Valuing health‐related quality of life: An EQ‐5D‐5L value set for England

A new version of the EQ‐5D, the EQ‐5D‐5L, is available. The aim of this study is to produce a value set to support use of EQ‐5D‐5L data in decision‐making. The study design followed an international research protocol. Randomly selected members of the English general public completed 10 time trade‐off and 7 discrete choice experiment tasks in face‐to‐face interviews. A 20‐parameter hybrid model was used to combine time trade‐off and discrete choice experiment data to generate values for the 3,125 EQ‐5D‐5L health states. Valuation data are available for 996 respondents. Face validity of the data has been demonstrated, with more severe health states generally given lower values. Problems with pain/discomfort and anxiety/depression received the greatest weight. Compared to the existing EQ‐5D‐3L value set, there are considerably fewer “worse than dead” states (5.1%, compared with over one third), and the minimum value is higher. Values range from ?0.285 (extreme problems on all dimensions) to 0.950 (for health states 11211 and 21111). Results have important implications for users of the EQ‐5D‐5L both in England and internationally. Quality‐adjusted life year gains from interventions seeking to improve very poor health may be smaller using this value set and may previously have been overestimated.

     

老年人慢性病对日常生活功能的影响

目的：研究贵阳市城区老年慢性病人日常生活功能（ＡＤＬ和ＬＡＤＬ）的影响。方法：通过问卷问和体格检查相结合，对贵阳市我９６６名≥６０岁的老年人进行了慢性病和日常生活功能调查。运用非条件Ｌｏｇｉｓｔｉｃ回归分析有关慢性病对老年人日常生活功能损害原作用大小。结果：慢性病患病率为５７．８％，ＡＤＬ损害率为９．４％，ＩＡＤＬ损害率为２３．２％。对ＡＤＬ损害影响显著的疾病依次为脑血管疾病、白内障、慢性阻塞性肺     

Rethinking how we understand individual healthcare needs for people living with long‐term conditions: a qualitative study

It has been suggested that we need to ‘Think Differently’ about how we organise care for people with long‐term conditions. Current approaches prioritise reducing population disease burden, meaning health need is defined predominantly in terms of disease status, or even risk of disease. However, the result is care which overburdens some individuals. The World Health Organisation has described the need to view health as a ‘resource for living’ and not an end in itself. This study considers whether this view of health offers an alternative view of healthcare need in people living with long‐term conditions. We know that chronic disease can be disruptive for some people; but not all. Our research question asked: Why do people experience long‐term conditions differently, and what are the implications for understanding healthcare need? Our phenomenographic study involved qualitative interviews with 24 people living with at least one of the three conditions (diabetes, depression and chronic pain) and explored resources for and demands on daily living. Interviews all took place during 2012 and 2013. A narrative form analysis identified three patterns of illness experience (Gliding Swan, Stormy Seas and Stuck Adrift). Narrative content analysis revealed four factors explaining the variation: personalising care, existence of meaningful anchors, partnership and excess demands. We thus propose three new categories of healthcare need described by a consideration of health as a resource for living: Resilient, Vulnerable and Disconnected. We discuss how the emerging findings may offer scope to develop new needs assessment and patient‐reported outcome measure tools. And so, offer a different way of thinking about the organisation for care for people with long‐term conditions.     

湖南省赫山区老年人失能现况及影响因素分析

目的调查湖南省赫山区65岁以上老年人日常生活活动能力现状及影响因素,为制定干预措施、养老服务规划提供理论依据。方法采用多阶段随机抽样的原则,分别抽取赫山区2个街道(村)共460名65岁以上老年人,对其进行问卷调查。评估基本生活自理能力(basicactivities of daily living,BADL)和工具性日常生活活动能力(instrumental activities of daily living,IADL)。使用χ^(2)检验分析不同特征老年人群失能率差异,采用多因素logistic回归模型分析老年人BADL和IADL失能的影响因素。结果赫山区65岁以上BADL总体失能率为13.76%,IADL总体失能率47.82%。BADL损失率排前3位的项目依次是洗澡、穿衣、上厕所;IADL损失中搭乘公共交通受损率最高(34.06%),其次是使用电话、食物烹调。多因素分析结果显示:年龄越大,BADL、IADL损失的可能性越高;近1年未跌倒(OR=0.429,95%CI:0.182~1.010)、无慢性病(OR=0.136,95%CI:0.056~0.332)是BADL发生的保护因素,而初中以上文化程度(OR=0.418,95%CI:0.217~0.806)、近1年未跌倒(OR=0.313,95%CI:0.137~0.717)、无慢性病(OR=0.250,95%CI:0.141~0.443)是IADL失能的保护因素。结论湖南省益阳市赫山区65岁以上老年人失能率较高。高龄、跌倒、患有慢性病是BADL损失发生的危险因素,高龄、较低的文化程度、跌倒、患慢性病是IADL损失的危险因素,对该地区老年人日常生活活动能力进行有针对性地干预十分必要。     

Response‐Scale Heterogeneity in the EQ‐5D

This paper discusses two types of response‐scale heterogeneity, which may impact upon the EQ‐5D. Response‐scale heterogeneity in reporting occurs when individuals systematically differ in their use of response scales when responding to self‐assessments. This type of heterogeneity is widely observed in relation to other self‐assessed measures but is often overlooked with regard to the EQ‐5D. Analogous to this, preference elicitation involving the EQ‐5D could be subject to a similar type of heterogeneity, where variations across respondents may occur in the interpretations of the levels (response categories) being valued. This response‐scale heterogeneity in preference elicitation may differ from variations in preferences for health states, which have been observed in the literature. This paper explores what these forms of response‐scale heterogeneity may mean for the EQ‐5D and the potential implications for researchers who rely on the instrument as a measure of health and quality of life. We identify situations where they are likely to be problematic and present potential avenues for overcoming these issues. Copyright © 2016 John Wiley & Sons, Ltd.     

The effect of chronic diseases on functional status of the elderly living in the city of São Paulo, Brazil

The main focus of this study was the effect of chronic disease (hypertension, diabetes mellitus, heart disease, lung disease, cancer, and arthropathy) on the functional status (activities of daily living - ADL, instrumental activities of daily living - IADL) among the elderly, controlling for age, gender, living arrangements, education, and comorbidity. The analysis was based on information provided by the SABE Project, from the city of S?o Paulo, Brazil, including individuals 60 years of age and over (n = 1,769), from January 2000 to March 2001. A multinomial logistic regression model was used. Compared to the absence of dependency category, heart disease (OR = 1.82), arthropathy (OR = 1.59), lung disease (OR = 1.50), and hypertension (OR = 1.39) were the main diseases that affected the IADL dependency category. Lung disease (OR = 2.58), arthropathy (OR = 2.27), hypertension (OR = 2.13), and heart disease (OR = 2.10) had important impact on the IADL and ADL dependency categories. The results were statistically significant (p < 0.05).     

Factors associated with functional dependence in older adults: a secondary analysis of the National Study on Health and Aging, Mexico, 2001]

OBJECTIVES: To identify factors associated with dependence for basic activities of daily living (BADL) and instrumental activities of daily living (IADL) in elderly adults in Mexico. METHODS: A cross-sectional study of data from the first round of Mexico's National Study on Health and Aging, 2001, was undertaken. The sample consisted of 7 171 participants, 60 years of age or older. Multifactorial regression analysis was used to identify associations between BADL and IADL dependence and lifestyle, sociodemographics, family background, and health history, from childhood to present. RESULTS: The mean age of the participants was 69.4 +/- 7.6 years of age, with a range of 60-105 years; females made up 53.4% of the sample. The BADL- and IADL-dependent groups had a higher mean age (P < 0.01), were predominantly female (P < 0.01), had a greater incidence of illiteracy, and reported a significantly higher number of chronic diseases and greater frequency of pain than did the independent participants. Among the 521 (7.3%) BADL-dependent, there was a higher percentage who were single or widowed (P < 0.01), and their self-assessed health was poorer, than that of the independent (P < 0.01). Among the 603 (8.4%) IADL-dependent, significant, independently associated factors were age, cerebrovascular and other chronic diseases, depression, vision issues, excessive pain, and amputation of a limb. Absence of childhood trauma and fewer years of employment were related to a lower incidence of IADL dependence. CONCLUSIONS: Functional dependence in older adults is directly related to aging and has multiple determinants. Awareness of these determinants should help design health programs that can identify individuals who are at high risk of losing their independence, and implement interventions for slowing or reversing the process.     

2011年济宁市城区部分老年人日常生活活动能力评价

[目的]了解济宁市老年人基本日常生活活动能力和工具性日常生活活动能力,为社区及乡镇卫生服务机构有效开展老年卫生服务和健康维护提供参考。[方法]2011年3～4月,采用多阶段随机抽样方法,在济宁市城区抽取≥65岁常住户口的老年504人应用Katz日常生活活动量表(Katz-ADL)和工具性日常生活活动量表(Lawton-IADL)进行调查。[结果]测评人504人,Katz-ADL得分为5.66±0.91分。6项功能均保持的占80.95%,6项功能均丧失的占0.79%。6项功能均保持者所占比例,男性为86.67%,女性为74.36%(P<0.01)。测试的504人中,Lawton-IADL得分:男性为3.72±1.59分,女性为5.06±2.83分。其中,男女相同的5项功能均保持者所占比例为33.53%,男性为44.08%,女性为21.37%(P<0.01);5项功能均丧失者所占比例为11.31%,男性为7.78%,女性为15.38%(P<0.01)。[结论]济宁市城区老年人日常生活活动能力和工具使用生活能力较高,多项生活活动能力保持率男性高于女性。     

上海市杨浦区离休干部日常生活能力及相关因素的调查

目的研究上海市杨浦区离休干部慢性病患病状况以及社会人口学因素对日常生活功能的影响。方法采用普查方法对杨浦区2944名离休干部进行日常生活能力[应用日常生活能力（ADL）和工具性日常生活能力（IADL）量表]和慢性病等相关因素的问卷调查，并做多因素Logistic回归统计分析。结果离休干部慢性病患病率为98．9％，ADL和IADL受损率分别为20．1％和45．2％。显著影响ADL受损的慢性病依次为脑出血、脑梗死、心脏病、肿瘤、哮喘、糖尿病、慢性支气管炎和骨关节病，显著影响IADL受损的慢性病依次为脑出血、脑梗死、哮喘、心脏病、糖尿病、肾脏病和前列腺增生。男性、年龄增长、文化程度低以及经济支配能力减弱与日常生活功能受损有关。结论各种慢性病可不同程度地引起ADL和IADL的受损。     

Valuing health using EQ‐5D: The impact of chronic diseases on the stock of health

Chronic diseases strongly affect individuals' health status. In aggregate terms, this impact is reflected by the stock of health, which measures the amount of health of a population in a given period of time. The objectives of this study were to measure the relative burden of chronic illnesses by assessing health‐related quality of life using the EQ‐5D‐5L instrument, to rank diseases according to their associations with the stock of health, and to calculate the stock of health of the Spanish population and the amount of health loss attributable to each chronic disease from a social perspective. Data were gathered from the Spanish Health Survey (ENSE 2011–2012, N = 20,587). A population weighted least squares model was used. Chronic diseases represent 19.19% of the stock of health losses in Spain compared with a country free from those diseases. In Spain, the stock of health in 2011 was 31.86 million units on the visual analog scale. The diseases with the strongest impact in terms of loss of stock of health at the individual level were mental illness and embolism, stroke, or cerebral hemorrhage. Collectively, the diseases with the largest impact included osteoarthritis, arthritis, or rheumatism; chronic back pain; and high blood pressure.     

Can social firms contribute to alleviating the economic burden of psychiatric disabilities for the public healthcare system?

In a number of countries, unemployment rates for people with psychiatric disabilities are much higher than in the general population. On the one hand, the expenses for mental health reach 3.5% of the total public health and social services budget in Québec. On the other hand, social firms (SFs) receive government subsidies. The objective was to compare public healthcare expenses for people with psychiatric disabilities who work in SFs with those associated with people with a similar condition who are looking for a job in the competitive labour market. This study followed a retrospective comparative design and considered two groups, namely: 122 employees working in SFs and 64 individuals participating in a supported employment program as job‐seekers. Two complementary datasets were used: a self‐report questionnaire and public healthcare databases. The cost analysis was performed from the perspective of the public healthcare system and included outpatient visit fees to physicians, outpatient visits to health professionals other than physicians in public healthcare centres, inpatient expenses due to hospitalisations, emergency room visits and amounts reimbursed to patients for medication. Regression analyses using generalised linear models with a gamma distribution and log link were used. Our results revealed that when controlling for sociodemographic variables (gender, age, marital status, education, physical disability), global health (EuroQol EQ‐5D‐5L), the severity of psychiatric symptoms (18‐item Brief Symptom Inventory) and self‐declared primary mental health diagnosis, annual healthcare costs paid by the public insurance system were between $1,924 and $3,912 lower for people working in SFs than for the comparison group. An explanatory hypothesis is that working in SFs could act as a substitute for medical treatments such as outpatient visits and medication use. There might be a form of compensation between supporting SFs and financing the public healthcare system, which provides valuable insights for public decision‐making.     

贵阳市居家养老老年人日常生活能力影响因素研究?

目的调查贵阳市居家养老人群日常生活能力,分析其可能的影响因素,为老年人居家养老护理提供参考。方法采用多阶段分层整群随机抽样的方法,随机抽取8个居委会中年龄≥60岁的1 898名居家老年人进行日常生活能力调查;日常生活能力影响因素单因素分析采用t检验、F检验,两两比较采用LSD法,多因素分析采用多元线性回归。结果调查对象平均年龄为(71.4±5.9)岁。贵阳市居家老年人日常生活能力(ADL)总分为(14.91±3.88)分,躯体性日常生活能力(PADL)得分为(6.26±1.27)分,工具性日常生活能力(IADL)得分为(8.65±2.75)分。多元线性回归分析显示:对PADL、IADL和总的ADL有影响的因素及影响大小依次为年龄、是否参加体育锻炼、是否患慢性病和文化程度,差异均有统计学意义(P0.05)。结论贵阳市居家老年人日常生活能力总体水平较好,居家养老护理应重点关注高龄、患有慢性病和文化程度低的老年人。     

贵阳市城区老年人生活质量研究

目的　探讨城市老年人生活质量现状及其影响因素。方法　在贵阳市城区采用整群抽样方法，用标准量表调查了９６６ 名６０ 岁及以上的老年人。结果　慢性病的患病率为５７８％ ，ＡＤＬ和ＩＡＤＩ损害率分别为９４％ 和２３２％ ，ＬＳＩＡ 平均得分为２９８５ 分，５３７％ 的人经历过负性事件，２３２％ 的老年人社会支持程度相对较低。多因素分析结果表明，年龄、收入状况、健康自评、慢性病、日常生活功能、负性生活事件、社会支持程度等与老年人生活质量高度关联。结论　老年人生活质量受较多因素影响，有必要采取综合措施来改善他们的整体健康水平，从而提高其生活质量。     

Low‐income homebound older adults receiving home‐delivered meals: Physical and mental health conditions,incidence of falls and hospitalisations

Significant differences in health across racial/ethnic and socioeconomic groups in the US signal increasing numbers of low‐income homebound older adults in a rapidly ageing society. The purpose of this study was to examine physical and psychiatric conditions and their association with incidence of self‐reported falls and hospitalisations among largely low‐income and racial/ethnic minority adults age 50+ (N = 2,224), clients from a home‐delivered meals programme in Central Texas. Data came from comprehensive, in‐home assessments done in 2017 by these older adults’ case managers. We used bivariate analyses to compare those with and without incidence of self‐reported past‐year falls and those with and without a hospitalisation episode with respect to their sociodemographic and clinical characteristics. We used multivariable logistic regression analysis to examine sociodemographic and clinical correlates of any incidence of falls and negative binomial regression analysis to examine these correlates of the number of hospitalisations in the preceding 12 months. The rates of chronic physical illnesses, including cardiovascular disease, diabetes, gastrointestinal disease, lung disease and renal failure, were extremely high. The 41% of reported falls among the study sample was also higher than the rate among US older adults in general. More diagnosed physical illnesses, depression, chewing/swallowing problems, chronic/severe pain, activities and instrumental activities of daily living (ADL/IADL) impairments and ambulation assistive device use were associated with greater odds of falling. The rate of past‐year hospitalisation was 26%, and more diagnosed physical illnesses, ADL/IADL impairments, ambulation assistive device use and any fall incidence were positively associated with the number of hospitalisations. These findings indicate the need for fall prevention programmes for frail homebound older adults as well as health and social care services that help older adults better manage physical/mental health problems and reduce preventable health crises and hospitalisations.     

老年人群慢性病现状及对日常生活功能的影响

目的：为老年人群慢性病防治和生活质量的改善提供科学依据。方法：采用多级抽样调查和logistic回归分析方法对1109名老年人慢性病状况及对日常生活功能的影响进行研究。结果：（1）慢性病患病率为67.2%，大多患2种以上，前五位依次为高血压，心脏病，白内障，骨质疏松和胃肠疾病；（2）日常生活功能ADL和IADL损害率分别为8.0%和43.6%;（3）对ADL损害有显著意义的因素有高血压，脑血管病，精神病，白内障，泌尿系疾病和肿瘤，对IADL损害有显著意义的因素有年龄，脑血管病和肿瘤，ADL和IADL的影响因素有较大差别，而且其与患病率高低，患多少种病并无一致的对应关系。结论；老年人慢性病患病率高，不少疾病对日常生活功能造成明显损害，而疾病的性质可能所起作用较大，应采取适宜的策略和和措施防治慢性病。     

应用EQ-5D量表对北京房山农村中老年人慢性病患者生命质量及影响因素的研究

目的 研究高血压、糖尿病、冠心病和脑卒中四种常见慢性病(四病)对农村中老年人生命质量的影响,探讨其主要影响因素与特点.方法 采取整群抽样方法,对北京市房山区中老年人进行健康体检和流行病学问卷调查,采用欧洲五维度健康量表(EQ-5D)进行生命质量测量.应用Probit回归模型,以人群归因危险度百分比(PAR％)为核心指标,分析四病对生命质量各维度的影响及其控制的公共卫生学意义.结果 共调查5345名研究对象,72.1％患四病,慢性病患者的平均EQ-5D健康指数低于非患者,差异有统计学意义(t=15.082,P＜0.001).慢性病患者在各健康维度的生命质量问题比例均高于不患慢性病者(P＜0.001),主要问题集中于疼痛不适维度(20.4％).与不患慢性病者相比,冠心病患者在疼痛不适维度的相对危险升高了31.6％(RR=1.316,95％CI:1.205～ 1.436),脑卒中患者在自我照顾和平常活动维度相对危险分别升高了30.4％(RR=1.304,95％CI:1.104～1.541)和33.8％(RR=1.338,95％CI:1.151～1.555).四病对人群生命质量影响程度的PAR％分别为高血压31.05％、糖尿病4.84％、冠心病23.39％和脑卒中4.44％.结论农村社区中老年人冠心病患者在疼痛不适维度发生问题的风险最高,患脑卒中在自我照顾和平常活动维度发生问题的风险最高,冠心病患者发生健康状态不良的风险最大,对该地区控制高血压可以较大程度提高人群生命质量.     

Gender disparity of successful aging in Taiwan

The purpose of this longitudinal study was to examine the association of gender on successful aging during a 6-year follow-up study. Data were drawn from the 1989, 1993, 1996, and 1999 Survey of Health and Living Status of the Elderly in Taiwan, a national representative population survey of 4,049 participants aged 60 years or older; 43% were women. Successful aging indicators were defined as physical (absence of disease and physical disability), mental (normal cognitive function and absence of depression), and social (good social support and participation in productive activities). Gender differences related to successful aging during the 6 years were analyzed with Cox proportional hazards regression model. Significant disparities were found between elderly men and women in activities of daily living (ADL), instrumental activities of daily living (IADL), cognitive function, depressive symptoms, social support and productive activities. When the data included individuals who were deceased, elderly women showed better maintenance of ADL and less vulnerability to IADL impairment than elderly men. However, when the analysis included only survivors during the follow-up, the elderly were more likely to be impaired in IADL and cognitive function, have depressive symptoms, and lack engagement in productive activities. Cumulative disadvantage was associated with health disparities in elderly women. This research demonstrates the need to develop gender-sensitive policies.     

Relationship between keeping a companion animal and instrumental activity of daily living (IADL). A study of Japanese elderly living at home in Satomi Village

OBJECTIVE: The purpose of this study was to clarify the relationship between the companionship of an animal and the level of Instrumental Activity of Daily Living (IADL) of elderly people living at home, and to consequently determine beneficial effects on the overall health of the elderly. METHODS: For this study, 400 elderly people aged 65 years and over were randomly selected from among the 1,345 citizens of Satomi Village, Ibaraki Prefecture. Self-administered questionnaires were mailed to the selected subjects in March of 1999. In the survey, the respondents were asked if they could accomplish all seven IADL activities. Subjects for whom this was the case were classified as having no IADL disability. Elderly who answered "No" for even one were listed as having an IADL disability. Using the existence of an IADL disability as a dependent variable and various factors related to companion animals as independent variables, a logistic regression analysis was performed. RESULTS: Out of the 400 individuals, 84.8% responded. With respect to the possession of a companion animal, the number of participants who never had a companion animal was 115 (35.8%); while 118 (36.8%) possessed a companion animal in the present. With regard to factors relevant to IADL of elderly people, the odds ratio (OR) adjusted for age and sex for participants who owned dogs was 0.53 (95% confidence interval [CI] 0.27-0.99) relative to those who never had a companion animal: The difference was significant. For those respondents who indicated that their companion animals were their best friends, the OR was 0.48 (95% CI 0.23-0.99), and again significant. The OR tended to decrease with increase in the duration of owning a companion animal. CONCLUSION: In this study, owning a dog and everyday contact with the companion animal were related to the IADL of the elderly living at home. It is possible that keeping a companion animal may be linked to better overall health in the elderly.     

Quality of life in people with multiple sclerosis: data from the Sonya Slifka Longitudinal Multiple Sclerosis Study

Current knowledge about the health-related quality of life (HRQoL) experienced by people with multiple sclerosis (MS) is limited. We compared item and component scale scores on the Medical Outcomes Short Form 12 (SF-12) of 2,109 people with MS to U.S. norms and published data on persons with other medical conditions. We also built regression models for SF-12-derived mental (MCS) and physical component scale (PCS) scores. Seventy-five percent of the sample had been diagnosed with MS for over 5 years, and one-half to two-thirds received help with at least one activity of daily living (ADL) or instrumental activity of daily living (IADL), respectively. The mean PCS score was 36.2 (Standard Error: 0.27), significantly lower by 14 points than the U.S. population norm and by 4-12 points than mean scores for individuals with diabetes, congestive heart failure, myocardial infarction, hypertension or depression. The mean MCS score was 49.2 (Standard Error: 0.25), significantly lower than the norm for the U.S. population and the mean scores for the chronic condition groups except congestive heart failure and depression. We identified several demographic, disease, and health services factors that were significantly related to quality of life and highlighted a number of areas for improvement. We concluded that the quality of the lives of people with MS could be enhanced by removing barriers to MS care, general health care, and mental health care; meeting needs for help with activities of daily living and instrumental activities of daily living; supporting employment; and improving access to disease modifying agents and symptomatic treatments.