BMJ 2000;320:341-346 ( 5 February )

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

G Salkeld, senior lecturer, ^a I D Cameron, associate professor, ^c R G Cumming, associate professor, ^b S Easter, research assistant, ^d J Seymour, research scholar, ^b S E Kurrle, director of rehabilitation and aged care service, ^d S Quine, associate professor. ^b

^a Social and Public Health Economics Research Group (SPHERe), Department of Public Health and Community Medicine, University of Sydney, New South Wales 2006, Australia, ^b Department of Public Health and Community Medicine, University of Sydney, ^c Rehabilitation Studies Unit, Department of Medicine, University of Sydney, PO Box 6, Ryde, New South Wales 1680, Australia, ^d Hornsby Ku-ring-gai Hospital, New South Wales 2077, Australia

Correspondence to: G Salkeld glenns{at}pub.health.usyd.edu.au

Objective: To estimate the utility (preference for health) associated with hip fracture and fear of falling among older women.
Design: Quality of life survey with the time trade off technique. The technique derives an estimate of preference for health states by finding the point at which respondents show no preference between a longer but lower quality of life and a shorter time in full health.
Setting: A randomised trial of external hip protectors for older women at risk of hip fracture.
Participants: 194 women aged  75 years enrolled in the randomised controlled trial or who were eligible for the trial but refused completed a quality of life interview face to face.
Outcome measures: Respondents were asked to rate their own health by using the 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 technique.
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 community) 0.31, and fear of falling 0.67. Of women surveyed, 80% would rather be dead (utility=0) than experience the loss of independence and quality of life that results from a bad hip fracture and subsequent admission to a nursing home. The differences in mean utility weights between the trial groups and the refusers were not significant. A test-retest study on 36 women found that the results were reliable with correlation coefficients within classes ranging from 0.61 to 0.88.
Conclusions: Among older women who have exceeded average life expectancy, quality of life is profoundly threatened by falls and hip fractures. Older women place a very high marginal value on their health. Any loss of ability to live independently in the community has a considerable detrimental effect on their quality of life.

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© BMJ 2000
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