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.
Highlights
Dementia refers to a group of progressive brain disorders that result in multiple cognitive and behavioural impairments (Ballard et al 2011)
In this systematic review and meta-analysis, we examined evidence from quantitative observational studies in order to identify factors associated with quality of life (QoL), well-being and life satisfaction in people with dementia
Data on QoL were reported in 205 studies, well-being in five and life satisfaction in three
Summary
Dementia refers to a group of progressive brain disorders that result in multiple cognitive and behavioural impairments (Ballard et al 2011). It is important to gain a clear understanding of the extensive range of factors that may influence ability to live well with dementia in order to identify potential targets for intervention. In instances where it has been discussed explicitly Small, 2007), the concept of ‘living well’ with dementia has been equated with experiencing a good quality of life (QoL). The constructs of QoL, subjective well-being and life satisfaction are inter-related but encompass distinct elements (Clare et al 2014a)
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