Characteristics Associated with Quality of Life in Long-Term Care Residents with Dementia: A Cross-Sectional Study

Abstract

Background: To determine which characteristics are associated with quality of life (QOL) in residents with moderate to very severe dementia in long-term care facilities (LTCFs). Material and Methods: This was a cross-sectional analysis of a cluster randomized controlled study in 12 Dutch LTCFs that enrolled 288 residents, with moderate to severe dementia assessed with the Reisberg Global Deterioration Scale (Reisberg GDS) and QOL with the QUALIDEM. Characteristics that were hypothesized to be associated with the six domains of QOL (applicable to very severe dementia) included demographic variables, activities of daily living (Katz ADL), cognitive performance (Cognitive Performance Scale; CPS), pain (Pain Assessment Checklist for Seniors with Limited Ability to Communicate; PACSLAC-D), neuropsychiatric symptoms (Neuropsychiatric Inventory-Nursing Home Version; NPI-NH) and comorbidities. Results: Multivariate logistic regression modelling showed associations with age in the domain Social isolation [odds ratio, OR, 0.95 (95% confidence interval, CI, 0.91-0.99)], ADL level in the domain Positive affect [OR 0.89 (95% CI 0.83-0.95)] and the domain Social relations [OR 0.87 (95% CI 0.81-0.93)], severity of dementia in the domain Social relations [OR 0.28 (95% CI 0.12-0.62)] and in the domain Social isolation [OR 2.10 (95% CI 1.17-3.78)], psychiatric disorders in the domain Positive affect [OR 0.39 (95% CI 0.17-0.87)] and pulmonary diseases in the domain Negative affect [OR 0.14 (95% CI 0.03-0.61)] of the QUALIDEM. Neuropsychiatric symptoms were independently associated with all six domains of the QUALIDEM [OR 0.93 (95% CI 0.90-0.96) to OR 0.97 (95% CI 0.95-0.99)]. Pain was associated with the domains Care relationship [OR 0.92 (95% CI 0.84-1.00)] and Negative affect [OR 0.92 (95% CI 0.85-1.00)]. Conclusion: QOL in dementia is independently associated with age, ADL, dementia severity, pain, psychiatric disorders, pulmonary diseases and neuropsychiatric symptoms. It is possible to detect persons with dementia at risk for a lower QOL. This information is important for developing personalized interventions to improve QOL in persons with dementia in LTCFs.

Associations between Pain and Quality of Life in Severe Dementia: A Norwegian Cross-Sectional Study

“…However, our data do not support this hypothesis. An association between ADL and QoL has been reported in previous studies [10, 11, 12]. Thus, we hypothesised that previous studies found a significant association whereas we did not because ADL is more important for certain domains of QoL rather than for overall QoL, such as the “well-being” subscale of the QUALID scale, as considered previously [10], or the QUALID “comfort” subscale [11].…”

Psychometric Validation of the Czech Version of the Quality of Life – Alzheimer’s Disease Scale in Patients with Early-Stage Dementia

“…The internal consistency between the caregiver’s and the patient’s responses have been reported to be excellent [9]. Concurrent validity is indicated by strong correlations with other scales associated with the activities of daily living level and the degree of depression [9, 11-13]. The QoL-AD appears to be the most researched among all the instruments [10].…”

Psychometric Evaluation of the Electronic Pain Assessment Tool: An Innovative Instrument for Individuals with Moderate-to-Severe Dementia

“…Failure to do so may result in a denial of appropriate medication or therapeutic intervention, prescription of analgesics at inadequate dosages, or use of inappropriate medication (e.g., antipsychotics) [15-20]. These may lead to poor quality of life and premature death in these individuals [21-25]. Assessing pain requires a tool with sound psychometric properties and innovative characteristics so that timely access to appropriate pain management is assured.…”