Quality of life related to fear of falling and hip fracture in older women: a time trade off study Commentary: Older people's perspectives on life after hip fractures

Abstract

Objective To estimate the utility (preference for health) associated with hip fracture and fear of falling among older women. Design Quality of life survey with the time trade off technique. The technique derives an estimate of preference for health states by finding the point at which respondents show no preference between a longer but lower quality of life and a shorter time in full health. Setting A randomised trial of external hip protectors for older women at risk of hip fracture. Participants 194 women aged > 75 years enrolled in the randomised controlled trial or who were eligible for the trial but refused completed a quality of life interview face to face. Outcome measures Respondents were asked to rate their own health by using the Euroqol instrument and then rate three health states (fear of falling, a "good" hip fracture, and a "bad" hip fracture) by using time trade off technique.Results On an interval scale between 0 (death) and 1 (full health), a "bad" hip fracture (which results in admission to a nursing home) was valued at 0.05; a "good" hip fracture (maintaining independent living in the community) 0.31, and fear of falling 0.67. Of women surveyed, 80% would rather be dead (utility = 0) than experience the loss of independence and quality of life that results from a bad hip fracture and subsequent admission to a nursing home. The differences in mean utility weights between the trial groups and the refusers were not significant. A test-retest study on 36 women found that the results were reliable with correlation coefficients within classes ranging from 0.61 to 0.88. Conclusions Among older women who have exceeded average life expectancy, quality of life is profoundly threatened by falls and hip fractures. Older women place a very high marginal value on their health. Any loss of ability to live independently in the community has a considerable detrimental effect on their quality of life.

Older patients' perception of their own capacity to regain pre-fracture function after hip fracture surgery – an explorative qualitative study

“…Older patients value independence very highly. Any loss of function that threatens the ability to manage things by themselves has a considerable detrimental effect on their self-confidence and quality of life (Haak et al, 2007;Salkeld et al, 2000). They are especially vulnerable to loss of dignity because impaired health results in loss of functions and greater physical dependency in acute hospitals.…”

Potential analysis for research on occupational therapy-led physical exercise programmes and home environment adaptation programmes to prevent falls for elderly people living at home / Potenzialanalyse zu ergotherapeutischen körperlichen Trainingsprogrammen und Wohnraumanpassungen zur Vermeidung von Stürzen bei zu Hause lebenden älteren Menschen

“…Die Studien zeigen auf, dass ältere Menschen besser aufgeklärt werden und mehr über die Gründe für ihr Sturzrisiko erfahren wollen (Carroll et al, 2010). Sie nehmen insbesondere dann an Sturzpräventionsprogrammen teil, wenn diese ihre Selbstständigkeit, Gesundheit, Autonomie, eigene Entscheidungen zu treffen und soziale Kontaktmöglichkeiten fokussieren (Calhoun et al, 2011;Carroll et al, 2010;Bunn et al, 2008;Hughes et al, 2008;Yardley et al, 2006a;McInnes, & Askie, 2004;Salkeld et al, 2000).…”

“…Dazu müssen den Betroffenen ausreichende und verständliche Informationen zur Verfügung gestellt werden. Die Möglichkeit, zwischen unterschiedlichen Sturzpräventionsprogrammen auswählen zu können, wird von älteren Menschen sehr geschätzt (Haines, & McPhail, 2011 (Bunn et al, 2008;Salkeld et al, 2000;Calhoun et al, 2011;Hughes et al, 2008;Yardley et al, 2006a;Calhoun et al, 2011;McInnes, & Askie, 2004). …”

Health economics of osteoporosis

“…There are a number of studies that have estimated the health related quality of life associated with osteoporotic fracture using time-trade off or standard gamble methods [79][80][81][82][83]. However, few of these have collected information in such a way that the calculation of Qol loss over a period of time is feasible.…”