Developing the descriptive system for a new preference-based quality of life measure with older people receiving aged care services at home

Author: Jenny Cleland

Cleland, Jenny, 2022 Developing the descriptive system for a new preference-based quality of life measure with older people receiving aged care services at home, Flinders University, College of Nursing and Health Sciences

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Australia’s population is ageing rapidly and by 2045 demographic projections indicate that one in four Australians will be older (aged 65 years or more) and nearly one in ten will be 80 years or over. This demographic transformation is replicated internationally and poses major challenges for health and aged care systems. As older people are living longer, they often experience frailty and other health conditions and require care and support to maximise their quality of life. Many older people prefer to age in place, resulting in increased demand and pressure on aged care services, in particular support within the home. Government expenditure on aged care is increasing and this trend is projected to continue, therefore it is important that limited resources are allocated efficiently to maximise older people’s quality of life as they age.

Economic evaluation offers a rigorous and systematic framework to compare new and existing services to ensure resources are allocated efficiently and effectively. Currently, no preference-based measure exists that focuses specifically on older people accessing aged care, incorporating their values and preferences into the measurement and valuation of quality of life for quality assessment and economic evaluation. Additionally, there have been limited economic evaluations conducted in the aged care sector despite the widespread potential benefits of this approach in guiding the allocation of limited resources to maximise the quality of life of older people.

This research addresses this gap by developing the descriptive system for the first preference-based quality of life measure to be developed from its inception with older people accessing aged care: Quality of Life – Aged Care Consumers (QOL-ACC). Developing a descriptive system is the first crucial stage in the development of a preference-based measure and this research adopts a unique approach by incorporating older people’s views and values of quality of life in its development.

An innovative mixed method approach was adopted to develop the QOL-ACC descriptive system consisting of several rigorous stages of development. Stage one comprised a series of in-depth semi-structured interviews with older people accessing aged care services in their own homes. Five salient characteristics were identified that were important to older people to experience a good quality of life: independence, mobility, social connections, emotional wellbeing, and activities. Stage two developed draft items for the descriptive system based on the five quality of life characteristics identified, in partnership with a research team and my Project Advisory Group (including aged care consumers and service provider representatives). Stage three tested the draft items for face validity with older people and the results confirmed that the items were measuring what they intended. The draft items were then subject to robust psychometric assessments during stage four, and it was demonstrated the items had excellent psychometric properties and met the necessary psychometric standards. Stage five developed a final item for each dimension of the QOL-ACC descriptive system by combining quantitative and qualitative evidence from the previous stages using an approach based on a traffic light pictorial format with a team of researchers and a panel of experts. The final stage assessed further psychometric properties of the QOL-ACC measure. Strong evidence of construct (convergent and known group) validity was provided indicating that the QOL-ACC descriptive system is a robust and valid measure of quality of life for older people in receipt of aged care services.

The QOL-ACC makes an important contribution to aged care research, policy, and practice. The QOL-ACC can be applied in routine application of quality assessments by aged care providers to measure the impact of existing and new services and outcomes against the new aged care quality standards. It can also be used to monitor older people’s quality of life over time, to compare interventions and to highlight service needs. Future research will develop a scoring algorithm for the measure which will enable the QOL-ACC to assess the cost-effectiveness of new aged care interventions and to make comparisons between existing services to ensure the quality of life of older Australians is maximised. The development of this new measure makes a significant contribution, providing an important mechanism for measuring and ultimately positively impacting the quality of life of older people.

Keywords: quality of life, ageing, aged care services, economic evaluation, preference-based measure

Subject: Ageing Studies thesis

Thesis type: Doctor of Philosophy
Completed: 2022
School: College of Nursing and Health Sciences
Supervisor: Julie Ratcliffe