Evaluation of methods for measuring quality of life in the elderly with end stage renal disease

Objective: To review the types of quality of life instruments employed, and the extent of their use in assessing elderly patients with end-stage renal disease (ESRD) and to summarize current data on the quality of life of elderly patients with ESRD. Data sources: Papers examining the quality of life in the ESRD population were identified using computer and bibliography searches. Study selection: All English language articles published between 1984-92 that stated quality of life as being a primary focus of interest in the ESRD population. Data Extraction: Using a rating scale, the measurement properties of each quality of life instrument was independently ranked by two observers. Results: Twenty studies were assessed. Fifteen studies employed descriptive cross-sectional design. Age ranges were between 18 and 85. Only seven studies attempted to separately analyze the elderly subgroup. Thirty-nine different measurement instruments were used to assess quality of life. These ranged from ad hoc instruments to single or multi-item instruments. The instruments in which measurement properties were best documented were the Time Trade Off Scale, the Kidney Disease Questionnaire, and Parfrey's Specific Symptom and Affect Scale. Conclusions: Most of the instruments used to report quality of life in the ESRD population have not been adequately validated. The experience with quality of life scales in the elderly ESRD population is not wide but more recent studies have used instruments with improved measurement properties. Further efforts in the future should be directed towards cross-validation of these instruments. How to interpret improvements in disease-specific quality of life measures, if generic quality of life measures do not change, will be an important challenge.