Factors associated with care home resident quality of life: Demonstrating the value of a pilot Minimum Data Set using cross-sectional analysis from the DACHA study

Abstract

BackgroundTo maintain good standards of care, evaluations of policy interventions or potential improvements to care are required. A number of quality of life (QoL) measures could be used but there is little evidence for England as to which measures would be appropriate. Using data from a pilot Minimum Data Set (MDS) for care home residents from the Developing resources And minimum dataset for Care Homes’ Adoption (DACHA) study, we assessed the construct validity of QoL measures and analysed factors associated with QoL. This was to demonstrate the value of the pilot MDS data and to provide evidence for the inclusion of QoL measures in a future MDS.MethodsCare home records for 679 residents aged over 65 from 34 care homes were available that had been linked to health records and official care home provider data. In addition to data on demographics, level of needs and impairment, several questions about the social care- and health-related QoL of participants were completed through proxy report (ASCOT proxy-resident, ICECAP-O, EQ5D-5D-5L Proxy 2). Construct validity was assessed through testing hypotheses developed from previous research and QoL measure constructs using discriminant analysis. Multilevel regression models were developed to understand how QoL was influenced by personal characteristics (e.g. sex, levels of functional and cognitive ability), care home level factors (type of home, level of quality) and resident use of health services (potentially avoidable emergency hospital admissions). Multiple imputation was used for missing data.ResultsAll three measures were negatively associated with levels of cognitive impairment, whilst ICECAP-O and EQ-5D-5L Proxy 2 were negatively associated with low levels of functional ability. ASCOT Proxy-Resident was positively associated with aspects of quality and care effectiveness at both resident- and care home-level. All three QoL measures had acceptable construct validity and captured different aspects of QoL.ConclusionThe study found acceptable construct validity for ASCOT-Proxy-Resident, ICECAP-O and EQ-5D-5L Proxy 2 in care homes as complementary measures based on different constructs. The study has demonstrated both the value of the DACHA study pilot MDS data and a rationale for the inclusion of these QoL measures in any future MDS.

Cross-sectional study assessing the feasibility of measuring residents’ Quality of Life in English care homes and assessing the construct validity and internal consistency of measures completed by staff-proxy

“…However, the psychometric analysis reported in this paper did not require these data and further analysis using the data to better understand the quality of life of care home residents has used the complete DACHA MDS [61], in which demographic data has been populated through linkage with NHS data [61,85]. The linked data has been compared to the overall care home resident population in England to explore representativeness: findings indicate that the DACHA MDS sample is comparable by sex and type of care home but the very old and ‘White’ ethnic group are over-represented [86].…”