title: Quality of life assessments in nursing homes revealed a tendency of proxies to moderate patients' self-reports.
abstract: Research into different patient populations suggests that, on average, proxies report poorer health-related quality of life (HRQoL) compared to self-reports. We aimed to investigate whether the difference between proxy reports and self-reports (interrater gap) varies across the whole range of self-reports from low to high HRQoL scores.
  
  
  
  A cross-sectional study in 16 Dutch nursing home (NH) dementia special care (DSC) units (n = 256) and 17 somatic units (n = 326). Professional carers, blinded to self-reports, provided EuroQol-5D scores from two perspectives: their own perspective (proxy-proxy) of the patients' HRQoL and the estimation of the patient's view (proxy-patient).
  
  
  
  The interrater gap varied linearly in both DSC and somatic patients from proxy scores overestimating low self-reports to proxy scores underestimating high self-reports. This attenuation tendency existed for both proxy-proxy and proxy-patient perspectives. The interrater gap tended to be smaller for the proxy-patient perspective.
  
  
  
  Proxies (professional carers) tend to attenuate self-reports in NH patients with and without dementia toward moderate scores rather than report systematically poorer HRQoL. A proxy-patient perspective may be preferable to a proxy-proxy perspective for the purpose of estimating self-reports. Further research into other populations is needed to understand whether the attenuation tendency is a general phenomenon.
authors.affiliation: Department of Primary and Community Care, Center for Family Medicine, Geriatric Care and Public Health, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands; Faculty of Psychology and Educational Sciences, Open University of the Netherlands, P.O. Box 2960, 6401 DL Heerlen, The Netherlands; Radboud Alzheimer Centre, Nijmegen, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands. Electronic address: roeslan.leontjevas@ou.nl.
authors.forename: Ruslan
authors.initials: R
authors.lastname: Leontjevas
authors.affiliation: Section Biostatistics, Radboud Institute for Health Sciences, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
authors.forename: Steven
authors.initials: S
authors.lastname: Teerenstra
authors.affiliation: Department of General Practice and Elderly Care Medicine and the EMGO+ Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
authors.forename: Martin
authors.initials: M
authors.lastname: Smalbrugge
authors.affiliation: Department of Primary and Community Care, Center for Family Medicine, Geriatric Care and Public Health, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands; Radboud Alzheimer Centre, Nijmegen, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands; Joachim en Anna, Centre for Specialized Geriatric Care, Postbus 31071, 6503 CB, Nijmegen, The Netherlands.
authors.forename: Raymond T C M
authors.initials: RT
authors.lastname: Koopmans
authors.affiliation: Department of Primary and Community Care, Center for Family Medicine, Geriatric Care and Public Health, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands; Radboud Alzheimer Centre, Nijmegen, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
authors.forename: Debby L
authors.initials: DL
authors.lastname: Gerritsen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers / Q000523:psychology* / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D005260:Female; D015577:Geriatric Assessment / Q000379:methods / Q000706:statistics & numerical data*; D006707:Homes for the Aged; D006801:Humans; D008297:Male; D009426:Netherlands; D009735:Nursing Homes; D019727:Proxy / Q000523:psychology / Q000706:statistics & numerical data; D011788:Quality of Life / Q000523:psychology*; D057566:Self Report; D011795:Surveys and Questionnaires
keywords: Assessment; Attenuation tendency; Bias; Nursing home; Proxy score; Quality of life