1 Divisions of Clinical Epidemiology, Geriatrics, Experimental Medicine, Department of Medicine School of Physical and Occupational Therapy, Center for Outcomes Research and Evaluation (CORE), McGill University Health Center (MUHC), MUHC-Research Institute, McGill University, 5252 de Maisonneuve, Montreal, QC, H4A 3S5, Canada. nancy.mayo@mcgill.ca.
2 The Rehabilitation and Health Leadership Program, School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada.
3 Department of Physical Therapy, College of Rehabilitation Sciences, Rady Faculty of Health Sciences, University of Manitoba, R106-771 McDermot Ave, Winnipeg, MB, R3E 0T6, Canada.
4 RR323A, Rehabilitation Hospital, 800 Sherbrook St, Winnipeg, Canada.
5 Center for Health and Aging, Pasadena, CA, 91106, USA.
6 Department of Public Health & Sports Sciences, Faculty of Health and Life Sciences, College of Medicine and Health, University of Exeter, University of Exeter Medical School, Medical School Building, St Lukes Campus, Heavitree Road, Exeter, EX12LU, England.
7 Department of Public Health, Erasmus MC University Medical Center Rotterdam, 3000 CA, PO Box 2040, Rotterdam, The Netherlands.
8 Communication Studies, Concordia University, Montreal, QC, Canada.
9 Department of Philosophy, McGill University, Leacock Building, Room 933, Montreal, Canada.
10 School of Nursing, UT Health San Antonio, San Antonio, USA.
11 Center for Outcomes Research and Evaluation (CORE), Research Institute of McGill University Health Center, Montreal, Canada.
12 School of Rehabilitation Science, McMaster University, Hamilton, Canada.
13 Occupational Science & Occupational Therapy, T325 - 2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada.
14 Digital Health Innovation and Public Health, Co-Module Lead Rehabilitation Science CSC3021, Medical School, University of Exeter, Exeter, UK.
15 Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada.
16 School of Rehabilitation Science, McMaster University, 1400 Main Street West, Hamilton, ON, L8S 1C7, Canada.

Aims: Many older persons do not think of themselves as "patients" but as persons wishing to live as actively as possible for as long as possible. However, most health-related quality of life (HRQL) measures were developed for use with clinical populations. The aim of this project was to fill that gap and to develop, for international use, a measure of what matters to older persons as they age and seek to remain as active as possible, Older Persons for Active Living (OPAL).

Methods: For content development, interviews about active living were conducted with older persons from Canada, USA, UK, and the Netherlands in English, French, Spanish and Dutch, respectively with subsequent thematic analysis and harmonization.

Results: Analyses of transcripts from 148 older persons revealed that active living was a "way of being" and not merely doing activities. Saturation was reached and a total of 59 content areas were identified. After grouping similar "ways" together and after conducting a consensus rating of importance, 19 unique and important "ways" remained. In some languages, formulating was challenging for three of the 19, resulting in changes to two English words and dropping two other words, yielding a final list of 17 "ways of being" with harmonized wording in 4 languages.

Conclusion: This study underscores the significance of listening to older adults and highlights the importance of considering linguistic and cultural nuances in measure development.