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Development of a quality of life questionnaire for nursing home residents in mainland China

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Abstract

Objective

To develop and validate a quality of life (QOL) questionnaire for nursing home (NH) residents in mainland China.

Methods

A cross-sectional study including a development sample (n = 176) and validation sample (n = 371) of NH residents aged 60 and older was conducted between 2015 and 2016 in Jinan, Shandong Province, China. Resident interviews, literature reviews, expert panels, and pilot studies were used to identify QOL domains and items pertinent to NH life. Exploratory and confirmatory factor analysis were used to develop and validate a QOL questionnaire. Reliability (internal consistency, spilt-half reliability, and test–retest reliability) and validity (construct and criterion validity) were evaluated for the questionnaire.

Results

The self-report Chinese NH QOL questionnaire had 9 domains and 38 items including physical health (4 items), food enjoyment (6 items), security (3 items), environmental comfort (5 items), autonomy (2 items), meaningful activity (3 items), interrelationship (6 items), family relationships (3 items), and mood (6 items). The nine-factor model was confirmed with the following fit indices: χ2/df = 1.872, root mean square error of approximation = 0.049, comparative fit index = 0.913, and Tucker-Lewis index = 0.903. The 38-item NH QOL questionnaire showed satisfactory construct validity, criterion validity, internal consistency (Cronbach’s alpha = 0.89, spilt-half reliability = 0.73, test–retest reliability = 0.76).

Conclusions

The NH QOL questionnaire appears to be a reliable and valid instrument and should be incorporated into a set of quality measures for use with NH residents in mainland China

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References

  1. Kane, R. A., Kling, K. C., Bershadsky, B., Kane, R. L., Giles, K., Degenholtz, H. B., et al. (2003). Quality of life measures for nursing home residents. Journals of Gerontology Series A, Biological Sciences and Medical Sciences,58, 240–248.

    Google Scholar 

  2. Kane, R. L., & Kane, R. A. (2001). What older people want from long-term care, and how they can get it. Health Aff (Millwood),20, 114–127.

    CAS  Google Scholar 

  3. Kane, R. L., Rockwood, T., Hyer, K., Desjardins, K., Brassard, A., Gessert, C., et al. (2005). Rating the importance of nursing home residents’ quality of life. Journal of the American Geriatrics Society,53, 2076–2082.

    PubMed  Google Scholar 

  4. Kelley-Gillespie, N. (2012). A secondary analysis of perceptions of quality of life of older adults residing in a nursing home and assisted living setting using an integrated conceptual model of measurement. Applied Research Quality Life.,7(2), 137–154.

    Google Scholar 

  5. Lai, F. C., Chen, I. H., Chen, P. J., Chen, I. J., Chien, H. W., & Yuan, C. F. (2017). Acupressure, sleep, and quality of life in institutionalized older adults: A randomized controlled trial. Journal of the American Geriatrics Society,65, e103–e108.

    PubMed  Google Scholar 

  6. Xiao, H., Yoon, J. Y., & Bowers, B. (2017). Quality of life of nursing home residents in China: A mediation analysis. Nurs Health Sci,19, 149–156.

    PubMed  Google Scholar 

  7. Scocco, P., & Nassuato, M. (2017). The role of social relationships among elderly community-dwelling and nursing-home residents: Findings from a quality of life study. Psychogeriatrics,17, 231–237.

    PubMed  Google Scholar 

  8. Lung, T., Howard, K., Etherton-Beer, C., Sim, M., Lewin, G., & Arendts, G. (2017). Comparison of the HUI3 and the EQ-5D-3L in a nursing home setting. PLoS ONE,12, e0172796.

    PubMed  PubMed Central  Google Scholar 

  9. Huang, H. L., Weng, L. C., Tsai, Y. H., Chiu, Y. C., Chen, K. H., Huang, C. C., et al. (2015). Predictors of self- and caregiver-rated quality of life for people with dementia living in the community and in nursing homes in northern Taiwan. International Psychogeriatrics,27, 825–836.

    PubMed  Google Scholar 

  10. Harrison, S. L., O’Donnell, L. K., Bradley, C. E., Milte, R., Dyer, S. M., Gnanamanickam, E. S., et al. (2018). Associations between the drug burden index, potentially inappropriate medications and quality of life in residential aged care. Drugs and Aging,35, 83–91.

    PubMed  Google Scholar 

  11. Grske, J., Meyer, S., & Wolf-Ostermann, K. (2014). Quality of life ratings in dementia care? a cross-sectional study to identify factors associated with proxy-ratings. Health and Quality of Life Outcomes,12, 177.

    Google Scholar 

  12. Tiit, E. M., & Saks, K. (2008). Subjective quality of life of care-dependent older people in five european union countries. In N. Y. New York (Ed.), Care-related quality of life in old age: Concepts, models and empirical findings (pp. 153–167). York: Springer, New.

    Google Scholar 

  13. Meyer, R., Drewniak, D., Hovorka, T., & Schenk, L. (2018). Questioning the questionnaire: Methodological challenges in measuring subjective quality of life in nursing homes using cognitive interviewing techniques. Qualitative Health Research. https://doi.org/10.1177/1049732318812042.

    Article  PubMed  Google Scholar 

  14. Schenk, L., Meyer, R., Behr, A., Kuhlmey, A., & Holzhausen, M. (2013). Quality of life in nursing homes: Results of a qualitative resident survey. Quality of Life Research,22(10), 2929–2938.

    PubMed  Google Scholar 

  15. Makai, P., Brouwer, W. B., Koopmanschap, M. A., Stolk, E. A., & Nieboer, A. P. (2014). Quality of life instruments for economic evaluations in health and social care for older people: A systematic review. Social Science and Medicine,102, 83–93.

    PubMed  Google Scholar 

  16. Estermann, J., & Kneubuhler, H. (2006). How to measure quality of life in nursing homes. European Journal of Public Health, Supplement 1,16, 39–40.

    Google Scholar 

  17. Kane, R. A. (2001). Long-term care and a good quality of life: Bringing them closer together. Gerontologist,41, 293–304.

    CAS  PubMed  Google Scholar 

  18. Kane, R. L., Bershadsky, B., Kane, R. A., Degenholtz, H. H., Liu, J. J., Giles, K., et al. (2004). Using resident reports of quality of life to distinguish among nursing homes. The Gerontologist,44, 624–632.

    PubMed  Google Scholar 

  19. Liu, C., Feng, Z., & Mor, V. (2014). Case-mix and quality indicators in Chinese elder care homes: Are there differences between government-owned and private-sector facilities? Journal of the American Geriatrics Society,62, 371–377.

    PubMed  PubMed Central  Google Scholar 

  20. Zhang, H. H., Liu, P. C., Ying, J., Shi, Y., Wang, S. Q., Zhang, M. L., et al. (2018). Evaluation of MESSAGE communication strategy combined with group reminiscence therapy on elders with mild cognitive impairment in long-term care facilities. International Journal of Geriatric Psychiatry,33, 613–622.

    PubMed  Google Scholar 

  21. Wu, M., Yang, Y., Zhang, D., Zhao, X., Sun, Y., Xie, H., et al. (2018). Association between social support and health-related quality of life among Chinese rural elders in nursing homes: The mediating role of resilience. Quality of Life Research,27, 783–792.

    PubMed  Google Scholar 

  22. Wang, J., Wang, J., Cao, Y., Jia, S., & Wu, B. (2016). Older residents’ perspectives of long-term care facilities in China. J Gerontol Nurs,42, 34–43.

    CAS  PubMed  Google Scholar 

  23. Ai, Y., Wang, L., Gao, X., Ren, H., Wang, Z., & Hu, H. (2017). Quality of life of the aged stroke survivors in an advanced nursing home in China: A qualitative research. Journal of the American Geriatrics Society,65, S338.

    Google Scholar 

  24. The WHOQOL Group. (1993). Study protocol for the World Health Organization project to develop a Quality of Life assessment instrument (WHOQOL). Quality of Life Research,2(2), 153–159.

    Google Scholar 

  25. Leung, B. W., Moneta, G. B., & McBride-Chang, C. (2005). Think positively and feel positively: Optimism and life satisfaction in late life. International Journal of Aging and Human Development,61, 335–365.

    PubMed  Google Scholar 

  26. Diener, E. (2000). Subjective well-being. The science of happiness and a proposal for a national index. American Psychologist,55, 34–43.

    CAS  Google Scholar 

  27. Gu, D., Dupre, M. E., & Liu, G. (2007). Characteristics of the institutionalized and community-residing oldest-old in China. Social Science & Medicine,64(4), 871–883.

    Google Scholar 

  28. Shi, Z. (2016). Does the number of children matter to the happiness of their parents? Journal of Chinese Sociology,3, 16.

    Google Scholar 

  29. Liu, G., Dupre, M. E., Gu, D., Mair, C. A., & Chen, F. (2012). Psychological well-being of the institutionalized and community-residing oldest old in China: The role of children. Social Science & Medicine,75(10), 1874–1882.

    Google Scholar 

  30. Li, T., Wang, S. W., Zhou, J. J., Ren, Q. Z., & Gao, Y. L. (2018). Assessment and predictors of grief reactions among bereaved Chinese adults. Journal of Palliative Medicine,21(9), 1265–1271. https://doi.org/10.1089/jpm.2018.0001.

    Article  PubMed  Google Scholar 

  31. Mou, H., Chen, L., Zhu, S., Xu, D., Ling, J., & Wang, K. (2018). Qualitative research on the quality of life of the elderly in the old-age care institution. Journal of Qilu Nursing,24(4), 5–7.

    Google Scholar 

  32. An, R., & Liu, G. G. (2016). Cognitive impairment and mortality among the oldest-old Chinese. International Journal of Geriatric Psychiatry,31, 1345–1353.

    PubMed  Google Scholar 

  33. Rabin, R., & de Charro, F. (2001). EQ-5D: A measure of health status from the EuroQol Group. Annals of Medicine,33, 337–343.

    CAS  PubMed  Google Scholar 

  34. Brooks, R. (1996). EuroQol: The current state of play. Health Policy,37, 53–72.

    CAS  PubMed  Google Scholar 

  35. Folstein, M. F., Folstein, S. E., & McHugh, P. R. (1975). “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research,12, 189–198.

    CAS  PubMed  Google Scholar 

  36. Honig, L. S., Vellas, B., Woodward, M., Boada, M., Bullock, R., Borrie, M., et al. (2018). Trial of solanezumab for mild dementia due to alzheimer’s disease. The New England Journal of Medicine,378(4), 321–330.

    CAS  PubMed  Google Scholar 

  37. Mahoney, F. I., & Barthel, D. W. (1965). Functional evaluation: The barthel index. Maryland State Medical Journal,14, 61–65.

    CAS  PubMed  Google Scholar 

  38. Groll, D. L., To, T., Bombardier, C., & Wright, J. G. (2005). The development of a comorbidity index with physical function as the outcome. Journal of Clinical Epidemiology,58, 595–602.

    PubMed  Google Scholar 

  39. Doustmohammadian, A., Omidvar, N., Keshavarz-Mohammadi, N., Abdollahi, M., Amini, M., & Eini-Zinab, H. (2017). Developing and validating a scale to measure food and nutrition literacy (FNLIT) in elementary school children in Iran. PLoS ONE,12(6), e0179196.

    PubMed  PubMed Central  Google Scholar 

  40. Reigada, L. C., Moore, M. T., Martin, C. F., & Kappelman, M. D. (2018). Psychometric evaluation of the IBD-specific anxiety scale: A novel measure of disease-related anxiety for adolescents with IBD. Journal of Pediatric Psychology,43(4), 413–422.

    PubMed  Google Scholar 

  41. Givens, J. L., Jones, R. N., Mazor, K. M., Prigerson, H. G., & Mitchell, S. L. (2015). Development and psychometric properties of the family distress in advanced dementia scale. Journal of the American Medical Directors Association,16(9), 775–780.

    PubMed  PubMed Central  Google Scholar 

  42. Bentler, P. M. (1990). Comparative fit indexes in structural models. Psychological Bulletin,107, 238–246.

    CAS  PubMed  Google Scholar 

  43. Muthén, B. O. (1989). Latent variable modeling in heterogeneous populations. Psychometrika,54, 557–585.

    Google Scholar 

  44. Han, J., Meng, Y., Xu, C., & Qin, S. (2017). Urban residents’ religious beliefs and influencing factors on christianity in Wuhan. China. Religions,8, 244.

    Google Scholar 

  45. Low, L. P., Lee, D. T., & Chan, A. W. (2007). An exploratory study of Chinese older people’s perceptions of privacy in residential care homes. Journal of Advanced Nursing,57(6), 605–613.

    PubMed  Google Scholar 

  46. Wu, B., Mao, Z. F., & Zhong, R. (2009). Long-term care arrangements in rural China: Review of recent developments. Journal of the American Medical Directors Association,10(7), 472–477.

    PubMed  Google Scholar 

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Acknowledgements

The authors would like to thank all the participants in this study.

Funding

This study was funded by the National Social Sciences Fund of China (14CSH063).

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Authors and Affiliations

Authors

Contributions

WK and XD initiated, participated in the design of, and coordinated the study and helped in the drafting and editing of the article. XD, GJ, WX and LJ prepared the database and performed the statistical analyses. GJ, CL and MH participated in the implementation of the study, prepared the database, and participated in the drafting of the article. All the authors have read and approved the final version of the manuscript.

Corresponding author

Correspondence to Kefang Wang.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the Institutional Review Board of Shandong University.

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Informed consent was obtained from all individual participants included in the study.

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Xu, D., Gao, J., Chen, L. et al. Development of a quality of life questionnaire for nursing home residents in mainland China. Qual Life Res 28, 2289–2297 (2019). https://doi.org/10.1007/s11136-019-02180-2

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