Quality Of Life Evaluation And Response Shift In Older Adults With Multimorbidity

ObjectiveTo understand the current situation of response shift quality of life evaluation in Chinese older adults with multimorbidity,and to explore the impact of different response shift dimensions on the evaluation of quality of life among older adults with multimorbidity.Methods(1)This study adopts a mixed method research approach,combining the advantages of quantitative and qualitative research,and used a parallel nested study design to investigate the response shift phenomenon in older adults with multimorbidity in Guangdong Province(2)In the quantitative part of this study,a Then-test evaluation method was adopted,and a self-prepared general condition questionnaire and the European fivedimensional health scale were used to carry out follow-up surveys.A multi-stage random sampling method was employed,with a total of 170 valid follow-up samples obtained.SPSS 23.0 and Prism 9 software were used to conduct the analysis,with methods of the Minimal Important Difference,Intra-Class Correlation,and Limits of Agreement applied.(3)The qualitative research method was conducted through face-to-face semistructured interviews,and the data were collected through a combination of "purposive sampling","heterogeneous sampling",and "snowball sampling".Interviews were conducted with 44 older adults by trained investigators.Qualitative analysis software ATLAS.ti and ROST CM6 were employed for coding and word frequency statistics.ResultsThe quantitative findings revealed that:(1)at the individual level,the recalibration of response shift was mainly present in the visual analogue scale and health utility index dimensions,but less occurred in the five-level health description system;the identification of the recalibration in the visual analogue scale and health utility index dimensions were facilitated by the minimum important difference;at the group level,the recalibration phenomenon occurred only in the visual analog scale dimension.(2)A retrospective quality of life assessment perspective that incorporates the response shift phenomenon could help improve the identification of quality of life changes in multimorbid older adults.The differences between the traditional and retrospective method to quality-of-life evaluation were only reflected in the visual analog scale score alone,and the analysis by the Intra-Class Correlation and Limits of Agreement confirmed the non-substitutability of the two evaluation methods.(3)In the different orientation groups,the changes in the visual analog scale scores,health utility index,pain/discomfort,daily activities,anxiety/depression,and mobility dimensions showed a decreasing distribution from more to less,while no statistically significant changes in the self-care dimension of quality of life occurred in older adults with multimorbidity in this study.The results of the qualitative analysis revealed that(1)The phenomenon of quality-of-life response shift in multimorbid older adults is relatively common,which was shown in all three dimensions of recalibration,reprioritization,and reconceptualization.(2)The response shift phenomenon is influenced by a variety of factors,and the reasons for the occurrence of the response shift mentioned by different interviewees in the interview vary,showing a differentiated and individualized character.(3)The influencing factors of the response shift phenomenon in multimorbid older adults were interlinked.ConclusionsThe response shift phenomenon in quality of life assessment is prevalent among older adults with multimorbidity,and attention to the response shift phenomenon is important for health management.This study paves the way for the design and implementation of quality-of-life improvement programs for multimorbid older adults and provides a scientific basis for the government to improve health management policies.Meanwhile,this study proposes to further investigate the phenomenon of quality-of-life response shift and its underlying mechanisms by means of a statistical approach combined with a design approach,and to develop theoretical models and application fields of the response shift phenomenon.