In Italy, as in many other countries, there is little information on the quality of life among the elderly.
Those studies that have been done often lack standard-ization and validation of the instruments. The project describedin the rest of this paper will use standardized instruments to assess functioning. When possible, the reliability of the measurements and the validity of the instruments will be assessed.
Study design
The study design is cross-sectional and consists of a personal interview of 3,000 community-dwelling elderly persons living in 10 geographically different areas of Veneto. If a respondent is unable to be interviewed, a proxy will be asked to provide the basic information (demographic characteristics and func-tional status).
Objectives
The major objective of this study is to assess the quality of life of the elderly population. This includes measurement of functional capacity to pex-forrnphysi-cal activities and to participate in social events and assessment of cognitive status and self-reported health status. The information gathered will be used to plan health and social interventions.
Method
Each city or town in Italy has available a list of all the citizens resident in the area, with information on their date of birth, marital status, and current address.
A random sample of individuals 65–84 years of age ,md all persons 85 years and over in the 10 defined
weas of Veneto will be selected for the study.
The participants will be interviewed at home by a trained interviewer. The interviewers will be 30 phy-sicians who are completing a residency in gerontology at the University of Padua. There are two reasons why we have chosen physicians as interviewers. First, residents in gerontology at the University of Padua are involved in clinical as well as in epidemiologic stud-ies. In this project, particularly, the participants will be asked to do performance tests of physical functioning, and visual and hearing tests will also be administered.
In case of falls or any other health problems during the tests, the interviewer will be able to intervene, avoid-ing medical and legal consequences. Second, in Italy, unlike the United States, we do not have nurses trained for health interview work.
There will be a 7-day training period for all of the interviewers. Random reinterviews will be done by the principal investigator to check the quality of the data collected. Moreover, each interview will be re-corded on audiotape. At the end of each interview, the interviewer will fill in a form evaluating the respond-ents’ attitude toward the questions and providing a general description of the living arrangements.
Questionnaire
The items used for the determination of the quality of life are:
Family composition and support.
Social activities and support.
Education and occupation.
Retirement and income.
Sensory impairments.
Dental conditions.
Chronic diseases.
Fecal and urine incontinence.
Sleeping problems.
Activities of daily living (ADL’s) and instrumen-tal activities of daily living (IADL’s)(6-8).
Current health perception.
Drug consumption.
Alcohol and smoking habits.
Health services use.
Emotional and cognitive status (9,10).
Direct measurements to be made are:
● Visual acuity test.
s Maddox lens test.
● Hearing test.
● Physical performance test.
● Weight and height.
Validity and reliability
The respondents’ self-assessment of the quality of life may raise questions about the validity and the
reliability of the information gathered. However, our primary concern is not to obtain a detailed report on specific conditions in order to formulate a “diagnosis”
but to assess the vitality of the elderly from the perspec-tive of physicaI, mental, and socia.Ifimctioning. Even if it is impossible to validate each section of the interview, we will be able to validate information on the respond-ents’ health status and on their physical fi.mctioning.
Several methods will be used to check thevalidity and the reliability of some of the self-reported infor-mation in a sample of participants:
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Medical validation—Physicianswill be asked to provide medical information about health status, drug consumption, and hospitalization for the participants.
Clinical assessment—Assessment of the visual and hearing functions will be done in a random sample to check the validity of the tests adminis-tered during the home visit.
Pe&ormancetest—During the interview, each in-dividual will be asked to perform some physical function, such as walking, getting in or out of a chair, moving the arms above the shoulders, kneeling, or writing.
Interviewof aproxy-A proxy will be interviewed to assess the reliability of demographic data, family composition and support, social activities, physi-cal functioning, drug consumption, and alcohol and smoking habits.
Conclusion
The assessment of the quality of life among the elderly is an important task in our aging societies. The information gathered by interview may have some shortcomings, but several studies, some of them very recent, have shown the accuracy of the data collected by questionnaire in the elderly to be quite good (1l–
14). Moreover, it has been shown that self-rated health status is abetterpredictorof mortality than aphysician’s assessment (15). The use of the methods previously presented for the validation of the self-reported infor-mation could ako give more confidence in the accu-racy of the data collected.
The study on the quality of life in the elderly population of the Veneto region will:
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Use standardized measurements for some relevant variable-ADL, IADL, Center for Epidemiologi-cal Studies–Depression (CES–D) scale, Mini Mental State—that allow comparisons with other major studies.
Include a representative sample of the elderly population.
Have staff responsible for the project who already have been involved in previous epidemiologic studies on aging.
Provide common training for the interviewers.
Work with international consultants from The Johns Hopkins University and the National Insti-tute on Aging.
of Statistics. Annuario statistic
National Institute of Statistics. Compendio statistic italiano, ed. 1986.
National Institute of Statistics. Annuario di statistiche sanitarie, ed. 1985.
Berkrnan LF, Breslow L. Health and ways of living.
New York: Oxford University Press. 1983.
House JS, Robbins C, Metzner H. The association of social relationship and activities with mortality: Pro-spective evidence from the Tecumseh Community Health Study. Am J Epidemiol 116:12340, 1982.
Katz SC, Ford AB, Moskowitz RW, et al. Studies of illness in the aged. The index of ADL: A standardized measure of biological and psychological fimction.
JAMA 185:914-9.1963.
Nagi S2. An epidemiology of disability among adults in the United States. MilbankMem Fund Q 6:493–508.
1976.
Resow 1, Breslau N. A Guttman health scale for the aged. J Gerontol 21:556-9.1966.
Radloff LS. The CES-D scale: A self-report depres-sion scale for research in the general population. Appl Psych Measur 1:385401.1977.
Folstein MF, FoIstein SE, McHugh PR. Mini Mental State: A practical method for grading the cognitive state of patients for the clinician. J Psychlatr Res 12:189–98. 1975.
11. BushTL, MlllerSR, Golden AL, Hale WE. Self-report 14. Suchman EG, Streib G, Phillips B. An analysis of the and medical record report agreement of selected con- validity of health questionnaire. Soc Fomes 36:223-ditionsintheelderly. Am JPublicHealth79(l 1):1554- 32.1958.
6.1989. 15. Mossey JM, Shapiro E. Self-rated health: A predictor
12. Rodgers WL, Herzog AR. Interviewing older adults: of mortality among the elderly. Am J Public Health The accuracy of factual information. J Gerontol 72:80&8. 1982.
42(4):387–94. 1987.
13. Friedsam H, Martin H. A comparison of self-reported and physicians’ health ratings in an older population. J Health Hum Behav 4:179-83.1963.