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.
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Australian Institute of Health and Welfare. The problem of osteoporotic hip fracture in Australia. Australian Government, Institute of Health and Welfare, Bulletin No. 76, March 2010, Canberra.
Braithwaite RS, Col NF, Wong JB. Estimating hip fracture morbidity, mortality and costs. J Am Geriatr Soc. 2003;51:364–70.
Koval KJ, Zuckerman JD. Functional recovery after fracture of the hip. J Bone Joint Surg Am. 1994;76:751–8.
Kane R, Kling K, Bershadsky B, et al. Quality of life measures for nursing home residents. J Gerontol A Biol Sci Med Sci. 2003;58A:240–8.
Giles LC, Hawthorne G, Crotty M. Health-related quality of life among hospitalized older people awaiting residential aged care. Health Qual Life Outcomes. 2009;7:1–7.
Crotty M, Ratcliffe J. If Mohammed won’t come to the mountain, the mountain must go to Mohammed. Age Ageing. 2011;40:290–2.
Smith SC, Lamping D, Banerjee S, et al. Measurement of health-related quality of life for people with dementia: development of a new instrument (DEMQOL) and an evaluation of current methodology. Health Technol Assess (Winch Eng). 2005;9:1–93.
Smith SC, Lamping D, Banerjee S, et al. Development of a new measure of health-related quality of life for people with dementia: DEMQOL. Psychol Med. 2007;37:737–46.
Brazier J, Ratcliffe J. Measuring and valuing health benefits for economic evaluation. New York: Oxford University Press; 2007.
Mulhern B, Rowen D, Brazier J, et al. Development of DEMQOL-U and DEMQOL-PROXY-U: generation of preference-based indices from DEMQOL and DEMQOL-PROXY for use in economic evaluation. Health Technol Assess (Winch Eng). 2013;17:1–160.
Rowen D, Mulhern B, Banerjee S, et al. Estimating preference-based single index measures for dementia using DEMQOL and DEMQOL-Proxy. Value Health. 2012;15:346–56.
Brazier J, Ratcliffe J, Salomon J, Tsuchiya A. Measuring and valuing health benefits for economic evaluation. Oxford: Oxford University Press; 2007.
Aguirre E, Kang S, Hoare Z, et al. How does the EQ-5D perform when measuring quality of life in dementia against two other dementia-specific outcome measures? Qual Life Res. 2016; 25(1):45–9.
Devine A, Diaz-Ordaz K, Taylor SJC, et al. The agreement between proxy and self-completed EQ-5D for care home residents was better for index scores than individual domains. J Clin Epidemiol. 2014;67:1035–43.
Gordon AL, Franklin M, Bradshaw L, et al. Health status of UK care home residents: a cohort study. Age Ageing. 2014;43:97–103.
Diaz-Redondo A, Rodriquez-Blazquez C, Ayala A, et al. EQ-5D rated by proxy in institutionalized older adults with dementia: psychometric pros and cons. Geriatr Gerontol Int. 2014;14:346–53.
Herdman M, Gudex C, Llloyd A, et al. Development and preliminary testing of the new five level version of the EQ-5D (EQ-5D-5L). Qual Life Res. 2011;20:1727–36.
Orgeta V, Tudor Edwards R, Hounsome B, Orrell M, Woods B. The use of the EQ-5D as a measure of health-related quality of life in people with dementia and their carers. Qual Life Res. 2015;24:315–24.
Devlin N, Shah K, Feng Y, Mulhern B, Van Hout B. Valuing health related quality of life: an EQ-5D-5L value set for England. HEDS Discussion Paper No 16.02, University of Sheffield, 2016.
Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12:189–98.
Sallam K, Amr M. The use of the mini-mental state examination and the clock drawing test for dementia in a tertiary hospital. J Clin Diagn Res. 2013;7:484–8.
Peneczy R, Wagenpfeil S, Kornossa K, et al. Mapping scores onto stages: mini-mental state examination and clinical dementia rating. Am J Geriatr Psychiatry. 2006;14:139–44.
Alexopoulos GS, Abrams RC, Young RC, Shamoian CA. Cornell Scale for Depression in Dementia. Biol Psychiatry. 1988;23:271–84.
Kurlowicz LH, Evans LK, Strumpf NE, Maislin G. A psychometric evaluation of the Cornell Scale for Depression in Dementia in a frail, nursing home population. Am J Psychiatry. 2002;10:600–8.
Shah S, Vanclay F, Cooper B. Improving the sensitivity of the Barthel Index for stroke rehabilitation. J Clin Epidemiol. 1989;42:703–9.
Warden V, Hurley A, Volicer L. Development and Psychometric Evaluation of the Pain Assessment in Advanced Dementia (PAINAD) Scale. J Am Med Dir Assoc. 2003;4:9–15.
Cohen J. Statistical power analysis for the behavioural sciences. 2nd ed. Hillsdale: Lawrence Erlbaum Associates; 1998.
Dancey CP, Reidy J. Statistics without maths for psychology: using SPSS for windows. Harlow: Prentice Hall; 2004.
Mesterton J, Wimo A, By A, Langworth S, Winblad B, Jonsson L. Cross sectional observational study on the societal costs of Alzheimers disease. Curr Alzheimer Res. 2010;7:358–67.
Neumann J, Kuntz M, Leon S, Araki C, Hermann C, Hsu C, Weinstein C. Health utilities in Alzheimer’s disease: a cross-sectional study of patients and caregivers. Med Care. 1999;37:27–32.
Beerens H, Zwakhalen S, Verbeek H, Ruwaard D, Hamers J. Factors associated with quality of life of people with dementia in long-term care facilities: a systematic review. Int J Nurs Stud. 2003;50:1259–70.
Trigg R, Jones R, Knapp M, King D, Lacey L, Groups D. The relationship between changes in quality of life outcomes and progression of Alzheimer’s disease: results from the dependence in AD in England 2 longitudinal study. Int J Geriatr Psychiatry. 2014;30(4):400–8.
Coucill W, Bryan S, Bentham P, et al. EQ-5D in patients with dementia: an investigation of inter-rater agreement. Med Care. 2001;39:760–71.
Arons A, Van Der Wilt G, Krabbe P, et al. Quality of life in dementia: a study on proxy bias. BMC Med Res Methodol. 2013;13:1–8.
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.
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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Ratcliffe, J., Flint, T., Easton, T. et al. 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. Appl Health Econ Health Policy 15, 399–412 (2017). https://doi.org/10.1007/s40258-016-0293-7
- Residential Care
- Utility Score
- Residential Aged Care
- Economic Evaluation Study