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      Quality of Life of Nursing Home Residents with Dementia: Validation of the German Version of the ICECAP-O

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          Abstract

          Objectives

          To validate the ICECAP-O capability wellbeing measure’s German translation in older people with dementia living in a nursing home, and to investigate the influence of proxy characteristics on responses.

          Method

          Cross-sectional study. For 95 residents living in a German nursing home, questionnaires were completed by nursing professionals serving as proxy respondents. We investigated the convergent validity of the ICECAP-O with other Quality of Life (Qol) measures, the EQ-5D extended with a cognitive dimension (EQ-5D+C), the Alzheimer’s Disease Related Quality of Life (ADRQL) measures, and the Barthel-index measure of Activities of Daily Living (ADL). Discriminant validity was investigated using bivariate and multivariate stepwise regression analysis, comparing ICECAP-O scores between subgroups varying in dementia severity, care dependency, ADL status and demographic characteristics.

          Results

          Convergent validity between the ICECAP-O, EQ-5D+C, ADRQL and Barthel-Index scores was moderate to good (with correlations of 0.72, 0.69 and 0.53 respectively), but differed considerably between dimensions of the instruments. Discriminant validity was confirmed by finding differences in ICECAP-O scores between subgroups based on ADL scores (0.58 below 65 points on the Barthel-index and 0.80 above 65 points) and other characteristics. The ICECAP-O scores based on available tariffs were related to proxy characteristics gender (0.52 males versus 0.65 females) and work experience (0.61 below 2 years of experience versus 0.68 above 2 years).

          Discussion

          The results of this study suggest that the ICECAP-O is a promising generic measure for general Qol and capability of people with dementia living in a nursing home. Validity tests generally yielded favorable results. Work experience and gender appeared to influence proxy response, which raises questions regarding appropriate proxies, especially since the ICECAP-O may be completed by proxies relatively often. Further research is necessary to validate the German version of the ICECAP-O, with specific attention to proxy completion for people with dementia.

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          Developing attributes for a generic quality of life measure for older people: preferences or capabilities?

          John Bond, Jane Lewis, Joanna Coast … (2006)
          Current UK policy with respect to the provision of health and social care for older people suggests that greater integration is required. Economists' attempts to assist resource allocation decisions, however, are very health focused, with concentration on the use of health-related quality of life measures. This paper reports an attempt to determine attributes for a new index clearly focusing on quality of life for older people rather than health or other influences on quality of life. In-depth interviews were conducted with 40 purposively selected informants aged 65 and over in private households to explore their views about what is important to them in terms of quality of life. Data were analysed using Framework qualitative analysis. Initial discussions tended to concentrate upon factors influencing quality of life including activities, relationships, health, wealth and surroundings. Further probing and analysis suggested five conceptual attributes: attachment, role, enjoyment, security and control. The data also suggested that the quality of informants' lives was limited by the loss of ability to pursue these attributes. So, for example, it is not poor health in itself, which reduces quality of life, but the influence of that poor health upon each informant's ability to, say, be independent, that is important. Amartya Sen's work on functioning and capability is particularly pertinent here. Using this work, it is possible to interpret the five conceptual attributes as a set of functionings-important for older people in the UK in the 21st century-but noting that it is the capacity to achieve these functionings that appears to be of importance. This suggests that further development of this measure should focus on an index of capability rather than preference-based utility.
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            The effect of adding a cognitive dimension to the EuroQol multiattribute health-status classification system.

            Paul F.M. Krabbe, Marlies E.A. Stouthard, Marie-Louise Essink-Bot … (1999)
            A methodological study was conducted to examine the effect of extending a frequently used simple multiattribute health-status classification system by adding a cognitive dimension. The EQ-5D questionnaire is a generic instrument to value health, developed by the EuroQol Group. The EQ-5D defines health according to five dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. We defined 18 different health states according to the standard EQ-5D classification. A second set of health states was constructed similar to the first, except for the addition of a cognitive dimension (EQ-5D+C). Valuations of both sets of health states were statistically analyzed to detect the effect of the additional dimension. The cognitive dimension generated systematically different values compared with the standard EQ-5D version, whereas the content validity improved. Both systems evoked equally reliable values. Analyses showed that a simple additive model to predict summary values for health states was not optimal for both systems. Although there is a current lack of consensus regarding the domains that are selected to represent health status, this study has shown the importance of considering the inclusion of a cognitive domain.
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              Validating the EQ-5D with time trade off for the German population.

              Johannes Greiner, Jan Busschbach, C Claes … (2005)
              The aim of this survey study was to derive the societal values of the general public for the EuroQol EQ-5D. Using the same protocol as previously used in the United Kingdom, we compared the German values with the British. In face-to-face interviews a sample of 339 individuals in northern Germany valued 15 different health states from a sample of 36 states. Values were derived using the York MVH protocol for time trade-off (TTO) and a visual analogue scale (VAS). Values for all 243 health states of the EQ-5D were estimated by a regression model. The VAS values revealed close a resemblance to the British VAS results. German TTO values were higher than the British. This was especially the case for the worse health states. The results suggest that the TTO values are more related to national variables than values derived by VAS. The use of the TTO values of this investigation makes it possible to anticipate these cultural differences in studies carried out in Germany.
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                Author and article information

                Contributors
                Terence J. Quinn: Role: Editor
                Journal
                Journal ID (nlm-ta): PLoS One
                Journal ID (iso-abbrev): PLoS ONE
                Journal ID (publisher-id): plos
                Journal ID (pmc): plosone
                Title: PLoS ONE
                Publisher: Public Library of Science (San Francisco, USA )
                ISSN (Electronic): 1932-6203
                Publication date Collection: 2014
                Publication date (Electronic): 14 March 2014
                Volume: 9
                Issue: 3
                Electronic Location Identifier: e92016
                Affiliations
                [1 ]Department of Geriatrics, Radboud University Medical Centre, Nijmegen, The Netherlands
                [2 ]Siemens Health Insurance Fund, Munchen, Germany
                [3 ]Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
                University of Glasgow, United Kingdom
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Conceived and designed the experiments: PM FB. Performed the experiments: FB. Analyzed the data: PM FB JvE. Wrote the paper: FB PM WB JvE.

                Article
                Publisher ID: PONE-D-13-43821
                DOI: 10.1371/journal.pone.0092016
                PMC ID: 3954837
                PubMed ID: 24632775
                SO-VID: bbe130ca-f619-4948-b0e5-f818927b5957
                Copyright statement: Copyright @ 2014
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date received : 28 October 2013
                Date accepted : 18 February 2014
                Page count
                Pages: 10
                Funding
                The authors have no support or funding to report.
                Categories
                Subject: Research Article
                Subject: Medicine
                Subject: Clinical Research Design
                Subject: Survey Research
                Subject: Epidemiology
                Subject: Survey Methods
                Subject: Geriatrics
                Subject: Long-Term Care
                Subject: Mental Health
                Subject: Psychiatry
                Subject: Dementia
                Subject: Non-Clinical Medicine
                Subject: Health Care Policy
                Subject: Quality of Life
                Subject: Social and Behavioral Sciences
                Subject: Economics
                Subject: Health Economics
                Subject: Cost Effectiveness
                Subject: Psychology
                Subject: Psychometrics

                ScienceOpen disciplines: Uncategorized
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                ScienceOpen disciplines: Uncategorized

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