Validation of the Tolerance of Surroundings Scale and Autonomy Scale among People with Long-Term Care Needs

Social relationships with surrounding people and an individual's autonomy are fundamental components of age-friendly community and long-term care (LTC). The objective of the present study was to evaluate the psychometric properties of the Tolerance of Surroundings Scale (TSS) and Autonomy Scales (AS) among people with LTC needs. We distributed a self-administered questionnaire to four daycare/day-services facilities and three home-visit nurse stations in Japan. The TSS consists of 20 items under 4 factors and the AS includes 20 items based on 3 factors. These scales were previously validated in the Japanese general population. 259 people participated in the survey. Confirmatory factor analysis demonstrated model fit for the TSS was good, whereas that for the AS was acceptable. In addition, explanatory factor analysis demonstrated that the AS had 2-factor structure specified for people with LTC. The regression coefficients for subjective well-being were 0.43 (95%CI 0.23, 0.62) and 0.73 (95%CI 0.50, 0.96), respectively. The alphas in the TSS and the AS ranged from 0.75 to 0.88, from 0.53 to 0.91, respectively. The alphas of the AS in first and second factors specified for people with LTC needs were 0.91 and 0.70, respectively. In conclusion, the TSS and the AS were valid and reliable in people with LTC needs. However, regarding the AS, different factor structures should be used (the structure in general population and that specified in people with LTC needs) depending on the purpose of the assessment. In addition, further studies to assess test-retest reliability and measurement error are needed.