Response shift in health-related quality of life in older men: The Manitoba follow-up study
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Problem: Older adults may change their view on what is important to their health-related quality of life (HRQOL). They may alter their opinion about areas relevant to HRQOL (reconceptualization), or how important these areas are to them (reprioritization), and this can be referred to as response shift (RS). Overtime, changes in HRQOL may be imprecise (underestimated or overestimated) if RS occurs. Providing detailed information about RS in the older adult population will have many implications for health professionals, family members, caregivers, policy makers, and researchers. The purpose was to explore RS in HRQOL in community-dwelling older men. Methods: Data from the Manitoba Follow-up Study (MFUS) was used as 360 older men returned the Successful Aging Questionnaire in each of five years (2007-2011). The participants identified the importance of 15 items, which reflect the physical (2 items), mental (5 items), and social domains (8 items) of HRQOL. Descriptive analysis was performed using SPSS21. An individualized method was used to identify different aspects of RS at group and individual levels, as well as the item level. Predictors of RS were also identified using logistic regression in a one-year period. Results: Mean age of participants was 89.7 years (SD 2.9) in 2011. Across 15 items over a one-year period, RS varied from a low of 9.3% for the ‘being mentally aware’ item to 39.3% for the ‘having goals/making plans’ item. Because we were examining RS of 15 items, it was very uncommon to find older men with no RS on all items. Only 27 out of 360 older men (7.5%) provided the same response on all the items they answered at both times (2010-2011). The average of the percent of people showing RS over 15 items, across four time periods, within three domains, was 24.4%. Reprioritization was more common in physical and mental domains, respectively, whereas reconceptualization was seen mainly in the social domain. Further, most of those who showed reprioritization, showed a decrease in importance, while most of those who showed reconceptualization, dropped a concept. Older men who were older, married, living independently, and recently did not participate in activities, were more likely to show RS in certain items. Older men with lower self-rated health were less likely to show RS. Conclusions: Data from the MFUS presents an opportunity to assess RS by using an individualized method that is simple to conduct and interpret in research and clinical settings. This method provides extensive demonstration of RS including magnitude, timing, type, direction, and predictors. RS should be considered an important part of aging, when planning resources and individualizing interventions for the older adult population. Future studies should design a method that evaluates RS individually, similar to our method.