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. 2024 Jan 7;22(1):4.
doi: 10.1186/s12955-023-02222-x.

Exploring older people's understanding of the QOL-ACC, a new preference-based quality-of-life measure, for quality assessment and economic evaluation in aged care: the impact of cognitive impairment and dementia

Kiri Lay  1 , Matthew Crocker  2 , Lidia Engel  3 , Julie Ratcliffe  2 , Rachel Milte  2 , Claire Hutchinson  2
Affiliations

Exploring older people's understanding of the QOL-ACC, a new preference-based quality-of-life measure, for quality assessment and economic evaluation in aged care: the impact of cognitive impairment and dementia

Kiri Lay et al. Health Qual Life Outcomes. .

Abstract

Background: Quality-of-life is an essential outcome for quality assessment and economic evaluation in health and social care. The-Quality-of-Life - Aged Care Consumers (QOL-ACC) is a new preference-based quality-of-life measure, psychometrically validated with older people in aged care. More evidence is needed to inform the self-report reliability of the QOL-ACC in older people with varying levels of cognitive impairment and dementia.

Methods: A think-aloud protocol was developed and applied with older residents. The Mini Mental State Examination (MMSE) was applied to assign participants to no cognitive impairment (NCI - MMSE score ≥ 27) and cognitive impairment (MMCI - MMSE score < 27) subgroups. Three independent raters utilised a Tourangeau survey response model-based framework to identify response issues. Data were compared across cognition subgroups and synthesized using a 'traffic light' grading to classify frequency and type of response issues. Gradings were utilised to assess self-report reliability according to different levels of cognitive impairment.

Results: Qualitative data from 44 participants (NCI = 20, MMCI = 24) were included for analysis. Response issues were more evident in the cognitive impairment subgroup than the no cognitive impairment subgroup. All participants who received a 'red' grade had an MMSE score of < 20 and 66% of 'amber' grades occurred in the cognitive impairment subgroup.

Conclusions: The QOL-ACC is able to be completed reliably by older residents with an MMSE score > 17. Future research is needed to assess the generalisability of these findings to other preference-based quality of life instruments and for older people in other care settings including health systems.

Keywords: Aged care; Cognitive impairment; Self-report; Think-aloud.

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Conflict of interest statement

The authors have no relevant financial interests or non-financial interests to declare.

Figures

Fig. 1
Fig. 1
Percentage of participants with response issues by dimension and cognition subgroup
Fig. 2
Fig. 2
Participant level issues and traffic light grade – ordered by MMSE score
See this image and copyright information in PMC

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