Quality of life related to fear of falling and hip fracture in older women: a time trade off study

Objective To estimate the utility (preference for health) associated with h ip facture and fear of falling among older women. Design Quality of life survey with the time trade off technique. The techni que derives an estimate of preference for health stales by finding the poin t at which respondents show no preference between a longer but lower qualit y of life and a shorter time in full health. Setting A randomised trial of external hip protectors for older women at ri sk of hip fracture. Participants 194 women aged greater than or equal to 75 years enrolled in t he randomised controlled trial or who were eligible for the trial but refus ed completed a quality of life inter view face to face. Outcome measures Respondents were asked to rate their own health by using t he 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 tec hnique. 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 communit y) 0.31, and fear of falling 0.67. Of women surveyed, 80% would rather be d ead (utility = 0) than experience the loss of independence and quality of l ife that results from a:bad hip:fracture and subsequent admission to a nurs ing home. The differences in mean utility weights between the trial groups and the refusers were not significant. A test-retest study on 36 women foun d that the results were reliable with correlation coefficients within class es ranging from 0.61 to 0.88. Conclusions Among older women who have exceeded average life expectancy, qu ality of life is profoundly threatened by falls and hip fractures. Older x- omen place a very high marginal value on their health. Any loss of ability to live independently in the community has a consider-able detrimental effe ct on-their quality of life.