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Proxy reports on the EQ-5D-5L in residential aged care facilities: a validation study
Tiet-Hanh Dao-Tran1,2, Syed Afroz Keramat3, Christopher Etherton-Beer4
1Medical School, Faculty of Health, Medicine & Behavioural Sciences, University of Queensland, Brisbane, Australia.
Health and Quality of Life Outcomes
|May 30, 2026
Summary
Proxy reports on the EQ-5D-5L in aged care are valid for measuring health-related quality of life. However, domain-level data from proxies is not recommended for research due to poor reliability.
Area of Science:
- Gerontology
- Health Services Research
- Psychometrics
Background:
- The EuroQol 5-Dimension 5-Level questionnaire (EQ-5D-5L) is widely used to assess health-related quality of life (HRQOL) in residential aged care.
- Many residents require proxy respondents (e.g., staff) to complete the EQ-5D-5L due to an inability to self-report.
- The reliability and validity of proxy-reported EQ-5D-5L data are not well-established.
Purpose of the Study:
- To evaluate the psychometric properties of proxy-reported EQ-5D-5L data.
- Specifically examining convergent validity, known-group validity, interrater reliability, and responsiveness.
Main Methods:
- Data were collected from 281 residents in a 12-month deprescribing randomized controlled trial in Australia.
- Interview-administered questionnaires were used for data collection.
- Psychometric properties were assessed using hypothesis testing, intra-class correlation coefficients, weighted Cohen's kappa, and Bland-Altman plots.
Main Results:
- Proxy (staff) reports on the EQ-5D-5L showed significant associations with residents' cognitive function, physical function, neuropsychiatric behaviors, and frailty.
- Proxy reports differed significantly across patient groups with varying levels of these characteristics.
- Interrater reliability for the total EQ-5D-5L score was moderate (ICC 0.664-0.744), but domain-level reliability was poor (kappa 0.206-0.432).
Conclusions:
- Proxy-reported EQ-5D-5L data demonstrated acceptable convergent validity, known-group validity, and responsiveness.
- While total utility scores from proxies are moderately reliable, domain-level data exhibits poor interrater reliability.
- Proxy reports can be a viable alternative for measuring residents' overall HRQOL, but domain-level data should be used cautiously in research and practice.
