social Sciences (SPSS) version 23.0 (IBM Corp., Armonk, NY, USA). Descriptive statistical methods, including mean, standard deviation, frequency, and percentage calculations, were used. Normality was assessed using Skewness and Kurtosis tests. In the present study, Skewness values ranged from -1.69 to 1.89, while Kurtosis values ranged from -1.09 to 1.43. According to the literature, if Skewness and Kurtosis values fall within the range of -2 to +2, the data are considered normally distributed ¹². For the comparison of two independent groups, the t-test was used, while analysis of variance (ANOVA) was applied to compare more than two groups. Pearson correlation analysis was conducted to examine relationships between variables. A p-value of <0.05 was considered statistically significant.

Limitations and Strengths of the Study: A limitation of the study was that the data were collected from a single nursing home in one province, which may restrict the generalizability of the findings. However, a strength of the study was that the researchers collected the data in the elderly individuals' natural environment, allowing for a more immersive and contextualized research process.

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Table 1: Comparison of Demographic Characteristics and Quality of Life Scale Scores in Older Adults

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Table 1: Continuation of

The mean score of the Autonomy and Satisfaction Perception sub-dimension was significantly higher among the participants who had friends in the nursing home (14.36±6.73, p<0.05) (Table 1). The mean score of the Perceived Constraint sub-dimension was significantly higher among the participants who were 85 years or older (5.75±2.28) and male (5.35±2.11), had no social security (5.45±2.21), had a chronic illness (5.60±1.85), experienced bodily pain or sensitivity (6.57±1.59), were concerned about their health (5.76±2.01), or believed that there was no regular exercise program in the institution (6.07±2.03), (p<0.05) (Table I).

The Quality of Life Scale score was significantly higher among the participants who did not experience bodily pain or sensitivity (20.96±6.88) and did not feel lonely or without social support (20.21±7.90), (p<0.05) (Table 1).

The overall mean scores of the participants were 13.64±7.26 for the Autonomy and Satisfaction Perception sub-dimension, 4.86±2.34 for the Perceived Constraint sub-dimension, and 18.50±7.36 for the total Quality of Life Scale (p<0.05) (Table 1).

There is a highly significant positive correlation (r = 0.949) between the Quality of Life Scale in Older Adults and the Autonomy and Satisfaction Perception sub-dimension (Table 2).

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Table 2: Examination of the Relationship Between the Quality of Life Scale in Older Adults and its Sub-Dimensions

While some studies in the literature reveal that the quality of life of elderly individuals with high income levels is higher than those with low income levels ^19,20. our study and other studies conducted especially in the nursing home environment ^21,22. show that income level has no significant effect on quality of life in this environment. This contradiction can be explained by the fact that the basic needs of elderly individuals in nursing homes are met by the state or the institution, thus reducing the impact of personal financial resources. Therefore, it can be concluded that the effect of income level on quality of life may vary according to the living environment of the elderly and this effect is more limited in institutionalised care settings.

In the study, those aged 85 and above, the male participants, those without social security, those with chronic illnesses, those experiencing bodily pain/sensitivity, those concerned about their health, and those without access to a regular exercise program in the institution reported higher levels of perceived constraints. Niederstrasser & Attridge (2022) conducted a study in older adults and found that older adults with high pain levels had significantly lower physical activity levels, which led to a restriction in exercise perception ²³. These findings show a strong similarity with the results of our study, supporting that lack of access to exercise, pain, social security and psychological barriers systematically limit the perception of exercise in older adults.

In our study, it was found that the educational level of elderly individuals did not have a significant effect on quality of life. This finding is similar to the results of a study conducted in French nursing homes showing that sociodemographic variables, including educational level, do not affect quality of life ²⁴. A study evaluatıng elderly indıvıduals under ınstıtutıonal care in Guangzun concluded that level of education has no impact on quality of life ²⁵. Although these data strongly support the result of our study, it shows that education level is not a determining factor of quality of life in care centres such as nursing homes. When the literature is analysed, there are opposite findings. When most of the studies in the literature were analysed, it was found that high level of education positively affected the quality of life of the elderly in the opposite direction to our findings ^{15,19,20,25-28}.

This study found that autonomy/satisfaction perception and overall quality of life among older adults residing in nursing homes were moderate, while perceived constraints were high. Another significant finding was that the mean scores of autonomy and satisfaction perception of the participants who had friends in the nursing home were significantly higher is a result parallel to the effect of social support on the feeling of autonomy in the literature. In the Marmara University study, a statistically significant relationship was found between friend support and self-confidence of nursing home residents ²⁹. In addition, in a study conducted in Australia, autonomy-supported approaches that provide individuals with choice in a nursing home significantly increased life satisfaction by explaining 25% of the difference in quality of life (especially with the effect of choice in social activities and staff-resident interaction) ³⁰. These findings strongly support that increased perceptions of autonomy and satisfaction in our study are associated with nursing home companionship. The presence of social support and friendships plays a vital role in enhancing quality of life in older adults. We can say that strong and qualified social ties increase quality of life in older ages. It has been observed that the CASP-19 scores of elderly individuals who have established intensive social relationships are higher ³¹. In addition, a high level of social support is considered to be an effective factor on quality of life ³². In the study conducted by Aydıner Boylu and Günay, it was revealed that increasing the social support relationships of the elderly had a positive contribution to life satisfaction ³³. Although it is known that social support has a great impact on the economic, psychological, and physical life satisfaction of the elderly, it protects them from the negative effects of life crises and improves their quality of life ^34,35.

In addition, among the older adults in our study, those who did not experience physical pain, used their medications regularly, did not feel lonely, and ate regularly had higher total quality of life scores. Various studies have shown that the ability to fulfill activities of daily living increases life satisfaction and quality of life ^36,37. In this context, the ability of elderly individuals to meet their own needs, to fulfill their daily activities independently and to avoid the feeling of loneliness can be considered as important factors contributing to increased quality of life. Professionals providing care in nursing homes can improve the quality of life of elderly individuals by focusing on areas such as pain management, supporting medication compliance, reducing social isolation and balanced nutrition.

Several factors were found to positively influence quality of life in nursing home residents, including satisfaction with living in the nursing home, having friends in the institution, receiving visitors, participating in physical exercise, the absence of chronic illness, and not having health concerns. Similarly, previous research showed that older adults who engage in physical activity reported higher life satisfaction and better quality of life ³⁸. Furthermore, marital status, socioeconomic status, and age, along with employment status, cognitive impairments, and social isolation, were identified as factors associated with quality of life in older adults ¹³. These factors should be taken into account when evaluating quality of life in old age, as understanding them plays a crucial role in protecting and improving older adults' health and ensuring their overall well-being and happiness ⁴. In our study, age, gender, and number of children did not significantly affect quality of life. However, not feeling lonely and being married positively influenced autonomy and satisfaction perception. Moreover, a strong positive correlation was found between the Quality of Life Scale and the Autonomy and Satisfaction Perception sub-dimension.

Our study on older adults living in nursing homes indicates that social support is weakly associated with quality of life. Additionally, the results show that the participants who reported having a chronic illness had lower total quality of life scores. As aging progresses, the prevalence and number of chronic diseases increase, which can lead to greater dependence, reduced life satisfaction, and a more negative attitude toward life ³⁹.

The high positive correlation of r = 0.949 observed in our study clearly indicates that autonomy and satisfaction with life are central to overall quality of life. This result is consistent with data from different contexts such as Taiwan and Brazil. Therefore, it is clear that practices that support older people's freedom of decision-making and satisfaction (individual preferences, activities, socialisation, etc.) in nursing home settings play a critical role in enhancing QoL ^40,41.

Conclusion and Recommendations: As a result of the study, it was determined that those older adults residing in nursing homes who had friends in the institution had higher autonomy and satisfaction perception, whereas those who were 85 years and older and male, lacked social security, had a chronic illness, experienced bodily pain/sensitivity, had health concerns, and did not have access to a regular exercise program in the institution had higher perceived constraints. Additionally, it was found that all participants in the study had autonomy/satisfaction perceptions and quality of life scores were close to moderate levels, while their perceived constraints were high. Maintaining functional capacity, managing chronic diseases, preventing social isolation, and providing psychological support play an important role in this process. In addition, ensuring the active participation of the elderly in decision-making processes, supporting their independence and establishing a respect-based communication contribute to the sustainable improvement of quality of life. In this context, health services supported by interdisciplinary cooperation and continuous education enable older people to lead a healthier, safer, and more meaningful life.

Acknowledgement: The authors would like to thank anyone who contributed to this study sincerely.

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