What's important in defining quality of life for older people? An exploratory study of the views of older South Australians

<b>Background</b><br />Cost-effectiveness analyses of interventions for older adults have traditionally focused on health status. There is increasing recognition of the need to develop new instruments to capture quality of life in a broader sense in the face of age-associated increasing frailty and declining health status, particularly in the economic evaluation of aged and social care interventions which may have positive benefits beyond health. <div><br /><b>Objective</b><br />To explore the relative importance of health and broader quality of life domains for defining quality of life from the perspective of older South Australians.<br /><br /><b>Methods</b><br />Older adults (n=21) from a day rehabilitation facility in Southern Adelaide, South Australia attended one of two audiorecorded focus groups. A mixed methods (qualitative and quantitative) approach was adopted. The study included three main components. Firstly, a general group discussion on quality of life and the factors of importance in defining quality of life. Secondly, a structured ranking exercise in which individuals were asked to rank domains from the brief Older People’s Quality of Life questionnaire (OPQOL-brief) and Adult Social Care Outcomes Toolkit (ASCOT) in order of importance. Thirdly, participants were asked to self-complete the Euroqol (EQ-5D) a measure of health status, and two broader quality of life measures: the OPQOL-brief and ASCOT.<br /><br /><b>Results</b><br />Mean scores on the EQ-5D, OPQOL-brief and ASCOT were 0.71 (SD 0.20, range 0.06-1.00), 54.6 (SD 5.5, range 38-61) and 0.87 (SD 0.13, range 0.59-1.00) respectively, with higher scores reflecting better ratings of QOL. EQ-5D scores were positively associated with OPQOL-brief (rho: .730, p<.01), but not ASCOT. Approximately half (52.4%) of the respondents ranked either “health” or “psychological and emotional well- being” as the domain most important to their quality of life. However, one-third (33.3%) of the total sample ranked a non-health domain from the ASCOT or OPQOL-brief (safety, dignity, independence) as the most important contributing factor to their overall quality of life. Qualitative analysis of focus group transcripts supported the high value of both health-related (health, psychological well-being) and social (independence, safety) domains to quality of life.<br /><br /><b>Conclusions</b><br />Older adults value both health and social domains as important to their overall quality of life. Future economic evaluations of health, community and aged-care services for older adults should include assessment of both healthrelated and broader aspects quality of life.</div>