title: Correlates of quality of life for individuals with dementia living at home: the role of home environment, caregiver, and patient-related characteristics.
abstract: OBJECTIVE
  To examine prevalence of modifiable risk factors and their contribution to patient quality of life (QoL) as rated by dementia patients and family caregivers.
  
  
  METHODS
  Cross-sectional.
  
  
  METHODS
  Home environment.
  
  
  METHODS
  88 patients and their caregivers.
  
  
  METHODS
  Modifiable characteristics of home environments, patients, and caregivers were observed or obtained through interview. Demographics and ratings of patients' QoL were obtained from patients and caregivers.
  
  
  RESULTS
  Patients had mean Mini-mental Status Examination (MMSE) score = 17.7 ± 4.6, (range: 10-28) on an average 7.7 ± 2.4 neuropsychiatric behaviors, 6.0 ± 3.1 health conditions and moderate functional challenges; 70.7% (N = 58) had fall risk; 60.5% (N = 52) had sleep problems at least once weekly; and 42.5% (N = 37) had pain. An average of 8.1 ± 5.2 home hazards and 5.4 ± 4.1 adaptations were observed; 51.7% had unmet device/navigation needs. Patients' and caregivers' QoL ratings were unrelated to MMSE; and patients' self-rated QoL was higher than rated by caregivers. Number of health conditions and unmet device/navigation needs were inversely associated with patient self-rated QoL, and number of health conditions, frequency of behaviors, and level of negative communications were inversely associated with caregiver's assessment of patient QoL. Positive endorsement of caregiving was positively associated with caregiver's appraisal of patient QoL. Other factors were unrelated.
  
  
  CONCLUSIONS
  Most patients lived at home with high fall risk, unmanaged behavioral symptoms, pain, sleep disturbances, environmental challenges, and multiple hazards. Except for health, factors associated with lower QoL differed for patients and caregivers. Results suggest need to improve QoL by addressing modifiable risk factors and tailoring interventions to patient and caregiver perspectives.
authors.affiliation: Johns Hopkins University School of Nursing, Baltimore, MD. Electronic address: lgitlin1@jhu.edu.
authors.forename: Laura N
authors.initials: LN
authors.lastname: Gitlin
authors.affiliation: Johns Hopkins University School of Nursing, Baltimore, MD.
authors.forename: Nancy
authors.initials: N
authors.lastname: Hodgson
authors.affiliation: Jefferson Elder Care, Thomas Jefferson University, Philadelphia, PA.
authors.forename: Catherine Verrier
authors.initials: CV
authors.lastname: Piersol
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Edward
authors.initials: E
authors.lastname: Hess
authors.affiliation: Sycamore Consulting LLC, New Hope, PA.
authors.forename: Walter W
authors.initials: WW
authors.lastname: Hauck
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers / Q000523:psychology / Q000706:statistics & numerical data; D003704:Dementia / Q000523:psychology* / Q000628:therapy; D005260:Female; D006701:Home Nursing / Q000523:psychology* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D015995:Prevalence; D011788:Quality of Life / Q000523:psychology; D012307:Risk Factors; D011795:Surveys and Questionnaires
keywords: Dementia care; caregiving; health-related quality of life; neuropsychiatric behaviors
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