Instrumentation of the Care Keys Research

  • Marja Vaarama
  • Richard Pieper
  • Andrew Sixsmith
  • Ene-Margit Tiit
  • Seija Muurinen
  • Kai Saks
  • Margaret Hammond
Research on care-related quality of life (crQoL) focuses mainly on the interaction between the quality of care (QoC) and the quality of life (QoL). However, the conditions for a good QoC are also important, that is the resources, structures and processes which facilitate good care outcomes. For comprehensive evaluation of care-related QoL, all the perspectives that have been included in the multi-dimensional and multi-actoral evaluation model developed in the Care Keys project are important. Hence, the instrumentation of the research carried out within Care Keys was designed to cover all the different elements within the meta-model and quality matrix that guided the project:
  1. 1.

    Subjective QoL in old persons receiving home care or care in institutional settings, and determinants of it.

  2. 2.

    Objective (assessed) QoL in old persons, and determinants of it.

  3. 3.

    QoL in old persons with dementia.

  4. 4.

    Subjective QoC in old persons using home care or care in institutional settings, and determinants of it.

  5. 5.

    Professional quality of home care and care in institutional settings, and determinants of it.

  6. 6.

    Quality management of home care and care in institutional settings, and determinants of it.


It followed from this, firstly, that instruments were needed for carrying out interviews with clients to access their subjective perceptions about their QoL and the QoC they received. Secondly, instruments had to describe the QoL as professionally assessed and documented including professional (e.g. clinical) care outcomes. Thirdly, instruments were required for the evaluation of the QoL of older persons with dementia, who may be unable to provide the information themselves. Fourthly, a standardised instrument was needed for the collection of information on professional QoC, covering key components within the meta-model. Fifthly, an instrument was required to collect all the information needed from the perspective of management. Besides quality management information, the instrument also had to collect information at the organisational level on such issues as material resources, costs and organisational structures for quality management. The information sources for this information were the care managers at different management levels.


Depression Dementia Coherence Assure Dexamethasone 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Alexopoulos, G. S., Abrams, R. C., Young, R. C., & Shamoian, C. A. (1988). Cornell scale for depression in dementia. Biological Psychiatry, 23, 271–284.CrossRefPubMedGoogle Scholar
  2. Antonovsky, A. (1993). The structure and properties of the sense of coherence scale. Social Science and Medicine, 36, 725–733.CrossRefPubMedGoogle Scholar
  3. Balcombe, N. R., Ferry, P. G., & Saweirs, W. M. (2001). Nutritional status and well being. Is there a relationship between body mass index and the well-being of older people? Current Medical Research and Opinion, 17(1), 1–7.CrossRefPubMedGoogle Scholar
  4. Baltes, P. B., & Baltes, M. M. (1990). Psychological perspectives on successful aging: The model of selective optimization with compensation. In P. B. Baltes, & M. Baltes (Eds.), Successful aging. Perspectives from the behavioural sciences. Cambridge, MA: Cambridge University Press.Google Scholar
  5. Baltes, P. B., & Mayer, K. U. (Eds.). (1999). The Berlin Aging Study, aging from 70 to 100. Cambridge, MA: Cambridge University Press.Google Scholar
  6. Bengtson, V. L., & Roberts, R. E. L. (1991). Intergenerational solidarity in aging families. In P. Benner, Ch. A. Tanner, & C. A. Chesla Pflegeexperten, Pflegekompetenz, klinisches Wissen und alltägliche Ethik. Bern: Hans Huber, 2000.Google Scholar
  7. Blonski, H., & Stausberg, M. (Eds.). (2003). Prozessmanagement in Pflegeorganisationen. Hannover: Schlütersche Verlag.Google Scholar
  8. Bowling, A. (1991). Measuring health. A review of quality of life measurement scales. Glasgow: Open University Press.Google Scholar
  9. Brandstätter, J., & Renner, G. (1990). Tenacious goal pursuit and flexible goal adjustment. Explication and age-related analysis of assimilative and accommodative strategies of coping. Psychology and Aging, 5(1), 58–67.CrossRefGoogle Scholar
  10. Brod, M., Stewart, A. L., Sands, L., & Walton, P. (1999). Conceptualization and measurement of quality of life in dementia: The dementia quality of life instrument (DQoL). The Gerontologist, 39, 25–35.PubMedGoogle Scholar
  11. Bruce, E. (2000). Looking after well-being: A tool for evaluation. Journal of Dementia Care, 8(6), 25–27.Google Scholar
  12. Bruhn, M. (2003). Qualitätsmanagement für Dienstleistungen. Grundlagen, Konzepte, Methoden. 4., verbesserte. Auflage: Springer.Google Scholar
  13. City of Helsinki (2002). Social Services Department. Handbook for documentation. Unpublished, in internal use only, updated 2005.Google Scholar
  14. Currie, V., Harvey, G., West, E., McKenna, H., & Keeney, S. (2005). Relationships between quality of care, staffing levels, skill mix and nurse autonomy: Literature review. Journal of Advanced Nursing, 51, 73–82.CrossRefPubMedGoogle Scholar
  15. Daatland, S. O. (1990). What are families for? On family solidarity and preferences for help. Ageing and Society, 10, 1–15.CrossRefGoogle Scholar
  16. de Jong-Gierveld, J., & van Tilburg, T. (1999). Manual of the loneliness scale. Amsterdam: Vrije Universiteit.Google Scholar
  17. Department of Health (UK). (2003), Domiciliary Care: National Minimum Standards.Google Scholar
  18. Derogatis, L. R., Lipman, R. S., Rickels, K., Uhlenhuth, E. H., & Covi, L. (1974). The Hopkins Symptom Checklist (HSCL): A self-report symptom inventory. Behavioral Science, 19, 1–15.CrossRefPubMedGoogle Scholar
  19. Donabedian, A. (1969). Some issues in evaluation the quality of nursing care. American Journal of Public Health, 59, 1833–1836.CrossRefPubMedGoogle Scholar
  20. Duffy, J. A., Duffy, M., & Kilbourne, W. (1997). Cross national study of perceived service quality in long-term care facilities. Journal of Aging Studies, 11(4), 327–336.CrossRefGoogle Scholar
  21. Eskola, I., & Valvanne, J. (2000). Kotihoidon kehittäminen Helsingissä (Home Care Programme for Helsinki City) Sosiaaliviraston julkaisusarja A 7/2000. City of Helsinki, Social Services Department, Helsingin kaupungin sosiaalivirasto.Google Scholar
  22. Folstein, M., Folstein, S., & McHugh, P. (1975). Mini mental state, a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatry Research, 12, 187–198.CrossRefGoogle Scholar
  23. Friedag, H. R., & Schmidt, W. (2004). Balanced scorecard. Planegg bei München.Google Scholar
  24. Gebert, A. (2001). Qualitätsbeurteilung und Evaluation in der Qualitätssicherung in Pflegeheimen (Quality assessment and evaluation in quality assurance in nursing homes). Bern: Huber Publisher.Google Scholar
  25. Geron, S. M., Smith, K., Tennstedt, S., Jette, A., Chassler, D., & Kasten, L. (2000). The home care satisfaction measure: A client-centred approach to assessing the satisfaction of frail older adults with home care services. Journal of Gerontology (B): Psychological Sciences and Social Sciences, 55, S259–S270.Google Scholar
  26. Goldstone, L., & Maselino-Okai, C. (1986). Senior Monitor. An index of the quality of nursing care for senior citizens on hospital wards. Newcastle upon Tyne: Newcastle upon Tyne Polytechnic Products Ltd.Google Scholar
  27. Growing Older Project. <>.
  28. Görres, St. (1999). Qualitätssicherung in Pflege und Medizin (Quality assurance in care and medicine). Bern: Huber Publisher.Google Scholar
  29. Hamilton, M. (1967). A rating scale for depression. Journal of Neurology Neurosurgery and Psychiatry, 23, 56–62.CrossRefGoogle Scholar
  30. Hartmaier, S. L., Sloane, P. D., Guess, H. A., Koch, G. G., Mitchell, C. M., & Phillips, C. D. (1995). Validation of the minimum data set cognitive performance scale: Agreement with the mini-mental state examination. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 50(2), M128–M133.PubMedGoogle Scholar
  31. Haubrock, M., & Gohlke, S. (2001). Benchmarking in der Pflege (Benchmarking in care. A benchmarking study of home care services). Bern: Huber Publisher.Google Scholar
  32. Kane, R. L. (1998). Assuring quality in nursing home care. Journal of the American Geriatrics Society, 46, 232–237.PubMedGoogle Scholar
  33. Kaplan, R. S., & Norton, D. P. (1996). Translating strategy into action. The balanced scorecard. Boston, MA: Harvard Business School Press.Google Scholar
  34. Katona, C. L., & Aldridge, C. R. (1985). The dexamethasone suppression test and depressive signs in dementia. Journal of Affective Disorders, 8, 83–89.CrossRefPubMedGoogle Scholar
  35. Kercher, K. (1992). Assessing subjective well-being in the old-age. Research on Ageing, 14, 131–168.CrossRefGoogle Scholar
  36. Kitwood, T., & Bredin, K. (1992). A new approach to the evaluation of dementia care. Journal of Advances in Health and Nursing Care, 1(5), 41–60.Google Scholar
  37. Kunzmann, U., Little, T., & Smith, J. (2002). Perceiving control: A double-edged sword in old age. Journal of Gerontology. Psychological Sciences, 57B(6), 484–491.Google Scholar
  38. Lawton, M. P. (1975). The Philadelphia Geriatric Center Morale Scale: A revision. Journal of Gerontology, 30, 85–89.PubMedGoogle Scholar
  39. Lawton, M. P. (2001). Quality of care and quality of life in dementia care units. In L. S. Noelker, & Z. Harel (Eds.), Linking Quality of Long-Term Care and Quality of Life (pp. 148). New York: Springer.Google Scholar
  40. Lelliott, P., Beevor, A., Hogman, G., Hyslop, J., Lathlean, J., & Ward, M. (2001). Carers’ and users’ expectations of services—user version (CUES-U): A new instrument to measure the experience of users of mental health services. British Journal of Psychiatry, 179, 67–72.CrossRefPubMedGoogle Scholar
  41. Logsdon, R. G., Gibbons, L. E., McCurry, S. M., & Teri, L. (2002). Assessing quality of life in older adults with cognitive impairment. Psychosomatic Medicine, 64, 510–519.PubMedGoogle Scholar
  42. Löwenstein, A., Katz, R., Mehlhausen-Hassoen, D., & Prilutzky, D. (2002). The Research Instruments in the OASIS Project–Old Age and Autonomy: The Role of Service Systems and Intergenerational Family Solidarity. Haifa, The Center for Research and Study of Ageing–The Faculty for Welfare and Health Studies, University of Haifa.Google Scholar
  43. Mahoney, F., & Barthel, D. (1965). Functional evaluation: The Barthel index. Maryland State Medical Journal, 14, 61–65.PubMedGoogle Scholar
  44. Maruyama, G. M. (1986). Basics of structural equation modeling. Thousand Oaks, CA:SAGE Publications.Google Scholar
  45. Morris, J. N., Fries, B. E., Mehr, D. R., Hawes, C., Phillips, C., Mor, V., et al. (1994). MDS cognitive performance scale. Journal of Gerontology, 49M, 174–182.Google Scholar
  46. Morris, J., Fries, B. E., Steel, K., Ikegami, N., Bernabei, R., Carpenter, G. I., et al. (1997). Comprehensive Clinical Assessment in Community Settings: Applicability of the MDS-HC. Journal of the American Geriatrics Society, 45, 1017–1024.PubMedGoogle Scholar
  47. Muurinen, S. (2003). Hoitotyö ja hoitohenkilöstön rakenne vanhusten lyhytaikaisessa laitoshoidossa (Care and staff-mix in institutional respite care for elderly). Academic Dissertation. Acta Universitatis Tamperensis, 936. Tampere University Press. Tampere.Google Scholar
  48. Niven, P. R. (2003). Balanced scorecard–Schritt für Schritt. Einführung, Anpassung und Aktualisierung. Weinheim: Wiley GmbH & Co. KG&A.Google Scholar
  49. Øvretveit, J. (1998). Evaluating health interventions. An introduction to evaluation of health treatments, services, policies and organizational interventions. Buckingham, Philadelphia, PA: Open University Press.Google Scholar
  50. Paljärvi, S., Rissanen, S., & Sinkkonen, S. (2003). Kotihoidon sisältö ja laatu vanhusasiakkaiden, omaisten ja työntekijöiden arvioimana - Seurantatutkimus Kuopion kotihoidosta. Gerontologia, 2, 85–97.Google Scholar
  51. Parasuraman, A., Berry, L. L., & Zeithaml, V. A. (1988). ‘SERVQUAL: A multiple-item scale for measuring customer perceptions of service quality’. Journal of Retailing, 64, 12–40.Google Scholar
  52. Parasuraman, A., Zeithaml, V. A., & Berry, L. L. (1985). A conceptual model of service quality and its implications for future research. Journal of Marketing, 49, 41–50.CrossRefGoogle Scholar
  53. Parasuraman, A., Zeithaml, V. A., & Berry, L. L. (1986). SERVQUAL: A Multiple-Item Scale for Measuring Customer Perceptions of Service Quality. Cambridge, MA: Marketing Science Institute.Google Scholar
  54. Parasuraman, A., Zeithaml, V. A., & Berry, L. L. (1994). Reassessment of expectations as a comparison standard in measuring service quality: Implications for future research. Journal of Marketing, 58, 111–124.CrossRefGoogle Scholar
  55. Pavot, W., Diener, E., Colvin, C. R., & Sandvik, E. (1991). Further validation of the satisfaction with life scale: Evidence for the cross-method convergence of well-being. Journal of Personality Assessment, 57, 149–161.CrossRefPubMedGoogle Scholar
  56. Pearlin, L. I., & Schooler, C. (1978). The structure of coping. Journal of Health and Social Behaviour, 19, 2–21.CrossRefGoogle Scholar
  57. Porell, F., & Caro, F. G. (1998). Facility-level outcome performance measures for nursing homes. The Gerontologist, 38, 665.PubMedGoogle Scholar
  58. Power, M., Quinn, K., Schmidt, S., & WHOQOL-OLD Group (2005). Development of the WHOQOL-Old module. Quality of Life Research, 14, 2197–214.Google Scholar
  59. Radloff, L. S. (1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385–401.CrossRefGoogle Scholar
  60. Raynes, N., Temple, B., Glenister, C., & Coulthard, L. (2001). Quality at home for older people: Involving service users in defining home care specifications. Bristol: The Policy Press. Published in association with Joseph Rowntree Foundation.Google Scholar
  61. Ready, R. E., Ott, B. R., Grace, J., & Fernandez, I. (2002). The Cornell-Brown Scale for Quality of Life in Dementia. Alzheimer Dis. Assoc. Disord, 16(2), 109–15.CrossRefPubMedGoogle Scholar
  62. Rosenberg, M. (1965). Society and the adolescent self-image. Princeton, NJ: Princeton University Press.Google Scholar
  63. Russell, D., Peplau, L. A., & Cutrona, C. E. (1980). The revised UCLA loneliness scale: Concurrent and discriminant validity evidence. Journal of Personality and Social Psychology, 39, 472–480.CrossRefPubMedGoogle Scholar
  64. Ryff, C. D., & Keyes, C. L. M. (1995). The structure of psychological well-being revisited. Journal of Personality and Social Psychology, 69, 719–27.CrossRefPubMedGoogle Scholar
  65. Saks, K., Tiit, E.-M., & Käärik, E. (2000). Health and coping of older Estonians. University of Tartu.Google Scholar
  66. Saks, K., Tiit, E.-M., & Vähi, M. (2003). Measuring and modelling the quality of life of older Estonians. The 7th Tartu Conference on Multivariate Statistics. Abstracts.Google Scholar
  67. Sixma, H. J., van Campen, C., Kerssens, J. J., & Peters, L. (2000). Quality of care from the perspective of elderly people: The QUOTE-elderly instrument. Age and Ageing, 29, 173–178.CrossRefPubMedGoogle Scholar
  68. Solem, P. E. (2003). Forskningsinstrumentene i norLAG (Research instruments in norLAG). norLAG. Den norske studien av livsløp, aldring og generasjon. Oslo: NOVA.Google Scholar
  69. Spector, W. D., & Mukamel, D. B. (1998). Using outcomes to make inference about nursing home quality. Evaluation & The Health Professions, 21, 291–315.CrossRefGoogle Scholar
  70. Tellis-Nayak, V. (2001). In search of a universal satisfaction survey tool: An analysis of satisfaction-survey instruments for nursing home residents, families and staff. A report submitted to the American Health Care Association.Google Scholar
  71. Urman, G. C., & Urman, H. N. (1997). Measuring consumer satisfaction in nursing home residents. Nutrition, 13, 705–707.CrossRefPubMedGoogle Scholar
  72. Vaarama, M. (2004). Ikääntyneiden toimintakyky ja hoivapalvelut. Nykytila ja vuosi 2015 (Independent living and QoL in Old Age, and the role of care. State of the Art in Finland and prospects up to the year 2015). In Ikääntyminen voimavarana. Tulevaisuusselonteon liiteraportti 5 (Ageing as a resource). Valtioneuvoston kanslian julkaisusarja 33/2004. Helsinki: Edita Prima Oy. <>.
  73. Vaarama, M., Hakkarainen, A., & Laaksonen, S. (1999). Vanhusbarometri 1998 (Old Age Barometer 1998). Sosiaali- ja terveysministeriön selvityksiä 1999:3. Helsinki.Google Scholar
  74. Vaarama, M., & Hertto, P. (2003). Efficiency and equity of the care of older persons—exploring an evaluation model. Revista Española de Geriatría y Gerontología. <>.
  75. Vaarama, M., & Kaitsaari, T. (2002). Ikääntyneiden toimintakyky ja koettu hyvinvointi (Functional ability in old age and subjective well-being). In M. Heikkilä, & M. Kautto (Eds.), Suomalaisten hyvinvointi (Well-being of Finns). Jyväskylä: Gummerus.Google Scholar
  76. Vaarama, M., Mattila, V., Laaksonen, S., & Valtonen, H. (1997), Target efficiency. Report on development and piloting of the target efficiency indicators and model, STAKES.Google Scholar
  77. Vaarama, M., Pieper, R., & Sixsmith, A. (2006). Care-related quality of life. The concept and empirical exploration. In H. Mollenkopf, & A. Walker (Eds.), Quality of life in old age. International and Multi-Disciplinary Perspectives. New York: Springer Science and Business Media.Google Scholar
  78. Valvanne, J. (2005). Integrating social and health care in practice—A Finnish example. In M. Vaarama, & R. Pieper. Managing integrated care for older persons. Stakes and the European Health Management Association, Gummerus Printing.Google Scholar
  79. Veenhoven, R. (1996). Happy life-expectancy. A comprehensive measure of quality-of-life in nations. Social Indicators Research, 39, 1–58.CrossRefGoogle Scholar
  80. Veenhoven, R. (2000). The four qualities of life. Ordering concepts and measures of the good life. Journal of Happiness Studies, 1, 1–39.CrossRefGoogle Scholar
  81. Ware, J. E., Kosinski, M., & Keller, S. D. (1996). A 12-item Short Form Health Survey: Construction of scales and preliminary tests of reliability and validity. Medical Care, 34(3), 220–233.CrossRefPubMedGoogle Scholar
  82. Watson, D., Clark, L., & Tellegen, A. (1988). Development and validation of brief measures of positive and negative affect: The PANAS scales. Journal of Personality and Social Psychology, 54(6), 1063–1070.CrossRefPubMedGoogle Scholar
  83. Weiner, M. F., Martin-Cook, K., Svetlik, D. A., Sainem, K., Foster, B., & Fontaine, C. S. (2000). The quality of life in late-stage dementia (QUALID) scale. Journal of the American Medical Directors Association, 1, 114–116.PubMedGoogle Scholar
  84. WHOQOL Group (1998). Development of the World Health Organization WHOQOL-Bref quality of life assessment. The WHOQOL Group. Psychological Medicine, 28(3), 551–558.Google Scholar
  85. Zeithaml, V. A., Berry, L. L., & Parasuraman, A. (1988). Communication and control processes in the delivery of service quality. Journal of Marketing, 52(4), s.35–48.Google Scholar
  86. Zigmund, A. S., & Snaith, R. P. (1983). The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica, 67, 361–370.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Marja Vaarama
    • 1
  • Richard Pieper
    • 2
  • Andrew Sixsmith
    • 3
  • Ene-Margit Tiit
  • Seija Muurinen
  • Kai Saks
  • Margaret Hammond
  1. 1.Department of Social WorkUniversity of LaplandFinland
  2. 2.Fak. Sozial-u. Wirtschaftswiss. Urbanistik und SozialplanungUniversity of BambergGermany
  3. 3.Department of GerontologySimon Fraser University at Harbour CentreVancouverCanada

Personalised recommendations