Instruments to Assess Dementia Fear Among Older Adults: A Systematic Review of Measurement Properties

To critically appraise, compare and summarise the measurement properties of existing instruments that assess dementia fear among older adults (≥ 60 years). Structured searches in six English electronic databases and two Chinese databases. Additionally, ProQuest Dissertations and Theses, DART Europe, and Google Scholar were searched from their inception to August 2024. Two researchers independently identified eligible studies. They assessed the methodological quality of the studies (rated 'very good', 'adequate', 'doubtful' and 'inadequate') and quality of measurement properties (rated 'sufficient', 'insufficient' or 'indeterminate') using the COSMIN guidelines. Among the 4104 studies identified, eight studies reported on the psychometric properties of five identified patient-reported outcome measures. The methodological quality of content validity for relevance, comprehensiveness, and comprehensibility of all instruments in this review was doubtful or inadequate. The methodological quality of structural validity in the majority of the studies was adequate, whereas the quality of hypothesis testing for construct validity was doubtful. The internal consistency was assessed by calculating Cronbach's alpha coefficient in all studies. The measurement properties that were not conducted were measurement invariance, measurement error and responsiveness. This study suggests that existing research and evidence supporting the selection of dementia fear instruments suitable for older adults are insufficient. All included instruments have the potential to be recommended, whereas none of the identified dementia fear instruments for older adults appears to be generally superior to the others. Therefore, further research is needed to validate the measurement properties of existing dementia fear instruments for older adults, with a particular focus on content validity as guided by COSMIN.