Quality of life and quality of care for people with dementia receiving long term institutional care or professional home care: the European RightTimePlaceCare study.
OBJECTIVE
To explore how quality of life (QoL) and quality of care (QoC) for people with dementia (PwD) vary across 8 European countries; to explore how QoL and QoC for PwD vary across living arrangements; and to assess the association between QoL and QoC.


METHODS
Cross-sectional survey.


METHODS
Institutional long term care and home care in 8 European countries (England, Estonia, Finland, France, Germany, the Netherlands, Spain, and Sweden).


METHODS
PwD receiving formal home care but at risk for admission to an institutional setting, and PwD who were recently admitted.


METHODS
QoL was assessed by the PwD and by their best informed proxies using the Quality of Life-Alzheimer's Disease scale (QoL-AD) (range 13-52). QoC was measured using quality of care indicators (eg, the presence of depressive symptoms, the presence of pressure ulcers).


RESULTS
A total of 1123 PwD living at home (mean age 82.2, 63%women) and 791 PwD living in institutional care (mean age 84.1, 74% women) participated. QoL of PwD was most often rated highest in Sweden and England and lowest in Estonia and Spain. No differences in QoL were detected among the settings. For the QoC indicators, no consistent patterns were visible in such a way that certain countries or settings scored "higher" or "lower." The presence of depressive symptoms was most consistently associated with lower QoL (P ≤ .001).


CONCLUSIONS
There is great variation in QoL and QoC scores among European countries and settings. To gain insight into the underlying causes of these differences, more knowledge is needed about the effect of different national health care systems and dementia strategies on QoL and QoC indicators. Depressive symptoms were associated with QoL, and executing longitudinal studies investigating which factors are associated with change in QoL is highly recommended.
Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, CAPHRI School for Public Health and Primary Care, Maastricht, The Netherlands. Electronic address: h.beerens@maastrichtuniversity.nl.
Hanneke C
HC
Beerens
Personal Social Services Research Unit, Faculty of Medical and Human Sciences, The University of Manchester, Manchester, United Kingdom.
Caroline
C
Sutcliffe
School of Nursing Science, Faculty of Health, University of Witten/Herdecke, Witten, Germany.
Anna
A
Renom-Guiteras
Department of Geriatric Medicine, CHU Toulouse University Hospital, Toulouse, France.
Maria E
ME
Soto
Department of Nursing Science, University of Turku, Turku, Finland.
Riitta
R
Suhonen
Fundació Privada Clínic per a la Recerca Biomèdica, Hospital Clinic of Barcelona, Barcelona, Spain.
Adela
A
Zabalegui
Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden.
Christina
C
Bökberg
Department of Internal Medicine, University of Tartu, Tartu, Estonia.
Kai
K
Saks
Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, CAPHRI School for Public Health and Primary Care, Maastricht, The Netherlands.
Jan P H
JP
Hamers
D000058:Accidental Falls / Q000706:statistics & numerical data; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003704:Dementia / Q000453:epidemiology*; D003863:Depression / Q000453:epidemiology; D004363:Drug Utilization; D005060:Europe / Q000453:epidemiology; D005260:Female; D006699:Home Care Services; D006801:Humans; D008297:Male; D010146:Pain / Q000453:epidemiology; D003668:Pressure Ulcer / Q000453:epidemiology; D011446:Prospective Studies; D019727:Proxy; D011619:Psychotropic Drugs / Q000627:therapeutic use; D011787:Quality of Health Care; D011788:Quality of Life; D012112:Residential Facilities; D012149:Restraint, Physical / Q000706:statistics & numerical data; D057566:Self Report; D011795:Surveys and Questionnaires; D015431:Weight Loss
D011619:Psychotropic Drugs
Dementia; international comparisons; quality of care; quality of life