title: Factors associated with quality of life of people with dementia in long-term care facilities: a systematic review.
abstract: BACKGROUND
  Quality of life has become an important outcome measure in dementia research. Currently there is no convincing evidence about which factors are associated with quality of life of people with dementia living in long-term care facilities.
  
  
  OBJECTIVE
  This study aims to investigate which factors are associated with quality of life, including factors associated with change over time, of people with dementia living in long-term care facilities.
  
  
  METHODS
  A systematic literature review was performed.
  
  
  METHODS
  Cochrane, Pubmed, CINAHL, Web of Science, and PsycINFO were searched.
  
  
  METHODS
  Three researchers independently assessed studies for eligibility. The inclusion criteria were: (1) the primary focus was on factors related to quality of life; (2) the study was performed in long-term care facilities; (3) the study regarded quality of life as multidimensional construct. Methodological quality of studies included in the review was assessed with a quality criteria checklist.
  
  
  RESULTS
  Ten cross-sectional and three longitudinal articles were included in the review. In cross-sectional studies, depressive symptoms were negatively related to self-rated quality of life of people with dementia. The association between depressive symptoms and proxy-rated quality of life was less clear. Behavioural disturbances, especially agitation, appeared to be negatively related to proxy-rated quality of life. There appeared to be a negative relation between quality of life, activities of daily living and cognition, although this could not be confirmed in all studies. In longitudinal studies, depressive symptoms were negatively related and cognition was positively related to self-rated quality of life, whereas dependency and depressive symptoms were negatively related to proxy-rated quality of life.
  
  
  CONCLUSIONS
  There are only few high quality studies that investigate associations of (change in) quality of life of people with dementia living in long-term care facilities. Our results suggest that depressive symptoms and agitation are related to lower quality of life. Perspective of quality of life measurement, i.e. self- or proxy rating, may influence its associations. Longitudinal studies are needed to determine which factors are related to change in quality of life over time. This information is essential for the development of interventions that aim to improve quality of life.
authors: Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, CAPHRI School for Public Health and Primary Care, Maastricht University, The Netherlands. h.beerens@maastrichtuniversity.nl
authors: Hanneke C
authors: HC
authors: Beerens
authors: Sandra M G
authors: SM
authors: Zwakhalen
authors: Hilde
authors: H
authors: Verbeek
authors: Dirk
authors: D
authors: Ruwaard
authors: Jan P H
authors: JP
authors: Hamers
mesh_terms: D000203:Activities of Daily Living; D003430:Cross-Sectional Studies; D003704:Dementia / Q000188:drug therapy / Q000503:physiopathology* / Q000523:psychology; D006801:Humans; D008134:Long-Term Care; D008137:Longitudinal Studies; D009735:Nursing Homes; D011788:Quality of Life
keywords: Agitation; Associations; Dementia; Depression; Long-term care; Nursing home; Quality of life; Review