Abstract
BackgroundDementia often eventually leads to dependency on others and finally to residential care. However, in Norway about half of the dementia population lives at home, due to individual and political wishes. There is scarce and inconclusive knowledge of how living in a nursing home differs from living at home for persons with dementia (PWDs) with regard to their quality of life (QoL). The first aim of the study was therefore to compare QoL, cognitive and physical functions, social contacts, sleep patterns, physical activity levels, exposure to light, and medication of PWDs in nursing homes and home-dwelling PWDs, and whether living in nursing homes was associated with a lower QoL than living at home for PWDs. A second aim was to examine if possible differences between residencies in QoL were consistent over time.MethodsThe cross-sectional study was based on baseline data from two RCT studies of PWDs. A total of 15 nursing homes with adapted units for PWDs and 23 adapted day care centres for home-dwelling PWDs recruited 78 and 115 participants respectively. Trained nurses scored sociodemographic data, level of dementia (on the Clinical Dementia Rating scale), amount of medication, and QoL (QUALID). Sleep patterns, physical activity levels, and light exposure were measured by actigraphy. A multiple regression analysis was used to test the association between residency and QoL. The association between residency and change in QoL over time was investigated by linear regression analysis of a subsample with follow-up data.ResultsHome-dwelling PWDs showed significantly higher QoL than PWDs in nursing homes. This difference was maintained even after stratifying on the severity of dementia. Home-dwelling PWDs with moderate dementia showed significantly less use of walking aids, more social contact, higher levels of activity and exposure to daylight, and less use of psychotropic medications. The regression model explained 28 % of the variance in QoL in persons with moderate dementia. However, only residency contributed significantly in the model. Residency also significantly predicted negative change over time in QoL.ConclusionThe study indicated that living at home as long as possible is not only desirable for economic or health political reasons but also is associated with higher QoL for persons with moderate dementia. More studies are needed to investigate how QoL could be increased for PWDs in nursing homes.
Highlights
Dementia often eventually leads to dependency on others and to residential care
Significant differences were observed in the severity of dementia: 9 % persons with dementia (PWDs) living in nursing homes had mild dementia, 43.6 % had moderate dementia, and 47.4 % had severe dementia
quality of life (QoL), sleep patterns, physical activity, light exposure, and medication In the whole sample, PWDs living in nursing homes showed a significantly lower QoL than home-dwelling PWDs (Table 1)
Summary
Dementia often eventually leads to dependency on others and to residential care. There is no cure for dementia [4], and development of dementia eventually leads to a loss of cognitive and physical functions [5, 6]. This in turn will often lead to total dependency on others and to residential care [7]. Several studies have evaluated risk factors for the institutionalization of the elderly and persons with dementia (PWDs), and older age, cognitive impairment, poor social support, loss of physical function, and use of medication are all factors associated with increased risks of long-term admission to care facilities [9, 12,13,14]
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