The Effect of a Multicomponent Intervention on Quality of Life in Residents of Nursing Homes: A Randomized Controlled Trial (COSMOS)

Abstract

Objectives: To investigate if the multicomponent intervention of the COSMOS trial, combining communication, systematic pain management, medication review, and activities, improved quality of life (QoL) in nursing home patients with complex needs. Design: Multicenter, cluster-randomized, single-blinded, controlled trial. Setting: Thirty-three nursing homes with 67 units (clusters) from 8 Norwegian municipalities. Participants: Seven hundred twenty-three patients with and without dementia (!65 years) were cluster randomized to usual care or intervention in which health care staff received standardized education and on-site training for 4 months with follow-up at month 9. Measurements: Primary outcome was change in QoL as measured by QUALIDEM (QoL dementia scale); QUALID (QoL late-stage dementia scale), and EQ-VAS (European QoLevisual analog scale) from baseline to month 4. Secondary outcomes were activities of daily living (ADL), total medication, staff distress, and clinical global impressions of change (CGIC). Results: During the active intervention, all 3 QoL measures worsened, 2 significantly (QUALID P ¼ .04; QUALIDEM P ¼ .002). However, follow-up analysis from month 4 to 9 showed an intervention effect for EQ-VAS (P ¼ .003) and QUALIDEM total score (P ¼ .01; care relationship P ¼ .02; positive affect P ¼ .04, social relations P ¼ .01). The secondary outcomes of ADL function, reduction of medication (including psychotropics) and staff distress, improved significantly from baseline to month 4. Intervention effects were also demonstrated for CGIC at month 4 (P ¼ .023) and 9 (P ¼ .009), mainly because of deterioration in the control group. Conclusion and implications: Temporarily, the QoL decreased in the intervention group, leading to our hypothesis that health care staff may be overwhelmed by the work-intensive COSMOS intervention period. However, the decrease reversed significantly during follow-up, indicating a potential learning effect. Further, the intervention group improved in ADL function and received less medication, and staff Declaration of Interest: BSH, EF, IA, CG, TH, TE, GS, IT, and DDS declare that they have no competing interests.CB reports grants and personal fees from Lundbeck, grants and personal fees from Acadia, personal fees from Roche, personal fees from Orion, personal fees from GSK, personal fees from Otusaka, personal fees from Heptares, personal fees from Lilly, outside the submitted work. DA has received research support and/or honoraria from AstraZeneca, H. Lundbeck, Novartis Pharmaceuticals and GE Health, and serves as paid consultant for H. Lundbeck, Eisai, and Axovant.Role of the funding source: The funding source had no role in study design, data collection, data analyses, data interpretation or writing of the report.

Quality of life in people with dementia living in nursing homes: validation of an eight-item version of the QUALIDEM for intensive longitudinal assessment

“…This finding was in line with majority of the research that investigated mood, depressive symptoms, affective status, and happiness [39][40][41]. Further, most studies showed comparable results investigating multidimensional associations of the QUALI-DEM subscales [25][26][27][28][29][30]. Moreover, in our study, we did not find significant outcomes regarding gender, age, FAST, and Barthel Index, which contradicts findings from the literature [42,43].…”

“…The varimax-rotated PCA solution accounted for 67.2% of the overall variance. Next to the subscales, we created a composite sum score across all 37 items, which has been used extensively in the literature as well [25][26][27][28][29][30]. Thus, in our analyses, we look into both the comprehensive sum score (Table 2) as well as subscale results ( 'positive affect', 'negative affect', 'restlessness', and 'social relationships' of the full 37-item version of QUALIDEM (i.e., subscale B, subscale C, subscale D, and subscale F) [8,31].…”

Determinants of self‐ and carer‐rated quality of life and caregiver burden in Alzheimer disease

“…38 A recent study on older nursing home residents with and without dementia indicates that a standardised education and training programme for health care staff vs usual care resulted in improved ADL and QoL as well as reduced use of psychotropic medication and staff distress. 39 These findings also highlight that nonpharmacological interventions may be more effective than longterm medication for management of BPSD. Systematic reviews show that different effective strategies exist, including music therapy and behavioural management techniques, 40 and improved BPSD may also have a positive impact on the carers' QoL.…”

Sykepleiere er avgjørende for god smertebehandling

“…Disse aktivitetene sammen har vist en svaert lovende e ekt på livskvaliteten for personer med demens (22,23). Fremfor å bare kartlegge smerte eller ta bort medisiner må sykehjemspersonalet gjennomføre en grundig evaluering av hver pasient i et tverrprofesjonelt team, der ikkemedikamentelle intervensjoner og miljøbehandling integreres.…”

“…Det er kombinasjonen av ikke-medikamentelle og medikamentelle tiltak som iverksettes basert på kartlegging og evaluering, som har e ekt på smerte og livskvalitet (23,33).…”