Research Letters Proxy assessment of health-related quality of life in the frail elderly SIR—Numerous studies have examined the usefulness of proxy assessments of health-related quality of life (HRQoL), with the majority of these studies focusing on cancer patients, community-dwelling older persons or patients with specific conditions e.g. post-stroke patients [1]. We studied the agreement between proxy assessment and self-classification of HRQoL in a group of frail older persons recruited in the Fracture Risk Epidemiology in the frail Elderly Study (FREE study) [2], a prospective study designed to identify risk factors for falls and frac- tures in older people recruited from randomly selected residential aged-care facilities in northern Sydney, Australia. All study subjects were 65 years or older. At baseline, study subjects completed a detailed questionnaire as well as a clinical examination for balance and sensori-motor function [3]. Cognition was assessed using the Stand- ardized Mini-Mental State Examination (SMMSE) [4], and subjects were also asked to complete the EQ-5D self-classifier questionnaire. The EQ-5D is a generic instrument that classified HRQoL in terms of five dimensions (mobility, self-care, usual activities, pain/ discomfort and anxiety), with each dimension being divided into three levels (no problem, some or moderate problems, extreme problems) [5]. The EQ-5D ques- tionnaires were also sent to next-of-kin (NOK) with a cover letter requesting that they complete the ques- tionnaire as they believed the subjects would. Only NOK who visited the subjects regularly and maintained close contact with the subjects were included. We examined the first 51 completed sets of proxy assessment and self- classification of HRQoL amongst cognitively intact subjects (defined as subjects with SMMSE scores 018) to determine the level of agreement between the NOK and the subjects. The agreement between the subject’s perception of HRQoL and the proxies’ assessment for the five dif- ferent domains of the EQ-5D ranged from poor (weighted k = 0.14 for the domain ‘self-care’) to fair (weighted k = 0.27 for the domain ‘pain’), but were more often in the fair category. In general, proxy assessment tended to be more pessimistic than self-assessment by the residents (Figure 1). A sub-group analysis comparing subjects who were cognitively intact (SMMSE 024, n = 21) and those with mild cognitive impairment (SMMSE 018 and -24, n = 30) showed similar results, suggesting that cognitive status did not impact the level of agreement. Our results suggest that proxy assessment of HRQoL by next-of-kin may not accurately reflect the true state of health for frail older persons living in residential aged-care facilities. Further studies examining proxy assessments by professional carers who have daily contact with these frail subjects are warranted. 1 Institute of Bone & Joint Research, 2 Department of Public Health, 3 Department of Medicine, University of Sydney, Royal North Shore Hospital, St Leonards, Sydney 2065, NSW, Australia Fax: (q61) 02 9906 1859 Email: Yih_Yiow_Sitoh@ttsh.com.sg 4 Prince of Wales Medical Research Institute, Sydney, Australia 1. Lobchuk MM, Degner LF. Patients with cancer and next-of- kin response comparability on physical and psychological symptom well-being: trends and measurement issues. Cancer Nurs 2002; 25: 358–74. 2. Zochling J, Sitoh YY, Lau TC et al. Quantitative ultrasound of the calcaneus in frail older men and women: the FREE study. Osteoporos Int 2002; 13: 882–7. 3. Lord SR, March LM, Cameron ID et al. Differing risk factors for falls in nursing home and hostel residents who can and cannot stand. J Am Geriatr Soc 2003; (in press). 4. Molloy DW, Alemayehu E, Roberts R. Reliability of a standardized Mini-Mental State Examination compared with the traditional Mini-Mental State Examination. Am J Psychiatry 1991; 148: 102–5. 5. Rabin R, de Charro F. EQ-5D: a measure of health status from the EuroQol Group. Ann Med 2001; 33: 337–43. AGE AND AGEING Research letters.3d 9/6/03 15:38:29 Rev 7.51n/W (Jan 20 2003) The Charlesworth Group, Huddersfield 01484 517077 (beta) Figure 1. Number of subjects who reported ‘No Problems’ as compared to proxy assessments in the five domains of the EQ-5D. YIH YIOW SITOH 1 ,TANG CHING LAU 1 ,J ANE ZOCHLING 1 , ROBERT G. CUMMING 2 ,STEPHEN R. LORD 4 , J ENNIFER SCHWARZ 1 ,LYN M. MARCH 1 , PHILIP N. SAMBROOK 1 ,I AN D. DOUGLAS 3 Age and Ageing 2003; 32: 459–461 Age and Ageing Vol. 32 No. 4 # 2003, British Geriatrics Society. All rights reserved. 459 by guest on December 11, 2016 http://ageing.oxfordjournals.org/ Downloaded from