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Provide a primer for systematic reviewers, clinicians, and researchers on assessing functional status and health-related quality of life (HRQL) in older adults. Systematic reviewers are increasingly focusing on interventions that address the problems of older people, who often have functional impairments and multiple morbidities. Key outcomes are function and HRQL. The paper provides an overview of the methods for assessing function and HRQL, and evidence on the measurement properties of prominent measures.
The paper provides an overview of the methods for assessing function and HRQL, and evidence on the measurement properties of prominent instruments.
Key measurement properties include construct validity (does the instrument measure what it is supposed to measure?), responsiveness (the ability to detect meaningful change) and interpretation (is the magnitude of change trivial or important?). Special challenges in older adult populations include sometimes sparse evidence on the measurement properties; using proxy respondents; a paucity of evidence on the magnitude of change that is patient-important; and threats to detecting patient-important changes due to floor and ceiling effects.
While further study of the measurement properties of measures in older populations is needed, studies of older adults should include measures of HRQL and function. Further, to generate rigorous evidence on effectiveness, older adults should be included in randomized controlled clinical trials. HRQL evidence from natural-history cohorts is important in interpreting results from intervention studies.