Quality of Life in Nursing Home Residents with Advanced Dementia

Abstract

OBJECTIVES To examine quality of life (QOL) in nursing home (NH) residents with advanced dementia and identify correlates of QOL near the end of life. DESIGN Cross-sectional data derived from NH records, interviews with residents’ surrogate decision-makers, QOL ratings by NH caregivers, and assessment of residents’ cognitive function. SETTING Three NHs in Maryland. PARTICIPANTS A cohort of NH residents with dementia (n=119), who were either receiving hospice or palliative care or met hospice criteria for dementia, and their surrogates. MEASUREMENTS QOL based on the proxy-rated Alzheimer Disease Related Quality of Life (ADRQL) scale administered to NH staff and validated against a single-item surrogate-rated measure of QOL, the Severe Impairment Rating Scale to measure cognitive function, and dichotomous indicators of neuropsychiatric symptoms (i.e., behavior problems, mood disorders, psychosis/delusions). RESULTS Total ADRQL scores, ranging from 12.4 to 95.1 out of 100, were normally distributed and positively correlated (p<.001) with surrogate-rated QOL. Multiple regression analysis of ADRQL scores showed that residents with higher cognitive function (p<.001, CI = .966 – 1.650) and those receiving pain medication (p=.006, CI = 3.303 – 19.588) had higher QOL, while residents with behavior problems (p=.014, CI = −11.604 – −1.298) had lower QOL. CONCLUSION The ADRQL is a valid indicator of QOL in NH residents with advanced dementia. QOL in this population may be improved near the end of life by appropriate assessment and treatment of pain and more effective management of behavior problems.

Management of patients with Alzheimer’s disease: pharmacological treatment and quality of life

“…In a sample of Italian older home-care patients, reporting chronic daily pain, 34% received any analgesic drug, while only 26% of subjects with dementia received the treatment, with an adjusted odds ratio of 0.80 (95% CI 0.69-0.93) [Landi et al 2001]. However, analgesia is associated with better proxy-rated QoL, measured with ADRQL, in nursing home patients with advanced dementia [Cordner et al 2010]. This is in agreement with the results of a randomized, double-blind, placebo-controlled, crossover trial, which has shown that the administration of paracetamol 3 g/day to patients with moderate to severe AD in nursing homes results in increased social interaction and engagement with environment versus patients who received placebo [Chibnall et al 2005].…”

Evaluating the Quality of Life of People with Dementia in Residential Care Facilities

“…There is a growing consensus that the individual QoL of patients with dementia is an important outcome for effective intervention. Self-ratings are a preferable means to measure the QoL of most dementia patients capable of appraising their own QoL; however, it remains a challenge in advanced dementia patients who are not able to communicate their perspective [35]. …”

The influence of institutionalization on the perception of autonomy and quality of life in old people

“…There is even talk of a syndrome specific to institutionalisation which is characterised by symptoms such as apathy and indifference, a decrease in cognitive capacity, difficulties in expressing feelings, loss of autonomy, etc. (29) as well as the importance of a perception of control and the negative effect during the settling-in period of a sense of lack of personal control on one's surroundings (13,17) .…”

“…The 6 th European Conference of Health Ministers also called for autonomy to be recognized as an essential factor in personal dignity (17) .…”

“…Quality of life is a multi-dimensional concept integrating a series of different areas, and must be circumscribed to certain personal and contextual variables. Various gerontological studies have focused on analysing what is quality of life and its repercussions in the process of successful aging (16)(17) . Several studies associate a decrease in autonomy in the elderly institutionalised population and a perception of health and quality of life, significantly correlated to these modifications (13,18) .…”