Characteristics Associated with Quality of Life in Long-Term Care Residents with Dementia: A Cross-Sectional Study.
To determine which characteristics are associated with quality of life (QOL) in residents with moderate to very severe dementia in long-term care facilities (LTCFs).



This was a cross-sectional analysis of a cluster randomized controlled study in 12 Dutch LTCFs that enrolled 288 residents, with moderate to severe dementia assessed with the Reisberg Global Deterioration Scale (Reisberg GDS) and QOL with the QUALIDEM. Characteristics that were hypothesized to be associated with the six domains of QOL (applicable to very severe dementia) included demographic variables, activities of daily living (Katz ADL), cognitive performance (Cognitive Performance Scale; CPS), pain (Pain Assessment Checklist for Seniors with Limited Ability to Communicate; PACSLAC-D), neuropsychiatric symptoms (Neuropsychiatric Inventory-Nursing Home Version; NPI-NH) and comorbidities.



Multivariate logistic regression modelling showed associations with age in the domain Social isolation [odds ratio, OR, 0.95 (95% confidence interval, CI, 0.91-0.99)], ADL level in the domain Positive affect [OR 0.89 (95% CI 0.83-0.95)] and the domain Social relations [OR 0.87 (95% CI 0.81-0.93)], severity of dementia in the domain Social relations [OR 0.28 (95% CI 0.12-0.62)] and in the domain Social isolation [OR 2.10 (95% CI 1.17-3.78)], psychiatric disorders in the domain Positive affect [OR 0.39 (95% CI 0.17-0.87)] and pulmonary diseases in the domain Negative affect [OR 0.14 (95% CI 0.03-0.61)] of the QUALIDEM. Neuropsychiatric symptoms were independently associated with all six domains of the QUALIDEM [OR 0.93 (95% CI 0.90-0.96) to OR 0.97 (95% CI 0.95-0.99)]. Pain was associated with the domains Care relationship [OR 0.92 (95% CI 0.84-1.00)] and Negative affect [OR 0.92 (95% CI 0.85-1.00)].



QOL in dementia is independently associated with age, ADL, dementia severity, pain, psychiatric disorders, pulmonary diseases and neuropsychiatric symptoms. It is possible to detect persons with dementia at risk for a lower QOL. This information is important for developing personalized interventions to improve QOL in persons with dementia in LTCFs.
Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.
Maartje S
MS
Klapwijk
Monique A A
MA
Caljouw
Marjoleine J C
MJ
Pieper
Jenny T
JT
van der Steen
Wilco P
WP
Achterberg
D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003704:Dementia / Q000453:epidemiology / Q000503:physiopathology / Q000523:psychology*; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D016015:Logistic Models; D008134:Long-Term Care; D008171:Lung Diseases / Q000453:epidemiology / Q000523:psychology; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000523:psychology; D015999:Multivariate Analysis; D009735:Nursing Homes; D010146:Pain / Q000453:epidemiology / Q000523:psychology; D010147:Pain Measurement; D011788:Quality of Life / Q000523:psychology*; D012720:Severity of Illness Index; D012934:Social Isolation
Int Psychogeriatr. 2012 Jul;24(7):1094-102
22414494
Dementia (London). 2013 Sep;12(5):536-50
24337328
Gerontologist. 2001 Apr;41(2):173-9
11327482
BMC Geriatr. 2014 Feb 10;14:18
24512291
Ageing Res Rev. 2010 Apr;9(2):163-83
19781667
Am J Psychiatry. 1982 Sep;139(9):1136-9
7114305
J Adv Nurs. 2007 Jun;58(5):493-502
17442027
Neurology. 1997 May;48(5 Suppl 6):S10-6
9153155
Int Psychogeriatr. 2014 Aug;26(8):1273-82
24965359
Neurology. 1994 Dec;44(12):2308-14
7991117
BMC Geriatr. 2011 Mar 17;11:11
21414185
Am J Alzheimers Dis Other Demen. 2013 Dec;28(8):723-33
24005852
Aging Ment Health. 2015 Jan;19(1):13-31
24881888
J Am Med Dir Assoc. 2014 Oct;15(10):697-705
25037168
BMC Geriatr. 2015 Sep 09;15:109
26354753
Ageing Res Rev. 2013 Sep;12(4):1042-55
23727161
Dement Geriatr Cogn Disord. 2004;18(2):159-64
15211071
Alzheimer Dis Assoc Disord. 2000 Apr-Jun;14(2):68-80
10850745
J Am Geriatr Soc. 2015 Jan;63(1):24-38
25597556
Int Psychogeriatr. 2013 Oct;25(10):1687-95
23746265
Int J Geriatr Psychiatry. 2007 Jun;22(6):549-56
17152121
J Am Med Dir Assoc. 2013 Nov;14(11):781-3
24021540
J Am Med Dir Assoc. 2015 Feb;16(2):165-71
25544001
Pain Med. 2015 Jun;16(6):1083-9
25800276
Int J Geriatr Psychiatry. 2015 Jan;30(1):97-104
24789766
JAMA. 1963 Sep 21;185:914-9
14044222
BMC Geriatr. 2014 May 22;14:67
24884563
Int J Geriatr Psychiatry. 2013 May;28(5):530-8
22886912
Age Ageing. 2014 Sep;43(5):596-603
25092719
J Clin Epidemiol. 2000 Sep;53(9):895-907
11004416
J Am Med Dir Assoc. 2014 Jan;15(1):54-61
24220139
Aging Ment Health. 2014;18(8):1013-21
24911813
Cochrane Database Syst Rev. 2013 Dec 04;(12):CD006489
24302466
BMC Geriatr. 2015 Apr 19;15:49
25928621
Pain Manag Nurs. 2004 Mar;5(1):37-49
14999652
Int Psychogeriatr. 2015 Nov;27(11):1875-92
26138674
Int Psychogeriatr. 2013 Jul;25(7):1077-84
23575107
J Am Geriatr Soc. 2010 Dec;58(12):2394-400
21054329
BMC Geriatr. 2006 Jan 27;6:3
16441889
Clin Interv Aging. 2012;7:207-23
22807630
Am J Geriatr Psychiatry. 2014 Feb;22(2):138-47
23567444
Dement Geriatr Cogn Disord. 2010;29(3):189-97
20215750
J Am Geriatr Soc. 2016 Feb;64(2):261-9
26804064
Dement Geriatr Cogn Dis Extra. 2015 Apr 10;5(1):123-34
25999979
Int Psychogeriatr. 2015 Jan;27(1):103-10
25162434
Br J Psychiatry. 2014 Dec;205(6):436-42
25452601
Int Psychogeriatr. 2012 Jun;24(6):856-70
22244371
Qual Life Res. 2005 Apr;14(3):675-86
16022061
J Gerontol A Biol Sci Med Sci. 1995 Mar;50(2):M128-33
7874589
Int J Geriatr Psychiatry. 2011 Jul;26(7):711-22
20845397
Cochrane Database Syst Rev. 2015 Apr 15;(4):CD006489
25874613
Int Psychogeriatr. 2005 Sep;17(3):353-70
16252370
Qual Life Res. 2014 Nov;23(9):2595-601
24800714
Int J Geriatr Psychiatry. 2007 May;22(5):424-30
17044131
Eur J Pain. 2009 Jan;13(1):89-93
18486509
Int Psychogeriatr. 2013 May;25(5):691-706
23347698
Int Psychogeriatr. 2014 May;26(5):825-36
24507554
BMC Geriatr. 2011 Mar 24;11:12
21435251
BMC Med Res Methodol. 2013 Sep 06;13:110
24011428
Gerontologist. 2015 Aug;55(4):643-55
24352532
Gerontologist. 1970 Spring;10(1):20-30
5420677
Health Qual Life Outcomes. 2014 Dec 12;12:177
25495548
Int Psychogeriatr. 2012 Nov;24(11):1805-15
22697366
Alzheimer Dis Assoc Disord. 2007 Apr-Jun;21(2):172-8
17545745
Int J Nurs Stud. 2013 Sep;50(9):1259-70
23465959
Tijdschr Gerontol Geriatr. 2002 Sep;33(4):150-5
12378786
Dement Geriatr Cogn Disord. 2011;31(6):435-42
21757909
Int J Geriatr Psychiatry. 2005 Apr;20(4):330-43
15799079
Soc Sci Med. 1995 Nov;41(10):1403-9
8560308
Int J Geriatr Psychiatry. 2009 Jan;24(1):15-24
18727132
Qual Life Res. 2014 Mar;23(2):549-59
23975378