Even though changing unhealthy habits such as smoking and poor diet are difficult, chronic diseases such as arthritis make exercise challenging, and terminal disease makes it tough to see the benefits of changing one’s habits, the fact remains that such changes typically increase functional capability. Current models of behavioral change are complex and include not only behavioral, but also motiva­tional, cognitive, and social components (Aldwin & Gilmer, 2004). Two that are the focus of most research are the self-efficacy model, which empha­sizes the role of goal setting and personal beliefs in the degree to which one influences the outcome, and the self-regulation model, which focuses on the person’s motivation for change.

There is surprisingly little research on health promotion programs designed specifically for older adults (Aldwin & Gilmer, 2004). However, a few trends are apparent. First, although exercise is key to health, because older adults are more prone to injury, exercise programs for older adults need to take such issues into account. Second, health edu­cation programs are effective in minimizing the effects of emotional stress. Third, health screen­ing programs are effective in identifying serious

chronic disease that can limit the quality of life. Each of these areas within health promotion is successful only if ethnic differences are taken into account in designing the programs (Landrine & Klonoff, 2001).

One’s state of health influences one’s quality of life, that is, one’s well-being and life satisfaction. Quality of life includes interpersonal relationships and social support, physical and mental health, environmental comfort, and many psychological constructs such as locus of control, emotions, usefulness, personal­ity, and meaning in life (Kaplan & Erickson, 2000). It is usually divided into environmental, physical, social, and psychological domains of well-being. Personal evaluation of these dimensions is criti­cal to understanding how people view their situa­tions. For example, although half of the people in Strawbridge, Wallhagen, and Cohen’s (2002) study did not meet certain objective criteria for successful aging, they nevertheless defined themselves as suc­cessful and as having a good quality of life.

In short, quality of life is a person’s subjective assessment or value judgment of his or her own life (Aldwin & Gilmer, 2004). This subjective judgment may or may not correspond to the evaluation of others. And even though self – and other-perceived quality of life may diminish in late life, it may not seem like a loss for the older person. For example, an older woman who has difficulty walking may feel happy to simply be alive, whereas another who is in objective good health may feel useless. Quality of

For most people, doing what you enjoy enhances quality of life.

life is best studied from the point of view of the person.

Still, when the level of medical intervention increases as people grow more frail, medical pro­fessionals must be concerned about the trade-off between extending life at all costs and the quality of that life (Michel, Newton, & Kirkwood, 2008). This debate will continue, and will benefit from informed discussions of various options at the end of life, as described in Chapter 13.