Quality of Life of Nursing Home Residents with Dementia: Validation of the German Version of the ICECAP-O

Abstract

ObjectivesTo validate the ICECAP-O capability wellbeing measure’s German translation in older people with dementia living in a nursing home, and to investigate the influence of proxy characteristics on responses.MethodCross-sectional study. For 95 residents living in a German nursing home, questionnaires were completed by nursing professionals serving as proxy respondents. We investigated the convergent validity of the ICECAP-O with other Quality of Life (Qol) measures, the EQ-5D extended with a cognitive dimension (EQ-5D+C), the Alzheimer’s Disease Related Quality of Life (ADRQL) measures, and the Barthel-index measure of Activities of Daily Living (ADL). Discriminant validity was investigated using bivariate and multivariate stepwise regression analysis, comparing ICECAP-O scores between subgroups varying in dementia severity, care dependency, ADL status and demographic characteristics.ResultsConvergent validity between the ICECAP-O, EQ-5D+C, ADRQL and Barthel-Index scores was moderate to good (with correlations of 0.72, 0.69 and 0.53 respectively), but differed considerably between dimensions of the instruments. Discriminant validity was confirmed by finding differences in ICECAP-O scores between subgroups based on ADL scores (0.58 below 65 points on the Barthel-index and 0.80 above 65 points) and other characteristics. The ICECAP-O scores based on available tariffs were related to proxy characteristics gender (0.52 males versus 0.65 females) and work experience (0.61 below 2 years of experience versus 0.68 above 2 years).DiscussionThe results of this study suggest that the ICECAP-O is a promising generic measure for general Qol and capability of people with dementia living in a nursing home. Validity tests generally yielded favorable results. Work experience and gender appeared to influence proxy response, which raises questions regarding appropriate proxies, especially since the ICECAP-O may be completed by proxies relatively often. Further research is necessary to validate the German version of the ICECAP-O, with specific attention to proxy completion for people with dementia.

Validation of the Spanish Version of the ICECAP-O for Nursing Home Residents with Dementia

“…The average ICECAP-O tariff score found in this study within a nursing home setting (0.61) was comparable to the scores reported in a Dutch study performed in nursing homes (0.63) [28] and in a German study also performed in nursing homes (0.63) [30], and was substantially lower than the score for community-living elderly, where the average scores ranged between 0.81–0.84 [22] [27] [31] [32] [37–41]. These findings support the reliability of our results.…”

“…The same finding was observed in the Dutch and German ICECAP-O validation studies in which no correlation with the dimension “security” was found [29, 30]. This might be because people with dementia do not generally worry about the future past a certain point, [41].…”

“…On the other hand, the moderately to highly significant correlations of the capability dimensions “enjoyment,” “role,” and “control” with the ADRQL and the EQ-5D+C dimensions support the hypothesis that the ICECAP-O captures dimensions that are relevant for the elderly. Such correlations with the EQ-5D were also found in the general British population [22] and in the German nursing homes [30] [41]. …”

“…Validation studies confirmed that the ICECAP-O evaluates a spectrum of outcomes beyond HRQoL [26]. Until now, the ICECAP-O was used in the general population in the UK [22] and Australia [27], in a psychogeriatric nursing home setting in the Netherlands [28], in Dutch psycho-geriatric nursing homes [29], in nursing home residents with dementia in German [30], in a population of post-hospitalized older adults in the Netherlands [31], and among older adults with mobility impairments in Canada [32]. After carrying out a systematic review and contacting the original authors of the instrument [22, 23], to date, the ICECAP-O has not been validated in a population of patients with dementia in nursing homes in Spain.…”

Comparing Measurement Properties of the EQ-5D-3L, ICECAP-O, and ASCOT in Frail Older Adults

“…One study indicated that the test-retest reliability of ASCOT after 74 days was acceptable [13]. Other studies have shown that both ICECAP-O and ASCOT are moderately to strongly associated with not only general quality-of-life scales but also the EQ-5D, activities of daily living (ADL) limitations, illness, and depressive symptoms [6,13,15,[20][21][22][23][24][25][26][27]. There is some evidence that compared with the EQ-5D, ICECAP-O and ASCOT are equally or strongly associated with the quality of care services and the intensity of care, as measured by hours delivered [6,21,23,28].…”