Living well with dementia: a systematic review and correlational meta-analysis of factors associated with quality of life, well-being and life satisfaction in people with dementia

Abstract

Current policy emphasises the importance of 'living well' with dementia, but there has been no comprehensive synthesis of the factors related to quality of life (QoL), subjective well-being or life satisfaction in people with dementia. We examined the available evidence in a systematic review and meta-analysis. We searched electronic databases until 7 January 2016 for observational studies investigating factors associated with QoL, well-being and life satisfaction in people with dementia. Articles had to provide quantitative data and include ⩾75% people with dementia of any type or severity. We included 198 QoL studies taken from 272 articles in the meta-analysis. The analysis focused on 43 factors with sufficient data, relating to 37639 people with dementia. Generally, these factors were significantly associated with QoL, but effect sizes were often small (0.1-0.29) or negligible (<0.09). Factors reflecting relationships, social engagement and functional ability were associated with better QoL. Factors indicative of poorer physical and mental health (including depression and other neuropsychiatric symptoms) and poorer carer well-being were associated with poorer QoL. Longitudinal evidence about predictors of QoL was limited. There was a considerable between-study heterogeneity. The pattern of numerous predominantly small associations with QoL suggests a need to reconsider approaches to understanding and assessing living well with dementia.

The relationship between perceived functional difficulties and the ability to live well with mild‐to‐moderate dementia: Findings from the IDEAL programme

“…This study extends previous research, which has primarily focussed only on the association between functional ability and QoL 25,40. This study extends previous research, which has primarily focussed only on the association between functional ability and QoL 25,40.…”

“…Despite functional difficulties being required for a diagnosis of dementia, ratings by 136 people with dementia and 31 informants reported no functional impairment. This measure was designed for people with Alzheimer's disease and may not be sensitive to measure QoL in other dementias, though our meta-analysis found it is used extensively across all dementias 40. The FAQ has been described as one of the more sensitive functional questionnaires for people with early-stage dementia44,70 with studies recommending its use to distinguish mild cognitive decline from dementia 71,72.…”

People with dementia attending farm‐based day care in Norway – Individual and farm characteristics associated with participants’ quality of life

“…The relationship between quality of life and having social support is in line with earlier research (Wolverson et al, ). Also, the association between depressive symptoms and a reduction in quality of life among people with dementia are consistent with a large body of literature (Barca et al, ; Conde‐Sala et al, ; Martyr et al, ). This underscore the need for surroundings and care environments that promotes social support and prevent depression.…”

“…To prevent isolation and to maintain a meaningful life in the stages of mild and moderate dementia, many people with dementia emphasise the importance of having social relations with others in the same situation as achieved at day care (Eriksen et al, ). Furthermore, the quality of life of people with dementia is negatively associated with neuropsychiatric symptoms as depression and reduced functions in daily living (Martyr et al, ; Mjørud, Engedal, Røsvik, & Kirkevold, ; Rokstad et al, ). People with dementia have more neuropsychiatric symptoms than the population in general (Bergh & Selbæk, ; Borsje, Lucassena, Wetzelsa, Potd, & Koopmans, ) and their use of psychotropic drugs is reported to be high (Bergh & Selbæk, ; Borsje et al, ; Wergeland, Selbæk, Høgset, Kirkevold, & Söderhamn, ).…”

Inequalities in living well with dementia—The impact of deprivation on well‐being, quality of life and life satisfaction: Results from the improving the experience of dementia and enhancing active life study

“…There is a substantial body of research focusing on quality of life and positive health outcomes in relation to living with dementia . A large number of observational studies have used different types of quality of life measures and investigated their associations with a wide range of social, psychological, and physical health factors . However, existing studies have predominantly focused on individual level factors.…”