Register's Theory of Generative Quality of Life for the Elderly (GQOLE) is an innovative and intriguing model that comprehensively addresses QOL issues in older adult populations. Furthermore, creating this model from a theoretical framework using an ontological perspective and introducing the concept of connectedness as a missing factor among other QOL models and measurement tools builds a strong foundation for a new perspective in how QOL can best be evaluated.

"A Middle Range Theory for Generative Quality of Life for the Elderly" not only describes Register's GQOLE model and its potential implications for nursing practice but also brings up salient points regarding the structure and evolution of QOL models and measurement tools over time. Furthermore, though not directly mentioned, there is speculation that the authors themselves may be creating a QOL measurement tool based on this model in order to accurately assess the state and well-being of older adult patients. It is unclear, however, how this might be put effectively into practice in the traditional sense of such a tool, as the authors noted the numerous QOL categories and areas that can have variable meanings based on individual values and beliefs. Although the underlying premise is connectedness within each of these areas, it seems that in order to both holistically measure each patient and allow for individual preferences of which areas are perceived as important QOL factors, there would have to be a complex system of identifying those important areas without quantifying less important areas that could lead to assessing an individual as having a poorer QOL than he or she perceives. In order to achieve the true meaning of QOL, a standard paper-type measurement tool may be inappropriate and a more elaborate electronically based system may be warranted. Based on Register's GQOLE model, it would seem paramount to first identify which areas each patient deemed important QOL factors for himself or herself, then measure his or her perceptions or "connectedness' within each one, and perhaps look at these factors over time. It will be interesting to see the tool that is created through this model.

Aside from the description of the model and its implications for nursing practice, there was one point the article made that was slightly concerning regarding elders being displaced to new living arrangements in residential centers, assisted living facilities, or institutional centers. The authors emphasized that this can be a negative experience with decreased QOL perceptions for residents. This may be true for some who view such a move as a loss of autonomy, but it should also be noted that many older adults who move to these facilities feel an enhanced QOL. They make new friends and connections, get involved in any number of activities, feel a greater sense of security from the surrounding residents and healthcare staff, and are less burdened with chores such a cooking meals and cleaning.

Again, QOL varies for each individual and changes through different stages and phases in life. Acknowledging and respecting this individuality is paramount in truly assessing QOL. Register's GQOLE is perhaps the most accurate model to date in capturing this intricate essence.

Marilyn J. Hammer, DC, RN

Predoctoral Student, University of Washington, School of Nursing

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