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Control, Autonomy, Self-Realization and Pleasure (CASP-19)

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Purpose

The CASP-19 is used to measured self-reported Quality of Life measure among adults aged 60 and older.

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Instrument Details

Acronym CASP-19

Area of Assessment

Quality of Life

Assessment Type

Patient Reported Outcomes

Cost

Free

Actual Cost

$0.00

Key Descriptions

  • The CASP-19 is composed of 4 subscales that make up the instrument’s acronym: Control, Autonomy, Self-Realization and Pleasure.
    Each subscale contains 4-5 questions, and the entire assessment contains 19 items total.
    A Likert scale is used for responses, including “often,” “sometimes,” “not often” and “never.”
    For scoring purposes, these responses correspond to 0-3 points per question. Higher scores indicate better quality of life.

Number of Items

19

Equipment Required

  • Paper instrument and writing utensil

Time to Administer

10 minutes

Required Training

No Training

Age Ranges

Adult

18 - 64

years

Elderly Adult

65 +

years

Instrument Reviewers

Jamien Cvjetnicanin, Andrea Horsfield, Caitlin Bernert, Megan Black

(Master of Occupational Therapy Students)

Faculty mentor: Danbi Lee, PhD, OTD, OTR/L

Division of Occupational Therapy, Department of Rehabilitation Medicine, University of Washington, Seattle

ICF Domain

Activity
Participation

Measurement Domain

General Health

Considerations

The CASP-19 has been translated into 14 languages and used in 20 countries and 70 studies. https://casp19.com/casp-translations/

Scoring information is based on how the instrument was used in the English Longitudinal Survey of Ageing (ELSA). According to the publisher’s web site, this scoring method differs from the original paper, but is now the most commonly used method

Older Adults and Geriatric Care

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Test/Retest Reliability

Older Adults: (Nalathamby et al, 2017; n=446; Mean Age = 73.1 (6.8); Malaysian sample)

  • Adequate test-retest reliability: (r= 0.769)  

 

Older Adults: (Černovas et al., 2018; n=132; Mean Age = 73.1 (8.1); Lithuanian sample)

  • Adequate test-retest reliability: (ICC = 0.82)

 

Older Adults: (Miremadi et al., 2018, n=200; Elderly sample; Persian sample)

  • Adequate to Excellent test-retest reliability: (ICC range: 0.65 - 0.96)

Internal Consistency

Early old age: (Hyde et al, 2003; n=286; Age = 65-75)

  • Poor to Adequate: Cronbach's alpha range from 0.59- 0.77

 

Older Adults: (Sim et al., 2011; n=264; Mean Age = 77.5; UK sample)

  • Poor to Excellent: Cronbach’s alpha range from 0.52-0.84

 

Early old age: (Oluboyede et al., 2013; n=7,732; Mean Age > 50)

  • Excellent: Cronbach’s alpha range from 0.87-0.88

 

Older Adults: (Wu et al., 2013; n=699; Mean Age = 75.5 (6.5); Taiwanese sample)

  • Poor= to Adequate: Cronbach’s alpha range from 0.47-0.77

 

Early old age: (Kim et al., 2014; n=13,210, Mean Age across 3 countries: 61-64 years; Czech Republic, Russia, and Poland sample)

  • Excellent: Cronbach’s alpha range from 0.83-0.86

 

Older Adults: (Lima et al., 2014; n=87; Mean Age = 75.6 (0.7); Brazilian-Portuguese Sample)

  • Poor to Excellent: Cronbach’s alpha range from 0.50-0.80

 

Older Adults who are Overweight: (Jackson et al., 2015; n=5056, Mean Age = 67.49; English population)

  • Excellent: Cronbach's alpha = 0.86

 

Older Adults: (Nalathamby et al, 2017)

  • Poor to Excellent: Cronbach’s alpha range from 0.196- 0.976*

 

 Older Adults: (Černovas et al., 2018)

  •  Excellent: Cronbach’s alpha = 0.85

 

Early old age: (Neri et al., 2018; n=368; Age >55; Brazilian sample)

  • Poor to Excellent: Cronbach’s alpha range from 0.670- 0.874

 

*Scores higher than .9 may indicate redundancy in the scale questions.

Criterion Validity (Predictive/Concurrent)

Concurrent validity:

Early old age: (Hyde et al, 2003)

  • Excellent concurrent validity of CASP-19 with the Life Satisfaction Index—Well-being (LSI-W) (r = 0.6)

Construct Validity

Convergent Validity:

Early old age: (Hyde et al, 2003)

  • Excellent convergent validity between CASP-19 and the LSI-W scale (r = 0.63)

 

Older Adults: (Sim et al., 2011)

  • Adequate-Excellent convergent validity of the CASP-19 to the Diener Satisfaction with Life Scale and SF-12. (r=0.49-0.66)

 

Convergent validity

r Value

Correlations

Diener Satisfaction with Life Scale

0.66

Excellent

SF-12 Physical

0.53

Adequate

SF-12 Mental

0.49

Adequate

 

Early old age: (Kim et al., 2014)

  • Adequate convergent validity. CASP-19 scores correlated moderately with SF-10. (r=.40-.41)

 

Older Adults: (Nalathamby et al, 2017)

  • Moderate correlation between CASP-19 and SF-12 (r = 0.396)

 

Older Adults: (Černovas et al., 2018)

  • Poor-Excellent convergent validity of the CASP-19 to EQ-5D index (r = -0.36-0.39)

 

Convergent validity

r Value

Correlations

EQ-5D index

0.39

adequate

EQ-5D: mobility

-0.37

adequate

EQ-5D: usual activities

-0.36

adequate

 

Older Adults: (Caliskan et al., 2019; n=168; Mean Age = 73.3 (5.9); Turkish sample)

  • Excellent convergent validity of CASP-19 to Older People's Quality of Life questionnaire (r = 0.763)

 

Divergent Validity:

Older Adults: (Pereiro et al, 2015; n=643; Mean Age = 67.23 (11.02); Galician Spanish Sample)

  • Poor correlation between CASP-19 and Cambridge Cognitive Assessment–Revised was estimated (r= .30)

 

Older Adults: (Černovas et al., 2018; n=132; Mean Age = 73.1 (8.1); Lithuanian sample)

  • Excellent divergent validity of the CASP-10 to EQ-5D index (r = -0.32- -0.17)

 

Divergent validity

r Value

Correlations

EQ-5D: self-care

-0.32

adequate

EQ-5D: pain/discomfort

-0.17

excellent

EQ-5D: anxiety/depression

-0.3

adequate

 

Factor Analysis:

Early old age: (Sexton et al, 2013; n=6823; Mean Age = 63.6 (9.6); Irish sample)

  • Confirmatory factor analysis did not support the validity of the 4-factor model of the CASP-19.

Content Validity

Early old age: (Hyde et al, 2003; n=286; Age = 65-75).

  • A 23-item scale was developed and piloted with focus groups to determine content validity. This was also tested with individual cognitive interviews. Both groups reported that the questions were meaningful and easy to complete. They suggested removing one question, which left researchers with a 22-item scale.

Face Validity

Early old age: (Hyde et al, 2003; n=286; Age = 65-75)

  • Face validity was established with an advisory panel of gerontology and methodology experts.

 

Older Adults: (Wu et al., 2013; n=699; Mean Age = 75.5 (6.5); Taiwanese sample)

  • Face validity of the CASP-19 (Taiwanese) was determined by interview of ten literate, community-dwelling senior Taiwanese residents representing the socio-demographic characteristics the CASP-19 was designed for. From the results of these interviews, Tai-Yin Wu et al. (2013) concluded that the instrument has adequate face validity (section 2).

Floor/Ceiling Effects

Early old age: (Sexton et al, 2013)

  • Poor ceiling effect of 68-85% found for the pleasure domain. Item 12 had 85% and was excluded from further analyses.

 

Older Adults: (Wu et al., 2013; n=699; Mean Age = 75.5 (6.5); Taiwanese sample)

  • Poor ceiling effect of 62.9% found for the autonomy domain.
  • Poor ceiling effect of 47.9% found for the pleasure domain.

 

Older Adults: (Černovas et al., 2018; n=132; Mean Age = 73.1 (8.1); Lithuanian sample)

  • Excellent floor/ceiling effects.

Responsiveness

Older Adults: (Howel., 2012; n=6,482; Age %: 43% of participants 50-59, 32% of participants 60-69, 25% of participants 70+)

  • Statistically significant at the 5% level for 6/8 variables. This indicated that CASP-19 is responsive to changes that reflect QoL (p ≤0.01)

 

Early old age: (Oluboyede et al., 2013; n=7,732; Mean Age > 50)

  • A statistically significant difference was found for the mean person measure (p<0.001), suggesting quality of life improves as people age. Article did not address timeline for responsiveness measure.

Alzheimer's Disease and Progressive Dementia

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Normative Data

Dementia: (Stoner et al., 2019; n=225; Mean Age=77.1 (9.4), time since diagnosis=73% less than 3 years; Alzheimer’s disease n=109; Vascular dementia n=40; Dementia of mixed aetiology n=47; Parkinson’s related dementia n=4; Other and unknown n=28)

  • Mean scores =40.57 (9.08), Range 15-57

Test/Retest Reliability

Dementia: (Stoner et al., 2019)

  • Adequate test-retest reliability within one week when tested with subsample n=48 (ICC=0.616-0.856)

Internal Consistency

Dementia: (Stoner et al., 2019)

  • Poor to Excellent: Cronbach’s alpha range from 0.505 to = 0.856

Criterion Validity (Predictive/Concurrent)

Concurrent validity:

Dementia: (Stoner et al, 2019)

  • Excellent concurrent validity of CASP-19 to the Quality of Life in Alzheimer’s Disease Questionnaire (r=0.707)

Construct Validity

Convergent validity:

Dementia: (Stoner et al., 2019)

  • Excellent convergent validity of CASP-19 to the Geriatric Depression Scale Short Form (r=-0.707), Engagement And Independence In Dementia (r=0.75) and Positive Psychology Outcome Measure (r = 0.73)

Floor/Ceiling Effects

Dementia: (Stoner et al., 2019)

  • Adequate ceiling effect of 0.88% and excellent floor effect

Bibliography

Caliskan, H., Aycicek, G.S., Ozureckci, C., Dogrul, R.T., Baci, C., Sumer, F., Ozcan, M., Karabulut, E., Halil, M., Cankurtaran, M., & Yavuz, B.B. (2019). Turkish validation of a new scale from older people’s perspectives: Older people’s quality of life-brief (OPQOL-brief). Archives of Gerontology and Geriatrics, 83, 91-95. https://doi.org/10.1016/j.archger.2019.04.002

 

Černovas, A., Alekna, V., Tamulaitiene, M., & Stukas, R. (2018). Reliability and validity of the Lithuanian version of CASP-19: A quality of life questionnaire for the elderly. Medicina (Kaunas), 54(6), 103. https://doi.org/10.3390/medicina54060103

 

Howel, D. (2012). Interpreting and evaluating the CASP-19 quality of life measure in older people. Age and Ageing, 41(5), 612–617.

               https://doi.org/10.1093/ageing/afs023

 

Hyde, M., Wiggins, R. D., Higgs, P., & Blane, D. B. (2003). A measure of quality of life in early old age: The theory, development and properties of a needs satisfaction model (CASP-19). Aging & Mental Health, 7(3), 186–194.  https://doi.org/10.1080/136078603100010115

 

Jackson, S. E., Beeken, R. J., & Wardle, J. (2015). Obesity, perceived weight discrimination, and psychological well-being in older adults in England. Obesity, 23(5), 1105-1111. https://doi.org/10.1002/oby.21052

 

Kim, G.R., Netuveli, G., Blane, D., Peasey, A., Malyutina, S., Simonova, G., Kubinova, R., Pajak, A., Croezen, S., Bobak, M., & Pikhart, H. (2015). Psychometric properties and confirmatory factor analysis of the CASP-19, a measure of quality of life in early old age: the HAPIEE study. Aging & Mental Health, 19(7), 595-609. https://doi.org/10.1080/13607863.2014.938605

 

Lima, F.M., Hyde, M., Chungkham, H.S., Correia, C., Siqueira-Campos, A., & Campos, M. (2014). Quality of life amongst older Brazilians: A cross-cultural validation of the CASP-19 into Brazilian-Portuguese. PLOS ONE, 9(4), 94289. https://doi-org/10.1371/journal.pone.0094289

 

Miremadi, M. (2018). Validation of the Persian version of Aging Perceptions Questionnaire (APQ). Pāyish, 17(2), 199-207.  https://payeshjournal.ir/article-1-59-en.html

 

Nalathamby, N., Morgan, K., Mat, S., Tan, P., Kamaruzzaman, S., & Tan, M. (2017). Validation of the CASP-19 quality of life measure in three languages in Malaysia. Journal of Tropical Psychology, 7(1), e4. https://doi.org/10.1017/jtp.2017.4

 

Neri, A. L., Borim, F., Batistoni, S., Cachioni, M., Rabelo, D. F., Fontes, A. P., & Yassuda, M. S. (2018). Nova validação semântico-cultural estudo psicométrico da CASP-19 em adultos idosos brasileiros (New semantic-cultural validation and psychometric study of the CASP-19 scale in adult and elderly Brazilians). Cadernos de Saude Publica, 34(10), e00181417. https://doi.org/10.1590/0102-311X00181417

 

Oluboyede, Y., & Smith, A.B.  (2013). Evidence for a unidimensional 15-item version of the CASP-19 using a Rasch model approach. Quality of Life Research, 22(1), 2429–2433.  https://doi.org/10.1007/s11136-013-0367-z

 

Pereiro, A.X., Ramos-Lema, S., Juncos-Rabadán, O., Facal, D., & Lojo-Seoane, C. (2015). Normative scores of the Cambridge Cognitive Examination-Revised in healthy Spanish population. Psicothema, 27(1), 32-39. https://doi.org/10.7334/psicothema2014.169

 

Sexton, E., King-Kallimanis, B.L., Conroy, R.M., & Hickey, A. (2013). Psychometric evaluation of the CASP-19 quality of life scale in an older Irish cohort. Quality of Life Research, 22, 2549-2559.  https://doi.org/10.1007/s11136-013-0388-7

 

Sim, J., Bartlam, B., & Bernard, M.  (2011). The CASP-19 as a measure of quality of life in old age: Evaluation of its use in a retirement community. Quality of Life Research, 20(1), 997–1004.  https://doi.org/10.1007/s11136-010-9835-x

 

Stoner, C.R., Orrell, M., & Spector, A. (2019) The psychometric properties of the control, autonomy, self-realization and pleasure scale (CASP-19) for older adults with dementia. Aging & Mental Health, 23(5), 643-649. https://doi.org/10.1080/13607863.2018.1428940

 

Wu, T.Y., Chie, W.C., Kuo, K.L., Wong, W.K., Liu, J.P., Chiu, S.T., Cheng, Y.H., Netuveli, G., & Blane, D. (2013). Quality of life (QOL) among community dwelling older people in Taiwan measured by the CASP-19, an index to capture QOL in old age. Archives of Gerontology and Geriatrics, 57(2), 143-150. https://doi.org/10.1016/j.archger.2013.03.010

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