Various sources of data provided different perspectives on resident's QoL. Each perspective is relatively independent and somewhat unique. In those patients with mild to moderate cognitive impairment, direct measures of QoL should be considered.
The QoL perception by persons with dementia living in a nursing home is mainly affected by their emotional state (depression level), while proxies' perceptions (both family and staff) are mainly associated with patients' functional autonomy in daily living. Therefore, perspectives of persons with dementia and their informants are not congruent. Moreover, facility features and family and staff members' personal features do not affect QoL ratings.
Support groups (SG) for family caregivers are an intervention frequently used by associations and institutions. But their extensive use does not correspond to the current scientific interest in them. The aim of this paper is to make a historical review of the use and study of SGs for family caregivers of Alzheimer patients, describing their main features and variations, with special emphasis on data about their efficacy. In this analysis, three stages were differentiated: an initial stage (late 1970s -1985) with studies based on subjective impressions and questionnaires showing high satisfaction among caregivers; a second stage (1985)(1986)(1987)(1988)(1989)(1990)(1991)(1992)(1993)(1994)(1995) with more rigorous methodology, which led to doubts about SGs' efficacy; and a third stage (1995 -present) in which qualitative methodology focused on group process has led to renewed interest. At the end some proposals regarding the future of research on caregiver SGs are discussed.
QoL self-rating should be the first-line option when assessing residents with severe cognitive impairment. For those that are not able to complete self-report measures, proxies' report could be an alternative, although the development of other assessment procedures (e.g. observational) should be considered.
Although residents in SCUs present higher levels of impairment, there are no real differences in the care provided besides a higher probability of having individual rooms. Regulations on required features for SCUs in Spain are necessary to guarantee that care provided to residents is truly special.
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