Table 1 Outcome measures with associated administration notes and collection time points
From: An Australian aged care home for people subject to homelessness: health, wellbeing and cost–benefit
Domain | Measure | Measure details | Collection time point(s) | Administration notes |
|---|---|---|---|---|
Cost-utilisation | Self-report survey, contact with service providers, hospital records | See Additional file 1 for details | Baseline 12-months | Researcher interview with resident; researcher follow-up (email and/or phone) with services and hospitals |
Functional independence | Australian Functional Measure (AFM): motor functional independence; cognitive functional independence | 17 items that are summed to provide two domains: motor functional independence scored out of 84 (12 items covering self-care, sphincter control, transfers, locomotion), and cognitive functional independence scored out of 35 (5 items covering communication, social cognition). Each item is scored on a scale from 1 (total assistance required) to 7 (complete independence), accounting for what the resident is capable of doing in terms of physical ability, mental health, cognition and behaviour [24, 25] | Baseline 6-months 12-months | Researchers interviewed care staff directly involved with care of each specific resident |
Cognition | Rowland Universal Dementia Assessment (RUDAS) | Scored out of 30, the scale includes six items covering: memory, visuospatial orientation, praxis, visuo-constructional drawing, judgement and language. Scores of 22 or less are indicative of potential dementia or cognitive impairment [26, 27]. High test–retest (ICC 0.98) and interrater (ICC 0.99) reliability [26], and good internal consistency (Cronbach’s α = 0.80; [28]) | Researchers administered the RUDAS directly with each resident | |
Frailty | Clinical Frailty Scale (CFS) | The scale ranges from 1—‘very fit’ to 9—‘terminally ill’ where a higher score indicates a higher degree of frailty. A score of 6 indicates ‘moderate frailty’ [29, 30]. Very good interrater reliability (weighted kappa 0.86, 95%CI 0.84–0.87 [31];) | Researchers interviewed care staff directly involved with care of each specific resident | |
Mobility | Timed Up and Go test (TUG) | The TUG involves measuring the time (secs) taken to stand up from a seated position, walk three metres, turn around, and return to the seated starting position. A score ≥ 16.5 s indicates reduced mobility and a greater likelihood of falling [32]. High test–retest (ICC 0.91) and interrater (ICC 0.91) reliability in residential care [33] | Administered by the research team with each resident who was physically able | |
Mental health | Geriatric Depression Scale (GDS) | 15-items. Higher scores are indicative of greater likelihood of depression, with a cut-off score ≥ 5 suggesting the presence of depression [34, 35]. Moderate internal consistency (Cronbach’s α = 0.75; [36]) | Residents were provided the form to self-complete their ratings, however the majority requested the researchers to administer the scales in interview form | |
PTSD Checklist – Civilian | 17-items. Respondents rate how much they have been bothered by each listed PTSD symptom from 1 – ‘not at all’ to 5 – ‘extremely’. Scores range from 17–85, with higher scores indicating greater likelihood of PTSD. With an estimated pooled prevalence rate of PTSD in homeless populations of 27% [37], we selected 36–44 as the cut-off score for individuals in this study [38, 39]. High internal consistency (Cronbach’s α = 0.94) and good test–retest reliability (ICC 0.92) [40] | |||
Subjective wellbeing | Personal Wellbeing Index-Adult (PWI-A) | Satisfaction across 7 life domains is measured on a scale from 1 – ‘no satisfaction at all’ to 10 – ‘completely satisfied’: standard of living, health, achieving in life, relationships, safety, community connectedness, future security. Each domain is converted to a standard score from 1–100 and then averaged across domains to determine an overall subjective wellbeing score, also known as ‘personal wellbeing index’ [41]. Higher scores indicate better subjective wellbeing; scores between 51–69 indicate personal wellbeing that is likely to be ‘challenged’ or ‘compromised’, and scores ≥ 70 suggest a ‘normal’ level of wellbeing [42]. The Australian national index of subjective wellbeing is 75.1 [43]. Moderate to good internal consistency (Cronbach’s α = 0.70–0.85; [41]) | ||
Overall health related quality of life | EuroQol-5 Dimension (EQ-5D) Visual Analogue Scale (VAS) | Participants indicate their perceived health on a scale from 0 – ‘worst health you can imagine’ to 100 – ‘best health you can imagine’. Mean VAS scores according to a South Australian norms project were 78.6 (65–74 years) and 72.7 (75 + years) [44]. Sufficient test–retest reliability [45] | Researchers provided the scale, and residents indicated their score | |
Cost–benefit | EQ-5D-5L system | Comprises 5 dimensions: mobility, self-care, usual activities, pain/discomfort and anxiety/depression [46]. Each dimension has 5 levels: no problems (level 1), slight problems, moderate problems, severe problems and extreme problems (level 5). The person is asked to indicate their health state by ticking the box next to the most appropriate statement in each of the five dimensions. There are 3,125 possible health states defined by combining one level from each dimension, ranging from 11,111 (full health) to 55,555 (worst health). Excellent test–retest reliability at the index score level [47] | Residents were provided the form to self-complete their ratings, however the majority requested the researchers to administer the scales in interview form |