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. 2015 Jul 8:10:1131-9.
doi: 10.2147/CIA.S78698. eCollection 2015.

The influence of age on health valuations: the older olds prefer functional independence while the younger olds prefer less morbidity

Cynthia S Hofman  1 , Peter Makai  2 , Han Boter  3 , Bianca M Buurman  4 , Anton J de Craen  5 , Marcel G M Olde Rikkert  2 , Rogier Donders  6 , René J F Melis  2
Affiliations

The influence of age on health valuations: the older olds prefer functional independence while the younger olds prefer less morbidity

Cynthia S Hofman et al. Clin Interv Aging. .

Abstract

Background: To assess the effectiveness of geriatric interventions, The Older Persons and Informal Caregivers Survey - Composite Endpoint (TOPICS-CEP) has been developed based on health valuations of older persons and informal caregivers. This study explored the influence of the raters' age on the preference weights of TOPICS-CEP's components.

Methods: A vignette study was conducted with 200 raters (mean age ± standard deviation: 72.5±11.8 years; 66.5% female). Profiles of older persons were used to obtain the preference weights for all TOPICS-CEP components: morbidity, functional limitations, emotional well-being, pain experience, cognitive functioning, social functioning, self-perceived health, and self-perceived quality of life. The raters assessed the general wellbeing of these vignettes on a 0-10 scale. Mixed linear regression analysis with interaction terms was used to explore the effects of raters' age on the preference weights.

Results: Interaction effects between age and the TOPICS-CEP components showed that older raters gave significantly (P<0.05) more weight to functional limitations and social functioning and less to morbidities and pain experience, compared to younger raters.

Conclusion: Researchers examining effectiveness in elderly care need to consider the discrepancies between health valuations of younger olds and older olds when selecting or establishing outcome measures. In clinical decision making, health care professionals need to be aware of this discrepancy as well. For this reason we highly recommend shared decision making in geriatric care.

Keywords: age; composite endpoint; domains; general wellbeing; preferences; valuation.

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Figures

Figure 1
Figure 1
Study framework. Note: Framework: combining eight components into one generic composite endpoint (TOPICS-CEP) and the influence of rater characteristics. Abbreviations: QOL, quality of life; TOPICS-CEP, The Older Persons and Informal Caregivers Survey – Composite Endpoint index.
Figure 2
Figure 2
Bland–Altman plot of TOPIC-CEP scores of 65-year-old versus 85-year-old persons. Notes: Bland–Altman plot: difference between CEP scores of the vignette cases based on preferences of 65-year-old versus 85-year-old persons plotted against their average. Bold solid line represents the average difference between methods; dotted lines represent the 95% confidence limits. Abbreviations: QOL, quality of life; TOPICS-CEP-65, The Older Persons and Informal Caregivers Survey – Composite Endpoint scores for 65-year-old persons; TOPICS-CEP-85, The Older Persons and Informal Caregivers Survey – Composite Endpoint scores for 85-year-old persons.
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