title: An Empirical Comparison of the EQ-5D-5L, DEMQOL-U and DEMQOL-Proxy-U in a Post-Hospitalisation Population of Frail Older People Living in Residential Aged Care.
abstract: OBJECTIVE
  To empirically compare the measurement properties of the DEMQOL-U and DEMQOL-Proxy-U instruments to the EQ-5D-5L and its proxy version (CEQ-5D-5L) in a population of frail older people living in residential aged care in the post-hospitalisation period following a hip fracture.
  
  
  METHODS
  A battery of instruments to measure health-related quality of life (HRQoL), cognition, and clinical indicators of depression, pain and functioning were administered at baseline and repeated at 4 weeks' follow-up. Descriptive summary statistics were produced and psychometric analyses were conducted to assess the levels of agreement, convergent validity and known group validity between clinical indicators and HRQoL measures.
  
  
  RESULTS
  There was a large divergence in mean (SD) utility scores at baseline for the EQ-5D-5L and DEMQOL-U [EQ-5D-5L mean 0.21 (0.19); DEMQOL-U mean 0.79 (0.14)]. At 4 weeks' follow-up, there was a marked improvement in EQ-5D-5L scores whereas DEMQOL-U scores had deteriorated. [EQ-5D-5L mean 0.45 (0.38); DEMQOL-U mean 0.58 (0.38)]. The EQ-5D and CEQ-5D-5L were more responsive to the physical recovery trajectory experienced by frail older people following surgery to repair a fractured hip, whereas the DEMQOL-U and DEMQOL-Proxy-U appeared more responsive to the changes in delirium and dementia symptoms often experienced by frail older people in this period.
  
  
  CONCLUSIONS
  This study presents important insights into the HRQoL of a relatively under-researched population of post-hospitalisation frail older people in residential care. Further research should investigate the implications for economic evaluation of self-complete versus proxy assessment of HRQoL and the choice of preference-based instrument for the measurement and valuation of HRQoL in older people exhibiting cognitive decline, dementia and other co-morbidities.
authors.affiliation: Flinders Health Economics Group, School of Medicine, Flinders University, Adelaide, SA, Australia. julie.ratcliffe@flinders.edu.au.
authors.forename: Julie
authors.initials: J
authors.lastname: Ratcliffe
authors.affiliation: Flinders Health Economics Group, School of Medicine, Flinders University, Adelaide, SA, Australia.
authors.forename: Thomas
authors.initials: T
authors.lastname: Flint
authors.affiliation: Department of Rehabilitation and Aged Care, School of Health Sciences, Flinders University, Adelaide, Australia.
authors.forename: Tiffany
authors.initials: T
authors.lastname: Easton
authors.affiliation: Department of Rehabilitation and Aged Care, School of Health Sciences, Flinders University, Adelaide, Australia.
authors.forename: Maggie
authors.initials: M
authors.lastname: Killington
authors.affiliation: John Walsh Centre for Rehabilitation Research, Kolling Institute, University of Sydney, Sydney, Australia.
authors.forename: Ian
authors.initials: I
authors.lastname: Cameron
authors.affiliation: Department of Rehabilitation and Aged Care, School of Health Sciences, Flinders University, Adelaide, Australia.
authors.forename: Owen
authors.initials: O
authors.lastname: Davies
authors.affiliation: Department of Rehabilitation and Aged Care, School of Health Sciences, Flinders University, Adelaide, Australia.
authors.forename: Craig
authors.initials: C
authors.lastname: Whitehead
authors.affiliation: John Walsh Centre for Rehabilitation Research, Kolling Institute, University of Sydney, Sydney, Australia.
authors.forename: Susan
authors.initials: S
authors.lastname: Kurrle
authors.affiliation: Department of Nutrition and Dietetics, School of Health Sciences, Flinders University, Adelaide, Australia.
authors.forename: Michelle
authors.initials: M
authors.lastname: Miller
authors.affiliation: Department of Rehabilitation and Aged Care, School of Health Sciences, Flinders University, Adelaide, Australia.
authors.forename: Enwu
authors.initials: E
authors.lastname: Liu
authors.affiliation: Department of Rehabilitation and Aged Care, School of Health Sciences, Flinders University, Adelaide, Australia.
authors.forename: Maria
authors.initials: M
authors.lastname: Crotty
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D016330:Frail Elderly / Q000523:psychology* / Q000706:statistics & numerical data*; D006620:Hip Fractures / Q000534:rehabilitation*; D006707:Homes for the Aged / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes / Q000592:standards*; D011594:Psychometrics; D011788:Quality of Life / Q000523:psychology*; D011795:Surveys and Questionnaires