Risk Factors and Number of Falls as Determinants of Quality of Life of Community-Dwelling Older Adults

Prevalent falls, fall frequencies and health-related quality of life among community-dwelling older Chinese adults

PURPOSE

Fall is a serious health hazard to older adults. The aim of our study was to investigate the relationship between falls and health-related quality of life (HRQOL) in mainland China.

METHODS

Data from 4579 Chinese community-dwelling older adults was analyzed. Data of falls was self-reported by participants, the HRQOL of older adults was measured by the 3-Level EQ-5D (EQ-5D-3L, 3L). Regression models were built to explore the associations of falls (experience and frequency) with the 3L data (index score, EQ-VAS score and health problems). The potential interaction effects between falls and gender on HRQOL were assessed using a likelihood ratio test, sex-stratified analysis was also performed to separately investigate the associations in men and women.

RESULTS

A total of 368 (8.0%) participants had the experience of fall during the last year. Falls (experience and frequency) were significantly related to EQ-5D-3L index and EQ-VAS scores, fall experience contributed to pain/discomfort and anxiety/depression problems, while fall frequency was associated with physical-related problems and pain/discomfort. Significant interactions between falls and sex in several EQ-5D measures were also observed, and men had lager magnitude of associations than women.

CONCLUSION

Falls were negative associated with overall HRQOL as well as separate HRQOL dimensions among older adults. It also appears that the HRQOL influence on older men is more evident than older women.

Smart health technologies used to support physical activity and nutritional intake in fall prevention among older adults: A scoping review

BACKGROUND

Falls are the second leading cause of accidental injury deaths globally. Older age is a key risk factors for falls. Besides older age, physical inactivity and malnutrition are identified risk factors for falls. Smart health technologies might offer a sustainable solution to prevent falls by supporting physical activity and nutritional status.

OBJECTIVE

The aim is to identify, describe, and synthesize knowledge, and identify knowledge gaps on the use of existing smart health technologies to support health behaviour in relation to physical activity and nutrition, among older (65+) in risk of falling.

METHODS

A scoping review was conducted following the PRISMA-ScR. Searches were carried out in PubMed, Scopus, and Embase using search strings on the themes; smart health technology, physical activity, nutrition, behaviour, falls and older. Identified literature was screened. Data from the included studies was extracted and synthesized.

RESULTS

2948 studies were obtained through searches. 18 studies were included. Various smart health technologies are used for fall prevention to support physical activity among older, including software and applications for smart phones, TV, and tablet. Three gaps were identified: use of smart health technologies to support nutrition in fall prevention. Inclusion of relevant stakeholders and fall prevention in low-and middle-income countries.

CONCLUSIONS

Smart health technology can offer sustainable and cost-effective fall prevention in the future. More knowledge is needed on the use of smart health technologies to support nutritional status for fall prevention, and studies involving older with physical and cognitive conditions, and studies on measures for fall prevention in low- and middle-income countries is needed.

Specialized Care Resources for Diagnosis and Management of Patients Who Have Suffered Falls: Results of a National Survey in Geriatric Units

INTRODUCTION

Clinical guidelines recommend comprehensive multifactorial assessment and intervention to prevent falls and fractures in older populations.

METHODS

A descriptive study was conducted by the Falls Study Group of the Spanish Geriatric Medicine Society (SEMEG) to outline which types of healthcare-specific resources were assigned for fall assessment in Spanish geriatric departments. A self-reported seven-item questionnaire was delivered from February 2019 to February 2020. Where geriatric medicine departments were not available, we tried to contact geriatricians working in those areas.

RESULTS

Information was obtained regarding 91 participant centers from 15 autonomous communities, 35.1% being from Catalonia and 20.8% from Madrid. A total of 21.6% reported a multidisciplinary falls unit, half of them in geriatric day hospitals. Half of them reported fall assessment as part of a general geriatric assessment in general geriatric outpatient clinics (49.5%) and, in 74.7% of cases, the assessment was based on functional tests. A total of 18.7% reported the use of biomechanical tools, such as posturography, gait-rides or accelerometers, for gait and balance analysis, and 5.5% used dual X-ray absorptiometry. A total of 34% reported research activity focused on falls or related areas. Regarding intervention strategies, 59% reported in-hospital exercise programs focused on gait and balance improvement and 79% were aware of community programs or the pathways to refer patients to these resources.

CONCLUSIONS

This study provides a necessary starting point for a future deep analysis. Although this study was carried out in Spain, it highlights the need to improve public health in the field of fall prevention, as well as the need, when implementing public health measures, to verify that these measures are implemented homogeneously throughout the territory. Therefore, although this analysis was at the local level, it could be useful for other countries to reproduce the model.

Adaptation to repeated standing-slips in professional ballet dancers

Ballet training is being increasingly used to improve physical functions in older adults. Our previous work showed that ballet dancers react to a novel standing-slip more effectively than their non-dancer counterparts through better control of the recovery step and trunk movement. The purpose of this study was to test if and to what extent ballet dancers adapt differently to repeated standing-slips relative to non-dancers. Protected by a harness, twenty young adults (10 professional ballet dancers and 10 age/sex-matched non-dancers) experienced five repeated and standardized standing-slips on a treadmill. Changes from the first slip (S1) to the fifth slip (S5) in dynamic gait stability (primary outcome) and other variables, including the center of mass position and velocity, step latency, slip distance, ankle angle, and trunk angle (secondary outcomes) were compared between groups. Results revealed that both groups adopted similar proactive controls to improve dynamic gait stability by using the ankle and hip strategies. However, dancers showed a better reactive improvement in stability after the repeated slips than non-dancers. From S1 to S5, dancers reactively improved their dynamic gait stability more than non-dancers at the recovery step liftoff (p = 0.003). Dancers decreased their recovery step latency (p = 0.004) and shortened the slip distance (p = 0.004) significantly more than non-dancers from S1 to S5. These findings suggest that ballet dancers could facilitate the adaptation to repeated slips, which may be attributed to their ballet practice experience. This finding augments our understanding of the underlying mechanisms of ballet practice reducing falls.

Impact of Physical Activity on Anxiety, Depression, Stress and Quality of Life of the Older People in Brazil

BACKGROUND

Population aging all over the world invites older people to be active, considering physical activity (PA) as associated with reduced anxiety, depression and stress and a high quality of life (QOL) in older people.

OBJECTIVE

To analyze anxiety, depression, stress and QOL as a function of PA in older people.

METHODOLOGY

Descriptive analytical research. Six hundred and ninety older people answered the instrument composed of sociodemographic questions, followed by questions from the WHOQOL-Old, Baecke-Old, WHOQOL-SRPB, Stress Perception Scale, Beck Anxiety Inventory and Beck Depression Inventory.

RESULTS

The beneficial effect of PA on the elderly is evident in this sample with such a high QoL (73%) and such a high level of physical activity (84%), and even with an advanced level of education (75%) and high spirituality (99.6%). The influence of PA on the anxiety and stress cluster showed Pearson's chi-square = 9.9, DF = 4, p = 0.04239, critical value = 9.5. The influence of PA on the anxiety, depression and stress cluster showed Pearson's chi-square = 6.8; DF = 5; p-value = 0.24; critical value = 11.1.

CONCLUSION

In the elderly, PA has a significant relationship with anxiety, stress and QOL. In addition, the high level of QOL of the elderly in the sample demonstrates the capacity for PA, educational level and spirituality for personal satisfaction.

Recovery from an unexpected standing-slip in professional ballet dancers

Although interventional studies have suggested that dance-based training may reduce fall risk for older adults based on unperturbed assessments, it remains unknown whether dance (particularly ballet) enhances recovery from an external perturbation. This preliminary study sought to test if and how ballet dancers respond differently to a novel standing-slip perturbation relative to non-dancers. Ten young professional ballet dancers and 10 age/sex-matched non-dancers were exposed to an unannounced slip while standing on the treadmill. Their reactions to the slip, characterized by dynamic gait stability (primary outcome), and the recovery stepping and trunk movements (secondary outcomes), were compared between groups. No significant group difference in dynamic gait stability was found at slip onset and recovery step liftoff, but dancers were more stable than non-dancers at touchdown (p = 0.046). Compared to non-dancers, dancers took a longer (p = 0.049) and faster (p = 0.007) backward recovery step and exhibited a less backward leaned trunk at all instants (p ≤ 0.026). Our study suggests that professional ballet dancers are more stable after a novel standing-slip than non-dancers. This better slip-related fall resistance among dancers could result from their more effective recovery stepping strategy and better trunk movement control after the slip. Both reactions may be attributed to ballet training, which requires frequent backward stepping and an upright trunk. Our findings could potentially provide preliminary evidence for applying ballet training to reduce balance losses and falls in people at a high fall risk. More studies are needed to examine ballet training's effects among other populations with elevated fall risk in real-life situations.

Multivariate analysis of independent determinants of ADL/IADL and quality of life in the elderly

BACKGROUND

This study evaluated the determinants of disability and quality of life in elderly people who participated at the multi-centred RubiN project (Regional ununterbrochen betreut im Netz) in Germany.

METHODS

Baseline data of the subjects aged 70 years and older of the RubiN project were used and only subjects with complete data sets were considered for the ensuing analysis (complete case analysis (CCA)). Disability was examined using the concepts of ADL (activities of daily living) and IADL (instrumental activities of daily living). Subjects exhibiting one or more deficiencies in ADL respectively IADL were considered as ADL respectively IADL disabled. Quality of life was assessed using the WHOQOL-BREF and the WHOQOL-OLD. Applying multivariate analysis, sociodemographic factors, psychosocial characteristics as well as the functional, nutritional and cognitive status were explored as potential determinants of disability and quality of life in the elderly.

RESULTS

One thousand three hundred seventy-five subjects from the RubiN project exhibited data completeness regarding baseline data. ADL and IADL disability were both associated with the respective other construct of disability, sex, a reduced cognitive and functional status as well as domains of the WHOQOL-BREF. Furthermore, ADL disability was related to social participation, while IADL disability was linked to age, education and social support. Sex, ADL and IADL disability, income, social support and social participation as well as the functional status were predictors of the domain 'Physical Health' (WHOQOL-BREF). The facet 'Social Participation' (WHOQOL-OLD) was affected by both ADL and IADL disability, income, social participation, the nutritional and also the functional status.

CONCLUSIONS

Several potential determinants of disability and quality of life were identified and confirmed in this study. Attention should be drawn to prevention schemes as many of these determinants appear to be at least partly modifiable.

Baseline health-related quality of life predicts falls: a secondary analysis of a randomized controlled trial

PURPOSE

Among older adults, health-related quality of life (HRQoL) and falls are associated. Generic patient-reported outcomes measures (PROMs) assess individual's HRQoL. The role for PROMs, a potential tool for predicting subsequent falls, remains under-explored. Our primary aim was to determine whether a baseline PROMs assessment of HRQoL may be a useful tool for predicting future falls.

METHODS

A secondary analysis of a 12-month randomized clinical trial (RCT) of a home-based exercise program among 344 adults (67% female), aged ≥ 70 years, with ≥ 1 falls in the prior year who were randomized (1:1) to either a home-based exercise program (n = 172) or usual care (n = 172). A negative binomial regression model with total falls count as the dependent variable evaluated the main effect of the independent variable-baseline HRQoL (measured by the Short-Form-6D)-controlling for total exposure time and experiment group (i.e., exercise or usual care) for the total sample. For the usual care group alone, the model controlled for total exposure time.

RESULTS

For the total sample, the rate of subsequent total falls was significantly predicted by baseline HRQoL (IRR = 0.044; 95% CI [0.005-0.037]; p = .004). For the usual care group, findings were confirmed with wider confidence intervals and the rate of prospective total falls was significantly predicted by baseline HRQoL (IRR = 0.025; 95% CI [0.001-0.909]; p = .044).

CONCLUSION

These findings suggest the ShortForm-6D should be considered as part of falls prevention screening strategies within a Falls Prevention Clinic setting. Trial Registrations ClinicalTrials.gov Protocol Registration System. Identifier: NCT01029171; URL: https://clinicaltrials.gov/ct2/show/NCT01029171 . Identifier: NCT00323596; URL: https://clinicaltrials.gov/ct2/show/NCT00323596 .

Characteristics of community-based exercise programs for community-dwelling older adults in rural/regional areas: a scoping review

Community-based exercise programs for older adults play a potentially important role in mitigating the decline in functional outcomes, body composition, psychosocial outcomes, and cardiovascular health outcomes that commonly occurs with advancing age. There is a limited understanding of the characteristics and effectiveness of community-based exercise programs, particularly when those programs are offered outside metropolitan areas. Rural/regional settings face unique challenges, such as limited access to equipment/resources, transportation, and services, as well as significant costs to run programs. The objective of this scoping review was to characterise studies in the field that have aimed to implement community-based programs in settings identified as rural / regional. A secondary aim was to establish guidance for future exercise programs in this setting and highlight future research directions. A total of 12 studies were conducted in settings identified as rural/regional areas in various countries across the world were included. Of the included studies, five were randomised controlled trials. The majority of included studies reported on functional outcomes (83%) and psychosocial outcomes (75%), yet only 42% reported body composition, 17% reported cardiovascular health and 17% reported dietary outcomes. Low male representation was observed, with women outnumbering men in 7 of 12 studies. There was also minimal investigation of qualitative outcomes in existing community-based exercise programs in rural/regional settings, presenting a key gap for future research to address. Study Protocol: https://osf.io/txpm3/ . Date of registration: 20 July 2020.

Strong relationship of muscle force and fall efficacy, but not of gait kinematics, with number of falls in the year after Total Hip Arthroplasty for osteoarthritis: An exploratory study

BACKGROUND

In people with moderate hip osteoarthritis, gait kinematics was reported to be correlated with number of falls in the preceding year. After Total Hip Arthroplasty, subjects generally improve but still fall. The present study explores recovery and correlations with number of falls in the year after Total Hip Arthroplasty.

METHODS

We assessed 12 patients one year after Total Hip Arthroplasty, 12 patients with moderate hip osteoarthritis with at least one fall in the preceding year, and 12 healthy peers. Maximum hip abduction strength, Fall Efficacy Scale - International, Harris Hip Score, pain, and number of falls in the preceding year were assessed. Participants walked on a treadmill with increasing speeds, and gait kinematics were registered optoelectronically. We assessed group differences, and correlations of all variables with number of falls.

FINDINGS

After arthroplasty, subjects tended to score better on variables measured, often non-significantly, compared to subjects with moderate osteoarthritis, but worse than healthy peers. Maximum hip abduction strength together with fall efficacy had a strong regression on the number of falls in the preceding year (R² = 92%). Gait kinematics did not correlate with number of falls, and also fall efficacy was not related to gait kinematics.

INTERPRETATION

One year after hip arthroplasty, muscle strength sufficiently recovered for normal walking, but not to avoid falling in risky situations. Rehabilitation should focus on muscle strength. The lack of correlation between the Fall Efficacy International and gait kinematics, suggests that it reflected the experience of having fallen rather than fear.

Positive-word stimuli via a smartphone application have no immediate-term effects on multi-directional reach ability in standing position: a randomized controlled trial

OBJECTIVES

The purpose of the study was to examine the immediate-term effect of positive-word stimuli via a smartphone application on the multi-directional reach ability in standing position in young adults.

METHODS

This study was an immediate-term, assessor-blinded, two-arm, parallel-group, randomized controlled trial among young adults recruited from one university in Japan. Participants were randomly assigned to the experimental group or control group using a computer-based random number-generating programme. Participants of the experimental group used an application on iPhone and watched 3-min videos displaying positive-word stimuli. This application repeatedly displayed positive-word stimuli every 5 s. The participants of the control group used an application on iPhone and watched the same videos as in the experimental group. However, a positive-word stimulus did not appear in the videos. The primary outcome was the multi-directional reach test (MDRT) from baseline to immediately after the intervention protocol.

RESULTS

Among the 62 randomized participants (experimental group, n = 31; control group, n = 31), 62 (100%) completed the MDRT immediately after the intervention protocol. There were no differences in mean group change values in MDRT between the experimental and control groups.

CONCLUSIONS

Among young adults, positive-word stimuli via a smartphone application did not significantly improve multi-directional reach ability in standing position. These findings do not support the superiority of this intervention among young adults. Trial Registration: Clinicaltrials.gov, NCT03546218. Registered 6 June 2018, https://clinicaltrials.gov/ct2/show/NCT03546218KEY MESSAGESIn our study, among young adults, positive-word stimuli via an SPSRS application did not significantly improve the multi-directional reach ability in the standing position.These findings do not support the superiority of this intervention among young adults.

Evaluation of Implementing TOM: A Group-Based Fall Prevention Programme among Community-Dwelling Older Adults in The Netherlands

There is strong evidence that effective fall prevention elements exist, but the implementation into society remains difficult. The aim of the current study is to describe and evaluate the implementation of the fall prevention programme "Thuis Onbezorgd Mobiel" (TOM). This novel approach combines effective components into a multidisciplinary group-based programme for adults aged 65 years or older with an increased risk of falling. To investigate the impact on several health-related outcomes such as subjective health, quality of life, physical functioning, and falls, we applied a quasi-experimental pre-post design including a follow-up period. A total of 164 older adults subscribed to the programme: 80 were eligible to start and 73 completed it. The impact analysis revealed a significant improvement in subjective health, physical functioning, and quality of life directly after participating in the programme. The impact on subjective health and quality of life persisted six months after the programme. Important facilitators for the implementation of the programme were social contact and clear communication. Lack of a concrete follow-up was seen as an important barrier. The results of the current research help guide further implementation of effective fall prevention interventions in practice.

Relationship between fall behavior and quality of life of elderly individuals

The aim of this study was to examine the association between the quality of life and the fall behavior in elderly individuals. The study was conducted as a descriptive and correlational study design. Data were collected with the Patient Information Form, The Fall Behavior Scale for the Elderly and the World Health Organization Quality of Life module for the elderly. There were 110 older people included in study. When the relationship between the Fall Behavior Scale for the Elderly and the World Health Organization Quality of Life Module for the Elderly sub-scale and total scores were examined, there was a statistically significant negative correlation between the Fall Behavior Scale for the Elderly safe movement sub-scale and the World Health Organization Quality of Life Module social participation sub-scale scores (p < .01).

Perceived Physical Functioning and Gait Speed as Mediators in the Association Between Fear of Falling and Quality of Life in Old Age

Preserving Quality of Life (QoL) in old age gains in importance, but Fear of Falling (FoF) considerably limits QoL. The aim of our study was to understand how physical mediators may translate FoF to QoL. At Time 1, FoF, subjective leg strength, balance, QoL, and objective gait speed were assessed. QoL was reassessed after 6 months, at Time 2 (n = 125). A sequential mediation analysis examined whether the relationship between FoF and QoL could be mediated by leg strength, balance, and gait speed. FoF was directly associated with QoL (β = -.27; 95% CI [-0.007, -0.001]) as well as indirectly via leg strength, balance, and gait speed (specific sequential indirect effect: β = -.03; 95% CI [-0.06, -0.001]; R² = .40 in QoL; controlled for age, QoL at Time 1). An intervention approach could be to address FoF and foster physical functioning and gait speed to maintain QoL.

Health-Related Quality of Life in Community-Dwelling Older People with Cognitive Impairment: EQ-5D-3L Measurement Properties

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.

Psychoactive drug use and falls among community-dwelling Turkish older people

OBJECTIVE:

Data on the relationship between fall and psychoactive drug use among Turkish older people are limited. This study aims to investigate the prevalence of falls and the associations between psychoactive drug use and falls in community-dwelling Turkish older people.

METHODS:

This single center study was performed using the medical records of subjects aged over 65 years admitted to the geriatric care unit. Demographic and lifestyle factors, clinical characteristics, medications, and data on mood, cognitive status, and functional performance were obtained from the comprehensive geriatric assessment records. Based on a fall history in the last 12 months, subjects were grouped as fallers and non-fallers. Subjects treated with a psychoactive drug were identified.

RESULTS:

Among the total of 429 subjects, there were 184 (42.9%) fallers and 245 (57.1%) non-fallers. Of those, 33.3% were on psychoactive drug treatment. The proportion of psychoactive drug users was higher in the fallers group compared to non-fallers (45.1% vs. 24.5%, p<0.001). Multivariable logistic regression analysis showed age ≥75 years (OR=1.83;CI: 1.09–3.09; p=0.023), female gender (OR=2.70;CI: 1.6–4.50; p<0.001), and psychoactive drug use (OR=2.14;CI 1.32–3.48; p=0.002) as independent predictors of falls.

CONCLUSION:

We found that about one-third of geriatric outpatients were on psychoactive drug treatment in Turkey that was independently associated with the risk of falls.

Nutritional Status and Risk Factors for Frailty in Community-Dwelling Older People: A Cross-Sectional Study

OBJECTIVE

This study aims to assess the relationship that frailty has with nutritional status and functional risk factors in community-dwelling older adults.

METHODS

Cross-sectional study in community-dwelling older people, independent for walking and without impaired cognition. Frailty was assessed by Fried criteria. Nutritional status was analyzed by the Mini Nutritional Assessment Short Form (MNA-SF), biochemical markers (albumin, total proteins, cholesterol, lymphocytes, and hemoglobin); and anthropometric parameters (body mass index [BMI], body fat percentage, handgrip, and perimeters). A comprehensive geriatric assessment analyzed other risk factors: functionality, cognition, falls, comorbidity, polypharmacy, physical activity, and quality of life (QoL).

RESULTS

We included 564 elderly people with a mean age of 76.05 (standard deviation 3.97) years; 63.1% (n = 356) were women, and 83.9% (n = 473) were prefrail, and frail. The sample presented high functionality and a nutritional status with a predominance of overweight and obesity. Factors associated with frailty (R² = 0.43) were age over 75 years (odds ratio [OR] 3.31, 95% confidence interval [CI] 1.76, 6.21; p < 0.001), female gender (OR 2.37, 95% CI 1.24, 4.52; p = 0.009), anemia (OR 2.45, 95% CI 1.19, 5.02; p = 0.015), falls (OR 1.94, 95% CI 1.12, 3.25; p = 0.016) and the fear of falling (OR 4.01: 95% CI 1.76, 9.16; p = 0.001). Performing more than 3 weekly hours of physical activity was found to be a protective factor (OR 0.23, 95% CI 0.15, 0.35; p < 0.001).

CONCLUSIONS

The relationship between frailty and malnutrition in functionally independent community-dwelling older people is unclear. More studies are needed to know what nutritional markers are related to frailty, cognition, and functionality in order to discriminate the risk factors for community-dwelling older people at risk of malnutrition and dependency.

A Review of the Development and Application of Generic Preference-Based Instruments with the Older Population

Older people (aged 65 years and over) are the fastest growing age cohort in the majority of developed countries, and the proportion of individuals defined as the oldest old (aged 80 years and over) living with physical frailty and cognitive impairment is rising. These population changes put increasing pressure on health and aged care services, thus it is important to assess the cost effectiveness of interventions targeted for older people across health and aged care sectors to identify interventions with the strongest capacity to enhance older peoples' quality of life and provide value for money. Cost-utility analysis (CUA) is a form of economic evaluation that typically uses preference-based instruments to measure and value health-related quality of life for the calculation of quality-adjusted life-years (QALYS) to enable comparisons of the cost effectiveness of different interventions. A variety of generic preference-based instruments have been used to measure older people's quality of life, including the Adult Social Care Outcomes Toolkit (ASCOT); Health Utility Index Mark 2 (HUI2); Health Utility Index Mark 3 (HUI3); Short-Form-6 Dimensions (SF-6D); Assessment of Quality of Life-6 dimensions (AQoL-6D); Assessment of Quality of Life-8 dimensions (AQoL-8D); Quality of Wellbeing Scale-Self-Administered (QWB-SA); 15 Dimensions (15D); EuroQol-5 dimensions (EQ-5D); and an older person specific preference-based instrument-the Investigating Choice Experiments Capability Measure for older people (ICECAP-O). This article reviews the development and application of these instruments within the older population and discusses the issues surrounding their use with this population. Areas for further research relating to the development and application of generic preference-based instruments with populations of older people are also highlighted.