title: Use of the QOL-AD for measuring quality of life in people with severe dementia--the LASER-AD study.
abstract: BACKGROUND
  Health-related quality of life (HR-QOL) scales are particularly important in older people as global outcome measures for interventions. It is known that people with mild to moderate dementia can provide valid assessments of their own QOL, but it is unclear whether these instruments are useful in those with severe dementia.
  
  
  OBJECTIVE
  We examined the usefulness of the QOL scale in Alzheimer's disease (QOL-AD) in people with severe dementia by considering the ability of older people with a Mini-Mental State Examination (MMSE) score of <12 and their caregivers to complete this scale, as well as its construct validity and internal consistency.
  
  
  METHODS
  Data were collected from people with Alzheimer's disease and their caregivers using a range of instruments measuring cognition, mood, behaviour, QOL and functional ability.
  
  
  RESULTS
  Of 79 participants and their caregivers, 41 (52%) could complete the QOL-AD. Cognition and functional abilities were significantly higher in the completers than in the non-completers (P < 0.001). The QOL-AD showed internal consistency and construct validity as it correlated with ability to look after self, fewer limitations due to physical health, positive mood status and low levels of apathy.
  
  
  CONCLUSIONS
  There is evidence for the validity and reliability of the QOL-AD in people with MMSE scores of 3-11, as well as the practicality of administering the scale in this population. The scale is unlikely to generate useful information for people with MMSE scores of <3. QOL does not decrease as cognition worsens. This throws into question most people's assumption that decreasing cognition worsens QOL. We consider that it may be important to inform the public of this, as living wills are used increasingly in our culture.
authors.affiliation: Centre for Ageing and Mental Health Sciences, Department of Mental Health Sciences, University College London, Archway Campus, Holborn Union Building, Highgate Hill, London N19 5LW, UK.
authors.forename: Juanita
authors.initials: J
authors.lastname: Hoe
authors.forename: Cornelius
authors.initials: C
authors.lastname: Katona
authors.forename: Brigitte
authors.initials: B
authors.lastname: Roch
authors.forename: Gill
authors.initials: G
authors.lastname: Livingston
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000523:psychology*; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D008609:Mental Status Schedule / Q000706:statistics & numerical data; D008875:Middle Aged; D011581:Psychological Tests / Q000706:statistics & numerical data; D011594:Psychometrics; D011788:Quality of Life / Q000523:psychology*; D006113:United Kingdom