The influence of age on health valuations: the older olds prefer functional independence while the younger olds prefer less morbidity

Abstract

Background

To assess the effectiveness of geriatric interventions, The Older Persons and Informal Caregivers Survey – Composite Endpoint (TOPICS-CEP) has been developed based on health valuations of older persons and informal caregivers. This study explored the influence of the raters’ age on the preference weights of TOPICS-CEP’s components.

Methods

A vignette study was conducted with 200 raters (mean age ± standard deviation: 72.5±11.8 years; 66.5% female). Profiles of older persons were used to obtain the preference weights for all TOPICS-CEP components: morbidity, functional limitations, emotional well-being, pain experience, cognitive functioning, social functioning, self-perceived health, and self-perceived quality of life. The raters assessed the general wellbeing of these vignettes on a 0–10 scale. Mixed linear regression analysis with interaction terms was used to explore the effects of raters’ age on the preference weights.

Results

Interaction effects between age and the TOPICS-CEP components showed that older raters gave significantly (P<0.05) more weight to functional limitations and social functioning and less to morbidities and pain experience, compared to younger raters.

Conclusion

Researchers examining effectiveness in elderly care need to consider the discrepancies between health valuations of younger olds and older olds when selecting or establishing outcome measures. In clinical decision making, health care professionals need to be aware of this discrepancy as well. For this reason we highly recommend shared decision making in geriatric care.

Keywords:

• general wellbeing
• preferences
• valuation
• domains
• composite endpoint
• age

Acknowledgments

We are very grateful to all participants. In addition, we would like to thank Wim Lemmens for his technical support and George Borm for his advice on study design. This work was supported by a grant from The Dutch National Care for the Elderly Program, coordinated and sponsored by ZonMw, Organization for Health Research and Development, the Netherlands (grant number 60-6190098-302).

Author contributions

All authors made substantial contributions to data generation and analysis, drafting or critical revision of the manuscript, and approval for the final version to be published.

Disclosure

The authors report no conflicts of interest in this work.

Supplementary materials

Table S1 The health outcome domains, their preference weights, items per component, and levels per item

Table S2 The original TOPICS-CEP components’ weights and the weights adjusted for the age distribution of older persons (≥65 years old) in the Netherlands

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