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Health status versus quality of life in older patients: does the distinction matter?

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Abstract

PURPOSE: Although health-related quality of life in older people is generally assessed by measuring specific domains of health status, such as activities of daily living or pain, the association between health-status measures and patients’ perceptions of their quality of life is not clear. Indeed, it is controversial whether these health-status measures should be considered measures of quality of life at all. Our objective was to determine the association between health-status measures and older patients’ perceptions of their global quality of life.

SUBJECTS AND METHODS: We performed a cross-sectional study of 493 cognitively intact patients 80 years of age and older, interviewed 2 months after a hospitalization. We measured patients’ self-assessed global quality of life and four domains of health status: physical capacity, limitations in performing activities of daily living, psychological distress, and pain.

RESULTS: Each of the four scales was significantly correlated with patients’ global perceptions of their quality of life (P <0.001). The ability of the health-status scales to discriminate between patients with differing global quality of life was generally good, especially for the physical capacity (c statistic = 0.72) and psychological distress scales (c statistic = 0.70). However, for a substantial minority of patients, scores on the health-status scales did not accurately reflect their global quality of life. For example, global quality of life was described as fair or poor by 15% of patients with the highest (best tertile) physical capacity scores, 25% of patients who were independent in all activities of daily living, 21% of patients with the least psychological distress (best tertile), and by 30% with no pain symptoms. Similarly, global quality of life was described as good or better by 43% of patients with the worst physical capacity (worst tertile), 49% of patients who were dependent in at least two activities of daily living, 47% of patients with the most psychological distress (worst tertile), and 51% of patients with severe pain.

CONCLUSION: On average, health status is a reasonable indicator of global quality of life for groups of older patients with recent illness. However, disagreement between patients’ reported health status and their perceptions of their global quality of life was common. Therefore, assumptions about the overall quality of life of individual patients should not be based on measures of their health status alone.

Section snippets

Patients

Patients were enrolled in the Hospitalized Elderly Longitudinal Project—a four-hospital study of outcomes, preferences, and decision making for older patients (11)—and interviewed 2 months after a hospitalization. The project was conducted in tandem with the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment (SUPPORT) and used similar methods 12, 13. From February to November 1994, we enrolled 1,266 persons 80 years of age or older who were hospitalized at one of

Results

Of the 1,057 patients who survived 2 months, 279 were not eligible for this study because they could not be interviewed by phone, generally because of either a severe hearing impairment or dementia, and 116 were not eligible because they failed a preinterview cognitive screen. Of the remaining 662 eligible patients, 169 did not complete interviews for the following reasons: patient refusal (n = 80); physician did not permit interview (n = 21); or other reasons, including logistic difficulties

Discussion

Most investigators purporting to measure quality of life actually measure various aspects of health status, conceptualizing these measures as health-related quality of life 2, 3. This approach has been criticized 4, 5, 6, 7, 8 and defended (19). Much of the criticism has revolved around whether domain-specific measures of health status truly reflect quality of life. The goal of this study was to quantify the association between health-status measures and patients’ perceptions of their quality

Acknowledgements

We thank Sidney Katz, MD, Eva M. Kahana, PhD, and Mary-Margaret Chren, MD for their advice and thoughtful review of this manuscript.

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    Supported by the Robert Wood Johnson Foundation. The views expressed in this article do not necessarily represent those of the Robert Wood Johnson Foundation or its Board of Trustees. Dr. Covinsky was supported in part by a clinical investigator award from the National Institute on Aging (AG00714).

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