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Can care staff accurately assess health-related quality of life of care home residents ? A secondary analysis of data from the OPERA trial
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Parker, Benjamin A., Madan, Jason, Petrou, Stavros and Underwood, Martin (2017) Can care staff accurately assess health-related quality of life of care home residents ? A secondary analysis of data from the OPERA trial. BMJ Open, 7 (4). e012779. doi:10.1136/bmjopen-2016-012779 ISSN 2044-6055.
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Official URL: http://doi.org/10.1136/bmjopen-2016-012779
Abstract
Objectives:
To compare assessments of health- related quality of life outcomes of care home residents reported by residents and care staff acting as proxies.
Design:
Linear regression and bivariate modelling of paired assessments from care home residents and care staff. Setting: 78 care homes in 2 regions in England. Participants: 556 care home residents aged 65 years or older and care staff. Main outcome measures: EQ-5D utility scores and responses to individual EQ-5D dimensions.
Results:
The depression status, cognitive function, physical function, activities of daily living, social engagement, pain and dementia diagnosis of care home residents all predicted discrepancies in EQ-5D reporting. For residents with no depressive symptoms, care staff underestimated residents’ mean EQ-5D utility score by 0.134 (95% CI 0.097 to 0.171) and for those with severe depressive symptoms they overstated mean utility scores by 0.222 (95% CI 0.104 to 0.339). With increasing levels of pain in residents the care staff progressively estimated EQ-5D utilities above self-reported values; by 0.236 (95% CI 0.003 to 0.469) in those with the second highest pain scores. For those with no cognitive impairment, proxies overstated mean utility scores by 0.097 (95% CI 0.049 to 0.146), while for those with severe cognitive impairment they underestimated mean utility scores by 0.192 (95% CI 0.143 to 0.241).
Conclusions:
Care home residents and staff appear to differ fundamentally in their assessment of the health- related quality of life, as measured by the EQ-5D, of residents with different levels of depression, pain and/or cognitive impairment. This could lead to interventions evaluated using proxy-based quality-adjusted life year estimates being wrongly rejected on cost-effectiveness grounds and may also make it difficult for carers to act as advocates with health and social care professionals for certain groups of residents. A more resident-focussed approach to assessment of health-related quality of life is needed.
Item Type: | Journal Article | ||||||||||||
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Subjects: | H Social Sciences > HV Social pathology. Social and public welfare R Medicine > RA Public aspects of medicine |
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Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Clinical Trials Unit Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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Library of Congress Subject Headings (LCSH): | Older people -- Home care -- Statistics -- England, Health status indicators, Old age homes -- Employees -- England, Depression, Mental -- Diagnosis, Cognition -- Testing, Disabilities, Pain in old age, Dementia -- Diagnosis, Cognition disorders | ||||||||||||
Journal or Publication Title: | BMJ Open | ||||||||||||
Publisher: | BMJ | ||||||||||||
ISSN: | 2044-6055 | ||||||||||||
Official Date: | 1 April 2017 | ||||||||||||
Dates: |
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Volume: | 7 | ||||||||||||
Number: | 4 | ||||||||||||
Article Number: | e012779 | ||||||||||||
DOI: | 10.1136/bmjopen-2016-012779 | ||||||||||||
Status: | Peer Reviewed | ||||||||||||
Publication Status: | Published | ||||||||||||
Access rights to Published version: | Open Access (Creative Commons) | ||||||||||||
Date of first compliant deposit: | 16 January 2017 | ||||||||||||
RIOXX Funder/Project Grant: |
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