Validation of the French version of the LEIPAD in community-dwelling people aged 80 years and above
Validation of the French version of the LEIPAD in community-dwelling people aged 80 years and above
Isabelle JalenquesID 0 1
Candy Guiguet-Auclair 1
Laurent Gerbaud 1
Chlo e? Rachez 1
Fabien Rondepierre 1
0 Universit e ? Clermont Auvergne , CHU Clermont-Ferrand , Service de Psychiatrie de l'Adulte A et Psychologie M e ?dicale, Centre M e ?moire de Ressources et de Recherche, Clermont-Ferrand, France , 2 CHU Clermont- Ferrand , Service de Sant e ? Publique, Clermont-Ferrand, France , 3 CHU Clermont-Ferrand , Service de Psychiatrie de l'Adulte A et Psychologie M e ?dicale, Centre M e ?moire de Ressources et de Recherche , Clermont-Ferrand , France
1 Editor: Mathieu F. Janssen, Erasmus MC Desiderius School , NETHERLANDS
Funding: This work was supported by the
University Hospital of Clermont-Ferrand (CHU
Clermont-Ferrand, AOI 2012, Jalenques). The
funders had no role in study design, data collection
and analysis, decision to publish, or preparation of
Competing interests: The authors have declared
that no competing interests exist.
The validation of this specific questionnaire will make it possible to investigate individually
the health-related quality of life of French older people living at home and will enable
French-speaking investigators to contribute to national and international research projects.
The world?s population is ageing in virtually every country, a trend that is even more
pronounced in Europe. In 2016, the number of people aged 80 years and above was over 130
million; it is expected that this number will rise to 315 million by 2040. People aged 80 years and
above will represent 3.5% of the world?s population [
] and 9.1% of the European population
A number of health conditions exist that can substantially affect the health-related quality
of life (HRQoL) of older population [
]. Hence the appropriate assessment of HRQoL in older
people is assuming greater importance in research projects gauging the performance and
economic evaluations of health systems.
When we started the cross-cultural evaluation of the French version of the LEIPAD, in
2007, few self-administered instruments had been developed to assess HRQoL specifically in
older people. Some had good psychometric properties (LEIPAD, Perceived Well-being Scale,
Quality of Life Profile?Seniors Version, Wellness Index, CASP-19 and the WHOQOL-Old, a
complementary module of the WHOQOL-100 or the WHOQOL-BREF) [
]. To our
knowledge at that time, these scales were not available and formally validated in French [
were looking for a scale that would allow the assessment of older people?s HRQoL in a context
of medical and psychosocial interventions. The LEIPAD, an acronym deriving from the first
two of the three universities involved in its development (LEIden in the Netherlands and
PADua in Italy) is a questionnaire especially designed in 1998 in English for self-assessment of
HRQoL for community?dwelling subjects aged 65 years and above . It was developed by
the European office of WHO, with the aim of providing an instrument that could be easily
used in clinical assessment, and that could be applied to different cultural settings. It was
validated in an initial study of 586 people aged 72.5 years (standard deviation SD 5.9) [
including quite a few adults aged 80 years and above. It showed good psychometric characteristics
The LEIPAD was cross-culturally adapted in French for self-assessment by our team [
However, in our validation of the French version of the LEIPAD, only 32 participants were
aged 80 years and above [
] which called into question the validity of the questionnaire in
this age group. Patient-reported outcome measures, such as HRQoL, can now be used only
after their psychometric characteristics have been validated for the population of interest.
Thus, we decided to perform a new study to assess the psychometric properties of the French
version of the LEIPAD questionnaire in a large sample of community-dwelling individuals
aged 80 years and above.
Guidelines for assessing the validity of a HRQoL questionnaire have been defined and
cover eight quality criteria [
]: content validity, floor and ceiling effects, internal consistency,
criterion validity, construct validity or convergent validity, reliability, responsiveness, and
interpretability. Content validity of the questionnaire was performed by De Leo et al. at the
time of its initial development [
]. Criterion validity cannot be tested for the LEIPAD as there
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is no gold standard for the measurement of HRQoL in people aged 80 years and above.
Responsiveness and interpretability were not tested in our cross-sectional study.
The psychometric properties evaluated in the present study, therefore, were acceptability
(relevance), floor and ceiling effects, internal consistency, convergent validity and reliability.
The project was approved by the French regional ethics committee ?Comite? d?Ethique des
Centres d?Investigation Clinique de l?Inter-re?gion Rho?ne-Alpes-Auvergne?CE-CIC
Grenoble? (IRB 00005921) and conducted according to the principles expressed in the Declaration of
Helsinki. All subjects enrolled gave their written informed consent.
Adults aged 80 years and over who were not living in an institution were identified from
the records of six town councils of a French territorial division. Each council gave a list
containing the identities and the household addresses of older inhabitants, of whom 2071 were
identified as eligible to participate.
The study design was the same as that previously described in detail for the validation in
people aged 65 years and above [
]. Over a period of eight months, 1501 subjects were selected
at random to participate. This sample size was calculated on the basis of two hypotheses: (i) the
participation rate in the study would be lower in older people (10% rather than the overall rate
of 15% in the previous study with the same design in subjects aged 65 years and over [
]); (ii) a
subject-item ratio of 5 is required as an adequate size for factor analysis [
All the selected subjects were sent a letter explaining the aim of the study and asking if they
would agree to participate. Adults who accepted were sent medical and socio-demographic
questionnaires, a life events questionnaire, the French culturally adapted version of the
LEIPAD, the SF-36 [
] and a letter explaining how to complete these questionnaires.
We randomly selected 110 subjects among respondents (the sample size required for an
estimation of intraclass correlation coefficient of 0.50 with power of 80% and alpha of 5% and
with an estimated response rate to test-retest of 20%) to study the reliability of the LEIPAD
by test-retest [
]. The set of questionnaires was administered a second time about 15 days
after the initial assessment [
]. Only respondents indicating no change in health status were
retained in this analysis, as recommended [
]. Those who declared any additional health
problems or treatment modifications since the first evaluation and who mentioned any events
that would have disrupted their life between test and retest were excluded from reliability
Patient inclusion criteria were: at least 80 years of age; living at home; not living in an
institution; without dementia syndrome or other neurodegenerative diseases; and capable of
completing the questionnaires without help.
Once all the data were collected, subjects who had not completed the questionnaires on
their own (identified by a question to that effect) and who were suspected of having a
neurodegenerative disease (identified by an item about their current treatment) were removed from
The French versions of the LEIPAD [
] (S1 Fig) and of the SF-36 questionnaires [
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LEIPAD. The LEIPAD questionnaire comprises 31 items [
] which are grouped into seven
scales forming the core of the instrument: ?Physical function? (5 items), ?Self-care? (6 items),
?Depression and anxiety? (4 items), ?Cognitive functioning? (5 items), ?Social functioning? (3
items), ?Sexual functioning? (2 items), and ?Life satisfaction? (6 items). Each of these items is rated
on a 4-point Likert scale, from 0 (corresponding to the best condition) to 3 (the worst condition).
For each scale a total score is calculated by adding the individual scores of the items making
up the scale (only if all items are completed), with lower scores referring to good conditions.
SF-36. The SF36 is a general self-assessed instrument for measuring quality of life that is
available in French. It is the most frequently used questionnaire for older people and has
among the best metric properties [
]. The SF-36 consists of 36 items assigned to eight
multiitem scales: ?Physical functioning?, ?Role physical?, ?Mental health?, ?Role emotional?, ?Social
functioning?, ?Bodily pain?, ?Vitality?, and ?General health?. For each scale, the subject obtains a
score between 0 and 100, with higher values indicating better HRQoL.
Demographic characteristics, current health problems (according to ICD-10 classification)
and treatments, negative life events that may have disrupted their life during the last twelve
months (such as bad health, hospitalisations, bereavements, financial worries, or conflicts with
children) were also recorded.
Statistical analyses were performed with SAS v9.4 software for Windows. P-values <0.05 were
considered to be statistically significant.
Data completeness, score distribution, floor and ceiling effects. Data completeness (or
respondent acceptability) of the LEIPAD was determined by looking at the frequency of
missing values for each scale.
The distribution of the LEIPAD scores was evaluated using mean, standard deviation,
range and median. For each scale of the LEIPAD floor effect (percentage of patients scoring at
minimum level) and ceiling effect (percentage scoring at maximum level) were investigated.
These effects were present if more than 15% of the subjects obtained the lowest or highest
possible score [
Factor analysis. Factor analysis, with principal axis extraction method and oblique
promax rotation (assuming that the factors are correlated), was performed to study the
multidimensionality and distribution of the items in the hypothesized original scales. As the
perception and definition of HRQoL varies from culture to culture, there was no guarantee
that the French version reproduced the seven scales of the original instrument. We therefore
performed an exploratory analysis to determine the underlying factor structure of the items
]. Eigenvalues higher than one (Kaiser criterion) and Cattell?s scree plot [
] were used
to verify factor solution accuracy. The solution giving the most adequate factor structure (item
loadings greater than 0.32, no or few item cross loadings, i.e. no or few items with loadings at
0.32 or higher on two or more factors) was retained [
Internal consistency. Internal consistency was estimated by Cronbach?s ? coefficient for
multi-item scales [
]. The minimum required for the coefficient was 0.70, according to the
standard used for group comparisons [
]. For the scale composed of two items, Spearman
correlation coefficient was calculated.
Item-total correlations. Item-total correlations were used to evaluate the extent of the
linear relationship between an item and its scale, corrected for overlap [
]. A minimum
correlation coefficient of 0.40 was considered indicative of good item-total consistency .
Inter-scale correlations. Spearman?s coefficients were used to evaluate inter-scale
correlations. Hypotheses regarding the relationships between the seven scales of the LEIPAD were
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made in terms of direction and magnitude, based on our experience. Correlations were
considered very small for coefficients lower than 0.30, small for coefficients between 0.30 and 0.50,
moderate from 0.50 to 0.70 and strong if higher than 0.70 [
]. Positive correlations were
expected for all scales. The ?Physical function? scale was expected to correlate highly with the
?Self-care? scale (assessing physical tasks) and ?Depression and anxiety? scale (because items 6
and 7 related to sleep and tiredness could be symptoms of depression and anxiety). The
?Selfcare? scale was expected to have small to moderate correlations with the ?Depression and
anxiety? and ?Cognitive functioning? scales. The scales assessing mental health (?Depression and
anxiety?, ?Cognitive functioning?, ?Social functioning? and ?Life satisfaction?) are hypothesized
to correlate moderately with one another. The ?Sexual functioning? scale was expected to have
small correlations with the other scales.
Reliability. Reliability was explored by test-retest measures. Intraclass correlation
coefficients (ICCs) [
], based on the two-way random effect model, were calculated for each of the
LEIPAD scales. Coefficients higher than 0.70 were considered satisfactory [
Convergent validity. Convergent validity was obtained by studying the relationships
between the LEIPAD and SF-36 scales and calculating Spearman?s correlation coefficients.
Hypotheses about correlations were made in terms of magnitude, based on our experience.
Negative correlations were expected between the LEIPAD and SF-36 scales because low
scores indicated good conditions for the LEIPAD but bad conditions for the SF-36.
Moderate to high correlations were expected between the LEIPAD ?Physical function? scale and the
SF-36 ?Physical functioning?, ?Role physical?, ?Bodily Pain?, ?Vitality? and ?General health?
scales, and between the LEIPAD ?Self-care? scale and the SF-36 ?Physical functioning? scale.
The LEIPAD ?Depression and anxiety? scale was expected to be correlated with the SF-36
?Mental health?, ?Role Emotional?, and ?Vitality? scales. The LEIPAD ?Cognitive functioning?
scale was expected to correlate with the mental dimensions of SF-36. The LEIPAD ?Social
functioning? scale was hypothesized to be poorly correlated with the SF-36 ?Social
functioning? scale, as the items making up these dimensions differed greatly between the two
instruments. The LEIPAD ?Sexual functioning? scale was expected to correlate with the SF-36
?Physical functioning?, and the LEIPAD ?Life satisfaction? scale with the SF-36 ?General
Description of the participants
Of the 1501 letter sent, 100 were not able to be distributed. Overall 448 subjects (32.0%)
responded (Fig 1) and of these 239 (53.3%) agreed to enrol in the study. A comparison of
subjects who agreed to participate and those who declined showed that the former were a little
younger (85 years (SD 3.6) vs. 85.8 years (SD 3.8), p = 0.0349) and had a higher level of
education (p<0.0001). No differences in terms of sex and location existed (p = 0.1442 and
p = 0.5001 respectively).
Of the 239 older adults who agreed to participate, 211 (88.3%) returned the questionnaires.
Twenty seven adults were then excluded because they did not fulfil the inclusion criteria. (Fig
1). Thus analyses were made of the data of 184 participants, who were aged between 80 and 95
years, with a mean age of 83.9 years (SD 16.3).
The sociodemographic characteristics of the respondents are shown in Table 1.
Data completeness, score distribution, floor and ceiling effects
The descriptive statistics and score distributions for the LEIPAD scales are given in Table 2.
The percentage of missing values per LEIPAD scale was low, with values ranging from 1.1%
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Fig 1. Organization chart of participation in the study.
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for the ?Social functioning? scale to 11.4% for the ?Life satisfaction? scale. Even the scale related
to sexuality had a very low percentage of missing values (4.3%).
Floor effects were obtained for the ?Self-care?, ?Depression and anxiety? and ?Social
functioning? scales. No ceiling effect was found except for the ?Sexual functioning? scale.
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The 31 item structure of the LEIPAD was tested by factor analysis with promax rotation. Five
factors accounting for 87.4% of the total variance were extracted and gave the best factor
structure solution (Table 3). Most of the items loaded higher on their hypothesized scale than on
The items of the ?Physical function? and ?Self-care? scales loaded higher than 0.32 on the
same factor 1, with two exceptions: item 4 (being able to eat without help) and item 6 of
?Physical function? scale (sleep problems), which loaded on factor 5 (?Sexual functioning? scale). The
items of ?Cognitive functioning? and ?Depression and anxiety? scales loaded higher than 0.32
on the same factor 2. Those of the ?Social functioning? and ?Sexual functioning? scales loaded
respectively on factors 3 and 5. The ?Life satisfaction? scale was split into factors 3 and 4. Items
29 and 30 loaded higher than 0.32 both on both factors 3 and 4. Items 26, 29 and 30 had
loadings greater than 0.32 on factor 3, the axis of the ?Social functioning? scale. These items were
related to hobbies, satisfaction with life at present when compared to the past and expectations
for the future.
The LEIPAD scales showed good internal consistency with Cronbach?s ? ranging from 0.68 to
0.87 (Table 4). The ?Social functioning? and ?Sexual functioning? scales did not obtain the
minimum required coefficient of 0.70. However Cronbach? ? coefficients were 0.69 and 0.68
respectively, values very close to 0.70.
Corrected item-total correlations ranged from 0.37 to 0.79 and they were higher than the 0.40
required, except for three items, which had values of 0.37, 0.38 and 0.39, all very close to 0.40.
These correlations indicate good item-total consistency.
Hypothesized positive relationships were found between the seven LEIPAD scales (Table 4).
The highest correlation was obtained between the ?Physical function? and ?Self-care? scales
(r = 0.71). Moderate correlations were observed between the ?Physical function? and
?Depression and anxiety? scales (r = 0.58) and between the ?Self-care? and ?Depression and anxiety?
scales (r = 0.37). An almost moderate correlation was found between the ?Self-care? and
?Cognitive functioning? scales (r = 0.29). Scales assessing mental health (?Depression and anxiety?,
?Cognitive functioning?, ?Social functioning? and ?Life satisfaction?) were moderately correlated
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with one another, with correlation coefficients ranging from 0.36 to 0.64. The ?Sexual
functioning? scale had small correlations with the other scales (ranging from 0.08 to 0.22), except for
the ?Physical function? scale with a moderate correlation of 0.30. All but three inter-scale
correlations (between the ?Sexual Functioning? scale and the ?Cognitive functioning? (r = 0.14),
?Social functioning? (r = 0.08) and ?Life satisfaction? (r = 0.10) scales) were significant (p<0.05)
with a range from 0.22 to 0.71.
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Cronbach?s ? for multi-item scales are reported on the diagonal and in bold text (Spearman correlation coefficients were calculated for two-item scales).
Inter-scale correlations are Spearman coefficients.
Significantly different from 0 (p<0.05).
Depression and anxiety
Cognitive functioning Social functioning Sexual functioning Life satisfaction
Of the participants selected for the retest, 87 (79.1%) returned completed questionnaires. We
checked for inclusion criteria and that the respondents had maintained stable health status
between the two evaluations. Thirty four subjects were excluded from the reliability analysis, 7
because of exclusion criteria (5 did not fill the questionnaires alone, 1 lived in an institution
and 1 was suspected of having a neurodegenerative disease) and 27 because of events that had
disrupted their life between test and retest. No patient declared any additional health problems
or treatment modifications since the first evaluation. Finally, 53 respondents were retained. All
ICCs for LEIPAD scales were greater than 0.70 (Table 5) ranging from 0.77 to 0.95.
Correlations between the LEIPAD and SF-36 scales were negative (Table 6). All LEIPAD
scales, except the ?Sexual functioning? scales, were significantly correlated with all the scales
of the SF-36 (p<0.05). The LEIPAD ?Physical function? scale was highly correlated with the
SF-36 ?Physical functioning? (r = -0.75), ?Role physical? (r = -0.70) and ?Vitality? (r = -0.70)
scales, and moderately correlated with the other SF-36 scales (correlation coefficients
ranging from -0.49 to -0.69). Correlation between the LEIPAD ?Self-care? scale and the SF-36
?Physical functioning? scale was high (r = -0.78). The LEIPAD ?Depression and anxiety?
scale was strongly correlated with the SF-36 ?Mental health? scale (r = -0.78), and moderately
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correlated with the SF-36 ?Role emotional? (r = -0.55) and ?Vitality? (r = -0.52) scales. The
LEIPAD ?Cognitive functioning? scale correlations with the SF-36 scales were mostly small
(r = -0.25 to -0.49), with the sole exception of the SF-36 ?Mental health? scale, which was
moderate (r = -0.57). The LEIPAD and SF-36 ?Social functioning? scales were rather
moderately correlated (r = -0.49). The LEIPAD ?Sexual functioning? scale was poorly correlated
with the SF-36 scales (r = -0.10 to -0.32), even with the ?Physical functioning? scale (r =
-0.28). Correlations between the LEIPAD ?Life satisfaction? scale and the SF-36 scales were
small (r = -0.26 to ?0.48), with ?Bodily pain? (r = -0.48) and ?General health? (r = -0.47) scales
being rather moderately correlated.
This study presents for the first time a psychometric analysis of the culturally adapted French
version of the LEIPAD questionnaire in a population aged 80 years old and over living at
In our first cross-cultural evaluation of the French LEIPAD [
], the number of adults
enrolled above the age of 80 was small, and so valid results were obtained only for the
subsample of those younger than 80 years old. The proportion of the world?s population of
people over 80 is going to increase drastically. Health problems and dependency increase with
aging and so we thought it would be valuable to enrich the psychometric evaluation of the
LEIPAD in a similar study specifically concerning this age group. The survey we undertook
benefited from several important methodological factors. Our sample size is to our
knowledge, after a reference database search, one of the largest to be used in a study of the
psychometric properties of self-assessed instruments of HRQoL in community-dwelling people
aged 80 years and above [
]. Our study population was comparable to those in other
published reports with regard to sociodemographic characteristics (French sample of 168 people
in the ESEMeD study [
]), living alone or not [
], driving a car [
] and medical
] except for the rate of eye diseases. According to the ICD 10 classification
it was lower than that recorded in the general population of the same age [
because subjects unable to complete the questionnaires without help were not included in
While older age groups often have higher frequencies of missing data [
], the French
version appeared to have very good acceptability in people aged 80 years and above with low
percentages of missing values, even for the scale related to sexuality. This last result is rarely
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mentioned. Indeed only a few studies have been made on the sexuality of older adults (up to
the age of 78 years) in the general population [
]. Some studies of HRQoL in people up to
the age of 80 years have included this dimension but only one, in which there were only 8.7%
missing data for items related to sexual activity, has addressed the topic specifically in older
]. We found a ceiling effect solely for the ?Sexual functioning? scale, which shows
that the only major health problem influencing their HRQoL was sexuality. That sexuality
influences HRQoL in people aged 80 years and above is not surprising, and yet the literature
on this topic is scarce [
]. It could be that problems with sexual functioning were the only
major problem in our participants who where living at home and relatively self-sufficient. At
the same time, it could be that the ?Sexual functioning? scale is too weak to pick up variances in
the concept of sexual functionality. The high floor effect of the ?Self-care? scale was certainly
due to the fact that respondents were home-dwelling and were relatively self-sufficient (for
example, 100% were able to eat without help?item 4). There was also a floor effect for the
?Depression and anxiety? scale, which can be explained in part by the state of health and
personal autonomy of the participants, and for the ?Social functioning? scale, probably owing to
the same mechanisms. This is consistent with similar levels of autonomy observed in other
] and with results reported in the dimension of ?Anxiety and Depression? in the
]. These observed floor and ceiling effects are not due to any flaw in the LEIPAD
questionnaire but rather to the relatively healthy status of our study subjects, who were still
living at home and relatively self-sufficient.
The results of our study supported construct validity of the LEIPAD instrument in people
aged 80 years and above, with a multidimensional structure in five independent scales. Item
4 had no loadings greater than 0.32 on factors, because of all subjects gave the same reply.
The fact that item 6 (sleep problems) of the ?Physical function? scale was related to sexuality
could reflect that the changes in sleep and sexuality that occur in old age. Whatever the case,
it does not really affect the construct validity of the ?Physical function? scale. The relation of
?Cognitive functioning? to ?Depression and anxiety? is consistent with the well-known impact
of depression/anxiety on cognitive functioning, particularly in old age [
]. Likewise, the
relation of ?Self-care? to ?Physical function? is consistent with the documented effects of
physical condition on the ability to take care of oneself in old age [
]. The fact that the ?Life
satisfaction? scale is split into two close factors, illustrates that the concept itself of life
satisfaction is somewhat heterogeneous. However, it is still worth keeping this dimension as a
single entity because of its Cronbach?s alpha coefficient greater than the required value of
The internal consistency of the scales was good for four scales (Cronbach?s ? greater than
0.80) and acceptable for three scales (Cronbach?s ? of 0.68, 0.69 and 0.72). Test-retest
reliability, which is an essential property [
], was good since strong ICCs were obtained for all scales.
Convergent validity was established by relating LEIPAD scores to the generic SF-36 scores,
with the expected correlations found.
The present study provides evidence of the good psychometric properties of the French
version of the LEIPAD in a community-dwelling population aged 80 years and over but has
certain limitations. First, of the subjects contacted to take part in our study, only 12.3% were
finally involved in the analysis, a proportion close to that in other surveys of this type among
older people with postal administration [
]. Those who agreed to participate were a little
younger and had a higher level of education than those who declined. This is not a major limit
to representativeness as our purpose was not to assess the HRQoL in the older people but to
study the psychometric properties of the French version of the LEIPAD. Second, we did not
assess the cognitive status of the subjects before they replied to the questionnaire. However, we
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discarded the questionnaires of those receiving treatment generally prescribed for cognitive
disorders and those who did not complete the questionnaire unaided.
In conclusion, our study provides evidence of the good psychometric properties of the French
version of the LEIPAD self-report questionnaire in people aged 80 years and above, similar to
those in subjects younger than 80. Future work, on a larger representative sample in
cross-sectional studies, should make it possible to establish population norms in older adults.
Responsiveness (the ability of the LEIPAD instrument to detect changes in HRQoL over time) and
interpretability (minimal important change, smallest detectable change, response shift) were
not studied. Future longitudinal surveys assessing the questionnaire?s sensitivity to change
need to be performed. Our study sample was composed of adults without any major health
problems that would make them unable to continue living at home. It would be useful to
evaluate the LEIPAD questionnaire among older people with significant somatic diseases [
or psychiatric disorders [
] barring cognitive disorders, which are incompatible with the
self-completion of questionnaires.
This cross-cultural adaptation of the LEIPAD for people aged 80 years and above is an
extension of our previous work and will allow investigators to propose all French-speaking
elderly subjects living at home as participants in national and international collaboration
research projects using this scale.
S1 Fig. French version of LEIPAD questionnaire.
This study was supported by a grant from the University Hospital of Clermont-Ferrand (CHU
Clermont-Ferrand, AOI 2012). The authors would like to thank the six town councils, Dr R
Tourtauchaux and the people who participated in this study and J. Watts for advice on the
English version of the manuscript.
Conceptualization: Isabelle Jalenques, Fabien Rondepierre.
Formal analysis: Candy Guiguet-Auclair.
Funding acquisition: Isabelle Jalenques.
Investigation: Fabien Rondepierre.
Methodology: Isabelle Jalenques, Candy Guiguet-Auclair.
Project administration: Isabelle Jalenques.
Supervision: Isabelle Jalenques, Laurent Gerbaud.
Visualization: Fabien Rondepierre.
Writing ? original draft: Isabelle Jalenques, Fabien Rondepierre.
Writing ? review & editing: Candy Guiguet-Auclair, Laurent Gerbaud, Chloe? Rachez.
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1. US Census Bureau DIS. International Programs , International Data Base [Internet]. [cite? 15 janv 2018 ]. Disponible sur: https://www.census.gov/data-tools/demo/idb/region.php?N=% 20Results %20& T=2&A= aggregate&RT=0 & Y= 2040 &R=1& C =
2. Eurostat-Statistics Explained . Structure et vieillissement de la population [Internet]. 2016 [cite? 7 fe?vr 2017 ]. Disponible sur: http://ec.europa.eu/eurostat/statistics-explained/index.php/Population_ structure_and_ageing/fr
3. Netuveli G , Blane D. Quality of life in older ages . Br Med Bull . 2008 ; 85 : 113 - 26 . https://doi.org/10.1093/ bmb/ldn003 PMID: 18281376
4. Haywood KL , Garratt AM , Fitzpatrick R . Older people specific health status and quality of life: a structured review of self-assessed instruments . J Eval Clin Pract. aou?t 2005 ; 11 ( 4 ): 315 - 27 . https://doi.org/ 10.1111/j.1365- 2753 . 2005 . 00538 . x PMID : 16011644
5. Jalenques I , Auclair C , Roblin J , Morand D , Tourtauchaux R , May R , et al. Cross-cultural evaluation of the French version of the LEIPAD, a health-related quality of life instrument for use in the elderly living at home . Qual Life Res Int J Qual Life Asp Treat Care Rehabil. avr 2013 ; 22 ( 3 ): 509 - 20 .
6. De Leo D , Diekstra RF , Lonnqvist J , Trabucchi M , Cleiren MH , Frisoni GB , et al. LEIPAD, an internationally applicable instrument to assess quality of life in the elderly . Behav Med Wash DC. 1998 ; 24 ( 1 ): 17 - 27 .
7. Jalenques I , Auclair C , Rondepierre F , Gerbaud L , Tourtauchaux R. [ Health-related quality of life evaluation of elderly aged 65years and over living at home] . Rev De?pide?miologie Sante? Publique. juin 2015 ; 63 ( 3 ): 183 - 90 .
8. Terwee CB , Bot SDM , de Boer MR , van der Windt DAWM , Knol DL , Dekker J , et al. Quality criteria were proposed for measurement properties of health status questionnaires . J Clin Epidemiol. janv 2007 ; 60 ( 1 ): 34 - 42 . https://doi.org/10.1016/j.jclinepi. 2006 . 03 .012 PMID: 17161752
9. Lepl?ge A , Ecosse E , Verdier A , Perneger TV . The French SF-36 Health Survey . J Clin Epidemiol. nov 1998 ; 51 ( 11 ): 1013 - 23 . PMID: 9817119
10. Bujang MA , Baharum N. A simplified guide to determination of sample size requirements for estimating the value of intraclass correlation coefficient: a review . Arch Orofac Sci . 2017 ; 12 ( 1 ): 1 - 11 .
11. Streiner DL , Norman GR . Health measurement scales: a practical guide to their development and use . 4th ed. Oxford; New York: Oxford University Press; 2008 . 431 p.
12. Lepl?ge A . Le questionnaire MOS SF-36: manuel de l'utilisateur et guide d'interpre?tation des scores . Editions Estem; 2001 . 156 p.
13. Haywood KL , Garratt AM , Fitzpatrick R . Quality of life in older people: a structured review of generic self-assessed health instruments . Qual Life Res Int J Qual Life Asp Treat Care Rehabil. sept 2005 ; 14 ( 7 ): 1651 - 68 .
14. Beaton DE , Bombardier C , Guillemin F , Ferraz MB . Guidelines for the process of cross-cultural adaptation of self-report measures . Spine . 15 de?c 2000 ; 25 ( 24 ): 3186 - 91 . PMID: 11124735
15. Bullinger M , Alonso J , Apolone G , Lepl?ge A , Sullivan M , Wood-Dauphinee S , et al. Translating health status questionnaires and evaluating their quality: the IQOLA Project approach . International Quality of Life Assessment. J Clin Epidemiol. nov 1998 ; 51 ( 11 ): 913 - 23 . PMID: 9817108
Ware JE , Gandek B . Methods for testing data quality, scaling assumptions, and reliability: the IQOLA Project approach . International Quality of Life Assessment. J Clin Epidemiol. nov 1998 ; 51 ( 11 ): 945 - 52 .
17. Gandek B , Ware JE , Aaronson NK , Alonso J , Apolone G , Bjorner J , et al. Tests of Data Quality, Scaling Assumptions, and Reliability of the SF-36 in Eleven Countries . J Clin Epidemiol. nov 1998 ; 51 ( 11 ): 1149 - 58 . PMID: 9817132
18. Cattell RB . The Scree Test For The Number Of Factors. Multivar Behav Res. 1 avr 1966 ; 1 ( 2 ): 245 - 76 .
19. Costello AB , Osborne JW . Best practices in exploratory factor analysis: Four recommendations for getting the most from your analysis . Pract Assess Res Eval . 2005 ;
20. Cronbach LJ . Coefficient alpha and the internal structure of tests . Psychometrika. sept 1951 ; 16 ( 3 ): 297 - 334 .
21. Nunnally JC , Bernstein IH . Psychometric theory ( 3rd ed.)) . McGraw-Hill , Inc. New Tork: NY; 1994 .
22. Gandek B , Ware JE . Methods for validating and norming translations of health status questionnaires: the IQOLA Project approach . International Quality of Life Assessment. J Clin Epidemiol. nov 1998 ; 51 ( 11 ): 953 - 9 . PMID: 9817112
Ware JE , Brook R , Williams K , Stewart A , Davies-Avery A . Conceptualisation and Measurement of Health for Adults in the Health Insurance Study . In: Model of Health and Methodology. Santa Monica , USA: RAND Corporation; 1980 .
24. Hinkle DE , Wiersma W , Jurs SG . Applied statistics for the behavioral sciences [Internet] . 5th ed. Boston, Mass.: Houghton Mifflin; London: Hi Marketing; 2002 [cite? 21 nov 2018 ]. Disponible sur: https:// trove.nla.gov.au/version/27775005
25. Bartko JJ . On various intraclass correlation reliability coefficients . Psychol Bull . 1976 ; 83 ( 5 ): 762 - 5 .
26. Ko? nig H-H , Heider D , Lehnert T , Riedel-Heller SG , Angermeyer MC , Matschinger H , et al. Health status of the advanced elderly in six European countries: results from a representative survey using EQ-5D and SF-12. Health Qual Life Outcomes. 29 nov 2010 ; 8 : 143 . PMID: 21114833
27. FNORS. Vieillissement des populations et e?tat de sante? les re?gions de France [Internet]. Minist?re de la Sante?, de la Jeunesse, des Sports et de la Vie associative.; 2008 [cite? 7 fe?vr 2017 ]. (Les e?tudes du re?seau des ORS) . Disponible sur: http://www.fnors.org/uploadedFiles/vieillissement.pdf
28. Directions de la Recherche, des Etudes de l' Evaluation et des Statistiques . Enqu?te Vie Quotidienne et Sante? 2014: Re?sultats De?partementaux. Minist?re des Affaires sociales et de la Sante?; 2016 oct p. 215 .
29. Pochet P. Mobilite ? et acc?s ? la voiture chez les personnes a?ge?es: e?volutions actuelles et enjeux . Elsevier; 2003 juin p. 93 - 106 . (Recherche, transports, se?curite?). Report No.: 79.
30. Marie Dit Asse L , Fabrigoule C , Helmer C , Laumon B , Lafont S. Automobile driving in older adults: factors affecting driving restriction in men and women . J Am Geriatr Soc. nov 2014 ; 62 ( 11 ): 2071 - 8 . https:// doi.org/10.1111/jgs.13077 PMID: 25371138
31. Dourgnon P , Guillaume S , Rochereau T. Enqu?te sur la sante? et la protection sociale 2010 . Institut de recherche et documentation en e?conomie de la sante?; 2012 juill. Report No.: 553.
32. Smeeth L , Fletcher AE , Stirling S , Nunes M , Breeze E , Ng E , et al. Randomised comparison of three methods of administering a screening questionnaire to elderly people: findings from the MRC trial of the assessment and management of older people in the community . BMJ . 15 de?c 2001 ; 323 ( 7326 ): 1403 - 7 . PMID: 11744565
33. Matthias RE , Lubben JE , Atchison KA , Schweitzer SO . Sexual activity and satisfaction among very old adults: results from a community-dwelling Medicare population survey . The Gerontologist. fe?vr 1997 ; 37 ( 1 ): 6 - 14 . PMID: 9046699
34. Trudel G , Dargis L , Villeneuve L , Cadieux J , Boyer R , Pre?ville M. Marital, sexual and psychological functioning of older couples living at home: The results of a national survey using longitudinal methodology (Part II) . Sexologies. avr 2014 ; 23 ( 2 ): e35 - 48 .
35. Flynn T-J , Gow AJ . Examining associations between sexual behaviours and quality of life in older adults . Age Ageing. sept 2015 ; 44 ( 5 ): 823 - 8 . https://doi.org/10.1093/ageing/afv083 PMID: 26178206
36. Molzahn A , Skevington SM , Kalfoss M , Makaroff KS . The importance of facets of quality of life to older adults: an international investigation . Qual Life Res Int J Qual Life Asp Treat Care Rehabil. mars 2010 ; 19 ( 2 ): 293 - 8 .
37. Forbes MK , Eaton NR , Krueger RF . Sexual Quality of Life and Aging: A Prospective Study of a Nationally Representative Sample . J Sex Res . 2017 ; 54 ( 2 ): 137 - 48 . https://doi.org/10.1080/00224499. 2016 . 1233315 PMID: 27798838
38. Trudel G , Dargis L , Villeneuve L , Cadieux J , Boyer R , Pre?ville M. Fonctionnement conjugal, sexuel et psychologique des couples a??ne?s vivant ? domicile: les re?sultats d'une enqu?te nationale avec me?thodologie longitudinale (deuxi?me partie) . Sexologies. avr 2014 ; 23 ( 2 ): 52 - 68 .
39. Ce?lant N , Guillaume S , Rochereau T. Enqu?te sur la sante? et la protection sociale 2012 . Paris: Institut de recherche et documentation en e?conomie de la sante?; 2015 . Report No.: 556 .
40. Luthy C , Cedraschi C , Allaz A-F , Herrmann FR , Ludwig C. Health status and quality of life: results from a national survey in a community-dwelling sample of elderly people . Qual Life Res Int J Qual Life Asp Treat Care Rehabil. juill 2015 ; 24 ( 7 ): 1687 - 96 .
41. Hill NL , Mogle J , Wion R , Munoz E , DePasquale N , Yevchak AM , et al. Subjective Cognitive Impairment and Affective Symptoms: A Systematic Review . The Gerontologist . 2016 ; 56 ( 6 ): e109 - 27 . https://doi. org/10.1093/geront/gnw091 PMID: 27342440
42. Motl RW , McAuley E . Physical activity, disability, and quality of life in older adults . Phys Med Rehabil Clin N Am. mai 2010 ; 21 ( 2 ): 299 - 308 . https://doi.org/10.1016/j.pmr. 2009 . 12 .006 PMID: 20494278
43. Fitzpatrick R , Davey C , Buxton MJ , Jones DR . Evaluating patient-based outcome measures for use in clinical trials . Health Technol Assess Winch Engl . 1998 ; 2 ( 14 ) : i-iv, 1 - 74 .
44. Alessi CA , Josephson KR , Harker JO , Pietruszka FM , Hoyl MT , Rubenstein LZ . The yield, reliability, and validity of a postal survey for screening community-dwelling older people . J Am Geriatr Soc. fe?vr 2003 ; 51 ( 2 ): 194 - 202 . PMID: 12558716
45. Mandelblatt J , Figueiredo M , Cullen J . Outcomes and quality of life following breast cancer treatment in older women: when, why, how much, and what do women want? Health Qual Life Outcomes . 17 sept 2003 ; 1 : 45 . https://doi.org/10.1186/ 1477 -7525-1-45 PMID: 14570595
46. Di Maio M , Perrone F. Quality of Life in elderly patients with cancer . Health Qual Life Outcomes. 17 sept 2003 ; 1 : 44 . https://doi.org/10.1186/ 1477 -7525-1-44 PMID: 14525617
47. Burra P , De Bona M , Canova D , Feltrin A , Ponton A , Ermani M , et al. Longitudinal prospective study on quality of life and psychological distress before and one year after liver transplantation . Acta GastroEnterol Belg . mars 2005 ; 68 ( 1 ): 19 - 25 .
48. Sainz-Barriga M , Baccarani U , Scudeller L , Risaliti A , Toniutto PL , Costa MG , et al. Quality-of-Life Assessment Before and After Liver Transplantation . Transplant Proc. juill 2005 ; 37 ( 6 ): 2601 - 4 . https:// doi.org/10.1016/j.transproceed. 2005 . 06 .045 PMID: 16182758
49. Condello C , Padoani W , Uguzzoni U , Caon F , De Leo D. Personality Disorders and Self-Perceived Quality of Life in an Elderly Psychiatric Outpatient Population . Psychopathology. 2003 ; 36 ( 2 ): 78 - 83 . https://doi.org/10.1159/000070362 PMID: 12766317
50. Aziz M , Mehringer A , Mozurkewich E , Razik GN . Cost-Utility of 2 Maintenance Treatments for Older Adults With Depression Who Responded to a Course of Electroconvulsive Therapy: Results From a Decision Analytic Model . Can J Psychiatry . 2005 ; 50 : 389 - 97 . PMID: 16086536