clinical focus
Quantifying quality
Measuring what older adults want to improve their quality of life .
Julie Ratcliffe interviewed by Eleanor Campbell
Quality of life measures in the aged care industry have typically relied on clinical indicators , such as an individual ’ s weight , past medical history or prescription use .
Professor Julie Ratcliffe from Flinders University led a team to interview 3,000 older Australians and their carers to ask what they believe makes a good quality of life .
A new set of ‘ person-focused ’ tools was developed using this research to help measure and assess quality of life standards in aged care settings .
Ratcliffe joined Aged Care Insite to dig into how we can define good standards of living , how providers can use new tools to improve care , and why people need to be at the centre of measuring life quality .
ACI : What tools have we typically used to measure standards of quality in aged care ? JR : Traditionally , quality hasn ’ t really been measured in Australia ’ s aged care system . More recently it has been measured , but with a focus on clinical indicators of care quality .
We haven ’ t had the voice of the consumer in Australia ’ s aged care system . It ’ s not particularly inclusive in terms of the perspective of the older person in Australia ’ s aged care system and , thinking about the key indicators which are most important to older people and the families in Australia as a society , what do we want from our aged care system ?
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Number one in my view , and I ’ m sure a lot of people would agree , is that we want to ensure older people have as good a quality of life as possible and that they have as good quality of care experience as possible , and those indicators which can be measured have really been missing from Australia ’ s aged care system .
Tell us about the research process that you underwent . I have a long-standing research interest in quality of life and how we measure quality of life . I became very interested in older people in our age care system around a decade ago when I became very conscious that we didn ’ t have good tools as researchers and as practitioners for measuring quality of life for older people in a health system context , but particularly in aged care .
What constitutes a good quality of life for an older Australian , and how did you factor this into the development of these tools ? We undertook a large-scale survey where we asked a representative sample of Australian adults of all ages about what quality of life means to them , and we asked them to rank 12 key indicators of quality of life relating to some health dimensions such as mobility , sleep , emotional wellbeing , happiness , the extent to which you ’ re worried , participation in society and activities .
We asked our sample to rank those key dimensions of quality of life in order of their relative importance , and we found some really notable differences between younger people and older people . We found that older people tended to place more importance on wider quality of life or wellbeing type dimensions .
There was a lot of emphasis on being able to remain as independent as possible , being able to maintain your connections to the community and your family and social relationships and being able to participate in meaningful activities as you age .
How do these tools work and what do they look like ? The Quality of Life Aged Care Consumers ( QOL-ACC ) tool is a three-year program of work which we ’ re just completing . It ’ s a mixed method study so we talked to a lot of older people in both home and residential care settings and we asked them , ‘ What does quality of life actually mean to you ? What features or characteristics would be important to you in having a good quality of life ?’
We took all the data from those interviews and distilled that down and analysed it using a qualitative research framework . We identified six key themes , which define quality of life to older people .
These themes were essentially the same , regardless of where we talked to the older person . They were : the ability to remain as independent as possible as you age , being able to be as physically mobile as you can , to have good emotional wellbeing , the ability to maintain your social connections , the ability to participate in meaningful activities and hobbies that you enjoy , and having your pain managed as well as possible .
The Quality of Care Experience ( QCE-ACC ) measure was developed through work that was funded by the Royal Commission into aged care . With that measure we commenced with an international literature review and again ,