Health-related quality of life evaluation amongst older adults: New ideas for old problems

Steven Mcphail (2010). Health-related quality of life evaluation amongst older adults: New ideas for old problems PhD Thesis, School of Health & Rehabilitation Sciences, The University of Queensland.

       
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Author Steven Mcphail
Thesis Title Health-related quality of life evaluation amongst older adults: New ideas for old problems
School, Centre or Institute School of Health & Rehabilitation Sciences
Institution The University of Queensland
Publication date 2010-09
Thesis type PhD Thesis
Supervisor Associate Professor Terry Haines
Associate Professor Elaine Beller
Total pages 360
Total colour pages 16
Total black and white pages 344
Subjects 11 Medical and Health Sciences
Abstract/Summary Modern healthcare interventions for older adults commonly aim to have a positive and meaningful impact on the quality of patients’ lives, rather than simply prevent death. Health-related quality of life evaluations permit external observers to gain insight into the meaning of health states to individuals experiencing them, in the context of their own lives, and thus are important in evaluating the impact of positive and negative health events. Furthermore, health-related quality of life evaluations inform economic analysis of healthcare interventions through cost-utility analysis. However, some difficulties exist in evaluating health-related quality of life amongst older adults. The purpose of this body of research is to provide new ideas and empirical evidence to improve health-related quality of life evaluation methodology amongst older adults. This includes assessments at a single point in time as well as discerning change in health-related quality of life over time. Five aims were identified following a review of existing literature. Five empirical investigations were then undertaken to address each of the respective aims. The first demonstrated that telephone evaluation could yield equivalent responses as face to face evaluation of health-related quality of life. The second demonstrated that agreement between clinician proxies and patient self reports are dependent on proxy perspective, the timing of assessment and patient cognitive ability. Studies three, four and five investigated the impact of changes in one’s understanding of health-related quality of life construct over time and its meaning to them personally (response shift). The third investigation demonstrated that respondents frequently do not consider the meaning of health state rating scales and shift their response after being asked to consider a description of a very good and very poor health state. The forth investigation revealed that conventional evaluation of change (post – pre) is not in agreement with patients’ perspective of change (post – then test) in health-related quality of life. From existing methodology it was not possible to determine whether this disagreement was due to response shift, or poor recollection of the patients’ earlier health states (recall bias). The final investigation reported a novel and practical method for determining the relative contribution of response shift and recall bias to disagreement between patient perceived and conventional longitudinal evaluation of change in health-related quality of life. It revealed that a large portion of the disagreement between patient perceived change and conventional longitudinal change amongst hospitalised older adults could be attributed to recall bias. In successfully addressing the five identified research aims, this body of research has provided new evidence and novel findings to assist in the improvement of health-related quality of life evaluation methodology amongst older adults. Future research directions include investigation of whose perspective of change in health-related quality of life is considered to be the most important to relevant stakeholders in clinical and research settings as well as further empirical investigation around the psychometric properties for the method of adjustment (for response shift and recall bias) reported in the final study in this body of research.
Keyword Cost-utility
elderly
Geriatric
Proxy
Response Shift
Health state
survey
Evaluation
Methodology
Additional Notes Color pages are listed as per page number in the pdf document not as per number in page footer: 123,178,205,206,229,309,314,316,330,336,340,345,347,352,357,360

 
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Created: Tue, 15 Mar 2011, 10:04:47 EST by Mr Steven Mcphail on behalf of Library - Information Access Service