Presents issues that should be considered when assessing the quality of life of older persons, particularly those with dementia. The authors suggest, for example, that it is important to distinguish between physical functioning and self-care and self-maintenance activities among these populations. In addition, depression and sleep disorders should be examined, and direct assessments should be short to allow for reduced attention spans. Research is needed to understand the bias and measurement error that may be introduced by the use of proxies in older and demented populations. The reliability and validity of existing HRQOL measures should be assessed and reported. The authors recommend that quality-of-life studies in these patients routinely incorporate at least one basic methodological question (e.g., validity test of a particular measure in relation to another measure or to clinical status) so that refinements can be made in instruments with poor psychometric characteristics. If researchers who use quality-of-life measures could be persuaded to be part of such an undertaking, a great deal of information across multiple studies would be obtained and the psychometric properties of HRQOL measures would be greatly improved.
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