L.ONG1, A.YEO1, J.P.LIM1, W.S.LIM1, J.CHEW1
Tan Tock Seng Hospital1
Perception of HRQoL differs between self- and proxy-reports, but how frailty status influences this discrepancy remains unknown. Using the EuroQoL(EQ)-5D-5L instrument, we aim to examine the agreement and impact of frailty on differences in self- and proxy-ratings of HRQoL in older adults.
Cross-sectional analysis of 66 patient-caregiver dyads (Patient mean age 80.9±6.5) recruited from a tertiary hospital geriatric clinic. Clinical Frailty Scale≥5 defined frailty(N=48,72.7%). We evaluated agreement between self-and proxy-rated EQ-5D-5L utility scores and domain responses using intra-class correlation coefficient (ICC,two-way mixed-effects) and Gwet’s AC1 statistic respectively, stratified by frailty status. We examined the association between frailty and differences in self-and proxy-rated EQ-5D utility scores using multiple linear regression, with caregiver burden (Zarit Burden Index) and cognitive impairment as covariates.
Overall, self-rated was higher than proxy-rated HRQoL (EQ-5D utility mean difference:0.31,P<0.001) with fair agreement observed between self-and proxy-ratings (ICC 0.29,P=0.009). Stratified by frailty, we found poorer agreement in frail (ICC 0.24,P=0.05) compared to non-frail individuals (ICC 0.64,P=0.002). A similar pattern was observed in EQ-5D dimensions of mobility (Gwet’s AC1, frail vs. non-frail:0.21,P=0.02 vs. 0.46,P=0.016), self-care (AC1:0.40,P<0.001 vs. 0.88,P<0.001) and usual activities (AC1:0.35,P<0.001 vs. 0.72,P<0.001). Frailty was associated with greater differences in self versus proxy EQ-5D utility scores (β=0.24,95%CI 0.02-0.5,P=0.03), independent of caregiver burden and presence of cognitive impairment.
Discrepant HRQoL ratings, particularly in frail individuals, suggest a mismatch between patients’ and caregivers’ perceptions of health and function, warranting further studies to understand its impact on the caregiving relationship and interventions to improve HRQoL in frail older adults.