Mohammed T. Abou-Saleh

NEEDS AND PROBLEMS 135include descriptions of the course of illness, comparisons of theoutcomes of competing treatments, monitoring of the performanceof healthcare systems, accounting for benefits derived fromresources allocated to various interventions, assisting decisions ontreatment choice, and informing policy formation on developmentof the health care system and its components.Yet there are problems of concept and measurement that haveemerged for which no satisfactory solutions have yet been found.For example, there are unresolved conflicting advantages andlimitations offered by generic or specific measures, by emphaseson subjective or objective approaches, by brief or comprehensiveassessments, or by combining or segregating status andpreferences.Many of the existing quality of life instruments have adoptedscales and indices that had a prior existence as measures of healthstatus. This has created a core of domains that are found in amajority of instruments: this core includes functioning in theactivities of daily living, mobility, cognitive status, depression ormorale, physical discomfort and self-perceived health. However,there are many other domains that appear in some instrumentsand not in all, so that the potential cumulative list is lengthy.There is little empirical work to identify which domains are mostcritical to a good quality of life.Choosing between the numerous established instruments is adaunting task for the relatively inexperienced researcher or for theclinician wishing to enhance practice standards. An instrumentwhich is widely used may appeal to researchers, reviewers andgrant committees on the grounds of its substantial psychometricdevelopment, provision of norms, comparison with findings fromprevious pertinent studies, as well as the credence that comes fromthe consensus implicit in a large constituency of users.Nevertheless, there are junctures in the growth of a fieldwithin the health sciences at which technological expediency canoutstrip the slower work of fundamental understanding. At suchpoints in the history of the maturation of a field the good canpre-empt the excellent. Whether this is the case for the currentstate of quality of life concept and measurement is a matter ofjudgment.REFERENCES1. Gallo JJ, Reichel W, Andersen L. Handbook of Geriatric Assessment.Gaithersburg, MD: Aspen, 1988.2. Gurland BJ. Mental Health Assessment: assessing mental health inthe elderly (Special Supplement Series: Multidisciplinary healthassessment of the elderly). 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