失能老人EQ-5D-5L自评与代评生命质量及其影响因素分析

Analysis of EQ-5D-5L Self-assessed and Proxy-assessed Quality of Life and Its Influencing Factors for the Disabled Elderly in Chengdu

目的:测评成都市60岁及以上失能老人自评与代评生命质量并分析其影响因素,评估2类结果的一致性及代评可行性.方法:使用EQ-5D-5L测量失能老人自评与代评的生命质量,应用加权Kappa和ICC进行一致性检验,使用Mann-Whitney/Wilcoxon和Kruskal-Wallis检验进行单因素与差异性分析,影响因素分析使用了广义线性模型回归.结果:自评、代评健康效用值与EQ-VAS一致性较好(ICC均大于0.70),各维度一致性为尚可或中等(加权Kappa值约为0.40~0.50).失能老人失能程度、经济状况、户外活动与睡眠、照护者与老人的关系、照护者是否掌握照护相关知识等对失能老人生命质量及自评、代评结果差异有统计学意义(P<0.05).结论:失能老人生命质量远低于常人,应综合考虑相关因素,提高失能老人生命质量;主要照护者的EQ-5D-5L代评结果可考虑作为失能老人自评结果的补充,但个别维度需谨慎应用,需考虑被评价对象的人群特征与个人差异、代理人类型、测量工具等.

Objective:To evaluate the self-assessed and proxy-assessed quality of life among disabled elderly individuals aged 60 and above in Chengdu,analyze the factors influencing these assessments,and assess the consistency between these two types of outcomes and the feasibility of proxy assessments.Methods:The quality of life for disabled elderly individuals is measured using the EQ-5D-5L for both self-assessments and proxy assessments.Consistency testing is conducted using weighted Kappa and Intraclass Correlation Coefficient(ICC).Univariate and differential analyses are performed with the Mann-Whitney/Wilcoxon and Kruskal-Wallis tests,respectively.The analysis of influencing factors employs generalized linear model regression.Results:The results of proxy assessments are slightly higher than those of self-assessments.The consistency between self-assessed and proxy-assessed health utility values and EQ-VAS scores is good(with ICC values exceeding 0.7),while the consistency across various dimensions is fair to moderate(with weighted Kappa values approximately between 0.4 and 0.5).The degree of disability,economic status,outdoor activities and sleep,the relationship between caregivers and the elderly,and whether caregivers possess relevant caregiving knowledge,all have a statistically significant impact on the quality of life of disabled elderly individuals and the differences between self-assessed and proxy-assessed outcomes(P<0.05).Conclusion:The quality of life of disabled elderly individuals is significantly lower than that of the general population.It is essential to consider various related factors to enhance the quality of life for these individuals.The EQ-5D-5L proxy assessment results from their primary caregivers can serve as a supplement to the self-assessment results of disabled elderly individuals.However,individual dimensions should be applied with caution,taking into account the characteristics and individual differences of the evaluated population,types of proxies,and measurement tools used.