New instrument improves quality of life for older Australians


To provide effective change for aged care in Australia, the right tools need to be in place – and Caring Future Institute’s Professor Julie Ratcliffe and her team have developed one very important solution that has been co-designed with older people.

The Quality of Life – Aged Care Consumer instrument (QOL-ACC) is the first quality of life instrument developed from its inception in Australia with older people, to provide person-centred quality assessment and economic evaluation in aged care.

“It’s a tool that places older peoples’ values where they should be – at the heart of Australia’s aged care system,” says Professor Ratcliffe. “It will be widely applied in shaping aged care policy and practice, ultimately improving the quality of life for older Australians.”


Professor Julie Ratcliffe


Professor Ratcliffe has driven the development and validation of the QOL-ACC instrument for quality assessment and economic evaluation in aged care, which aims to overcome resource constraints in Australia’s aged care system, while maximising the quality of life and wellbeing of older Australians.

The QOL-ACC project has directly addressed the limitations of existing quality of life instruments by incorporating the preferences and values of older people in evaluating aged care. Such consumer co-design is fundamental to the Caring Futures Institute’s aim of delivering new and innovative ways of caring that place the preferences and values of older people at the heart of aged care decision-making.

Two pilot studies funded by Flinders University have highlighted the central importance of quality-of-life attributes to older people. One study examined two focus groups of older people recovering from illness, who identified broad aspects to fully measure quality of life, including independence, control and social relationships.

The second study, published in the international journal Quality of Life Research and awarded outstanding article of the year in 2017 by the International Society for Quality of Life Research, compared the preferences of younger adults aged 18 to 64 years with those of adults aged 65 years and above, and found significant differences in their preferred quality of life attributes. Older people stated that the ability to be independent, physically mobile and to have control over their daily lives were their most important quality of life factors.

“Before the QOL-ACC was developed, no existing preference instrument incorporated these quality-of-life attributes, and this is a highly significant omission for informed decision-making in aged care policy and practice,” says Professor Ratcliffe,

The 3-year QOL-ACC linkage project, funded by the Australian Research Council, involved three key stages: in-depth qualitative interviews with older people; working in partnership with them to establish reliability and validity of the final items comprising the QOL-ACC descriptive system; then developing a preference-based scoring algorithm for the QOL-ACC.

“A particular strength of our project is its inclusivity,” says Professor Ratcliffe. “We have built upon our collective research and practical stakeholder experience to incorporate the preferences of older people from a variety of care settings in the development, validation and valuation of the QOL-ACC measure. This includes older people with mild to moderate cognitive impairment and dementia, who had previously been excluded from health economics research of this nature.”

The QOL-ACC has recently been included in the Department of Health’s quality indicators program, representing the first time that person-centred indicators of care quality have been embedded as a key component of quality assessment for Australia’s aged care sector.

Such recognition underlines that this project addresses the Australian Government’s response to the recent Royal Commission into Aged Care Quality and Safety by promoting better models of care and services which ultimately improve the quality of life and wellbeing of older Australians.

Crucially, this collaborative approach is striking the right note with consumers. “Through every stage of this research, we have received many messages of support from older people, family carers and our partner organisations,” says Professor Ratcliffe, “and all of them recognise quality of life as the most important quality indicator for aged care.”

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Quality Aged Care