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Huang MH, Tsai CF, Lin YS, Kuo YS, Hsu CC, Fuh JL. A national survey on health-related quality of life for people with dementia in residential long-term care institutions. J Formos Med Assoc 2024; 123:764-772. [PMID: 38072742 DOI: 10.1016/j.jfma.2023.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 11/03/2023] [Accepted: 11/22/2023] [Indexed: 06/23/2024] Open
Abstract
BACKGROUND Health-related quality of life (HRQoL) is an essential outcome parameter in geriatric research; however, the available evidence is mixed regarding the factors associated with HRQoL among people with dementia. We aimed to identify factors that contribute to HRQoL among people with dementia in residential long-term care (LTC) institutions. METHODS We randomly selected 299 of 1607 registered residential LTC institutions in Taiwan. A cross-sectional survey was conducted between 2019 and 2020, including items on demographic characteristics, comorbidities, the EuroQol-5 dimensions-5 levels (EQ-5D-5L; utility and visual analog scale [VAS] scores), the Mini-Mental State Examination (MMSE), the Clinical Dementia Rating (CDR), behavioral and psychological symptoms of dementia, activities of daily living (ADL), and instrumental ADL (IADL). RESULTS In total, 1313 people with dementia from 267 institutions were enrolled (mean age, 76.4 ± 12.7 years). The mean EQ-5D-5L utility and VAS scores were 0.10 (standard deviation [SD] = 0.48) and 66.57 (SD = 20.67), respectively. In multivariate linear regression analysis, higher scores for ADL, IADL, and CDR sum of boxes were associated with higher utility scores. Higher VAS scores were associated with higher ADL and MMSE scores. Lower utility scores and VAS scores were associated with more frequent depressive symptoms. CONCLUSION ADL, dementia severity, cognitive function, and depressive symptoms influenced the HRQoL of people with dementia in residential LTC institutions. Longitudinal studies should be conducted to better understand how HRQoL changes over time among people with disabilities.
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Affiliation(s)
- Mao-Hsuan Huang
- Department of Psychiatry, YuanShan and Suao Branches of Taipei Veterans General Hospital, Ilan, Taiwan; School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chia-Fen Tsai
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Psychiatry, Taipei Veterans General Hospital, Taiwan
| | - Yung-Shuan Lin
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan; Division of General Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; Brain Research Center, National Yang-Ming Chiao Tung University, Taipei, Taiwan
| | - Yu-Shan Kuo
- Division of General Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chih-Cheng Hsu
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan; Center for Geriatrics and Welfare Research, National Health Research Institutes, Yunlin, Taiwan
| | - Jong-Ling Fuh
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Division of General Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; Brain Research Center, National Yang-Ming Chiao Tung University, Taipei, Taiwan.
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Cheng LJ, Engel L, Chen LA, Soh SZY, Koh GCH, Luo N. Using EQ-5D for Proxy Assessment of Health-Related Quality of Life in Residential Care Facilities: A Systematic Review of Feasibility and Psychometric Properties. J Am Med Dir Assoc 2024; 25:104870. [PMID: 38043585 DOI: 10.1016/j.jamda.2023.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/19/2023] [Accepted: 10/23/2023] [Indexed: 12/05/2023]
Abstract
OBJECTIVES The accurate assessment of Health-Related Quality of Life (HRQoL) in residents of residential care facilities (RCF) necessitates the use of proxy-reported instruments that possess robust psychometric properties. Generally, these instruments are modified versions of self-reported tools, with adjustments made to pronouns and instructions to better suit the respondent. Among such tools, the EQ-5D has emerged as a prominent instrument for evaluating HRQoL within RCF settings. This review aimed to synthesize evidence on psychometric properties of the proxy version of EQ-5D. DESIGN Systematic review and meta-analysis. SETTING AND PARTICIPANTS Residents in RCF. METHODS An extensive search was conducted across 8 databases, covering articles from inception to May 29, 2023. We included a total of 20 articles reporting data that can be used to evaluate psychometric properties of this instrument in RCF. The quality appraisal employed the COSMIN Risk of Bias checklist, and data synthesis followed COSMIN methodology. RESULTS Most of the included studies were conducted in Europe, with 75% using nursing staff as proxies. Missing data rates were 5% for EQ-5D and 26% for EQ VAS. Evidence of moderate certainty on construct validity of the EQ-5D index was inconsistent, although the EQ VAS showed sufficient construct validity supported by high certainty. EQ-5D index responsiveness evidence was limited, characterized by low certainty and inconsistency. Proxy-resident agreement ranged from poor to moderate, and improved with repeated administration for the "mobility" and "usual activities" dimensions. The lowest agreement was observed when staff served as proxies or the proxy-proxy perspective was adopted. CONCLUSIONS AND IMPLICATIONS This review offers an overview of the psychometric properties of EQ-5D as a proxy HRQoL measure in RCF. The suboptimal evidence on psychometric properties of EQ-5D indicated the need for more validation studies and cautious use of the instrument in RCF.
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Affiliation(s)
- Ling Jie Cheng
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Lidia Engel
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Le Ann Chen
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Sonia Zhi Yi Soh
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Gerald Choon-Huat Koh
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore; Dean's Office and Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Medicine, National University Hospital, Singapore
| | - Nan Luo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
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Xu RH, Dai Y, Ng SSM, Tsang HWH, Zhang S, Dong D. Assessing validity of the EQ-5D-5L proxy in children and adolescents with Duchenne muscular dystrophy or spinal muscular atrophy. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2024; 25:103-115. [PMID: 36809586 DOI: 10.1007/s10198-023-01574-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 02/01/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE To assess the psychometric properties of the EuroQol-5-Dimension five-level instrument (EQ-5D-5L) proxy in caregivers of children and adolescents with Duchenne muscular dystrophy (DMD) or spinal muscular atrophy (SMA). METHOD Data were collected using the EQ-5D-5L proxy for individuals with DMD or SMA, as reported by their caregivers. Ceiling and floor effects, reliability (Cronbach's alpha), convergent and divergent validity (Spearman's correlation coefficient and Bland-Altman plot) and known-group validity (analysis of variance) was used to assess the instrument's psychometric properties. RESULTS Totally, 855 caregivers completed the questionnaire. Significant floor effects were observed for most dimensions of the EQ-5D-5L in both SMA and DMD samples. The EQ-5D-5L was strongly correlated with the hypothesized subscales of the SF-12, which confirmed satisfactory convergent and divergent validity. The EQ-5D-5L can significantly differentiate between impaired functional groups for individuals, demonstrating satisfactory discriminative ability. The agreement between the EQ-5D-5L utility and EQ-VAS scores was poor. CONCLUSIONS Based on the measurement properties assessed in this study, the EQ-5D-5L proxy is a valid and reliable tool for measuring the health-related quality of life of individuals with DMD or SMA rated by caregivers. Further studies should examine the content validity of the EQ-5D as well as the performance of its young version in these two patient groups.
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Affiliation(s)
- Richard Huan Xu
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Yi Dai
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Shamay S M Ng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Hector W H Tsang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
- Mental Health Research Centre, The Hong Kong Polytechnic University, Hong Kong, China
| | - Shuyang Zhang
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
| | - Dong Dong
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China.
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Ziegeler B, D' Souza W, Vinton A, Mulukutla S, Shaw C, Carne R. Neurological Health: Not Merely the Absence of Disease: Current Wellbeing Instruments Across the Spectrum of Neurology. Am J Lifestyle Med 2023; 17:299-316. [PMID: 36896041 PMCID: PMC9989493 DOI: 10.1177/15598276221086584] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Well-being and quality of life can vary independently of disease. Instruments measuring well-being and quality of life are commonly used in neurology, but there has been little investigation into the extent in which they accurately measure wellbeing/quality of life or if they merely reflect a diseased state of an individual. DESIGN Systematic searches, thematic analysis and narrative synthesis were undertaken. Individual items from instruments represented in ≥ 5 publications were categorised independently, without prior training, by five neurologists and one well-being researcher, as relating to 'disease-effect' or 'Well-being' with a study-created instrument. Items were additionally categorised into well-being domains. DATA SOURCES MEDLINE, EMBASE, EMCARE and PsycINFO from 1990 to 2020 were performed, across the 13 most prevalent neurological diseases. RESULTS 301 unique instruments were identified. Multiple sclerosis had most unique instruments at 92. SF-36 was used most, in 66 studies. 22 instruments appeared in ≥ 5 publications: 19/22 'well-being' outcome instruments predominantly measured disease effect (Fleiss kappa = .60). Only 1/22 instruments was categorised unanimously as relating to well-being. Instruments predominantly measured mental, physical and activity domains, over social or spiritual. CONCLUSIONS Most neurological well-being or quality-of-life instruments predominantly measure disease effect, rather than disease-independent well-being. Instruments differed widely in well-being domains examined.
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Affiliation(s)
| | | | | | | | - Cameron Shaw
- University Hospital Geelong, Deakin University, Geelong, VIC, Australia
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Hussain H, Keetharuth A, Rowen D, Wailoo A. Convergent validity of EQ-5D with core outcomes in dementia: a systematic review. Health Qual Life Outcomes 2022; 20:152. [DOI: 10.1186/s12955-022-02062-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 10/24/2022] [Indexed: 11/20/2022] Open
Abstract
Abstract
Objectives
To explore through a systematic review, the convergent validity of EQ-5D (EQ-5D-3L and EQ-5D-5L (total score and dimensions)) with core outcomes in dementia and investigate how this may be impacted by rater-type; with the aim of informing researchers when choosing measures to use in dementia trials.
Methods
To identify articles relevant to the convergent validity of EQ-5D with core dementia outcomes, three databases were electronically searched to September 2022. Studies were considered eligible for inclusion within the review if they included individual level data from people with dementia of any type, collected self and/or proxy reported EQ-5D and collected at least one core dementia outcome measure. Relevant data such as study sample size, stage of dementia and administration of EQ-5D was extracted, and a narrative synthesis was adopted.
Results
The search strategy retrieved 271 unique records, of which 30 met the inclusion criteria for the review. Twelve different core outcome measures were used to capture dementia outcomes: cognition, function, and behaviour/mood across the studies. Most studies used EQ-5D-3L (n = 27). Evidence related to the relationship between EQ-5D and measures of function and behaviour/mood was the most robust, with unanimous directions of associations, and more statistically significant findings. EQ-5D dimensions exhibited associations with corresponding clinical outcomes, whereby relationships were stronger with proxy-EQ-5D (than self-report).
Conclusion
Measuring health-rated quality of life in dementia populations is a complex issue, particularly when considering balancing the challenges associated with both self and proxy report. Published evidence indicates that EQ-5D shows evidence of convergent validity with the key dementia outcomes, therefore capturing these relevant dementia outcomes. The degree of associations with clinical measures was stronger when considering proxy-reported EQ-5D and differed by EQ-5D dimension type. This review has revealed that, despite the limited targeted psychometric evidence pool and reliance on clinical and observational studies, EQ-5D exhibits convergent validity with other dementia outcome measures.
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Buchholz I, Marten O, Janssen MF. Feasibility and validity of the EQ-5D-3L in the elderly Europeans: a secondary data analysis using SHARE(d) data. Qual Life Res 2022; 31:3267-3282. [PMID: 35624409 PMCID: PMC9546963 DOI: 10.1007/s11136-022-03158-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2022] [Indexed: 12/26/2022]
Abstract
PURPOSE To determine feasibility and validity of the EQ-5D-3L in the elderly European population. METHODS Secondary data analysis based on the study of health, ageing, and retirement in Europe (SHARE) to determine the percentage of missing items for EQ-5D dimensions and EQ VAS, and to demonstrate convergent/divergent validity with measures included in the SHARE survey. Known-groups validity was tested using literature-based hypotheses. Correlation coefficients and Cohen's f are reported. RESULTS Missing values were below 3% across all EQ-5D dimensions and gender strata, slightly increasing with age. Individuals' responses to each EQ-5D dimension were related to their ratings of other measures in expected directions. The EQ VAS and all EQ-5D dimensions (except anxiety/depression) moderately to strongly correlated with physical [e.g. number of limitations in activities of daily living (ADL): r = 0.313-0.658] and generic measures [CASP (control, autonomy, self-realization, pleasure)-19 scale, self-perceived health, number of symptoms: r = 0.318-0.622], while anxiety/depression strongly correlated with the EURO-D scale (r = 0.527). Both EQ-5D dimensions and EQ VAS discriminated well between two [or more] groups known to differ [e.g. anxiety/depression discriminated well between persons classified as depressed/not depressed using the EURO-D scale, f = 0.51; self-care differentiated best between individuals without and with 1 + ADL limitations, f = 0.69]. Sociodemographic variables like gender, education, and partner in household were hardly associated with EQ VAS scores (f < 0.25). CONCLUSION With item non-response of less than 3%, good discriminatory, and construct properties, the EQ-5D-3L showed to be a feasible and valid measure in the elderly Europeans.
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Affiliation(s)
| | - Ole Marten
- Department of Health Economics and Health Care Management, Bielefeld University, 33615, Bielefeld, Germany
| | - Mathieu F Janssen
- Department of Medical Psychology and Psychotherapy Erasmus MC, Erasmus University, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
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Cateau D, Ballabeni P, Niquille A. Effects of an interprofessional deprescribing intervention in Swiss nursing homes: the Individual Deprescribing Intervention (IDeI) randomised controlled trial. BMC Geriatr 2021; 21:655. [PMID: 34798826 PMCID: PMC8603597 DOI: 10.1186/s12877-021-02465-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 08/26/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Deprescribing polypharmacy and potentially inappropriate medications (PIMs) has been shown to be beneficial to nursing home (NH) residents' health. Medication reviews are the most widely studied deprescribing intervention; in a previous trial, we showed that another intervention, a deprescribing-focused interprofessional quality circle, can reduce the use of inappropriate medications at the NH level. However, this intervention cannot account for the variety of the residents' clinical situations. Therefore, we trialled a subsequent intervention in NH that enacted the quality circle intervention in the previous year. METHODS In 7 NHs, the most heavily medicated residents were recruited and randomised to receive usual care or the intervention. The intervention was a pharmacist-led, deprescribing-focused medication review, followed by the creation of an individualised treatment modification plan in collaboration with nurses and physicians. Intervention's effects were assessed after four months on the number and dose of PIMs used, quality of life, and safety outcomes (mortality, hospitalisations, falls, and use of physical restraints). Data were analysed using Poisson multivariate regression models. RESULTS Sixty-two NH residents participated, falling short of the expected 100 participants; 4 died before initial data collection. Participants used a very high number of drugs (median 15, inter-quartile range [12-19]) and PIMs (median 5, IQR [3-7]) at baseline. The intervention did not reduce the number of PIMs prescribed to the participants; however, it significantly decreased their dose (incidence rate ratio 0.763, CI95 [0.594; 0.979]), in particular for chronic drugs (IRR 0.716, CI95 [0.546; 0.938]). No adverse effects were seen on mortality, hospitalisations, falls, and restraints use, but, in the intervention group, three participants experienced adverse events that required the reintroduction of withdrawn treatments, and a decrease in quality of life is possible. CONCLUSIONS As it did not reach its recruitment target, this trial should be seen as exploratory. Results indicate that, following a NH-level deprescribing intervention, a resident-level intervention can further reduce some aspects of PIMs use. Great attention must be paid to residents' well-being when further developing such deprescribing interventions, as a possible reduction in quality of life was found in the intervention group, and some participants suffered adverse events following deprescribing. TRIAL REGISTRATION ClinicalTrials.gov (NCT03688542, https://clinicaltrials.gov/ct2/show/NCT03688542 ), registered on 31.08.2018.
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Affiliation(s)
- Damien Cateau
- Community Pharmacy, Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Rue du Bugnon 44, CH-1011, Lausanne, Switzerland.
- School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland.
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausanne, Geneva, Switzerland.
| | - Pierluigi Ballabeni
- Community Pharmacy, Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Rue du Bugnon 44, CH-1011, Lausanne, Switzerland
- Division of Biostatistics, Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Anne Niquille
- Community Pharmacy, Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Rue du Bugnon 44, CH-1011, Lausanne, Switzerland
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausanne, Geneva, Switzerland
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How well do nursing staff assess the wellbeing of nursing home residents? An explorative study of using single-question scales. AGEING & SOCIETY 2020. [DOI: 10.1017/s0144686x20001178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
AbstractPerson-centred care requires improved documentation of nursing home resident wellbeing, e.g. by nursing staff proxy assessments. Previous studies mainly focused on proxy self-report agreement of quality of life of people with dementia, using lengthy questionnaires. This is the first study to investigate how well nursing staff assess residents’ wellbeing after training, using a single-question assessment method of happiness and engagement. We conducted a cross-sectional mixed-method study, including proxy assessments from 49 nursing staff, and self-reports from 49 nursing home residents without dementia (mean age 85). We explored agreement between colleagues, and between proxy assessments and self-reports, and potential nursing staff characteristics associated to this (age, experience, hours worked per week). Brief written motivations were evaluated on nursing staffs’ understanding of the happiness and engagement concepts. The results showed low agreement between colleagues, and low agreement between proxy assessments and self-reports. Nursing staff assessed happiness and engagement substantially higher than residents’ self-reports. Hours worked per week was related to happiness proxy assessments, but none of the included nursing staff characteristics were related to proxy self-report agreement. Nursing staff interpreted the concepts in diverse ways. Overestimating resident wellbeing when using this single-assessment method may undermine subsequent efforts to improve wellbeing. We could not identify which nursing staff could best provide wellbeing assessments. For now, proxy wellbeing assessments should always be combined with regular self-reports whenever possible.
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Pérez-Ros P, Vila-Candel R, Martin-Utrilla S, Martínez-Arnau FM. Health-Related Quality of Life in Community-Dwelling Older People with Cognitive Impairment: EQ-5D-3L Measurement Properties. J Alzheimers Dis 2020; 77:1523-1532. [PMID: 32925071 DOI: 10.3233/jad-200806] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Assessing quality of life (QoL) in older people with cognitive impairment is a challenge. There is no consensus on the best tool, but a short, user-friendly scale is advised. OBJECTIVE This study aimed to assess the psychometric properties of the self-reported and generic EQ-5D (including the EQ index and EQ visual analog scale [VAS]) in community-dwelling older adults with cognitive impairment. METHODS Cross-sectional study analyzing the feasibility, acceptability, reliability, and validity of the EQ-5D based on 188 self-administered questionnaires in a sample of community-dwelling older adults with Mini-Mental State Examination (MMSE) scores of 10 to 24 points. RESULTS The EQ index was 0.69 (±0.27) and the EQ VAS was 63.8 (±28.54). Adequate measurement properties were found in acceptability and feasibility. Cronbach's alpha was 0.69. Good validity was observed in the correlation of each dimension of the EQ-5D with geriatric assessment scales. Higher validity was observed for the EQ index compared to the EQ VAS. CONCLUSION The EQ-5D scale could be a good tool for assessing health-related QoL in community-dwelling older adults with cognitive impairment, though it is necessary to assess the dimensions and the EQ index.
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Affiliation(s)
- Pilar Pérez-Ros
- Department of Nursing, Universidad Católica de Valencia San Vicente Mártir, Valencia, Spain.,GRICPAL Research Group, Universidad Católica de Valencia San Vicente Mártir, Valencia, Spain.,Frailty and Cognitive Impairment Research Group (FROG), Universitat de València, Valencia, Spain
| | - Rafael Vila-Candel
- Department of Nursing, Universidad Católica de Valencia San Vicente Mártir, Valencia, Spain.,Department of Obstetrics and Gynecology, Hospital Universitario de la Ribera, FISABIO, Valencia, Spain.,Department of Nursing, Faculty of Nursing and Podiatry, Universitat de València, Valencia, Spain
| | - Salvador Martin-Utrilla
- Department of Nursing, Universidad Católica de Valencia San Vicente Mártir, Valencia, Spain.,GRICPAL Research Group, Universidad Católica de Valencia San Vicente Mártir, Valencia, Spain.,Palliative Care Unit, Valencia Institute of Oncology, Valencia, Spain
| | - Francisco M Martínez-Arnau
- Frailty and Cognitive Impairment Research Group (FROG), Universitat de València, Valencia, Spain.,Department of Physiotherapy, Universitat de València, Valencia, Spain
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Feasibility of Proxy-Reported EQ-5D-3L-Y and Its Agreement in Self-reported EQ-5D-3L-Y for Patients With Adolescent Idiopathic Scoliosis. Spine (Phila Pa 1976) 2020; 45:E799-E807. [PMID: 32539293 DOI: 10.1097/brs.0000000000003431] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective cohort study. OBJECTIVE To compare feasibility of self-reported and proxy-reported youth version of EuroQoL Five-Dimension Three-Level Questionnaire (EQ-5D-3L-Y), to estimate the agreement of health outcome between patients with adolescent idiopathic scoliosis (AIS) and their proxies, and to examine factors that may affect patient-proxy agreement. SUMMARY OF BACKGROUND DATA The EQ-5D-3L-Y questionnaire has both self-reported and proxy-reported versions. Despite previous studies have indicated that proxies tended to respond with higher or lower levels of severity in specific dimensions than patients report, the level of agreement between children with AIS and their proxies remained unknown. METHODS A consecutive sample of patients with AIS and their caregivers were recruited. Feasibility was tested according to the proportion of missing responses. Agreements between self-report and proxy EQ-5D-3L-Y were evaluated using percentage agreement, Gwet agreement coefficients and the intraclass correlation coefficients. Linear regressions and logistic regressions were conducted to assess the factors associated with the agreement in health outcome between self-reported and proxy-reported EQ-5D-3L-Y. RESULTS A total of 130 patient-proxy pairs were involved in the study. Agreement of EQ-5D-3L-Y responses between the self-report and proxy version was good for "Feeling worried/sad/unhappy" dimension, and very good for other dimensions. Poor agreement in visual analog scale score was observed between patient and proxy versions. Proxy's education level, patient's curvature type, and treatment modality were the significant determinants of the agreement in "Mobility," "usual activities," and "pain/discomfort" dimension, respectively. CONCLUSION Proxy-reported EQ-5D-3L-Y demonstrates good feasibility and satisfactory agreement with patient version. Proxy's education appears to have positive influence in agreement between patient-proxy dyads. LEVEL OF EVIDENCE 2.
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Pérez-Ros P, Martínez-Arnau FM. EQ-5D-3L for Assessing Quality of Life in Older Nursing Home Residents with Cognitive Impairment. Life (Basel) 2020; 10:life10070100. [PMID: 32629807 PMCID: PMC7400476 DOI: 10.3390/life10070100] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 06/25/2020] [Accepted: 06/27/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Quality of life (QoL) is recognized as an important patient-reported outcome measure. Assessing QoL in older people with cognitive impairment is a challenge due to discrepancies in the collection of data via proxies versus self-report. This study aimed to assess the psychometric properties of the self-reported EQ-5D (including the EQ index and EQ visual analog scale (VAS)) in nursing homes residents with cognitive impairment and to analyze its validity based on scales included in the comprehensive geriatric assessment. METHODS Cross-sectional, multicenter study analyzing the feasibility, acceptability, reliability, and validity of the EQ-5D based on 251 self-administered questionnaires in a sample of nursing home residents with cognitive impairment. Reference scales were those from the comprehensive geriatric assessment, equivalent to the five dimensions of the EuroQol. RESULTS The EQ index was 0.31 (0.37) and the EQ VAS was 35.96 (29.86), showing adequate acceptability and feasibility. Cronbach's alpha was 0.723. The EQ index and EQ VAS, as outcome variables for multiple linear regression models including CGA titration scales, showed better validity for the EQ index than the EQ VAS. CONCLUSIONS As a self-administered generic scale, the EQ-5D-3L could be a good tool for QoL assessment in nursing home residents with cognitive impairment.
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Affiliation(s)
- Pilar Pérez-Ros
- Department of Nursing, Universidad Católica de Valencia San Vicente Mártir, 46007 Valencia, Spain
- Frailty and Cognitive Impairment Research Group (FROG), University of Valencia, 46010 Valencia, Spain;
- Correspondence:
| | - Francisco M Martínez-Arnau
- Frailty and Cognitive Impairment Research Group (FROG), University of Valencia, 46010 Valencia, Spain;
- Department of Physiotherapy, Universitat de València, 46010 Valencia, Spain
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Michalowsky B, Xie F, Kohlmann T, Gräske J, Wübbeler M, Thyrian JR, Hoffmann W. Acceptability and Validity of the EQ-5D in Patients Living With Dementia. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2020; 23:760-767. [PMID: 32540234 DOI: 10.1016/j.jval.2020.01.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 12/11/2019] [Accepted: 01/22/2020] [Indexed: 05/15/2023]
Abstract
OBJECTIVES To assess the acceptability and validity of the 3 levels of the EQ-5D (EQ-5D-3L) compared with the Quality of Life in Alzheimer's Diseases (QoL-AD) in patients living with dementia. METHODS The analysis was based on 560 dyads of persons with dementia and their caregivers of the multicenter observational study of dementia care networks in Germany (DemNet-D). Health-related quality of life was assessed by face-to-face interviews using the EQ-5D-3L (self-rating) and the QoL-AD (self- and proxy-rating). The number of missing values, the score ranges (observed vs possible range) and the floor and ceiling effects were used to assess the acceptability. We used one-way analyses of variance and multivariate linear regression models to evaluate the discriminative ability. The convergent validity was assessed using Spearman's correlation coefficient (rs) and multivariate regression models. RESULTS The EQ-5D index had a higher response rate (89% vs 84%) and a comparable floor (>1%) but a higher ceiling effect (18% vs >1%) compared with the QoL-AD. Both measures can significantly differentiate between different stages of general health, instrumental activities of daily living, and depression. The EQ-5D index and the visual analog scale self-rating scores strongly correlated with the QoL-AD self-rating (rs = 0.644 and 0.553, respectively) but not with the proxy-rating score (rs = 0.314 and rs = 0.170, respectively), which was confirmed by multivariate regression analyses. CONCLUSION The results satisfy acceptability, discriminative ability, and convergent validity for moderately cognitively and functionally impaired patients living with dementia. The EQ-5D-3L performed comparably with the QoL-AD, and could, therefore, be used in economic evaluations in dementia. The differences between self- and proxy-ratings should be evaluated and considered in the interpretation of health-related quality of life scores.
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Affiliation(s)
- Bernhard Michalowsky
- German Center for Neurodegenerative Diseases, Rostock/Greifswald site, Greifswald, Germany; Program for Health Economics and Outcome Measures, Hamilton, Ontario, Canada
| | - Feng Xie
- Program for Health Economics and Outcome Measures, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence and Impact (formerly Clinical Epidemiology and Biostatistics), McMaster University, Hamilton, Ontario, Canada.
| | - Thomas Kohlmann
- Institute for Community Medicine, Section Methods in Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Johannes Gräske
- Alice Salomon University of Applied Sciences Berlin, Berlin, Germany
| | - Markus Wübbeler
- University of Applied Sciences-Bochum, Department of Nursing Science, Bochum, Germany
| | - Jochen René Thyrian
- German Center for Neurodegenerative Diseases, Rostock/Greifswald site, Greifswald, Germany
| | - Wolfgang Hoffmann
- German Center for Neurodegenerative Diseases, Rostock/Greifswald site, Greifswald, Germany; Institute for Community Medicine, Section Epidemiology of Health Care and Community Health, University Medicine Greifswald, Greifswald, Germany
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13
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Liang Y, Che T, Zhang H, Shang L, Zhang Y, Xu Y, Guo L, Tan Z. Assessing the proxy response bias of EQ-5D-3 L in general population: a study based on a large-scale representative household health survey using propensity score matching. Health Qual Life Outcomes 2020; 18:75. [PMID: 32188480 PMCID: PMC7079393 DOI: 10.1186/s12955-020-01325-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 03/11/2020] [Indexed: 11/30/2022] Open
Abstract
Background Proxy respondent-someone who assists the intended respondent or responds on their behalf-are widely applied in the measurement of health-related quality of life (HRQL). However, proxies may not provide the same responses as the intended respondents, which may bias the findings. Objectives To determine whether the use of proxies is related to socio-demographic characteristics of the intended respondent, and to assess the possible proxy response bias of Chinese version of EQ-5D-3 L in general population. Methods A cross-sectional study based on a provincially representative sample from 2013 National Health Service Survey (NHSS) in Shaanxi, China was performed. HRQL was measured by Chinese version of EQ-5D-3 L. Propensity score matching (PSM) was used to get matched pairs of self-reports and proxy-reports. Before and after PSM, univariate logistic and linear models including the indicator of proxy response as the only independent variable, were employed to assess the possible proxy response bias of the dimensional and overall health status of EQ-5D-3 L respectively. Results 19.9% of the responses involved a proxy. Before PSM, the proxy-report group was younger in age and reported less unhealthy lifestyle, lower prevalence of disease, and less hospitalization than the self-report group. After PSM, it showed that the proxy-report group was statistically more likely to report health problem on each dimension of EQ-5D-3 L, with odds ratios larger than one comparing with self-report group. The means of EQ-5D-3 L index and EQ VAS of proxy-report group were 0.022 and 0.834 lower than self-report group. Conclusions Significantly negative proxy response bias was found in Chinese EQ-5D-3 L in general population, and the magnitude of the bias was larger in physical dimensions than psychological dimensions after using PSM to control confounders.
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Affiliation(s)
- Ying Liang
- Department of Health Statistics, Fourth Military Medical University, Xi'an, Shaanxi Province, China.,Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Tianle Che
- Department of Health Statistics, Fourth Military Medical University, Xi'an, Shaanxi Province, China.,Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Haiyue Zhang
- Department of Health Statistics, Fourth Military Medical University, Xi'an, Shaanxi Province, China.,Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Lei Shang
- Department of Health Statistics, Fourth Military Medical University, Xi'an, Shaanxi Province, China.,Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Yuhai Zhang
- Department of Health Statistics, Fourth Military Medical University, Xi'an, Shaanxi Province, China.,Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Yongyong Xu
- Department of Health Statistics, Fourth Military Medical University, Xi'an, Shaanxi Province, China.,Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Lingxia Guo
- Center of Health Statistics, Health General Office of Shaanxi Province, Xi'an, Shaanxi Province, China
| | - Zhijun Tan
- Department of Health Statistics, Fourth Military Medical University, Xi'an, Shaanxi Province, China. .,Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, Fourth Military Medical University, Xi'an, Shaanxi Province, China.
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14
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Assessing the quality of life and well-being of older adults with physical and cognitive impairments in a German-speaking setting: A systematic review of validity and utility of assessments / Die Erfassung von Lebensqualität und Wohlbefinden älterer Menschen mit psychischen und kognitiven Einschränkungen: ein systematisches Literaturreview zur Validität und Praktikabilität deutschsprachiger Assessments. INTERNATIONAL JOURNAL OF HEALTH PROFESSIONS 2019. [DOI: 10.2478/ijhp-2019-0014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Abstract
Background
For health professionals working with older adults with physical and cognitive impairments, improving or maintaining clients’ quality of life and well-being is of crucial importance. The aim of this study was to evaluate validity and utility of assessments of quality of life and well-being in German suitable for this group of clients.
Methods
In an initial literature search, we identified potentially viable assessments based on existing systematic reviews. We then conducted a systematic literature search in the databases Medline, CINAHL, and PsycINFO using keywords related to validity, utility, client group, and German. Assessments for which sufficient evidence was found were evaluated regarding their validity and utility when used with older adults with physical and cognitive impairments.
Results
For 14 of 27 initially identified assessments, sufficient evidence was found to evaluate validity and utility with this client group. WHOQOL-BREF, WHOQOL-OLD, WHO-5, EUROHIS-QOL 8, SF-36, SF-12, EQ-5D, NHP, SEIQOL-DW, SWLS, PANAS, DQOL, QOL-AD, and QUALIDEM were evaluated based on 82 studies. Of these, WHOQOL-BREF, WHO-5, SF-36, SF-12, EQ-5D, NHP, QUALIDEM, QOL-AD and DQOL are presented here.
Conclusion
Assessments differed widely in the way they operationalized quality of life/well-being, use of self-evaluation or evaluation-by-proxy, and amount of available evidence for their validity and utility. On the basis of our results in regard to the assessments’ validity, utility, and appropriateness of operationalization of quality of life/well-being to the client group, three assessments were recommended for use: WHOQOL-BREF for self-evaluation, QUALIDEM for evaluation-by-proxy in case of severe dementia, and EQ-5D for cost-utility analyses.
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15
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Ho P, Bulsara M, Patman S, Downs J, Bulsara C, Hill AM. Incidence and associated risk factors for falls in adults with intellectual disability. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2019; 63:1441-1452. [PMID: 31497918 DOI: 10.1111/jir.12686] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 06/03/2019] [Accepted: 08/01/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND People with intellectual disability (ID) experience age-related changes earlier in life, and as such, falls among people with ID are of serious concern. Falls can cause injury and consequently reduce quality of life. Limited studies have investigated the incidence of falls among people with ID and the associated risk factors. The purpose of this study was to investigate the incidence of falls and risk factors for falling in people with ID living in the community. METHODS A prospective observational cohort (n = 78) of community-dwelling adults with ID. Characteristics measured at baseline included falls history, medication use, balance and mobility. Falls were reported for 6 months using monthly calendars and phone calls. Data were analysed using univariate and multivariate logistic regression to identify risk factors associated with falling. RESULTS Participants [median (interquartile range) age 49 (43-60) years, female n = 32 (41%)] experienced 296 falls, with 36 (46.2%) participants having one or more falls. The incidence of falls was 5.7 falls (injurious falls = 0.8) per person year (one outlier removed from analysis). A history of falls [adjusted odds ratio (OR): 6.37, 95% confidence interval (CI) (1.90-21.34)] and being ambulant [adjusted OR: 4.50, 95% CI (1.15-17.67)] were associated with a significantly increased risk of falling. Falls were significantly less frequent among participants taking more than four medications [adjusted OR: 0.22, 95% CI (0.06-0.83)] and participants who were continent [adjusted OR: 0.25, 95% CI (0.07-0.91)]. CONCLUSIONS People with ID fall at a younger age compared with the broader community. The associated falls risk factors also differ to older community-dwelling adults. Health professionals should prioritise assessment and management of falls risk in this population.
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Affiliation(s)
- P Ho
- School of Physiotherapy, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - M Bulsara
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - S Patman
- School of Physiotherapy, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - J Downs
- Telethon Kids Institute, Perth Children's Hospital, West Perth, Western Australia, Australia
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - C Bulsara
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - A-M Hill
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
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16
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Martin A, Meads D, Griffiths AW, Surr CA. How Should We Capture Health State Utility in Dementia? Comparisons of DEMQOL-Proxy-U and of Self- and Proxy-Completed EQ-5D-5L. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2019; 22:1417-1426. [PMID: 31806199 DOI: 10.1016/j.jval.2019.07.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 06/07/2019] [Accepted: 07/12/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Dementia-specific and proxy-completed preference-based measures have been proposed for use in intervention studies involving people living in residential care, in instances where generic, self-reported preference-based measures have been deemed inappropriate. OBJECTIVE This study was conducted to investigate the construct validity, criterion validity, and responsiveness of DEMQOL-Proxy-U and of self- and proxy-completed EQ-5D-5L. METHODS The analysis used a 3-wave, individual-level data set of 1004 people living with dementia in residential care that included self-completed EQ-5D-5L and formal-carer and informal-carer proxy-completed EQ-5D-5L and DEMQOL-Proxy-U utility values, in addition to other nonutility cognitive measures (Functional Assessment Staging [FAST], Clinical Dementia Rating [CDR], Cohen-Mansfield Agitation Inventory [CMAI]) and health-related quality of life (HRQOL) measures (nursing home version of the Quality of Life with Alzheimer's disease scale [QOL-AD-NH], Quality of Life in Late-Stage Dementia [QUALID] scale). Construct validity, criterion validity, and responsiveness were assessed using correlation, Bland-Altman plots, and panel data regression models. RESULTS Self-completed EQ-5D-5L failed to reflect clinically important differences and changes in FAST, CDR, and CMAI but did capture the resident's own view of HRQOL (QOL-AD-NH). As dementia severity increased, collection of EQ-5D-5L-proxy and DEMQOL-Proxy-U data was more feasible than collection of self-completed EQ-5D-5L. These formal-carer and informal-carer proxy measures also better reflected changes in FAST, CDR, and CMAI but did not capture the resident's own view of HRQOL (QOL-AD-NH), despite adequately capturing the proxy's own view of the resident's HRQOL (QUALID). This indicates discrepancies between a proxy's view and resident's view of the impact that tangible declines in health, cognition, or functional abilities have on HRQOL. The EQ-5D-5L-proxy and DEMQOL-Proxy-U were generally poor substitutes. Regardless of which proxy completed it, the EQ-5D-5L-proxy was typically more responsive than the DEMQOL-Proxy-U to changes in CDR, FAST, and CMAI, indicating that use of the DEMQOL-Proxy-U is not always justified. CONCLUSION Disparities in the measurement properties of different utility measures mean that choices about how to measure utility in trials could affect economic evaluation outcomes and hence how resources are allocated for dementia care.
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Affiliation(s)
- Adam Martin
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, England, UK.
| | - David Meads
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, England, UK
| | - Alys W Griffiths
- Centre for Dementia Research, School of Health and Community Studies, Leeds Beckett University, Leeds, England, UK
| | - Claire A Surr
- Centre for Dementia Research, School of Health and Community Studies, Leeds Beckett University, Leeds, England, UK
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17
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Exploring self-report and proxy-report quality-of-life measures for people living with dementia in care homes. Qual Life Res 2019; 29:463-472. [PMID: 31646416 PMCID: PMC6994428 DOI: 10.1007/s11136-019-02333-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2019] [Indexed: 12/02/2022]
Abstract
Purpose There are many validated quality-of-life (QoL) measures designed for people living with dementia. However, the majority of these are completed via proxy-report, despite indications from community-based studies that consistency between proxy-reporting and self-reporting is limited. The aim of this study was to understand the relationship between self- and proxy-reporting of one generic and three disease-specific quality-of-life measures in people living with dementia in care home settings. Methods As part of a randomised controlled trial, four quality-of-life measures (DEMQOL, EQ-5D-5L, QOL-AD and QUALID) were completed by people living with dementia, their friends or relatives or care staff proxies. Data were collected from 726 people living with dementia living in 50 care homes within England. Analyses were conducted to establish the internal consistency of each measure, and inter-rater reliability and correlation between the measures. Results Residents rated their quality of life higher than both relatives and staff on the EQ-5D-5L. The magnitude of correlations varied greatly, with the strongest correlations between EQ-5D-5L relative proxy and staff proxy. Internal consistency varied greatly between measures, although they seemed to be stable across types of participants. There was poor-to-fair inter-rater reliability on all measures between the different raters. Discussion There are large differences in how QoL is rated by people living with dementia, their relatives and care staff. These inconsistencies need to be considered when selecting measures and reporters within dementia research.
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18
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Neumann S, Meidert U, Barberà-Guillem R, Poveda-Puente R, Becker H. Effects of an Exergame Software for Older Adults on Fitness, Activities of Daily Living Performance, and Quality of Life. Games Health J 2019; 7:341-346. [PMID: 30325234 DOI: 10.1089/g4h.2017.0079] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND As people become older, the biological process of aging leads to a decline in functional capabilities, which entails difficulties in the performance of daily tasks. Within the "Active and Assisted Living Joint Programme" a consortium from Spain, Germany, and Switzerland developed an interactive Exergame software for older adults to maintain their physical abilities and independence within the daily tasks. SUBJECTS AND METHODS An interventional study was conducted to validate the software. For 3 months, Swiss and Spanish seniors used the system at least three times a week for minimum half an hour in their homes. The physical condition in terms of maintaining or increasing strength, balance, safety, and mobility of the seniors was assessed by using the Berg Balance Scale and the Senior Fitness Test. In addition, the effect on independence within the activities of daily living was assessed by using the Canadian Occupational Performance Measure, the Performance Quality Rating Scale, and the Iconographical Falls Efficacy Scale. We used the EQ 5D to evaluate the "quality of life." RESULTS Twenty-nine participants (male; n = 14; female; n = 15) completed the study. Scores of endurance (2 minutes step test; P = 0.01, η2 = 0.3) increased significantly. Moderate effect sizes in quality of life (r = 0.3), lower body strength (η2 = 0.08), and large effect sizes in endurance (η2 = 0.3) were detected. A small effect was evaluated within the gait speed (r = 0.2), mobility in the lower body (r = 0.2), and the balance capabilities (r = 0.2). CONCLUSION The results of this study lead us to the conclusion that physical training with activity-focused exergames that are related to the everyday tasks of older adults could help to maintain and improve the individual fitness status.
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Affiliation(s)
- Silke Neumann
- 1 School of Health Professions, Institute Occupational Therapy, Research and Development OT, Zurich University of Applied Sciences , Winterthur, Switzerland
| | - Ursula Meidert
- 1 School of Health Professions, Institute Occupational Therapy, Research and Development OT, Zurich University of Applied Sciences , Winterthur, Switzerland
| | - Ricard Barberà-Guillem
- 2 Instituto de Biomecánica de Valencia, Universitat Politècnica de València , València, Spain
| | - Rakel Poveda-Puente
- 2 Instituto de Biomecánica de Valencia, Universitat Politècnica de València , València, Spain
| | - Heidrun Becker
- 1 School of Health Professions, Institute Occupational Therapy, Research and Development OT, Zurich University of Applied Sciences , Winterthur, Switzerland
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19
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Schaap FD, Dijkstra GJ, Stewart RE, Finnema EJ, Reijneveld SA. Effects of Dementia Care Mapping on well-being and quality of life of older people with intellectual disability: A quasi-experimental study. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2019; 32:849-860. [PMID: 30868692 PMCID: PMC6849613 DOI: 10.1111/jar.12576] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 11/15/2018] [Accepted: 01/23/2019] [Indexed: 12/31/2022]
Abstract
Background The ageing of people with intellectual disability, accompanied with consequences like dementia, challenges intellectual disability‐care staff and creates a need for supporting methods, with Dementia Care Mapping (DCM) as a promising possibility. This study examined the effect of DCM on the quality of life of older people with intellectual disability. Methods We performed a quasi‐experimental study in 23 group homes for older people with intellectual disability in the Netherlands, comparing DCM (n = 113) with care‐as‐usual (CAU; n = 111). Using three measures, we assessed the staff‐reported quality of life of older people with intellectual disability. Results DCM achieved no significantly better or worse quality of life than CAU. Effect sizes varied from 0.01 to −0.22. Adjustments for covariates and restriction of analyses to people with dementia yielded similar results. Conclusion The finding that DCM does not increase quality of life of older people with intellectual disability contradicts previous findings and deserves further study.
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Affiliation(s)
- Feija D Schaap
- Research Group Living, Wellbeing and Care for Older People, NHL University of Applied Sciences, Leeuwarden, The Netherlands.,Department of Health Sciences, Community & Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Geke J Dijkstra
- Department of Health Sciences, Applied Health Research, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Roy E Stewart
- Department of Health Sciences, Community & Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Evelyn J Finnema
- Research Group Living, Wellbeing and Care for Older People, NHL University of Applied Sciences, Leeuwarden, The Netherlands
| | - Sijmen A Reijneveld
- Department of Health Sciences, Community & Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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20
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Watts RD, Li IW. Use of Checklists in Reviews of Health Economic Evaluations, 2010 to 2018. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2019; 21:471-481. [PMID: 30832977 DOI: 10.1016/j.jval.2017.09.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 08/31/2017] [Accepted: 09/09/2017] [Indexed: 05/17/2023]
Abstract
OBJECTIVE It is useful for reviewers of economic evaluations to assess quality in a manner that is consistent and comprehensive. Checklists can allow this, but there are concerns about their reliability and how they are used in practice. We aimed to describe how checklists have been used in systematic reviews of health economic evaluations. METHODS Meta-review with snowball sampling. We compiled a list of checklists for health economic evaluations and searched for the checklists' use in systematic reviews from January 2010 to February 2018. We extracted data regarding checklists used, stated checklist function, subject area, number of reviewers, and issues expressed about checklists. RESULTS We found 346 systematic reviews since 2010 that used checklists to assess economic evaluations. The most common checklist in use was developed in 1996 by Drummond and Jefferson, and the most common stated use of a checklist was quality assessment. Checklists and their use varied within subject areas; 223 reviews had more than one reviewer who used the checklist. CONCLUSIONS Use of checklists is inconsistent. Eighteen individual checklists have been used since 2010, many of which have been used in ways different from those originally intended, often without justification. Different systematic reviews in the same subject areas would benefit from using one checklist exclusively, using checklists as intended, and having 2 reviewers complete the checklist. This would increase the likelihood that results are transparent and comparable over time.
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Affiliation(s)
- Rory D Watts
- School of Population and Global Health, The University of Western Australia, Crawley, Australia.
| | - Ian W Li
- School of Population and Global Health, The University of Western Australia, Crawley, Australia
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21
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Harrison SL, Kouladjian O'Donnell L, Bradley CE, Milte R, Dyer SM, Gnanamanickam ES, Liu E, Hilmer SN, Crotty M. Associations between the Drug Burden Index, Potentially Inappropriate Medications and Quality of Life in Residential Aged Care. Drugs Aging 2018; 35:83-91. [PMID: 29322470 DOI: 10.1007/s40266-017-0513-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Inappropriate polypharmacy may negatively impact the quality of life of residents in aged care facilities, but it remains unclear which medications may influence this reduced quality of life. OBJECTIVE The objective of this study was to examine whether the Drug Burden Index and potentially inappropriate medications were associated with quality of life in older adults living in residential care with a high prevalence of cognitive impairment and dementia. METHODS We conducted cross-sectional analyses of 541 individuals recruited from 17 residential aged care facilities in Australia in the Investigating Services Provided in the Residential Environment for Dementia (INSPIRED) study. Quality of life was measured using the EuroQol Five Dimensions Questionnaire (a measure of generic quality of life) and the Dementia Quality of Life Questionnaire completed by the participant or a proxy. RESULTS In the 100 days prior to recruitment, 83.1% of the participants received at least one anticholinergic or sedative medication included in the Drug Burden Index and 73.0% received at least one potentially inappropriate medication according to the Beers Criteria. Multi-level linear models showed there was a significant association between a higher Drug Burden Index and lower quality of life according to the EuroQol Five Dimensions Questionnaire [β (standard error): - 0.034 (0.012), p = 0.006] after adjustment for potential confounding factors. Increasing numbers of potentially inappropriate medications were also associated with lower EuroQol Five Dimensions Questionnaire scores [- 0.030 (0.010), p = 0.003] and Dementia Quality of Life Questionnaire-Self-Report-Utility scores [- 0.020 (0.009), p = 0.029]. Exposure to both Drug Burden Index-associated medications and potentially inappropriate medications was associated with lower Dementia Quality of Life Questionnaire-Self-Report-Utility scores [- 0.034 (0.017), p = 0.049]. CONCLUSION Exposure to anticholinergic and sedative medications and potentially inappropriate medications occurred in over three-quarters of a population of older adults in residential care and was associated with a lower quality of life.
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Affiliation(s)
- Stephanie L Harrison
- Department of Rehabilitation, Aged and Extended Care, Faculty of Medicine, Nursing and Health Sciences, School of Health Sciences, Flinders University, Level 4, Rehabilitation building, Flinders Medical Centre, Flinders Drive, Bedford Park, SA, 5042, Australia. .,NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, NSW, Australia.
| | - Lisa Kouladjian O'Donnell
- NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, NSW, Australia.,Kolling Institute of Medical Research, University of Sydney and Royal North Shore Hospital, St Leonards, 2065, NSW, Australia
| | - Clare E Bradley
- Department of Rehabilitation, Aged and Extended Care, Faculty of Medicine, Nursing and Health Sciences, School of Health Sciences, Flinders University, Level 4, Rehabilitation building, Flinders Medical Centre, Flinders Drive, Bedford Park, SA, 5042, Australia.,NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, NSW, Australia.,Infection and Immunity-Aboriginal Health, SAHMRI, Adelaide, 5001, SA, Australia
| | - Rachel Milte
- Department of Rehabilitation, Aged and Extended Care, Faculty of Medicine, Nursing and Health Sciences, School of Health Sciences, Flinders University, Level 4, Rehabilitation building, Flinders Medical Centre, Flinders Drive, Bedford Park, SA, 5042, Australia.,NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, NSW, Australia.,Institute for Choice, University of South Australia, Adelaide, 5001, SA, Australia
| | - Suzanne M Dyer
- Department of Rehabilitation, Aged and Extended Care, Faculty of Medicine, Nursing and Health Sciences, School of Health Sciences, Flinders University, Level 4, Rehabilitation building, Flinders Medical Centre, Flinders Drive, Bedford Park, SA, 5042, Australia.,NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, NSW, Australia
| | - Emmanuel S Gnanamanickam
- Department of Rehabilitation, Aged and Extended Care, Faculty of Medicine, Nursing and Health Sciences, School of Health Sciences, Flinders University, Level 4, Rehabilitation building, Flinders Medical Centre, Flinders Drive, Bedford Park, SA, 5042, Australia.,NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, NSW, Australia
| | - Enwu Liu
- Department of Rehabilitation, Aged and Extended Care, Faculty of Medicine, Nursing and Health Sciences, School of Health Sciences, Flinders University, Level 4, Rehabilitation building, Flinders Medical Centre, Flinders Drive, Bedford Park, SA, 5042, Australia.,NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, NSW, Australia.,Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, 3001, VIC, Australia
| | - Sarah N Hilmer
- NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, NSW, Australia.,Kolling Institute of Medical Research, University of Sydney and Royal North Shore Hospital, St Leonards, 2065, NSW, Australia
| | - Maria Crotty
- Department of Rehabilitation, Aged and Extended Care, Faculty of Medicine, Nursing and Health Sciences, School of Health Sciences, Flinders University, Level 4, Rehabilitation building, Flinders Medical Centre, Flinders Drive, Bedford Park, SA, 5042, Australia.,NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, NSW, Australia
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Ho P, Bulsara C, Patman S, Bulsara M, Downs J, Hill AM. Investigating falls in adults with intellectual disability living in community settings and their experiences of post-fall care services: protocol for a prospective observational cohort study. BMC Geriatr 2018; 18:171. [PMID: 30060735 PMCID: PMC6065066 DOI: 10.1186/s12877-018-0862-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 07/16/2018] [Indexed: 11/17/2022] Open
Abstract
Background Falls among older adults with intellectual disability (ID) are recognised as a serious health problem potentially resulting in reduced health-related quality of life and premature placement in residential care. However there are limited studies that have investigated this problem and thus falls rates among older adults with ID remain uncertain. Furthermore, people with ID rely heavily on familial and professional care support to address health problems, such as after having a fall. No studies have explored the post-fall care that people with ID receive. Method This research will be carried out in two phases using a convergent mixed methods design. The aim of Phase 1 is to estimate the falls rate by prospectively observing a cohort of older adults (≥ 35 years) with ID (n = 90) for six months. Phase 1 will be conducted according to STROBE guidelines. In Phase 2, participants from Phase 1 who have experienced a fall(s) will be asked to participate in a semi-structured interview to explore their post-fall experience. Discussion This study will determine the rate of falls among older adults with ID living in community based settings, which will assist to identify the extent of this problem. Data collected from the study will also aid in understanding the circumstance of falls and related falls risk factors in this cohort. This will include exploring any barriers that older adults with ID may encounter when seeking or undertaking recommended post-fall care advice. Findings from this research will potentially inform future development of falls prevention services for older adults with ID. This study has been approved by the University Human Research Ethics Committee. Trial registration The protocol for this study is registered with the Australian New Zealand Clinical Trial Registry (ACTRN12615000926538) on 7 September 2015. www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368990&isReview=true
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Affiliation(s)
- Portia Ho
- School of Physiotherapy, The University of Notre Dame Australia, 19 Mouat St, PO Box 1225, Fremantle, WA, 6959, Australia.
| | - Caroline Bulsara
- Institute for Health Research, The University of Notre Dame Australia, 19 Mouat St, PO Box 1225, Fremantle, WA, 6959, Australia
| | - Shane Patman
- School of Physiotherapy, The University of Notre Dame Australia, 19 Mouat St, PO Box 1225, Fremantle, WA, 6959, Australia
| | - Max Bulsara
- Institute for Health Research, The University of Notre Dame Australia, 19 Mouat St, PO Box 1225, Fremantle, WA, 6959, Australia
| | - Jenny Downs
- Telethon Kids Institute, 100 Roberts Road, Subiaco, PO Box 855, West Perth, Western, 6872, Australia.,School of Physiotherapy and Exercise Science, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia
| | - Anne-Marie Hill
- School of Physiotherapy and Exercise Science, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia
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23
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Montgomery W, Goren A, Kahle-Wrobleski K, Nakamura T, Ueda K. Alzheimer's disease severity and its association with patient and caregiver quality of life in Japan: results of a community-based survey. BMC Geriatr 2018; 18:141. [PMID: 29898679 PMCID: PMC6000944 DOI: 10.1186/s12877-018-0831-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 05/29/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Alzheimer's disease (AD) dementia, a progressive neurodegenerative disease, exerts significant burden upon patients, caregivers, and healthcare systems globally. The current study investigated the associations between AD dementia patient disease severity and health-related quality of life (HRQoL) of both patients (proxy report) and their caregivers living in Japan, as well as caregiving-related comorbidities such as depression. METHODS This cross-sectional study used self-reported data from caregivers of people diagnosed with AD dementia by a healthcare provider in Japan. Caregivers were identified via online panels and invited to participate in an online survey between 2014 and 2015. Caregivers completed survey items for themselves, in addition to providing proxy measures for patients with AD dementia for whom they were caring. Patient and caregiver HRQoL was measured using the EuroQoL 5-Dimension (EQ-5D). Additional outcomes for caregivers of AD dementia patients included the Patient Health Questionnaire (PHQ-9) of depressive symptomology, as well as comorbidities experienced since initiating caregiving for their AD dementia patients. These outcomes were examined as a function of AD dementia severity, as measured by long-term care insurance (LTCI) categories. Bivariate analyses between LTCI and outcomes were conducted using independent t-tests and chi-square tests. Multivariable analyses, controlling for potential confounders, were conducted using generalized linear models (GLMs) specifying a normal distribution. RESULTS Across 300 caregiver respondents, multivariable results revealed that increasing AD dementia severity was significantly associated with poorer patient and caregiver EQ-5D scores and a high proportion of caregivers (30.0%) reported PHQ-9 scores indicative of major depressive disorder (MDD). The most frequent comorbidities experienced after becoming caregivers of AD dementia patients included hypertension (12.7%) and insomnia (11.0%). Depression and other comorbidities did not differ significantly by patient severity. CONCLUSIONS The current study provides unique insight into the specific degree of incremental burden associated with increasing AD dementia severity among patients and caregivers alike. Importantly, greater disease severity was associated with poorer quality of life among both patients and caregivers. These results suggest that earlier detection and treatment of AD dementia may provide an opportunity to reduce the burden of disease for patients, caregivers, and society at large.
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Affiliation(s)
- William Montgomery
- Global Patient Outcomes & Real World Evidence, Eli Lilly Australia, 112 Wharf Rd, West Ryde, NSW 2114 Australia
| | - Amir Goren
- Health Outcomes Practice, Kantar Health, 11 Madison Ave, Floor 12, New York, NY 10010 USA
| | - Kristin Kahle-Wrobleski
- Global Patient Outcomes & Real World Evidence, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 46285 USA
| | - Tomomi Nakamura
- Medical Development Unit, Eli Lilly Japan K.K, 4-15-1, Akasaka, Minato-ku, Tokyo, 107-0052 Japan
| | - Kaname Ueda
- Health Outcomes, Health Technology Assessment, & Real World Evidence, Medical Development Unit, Eli Lilly Japan K.K, 5-1-28, Isogami-dori, chuou-ku, Kobe, 651-0086 Japan
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24
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Easton T, Milte R, Crotty M, Ratcliffe J. An empirical comparison of the measurement properties of the EQ-5D-5L, DEMQOL-U and DEMQOL-Proxy-U for older people in residential care. Qual Life Res 2018; 27:1283-1294. [PMID: 29305782 PMCID: PMC5891554 DOI: 10.1007/s11136-017-1777-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2017] [Indexed: 11/24/2022]
Abstract
PURPOSE This study aimed to empirically compare the measurement properties of self-reported and proxy-reported (in cases of severe cognitive impairment) generic (EQ-5D-5L) and condition-specific (DEMQOL-U and DEMQOL-Proxy-U) preference-based HRQoL instruments in residential care, where the population is characterised by older people with high rates of cognitive impairment, dementia and disability. METHODS Participants were recruited from seventeen residential care facilities across four Australian states. One hundred and forty-three participants self-completed the EQ-5D-5L and the DEMQOL-U while three hundred and eight-seven proxy completed (due to the presence of severe dementia) the EQ-5D-5L and DEMQOL-Proxy-U. The convergent validity of the outcome measures and known group validity relative to a series of clinical outcome measures were assessed. RESULTS Results satisfy convergent validity among the outcome measures. EQ-5D-5L and DEMQOL-U utilities were found to be significantly correlated with each other (p < 0.01) as were EQ-5D-5L and DEMQOL-Proxy-U utilities (p < 0.01). Both self-reported and proxy-reported EQ-5D-5L utilities demonstrated strong known group validity in relation to clinically recognised thresholds of cognition and physical functioning, while in contrast neither DEMQOL-U nor DEMQOL-Proxy-U demonstrated this association. CONCLUSIONS The findings suggest that the EQ-5D-5L, DEMQOL-U and DEMQOL-Proxy-U capture distinct aspects of HRQoL for this population. The measurement and valuation of HRQoL form an essential component of economic evaluation in residential care. However, high levels of cognitive impairment may preclude self-completion for a majority. Further research is needed to determine cognition thresholds beyond which an individual is unable to reliably self-report their own health-related quality of life.
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Affiliation(s)
- Tiffany Easton
- Flinders Health Economics Group, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
- NHMRC Partnership Centre on Dealing with Cognitive and Related Functional Decline in Older People, University of Sydney, Sydney, NSW, Australia
| | - Rachel Milte
- Institute for Choice, Business School, University of South Australia, Adelaide, SA, Australia
- NHMRC Partnership Centre on Dealing with Cognitive and Related Functional Decline in Older People, University of Sydney, Sydney, NSW, Australia
| | - Maria Crotty
- NHMRC Partnership Centre on Dealing with Cognitive and Related Functional Decline in Older People, University of Sydney, Sydney, NSW, Australia
- Rehabilitation, Aged and Extended Care, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Julie Ratcliffe
- Institute for Choice, Business School, University of South Australia, Adelaide, SA, Australia.
- NHMRC Partnership Centre on Dealing with Cognitive and Related Functional Decline in Older People, University of Sydney, Sydney, NSW, Australia.
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25
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Ratcliffe J, Flint T, Easton T, Killington M, Cameron I, Davies O, Whitehead C, Kurrle S, Miller M, Liu E, Crotty M. An Empirical Comparison of the EQ-5D-5L, DEMQOL-U and DEMQOL-Proxy-U in a Post-Hospitalisation Population of Frail Older People Living in Residential Aged Care. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2017; 15:399-412. [PMID: 27882528 DOI: 10.1007/s40258-016-0293-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To empirically compare the measurement properties of the DEMQOL-U and DEMQOL-Proxy-U instruments to the EQ-5D-5L and its proxy version (CEQ-5D-5L) in a population of frail older people living in residential aged care in the post-hospitalisation period following a hip fracture. METHODS A battery of instruments to measure health-related quality of life (HRQoL), cognition, and clinical indicators of depression, pain and functioning were administered at baseline and repeated at 4 weeks' follow-up. Descriptive summary statistics were produced and psychometric analyses were conducted to assess the levels of agreement, convergent validity and known group validity between clinical indicators and HRQoL measures. RESULTS There was a large divergence in mean (SD) utility scores at baseline for the EQ-5D-5L and DEMQOL-U [EQ-5D-5L mean 0.21 (0.19); DEMQOL-U mean 0.79 (0.14)]. At 4 weeks' follow-up, there was a marked improvement in EQ-5D-5L scores whereas DEMQOL-U scores had deteriorated. [EQ-5D-5L mean 0.45 (0.38); DEMQOL-U mean 0.58 (0.38)]. The EQ-5D and CEQ-5D-5L were more responsive to the physical recovery trajectory experienced by frail older people following surgery to repair a fractured hip, whereas the DEMQOL-U and DEMQOL-Proxy-U appeared more responsive to the changes in delirium and dementia symptoms often experienced by frail older people in this period. CONCLUSIONS This study presents important insights into the HRQoL of a relatively under-researched population of post-hospitalisation frail older people in residential care. Further research should investigate the implications for economic evaluation of self-complete versus proxy assessment of HRQoL and the choice of preference-based instrument for the measurement and valuation of HRQoL in older people exhibiting cognitive decline, dementia and other co-morbidities.
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Affiliation(s)
- Julie Ratcliffe
- Flinders Health Economics Group, School of Medicine, Flinders University, Adelaide, SA, Australia.
| | - Thomas Flint
- Flinders Health Economics Group, School of Medicine, Flinders University, Adelaide, SA, Australia
| | - Tiffany Easton
- Department of Rehabilitation and Aged Care, School of Health Sciences, Flinders University, Adelaide, Australia
| | - Maggie Killington
- Department of Rehabilitation and Aged Care, School of Health Sciences, Flinders University, Adelaide, Australia
| | - Ian Cameron
- John Walsh Centre for Rehabilitation Research, Kolling Institute, University of Sydney, Sydney, Australia
| | - Owen Davies
- Department of Rehabilitation and Aged Care, School of Health Sciences, Flinders University, Adelaide, Australia
| | - Craig Whitehead
- Department of Rehabilitation and Aged Care, School of Health Sciences, Flinders University, Adelaide, Australia
| | - Susan Kurrle
- John Walsh Centre for Rehabilitation Research, Kolling Institute, University of Sydney, Sydney, Australia
| | - Michelle Miller
- Department of Nutrition and Dietetics, School of Health Sciences, Flinders University, Adelaide, Australia
| | - Enwu Liu
- Department of Rehabilitation and Aged Care, School of Health Sciences, Flinders University, Adelaide, Australia
| | - Maria Crotty
- Department of Rehabilitation and Aged Care, School of Health Sciences, Flinders University, Adelaide, Australia
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Martinez-Martin P, Rodriguez-Blazquez C, Forjaz MJ, Kurtis MM, Skorvanek M. Measurement of Nonmotor Symptoms in Clinical Practice. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2017; 133:291-345. [PMID: 28802923 DOI: 10.1016/bs.irn.2017.04.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Nonmotor symptoms constitute a prominent part of Parkinson's disease manifestations. They are present since the first phases of the disease, increase their number and severity with disease progression, and importantly impact on patients' health and quality of life, caregivers' burden, and social resources. Research on Parkinson's disease has traditionally focused on the motor aspects of the disease, but an increasing interest in the nonmotor manifestations has risen in the past decade. The availability of assessment instruments for detecting and measuring these symptoms has allowed understanding of their importance and course over time, as well as estimation of therapeutic effects on them. In this chapter, a review of the basic characteristics of nonmotor symptom assessments used in clinical practice and research are presented.
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Affiliation(s)
- Pablo Martinez-Martin
- National Center of Epidemiology and CIBERNED, Institute of Health Carlos III, Madrid, Spain.
| | | | - Maria João Forjaz
- National School of Public Health and REDISSEC, Institute of Health Carlos III, Madrid, Spain
| | - Monica M Kurtis
- Movement Disorders Unit, Hospital Ruber Internacional, Madrid, Spain
| | - Matej Skorvanek
- P.J. Safarik University, Kosice, Slovakia; University Hospital of L. Pasteur, Kosice, Slovakia
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Sarabia-Cobo CM, Parás-Bravo P, Amo-Setién FJ, Alconero-Camarero AR, Sáenz-Jalón M, Torres-Manrique B, Sarabia-Lavín R, Fernández-Rodríguez A, Silio-García T, Fernández-Peña R, Paz-Zulueta M, Santibáñez-Margüello M. Validation of the Spanish Version of the ICECAP-O for Nursing Home Residents with Dementia. PLoS One 2017; 12:e0169354. [PMID: 28068375 PMCID: PMC5222189 DOI: 10.1371/journal.pone.0169354] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 12/15/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Measurement of health-related quality of life (HRQoL) is important for a chronic disease, such as dementia, which impairs the quality of life of affected patients in addition to their length of life. This is important in the context of economic evaluations when interventions do not (only) affect HRQoL and these other factors also affect overall quality of life. OBJECTIVE To validate the Spanish translation of the ICECAP-O's capability to measure Health-related quality of life in elderly with dementia who live in nursing homes. METHOD Cross-sectional study. For 217 residents living in 8 Spanish nursing homes, questionnaires were completed by nursing professionals serving as proxy respondents. We analyzed the internal consistency and other psychometric properties. We investigated the convergent validity of the ICECAP-O with other HRQoL instruments, the EQ-5D extended with a cognitive dimension (EQ-5D+C), the Alzheimer's Disease Related Quality of Life (ADRQL) measures, and the Barthel Index measure of activities of daily living (ADL). RESULTS The ICECAP-O presents satisfactory internal consistency (alpha 0.820). The factorial analysis indicated a structure of five principal dimensions that explain 66.57% of the total variance. Convergent validity between the ICECAP-O, EQ-5D+C, ADRQL, and Barthel Index scores was moderate to good (with correlations of 0.62, 0.61, and 0.68, respectively), but differed between dimensions of the instruments. Discriminant validity was confirmed by finding differences in ICECAP-O scores between subgroups based on ADL scores (0.70 low, 0.59 medium, and 0.39 high level care), dementia severity (0.72 mild, 0.63 medium, and 0.50 severe), and ages (0.59 below 75 years and 0.84 above 75 years). CONCLUSIONS This study presented the first use of a Spanish version of the ICECAP-O. The results indicate that the ICECAP-O appears to be a reliable Health-related quality of life measurement instrument showing good convergent and discriminant validity for people with dementia.
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Leontjevas R, Teerenstra S, Smalbrugge M, Koopmans RT, Gerritsen DL. Quality of life assessments in nursing homes revealed a tendency of proxies to moderate patients' self-reports. J Clin Epidemiol 2016; 80:123-133. [DOI: 10.1016/j.jclinepi.2016.07.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 07/09/2016] [Accepted: 07/18/2016] [Indexed: 10/21/2022]
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Wijers IGM, Ayala A, Rodriguez-Blazquez C, Rodriguez-Laso A, Rodriguez-Rodriguez V, Forjaz MJ. Disease burden morbidity assessment by self-report: Psychometric properties in older adults in Spain. Geriatr Gerontol Int 2016; 17:1102-1108. [PMID: 27426678 DOI: 10.1111/ggi.12835] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 02/09/2016] [Accepted: 04/26/2016] [Indexed: 11/30/2022]
Abstract
AIM To carry out an analysis of the psychometric properties of the Disease Burden Morbidity Assessment (DBMA) according to the assumptions of the Classical Test Theory. METHODS A sample of 707 community-dwelling adults aged 65 years and older, living in Spain, completed the DBMA. Psychometric properties of the scale (feasibility, acceptability, scaling assumptions, reliability and construct validity) were analyzed. RESULTS The mean DBMA score was 6.8. Feasibility and acceptability were satisfactory, except for large floor effects (>50%), as well as a skewed distribution (1.8). Item-total corrected correlation ranged 0.10-0.49, item homogeneity index was 0.09 and Cronbach's alpha was 0.72. Disease burden correlated strongly with physical functioning (r = -0.56) and perceived health (r = -0.56), and moderately with depression (r = 0.41) and the Personal Wellbeing Index (r = -0.41). Exploratory factor analysis extracted five factors, explaining 44% of the variance. CONCLUSIONS The DBMA is an acceptable and valid instrument for measuring disease burden in older adults. Future studies should include Rasch analysis to further assess dimensionality and explore other measurement properties. Geriatr Gerontol 2017; 17: 1102-1108.
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Affiliation(s)
- Irene G M Wijers
- Department of Preventive Medicine and Quality Management, General University Hospital Gregorio Marañón, Madrid, Spain
| | - Alba Ayala
- National School of Public Health, Institute of Health Carlos III and REDISSEC, Madrid, Spain
| | | | - Angel Rodriguez-Laso
- Department of Pharmacology and Biotechnology, Universidad Europea, Madrid, Spain
| | | | - Maria João Forjaz
- National School of Public Health, Institute of Health Carlos III and REDISSEC, Madrid, Spain
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Chevreul K, Gandré C, Brigham KB, López-Bastida J, Linertová R, Oliva-Moreno J, Serrano-Aguilar P, Posada-de-la-Paz M, Taruscio D, Schieppati A, Iskrov G, Gulácsi L, von der Schulenburg JMG, Kanavos P, Persson U, Fattore G. Social/economic costs and health-related quality of life in patients with fragile X syndrome in Europe. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2016; 17 Suppl 1:43-52. [PMID: 27072054 DOI: 10.1007/s10198-016-0784-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 01/13/2016] [Indexed: 05/07/2023]
Abstract
OBJECTIVE To estimate the social/economic costs of fragile X syndrome (FXS) in Europe and to assess the health-related quality of life (HRQOL) of patients and caregivers. METHODS A cross-sectional study was conducted in a sample of European countries. Patients were recruited through patients' associations. Data on their resource use and absence from the labour market were retrospectively obtained from an online questionnaire. Costs were estimated by a bottom-up approach and the EuroQol-5 Domain (EQ-5D) questionnaire was used to measure patients' and caregivers' HRQOL. RESULTS Five countries were included in the analysis. The mean annual cost of FXS per patient varied from €4951 in Hungary to €58,862 in Sweden. Direct non-healthcare costs represented the majority of costs in all countries but there were differences in the share incurred by formal and informal care among those costs. Costs were also shown to differ between children and adults. Mean EQ-5D utility score for adult patients varied from 0.52 in France (n = 42) to 0.73 in Hungary (n = 2), while for caregivers this score was consistently inferior to 0.87. CONCLUSION Our findings underline that, although its prevalence is low, FXS is costly from a societal perspective. They support the development of tailored policies to reduce the consequences of FXS on both patients and their relatives.
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Affiliation(s)
- Karine Chevreul
- URC Eco Ile de France, AP-HP, Paris, France.
- Université Paris Diderot, Sorbonne Paris Cité, ECEVE, UMRS 1123, Paris, France.
- INSERM, ECEVE, U1123, Paris, France.
| | - Coralie Gandré
- URC Eco Ile de France, AP-HP, Paris, France
- Université Paris Diderot, Sorbonne Paris Cité, ECEVE, UMRS 1123, Paris, France
- INSERM, ECEVE, U1123, Paris, France
| | - Karen Berg Brigham
- URC Eco Ile de France, AP-HP, Paris, France
- Université Paris Est, Créteil, France
| | - Julio López-Bastida
- University of Castilla-La Mancha, Talavera De La Reina, Toledo, Spain
- Red de Investigación en Servicios Sanitarios en Enfermedades Crónicas (REDISSEC), Madrid, Spain
| | - Renata Linertová
- Red de Investigación en Servicios Sanitarios en Enfermedades Crónicas (REDISSEC), Madrid, Spain
- Fundación Canaria de Investigación Sanitaria (FUNCANIS), Las Palmas de Gran Canaria, Spain
| | - Juan Oliva-Moreno
- Red de Investigación en Servicios Sanitarios en Enfermedades Crónicas (REDISSEC), Madrid, Spain
- University of Castilla-La Mancha, Toledo, Spain
| | - Pedro Serrano-Aguilar
- Red de Investigación en Servicios Sanitarios en Enfermedades Crónicas (REDISSEC), Madrid, Spain
- Evaluation and Planning Service at Canary Islands Health Service, Santa Cruz de Tenerife, Spain
| | | | - Domenica Taruscio
- National Center for Rare Diseases, Istituto Superiore di Sanità (ISS), Rome, Italy
| | - Arrigo Schieppati
- Centro di Ricerche Cliniche per Malattie Rare Aldo e Cele Daccò, Istituto di Ricerche Farmacologiche Mario Negri, Ranica (Bergamo), Italy
| | - Georgi Iskrov
- Institute of Rare Diseases, Plovdiv, Bulgaria
- Department of Social Medicine and Public Health, Faculty of Public Health, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - László Gulácsi
- Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary
| | | | - Panos Kanavos
- Department of Social Policy and LSE Health, London School of Economics and Political Science, London, UK
| | - Ulf Persson
- The Swedish Institute for Health Economics, Lund, Sweden
| | - Giovani Fattore
- Centre for Research on Health and Social Care Management (CERGAS), Bocconi University, Milan, Italy
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Abstract
BACKGROUND The goal of the study was to analyze the factors associated with quality of life (QoL) in institutionalized older adults with dementia, based on self and proxy ratings, and if these characteristics differ by dementia severity. METHODS Cross-sectional study of 525 people with dementia (PwD) and their caregivers (professional or family caregivers). Two different QoL questionnaires, leading to three measures, were used: QoL in Alzheimer's disease scale (QOL-AD), self and proxy-rated, and QoL in late-stage dementia scale (QUALID), proxy-rated. Multivariate linear regression models were tested for each QoL measure and for mild/moderate and severe stages of dementia. RESULTS Multiple regression analyses showed a significant association between the three QoL measures and depression. Functional ability was significantly associated with QoL when assessed by proxy. Other factors such as education level, leisure activities and frequency of visits were significantly related with QOL-AD by proxy. The associated factors that differed by dementia severity were education level for moderate dementia, and frequency of visits and who answered the questionnaire (professional vs. family member) for severe dementia. CONCLUSIONS QoL was consistently associated with depressive symptoms independently of the measures as well as functional ability and social leisure activities when the QoL questionnaire was rated by proxy. Treating depressive symptoms, increasing social activities and maintaining the functional ability may decrease the deterioration of QoL in institutionalized older adults with dementia.
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Chevreul K, Berg Brigham K, Brunn M, des Portes V. Fragile X syndrome: economic burden and health-related quality of life of patients and caregivers in France. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2015; 59:1108-1120. [PMID: 26369667 DOI: 10.1111/jir.12215] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 07/03/2015] [Accepted: 07/21/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Fragile X syndrome (FXS) is the main hereditary cause of intellectual disability. Although the associated burden appears to be considerable, to date no study has comprehensively assessed the cost incurred because of FXS, including its specific impact on health-related quality of life and the burden on caregivers using standardised quantitative tools. The aim of this article is to provide data in order to increase awareness of the repercussions of FXS on patients and caregivers as well as on the health and social care systems in France. METHODS A retrospective cross-sectional study was carried out on 145 patients recruited through Le Goëland X-Fragile and Mosaïques, the French FXS patient associations. Data on their demographic characteristics and resource use were obtained from an online questionnaire, and costs were estimated by a bottom-up approach. The EQ-5D health questionnaire was used to measure patients' and caregivers' health-related quality of life. Perceived burden of care was measured using the Zarit Caregiver Burden Interview. The Barthel index, a non-utility-based assessment, was used to measure patients' level of dependence. RESULTS The annual total direct cost of FXS was estimated at €25 800 per patient. The main contributors were informal care provided by the main caregiver (€10 500) and social services (€8400). Healthcare costs, estimated at €2700, represented only a minor share. Mean EQ-5D utility scores were 0.49 for patients and 0.75 for caregivers. The mean burden for caregivers as measured by the Zarit Caregiver Burden Interview was 39.9. CONCLUSIONS Fragile X syndrome requires significant resources that are mainly of a non-medical nature and are higher for children than for adults. Compared with related diseases, it constitutes a particularly high burden for caregivers. Using a bottom-up approach and a wide range of standardised measures, this study underscores the need for greater awareness of the burden of FXS as well as an assessment of new and existing interventions to address it.
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Affiliation(s)
- K Chevreul
- URC Eco Ile-de-France, DRCD, AP-HP, Paris, France
- ECEVE, UMRS 1123, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
- ECEVE, UMRS 1123, Inserm, Paris, France
| | - K Berg Brigham
- URC Eco Ile-de-France, DRCD, AP-HP, Paris, France
- Université Paris-Est Créteil Val de Marne, UFR de médecine (Laboratoire CEPIA), Créteil, France
| | - M Brunn
- URC Eco Ile-de-France, DRCD, AP-HP, Paris, France
- ECEVE, UMRS 1123, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
- ECEVE, UMRS 1123, Inserm, Paris, France
| | - V des Portes
- Centre de Réference National "X fragile et autres déficiences intellectuelles de causes rares", CIC1407-INSERM, Hospices Civils de Lyon, Université Lyon1, Bron, France
- CNRS UMR 5304, L2C2, Bron, France
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Pottel L, Lycke M, Boterberg T, Pottel H, Goethals L, Duprez F, Rottey S, Lievens Y, Van Den Noortgate N, Geldhof K, Buyse V, Kargar-Samani K, Ghekiere V, Debruyne PR. G-8 indicates overall and quality-adjusted survival in older head and neck cancer patients treated with curative radiochemotherapy. BMC Cancer 2015; 15:875. [PMID: 26553007 PMCID: PMC4640221 DOI: 10.1186/s12885-015-1800-1] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 10/16/2015] [Indexed: 12/12/2022] Open
Abstract
Background Evidence-based guidelines concerning the older head and neck cancer (HNCA) patient are lacking. Accurate patient selection for optimal care management is therefore challenging. We examined if geriatric assessment is indicative of long-term health-related quality of life (HRQOL) and overall survival in this unique population. Methods All HNCA patients, aged ≥65 years, eligible for curative radio(chemo)therapy were evaluated with the Geriatric-8 (G-8) questionnaire and a comprehensive geriatric assessment (CGA). Euroqol-5 dimensions (EQ-5D) and survival were collected until 36 months post treatment start. Repeated measures ANOVA was applied to analyse HRQOL evolution in ‘fit’ and ‘vulnerable’ patients, defined by G-8. Kaplan-Meier curves and cox proportional hazard analysis were established for determination of the prognostic value of geriatric assessments. Quality-adjusted survival was calculated in both patient subgroups. Results One hundred patients were recruited. Seventy-two percent of patients were considered vulnerable according to CGA (≥2 abnormal tests). Fit patients maintained a relatively acceptable long-term HRQOL, whilst vulnerable patients showed significantly lower median health states. The difference remained apparent at 36 months. Vulnerability, as classified by G-8 or CGA, came forward as independent predictor for lower EQ-5D index scores. After consideration of confounders, a significantly lower survival was observed in patients defined vulnerable according to G-8, compared to fit patients. A similar trend was seen based on CGA. Calculation of quality-adjusted survival showed significantly less remaining life months in perfect health in vulnerable patients, compared to fit ones. Conclusions G-8 is indicative of quality-adjusted survival, and should be considered at time of treatment decisions for the older HNCA patient. Electronic supplementary material The online version of this article (doi:10.1186/s12885-015-1800-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lies Pottel
- Kortrijk Cancer Centre, General Hospital Groeninge, campus loofstraat, Cancer Centre, Loofstraat 43, B-8500, Kortrijk, Belgium.
| | - Michelle Lycke
- Kortrijk Cancer Centre, General Hospital Groeninge, campus loofstraat, Cancer Centre, Loofstraat 43, B-8500, Kortrijk, Belgium.
| | - Tom Boterberg
- Department of Radiation Oncology, Ghent University Hospital, De Pintelaan 185, B-9000, Ghent, Belgium.
| | - Hans Pottel
- Department of Public Health and Primary Care, Subfaculty of Medicine, Catholic University Leuven Kulak, Etienne Sabbelaan 53, B-8500, Kortrijk, Belgium.
| | - Laurence Goethals
- Kortrijk Cancer Centre, General Hospital Groeninge, campus loofstraat, Cancer Centre, Loofstraat 43, B-8500, Kortrijk, Belgium.
| | - Fréderic Duprez
- Department of Radiation Oncology, Ghent University Hospital, De Pintelaan 185, B-9000, Ghent, Belgium.
| | - Sylvie Rottey
- Department of Medical Oncology, Ghent University Hospital, De Pintelaan 185, B-9000, Ghent, Belgium.
| | - Yolande Lievens
- Department of Radiation Oncology, Ghent University Hospital, De Pintelaan 185, B-9000, Ghent, Belgium.
| | - Nele Van Den Noortgate
- Department of Geriatrics, Ghent University Hospital, De Pintelaan 185, B-9000, Ghent, Belgium.
| | - Kurt Geldhof
- Department of Internal Medicine, Jan Yperman Hospital, Briekestraat 12, B-8900, Ypres, Belgium.
| | - Véronique Buyse
- Department of Internal Medicine, General Hospital OLV Lourdes, Vijfseweg 150, B-8790, Waregem, Belgium.
| | - Khalil Kargar-Samani
- Department of Oncology, Centre Hospitalier de Wallonie Picarde, RHMS, Chaussée de Saint-Amand 80, B-7500, Tournai, Belgium.
| | - Véronique Ghekiere
- Department of Geriatrics, General Hospital Groeninge, Reepkaai 4, B-8500, Kortrijk, Belgium.
| | - Philip R Debruyne
- Kortrijk Cancer Centre, General Hospital Groeninge, campus loofstraat, Cancer Centre, Loofstraat 43, B-8500, Kortrijk, Belgium. .,Ageing & Cancer Research Cluster, Centre for Positive Ageing, University of Greenwich, Avery Hill Rd., SE9 2UG, Eltham, London, UK.
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Yang SE, Park YG, Han K, Min JA, Kim SY. Dental pain related to quality of life and mental health in South Korean adults. PSYCHOL HEALTH MED 2015; 21:981-92. [PMID: 26456324 DOI: 10.1080/13548506.2015.1098781] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
High levels of stress, anxiety and depression have been reported in patients with orofacial pain. Dental pain has the potential to reduce quality of life (QOL), and pain relief is important aspect of QOL. The purpose of this study was to assess the relationships of dental pain with QOL and mental health using a nationally representative, population-based study. This study analyzed data from the 2012 Korea National Health and Nutrition Examination Survey (N = 5469). Oral health status was assessed using the oral health questionnaire, and oral examination was performed by trained dentists. Health-related QOL (HRQOL) was evaluated using EQ-5D and EQ-VAS, and mental health was evaluated by questionnaires. Logistic regression was applied to estimate adjusted odds ratios (AOR) and 95% confidence intervals (CI). Among 5469 adults, 1992 (36.42%) presented self-reported dental pain. Participants with anxiety/depression or pain/discomfort, and participants with stress, melancholy, suicidal thought or depression showed significantly higher prevalence of dental pain. After adjusting for covariates, five aspects of QOL and five aspects of mental health were related with dental pain. The AORs (95% CI) for dental pain were 1.39 (1.06-1.81) for mobility, 1.77 (1.19-2.63) for self-care, 1.38 (1.02-1.85) for usual activities, 1.73 (1.43-2.09) for pain/discomfort and 1.50 (1.13-1.98) for anxiety/depression. For mental health status factors, the AORs (95% CI) for dental pain were 1.29 (1.11-1.51) for stress, 1.37 (1.09-1.74) for melancholy, 1.26 (1.01-1.58) for suicidal thoughts, 1.43 (.93-2.19) for consultation to psychiatrist and 1.53 (1.07-2.19) for depression. This study showed that dental pain has an association with lower HRQOL and worse mental health status in South Korean adults.
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Affiliation(s)
- Sung-Eun Yang
- a Department of Conservative Dentistry , Seoul St. Mary's Dental Hospital, College of Medicine, The Catholic University of Korea , Seoul , Republic of Korea
| | - Yong-Gyu Park
- b Department of Biostatistics , College of Medicine, The Catholic University of Korea , Seoul , Republic of Korea
| | - Kyungdo Han
- b Department of Biostatistics , College of Medicine, The Catholic University of Korea , Seoul , Republic of Korea
| | - Jung-Ah Min
- c Department of Psychiatry , Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea , Seoul , Republic of Korea
| | - Sin-Young Kim
- a Department of Conservative Dentistry , Seoul St. Mary's Dental Hospital, College of Medicine, The Catholic University of Korea , Seoul , Republic of Korea
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Aguirre E, Kang S, Hoare Z, Edwards RT, Orrell M. How does the EQ-5D perform when measuring quality of life in dementia against two other dementia-specific outcome measures? Qual Life Res 2015; 25:45-9. [PMID: 26163146 DOI: 10.1007/s11136-015-1065-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2015] [Indexed: 12/18/2022]
Abstract
PURPOSE This study aimed to assess and compare the psychometric performance of the EQ-5D in relation to other dementia-specific measures, the QoL-AD and DEMQoL, within a psychosocial intervention study. METHODS Two hundred and seventy-two people with dementia completed the EQ-5D, DEMQoL and QoL-AD. Convergent and discriminant validity of the measures were assessed, and inter-rater reliability was tested by comparing the self-reported and proxy scores of the measures. Internal consistency was tested using Cronbach's alpha. RESULTS Results satisfy convergent validity amongst the three outcome measures. EQ-5D, DEMQoL and QoL-AD total scores were shown to be significantly correlated with each other (p < 0.001) in both participants with dementia and proxy reports. Results also satisfied discriminant validity for participant EQ-5D, DEMQoL and QoL-AD total scores. In relation to reliability between self and proxy scores, the EQ-5D showed higher reliability scores between participant and proxy total scores for mild and moderate level of cognitive impairment and performed better than the dementia-specific measures. Reliability assessed through Cronbach's alpha was satisfactory, indicating adequate internal consistency of all three measures. CONCLUSIONS The results suggest that the EQ-5D might have advantages over other dementia-specific measures, and it could be used routinely and as a stand-alone measure of quality of life in dementia research.
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Affiliation(s)
- Elisa Aguirre
- Division of Psychiatry, University College London, Charles Bell House, 67-73 Riding House Street, London, W1W 7EJ, England, UK.
| | - Sujin Kang
- Division of Psychiatry, University College London, Charles Bell House, 67-73 Riding House Street, London, W1W 7EJ, England, UK.
| | - Zoe Hoare
- Division of Psychiatry, University College London, Charles Bell House, 67-73 Riding House Street, London, W1W 7EJ, England, UK.
| | - Rhiannon Tudor Edwards
- Division of Psychiatry, University College London, Charles Bell House, 67-73 Riding House Street, London, W1W 7EJ, England, UK.
| | - Martin Orrell
- Division of Psychiatry, University College London, Charles Bell House, 67-73 Riding House Street, London, W1W 7EJ, England, UK.
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Castro-Monteiro E, Forjaz MJ, Ayala A, Rodriguez-Blazquez C, Fernandez-Mayoralas G, Diaz-Redondo A, Martinez-Martin P. Change and predictors of quality of life in institutionalized older adults with dementia. Qual Life Res 2014; 23:2595-601. [DOI: 10.1007/s11136-014-0706-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2014] [Indexed: 11/28/2022]
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