title: Quality of life by proxy and mortality in institutionalized older adults with dementia.
abstract: OBJECTIVE
  This study aimed at analyzing the effect of quality of life (QoL) on mortality in older adults with dementia living in long-term care facilities.
  
  
  METHODS
  A prospective observational cohort study was carried out on 412 residents aged older than 60 years, diagnosed with dementia according to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition. Besides assessment of QoL (EQ-5D index by proxy) and perceived health status (EQ-VAS), baseline measurements included severity of dementia (Clinical Dementia Rating Scale [CDR]), comorbidity (number of self-reported chronic conditions), disability evaluation (Barthel Index), cognitive state (Mini Examen Cognoscitivo, a validated and modified Spanish version of the Mini-Mental State Examination) and depression (Cornell Depression Scale for Dementia). Sociodemographic and clinical variables were analyzed as potential effect modifiers and confounders in the relationship between QoL and mortality using a multivariate logistic regression analysis.
  
  
  RESULTS
  After an 18-month follow up, 138 residents had died. Adjusting for CDR and Barthel Index, the odds of mortality were multiplied by 0.25 (95% CI 0.09-0.70) and 0.79 (95% CI 0.26-2.42) for every unit of change in the EQ-5D index in the residents with Cornell score <6 and ≥ 6, respectively.
  
  
  CONCLUSIONS
  The present study suggests that the effect of QoL on mortality in institutionalized adults with dementia should take into account the presence or absence of depression. In addition, residents with a greater disability and more advanced dementia should be a target for interventions in rehabilitation care.
authors.affiliation: Service of Preventive Medicine, University Hospital Ramón y Cajal, Madrid, Spain.
authors.forename: Abel E
authors.initials: AE
authors.lastname: González-Vélez
authors.forename: María Joao
authors.initials: MJ
authors.lastname: Forjaz
authors.forename: Carolina
authors.initials: C
authors.lastname: Giraldez-García
authors.forename: Salomé
authors.initials: S
authors.lastname: Martín-García
authors.forename: Pablo
authors.initials: P
authors.lastname: Martínez-Martín
mesh_terms: D003704:Dementia / Q000175:diagnosis / Q000401:mortality* / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D013030:Spain / Q000453:epidemiology; D011795:Surveys and Questionnaires; D015996:Survival Rate / Q000639:trends; D013997:Time Factors
keywords: dementia; long-term care settings; mortality; older adults; quality of life