Quality of life for older autistic people: The impact of mental health difficulties

Background: Having a mental health condition is related to significantly lower subjective Quality of Life (QoL) for people on the autism spectrum. Many autistic people do not participate in socalled 'normative' outcomes, i.e. the achievement of lifecourse goals judged to be important by adults in the general population (e.g. being employed). This study aimed to investigate whether there is an association between the presence of mental health conditions, subjective QoL and participation in normative outcomes in older autistic people. Methods: 69 autistic people (n = 48 males) aged 55 years and over were identified from two studies that are part of the UK Autism Spectrum Adulthood and Ageing research programme. Participants provided demographic data to establish normative outcome participation, and completed the World Health Organisation (WHO) QoL measure (WHOQoL-BREF) and the Hospital Anxiety and Depression Scale (HADS). Illustrative quotes focusing on normative outcomes were available from in-depth interviews (n = 8). Results: QoL scores across all domains were lower for individuals who met indicative clinical cutoffs for depression (F(8,126) = 6.171, p < 0.001); findings were similar for anxiety (F (8,126) = 3.902, p < 0.001). Subjective QoL did not differ according to participation in normative outcomes (F(12,124.64) = 1.363, p = 0.192). The illustrative quotes suggested that aspects of daily life were related to QoL (i.e. friendships). Conclusions: For older autistic people, the presence and severity of a likely mental health condition (i.e anxiety and depression) were associated with poorer QoL. However, participation in general population lifecourse goals may not well represent QoL of older autistic people, suggesting that service supports should be individually responsive.