Preferences for Dimensions of Quality of Life in Aged Care

Background Previously we developed a Quality of Life Aged Care Consumers (QOL-ACC) instrument with older Australians receiving aged-care services and a preference weighted scoring algorithm for the instrument. In this study we examine and compare the preferences for different dimensions of quality of life among people who all have an interest in aged care - taxpayers as funders of aged care, older Australians who will be future users and current users of aged care. Methods A choice experiment with 160 choice sets of two quality-of-life state-survival duration combinations blocked into 20 survey versions, was designed and administered with older Australians in home and residential care, and with the general population. The Swait and Louviere test was applied to test for scale and preference heterogeneity across three cohorts: general population aged 18-64 years, general population aged 65 years and over, and current aged care users. Conditional logit, mixed logit, and latent class logit models were estimated to explore observed and unobserved preference heterogeneity and compare preferences across the three groups. Results Results from the latent class logit models suggest there are three latent classes, which place different relative importance on the quality of life dimensions. Residential and home care participants ("class 1") have the lowest utility weights on survival duration whilst the general population aged 65 and above ("class 3") have the highest utility weights on survival duration. Individuals in class 1 have the highest utility weights for pain management and mobility, individuals in class 2 have the highest utility weights for independence and pain management, while individuals in class 3 have the highest utility weights for mobility and emotional wellbeing. Conclusions Policy design should account for preference heterogeneity among current users of aged care, funders of aged care, and future users of aged care in different quality of life dimensions measured by the QOL-ACC instrument.