Applied Health Economics and Health Policy

, Volume 12, Issue 1, pp 73–84 | Cite as

How Important Is Health Status in Defining Quality of Life for Older People? An Exploratory Study of the Views of Older South Australians

  • Catherine M. Milte
  • Ruth Walker
  • Mary A. Luszcz
  • Emily Lancsar
  • Billingsley Kaambwa
  • Julie RatcliffeEmail author
Original Research Article



Cost-effectiveness analyses of interventions for older adults have traditionally focused on health status. However, there is increasing recognition of the need to develop new instruments to capture quality of life in a broader sense in the face of age-associated increasing frailty and declining health status, particularly in the economic evaluation of aged and social care interventions that may have positive benefits beyond health.


To explore the relative importance of health and broader quality of life domains for defining quality of life from the perspective of older South Australians.


Older adults (n = 21) from a day rehabilitation facility in Southern Adelaide, South Australia attended one of two audio-recorded focus groups. A mixed methods (qualitative and quantitative) study design was adopted. The study included three main components. First was a general group discussion on quality of life and the factors of importance in defining quality of life. Second was a structured ranking exercise in which individuals were asked to rank domains from the brief Older People’s Quality of Life (OPQOL-brief) questionnaire and Adult Social Care Outcomes Toolkit (ASCOT) in order of importance. Third, participants were asked to self-complete the EuroQol five-dimension (EQ-5D), a measure of health status, and two broader quality-of-life measures: the OPQOL-brief and ASCOT.


Mean scores on the EQ-5D, OPQOL-brief and ASCOT were 0.71 (standard deviation [SD] 0.20, range 0.06–1.00), 54.6 (SD 5.5, range 38–61) and 0.87 (SD 0.13, range 0.59–1.00), respectively, with higher scores reflecting better ratings. EQ-5D scores were positively associated with OPQOL-brief (Spearman’s Rho: 0.730; p < 0.01), but not ASCOT. Approximately half (52.4 %) of the participants ranked either ‘health’ or ‘psychological and emotional well-being’ as the domain most important to their quality of life. However, one-third (33.3 %) of the total sample ranked a non-health domain from the ASCOT or OPQOL-brief (safety, dignity, independence) as the most important contributing factor to their overall quality of life. Qualitative analysis of focus group transcripts supported the high value of both health-related (health, psychological well-being) and social (independence, safety) domains to quality of life.


Older adults value both health and social domains as important to their overall quality of life. Future economic evaluations of health, community and aged-care services for older adults should include assessment of both health-related and broader aspects of quality of life.


Focus Group Adult Social Care Outcome Toolkit Adult Social Care Outcome Toolkit Ranking Exercise Aged Care Service 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



There are no sources of funding to disclose for this manuscript. The authors declare no conflicts of interest. CM, JR and RW initiated the study and contributed to data collection and analysis. All authors contributed to interpretation of results. CM drafted the manuscript. All authors read, edited and approved the final manuscript. JR is the guarantor for the overall content. Thank you to the staff and patients of the Repatriation General Hospital who participated in this study. We gratefully acknowledge Professor Maria Crotty for facilitating the recruitment of volunteers.


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Copyright information

© Springer International Publishing Switzerland 2013

Authors and Affiliations

  • Catherine M. Milte
    • 1
  • Ruth Walker
    • 2
  • Mary A. Luszcz
    • 3
  • Emily Lancsar
    • 4
  • Billingsley Kaambwa
    • 5
  • Julie Ratcliffe
    • 5
    • 6
    Email author
  1. 1.Flinders University Department of Rehabilitation and Aged CareRepatriation General HospitalDaw ParkAustralia
  2. 2.South Australian Community Health Research UnitFlinders UniversityAdelaideAustralia
  3. 3.Flinders Centre for Ageing Studies, School of PsychologyFlinders UniversityAdelaideAustralia
  4. 4.Centre for Health Economics, Faculty of Business and EconomicsMonash UniversityMelbourneAustralia
  5. 5.Flinders Health Economics Group, School of MedicineFlinders UniversityAdelaideAustralia
  6. 6.Flinders Clinical EffectivenessFlinders UniversityAdelaideAustralia

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