Health status versus quality of life in older patients: Does the distinction matter?

PURPOSE: Although health-related quality of life in older people is general ly assessed by measuring specific domains of health status, such as activit ies of daily living or pain, the association between health-status measures and patients' perceptions of their quality of life is not clear. Indeed, i t is controversial whether these health-status measures should be considere d measures of quality of life at all. Our objective was to determine the as sociation between health-status measures and older patients' perceptions of their global quality of life. SUBJECTS AND METHODS: We performed a cross-sectional study of 493 cognitive ly intact patients 80 years of age and older, interviewed 2 months after a hospitalization. We measured patients' self-assessed global quality of life and four domains of health status: physical capacity, limitations in perfo rming activities of daily living, psychological distress, and pain. RESULTS: Each of the four scales was significantly correlated with patients ' global perceptions of their quality of life (P <0.001). The ability of th e health-status scales to discriminate between patients with differing glob al quality of life was generally good, especially for the physical capacity (c statistic = 0.72) and psychological distress scales (c statistic = 0.70 ). However, for a substantial minority of patients, scores on the health-st atus scales did not accurately reflect their global quality of life. For ex ample, global quality of life was described as fair or poor by 15% of patie nts with the highest (best tertile) physical capacity scores, 25% of patien ts who were independent in all activities of daily living, 21% of patients with the least psychological distress (best tertile), and by 30% with no pa in symptoms. Similarly, global quality of life was described as good or bet ter by 43% of patients with the worst physical capacity (worst tertile), 49 % of patients who were dependent in at least two activities of daily living , 47% of patients with the most psychological distress (worst tertile), and 51% of patients with severe pain. CONCLUSION: On average, health status is a reasonable indicator of global q uality of life for groups of older patients with recent illness. However, d isagreement between patients' reported health status and their perceptions of their global quality of life was common. Therefore, assumptions about th e overall quality of life of individual patients should not be based on mea sures of their health status alone. (C) 1999 by Excerpta Medica, Inc.