Determining the quality of life-aged care consumer threshold to identify good quality of life in older adults in long-term care

Objective: With ageing populations and increasing demand for aged care, quality of life (QoL) has become a central focus of recent policy reforms in Australia and other countries. The Quality of Life-Aged Care Consumer (QOL-ACC), a preference-based measure, was introduced as a mandatory national quality indicator across Australia in 2023 to support assessment and public reporting of variation in QoL across long term aged care facilities (LTCFs). While its national implementation is a significant step forward, further guidance is needed to support the interpretation of QOL-ACC scores in practice. Therefore, this study aimed to identify an empirical reference point on the QOL-ACC to aid interpretation of scores in LTCFs. 

Methods: Data were collected through self-reports from LTCFs residents and proxy reports from informal carers. An anchor-based method was used, comparing QOL-ACC summative scores (range: 0 to 24; higher scores indicate better QoL) against two global items of health and QoL. Receiver Operating Characteristic (ROC) curve analysis assessed the discriminative ability of different QOL-ACC scores in identifying residents who rated their global health or quality of life as “good” or better. Sensitivity, specificity, and area under the curve (AUC) were calculated. 

Results: Of the total 316 care recipients included (200 [62.5%] self-reports and 116 [37.5%] proxy-reports), the majority were female (64.2%) with a mean age of 84 ± 8.2 years. A QOL-ACC summative score of ≥ 18 was identified as the optimal reference threshold for indicating good quality of life, with a sensitivity of 76%, specificity of 78%, and an AUC of 0.83 (95% CI 0.78—0.87), indicating good discriminative ability. 

Conclusion: This study provides a practical and evidence-based interpretive reference point for QOL-ACC scores in long-term care facilities. The identified cut-off may support interpretation of QOL-ACC outcomes in routine quality monitoring and inform care planning, service evaluation, and quality improvement interventions.