Quality of Life of Nursing Home Residents with Dementia: Validation of the German Version of the ICECAP-O

ObjectivesTo validate the ICECAP-O capability wellbeing measure’s German translation in older people with dementia living in a nursing home, and to investigate the influence of proxy characteristics on responses.MethodCross-sectional study. For 95 residents living in a German nursing home, questionnaires were completed by nursing professionals serving as proxy respondents. We investigated the convergent validity of the ICECAP-O with other Quality of Life (Qol) measures, the EQ-5D extended with a cognitive dimension (EQ-5D+C), the Alzheimer’s Disease Related Quality of Life (ADRQL) measures, and the Barthel-index measure of Activities of Daily Living (ADL). Discriminant validity was investigated using bivariate and multivariate stepwise regression analysis, comparing ICECAP-O scores between subgroups varying in dementia severity, care dependency, ADL status and demographic characteristics.ResultsConvergent validity between the ICECAP-O, EQ-5D+C, ADRQL and Barthel-Index scores was moderate to good (with correlations of 0.72, 0.69 and 0.53 respectively), but differed considerably between dimensions of the instruments. Discriminant validity was confirmed by finding differences in ICECAP-O scores between subgroups based on ADL scores (0.58 below 65 points on the Barthel-index and 0.80 above 65 points) and other characteristics. The ICECAP-O scores based on available tariffs were related to proxy characteristics gender (0.52 males versus 0.65 females) and work experience (0.61 below 2 years of experience versus 0.68 above 2 years).DiscussionThe results of this study suggest that the ICECAP-O is a promising generic measure for general Qol and capability of people with dementia living in a nursing home. Validity tests generally yielded favorable results. Work experience and gender appeared to influence proxy response, which raises questions regarding appropriate proxies, especially since the ICECAP-O may be completed by proxies relatively often. Further research is necessary to validate the German version of the ICECAP-O, with specific attention to proxy completion for people with dementia.

研究目的：验证ICECAP-O能力福祉量表（ICECAP-O）德语译版在居住于养老院的痴呆老年患者中的效度，并探究代理应答者特征对其作答结果的影响。
研究方法：本研究为横断面研究。招募了95名居住于德国养老院的痴呆症居民，由护理专业人员作为代理应答者完成问卷。本研究考察了ICECAP-O与其他生活质量（Quality of Life, QoL）量表的聚合效度，包括增设认知维度的EQ-5D（EQ-5D+C）、阿尔茨海默病相关生活质量（ADRQL）量表，以及日常生活活动能力（Activities of Daily Living, ADL）评定量表巴氏指数（Barthel-index）。同时采用双变量及多变量逐步回归分析检验区分效度，对比不同痴呆严重程度、护理依赖程度、日常生活活动能力状态及人口学特征亚组间的ICECAP-O评分差异。
研究结果：ICECAP-O与EQ-5D+C、ADRQL及巴氏指数的评分间存在中等至良好的相关性（相关系数分别为0.72、0.69及0.53），但各量表维度间的相关性差异显著。区分效度得到验证：基于ADL评分的亚组分析显示，巴氏指数得分低于65分的亚组ICECAP-O平均分为0.58，得分高于65分的亚组平均分为0.80，不同亚组间评分存在显著差异。此外，基于现有计分规则计算的ICECAP-O评分与代理应答者的特征相关：男性应答者的评分为0.52，女性为0.65；工作经验不足2年的应答者评分为0.61，工作经验2年以上者为0.68。
讨论：本研究结果表明，ICECAP-O是一种颇具应用前景的通用性生活质量及能力评估量表，适用于养老院居住的痴呆症患者。各项效度检验结果整体较为理想。研究发现代理应答者的工作经验与性别会对作答结果产生影响，这引发了关于合适代理应答者选择的疑问，尤其是考虑到ICECAP-O常需由代理应答者完成。未来仍需进一步研究以验证ICECAP-O德语译版的适用性，尤其应关注痴呆症患者的代理应答完成情况。