Towers Ann-Marie, Rand Stacey, Allan Stephen, Webster Lucy Anne, Palmer Sinead, Carroll Rachael, Gordon Adam L, Akdur Gizdem, Smith Nick, Burton Jennifer, Killett Anne, Hanratty Barbara, Meyer Julienne, Spilsbury Karen, Goodman Claire
Health and Social Care Workforce Research Unit, King's College London, London, UK
Personal Social Services Research Unit, University of Kent, Canterbury, UK.
BMJ Open. 2025 Jan 29;15(1):e090684. doi: 10.1136/bmjopen-2024-090684.
To assess the feasibility of capturing older care home residents' quality of life (QoL) in digital social care records and the construct validity (hypothesis testing) and internal consistency (Cronbach's alpha) of four QoL measures.
Cross-sectional data collected in wave 1 of the DACHA (eveloping resources nd minimum dataset for are omes' doption) study, a mixed-methods pilot of a prototype minimum dataset (MDS).
Care homes (with or without nursing) registered to provide care for older adults (>65 years) and/or those living with dementia. All homes used a digital record system from one of two suppliers.
Data were extracted from 748 residents. All permanent residents, aged 65 years or older, were eligible to participate, including those lacking capacity to consent. Temporary residents and residents in their last weeks of life were excluded.
The English language versions of Adult Social Care Outcomes Toolkit (ASCOT)-Proxy-Resident, ICEpop CAPability measure for Older people (ICECAP-O), EQ-5D-5L proxy and the QUALIDEM were added to the digital record. As there have not been any previous studies of the structural validity of the English language version of the QUALIDEM, ordinal exploratory factor analysis (EFA) was applied for this measure only. Feasibility (% missing by software provider and measure), % floor/ceiling effects (>15% at lower/upper end of the scales), convergent or divergent construct validity (criterion of >75% of hypotheses accepted) and internal consistency (Cronbach's alpha ≥0.7) were assessed for all four measures.
The ordinal EFA of QUALIDEM did not replicate the findings of previous research. A six-factor (36 item) solution was proposed and used in all subsequent analyses. There were low rates of missing data (<5%) for all items, except ASCOT-Proxy-Resident Control (5.1%) and Dignity (6.2%) and QUALIDEM item 35 (5.1%). Ceiling effects were observed for the ASCOT-Proxy-Resident and two of the QUALIDEM subscales. None of the scales had floor effects. Cronbach's alpha indicated adequate internal consistency (α ≥0.70) for the ASCOT-Proxy-Resident, ICECAP-O and EQ-5D-5L proxy. There were issues with two QUALIDEM subscales. Construct validity for all measures was adequate.
The findings support the use of EQ-5D-5L, ASCOT-Proxy-Resident and the ICECAP-O in care homes for older people. The choice of measure will depend on the construct(s) of interest. More research is needed to establish the psychometric properties of the QUALIDEM in an English care home setting.
评估在数字社会护理记录中获取老年护理院居民生活质量（QoL）的可行性，以及四项生活质量测量指标的结构效度（假设检验）和内部一致性（克朗巴哈系数）。
在DACHA（为护理院开发资源和最小数据集）研究的第1波中收集的横断面数据，这是一个最小数据集（MDS）原型的混合方法试点研究。
注册为老年人（>65岁）和/或痴呆症患者提供护理的护理院（有或没有护理服务）。所有护理院都使用来自两个供应商之一的数字记录系统。
从748名居民中提取数据。所有65岁及以上的永久居民都有资格参与，包括那些缺乏同意能力的人。临时居民和生命最后几周的居民被排除在外。
将成人社会护理结果工具包（ASCOT）-代理-居民、老年人ICECAP能力测量（ICECAP-O）、EQ-5D-5L代理和QUALIDEM的英文版本添加到数字记录中。由于之前没有关于QUALIDEM英文版本结构效度的研究，因此仅对该测量指标应用了有序探索性因子分析（EFA）。对所有四项测量指标评估了可行性（软件供应商和测量指标的缺失百分比）、地板/天花板效应百分比（量表低端/高端>15%）、收敛或发散结构效度（接受假设>75%的标准）和内部一致性（克朗巴哈系数≥0.7）。
QUALIDEM的有序EFA没有重复先前研究的结果。提出了一个六因素（36项）解决方案，并在所有后续分析中使用。除ASCOT-代理-居民控制项（5.1%）、尊严项（6.2%）和QUALIDEM第35项（5.1%）外，所有项目的数据缺失率都很低（<5%）。在ASCOT-代理-居民和两个QUALIDEM子量表中观察到天花板效应。没有一个量表有地板效应。克朗巴哈系数表明ASCOT-代理-居民、ICECAP-O和EQ-5D-5L代理具有足够的内部一致性（α≥0.70）。两个QUALIDEM子量表存在问题。所有测量指标的结构效度都足够。
研究结果支持在老年护理院中使用EQ-5D-5L、ASCOT-代理-居民和ICECAP-O。测量指标的选择将取决于感兴趣的结构。需要更多的研究来确定QUALIDEM在英国护理院环境中的心理测量特性。
