Quality of Life for People With Dementia Living in Residential and Nursing Home Care: The Impact of Performance on Activities of Daily Living, Behavioral and Psychological Symptoms, Language Skills, and Psychotropic Drugs

Ballard, Clive; O’Brien, John; James, Ian A.; Mynt, Pat; Lana, Marisa; Potkins, Dawn; Reichelt, Katharina; Lee, Lesley; Swann, Alan; Fossey, Jane

doi:10.1017/s1041610201007499

Cited by 153 publications

(123 citation statements)

References 20 publications

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“…Gonzalez-Salvador and colleagues 44 found that assisted-living residents with dementia reported consistently better HRQoL than those living in skilled nursing facilities, although the former group also had higher MMSE scores (mean 9.5 compared with 2.6). Ballard and colleagues 45 studied the impact of behaviour, ADL and taking psychotropic drugs on quality of life. The study has methodological problems, but lower performance on ADL and taking psychotropic drugs were both reported to be associated with lower well-being, increased social withdrawal and decreased engagement in activities.…”

Section: Impact Of Dementia On Quality Of Lifementioning

confidence: 99%

Measurement of health-related quality of life for people with dementia: development of a new instrument (DEMQOL) and an evaluation of current methodology

Smith¹,

Lamping²,

Banerjee

et al. 2005

Health Technol Assess

520

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Section: Impact Of Dementia On Quality Of Lifementioning

confidence: 99%

Measurement of health-related quality of life for people with dementia: development of a new instrument (DEMQOL) and an evaluation of current methodology

Smith¹,

Lamping²,

Banerjee

et al. 2005

Health Technol Assess

520

View full text Add to dashboard Cite

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“…The move away from antipsychotic medications, which too often are considered a "quick and easy fix" to manage difficult behavior, especially in acute hospital settings but also in residential care, and to replace them with effective and safe non-pharmacological interventions requires a paradigm shift for everyone involved in dementia care. The paper by Ballard et al (2001) was crucial to get us on the right track.…”

Section: Bpsd and Quality Of Lifementioning

confidence: 99%

TOP CITED PAPERS IN INTERNATIONAL PSYCHOGERIATRICS: 6a. QUALITY OF LIFE FOR PEOPLE WITH DEMENTIA LIVING IN RESIDENTIAL AND NURSING HOME CARE: THE IMPACT OF PERFORMANCE ON ACTIVITIES OF DAILY LIVING, BEHAVIORAL AND PSYCHOLOGICAL SYMPTOMS, LANGUAGE SKILLS, AND PSYCHOTROPIC DRUGS

Ballard

Margallo-Lana

O’Brien

et al. 2009

Int. Psychogeriatr.

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The majority of people with dementia develop behavioral and psychological symptoms of dementia (BPSD) at some point during their illness (Jeste et al., 2008). These symptoms, which are especially common among care home residents, are frequently distressing for the patients who experience them (Gilley et al., 2006; Jeste et al., 2008) and problematic for their professional and/or family caregivers. The starting point for our paper “Quality of life for people with dementia living in residential and nursing home care: the impact of performance on activities of daily living, behavioral and psychological symptoms, language skills, and psychotropic drugs” (Ballard et al., 2001) was to try and understand the impact of BPSD, function and language skills on quality of life in care home residents with dementia. Although there were frequent statements in previous work referring to the capacity of psychiatric and behavioral symptoms to reduce quality of life, we had been unable to identify any empirical evidence to support this clinical impression in a thorough literature review. The parallel validation of Dementia Care Mapping (DCM), predominantly a practice development tool, as an observational measure of well-being/quality of life (Kitwood and Bredin, 1997; Fossey et al., 2002) provided an excellent opportunity to examine this issue in a care home setting. The study focused on 209 people with dementia living in residential and nursing home care in north-east England in the U.K., who received a detailed assessment of BPSD, function and cognition. A DCM evaluation was completed for 112 of these individuals, providing a detailed observational measure of well-being, activities and social withdrawal as indices of quality of life over a six-hour daytime period. To our surprise, there was actually no association between well-being, social withdrawal or activities and BPSD. In contrast, there was a significant association between antipsychotic medication and reduced well-being, social withdrawal and activities respectively, even after controlling for the severity of behavioral disturbance. Using an arbitrary definition of “ill-being”, defined as a well-being score of less than zero, 5% of people not taking antipsychotics, 10% of people taking atypical antipsychotics and 22% of people taking typical antipsychotics were defined as having ill-being. Lower levels of functional ability were also associated with significantly lower well-being, less activities and more social withdrawal. At first this latter finding appears to be contrary to one of the central principles of DCM – namely, that the assessment should be independent of dementia severity. Although high levels of well-being and engagement are possible for people with severe dementia, this probably requires higher staff numbers and a workforce with more specialized skills in order to achieve this.

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“…Dette betyr at pasientens funksjonsevne er en viktig faktor for livskvalitet hos personer med demens. Funnet er i overensstemmelse med tidligere studier (6,11,15,44), og er ikke overraskende. Tap av egenomsorgsevne og autonomi er faktorer som man ut fra «common senses» forstår influerer på en persons livskvalitet.…”

Section: Metodeunclassified

“…Ulike faktorer påvirker livskvalitet hos personer med demens (8)(9)(10)(11)(12), blant annet får de utover i sykdommen problemer med å uttrykke tanker og følelser, og hukommelsen reduseres (13). Dette reduserer personens egen mulighet til selv å beskrive hvordan livet oppleves.…”

Section: Introduksjonunclassified

“…Dette kan blant annet skyldes at pasienter med demens, saerlig av moderat til alvorlig grad, har problemer med abstrakt tenkning, hukommelse og språkforståelse. På grunn av disse problemene er det også vanskelig å vurdere livskvalitet hos denne gruppen (9,26 blant personer med demens (10,16,27), mens andre studier finner at det er en sammenheng (6,11,28). I de ulike studiene ser man en tendens til at det oftere er sammenheng mellom funksjonsnivå og livskvalitet hos personer med demens når en annen enn pasienten gir informasjon.…”

Section: Introduksjonunclassified

See 1 more Smart Citation

Livskvalitet, depressive symptomer og funksjonssvikt hos personer med demens

Mjørud¹,

Engedal²,

Barca³

et al. 2011

Sykepleien

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English summary sammEndrag Quality of life, depressive symptoms and impairment in people with dementiaBackground: It is uncertain whether the association between quality of life, the symptoms of depression and impairment of daily living activities is as strong in people with dementia, as in those without dementia.Objective: To investigate the association between quality of life, the symptoms of depression, impairment of daily living activities and dementia.Methods: Information about 223 nursing home patients with dementia was collected through interviews with the primary caregivers. Quality of life was examined using the Quality of Life in Late Stage Dementia (QUA-LID) scale; symptoms of depression were examined using the Cornell scale; impairment of daily living activities was examined using Lawton's Physical Self-Maintenance Scale (PSMS); and the degree of dementia was examined using the Clinical Dementia Rating scale. Results: Correlation analysisshowed that reduce quality of life was significantly associated with depressive symptoms, functional impairment and dementia. A stepwise linear regression analysis showed that four of Cornell's five sub scales: the mood, behavioural, retardation and cyclic subscales were significantly associated with QUALID. The physical sub scale was not associated with quality of life in the regression analysis because retardation and physical sub scales correlated highly. Impairment of activities of daily living and degree of dementia are significantly associated to reduced quality of life. Conclusion:Quality of life in people with dementia is associated with symptoms of depression, especially the core symptoms of depression and level of impairment of activities of daily living.Key words: quality of life, symptoms of depression, impairment of activities in daily living, dementia.Bakgrunn: Det er usikkert om sammenhengen mellom livskvalitet, depressive symptomer og funksjonssvikt er like sterk hos personer med demens som hos dem uten demens.Hensikt: Å undersøke sammenhengen mellom livskvalitet, depressive symptomer, funksjonssvikt og grad av demens. Metode:Opplysninger om 223 pasienter med demens i sykehjem ble innhentet gjennom intervju av pasientenes primaerpleiere. Livskvalitet ble kartlagt med Quality of life in late stage dementia scale (QUALID), symptomer på depresjon med Cornell skala, funksjonsevne med Lawtons ADL skala og grad av demens med Klinisk demensvurdering.Resultater: Korrelasjonsanalyser viste at livskvalitet var signifikant assosiert til depressive symptomer, grad av demens og tap av funksjonsevne. Spearman's korrelasjon varierte mellom 0,37 og 0,53. En trinnvis lineaer regresjonsanalyse viste at fire av fem subskalaer i Cornell skalaen, affekt-, adferds-, retardasjon -og syklisk subskala var signifikant assosiert med QUALID-skåren. Den fysiske sub skalaen var det ikke fordi sub skalaene retardasjon og fysisk korrelerte sterkt. Tap av funksjonsevne og grad av demens var også signifikant relatert til redusert livskvalitet.Konklusjon: Livskvalitet hos personer med ...

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Quality of Life for People With Dementia Living in Residential and Nursing Home Care: The Impact of Performance on Activities of Daily Living, Behavioral and Psychological Symptoms, Language Skills, and Psychotropic Drugs

Cited by 153 publications

References 20 publications

Measurement of health-related quality of life for people with dementia: development of a new instrument (DEMQOL) and an evaluation of current methodology

Measurement of health-related quality of life for people with dementia: development of a new instrument (DEMQOL) and an evaluation of current methodology

TOP CITED PAPERS IN INTERNATIONAL PSYCHOGERIATRICS: 6a. QUALITY OF LIFE FOR PEOPLE WITH DEMENTIA LIVING IN RESIDENTIAL AND NURSING HOME CARE: THE IMPACT OF PERFORMANCE ON ACTIVITIES OF DAILY LIVING, BEHAVIORAL AND PSYCHOLOGICAL SYMPTOMS, LANGUAGE SKILLS, AND PSYCHOTROPIC DRUGS

Livskvalitet, depressive symptomer og funksjonssvikt hos personer med demens

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