Abstract
BackgroundWhile falls and urinary incontinence are prevalent among older patients, who sometimes rely on proxies to provide their health information, the validity of proxy reports of concern about falls and urinary incontinence remains unknown.MethodsTelephone interviews with 43 consecutive patients with falls or fear of falling and/or bothersome urinary incontinence and their proxies chosen by patients as most knowledgeable about their health. The questionnaire included items derived from the Medical Outcomes Study Short Form 12 (SF-12), a scale assessing concerns about urinary incontinence (UI), and a measure of fear of falling, the Falls Efficacy Scale (FES). Scores were estimated using items asking the proxy perspective (6 items from the SF-12, 10 items from a UI scale, and all 10 FES items). Proxy and patient scores were compared using intraclass correlation coefficients (ICC, one-way model). Variables associated with absolute agreement between patients and proxies were explored.ResultsPatients had a mean age of 81 years (range 75–93) and 67% were female while proxies had a mean age of 70 (range 42–87) and 49% were female. ICCs were 0.63 for the SF-12, 0.52 for the UI scale, and 0.29 for the FES. Proxies tended to understate patients' general health and incontinence concern, but overstate patients' concern about falling. Proxies who lived with patients and those who more often see patients more closely reflected patient FES scores compared to those who lived apart or those who saw patients less often. Internal consistency reliability of proxy responses was 0.62 for the SF-12, 0.86 for the I-QOL, and 0.93 for the FES. In addition, construct validity of the proxy FES scale was supported by greater proxy-perceived fear of falling for patients who received medical care after a fall during the past 12 months (p < .05).ConclusionCaution should be exercised when using proxies as a source of information about older patients' health perceptions. Questions asking about proxies' views yield suboptimal agreement with patient responses. However, proxy scales of UI and fall concern are internally consistent and may provide valid independent information.
Highlights
While falls and urinary incontinence are prevalent among older patients, who sometimes rely on proxies to provide their health information, the validity of proxy reports of concern about falls and urinary incontinence remains unknown
As part of a quality improvement intervention focused on care for falls and incontinence for older patients, we evaluated the validity of proxy responses assessing patient perceptions of health, fear of falling and incontinence
Sample This study examined proxy-reported measures that could supplement patient reports in the evaluation of an intervention to improve the quality of outpatient care for urinary incontinence, falls and gait impairment, and cognitive impairment
Summary
While falls and urinary incontinence are prevalent among older patients, who sometimes rely on proxies to provide their health information, the validity of proxy reports of concern about falls and urinary incontinence remains unknown. Patients sometimes are unable to provide information because of cognitive impairment or other communication disabilities (e.g., hearing problems and/ or language incompatibilities), or severity of illness. In such cases, investigators must decide whether to substitute the missing information with a proxy responder. In older populations, which are more likely to have cognitive impairment, studies have addressed this issue by comparing information provided independently by patients and proxies [1,2,3,4,5,6,7,8,9]. These studies show good agreement between patients and proxies concerning observable behavior (such as physical function), but levels of concordance tend to be lower for internal perceptions such as energy level or emotional well-being [10]
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