Neglected aspects of the quality of life

Health status indexes have focused on physical function such as the activities of daily living, perhaps because the National Health Survey provides data of this sort or because it is the object of rehabilitation programs. In an attempt to elicit values concerning loss of function, 150 health workers were asked to assign weights from zero to 10 for 50 abilities or functions. Serious methodological problems were encountered in finding terms describing functional loss that were simple and meaningful to a wide range of workers. In addition, an open-ended request was made to identify other functions not included in the list. The largest average values were assigned to ability to use one's mental abilities, to see, to think clearly, to love and be loved in return, to make decisions for oneself, to live at home, to walk, to maintain contact with family and friends, and to talk. Some of the functional loss implied in these responses may not be amenable to cure or rehabilitation but may be preventable and thus needs to be included in outcome measures.