Applied Health Economics and Health Policy

, Volume 15, Issue 3, pp 399–412 | Cite as

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

  • Julie RatcliffeEmail author
  • Thomas Flint
  • Tiffany Easton
  • Maggie Killington
  • Ian Cameron
  • Owen Davies
  • Craig Whitehead
  • Susan Kurrle
  • Michelle Miller
  • Enwu Liu
  • Maria Crotty
Original Research Article



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.


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.


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.


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.


Dementia Residential Care Utility Score Residential Aged Care Economic Evaluation Study 
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.


Author contributions

All authors contributed to the design of the study and JR wrote the draft manuscript with input from all authors. MK collected the data. TF and TE analysed the data with assistance from JR All authors provided critical review of the manuscript and final approval of the version to be submitted for publication. JR is the guarantor for the overall content.

Compliance with Ethical Standards

The authors gratefully acknowledge funding provided by the National Health and Medical Research Council (NHMRC) Partnership Centre on Dealing with Cognitive and Related Functional Decline in Older People, NHMRC Project ID GNT9100000. This study was approved by the Southern Adelaide Clinical Human Research Ethics Committee (SAC HREC EC00188) (Project no: 20.12). All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

Conflict of interest

Thomas Flint declares that he has no conflicts of interest. Julie Ratcliffe declares that she has no conflicts of interest. Tiffany Easton declares that she has no conflicts of interest. Maggie Killington declares that she has no conflicts of interest. Ian Cameron declares that he has no conflicts of interest. Owen Davies declares that he has no conflicts of interest. Craig Whitehead declares that he has no conflicts of interest. Susan Kurrle declares that she has no conflicts of interest. Michelle Miller declares that she has no conflicts of interest. Enwu Liu declares that he has no conflicts of interest. Maria Crotty declares that she has no conflicts of interest.


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Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Julie Ratcliffe
    • 1
    Email author
  • Thomas Flint
    • 1
  • Tiffany Easton
    • 2
  • Maggie Killington
    • 2
  • Ian Cameron
    • 3
  • Owen Davies
    • 2
  • Craig Whitehead
    • 2
  • Susan Kurrle
    • 3
  • Michelle Miller
    • 4
  • Enwu Liu
    • 2
  • Maria Crotty
    • 2
  1. 1.Flinders Health Economics Group, School of MedicineFlinders UniversityAdelaideAustralia
  2. 2.Department of Rehabilitation and Aged Care, School of Health SciencesFlinders UniversityAdelaideAustralia
  3. 3.John Walsh Centre for Rehabilitation Research, Kolling InstituteUniversity of SydneySydneyAustralia
  4. 4.Department of Nutrition and Dietetics, School of Health SciencesFlinders UniversityAdelaideAustralia

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