***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: As more research is undertaken on the elderly , accurately assessing changes in their quality of life becomes increasingly important . Generic instruments are the most popular method to assess quality of life , and one of the most widely used is the EQ-5D . However , the range of dimensions , sensitivity of scales and completion rates have been raised as concerns when using this measure with the elderly . The AQoL is a newer instrument which offers greater richness in dimensions of health covered , and potentially offers greater sensitivity to changes in quality of life . This paper presents the results of a ' head-to-head ' comparison of the EQ-5D and AQoL in terms of practicality , construct validity , agreement ( of absolute scores and their change over time ) and sensitivity to change , as part of a r and omised controlled trial in the elderly . Poor agreement was found between both the absolute scores from each instrument and change in scores over time . Although the AQoL appeared to have more favourable construct validity , the EQ-5D was easier to administer , had a higher completion rate , and appeared more sensitive to change . We conclude that the AQoL is probably less well suited to measuring health status in a very elderly population than the EQ-5D Background Cognition is a multidimensional construct and to our knowledge , no previous studies have examined the independent contribution of specific domains of cognition to health related quality of life . To determine whether executive functions are independently associated with health related quality of life assessed using Quality Adjusted Life Years ( QALYs ) calculated from the EuroQol EQ-5D ( EQ-5D ) in older women after adjusting for known covariates , including global cognition . Therefore , we conducted a secondary analysis of community-dwelling older women aged 65 - 75 years who participated in a 12-month r and omized controlled trial of resistance training .  We assessed global cognition using the  Mini-Mental State Examination ( MMSE )  and  executive functions  using the : 1 ) Stroop Test ; 2 ) Trail Making Test ( Part B ) and 3 ) Digits Verbal Span Backwards Test .  We calculated QALYs from the EQ-5D administered at baseline , 6 months and 12 months . Results Our multivariate linear regression model demonstrated the specific executive processes of set shifting and working memory , as measured by Trail Making Test ( Part B ) and Digits Verbal Span Backward Test ( p < 0.01 ) respectively , were independently associated with QALYs after accounting for age , comorbidities , general mobility , and global cognition . The final model explained 50 % of the variation in QALYs . Conclusions Our study highlights the specific executive processes of set shifting and working memory were independently associated with QALYs -- a measure of health related quality of life . Given that executive functions explain variability in QALYs , clinicians may need to consider assessing executive functions when measuring health related quality of life . Further , the EQ-5D may be used to track changes in health status over time and serve as a screening tool for clinicians . Trial Registration Clinical Trials.gov Identifier : NCT00426881 Summary Fractures and falls are serious cause of morbidity and cost to society . Our results suggest that the main burden to morbidity , measured as impact on health-related quality of life , is due to fear of falling rather than falls or their sequelae , such as fractures . Introduction Fractures and falls are serious cause of morbidity and cost to society . We investigated the impact on health-related quality of life ( HRQoL ) associated with  falls , fractures and fear of falling and falls and fractures cost . Methods Three data sets providing longitudinal data on fear of falling , HRQoL and a common set of baseline risk factors for fracture ( smoking status , weight and age ) were analysed . Multilevel r and om effects models were used to estimate the long-term impact on HRQoL associated with falls , fractures and fear of falling . Healthcare re source use primary data were collected to estimate falls and fractures cost . Results Older , low weight and smoking women reported lower HRQoL. The impact on HRQoL of a fracture was at least twice as large as that associated with falls . The largest negative effect on HRQoL was associated with self-reported fear of falling . The cost of falls was £ 1088 . Similarly , the cost of falls leading to a fracture was £ 15,133 , £ 2,753 , £ 1,863 , £ 1,331 and £ 3,498 for hip , wrist , arm , vertebral and other fractures , respectively . Discussion The main burden to morbidity is due to fear of falling . Interventions aim ed at reducing fear of falling may produce larger gains in 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 r and omised trial of external hip protectors for older women at risk of hip fracture . PARTICIPANTS 194 women aged > /= 75 years enrolled in the r and omised 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 Background There is limited knowledge on the ability of a poor quality of life ( QOL ) and  health-related QOL ( HRQOL ) to predict mortality and other adverse health events , independently of the frailty syndrome and other confounders , in older people living in the community and not selected on the basis of specific chronic conditions . Aim of this study was to evaluate the ability of the overall QOL and of the HRQOL to predict several adverse health outcomes at a one-year follow-up in an older outpatient population living in the community . Methods We carried out a prospect i ve cohort study on 210 community-dwelling out patients aged 65 + ( mean age 81.2 yrs ) consecutively referred to a geriatric clinic in Milan , Italy . At baseline participants underwent a comprehensive geriatric assessment including evaluation of overall QOL and HRQOL by means of the Older People 's Quality of Life ( OPQOL ) question naire . At a one-year follow-up , between June and December 2010 , we investigated nursing home placement and death in all 210 participants as well as any fall , any admission to the emergency department ( ED ) , any hospitalisation and greater functional dependence among the subset of subjects still living at home . Results One year after the visit 187 subjects were still living at home ( 89 % ) while 7 had been placed in a nursing home ( 3.3 % ) and 16 had died ( 7.7 % ) . At multiple logistic regression analyses the lowest score-based quartile of the OPQOL total score at baseline was independently associated with a greater risk of any fall and any ED admission . Also , the lowest score-based quartile of the health-related OPQOL sub-score was associated with a greater risk of any fall as well as of nursing home placement ( odds ratio [ OR ] 10.03 , 95 % confidence interval [ CI ] 1.25 - 80.54 , P = 0.030 ) and death ( OR 4.23 , 95 % CI 1.06 - 16.81 , P = 0.041 ) . The correlation with the latter two health outcomes was found after correction for age , sex , education , income , living conditions , comorbidity , disability and the frailty syndrome . Conclusions In an older outpatient population in Italy the OPQOL total score and its health-related sub-score were independent predictors of several adverse health outcomes at one year . Notably , poor HRQOL predicted both nursing home placement and death even after correction for the frailty syndrome . These findings support and enhance the prognostic relevance of QOL measures Background This study aim ed to assess the effects of a risk-based , multifactorial fall prevention programme on health-related quality of life among the community-dwelling aged who had fallen at least once during the previous 12 months . Methods The study is a part of a single-centre , risk-based , multifactorial r and omised controlled trial . The intervention lasted for 12 months and consisted of a geriatric assessment , guidance and treatment , individual instruction in fall prevention , group exercise , lectures on themes related to falling , psychosocial group activities and home exercise . Of the total study population ( n = 591 , 97 % of eligible subjects ) , 513(251 in the intervention group and 262 in the control group ) participated in this study . The effect of the intervention on quality of life was measured using the 15D health-related quality of life instrument consisting of 15 dimensions . The data were analysed using the chi-square test or Fisher 's exact test , the Mann-Whitney U-test and logistic regression . Results In men , the results showed significant differences in the changes between the intervention and control groups in depression ( p = 0.017 ) and distress ( p = 0.029 ) and marginally significant differences in usual activities ( p = 0.058 ) and sexual activity ( p = 0.051 ) . In women , significant differences in the changes between the groups were found in usual activities ( p = 0.005 ) and discomfort/symptoms ( p = 0.047 ) . For the subjects aged 65 to 74 years , significant differences in the changes between the groups were seen in distress ( p = 0.037 ) among men and in usual activities ( p = 0.011 ) among women . All improvements were in favour of the intervention group . Conclusion Fall prevention produced positive effects on some dimensions of health-related quality of life in the community-dwelling aged . Men benefited more than women The objective of this research was to determine the relative decrement in health-related quality of life , as measured by the health utilities index mark 3 ( HUI3 ) , in osteoporosis compared to other chronic medical conditions . The impact of chronic medical conditions other than osteoporosis on HUI3 measurements had been previously established in the 1996/1997 Canadian National Population Health Survey ( NPHS ) . The Canadian Multicentre Osteoporosis Study ( CaMos ) is a national population -based study in which regional participants were r and omly recruited , regardless of presence of osteoporosis . We analyzed data from participants aged ≥65 years who completed a baseline HUI3 question naire and provided information on their medical history ( n=3,750 ) . We determined the age- and gender-adjusted mean decrement in HUI3 for several chronic medical conditions , including osteoporosis . The mean changes in HUI3 adjusted for age and gender ( with 95 % confidence intervals ) were as follows : arthritis −0.10 ( −0.11 , −0.09 ) , chronic obstructive pulmonary disease ( COPD ) −0.07 ( −0.09 , -0.05 ) , diabetes mellitus −0.05 ( −0.08 , −0.03 ) , heart disease −0.06 ( -0.08 , −0.04 ) , hypertension −0.02 ( -0.03 , −0.01 ) , and osteoporosis −0.08 ( −0.11 , −0.06 ) , respectively ( model r2=0.17 ; P<0.0001 ) . These findings were comparable to those observed in the NPHS , with the exception of osteoporosis , which had not been previously studied in this fashion . The decrement in HUI3 score seen in participants with osteoporosis was comparable to that observed in other chronic medical conditions , such as arthritis , COPD , diabetes mellitus or heart disease BACKGROUND The subtrochanteric fracture constitutes approximately 5 - 10 % of all hip fractures . This particular fracture type , owing to its configuration and instability , poses significant challenges to the fixation method , especially in elderly patients with varying degrees of osteoporosis . There has been a gradual change in the operative techniques used to stabilise these fractures leading to the current widespread use of cephalomedullary nails . In contrast to the field of research on patients with the more common femoral neck and trochanteric fractures , few studies have evaluated the health-related quality of life ( HRQoL ) in patients with subtrochanteric fractures . OBJECTIVE To report the long-term outcome for patients with subtrochanteric fractures treated with a cephalomedullary nail with special regard to the HRQoL. SETTING Four university hospitals . DESIGN A prospect i ve cohort study with a 2-year follow-up . PATIENTS AND METHODS Eighty-seven consecutive elderly patients with a subtrochanteric fracture treated with a cephalomed 
    Output:
    
The most widely applied older person specific instrument was the ICEpop CAPability measure for Older people ( ICECAP-O ) in both community and residential aged care .
Conclusion In the absence of an ideal instrument for incorporating into economic evaluations in the aged care sector , this review recommends the use of a generic preference based measure of health related quality of life such as the EQ-5D to obtain quality adjusted life years , in combination with an instrument that has a broader quality of life focus like the ASCOT , which was design ed specifically for evaluating interventions in social care or the ICECAP-O , a capability measure for older people