PURPOSE: Previous research on nursing home resident quality of life (QOL) has mainly been cross-sectional. This study examined the association between changes in QOL and changes in resident clinical factors. DESIGN AND METHODS: A longitudinal study of resident QOL was conducted in two nursing homes. Self-report interviews using a multidimensional measure of QOL were linked with clinical data from the Minimum Data Set. Five waves of interviews were conducted at 6-month intervals. RESULTS: Residents with one or more Stage II or higher pressure ulcers for two consecutive 6-month periods reported declines in autonomy, security, and spiritual well-being QOL domains; those with declines in physical disability reported declines in the dignity domain. Increases in depressive symptoms were associated with decreases in comfort, meaningful activities, and food enjoyment domains, and increases in pain were associated with decreases in functional competence and dignity domains. IMPLICATIONS: There is evidence of an association between physical health and self-reported QOL. However, not every dimension of QOL exhibited the same pattern. Further research is needed on the link between specific clinical factors and aspects of QOL.