Abstract
AimTo investigate variables associated with change in quality of life (QOL), measured by QUALID scale and three subscales; tension, sadness and wellbeing, among dementia patients in nursing homes.MethodA 10 months follow-up study including 198 (female 156, 79%) nursing home patients, mean age 87 (s.d 7.7) years. Scales applied; quality of life in late stage dementia (QUALID) scale and three subscales (wellbeing, sadness and tension), neuropsychiatric inventory questionnaire 10 items (NPI-10-Q), clinical dementia rating (CDR) scale, physical self-maintenance (PSMS) scale and a scale of general medical health. Use of psychotropic medication, gender and age was collected from the patient's records.ResultsMean baseline QUALID score: 20.6 (s.d.7.0), follow-up score: 22.9 (s.d.7.4), mean change 2.8 (s.d.7.4). QOL improved in 30.8%, were unchanged in 14.7%, deteriorated in 54.6% of patients. A regression analysis revealed that change in QUALID score was significantly associated with: QUALID baseline score (beta -.381, p-value.000), change in NPI score (beta.421, p-value.000), explained variance 38.1%. Change in score on wellbeing subscale associated with: change in PSMS score (beta.185, p-value.019), wellbeing baseline score (beta -.370, p-value.000), change in NPI score (beta.186, p-value.017), explained variance 25.3%. Change in score on tension subscale associated with: change in CDR sum-of-boxes (beta.214, p-value.003), change in NPI score (beta.270, p-value.000), tension baseline score (beta -.423, p-value.000), explained variance 34.6%. Change in score on sadness subscale associated with: change in NPI score (beta.404, p-value.000), sadness baseline score (beta -.438, p-value.000), explained variance 38.8%.ConclusionThe results imply that a lower baseline score (better QOL) results in a larger change in QOL (towards worse QOL). Change in QOL is mostly associated with change in neuropsychiatric symptoms. In almost 50% of patients QOL did not deteriorate.
Highlights
Nursing home residents‘ quality of life (QOL) is an important outcome measure in the planning of service provision and as a quality indicator of care in nursing homes (NH) [1, 2]
Aim: To investigate variables associated with change in quality of life (QOL), measured by quality of life in late stage dementia (QUALID) scale and three subscales; tension, sadness and wellbeing, among dementia patients in nursing homes
The 46 patients who died before follow-up, differed from the baseline patient group as they were older (p-value 0.036), had more severe dementia (p-value 0.002), worse general medical health (p-value 0.001), being of male gender (p-value 0.002) and more impaired in activity of daily living (ADL) (p-value 0.010)
Summary
Nursing home residents‘ quality of life (QOL) is an important outcome measure in the planning of service provision and as a quality indicator of care in nursing homes (NH) [1, 2]. As persons with dementia (PWD) often reside for several years in nursing homes, it is of importance to know which variables affect changes in quality of life over time [3, 4] in order to effectively maintain or improve these patients’ QOL. Several cross-sectional NH studies using proxy reported QOL have examined the relationship between QOL and neuropsychiatric symptoms (NPS). These studies have shown that NPS, especially depression and anxiety, are associated with reduced QOL [4, 5]. We cannot draw conclusions whether the variables associated with a QOL measure in cross-sectional studies can predict the QOL for PWD in the future to come
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