Quality of life in older people: A structured review of generic self-assessed health instruments

Objective: To review evidence relating to the measurement properties of multi-item generic patient or self-assessed measures of health in older people. Methods: Systematic literature searches to identify instruments. Pre-defined criteria relating to reliability, validity and responsiveness. Results: 122 articles relating to 15 instruments met the inclusion criteria. The most extensive evidence was found for the SF-36, COOP Charts, EQ-5D, Nottingham Health Profile (NHP) and SIP. Four instruments have evidence of both internal consistency and test-retest reliability - NHP, SF-12, SF-20, SF-36. Four instruments lack evidence of reliability - HSQ-12, IHQL, QWB, SQL. Most instruments were assessed for validity through comparisons with other instruments, global judgements of health, or clinical and socio-demographic variables. Five instruments lack evidence of responsiveness - GQL, HSQ-12, IHQL, QLI and QWB. Conclusion: There is good evidence for reliability, validity and responsiveness for the SF-36, EQ-5D and NHP. There is more limited evidence for the COOP, SF-12 and SIP. The SF-36 is recommended where a detailed and broad ranging assessment of health is required, particularly in community dwelling older people with limited morbidity. The EQ-5D is recommended where a more succinct assessment is required, particularly where a substantial change in health is expected. Instrument content should be assessed for relevance before application. The concurrent evaluation of generic instruments in older people is recommended.