title: Factors Associated With Changes in Perceived Quality of Life Among Elderly Recipients of Long-Term Services and Supports.
abstract: OBJECTIVE
  Advance knowledge about changes in multiple dimensions of health related quality of life (HRQoL) among older adults receiving long-term services and supports (LTSS) over time and across settings.
  
  
  METHODS
  A prospective, observational, longitudinal cohort design.
  
  
  METHODS
  Nursing homes (NHs), assisted living facilities (ALFs), community.
  
  
  METHODS
  A total of 470 older adults who were first-time recipients of LTSS.
  
  
  METHODS
  Single-item quality-of-life measure assessed every 3 months over 2 years. HRQoL domains of emotional status, functional status, and social support were measured using standardized instruments.
  
  
  RESULTS
  Multivariable mixed effects model with time varying covariates revealed that quality-of-life ratings decreased over time (P < .001). Quality-of-life ratings were higher among enrollees with fewer depressive symptoms (P < .001), higher general physical function (P < .001), enhanced emotional well-being (P < .001), and greater social support (P = .004). Ratings also were higher among those with increased deficits in activities of daily living (P = .02). Ratings were highest among enrollees who received LTSS from ALFs, followed by NHs, then home and community-based services (H&CBS), but only findings between ALFs and H&CBS were statistically significant (P < .001). Finally, ratings tended to decrease over time among enrollees with greater cognitive impairment and increase over time among enrollees with less cognitive impairment (P < .001).
  
  
  CONCLUSIONS
  Findings advance knowledge regarding what is arguably the most important outcome of elderly LTSS recipients: quality of life. Understanding associations between multiple HRQoL domains and quality of life over time and directly from LTSS recipients represents a critical step in enhancing care processes and outcomes of this vulnerable population.
authors.affiliation: NewCourtland Center for Transitions and Health; University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania. Electronic address: naylor@nursing.upenn.edu.
authors.forename: Mary D
authors.initials: MD
authors.lastname: Naylor
authors.affiliation: NewCourtland Center for Transitions and Health; University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania.
authors.forename: Karen B
authors.initials: KB
authors.lastname: Hirschman
authors.affiliation: NewCourtland Center for Transitions and Health; University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania.
authors.forename: Alexandra L
authors.initials: AL
authors.lastname: Hanlon
authors.affiliation: Miami University, Department of Sociology and Gerontology, Scripps Research Center, Oxford, OH.
authors.forename: Katherine M
authors.initials: KM
authors.lastname: Abbott
authors.affiliation: NewCourtland Center for Transitions and Health; University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania.
authors.forename: Kathryn H
authors.initials: KH
authors.lastname: Bowles
authors.affiliation: College of Nursing and Health Sciences, University of Massachusetts - Boston, Boston, MA.
authors.forename: Janice
authors.initials: J
authors.lastname: Foust
authors.affiliation: Center for Home Care Policy and Research, Visiting Nurse Service of New York, New York, NY.
authors.forename: Shivani
authors.initials: S
authors.lastname: Shah
authors.affiliation: University of Pennsylvania School of Medicine, Department of Psychiatry, Philadelphia, PA.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Zubritsky
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D040561:Assisted Living Facilities; D003072:Cognition Disorders / Q000453:epidemiology; D003863:Depression / Q000453:epidemiology; D005260:Female; D006304:Health Status; D006699:Home Care Services; D006801:Humans; D008134:Long-Term Care; D008137:Longitudinal Studies; D008297:Male; D008873:Mid-Atlantic Region / Q000453:epidemiology; D008875:Middle Aged; D009735:Nursing Homes; D011446:Prospective Studies; D011788:Quality of Life; D012944:Social Support
keywords: Long-term care; assisted living; home- and community-based services; nursing home; quality of life