title: Measuring health status in older patients. The SF-36 in practice.
abstract: OBJECTIVE
  To examine the use of the Medical Outcomes Study short form 36-item (SF-36) health status measure in older patients receiving health care; to explore the influence of age and physical and cognitive status on response to and completion of the SF-36 questionnaire.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  Hospital and ambulatory patients aged 65 years and over in the medical and surgical wards and outpatient department of a teaching hospital and a local general practitioner's surgery.
  
  
  METHODS
  1014 hospital inpatients, 80 hospital outpatients and 40 patients attending their general practitioner's surgery.
  
  
  METHODS
  Response rates, overall rates of completion (sufficient to calculate a valid SF-36 score) and completion of individual questions.
  
  
  RESULTS
  37 out of 40 ambulatory patients in general practice (93%) and 71 out of 80 outpatients (89%) returned a self-completed questionnaire. In hospital inpatients the overall response rate was only 46% (369 of 802). This was improved by interview administration to 77.4% (164 of 212). Logistic regression analysis revealed that self-completion, cognitive dysfunction, disability and age were all independently associated with poor overall response rates. Among those patients who returned a completed questionnaire, completion of individual questions sufficient to calculate a valid score was variable. Only 62.5% of inpatients who self-completed a questionnaire gave sufficient response to calculate a score on the mental health subscale, compared with 93.7% of general practice patients.
  
  
  CONCLUSIONS
  The self-administered questionnaire is unacceptable for older hospital inpatients. Use of an interviewer improves response, but factors which influence health status, such as physical and cognitive dysfunction, have a significant effect on response rates. Therefore the utility of the SF-36 in its present form as a routine health status measure for use in older hospital inpatients is questioned.
authors.affiliation: Division of Medicine for the Elderly, University of Leicester, Leicester General Hospital, UK. sgp5@leicester.ac.uk
authors.forename: S G
authors.initials: SG
authors.lastname: Parker
authors.forename: S M
authors.initials: SM
authors.lastname: Peet
authors.forename: C
authors.initials: C
authors.lastname: Jagger
authors.forename: M
authors.initials: M
authors.lastname: Farhan
authors.forename: C M
authors.initials: CM
authors.lastname: Castleden
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D003704:Dementia / Q000175:diagnosis; D004185:Disability Evaluation; D005194:Family Practice; D005260:Female; D015577:Geriatric Assessment / Q000706:statistics & numerical data*; D006304:Health Status; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D011446:Prospective Studies; D015203:Reproducibility of Results