To examine the psychometric performance of the EQ-5D-5L in residential aged care and to explore the measurement properties of the EQ-HWB(-S), Adult Social Care Outcomes Toolkit (ASCOT), and Quality-of-Life Aged Care Consumers (QoL-ACC) in a smaller subsample.
Residents were eligible if consent was provided for 1 of the following: (1) self-reported quality of life (QoL); (2) staff proxy-reported QoL; or (3) family proxy-reported QoL. The EQ-5D-5L was administered first, with a second measure randomly assigned from either the ASCOT, QoL-ACC, or the EQ-HWB. Feasibility, floor and ceiling effects, convergent validity, known-group validity, and interrater reliability were examined.
We gathered cross-sectional QoL data from 103 consenting participants through self-report (N = 90), staff proxy report (N = 101), and family proxy report (N = 49). Missing values on the EQ-5D-5L ranged from 1% for staff to 14% for family members. No floor/ceiling effects were detected, and the EQ-5D-5L showed good convergent validity with the QoL-ACC (r = 0.62-0.82). Interrater reliability was good between residents and family (intraclass correlation = 0.84) and excellent between residents and staff (intraclass correlation = 0.96). Only staff-reported EQ-5D-5L scores could discriminate residents by cognitive impairment but all raters could discriminate by dependency levels. Other measures showed minimal missing data, no floor/ceiling effects, and moderate to good interrater reliability. Although most measures could discriminate by dependency level, some did not reach statistical significance.
The EQ-5D-5L showed promising performance and could serve as a potential candidate for implementation in residential aged care. Although this study also provided additional evidence for the EQ-HWB(-S), QoL-ACC, and ASCOT, further validation in larger samples are needed.
What is it about? The study examines how well the EQ-5D-5L, a tool used to assess quality of life, works in residential aged care settings. This topic is important because as more people move into aged care, there's a need for reliable ways to measure their quality of life, not just clinical outcomes. The researchers aimed to solve the problem of lacking tools that reflect residents' views on their own health and well-being. By exploring the EQ-5D-5L's effectiveness, this study fills a gap in understanding how to consistently assess quality of life in aged care facilities.
How was the research conducted? The study was designed to test the EQ-5D-5L's ability to measure quality of life through both self-reports from residents and proxy reports from staff and family. Researchers collected data from 103 participants in 2 aged care facilities in Australia. They used the EQ-5D-5L first, followed by 1 of 3 other measures: ASCOT, QoL-ACC, or EQ-HWB. This survey-based method allowed them to assess feasibility, reliability, and validity. Residents, staff, and family members were studied to gather diverse perspectives on quality of life. The choice of method helped ensure a thorough evaluation of the EQ-5D-5L in a real-world setting.
What were the results? The main finding was that the EQ-5D-5L showed good psychometric properties, meaning it effectively measured quality of life in aged care settings without significant floor or ceiling effects. Additionally, the tool demonstrated high agreement between residents and staff but less so with family members. A surprising result was that staff could better differentiate cognitive impairment levels in residents using the EQ-5D-5L compared to family members. The results for the other 3 measures were unclear and need more testing, as only a small number of residents completed them.
Why are the results important? These results are significant because they suggest the EQ-5D-5L can reliably measure quality of life in aged care settings, providing a consistent way to assess and improve care quality. Practically, this could lead to more resident-centered care approaches by focusing on what matters to residents themselves. The findings benefit residents, staff, and healthcare decision makers by offering a tool that aligns care practices with residents' well-being. Long term, using such a tool could enhance the overall quality of aged care services and inform policy decisions.
What are the strengths and weaknesses of this study? A major strength of this study is its comprehensive approach, using a well-structured design to evaluate the EQ-5D-5L in a real-world context. However, a limitation is the small sample size, particularly for some measures, which may affect the generalizability of the findings. Future research could expand on this study by including larger and more diverse samples to confirm the results and explore additional aspects like the tools' sensitivity to change over time.
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