Measuring Quality of Life to Promote Healthy Ageing and Integrated Care

Background: Internationally high numbers of people who are ageing experience chronic health conditions, which impacts on quality of life (QoL) and demands across the health system. Improving and maintaining QoL is the ultimate aim of healthcare by the World Health Organization (WHO), especially care for people living with chronic conditions and multi-morbidities. The most suitable QoL instruments for adults with chronic health conditions is unknown, and if identified offers potential to inform evaluation of tailored interventions to maximise health and QoL outcomes across the ageing trajectory and care settings.  Promoting QoL measurement provides the opportunity to support person-centred models of care fostering the integration of services across the care continuum.

Approach: Prospective cross-sectional study using an online survey collecting two QoL measures:  QoL Aged Care Consumers (QoL-ACC) and EQ-5D-5L was conducted in general practice settings between July 2023- February 2024. Inclusion criteria: People aged 40-70 years who had ≥1 chronic condition.  The project was co-designed with the primary health network, consumer needs assessment, and researchers in response to the Australian Government aged care priorities. A multidisciplinary team were involved in facilitating the  implementation of QoL assessment including medical, nursing and allied health practitioners, primary health care staff (designers and capacity builders), health economist and statistician.

Results: 224 participants completed the survey (mean (SD) age = 58.1 (9.5) years). A large proportion indicated they had poor QoL in the domains of pain management (40.5% had their pain well managed most of the time), leisure activities and hobbies (31.4% most of the time, 21.4% some of the time) on the QoL-ACC; and pain or discomfort (85.3%), anxiety and depression (71%), and performing their usual activities (61%) on the EQ-5D-5L. There were no significant differences in utility between the younger and older age groups for the EQ-5D-5L nor the QOL-ACC (except for emotional wellbeing dimension). For the EQ-5D-5L there were no differences between the older and younger age groups in the responses to the mobility dimension, compared to the pattern seen with the QoL-ACC mobility item, where a significantly higher proportion of older people reported limitations to their mobility.

Implications: There is a need to identify QoL of people at the onset of chronic disease, to provide person-centred interventions to promote health and wellbeing outcomes.  Further validation of the QoL-ACC with middle-older adults with chronic conditions in primary care is warranted. Our findings indicate that there should be a focus on engagement in leisure activities, social inclusion, and primary care interventions for pain management, anxiety and depression for people with chronic conditions, alongside the traditional focus on the management of physical health symptoms.

Next steps include the investigation of the use of QoL measurement for vulnerable people, such as people who are homeless, and from culturally and linguistically diverse backgrounds and the scales ability to measures change to inform care interventions, evaluation and integration across health and social care  sectors.