Validation of a quality-of-life measure for older people using urgent and emergency care

Older people (aged 65 years and over) frequently present to urgent or emergency care settings, often with multiple health and social care needs. Despite this, their quality-of-life (QOL) is rarely assessed in a systematic or meaningful way. Capturing QOL in these settings is essential for delivering person-centred care for guiding improvements in service planning and delivery. This study aimed to evaluate the construct validity of the Quality-of-life - Aged Care Consumers, (QOL-ACC), an older people specific QOL instrument, in the context of urgent or emergency care.

Data were collected via an online survey which included demographic questions, the QOL-ACC, the EQ-5D-5L (a health-specific measure), the Urgent Care Questionnaire (UCSQ) and global self-reported health and QOL questions. Construct validity was assessed through Convergent and known-group validity. Convergent validity was assessed using 13 a priori hypotheses predicting correlations between the QOL-ACC and its dimensions and the other validated instruments. Known group validity was assessed with four a priori hypotheses comparing QOL-ACC scores across subgroups defined by self-rated health and QOL, areas of socio-economic advantage and disadvantage care needs at home.

Among 205 respondents (mean age 75 ± 6.0 years, 59% female), 37 (18.0%) were receiving home-based aged care services. The QOL-ACC utility scores demonstrated moderate correlation with the EQ-5D-5L (ρ = 0.60) and the EQVAS (ρ = 0.57). Low to moderate correlation was demonstrated with the 3 dimensions of the UCSQ (ρ = 0.27 ρ = 0.34, ρ = 0.37). The QOL-ACC was able to discriminate between groups with different self-rated health and QOL levels (P < 0.001). No significant differences were observed by areas of socio-economic advantage and disadvantage nor by care needs at home.

The QOL-ACC demonstrated strong construct validity for assessing QOL in older people accessing urgent or emergency care. Its ability to distinguish between self-rated health and QOL, with consistent scores across socio-economic groups and care use, supports its broad applicability. Further research is needed to assess its reliability and responsiveness in these settings.