© 1998 Oxford University Press
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Measuring health status in older patients. The SF-36 in practice
Division of Medicine for the Elderly, University of Leicester, Leicester General Hospital Gwendolen Road, Leicester LE5 4PW, UK
1Department of Epidemiology and Public Health, University of Leicester, Leicester General Hospital Gwendolen Road, Leicester LE5 4PW, UK
2Department of General Practice, University of Leicester, Leicester General Hospital Gwendolen Road, Leicester LE5 4PW, UK
Address correspondence to: S. G. Parker. Fax: (+44) 116 2854666. email: sgp5{at}leicester.ac.uk
Objective: to examine the use of the Medical Outcomes Study short form 36-item (SF-36) health status measure in older patients receiving health care; to explore the influence of age and physical and cognitive status on response to and completion of the SF-36 questionnaire.
Design: prospective observational study.
Settings: hospital and ambulatory patients aged 65 years and over in the medical and surgical wards and outpatient department of a teaching hospital and a local general practitioner's surgery.
Subjects: 1014 hospital inpatients, 80 hospital outpatients and 40 patients attending their general practitioner's surgery.
Main outcome measures: response rates, overall rates of completion (sufficient to calculate a valid SF-36 score) and completion of individual questions.
Results: 37 out of 40 ambulatory patients in general practice (93%) and 71 out of 80 outpatients (89%) returned a self-completed questionnaire. In hospital inpatients the overall response rate was only 46% (369 of 802). This was improved by interview administration to 77.4% (164 of 212). Logistic regression analysis revealed that selfcompletion, cognitive dysfunction, disability and age were all independently associated with poor overall response rates. Among those patients who returned a completed questionnaire, completion of individual questions sufficient to calculate a valid score was variable. Only 62.5% of inpatients who self-completed a questionnaire gave sufficient response to calculate a score on the mental health subscale, compared with 93.7% of general practice patients.
Conclusion: the self-administered questionnaire is unacceptable for older hospital inpatients. Use of an interviewer improves response, but factors which influence health status, such as physical and cognitive dysfunction, have a significant effect on response rates. Therefore the utility of the SF-36 in its present form as a routine health status measure for use in older hospital inpatients is questioned.
Keywords: disability, elderly, health status, inpatients, quality of life, SF-36
Received January 29, 1997;
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