Quality Of Life In Alzheimer's Disease Research Articles

EFFECTS OF REHABILITATION PROGRAM FOCUSED ON IMPROVING REAL-LIFE DAILY ACTIVITIES OF PATIENTS WITH MILD COGNITIVE IMPAIRMENTS OR DEMENTIA AND THEIR CAREGIVERS.

To evaluate the effectiveness of a dyadic outpatient rehabilitation program focused on improving the real-life daily activities of patients with mild cognitive impairments or dementia and their caregivers. Retrospective study. Eight patients with mild cognitive impairments or dementia and their caregivers. The rehabilitation program comprised eight 1-hour sessions by occupational therapists with patients and his/her caregivers. Patients were assessed for motor function, cognitive function, and quality of life, and their caregivers were assessed for depression and caregiver burden. Participants were assessed at pre-program and post-program, and 3-month follow-up. The scores of caregiver-assessed Quality of life in Alzheimer's disease scale in patients significantly improved at post-program (median [interquartile range], 30.0 [7.0]) compared with pre-program (27.0 [2.8], effect size = 0.77, p = 0.029). In caregivers, the Zarit Caregiver Burden Interview scores decreased significantly at post-program (16.5 [13.0]) compared with pre-program (22.0 [17.5], effect size = 0.72, p = 0.042). There were no significant differences in other assessments. The rehabilitation program focused on real daily activities and demonstrated to improve patients' quality of life and caregivers' depression and caring burden through patient-caregiver interaction. Future enhanced follow-up systems are warranted.

A Visual Analog Scale for Self-Reported Quality of Life: A Comparison of VAS and QoL-AD in Older Adults.

People with dementia (PWD) are one of the fastest-growing clinical populations for speech-language pathologists. Self-reported quality of life (QoL) assessments are critical patient-reported outcome measures that align with person-centered care principles. However, proxy-reporting is most often used due to assumptions that PWD cannot provide reliable self-report. Visual analog scales (VASs) have been successfully used with people with expressive and cognitive deficits to measure subjective constructs such as QoL, mood, and pain. The purpose of this project is to evaluate the feasibility and reliability of a VAS QoL assessment tool. Twenty older adults free of cognitive impairment were assessed using the quality of life in Alzheimer's disease (QoL-AD) and the QoL-AD in combination with a VAS (VAS QoL-AD). The construct validity, internal consistency, and test-retest reliability of the VAS QoL-AD were assessed by performing both assessments twice, 4 weeks apart. Significant correlations between the overall VAS QoL-AD and the QoL-AD scale ratings, between most of the QoL-AD and VAS QoL-AD subtests, and between the first and second assessment scores were observed. Results indicated strong construct validity, internal consistency, and test-retest reliability of the VAS QoL-AD in people without dementia. These results warrant further research into the development of a dementia-specific, self-reported VAS QoL scale for PWD.

The quality of life in Alzheimer’s disease is not associated with handgrip strength but with activities of daily living–a composite study from 28 European countries

ObjectivesThe relationship between handgrip strength (HGS) and quality of life is inconsistent. The purpose of this study was to investigate the potential association between HGS and quality of life in the settings of ageing and Alzheimer’s disease (AD).MethodsWe investigated the HGS, CASP-12 (control, autonomy, self-realization, and pleasure) measure of quality of life, and physical capacity in European adults above 50, including controls (n = 38,628) and AD subjects (n = 460) using the survey of health, ageing, and retirement in Europe (SHARE; 2022).ResultsAD subjects exhibited lower HGS and CASP-12 scores than controls (both p < 0.05). Participants with higher CASP-12 quartiles had higher HGS in controls but not in AD subjects. A linear positive relation was found between HGS and CASP-12 in controls (0.0842, p < 0.05) but not in AD subjects (0.0636, p = 0.091). There was no effect of gender on this finding. Lastly, we found significant negative associations of difficulties walking, rising from chair, climbing stairs, and fatigue with CASP-12 scores in controls and AD subjects (all p < 0.05).ConclusionsAltogether, HGS was not associated with quality of life in individuals with AD. Conversely, difficulties in activities of daily living seem to be negatively associated with quality of life; thus, strategies are recommended to improve physical capacity.

Association Between Self- and Proxy-Reported Depression and Quality of Life in Mild-Moderate Alzheimer's Disease

Prior studies have reported an association between depression and quality of life (QOL) in Alzheimer's disease (AD), but the effect of self- versus proxy rating of mood and QOL has not been described. In this secondary analysis of data from a cohort study, the authors used a linear mixed-effects model to determine if the association between depression and QOL is affected by whether both measures are assessed by the same member of the patient-caregiver dyad. Participants and caregiver informants were recruited from 10 California Alzheimer Disease Centers. A total of 137 participants with mild-to-moderate Alzheimer's disease and their caregivers. Self- and proxy-rated scores on both the Geriatric Depression Scale (GDS) and the Quality of Life in Alzheimer's Disease scale (QoL-AD). Multivariable linear mixed-effects models were used to estimate the association between depression and QOL. Results of the multivariable linear mixed-effects models showed a significant association between self-rated QoL-AD and self-rated (B=-0.49, p <0.0001) but not proxy-rated GDS (B=-0.07, p=0.19) after adjusting for confounders. Likewise, there was a significant association between proxy-rated QoL-AD and proxy-rated GDS (B=-0.48, p <0.0001) but not self-rated GDS (B=0.05, p=0.36). Depression was associated with QOL in AD over short-term longitudinal follow-up, but the association was not statistically significant if both instruments are not administered to the same member of the patient-caregiver dyad. The choice of self- versus proxy-reported QOL should be intentionally considered in future studies as it may influence reported outcomes.

Spanish translation, retranslation, and content validation of the Quality of Life in Alzheimer's Disease scale in patients with Alzheimer's dementia.

It is estimated that by the year 2050, persons over 60 will account for 22% of the world population. Consequently, the incidence and prevalence of Alzheimer's disease will increase correspondingly. One of the pillars of the treatment of this condition is to improve the quality of life. In this sense, questionnaires such as the Quality of Life in Alzheimer's Disease allow us to measure the quality of life in patients and caregivers. To translate into Chilean Spanish and carry out the content validation of the Quality of Life in Alzheimer's Disease scale in patients with Alzheimer's dementia at the Guillermo Grant Benavente Hospital in Concepción, Chile. Translation, back-translation and content validity were carried out by expert judgment, using Lawshe analysis, pre-test and semantic validation using the respondent debriefing strategy. The translated and retranslated versions were compared with each other and with the original version. Lawshe indicates that a Content Validity Ratio equal 0.49 is adequate to consider the item valid when 15 experts participated in the content validation process, as in our study. The analysis yielded a content validity ratio greater than 0.49 in 11 of the 13 items on the scale. Of these, 8 obtained a value greater than 0.8 and 3 between 0.49 and 0.79. In semantic validation using the respondent debriefing strategy, the scale was applied to five people with Alzheimer's and their respective caregivers. With the data obtained, modifications were generated in those items that obtained a content validity ratio of less than 0.49. The version obtained in Spanish of the Quality of Life in Alzheimer's Disease scale is valid from the point of view of its content and equivalent to its original version.

Benefit of plasma exchange with albumin replacement on individual items of the quality of life‐Alzheimer’s disease score

AbstractBackgroundAlzheimer Management By Albumin Replacement (AMBAR) is a multicenter, randomized, placebo‐controlled, Phase IIb/III clinical trial that evaluated the efficacy and safety of Plasma Exchange with Albumin replacement (PE‐A) in patients with mild‐to‐moderate Alzheimer’s disease (Boada et al., Alzheimers Dement. 2020). PE‐A has demonstrated an overall benefit in quality of life as measured by the Quality of Life‐Alzheimer’s disease (QoL‐AD) score (Boada et al., Alzheimers Dement. 2021). We evaluated PE‐A treatment benefit for each of 13 individual patient‐rated QoL‐AD items.MethodA cumulative logistic mixed model was applied on the Full Analysis Set (FAS) population. The odds that a patient receiving PE‐A would have a more favorable response (i.e., higher item score) than a similar subject receiving placebo was estimated at final visit for each QoL‐AD item. Age, baseline MMSE score, and baseline individual QoL‐AD item responses were included as covariates.ResultThe FAS included 76 placebo patients and 229 PE‐A‐treated patients. A significant PE‐A treatment effect vs. placebo at final visit was observed for QoL‐AD item 4: Living situation (“How do you feel about the place you live now?“) [Odds Ratio (OR) = 3.92 (95% CI: 1.38‐11.12), p = 0.010] and for QoL‐AD item 13: Life as a whole (“When you think about your life as a whole, everything together, how do you feel about your life?”) [OR = 3.80 (95% CI: 1.32‐10.91), p = 0.013].ConclusionThe analysis demonstrated that when compared to patients on placebo, patients receiving PE‐A were more likely to have a favorable response for the QoL‐AD items “Living situation” and “Life as a whole”, suggesting that the reported benefit of PE‐A vs. placebo on the full QoL‐AD score is also observed in these individual QoL‐AD items.

The relationship of apathy with daily life activities, quality of life and caregiver burden in patients with dementia

AbstractBackgroundApathy is one of the most common neuropsychiatric symptoms in dementia. The aim of this study is to evaluate apathy and its relationships with activities of daily living, quality of life and caregiver burden in patients with dementia.MethodThe research was conducted in a descriptive analytic type. The sample consisted of 88 patients with a definite diagnosis of dementia attending outpatient clinic of a university hospital in Istanbul between October 2019‐March 2020 and their family caregivers. Depressive patients (assessed by Cornell Scale) and paid caregivers were not included. Apathy Evaluation Scale‐Clinician (AES‐C) and Informant (AES‐I) Forms, Neuropsychiatric Inventory (NPI), Mini Mental Test (MMSE), Quality of Life in Alzheimer’s Disease Scale (QoL‐AD), Lawton Instrumental (Lawton IADL) and the Katz Activities of Daily Living Scale (Katz ADL) were used for patients and Caregiver Burden Inventory (CBI) was used for caregivers.ResultsThe mean age of the patients was 73.11±11.68, and diagnosis duration was 3.9±3.1 years, 64.8% had Alzheimer’s type dementia and 53.4% (n = 47) had mild‐1 dementia. The mean MMSE score was 16.4±6.6, NPI‐Symptom score was 16.6±13.7, AES‐C score was 52.9±10.2. The QoL‐AD score was 28.8±6.1 in patient evaluation and 27.6±6.4 in caregiver evaluation. The AES‐C scores were correlated with NPI, MMSE, ADL, Cornell, QoL‐AD, and CBI. Apathy was found to be an important predictor of both the patient’s QoL and CBI.ConclusionIn dementia patients, apathy was found to be associated with patient’s activities of daily living, quality of life, and caregiver burden. It is recommended that patients be evaluated for apathy.

Quality of Life Ratings and Proxy Bias in Primary Progressive Aphasia: Two Sides to the Story?

A valid measure of quality of life is important for clinical goal setting and for evaluating interventions. In the amnestic dementias, proxy-raters (e.g. friends, families, clinicians) typically rate quality of life lower than the self-ratings given by the person with dementia - a proxy bias. This study investigated whether the same proxy bias occurs in Primary Progressive Aphasia (PPA), a language-led dementia.Quality of life was measured in 18 individuals with PPA using self-ratings, and proxy-ratings by their main communication partner, using the Quality of Life in Alzheimer's Disease Scale.There was no strong evidence for proxy bias at a group level, with no consistent pattern across dyads, where proxy- and self-ratings did not show good levels of agreement. We suggest that self-ratings and proxy-ratings of quality of life in PPA are not interchangeable. Higher-powered investigation of the patterns observed here is warranted in future studies.

Evidence for the external validity of the Consumer Choice Index Six Dimension (CCI-6D) for people living in residential aged care with dementia

Abstract The large proportion of people living in residential aged care services with dementia necessitates that any instrument used to measure quality of care is meaningful and practical to be completed by this group. This study assessed the external validity of using the Consumer Choice Index Six Dimension (CCI-6D) instrument to assess quality of care in a large sample of people living in residential aged care, including those with dementia. We applied the CCI-6D with 446 residents along with a range of measures of clinical and functional status and a measure of dementia-specific quality of life, the Quality of Life in Alzheimer's Disease (QOL-AD). Resident's cognitive abilities ranged from no evidence of cognitive impairment through to severe dementia. A high proportion of participants reported they felt very at home in their own room (82%, N = 367), while a lower proportion reported they could undertake meaningful activities that made them feel valued often (37%, N = 163). We identified moderate correlations between quality of care and quality of life, as measured through the QOL-AD utility score. Those with moderate dementia were significantly more likely to report poorer quality of care than those with no or mild dementia. This study provides further evidence for the use of the CCI-6D instrument to assess quality of care from the perspective of the individual receiving care even among those with living with dementia. Residents living with moderate dementia reported lower quality of care than those living with mild or without dementia, indicating the risks of poor care quality among this group.

Impact of Hearing Aids on Progression of Cognitive Decline, Depression, and Quality of Life Among People with Cognitive Impairment and Dementia.

Hearing loss is common in people with dementia (PwD) and a modifiable risk factor for cognitive decline. Recent studies revealed that hearing loss could cause social isolation and depression, which is associated with health-related quality of life (HRQoL). However, there is a lack of knowledge about the impact of the utilization of hearing aids on these outcomes. To assess whether hearing aids use might be positively associated with the progression of cognitive function, depression, and HRQoL among PwD. We analyzed two-year follow-up data from 258 PwD (≥70 years, living at home). Cognitive decline was measured with Mini-Mental Status Examination (MMSE), depression using Geriatric Depression Scale (GDS), and HRQoL with Quality of Life in Alzheimer's Disease Scale (QoL-AD). The impact of hearing aid utilization on the progression of outcomes was assessed using multivariate regression models. 123 patients had hearing loss (47.7%), from which n = 54 (43.9%) used hearing aids. Patients with hearing loss were older and had a lower HRQoL than those without hearing loss. Use of hearing aids in patients with hearing loss was associated with a lower increase in depressive symptoms (b = -0.74, CI95 -1.48 --0.01, p = 0.047) over time as compared to those not using hearing aids. There was no effect on PwD's cognition, and the association with higher HRQoL was significant after one, but not consistently over two years. Early detection and intervention of presbycusis using hearing aids might improve mental health and HRQoL in dementia.

Quality of life in older adults with mild cognitive impairment

Background: Mild cognitive impairment (MCI) is a common phenomenon which is noticeably common among the older individuals population. Progression of this disorder is known to increase risk of Alzheimer's disease and Dementia. Objective: The objective of this study was to determine the association of quality of life and mild cognitive impairment in geriatric population. Methods: The data was collected using Memory Symptom Assessment Scale-Short Form (MSAS-SF) and Quality of life- Alzheimer Disease (QOL-AD) during a time period of six months from 300 individuals aged between 55-85years. The data analysis of this study was done using SPSS 21 version. Spearman test values were calculated to obtain results. Results: MSAD-SF and QOL-AD showed a significant decline of QOL in individuals with mild cognitive impairment. MSAS-SF and QOL-AD had a significant association with pain, lack of energy, difficulty sleeping, problems with urination, lack of appetite, dizziness, feeling sad, worrying, feeling irritable, memory, ability to do chores around the house, physical health, self as a whole and ability to do things for fun (pvalue&lt; 0.05). Domains in both questionnaires indicated a decline in QOL with significant p-values of &lt;0.05. Conclusion: In conclusion, those who had higher impairment level had lower quality of life in multiple domains.

The impact of different researchers to capture quality of life measures in a dementia randomised controlled trial

BackgroundCapturing changes in health and wellbeing within randomised controlled trials (RCTs) can be complex. The precision and accuracy of outcome scales to measure change is crucial, and therefore, consideration needs to be given to potential measurement errors when collecting these outcomes.Many RCTs use multiple researchers to collect data, which has the potential to introduce variation in measurements. This study aimed to identify if there was a measurable effect of using different researchers to collect repeated assessments of quality of life (QoL) at different time points.MethodsA previously conducted study assessing the impact of reminiscence therapy on participants with dementia and carer (PwD-carer) dyads, ‘REMCARE’ (Reminiscence groups for people with dementia and their family caregivers), provided the platform for this exploratory secondary analysis. Data was categorised into two broad groups: those where the same researcher attended all assessments and those where different researchers undertook the assessments. ANCOVA (analysis of covariance) models used in the original REMCARE analysis with the addition of the ‘researcher-continuity’ variable were run on two QoL measures, the QoL-AD (Quality of Life in Alzheimer’s Disease) and QCPR (Quality of the Caregiving Relationship).ResultsThree hundred thirty PwD-carer dyads were included in the analysis. For the PwD, a statistically significant effect was found on the researcher continuity variable for the QoL-AD and QCPR outcome measures at follow-up 1 but not at follow-up 2 signifying an impact of researcher attendance at the first follow-up but not follow-up 2. For the carer data, analyses revealed no statistically significant effects at follow-up 1; however, the QoL-AD measure at follow-up 2 was found to be statistically significant.ConclusionsThese exploratory results indicate the possible impact of researcher continuity on QoL outcomes in dementia studies. Further research is required to explore this further and establish causality. If demonstrated, this would have implications for the planning of future empirical studies in dementia, in order to reduce this potential source of bias.

The Effects of Essential Oil and Massage on Patients’ Affected by Alzheimer’s Disease. An Observational Study

Background: Alzheimer's Disease (AD) is the most widespread form of dementia. The present study analyses the effects of aromatherapy using Melissa Officinalis essential oil, applied by massage to the hands and forearms of patients suffering from Alzheimer's disease. and to evaluate the effect on their perceived overall quality of life. Methods: A prospective observational study was conducted in two nursing homes in Italy in 2018. Data were collected through individual qualitative structured interviews based on the Quality of Life in Alzheimer’s Disease (QoL-AD) questionnaire and the Mini Mental State Examination (MMSE). The authors referred to STROBE guidelines for quality reporting of observational studies. Results: Treatment with Melissa Officinalis showed positive effects on all patients after the 12th week of treatment. The results were most evident in patients in class 3 MMSE. However, class 4 MMSE patients also benefited from the treatment. Conclusions: The aromatherapy treatment delivered in this observational study, using Melissa Officinalis essential oil applied to hands and forearms, showed an improvement in the quality of life of the patients living in two different nursing homes. Due to the small sample size in this study, it is suggested that more research be done on the effects and effectiveness of aromatherapy with Melissa Officinalis essential oil for Alzheimer's disease patients.

Evaluation of Psychiatric Status and Quality of Life in Alzheimer's Patients and Carers

Evaluation of Psychiatric Status and Quality of Life in Alzheimer's Patients and Carers

QUALITY OF LIFE IN ADULTS LIVING WITH COGNITIVE IMPAIRMENT: DEVELOPMENT OF A UNIVERSAL MEASURE

Abstract Quality of life is one of the most important and holistic measures of perceived overall well-being across the lifespan. For older adults living with cognitive impairment, quality of life has been conceptualized as consisting of an array of intertwined domains, such as relationship quality, physical health and ability, and opportunities for roles and activities. A subset of measures have been developed to gauge quality of life in older adults living with cognitive impairment, yet no “gold standard” in measurement has emerged. Quality of Life – Alzheimer’s Disease (QOL-AD) is one of the most commonly used and long-standing measures, yet it was developed in 2002 and has yet to be updated to reflect the evolution of our understanding of quality of life in adults living with cognitive impairment. Drawing from the literature on adults living with intellectual and developmental disabilities (IDD), the researchers identified several domains and items to update and expand the applicability of the QOL-AD measure. The proposed revised measure, Quality of Life – Alzheimer’s Disease/Intellectual and Developmental Disabilities (QOL-AD/IDD), is intended for adults living with cognitive impairment regardless of age or cause of impairment (e.g., dementia, IDD). The QOL-AD/IDD retains the format of the original measure, most notably the useful prompts that accompany each item and the supplemental proxy measure for caregivers. In this presentation, the researchers will discuss the development of the QOL-AD/IDD and ongoing (e.g., Delphi review) and planned steps to evaluate the reliability and validity of this promising measure.

DIURNAL CORTISOL SECRETION AND SELF-REPORTED AND CAREGIVER-REPORTED QUALITY OF LIFE IN PEOPLE LIVING WITH DEMENTIA

Abstract Introduction People living with dementia (PLwD) report lower quality of life (QoL), compared to healthy older adults. The poorer QoL is not fully accounted for by the severity of dementia. Dementia is associated with prominent neuroendocrine changes, however, there is a lack of research examining whether biological factors are related to QoL in PLwD. This study examined relationships between cortisol, symptom severity, and QoL in PLwD. Methods A total of 143 participants aged 55-94 years (65.7% women) in the Healthy Patterns Study (NCT03682185) provided three saliva samples at wake-up (AM1), 30 minutes (AM2) after waking, and bedtime (PM) on two consecutive days. We derived cortisol awakening response (CAR), wake to bedtime cortisol slope, and diurnal mean cortisol secretion. Sociodemographic and severity of dementia were assessed by interviews and questionnaires. Self-reported and caregiver-reported QoL was measured using the Quality of Life in Alzheimer’s Disease (QoL-AD). Results Poorer QoL was associated with more severe dementia rating. Flattened cortisol slope was significantly correlated with overall poorer self-reported QoL (β=0.43, p=0.017), but not caregiver-reported QoL (p=0.12), after controlling for severity of dementia and demographic variables. We did not find a significant relationship between CAR and diurnal mean cortisol with QoL. Conclusions This study provides novel evidence linking neuroendocrine mechanisms to QoL in PLwD. The findings indicate that dysregulation of the hypothalamic-pituitary-adrenal axis is linked to poorer QoL, independently of the severity of dementia. Biopsychosocial approaches to QoL for PLwD may lead to a greater understanding of the underlying mechanisms.

Cultural adaptation and validation of the social functioning in dementia scale (SF‐DEM) in Taiwanese patients with dementia

AbstractBackgroundThe social functioning in dementia scale (SF‐DEM) is a 20‐item interviewer‐administered questionnaire, with patient‐ and carer‐rated versions. It was the first test designed to measure social function in people with dementia. It has not been validated in people with dementia in a Taiwanese population. We aimed to culturally adapt then validate the SF‐DEM in Taiwan and explore correlates of social functioning.MethodWe culturally adapted the SF‐DEM for Taiwan (T‐SF‐DEM) according to guidelines and tested it with people with clinically diagnosed dementia and their caregivers in Northern Taiwan We used descriptive and correlation analysis to explore how scores relate to the Clinical Dementia Rating (CDR), Addenbrooke’s cognitive examination III (ACE‐III) and Quality of Life in Alzheimer’s Disease (QoL‐AD).ResultWe recruited 12 people aged 45 to 100 with dementia (5 Alzheimer’s disease, 4 Vascular dementia, 1 Parkinson’s disease dementia, and 2 mixed. All patients and 11/12 (92%) of carers completed the SF‐Dem. Nine participants (75%) scored 0.5 on CDR and three (25%) scored 1. The mean ACE‐III score was 64.4 (standard deviation (SD) 11.9). The mean scores of patients and their carers for the sub‐domains of “spending time with other people (max 21 points)” were 3.3 (3.1) and 4.9 (3.4), for “communicating with other people (max 18)” were 5.7 (4.0) and 5.4 (3.8), for “sensitivity to other people (max 12)” were 10.9 (1.8) and 8.7 (2.6). The correlation between carer‐ and patient‐ratings was low (r = 0.33). There was a moderate correlation of the carer‐rated SF‐DEM with ACE (r = 0.66) and carer‐rated quality of life (r = 0.44). Seventy‐five percent of patients stated that they did not want to change their social life, while 100% of the carers stated they would like the patients’ social life to change.ConclusionThe T‐SF‐DEM is an acceptable test for measuring social function in Taiwanese populations in memory clinic settings. Patients scored low on social contact as they were isolated due to the pandemic. We will test SF‐DEM in more patients and report the results.

Groepstherapie met assistentie van een pony. Het effect op de kwaliteit van leven van ouderen met dementie

As people worldwide generally live longer, the number of people with dementia is also increasing, a condition for which there is no cure yet. Therefore, there is a growing focus on enhancing the quality of life of people with dementia, as well as a growing need for (new) psychosocial interventions that enhance quality of life. An example of this is Animal assisted therapy (AAT), a goal oriented, planned and structured therapeutic intervention directed and/or delivered by professionals. Equine assisted therapy (EAT) is a specific form of AAT which uses horses or other equines. In our research, the effect of EAT as group therapy was compared to the effect of group therapy without the assistance of animals. Over a period of six weeks, weekly group therapy sessions were conducted by a professional, who is psychologist and equine assisted therapist. In both groups, quality of life was measured before and after the therapy program with the Qualidem and the Quality of Life in Alzheimer's Disease questionnaires. Compared to the group that only participated in group therapy sessions, participation in the EAT program with assistance of a pony led to better results.

Association of Psychotropic Education with Quality of Life: A Before-After Study in Residential Aged Care Facilities.

Improving or maintaining quality of life (QoL) is an important aim for caring for people with dementia living in residential aged care facilities (RACFs). This study aimed to investigate the effect of a specific intervention, the Medication Management Consultancy (MMC), on the QoL of residents of RACFs in Western Australia, and to examine the association between psychotropic medications and QoL. A before-after study was conducted. Staff from four RACFs participated in the MMC, and 56 residents with dementia from these RACFs were included. The MMC consisted of an online interactive staff education training course comprising educational videos, and a case study encompassing non-pharmacological strategies, person-centred care for behavioural and psychological symptoms of dementia (BPSD), and strategies to reduce the use of antipsychotics. Following the training, posters, reference cards, reminder stickers, administration of the Older Age Psychotropic Quiz (OAPQ), and 30-min video conferences with action groups in RACFs were utilised. At baseline (T0), QoL, neuropsychiatric symptoms (NPS) and staff distress, cognition, and activities of daily living were assessed by QoL in Alzheimer's Disease (QoL-AD), Neuropsychiatric Inventory-Questionnaire (NPI-Q), Standardised Mini-Mental State Examination (SMMSE) and Bristol Activity of Daily Living Scale (BADLS), respectively, and repeated at 6 (T1) and 12 months (T2). Medication data were obtained from residents' medication charts. At baseline, of the 56 participants, 33 completed the study. Compared with baseline (31.2, 95% confidence interval [CI] 28.9-33.6), QoL significantly improved at 6 months (33.5, 95% CI 30.9-36.0; p<0.001) but not from baseline to 12 months (31.09, 95% CI 28.5-33.7; p=0.58). The NPI-Q severity (residents) significantly improved from 9 (interquartile range [IQR] 11) at T0 to 6 (IQR 9.5) at T1 (p=0.014) and to 7 (IQR 11) at T2 (p=0.026). The medians of NPI-Q distress (staff) significantly improved from 12 (IQR 13.5) at T0 to 8 (IQR 9) at T1 (p=0.013) and to 6 (IQR 11.5) at T2 (p=0.018). Monthly doses of antipsychotics declined significantly by 51.8% at 6 months (p=0.003) and by 43.5% at 12 months (p=0.003); antidepressant doses declined significantly by 25.4% at 6 months (p=0.013) and by 39.4% at 12 months (p=0.016); benzodiazepines doses remained stable. QoL and use of psychotropics, age, sex, NPI-severity, and BADLS were not correlated. The MMC was associated with improvement in QoL, NPS, staff distress, and reduction in monthly use of antipsychotics and antidepressants among RACF residents. There was no correlation between improved QoL and reduction in use of psychotropic medications, but due to the limitations of our study, this should be confirmed in additional studies.

Life-Space Mobility in Aged Care Residents: Frailty In Residential Sector over Time (FIRST) Study Findings.

Life-space mobility is a measure of the extent and frequency of mobility in older adults reflecting not only physical function, but also cognitive, psychosocial, and environmental factors. This study aimed to (1) develop life-space mobility profiles for nursing home residents; (2) examine independent factors associated with these profiles; and (3) identify health outcomes [ie, mortality, quality of life (QoL) and falls] associated with the life-space mobility profiles at 1year. Prospective cohort study. Twelve nursing homes including 556 residents, mean age 87.73 ± 7.25years, 73.0% female. Life-space mobility was measured using the Nursing Home Life-Space Diameter (NHLSD). Mortality and falls were extracted from residents' records. QoL was measured using the QoL in Alzheimer Disease (QoL-AD) scale. NHLSD scores ranged from 0 to 50 with a mean score of 27.86 ± 10.12. Resident life-space mobility was mainly centered around their room (94.8%, n= 527) and wing (86.4%, n= 485). One-half of the residents left their wing daily (51.0%, n= 284), and over one-quarter (26.4%, n= 147) ventured outside their nursing home at least weekly. Significant associations (P &lt; .05) with high life-space mobility, identified through multivariable analyses, included lower age [odds ratio (OR) 0.70, 95% confidence interval (CI) 0.51, 0.96]; lower frailty levels (OR 0.67, 95% CI 0.50, 0.86); lower sarcopenia risk (OR 0.72, 95% CI 0.65, 0.79); and a better nutritional status (OR 1.16, 95% CI 1.05, 1.29). High life-space mobility was a predictor (P &lt; .05) of lower mortality, lower falls rate, and higher QoL at 1year when compared with moderate or low mobility. Given the independent association between high life-space mobility and lower frailty status, lower sarcopenia risk, and a better nutritional status, physical activity and nutritional interventions may be beneficial in leading to improved life-space use. This requires further investigation. Improved life-space mobility can lead to improved health outcomes, such as lower mortality, lower falls rate, and improved QoL.