Background Consideration of older adults’ quality of life (QoL) is becoming increasingly important in the evaluation, quality improvement and allocation of health and social care services. While numerous definitions and theories of QoL have been proposed, an overall synthesis of the perspective of older adults themselves is lacking. Methods Qualitative studies were identified in PubMed, Ebsco/Psycinfo and Ebsco/CINAHL, through a search on 28 November 2018. Articles needed to meet all of the following criteria: (i) focus on perceptions of QoL, (ii) older adults living at home as main participants, (iii) use of qualitative methodology, (iv) conducted in a Western country and (v) published in English (vi) not focused on specific patient groups. A thematic synthesis was conducted of the selected studies, using the complete ‘findings/results’ sections from the papers. Results We included 48 qualitative studies representing the views of more than 3,400 older adults living at home in 11 Western countries. The QoL aspects identified in the synthesis were categorized into nine QoL domains: autonomy, role and activity, health perception, relationships, attitude and adaptation, emotional comfort, spirituality, home and neighbourhood, and financial security. The results showed that although different domains can be distinguished, these are also strongly connected. Conclusion QoL can be expressed in a number of domains and related subthemes that are important for older adults living at home. The findings further support that the concept of QoL should be seen as a dynamic web of intertwined domains.

PurposeEconomic evaluation of services and interventions in care services tends to focus on quality of life(QoL) based on health-related measures such as EQ5D, with a major focus on health and functioning. The Capability Approach (CA) provides an alternative framework for measuring QoL and challenges some of the conventional issues in the current practice of measurement of QoL. The Adult Social Care Outcomes Toolkit (ASCOT) aims to measure social care-related QoL in a broad sense. This article investigates whether and, if so, how the ASCOT addresses issues put on the agenda by the CA.MethodsLiterature analysis concerning theoretical assumptions and arguments of CA and ASCOT.ResultsThe Capability Approach (CA) puts three issues on the agenda regarding QoL. First, the focus of evaluation should not be on functioning, but on freedom of choice. Second, evaluation should be critical about adaptive preferences, which entail that people lower expectations in situations of limited possibilities. Third, evaluation should not only address health, but also other domains of life. Our analysis shows that freedom of choice is reflected in the response option ‘as I want’ in the ASCOT questionnaire. The problem of adaptive preferences is countered in the ASCOT by developing a standard based on preferences of the general population. Third, the ASCOT contains several domains of life.ConclusionsWe conclude that the CA and the ASCOT contribute to the discussion on QoL, and that the ASCOT operationalizes core assumptions of the CA, translating the issues raised by the CA in a practical way.

the mapping problem as a missing data problem and clarify such conditions. Methods: We define a valid mapping algorithm as a mapping algorithm that can produce unbiased estimates of expected health utility in the experimental and control treatments in cost-utility analysis. This definition reflects the purpose of mapping (i.e., not for individual health utility prediction but for CUA). As mapping can be viewed as imputation of missing health utility data, we derive a sufficient set of statistical conditions for a valid mapping algorithm based on the theory of missing data analysis. We conducted a simulation study to investigate properties of a mapping algorithm under situations where the derived conditions are satisfied and violated. Results: The derived sufficient conditions indicate importance of the "complete overlap" of the source measure to the target health utility measure and a covariates that is omitted from a mapping algorithm but has an effect on the target health utility measure not captures by the source measure. The conditions cannot be verified from observed data in CUA, but can be supported using external data. A simulation study showed that when at least one of the derived conditions was violated, a mapping algorithm provided biased health utility estimates in CUA, and that prediction accuracy did not necessarily reflect performances of a mapping algorithm in CUA. Conclusions: The derived conditions for a valid mapping algorithm provide a guidance for better practices in developing and selecting a mapping algorithm for CUA.

De groeiende groep thuiswonende ouderen in Nederland vraagt om een goede ondersteuning door inzet van de juiste diensten, zoals huishoudelijke hulp of dagbesteding. Het bepalen van belangrijke uitkomsten is daarin cruciaal en hiervoor zijn brede uitkomsten in termen van kwaliteit van leven (KvL) relevant, waarbij gekeken wordt naar de invloed van diensten op iemands mogelijkheden of capabilities. In dit artikel worden de ontwikkeling en inhoud van de Adult Social Care Outcomes Toolkit (Nederlandstalige versie, ASCOT-NL) en de Extended Quality of Life Tool (EQLT) beschreven en de toepassingsmogelijkheden in de evaluatie van zorg belicht. Beide instrumenten beogen effecten van zorg op KvL van thuiswonende ouderen te meten op meerdere relevante domeinen. De ASCOT-NL kent acht domeinen; de EQLT bevat deze acht domeinen en voegt daar zes domeinen aan toe, hetgeen resulteert in totaal veertien domeinen. De domeinen van de ASCOT-NL zijn gebaseerd op de doelen van sociale ondersteuning en zorg; de aanvullende domeinen van de EQLT zijn gebaseerd op empirisch onderzoek naar KvL vanuit het perspectief van thuiswonende ouderen en de manier waarop zorg kan bijdragen aan KvL.