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Hoben M, Dymchuk E, Doupe MB, Keefe J, Aubrecht K, Kelly C, Stajduhar K, Banerjee S, O'Rourke HM, Chamberlain S, Beeber A, Salma J, Jarrett P, Arya A, Corbett K, Devkota R, Ristau M, Shrestha S, Estabrooks CA. Counting what counts: assessing quality of life and its social determinants among nursing home residents with dementia. BMC Geriatr 2024; 24:177. [PMID: 38383339 PMCID: PMC10880372 DOI: 10.1186/s12877-024-04710-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 01/15/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Maximizing quality of life (QoL) is a major goal of care for people with dementia in nursing homes (NHs). Social determinants are critical for residents' QoL. However, similar to the United States and other countries, most Canadian NHs routinely monitor and publicly report quality of care, but not resident QoL and its social determinants. Therefore, we lack robust, quantitative studies evaluating the association of multiple intersecting social determinants with NH residents' QoL. The goal of this study is to address this critical knowledge gap. METHODS We will recruit a random sample of 80 NHs from 5 Canadian provinces (Alberta, British Columbia, Manitoba, Nova Scotia, Ontario). We will stratify facilities by urban/rural location, for-profit/not-for-profit ownership, and size (above/below median number of beds among urban versus rural facilities in each province). In video-based structured interviews with care staff, we will complete QoL assessments for each of ~ 4,320 residents, using the DEMQOL-CH, a validated, feasible tool for this purpose. We will also assess resident's social determinants of QoL, using items from validated Canadian population surveys. Health and quality of care data will come from routinely collected Resident Assessment Instrument - Minimum Data Set 2.0 records. Knowledge users (health system decision makers, Alzheimer Societies, NH managers, care staff, people with dementia and their family/friend caregivers) have been involved in the design of this study, and we will partner with them throughout the study. We will share and discuss study findings with knowledge users in web-based summits with embedded focus groups. This will provide much needed data on knowledge users' interpretations, usefulness and intended use of data on NH residents' QoL and its health and social determinants. DISCUSSION This large-scale, robust, quantitative study will address a major knowledge gap by assessing QoL and multiple intersecting social determinants of QoL among NH residents with dementia. We will also generate evidence on clusters of intersecting social determinants of QoL. This study will be a prerequisite for future studies to investigate in depth the mechanisms leading to QoL inequities in LTC, longitudinal studies to identify trajectories in QoL, and robust intervention studies aiming to reduce these inequities.
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Affiliation(s)
- Matthias Hoben
- School of Health Policy and Management, Faculty of Health, York University, Room 301E Stong College, 4700 Keele StreetON, Toronto, M3J 1P3, Canada.
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada.
| | - Emily Dymchuk
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Malcolm B Doupe
- Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Janice Keefe
- Nova Scotia Centre on Aging, Mount Saint Vincent University, Halifax, Canada
| | - Katie Aubrecht
- Department of Sociology, Faculty of Arts, St. Francis Xavier University, Antigonish, NS, Canada
| | - Christine Kelly
- Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Kelli Stajduhar
- School of Nursing, Faculty of Human & Social Development, University of Victoria, Victoria, BC, Canada
| | - Sube Banerjee
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Hannah M O'Rourke
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Stephanie Chamberlain
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Anna Beeber
- School of Nursing, Johns Hopkins University, Baltimore, MD, USA
| | - Jordana Salma
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Pamela Jarrett
- Faculty of Medicine, Dalhousie University, Horizon Health Network, Saint John, New Brunswick, Canada
| | - Amit Arya
- Freeman Centre for the Advancement of Palliative Care, North York General Hospital, Toronto, ON, Canada
- Specialist Palliative Care in Long-Term Care Outreach Team, Kensington Gardens Long-Term Care, Kensington Health, Toronto, ON, Canada
- Division of Palliative Care, Department of Family & Community Medicine, University of Toronto, Toronto, ON, Canada
- Division of Palliative Care, Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Kyle Corbett
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Rashmi Devkota
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Melissa Ristau
- Dr. Gerald Zetter Care Centre, The Good Samaritan Society, Edmonton, AB, Canada
| | - Shovana Shrestha
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Carole A Estabrooks
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
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2
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Jayakody S, Arambepola C. Patient and caregiver perspectives on quality of life in dementia: Evidence from a South Asian population. PLoS One 2023; 18:e0285701. [PMID: 37200258 DOI: 10.1371/journal.pone.0285701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 04/30/2023] [Indexed: 05/20/2023] Open
Abstract
Dementia has become a public health priority along with population ageing worldwide. Owing to its chronic progressive nature in the absence of a cure, maintaining the best possible quality of life (QOL) has become the desired outcome for people with dementia. The aim of this study was to compare the Quality of Life (QOL) of patients with dementia in Sri Lanka when assessed based on the patient's and caregiver's perspectives. A cross-sectional study was conducted among 272 pairs of patients with dementia and their primary caregivers recruited systematically from the psychiatry outpatient clinics of tertiary care state hospitals in the district of Colombo, Sri Lanka. The QOL was assessed using the 28-item DEMQOL among patients and the 31-item DEMQOL-proxy among primary caregivers. The total QOL ratings and subscale scores obtained by patients and caregivers were compared and assessed for the significance of the mean scores using the independent t-test and of the mean difference in ratings using the Wilcoxon test. Agreement between patients and their caregivers on the ratings for QOL was also assessed using the Bland Altman plot. The mean overall QOL score according to patient ratings (mean = 79.7; SD = 12.0) was significantly higher than the caregiver ratings (mean = 70.6; SD = 12.3) (p< 0.001). Mean scores for the four subscales (positive emotion, negative emotion, memory, and daily life) were also significantly higher according to the patient's ratings (p<0.001). Total scores obtained by patients and their caregivers showed a positive and significant correlation (r = 0.385; p<0.001). Bland Altman plot demonstrated acceptable agreement between their ratings. The study confirms the ability of dementia patients with mild to moderate severity to successfully rate their own QOL. Furthermore, the caregiver's ratings cannot be substituted for the patient's ratings and vice versa.
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Affiliation(s)
- Surangi Jayakody
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Carukshi Arambepola
- Department of Community Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
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3
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Harper AE, Rouch S, Leland NE, Turner RL, Mansbach WE, Day CE, Terhorst L. A Systematic Review of Tools Assessing the Perspective of Caregivers of Residents With Dementia. J Appl Gerontol 2022; 41:1196-1208. [PMID: 34229505 DOI: 10.1177/07334648211028692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
In collaboration with stakeholders, we conducted a systematic review of psychometric evidence for self-report tools measuring the perspective of family caregivers of nursing home residents with dementia. Our rationale for this review was based on evidence that nonpharmacological interventions can ameliorate dementia symptoms in nursing home residents. Such interventions require caregiver participation, which is influenced by perspectives. Yet, no existing tool measures the multidomain caregiver perspective. Our review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol. The final sample included 42 articles describing 33 tools measuring domains of nursing home dementia care such as behavioral and psychological symptoms of dementia, resident quality of life, dementia-specific knowledge, communication, and medication use. We uncovered evidence gaps for tools measuring dementia-specific knowledge, communication, and medication use, all of which were important to our stakeholders. Future research should focus on development of psychometrically sound tools in alignment with the multidomain caregiver perspective.
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Hjort Telhede E, Arvidsson S, Karlsson S. Nursing staff's experiences of how weighted blankets influence resident's in nursing homes expressions of health. Int J Qual Stud Health Well-being 2021; 17:2009203. [PMID: 34904541 PMCID: PMC8740773 DOI: 10.1080/17482631.2021.2009203] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose The most common treatment for resident’s health problems is pharmacological. Little research has been done on how an intervention with a non-pharmacological method, such as a weighted blanket, Through the nursing staff view, we can learn how weighted blankets influence resident’s health in nursing homes. The aim of this study was to explore nursing staff’s experiences of how an intervention with weighted blankets influenced resident’s expressions of health. Methods The study had a descriptive qualitative design with semi-structured interviews with 20 nursing staff working in nursing homes, and an inductive content analysis was applied. Results The nursing staff expressed that the weighted blanket positively influenced resident’s health in the areas of sleep, physical activity, and psychological behaviour. The weighted blanket made them fall asleep faster, sleep was uninterrupted andthey felt more rested in the morning. The nursing staff observed an increased level of activity as the resident became more energetic . The nursing staff also experienced reduced negative psychological behaviours like anxiety and worrying. Conclusion This study indicated that the weighted blanket changed the health expression of resident in several crucial areas. Deep pressure treatment indicates an alternative health-improved treatment for resident in nursing homes.
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Affiliation(s)
| | - Susann Arvidsson
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Staffan Karlsson
- School of Health and Welfare, Halmstad University, Halmstad, Sweden.,Faculty of Health Science, Kristianstad University, Kristianstad, Sweden
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Siette J, Knaggs GT, Zurynski Y, Ratcliffe J, Dodds L, Westbrook J. Systematic review of 29 self-report instruments for assessing quality of life in older adults receiving aged care services. BMJ Open 2021; 11:e050892. [PMID: 34794991 PMCID: PMC8603300 DOI: 10.1136/bmjopen-2021-050892] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Quality of life (QoL) outcomes are used to monitor quality of care for older adults accessing aged care services, yet it remains unclear which QoL instruments best meet older adults', providers' and policymakers' needs. This review aimed to (1) identify QoL instruments used in aged care and describe them in terms of QoL domains measured and logistical details; (2) summarise in which aged care settings the instruments have been used and (3) discuss factors to consider in deciding on the suitability of QoL instruments for use in aged care services. DESIGN Systematic review. DATA SOURCES MEDLINE, EMBASE, PsycINFO, Cochrane Library and CINAHL from inception to 2021. ELIGIBILITY CRITERIA Instruments were included if they were designed for adults (>18 years), available in English, been applied in a peer-reviewed research study examining QoL outcomes in adults >65 years accessing aged care (including home/social care, residential/long-term care) and had reported psychometrics. DATA EXTRACTION AND SYNTHESIS Two researchers independently reviewed the measures and extracted the data. Data synthesis was performed via narrative review of eligible instruments. RESULTS 292 articles reporting on 29 QoL instruments were included. Eight domains of QoL were addressed: physical health, mental health, emotional state, social connection, environment, autonomy and overall QoL. The period between 1990 and 2000 produced the greatest number of newly developed instruments. The EuroQoL-5 Dimensions (EQ-5D) and Short Form-series were used across multiple aged care contexts including home and residential care. More recent instruments (eg, ICEpop CAPability measure for Older people (ICECAP-O) and Adult Social Care Outcomes Toolkit (ASCOT)) tend to capture emotional sentiment towards personal circumstances and higher order care needs, in comparison with more established instruments (eg, EQ-5D) which are largely focused on health status. CONCLUSIONS A comprehensive list of QoL instruments and their characteristics is provided to inform instrument choice for use in research or for care quality assurance in aged care settings, depending on needs and interests of users.
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Affiliation(s)
- Joyce Siette
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- Centre for Ageing, Cognition and Wellbeing, Macquarie University, Sydney, New South Wales, Australia
| | - Gilbert Thomas Knaggs
- NHMRC Partnership Centre for Health Systems Sustainability, Macquarie University, Sydney, New South Wales, Australia
| | - Yvonne Zurynski
- NHMRC Partnership Centre for Health Systems Sustainability, Macquarie University, Sydney, New South Wales, Australia
| | - Julie Ratcliffe
- Health and Social Care Economics Group, Caring Futures Institute, Flinders University of South Australia, Adelaide, South Australia, Australia
| | - Laura Dodds
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Johanna Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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6
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Hammarlund RA, Whatley KL, Zielinski MH, Jubert JC. Benefits of Affordable Robotic Pet Ownership in Older Adults With Dementia. J Gerontol Nurs 2021; 47:18-22. [PMID: 33626160 DOI: 10.3928/00989134-20210209-03] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 12/04/2020] [Indexed: 11/20/2022]
Abstract
The current study investigated the impact of affordable robotic pet ownership on agitation, quality of life, and depression in older adults with dementia. Data are reported for five adults with dementia receiving day services at an all-inclusive care center for older adults (one male; mean age = 82.8 years). Data were collected three times to obtain baseline (Time 1 to Time 2) and post-intervention (Time 2 to Time 3) scores. Self-reported quality of life and depression symptoms improved post-intervention, but not during baseline. Caregiver-reported agitation did not change consistently across participants during baseline or post-intervention. Simple ownership of affordable robotic pets may be a feasible option to improve quality of life and affective experiences in individuals with dementia. Further work with larger samples should examine whether a combination of ownership and structured activity would produce changes more perceptible to caregivers. [Journal of Gerontological Nursing, 47(3), 18-22.].
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Bonfigliuoli C, Miraglia Raineri A, Foa' C, Guizzardi A, Catellani A, Manfredini D, Tripicchio I, Davoli B, Pitti G, Tojalli S, Salsi M, Lo Mastro G, Artioli G, Sarli L. A protocol for Italian validation of DEMQoL-Proxy Scale: assessing the Quality of Life of people with moderate or mild dementia. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021040. [PMID: 34328128 PMCID: PMC8383214 DOI: 10.23750/abm.v92is2.11974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 07/07/2021] [Indexed: 11/23/2022]
Abstract
In this paper, we propose an adaptation of a protocol for a tool's validation. We have utilized this phases-theory to validate in Italian language an instrument to assess Quality of Life for people with moderate or mild dementia. We will explain the example of our Italian validation of DEMQoL-Proxy considering each De Vellis's phase. We will explain our application of De Vellis's model to Italian example described. For the first three phases, we reproduced the original validating study in which authors (Smith et al., 2005) defined what to measure, how generate a set of items and the structure of the scale. Indeed, for the last five phases we explained the adaptation of De Vellis's model to Italian validation. We hope that this model could be effective to validating goals, for researchers and in particular for all professionals who deal with caregivers and patients with moderate and mild dementia. Furthermore, the measurement of the Quality of Life makes the scale widely useful within the various professional specialties and setting. Finally, thanks to the methodological assumptions adopted following the De Vellis's eight-phase model, we can affirm that this first Italian pre-validation of the DEMQoL-Proxy seems to be an excellent forerunner for its effective validation in the Italian context.
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Affiliation(s)
| | | | - Chiara Foa'
- Department of Medicine and Surgery, University of Parma, Italy .
| | | | - Alice Catellani
- Department of Medicine and Surgery, University of Parma, Italy .
| | | | - Ilari Tripicchio
- Department of Medicine and Surgery, University of Parma, Italy .
| | - Barbara Davoli
- Department of Medicine and Surgery, University of Parma, Italy .
| | - Giovanni Pitti
- Department of Medicine and Surgery, University of Parma, Italy .
| | - Shelsi Tojalli
- Department of Medicine and Surgery, University of Parma, Italy .
| | - Monica Salsi
- Department of Medicine and Surgery, University of Parma, Italy .
| | | | | | - Leopoldo Sarli
- Department of Medicine and Surgery, University of Parma, Italy .
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8
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Ayton DR, Gardam ML, Pritchard EK, Ruseckaite R, Ryan J, Robinson SJ, Brodaty H, Ward SA, Ahern S. Patient-Reported Outcome Measures to Inform Care of People With Dementia-A Systematic Scoping Review. THE GERONTOLOGIST 2021; 61:e185-e194. [PMID: 32369109 DOI: 10.1093/geront/gnz179] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Patient-reported outcome measures (PROMs) captures the patient's perspective regarding quality of life, daily functioning, symptom severity, and overall health, and how these may be impacted by health care or other interventions. PROMs are used in clinical quality registries (CQRs) for a number of diseases to assess the patient's perspective of the impact of clinical care on quality-of-life. This scoping review aimed to identify dementia-specific PROMs, determine how the PROMs are being used, and whether they are used within dementia registries. RESEARCH DESIGN AND METHODS Three electronic databases were searched using Medical Subject Heading terms for dementia, quality of life, and patient-reported outcomes. Data were extracted on the PROMs used and the methods and mode of administering the PROM. RESULTS Seven dementia-specific PROMs were identified, however none were used in a dementia registry. All the PROMs were used at the patient level to identify patient needs and health service impacts. Three PROMs were also used at a system level to examine difference in care models. The majority of the PROMs were administered via a researcher or clinician and were predominantly completed by a proxy. DISCUSSION AND IMPLICATIONS PROMs provide an opportunity for a patient with dementia to share experiences and perspectives of care. A number of dementia-specific PROMs exist, yet none are used in dementia registries and the majority of studies utilize PROMs via a proxy. The use of PROM for patients with dementia, particularly in the context of dementia registries, requires further exploration and consideration.
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Affiliation(s)
- Darshini R Ayton
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Madeleine L Gardam
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Elizabeth K Pritchard
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Rasa Ruseckaite
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Joanne Ryan
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Sandra J Robinson
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Henry Brodaty
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Stephanie A Ward
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Susannah Ahern
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Orgeta V, Tuijt R, Leung P, Verdaguer ES, Gould RL, Jones R, Livingston G. Behavioral Activation for Promoting Well-Being in Mild Dementia: Feasibility and Outcomes of a Pilot Randomized Controlled Trial. J Alzheimers Dis 2020; 72:563-574. [PMID: 31609689 DOI: 10.3233/jad-190696] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Engaging in meaningful and enjoyable activities is an important contributor to well-being and maintaining good quality of life. There is a paucity of randomized controlled trials of interventions supporting people with mild dementia to engage in meaningful and purposeful activity. The aim of this study was to assess whether Behavioral Activation (BA) is an acceptable psychological intervention for people with mild dementia and whether a large-scale trial is feasible. Participants were randomly assigned to BA (n = 42) or treatment as usual (TAU) (n = 21). BA aimed at increasing engagement in enjoyable and meaningful activity, and preventing low mood. Follow-up was at 3 and 6 months. Assessors were blind to treatment allocation (trial registration number: ISRCTN75503960). Retention rate was above 80% at both assessment time points. Treatment acceptability and credibility were high. Depressive symptoms remained unchanged in both groups. There was evidence of improvement associated with BA for every day function (-3.92, 95% Confidence Interval (CI) -6.87 to -0.97), and engagement in meaningful and enjoyable activity (5.08, 95% CI 0.99 to 9.16) post-treatment (3 months) in comparison to TAU. Both carer-rated patient health-related quality of life (0.16, 95% CI 0.04 to 0.28) and physical health (11.31, 95% CI 2.03 to 20.59) showed evidence of improvement at 3 months. Improvements in meaningful and enjoyable activity were maintained at 6 months.BA for people with mild dementia is feasible and acceptable and may be associated with clinically significant changes in function and quality of life. A full scale randomized controlled trial of clinical effectiveness is now needed.
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Maresova P, Hruska J, Klimova B, Barakovic S, Krejcar O. Activities of Daily Living and Associated Costs in the Most Widespread Neurodegenerative Diseases: A Systematic Review. Clin Interv Aging 2020; 15:1841-1862. [PMID: 33061334 PMCID: PMC7538005 DOI: 10.2147/cia.s264688] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 09/04/2020] [Indexed: 12/20/2022] Open
Abstract
Nowadays, the population is rapidly ageing because of increasing life expectancy and decreasing birth rates. Thus, the purpose of this systematic review is to prepare a comprehensive overview which identifies the activities of daily living (ADLs) that are gradually reduced among patients with dementia, as well as explore the therapies applied in relation to dementia and how they effectively improve the quality of life (QoL) of patients and caregivers. Furthermore, we aim to summarise the ADL activities influenced by therapies and examine the treatment costs and care for patients so that recommendations for research and development (R&D) can be made to improve both the QoL of people with dementia and cost-saving measures. The research focuses on four selected neurodegenerative diseases: Alzheimer, Parkinson, vascular dementia, and amyotrophic lateral sclerosis. Therefore, the peer-reviewed English written articles from 2014 to 2019 were searched between September 1 and December 13, 2019. Twenty-seven papers were included in the analysis. The results show that essential assistance occurs in connection with activities: eating, drinking, dressing, bathing, personal hygiene, use of the toilet, and transport. By contrast, shopping or cleaning is not addressed as much. A lower ability to take care of oneself is connected with poor patient health and higher social care costs because the patient requires care from external sources, such as home aid or nurse visits. The challenge that remains is to shift new knowledge from scientific disciplines and connect it with the needs of patients to remove legitimate barriers and increase the acceptance of new solutions by popularisation. Additionally, regarding the burden on caregivers, it would be appropriate to promote this area of education and employment so that family members can use formal caregivers, ensuring them free time and much-needed rest.
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Affiliation(s)
- Petra Maresova
- Department of Economics, Faculty of Informatics and Management, University of Hradec Kralove, Hradec Kralove 500 03, Czech Republic
| | - Jan Hruska
- Department of Economics, Faculty of Informatics and Management, University of Hradec Kralove, Hradec Kralove 500 03, Czech Republic
| | - Blanka Klimova
- Department of Applied Linguistics, Faculty of Informatics and Management, University of Hradec Kralove, Hradec Kralove 500 03, Czech Republic
| | - Sabina Barakovic
- Faculty of Transport and Communications, University of Sarajevo, Sarajevo 71000, Bosnia and Herzegovina
| | - Ondrej Krejcar
- Center for Basic and Applied Science, Faculty of Informatics and Management, University of Hradec Kralove, Hradec Kralove 500 03, Czech Republic
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Guisado-Fernandez E, Blake C, Mackey L, Silva PA, Power D, O'Shea D, Caulfield B. A Smart Health Platform for Measuring Health and Well-Being Improvement in People With Dementia and Their Informal Caregivers: Usability Study. JMIR Aging 2020; 3:e15600. [PMID: 32706650 PMCID: PMC7413274 DOI: 10.2196/15600] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 05/08/2020] [Accepted: 05/25/2020] [Indexed: 12/15/2022] Open
Abstract
Background Dementia is a neurodegenerative chronic condition characterized by a progressive decline in a person’s memory, thinking, learning skills, and the ability to perform activities of daily living. Previous research has indicated that there are many types of technology interventions available in the literature that have shown promising results in improving disease progression, disease management, and the well-being of people with dementia (PwD) and their informal caregiver, thus facilitating dementia care and living. Technology-driven home care interventions, such as Connected Health (CH), could offer a convenient and low-cost alternative to traditional home care, providing an informal caregiver with the support they may need at home while caring for a PwD, improving their physical and mental well-being. Objective This study aimed (1) to create a multidimensional profile for evaluating the well-being progression of the PwD–informal caregiver dyad for a year during their use of a CH platform, designed for monitoring PwD and supporting their informal caregivers at home, and (2) to conduct a long-term follow-up using the proposed well-being profile at different time-interval evaluations. Methods The PwD–informal caregiver well-being profile was created based on the World Health Organization International Classification of Functioning considering the following outcomes: functional status, cognitive status, and quality of life for the PwD and mental well-being, sleeping quality, and burden for the informal caregiver. Over a year, comprehensive assessments of these outcomes were conducted every 3 months to evaluate the well-being of PwD–informal caregivers, using international and standardized validated questionnaires. Participants’ demographic information was analyzed using descriptive statistics and presented as means and SDs. A nonparametric Friedman test was used to analyze the outcome changes and the progression in the PwD-caregiver dyads and to determine if those changes were statistically significant. Results There were no significant changes in the well-being of PwD or their caregivers over the year of follow-up, with the majority of the PwD-caregiver dyads remaining stable. The only instances in which significant changes were observed were the functional status in the PwD and sleep quality in their caregivers. In each of these measures, post hoc pairwise comparisons did not indicate that the changes observed were related to the deployment of the CH platform. Conclusions The follow-up of this population of PwD and their informal caregivers has shown that disease progression and physical and mental well-being do not change significantly during the time, being a slow and gradual process. The well-being profile created to analyze the potential impact of the CH platform on the PwD–informal caregiver dyad well-being, once validated, could be used as a future tool to conduct the same analyses with other CH technologies for this population. International Registered Report Identifier (IRRID) RR2-10.2196/13280
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Affiliation(s)
| | - Catherine Blake
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Laura Mackey
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Paula Alexandra Silva
- Department of Informatics Engineering (DEI), Center for Informatics and Systems of the University of Coimbra (CISUC), University of Coimbra, Coimbra, Portugal
| | - Dermot Power
- Medicine for the Elderly, Mater University Hospital, Dublin, Ireland
| | - Diarmuid O'Shea
- Department of Geriatric Medicine, Saint Vincent's University Hospital, Dublin, Ireland
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Leroi I, Simkin Z, Hooper E, Wolski L, Abrams H, Armitage CJ, Camacho E, Charalambous AP, Collin F, Constantinidou F, Dawes P, Elliott R, Falkingham S, Frison E, Hann M, Helmer C, Himmelsbach I, Hussain H, Marié S, Montecelo S, Thodi C, Yeung WK. Impact of an intervention to support hearing and vision in dementia: The SENSE-Cog Field Trial. Int J Geriatr Psychiatry 2020; 35:348-357. [PMID: 31713262 PMCID: PMC7079053 DOI: 10.1002/gps.5231] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 11/07/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Hearing, vision, and cognitive impairment commonly co-occur in older adults. Improving sensory function may positively impact outcomes in people with dementia (PwD). We developed a "sensory intervention" (SI) to support hearing and vision in PwD. Here, we report the findings of an international open-label field trial, and nested case series, to explore the impact of the SI on dementia-related outcomes. METHODS This was a home-based trial conducted in France, England, and Cyprus. Participants were people with mild-to-moderate dementia and hearing and/or vision impairment (n = 19) and their study partners (unpaid carers; n = 19). The "basic" SI included a hearing and vision assessment and provision of glasses and/or hearing aids. A subsample received the "extended" SI with additional weekly visits from a sensory support therapist (SST). Exploratory analyses of dementia-related, health utility and resource utilisation outcomes were performed. RESULTS Quality of life (QoL) and sensory functional ability improved. Change in QoL exceeded the threshold for a minimum clinically important difference. There was a modest improvement (in absolute terms) post intervention in behavioural disturbance, self-efficacy, and relationship satisfaction. Study partner time assisting instrumental activities of daily living (iADL) and supervision decreased by about 22 and 38 hours per month, respectively, although time for personal ADL support increased. Qualitative data supported effectiveness of the intervention: PwD were more socially engaged, less isolated, less dependent on study partners, and had improved functional ability and communication. CONCLUSIONS These findings support the need for a definitive randomised controlled trial (RCT) to evaluate the effectiveness of the intervention.
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Affiliation(s)
- Iracema Leroi
- Global Brain Health InstituteTrinity College DublinDublinIreland
- Division of Neuroscience and Experimental PsychologyUniversity of ManchesterManchesterUK
| | - Zoe Simkin
- Division of Neuroscience and Experimental PsychologyUniversity of ManchesterManchesterUK
| | - Emma Hooper
- Division of Neuroscience and Experimental PsychologyUniversity of ManchesterManchesterUK
| | - Lucas Wolski
- Institute of Applied Research, Development and Further EducationCatholic University of Applied Sciences FreiburgFreiburgGermany
| | - Harvey Abrams
- Department of Communication Sciences and DisordersUniversity of South FloridaTampaFL
| | | | - Elizabeth Camacho
- Manchester Centre for Health EconomicsUniversity of ManchesterManchesterUK
| | | | - Fideline Collin
- INSERM, EUCLID/F‐CRIN Clinical Trials PlatformUniversity of BordeauxTalenceAquitaineFrance
| | | | - Piers Dawes
- Manchester Centre for Audiology and DeafnessUniversity of ManchesterManchesterUK
| | - Rachel Elliott
- Manchester Centre for Health EconomicsUniversity of ManchesterManchesterUK
| | - Sue Falkingham
- Department of AudiologyStarkey Hearing TechnologiesStockportUK
| | - Eric Frison
- INSERM, EUCLID/F‐CRIN Clinical Trials PlatformUniversity of BordeauxTalenceAquitaineFrance
| | - Mark Hann
- Centre for BiostatisticsUniversity of ManchesterManchesterUK
| | - Catherine Helmer
- INSERM, Bordeaux Population Health Research Center, Team LEHAUniversity of BordeauxTalenceAquitaineFrance
| | - Ines Himmelsbach
- Institute of Applied Research, Development and Further EducationCatholic University of Applied Sciences FreiburgFreiburgGermany
| | - Hannah Hussain
- Manchester Centre for Health EconomicsUniversity of ManchesterManchesterUK
| | - Sarah Marié
- Research and DevelopmentEssilor InternationalParisFrance
| | | | - Chryssoula Thodi
- Department of Health SciencesEuropean University CyprusNicosiaCyprus
| | - Wai Kent Yeung
- Division of Neuroscience and Experimental PsychologyUniversity of ManchesterManchesterUK
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13
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Robertson S, Cooper C, Hoe J, Lord K, Rapaport P, Marston L, Cousins S, Lyketsos CG, Livingston G. Comparing proxy rated quality of life of people living with dementia in care homes. Psychol Med 2020; 50:86-95. [PMID: 30691541 PMCID: PMC6945323 DOI: 10.1017/s0033291718003987] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 10/31/2018] [Accepted: 12/06/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Improving quality of life (QOL) for people with dementia is a priority. In care homes, we often rely on proxy ratings from staff and family but we do not know if, or how, they differ in care homes. METHODS We compared 1056 pairs of staff and family DEMQOL-Proxy ratings from 86 care homes across England. We explored factors associated with ratings quantitatively using multilevel modelling and, qualitatively, through thematic analysis of 12 staff and 12 relative interviews. RESULTS Staff and family ratings were weakly correlated (ρs = 0.35). Median staff scores were higher than family's (104 v. 101; p < 0.001). Family were more likely than staff to rate resident QOL as 'Poor' (χ2 = 55.91, p < 0.001). Staff and family rated QOL higher when residents had fewer neuropsychiatric symptoms and severe dementia. Staff rated QOL higher in homes with lower staff:resident ratios and when staff were native English speakers. Family rated QOL higher when the resident had spent longer living in the care home and was a native English. Spouses rated residents' QOL higher than other relatives. Qualitative results suggest differences arise because staff felt good care provided high QOL but families compared the present to the past. Family judgements centre on loss and are complicated by decisions about care home placement and their understandings of dementia. CONCLUSION Proxy reports differ systematically between staff and family. Reports are influenced by the rater:staff and family may conceptualise QOL differently.
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Affiliation(s)
- S. Robertson
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - C. Cooper
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - J. Hoe
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - K. Lord
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - P. Rapaport
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - L. Marston
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - S. Cousins
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - C. G. Lyketsos
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - G. Livingston
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
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14
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Robertson S, Cooper C, Hoe J, Lord K, Rapaport P, Livingston G. Why do staff and family think differently about quality of life in dementia? A qualitative study exploring perspectives in care homes. Int J Geriatr Psychiatry 2019; 34:1784-1791. [PMID: 31397501 DOI: 10.1002/gps.5193] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 08/06/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND Quality of life is important especially in incurable illness. In dementia, we often need proxy reports of quality of life, but we know little about how individuals make their judgements. In care homes, proxies may be staff providing care or relatives, but staff rate quality of life differently to family. To our knowledge, no one has explored this qualitatively, so we used qualitative interviews to explore why staff and family think differently about quality of life. METHODS We interviewed 12 staff and 12 relatives who had provided proxy ratings of quality of life for people living with dementia in care homes in the Managing Agitation and Raising Quality of life (MARQUE) study. We asked why they had rated the resident's quality of life as "Very Good, Good, Fair, or Poor." Using thematic analysis, we compared staff and relatives' proxy responses. RESULTS For staff, the concept of quality of life was often viewed synonymously with quality of care, influenced by their sense of responsibility and informed by their professional understanding. For relatives, quality of life was often judged in relation to how the person with dementia lived before diagnosis and was influenced by their perception of loss for the person with dementia and their own adjustment. CONCLUSIONS Proxy reports were influenced by rater's own contexts and experiences. This can enhance our understanding of widely used research tools, aid the evaluation of intervention outcomes, and indicate possible targets for improving perceived and actual quality of life of people with dementia.
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Affiliation(s)
- Sarah Robertson
- Division of Psychiatry, University College London (UCL), London, UK.,School of Psychology, University of Liverpool, Liverpool, UK
| | - Claudia Cooper
- Division of Psychiatry, University College London (UCL), London, UK
| | | | - Kathryn Lord
- Bradford Dementia Group, The University of Bradford, Bradford, UK
| | - Penny Rapaport
- Division of Psychiatry, University College London (UCL), London, UK
| | - Gill Livingston
- Division of Psychiatry, University College London (UCL), London, UK
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Chua KC, Böhnke JR, Prince M, Banerjee S. Health-related quality-of-life assessment in dementia: Evidence of cross-cultural validity in Latin America. Psychol Assess 2019; 31:1264-1277. [PMID: 31282701 PMCID: PMC6818683 DOI: 10.1037/pas0000743] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 04/24/2019] [Accepted: 05/16/2019] [Indexed: 11/17/2022]
Abstract
All health-related quality-of-life (HRQL) measures for dementia have been developed in high-income countries and none were validated for cross-cultural use. Yet, the global majority of people living with dementia reside in low- and middle-income countries. We therefore investigated the measurement invariance of a set of self- and informant-report HRQL measures developed in the United Kingdom when used in Latin America. Self-reported HRQL was obtained using (DEMQOL) at a memory assessment service in the United Kingdom (n = 868) and a population cohort study in Latin America (n = 417). Informant reports were collected using DEMQOL-Proxy at both sites (n = 909 and n = 495). Multiple-group confirmatory bifactor models for ordered categorical item responses were estimated to evaluate measurement invariance. Results support configural, metric, and scalar invariance for the concept of general HRQL in DEMQOL and DEMQOL-Proxy. The dominant impact of general HRQL on item responses was evident across U.K. English and Ibero American Spanish versions of DEMQOL (ωh = 0.87-0.90) and DEMQOL-Proxy (ωh = 0.88-0.89). Ratings of "positive emotion" did not show a major impact on general HRQL appraisal, particularly for Latin American respondents. Item information curves show that self- and informant-reports were highly informative about the presence rather than the absence of HRQL impairment. We found no major difference in conceptual meaning, sensitivity, and relevance of DEMQOL and DEMQOL-Proxy for older adults in the United Kingdom and Latin America. Further replication is needed for consensus over which HRQL measures are appropriate for making cross-national comparisons in global dementia research. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
- Kia-Chong Chua
- Centre for Implementation Science, Institute of Psychiatry, Psychology, and Neuroscience
| | - Jan R Böhnke
- School of Nursing and Health Sciences, University of Dundee
| | - Martin Prince
- King's Global Health Institute, Institute of Psychiatry, Psychology, and Neuroscience, King's College London
| | - Sube Banerjee
- Centre for Dementia Studies, Brighton and Sussex Medical School, University of Sussex
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16
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Guisado-Fernandez E, Caulfield B, Silva PA, Mackey L, Singleton D, Leahy D, Dossot S, Power D, O'Shea D, Blake C. Development of a Caregivers' Support Platform (Connected Health Sustaining Home Stay in Dementia): Protocol for a Longitudinal Observational Mixed Methods Study. JMIR Res Protoc 2019; 8:13280. [PMID: 31464187 PMCID: PMC6786855 DOI: 10.2196/13280] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 06/04/2019] [Accepted: 06/04/2019] [Indexed: 12/23/2022] Open
Abstract
Background Dementia disease is a chronic condition that leads a person with dementia (PwD) into a state of progressive deterioration and a greater dependence in performing their activities of daily living (ADL). It is believed nowadays that PwDs and their informal caregivers can have a better life when provided with the appropriate services and support. Connected Health (CH) is a new technology-enabled model of chronic care delivery where the stakeholders are connected through a health portal, ensuring continuity and efficient flow of information. CH has demonstrated promising results regarding supporting informal home care and Aging in Place, and it has been increasingly considered by researchers and health care providers as a method for dementia home care management. Objective This study aims to describe the development and implementation protocol of a CH platform system to support informal caregivers of PwDs at home. Methods This is a longitudinal observational mixed methods study where quantitative and qualitative data will be combined for determining the utility of the CH platform for dementia home care. Dyads, consisting of a PwD and their informal caregiver living in the community, will be divided into 2 groups: the intervention group, which will receive the CH technology package at home, and the usual care group, which will not have any CH technology at all. Dyads will be followed up for 12 months during which they will continue with their traditional care plan, but in addition, the intervention group will receive the CH package for their use at home during 6 months (months 3 to 9 of the yearly follow-up). Further comprehensive assessments related to the caregiver’s and PwD’s emotional and physical well-being will be performed at the initial assessment and at 3, 6, 9, and 12 months using international and standardized validated questionnaires and semistructured individual interviews. Results This 3-year funded study (2016-2019) is currently in its implementation phase and is expected to finish by December 2019. We believe that CH can potentially change the PwD current care model, facilitating a proactive and preventive model, utilizing self-management–based strategies, and enhancing caregivers’ involvement in the management of health care at home for PwDs. Conclusions We foresee that our CH platform will provide knowledge and promote autonomy for the caregivers, which may empower them into greater control of the care for PwDs, and with it, improve the quality of life and well-being for the person they are caring for and for themselves through a physical and cognitive decline predictive model. We also believe that facilitating information sharing between all the PwDs’ care stakeholders may enable a stronger relationship between them, facilitate a more coordinated care plan, and increase the feelings of empowerment in the informal caregivers. International Registered Report Identifier (IRRID) DERR1-10.2196/13280
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Affiliation(s)
- Estefania Guisado-Fernandez
- Insight Centre for Data Analytics, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Brian Caulfield
- Insight Centre for Data Analytics, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | | | - Laura Mackey
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - David Singleton
- Applied Research for Connected Health, University College Dublin, Dublin, Ireland
| | - Daniel Leahy
- Applied Research for Connected Health, University College Dublin, Dublin, Ireland
| | - Sébastien Dossot
- Applied Research for Connected Health, University College Dublin, Dublin, Ireland
| | - Dermot Power
- Medicine for the Older Person, Mater University Hospital, Dublin, Ireland
| | - Diarmuid O'Shea
- Department of Geriatric Medicine, St. Vincent's University Hospital, Dublin, Ireland
| | - Catherine Blake
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
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17
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Crotty M, Killington M, Liu E, Cameron ID, Kurrle S, Kaambwa B, Davies O, Miller M, Chehade M, Ratcliffe J. Should we provide outreach rehabilitation to very old people living in Nursing Care Facilities after a hip fracture? A randomised controlled trial. Age Ageing 2019; 48:373-380. [PMID: 30794284 PMCID: PMC6503935 DOI: 10.1093/ageing/afz005] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Revised: 12/11/2018] [Accepted: 01/22/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE to determine whether a 4-week postoperative rehabilitation program delivered in Nursing Care Facilities (NCFs) would improve quality of life and mobility compared with receiving usual care. DESIGN parallel randomised controlled trial with integrated health economic study. SETTING NCFs, in Adelaide South Australia. SUBJECTS people aged 70 years and older who were recovering from hip fracture surgery and were walking prior to hip fracture. MEASUREMENTS primary outcomes: mobility (Nursing Home Life-Space Diameter (NHLSD)) and quality of life (DEMQOL) at 4 weeks and 12 months. RESULTS participants were randomised to treatment (n = 121) or control (n = 119) groups. At 4 weeks, the treatment group had better mobility (NHLSD mean difference -1.9; 95% CI: -3.3, -0.57; P = 0.0055) and were more likely to be alive (log rank test P = 0.048) but there were no differences in quality of life. At 12 months, the treatment group had better quality of life (DEMQOL sum score mean difference = -7.4; 95% CI: -12.5 to -2.3; P = 0.0051), but there were no other differences between treatment and control groups. Quality adjusted life years (QALYs) gained over 12 months were 0.0063 higher per participant (95% CI: -0.0547 to 0.0686). The resulting incremental cost effectiveness ratios (ICERs) were $5,545 Australian dollars per unit increase in the NHLSD (95% CI: $244 to $15,159) and $328,685 per QALY gained (95% CI: $82,654 to $75,007,056). CONCLUSIONS the benefits did not persist once the rehabilitation program ended but quality of life at 12 months in survivors was slightly higher. The case for funding outreach home rehabilitation in NCFs is weak from a traditional health economic perspective. TRIAL REGISTRATION ACTRN12612000112864 registered on the Australian and New Zealand Clinical Trials Registry. Trial protocol available at https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id = 361980.
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Affiliation(s)
- Maria Crotty
- Rehabilitation, Aged and Extended Care, Flinders University, Finders Medical Centre, Level 4 Rehabilitation Building, Flinders Drive, Bedford Park SA, Australia
| | - Maggie Killington
- Rehabilitation, Aged and Extended Care, Flinders University, Finders Medical Centre, Level 4 Rehabilitation Building, Flinders Drive, Bedford Park SA, Australia
| | - Enwu Liu
- Rehabilitation, Aged and Extended Care, Flinders University, Finders Medical Centre, Level 4 Rehabilitation Building, Flinders Drive, Bedford Park SA, Australia
- Musculoskeletal Health and Ageing Research Program, Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne Vic, Australia
| | - Ian D Cameron
- John Walsh Centre for Rehabilitation Research, University of Sydney, Royal North Shore Hospital, St Leonards NSW, Australia
| | - Susan Kurrle
- Cognitive Decline Partnership Centre, University of Sydney, Hornsby Ku-ring-gai Hospital, Hornsby NSW, Australia
| | - Billingsley Kaambwa
- Health Economics Unit, Flinders University, Health Sciences Building, Sturt Road, Bedford Park SA, Australia
| | - Owen Davies
- Rehabilitation, Aged and Extended Care, Flinders University, Finders Medical Centre, Level 4 Rehabilitation Building, Flinders Drive, Bedford Park SA, Australia
| | - Michelle Miller
- Department of Nutrition and Dietetics, College of Nursing and Health Sciences, Flinders University, Bedford Park SA, Australia
| | - Mellick Chehade
- Centre for Orthopaedic Trauma and Research, University of Adelaide, Adelaide SA, Australia
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide SA, Australia
- Centre of Research Excellence in Frailty and Healthy Ageing, University of Adelaide, Adelaide SA, Australia
| | - Julie Ratcliffe
- Health and Social Care Economics Group, Flinders University, Sturt Road, Bedford Park SA, Australia
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18
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Usman A, Lewis S, Hinsliff-Smith K, Long A, Housley G, Jordan J, Gage H, Dening T, Gladman JRF, Gordon AL. Measuring health-related quality of life of care home residents: comparison of self-report with staff proxy responses. Age Ageing 2019; 48:407-413. [PMID: 30615057 PMCID: PMC6503932 DOI: 10.1093/ageing/afy191] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 10/25/2018] [Accepted: 11/22/2018] [Indexed: 12/31/2022] Open
Abstract
Introduction care home residents are often unable to complete health-related quality of life questionnaires for themselves because of prevalent cognitive impairment. This study compared care home resident and staff proxy responses for two measures, the EQ-5D-5L and HowRU. Methods a prospective cohort study recruited residents ≥60 years across 24 care homes who were not receiving short stay, respite or terminal care. Resident and staff proxy EQ-5D-5L and HowRu responses were collected monthly for 3 months. Weighted kappa statistics and intra-class correlation coefficients (ICCs) adjusted for clustering at the care home level were used to measure agreement between resident and proxies for each time point. The effect of staff and resident baseline variables on agreement was considered using a multilevel mixed effect regression model. Results 117, 109 and 104 matched pairs completed the questionnaires at 1, 2 and 3 months, respectively. When clustering was controlled for, agreement between resident and staff proxy EQ-5D-5L responses was fair for mobility (ICC: 0.29) and slight for all other domains (ICC ≤ 0.20). EQ-5D Index and Quality-Adjusted Life Year scores (proxy scores higher than residents) showed better agreement than EQ-5D-VAS (residents scores higher than proxy). HowRU showed only slight agreement (ICC ≤ 0.20) between residents and proxies. Staff and resident characteristics did not influence level of agreement for either index. Discussion the levels of agreement for EQ-5D-5L and HowRU raise questions about their validity in this population.
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Affiliation(s)
- Adeela Usman
- Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, University of Nottingham, Derby, UK
| | - Sarah Lewis
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Kathryn Hinsliff-Smith
- Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, University of Nottingham, Derby, UK
| | - Annabelle Long
- Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, University of Nottingham, Derby, UK
| | - Gemma Housley
- East Midlands Academic Health Science Network, Nottingham, UK
| | - Jake Jordan
- Department of Clinical and Experimental Medicine, Surrey Health Economics Centre, University of Surrey, Guildford, UK
| | - Heather Gage
- Department of Clinical and Experimental Medicine, Surrey Health Economics Centre, University of Surrey, Guildford, UK
| | - Tom Dening
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
| | - John R F Gladman
- Division of Rehabilitation and Ageing, University of Nottingham, Nottingham, UK
- East Midlands Collaboration for Leadership in Applied Health Research and Care, Nottingham, UK
- Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK
| | - Adam L Gordon
- Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, University of Nottingham, Derby, UK
- East Midlands Collaboration for Leadership in Applied Health Research and Care, Nottingham, UK
- Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK
- School of Health Sciences, City, University of London, London, UK
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Item distribution, internal consistency, and structural validity of the German version of the DEMQOL and DEMQOL-proxy. BMC Geriatr 2018; 18:247. [PMID: 30340468 PMCID: PMC6194625 DOI: 10.1186/s12877-018-0930-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 09/26/2018] [Indexed: 11/25/2022] Open
Abstract
Background Accurate assessment of health-related quality of life as an endpoint in intervention studies is a major challenge in dementia research. The DEMQOL (29 items) and the proxy version (32 items), which is partly based on the DEMQOL, are internationally used instruments. To date, there is no information on the structural validity, item distribution, or internal consistency for the German language version of these questionnaires. Methods This psychometric study is based on a secondary data analysis of a sample of 201 outpatients with a mild form of Alzheimer’s disease (AD) and their informal caregivers. The informal caregivers who were interviewed were involved in the care of the person with AD several times per week. The analysis for the evaluation of the structural validity was performed using Mokken scale analysis. The internal consistency was calculated using the ρ of the Molenaar Sijtsma statistic and Cronbach’s α. Results For both versions, four subscales were identified: [A] “positive emotions”, [B] “negative emotions”, [C] “physical and cognitive functioning”, and [D] “daily activities and social relationships”. For both instruments, the internal consistency of all subscales was considered “good” (ρ = 0.71–0.88, α = 0.72–0.87). Conclusions The results are a first indication of good construct validity of the instruments used for the German setting. We recommend further investigations of the test-retest reliability and the inter-rater reliability of the proxy instrument. Electronic supplementary material The online version of this article (10.1186/s12877-018-0930-0) contains supplementary material, which is available to authorized users.
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20
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Sopina E, Chenoweth L, Luckett T, Agar M, Luscombe GM, Davidson PM, Pond CD, Phillips J, Goodall S. Health-related quality of life in people with advanced dementia: a comparison of EQ-5D-5L and QUALID instruments. Qual Life Res 2018; 28:121-129. [PMID: 30187395 DOI: 10.1007/s11136-018-1987-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Assessing health-related quality of life (HRQOL) in people with advanced dementia is challenging but important for informed decision-making. Proxy measurement of this construct is difficult and is often rated lower than self-report. Accurate proxy rating of quality of life in dementia is related to identification of concepts important to the person themselves, as well as the sensitivity of the measures used. The main aim of this study was to compare the performance of two instruments-QUALID and EQ-5D-5L-on measuring HRQOL in people with advanced dementia. METHODS In a sub-study nested within a cluster-RCT we collected proxy(nurse)-completed EQ-5D-5L and QUALID measures at baseline, 3, 6, 9 and 12 months' follow-up for people with advanced dementia, residing in 20 nursing homes across Australia. Spearman's rank correlations, partial correlations and linear regressions were used to assess the relationship between the HRQOL instrument scores and their changes over time. RESULTS The mean weight from 284 people for the EQ-5D-5L and QUALID at baseline were 0.004 (95% CI - 0.026, 0.033) and 24.98 (95% CI 24.13, 25.82), respectively. At 12 months' follow-up, 115 participants remained alive. EQ-5D-5L weights and QUALID scores at baseline and at follow-up were moderately correlated (r = - 0.437; p < 0.001 at 12 months). Changes within QUALID and EQ-5D-5L across the same follow-up periods were also correlated (r = - 0.266; p = 0.005). The regression analyses support these findings. CONCLUSION Whilst these quality of life instruments demonstrated moderate correlation, the EQ-5D-5L does not appear to capture all aspects of quality of life that are relevant to people with advanced dementia and we cannot recommend the use of this instrument for use within this population. The QUALID appears to be a more suitable instrument for measuring HRQOL in people with severe dementia, but is not preference-based, which limits its application in economic evaluations of dementia care.
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Affiliation(s)
- Elizaveta Sopina
- Department of Public Health, Danish Centre for Health Economics (DaCHE), University of Southern Denmark, J.B. Winsløws Vej 9B, 5000, Odense C, Denmark.
| | - Lynn Chenoweth
- Centre for Healthy Brain Ageing, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Tim Luckett
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), Faculty of Health, University of Technology Sydney (UTS), Sydney, Australia
| | - Meera Agar
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), Faculty of Health, University of Technology Sydney (UTS), Sydney, Australia.,Ingham Institute for Applied Medical Research, 1 Campbell Street, Liverpool, 2164, UK
| | | | - Patricia M Davidson
- Department of Acute and Chronic Care, School of Nursing, John Hopkins University, Baltimore, MD, USA
| | - Constance D Pond
- Discipline of General Practice, University of Newcastle, Newcastle, Australia
| | - Jane Phillips
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), Faculty of Health, University of Technology Sydney (UTS), Sydney, Australia
| | - Stephen Goodall
- Centre for Health Economics Research and Evaluation, UUTS Business School, University of Technology Sydney, Sydney, Australia
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Abstract
Our experience evaluating a museum program for people with dementia together with their family members demonstrated benefits for all participants. We hypothesized that participation in a chorus would also have positive effects, giving them an opportunity to share a stimulating and social activity that could improve their quality of life. We inaugurated a chorus for people with dementia and their family caregivers in 2011, which rehearses and performs regularly. Each person with dementia must be accompanied by a friend or family member and must commit to attending all rehearsals and the concert that ensues. A pilot study included a structured assessment, take home questionnaires and focus groups. Analyses of pre-post scores were conducted; effect size was quantified using Cohen's d. Results showed that quality of life and communication with the other member of the dyad improved (Effect size: Cohen's d between 0.32 and 0.72) for people with dementia; quality of life, social support, communication and self-esteem improved (d between 0.29 and 0.68) for caregivers. Most participants stated that benefits included belonging to a group, having a normal activity together and learning new skills. Participants attended rehearsals in spite of harsh weather conditions. The chorus has been rehearsing and performing together for more than 6 years and contributing to its costs. Results of this pilot study suggest that people in the early to middle stage of dementia and their family members and friends can enjoy and learn from rehearsing and performing in concerts that also engage the wider community. It is essential to conduct additional larger studies of the benefits of participating in a chorus, which may include improved quality of life and social support for all, and reduced cognitive decline among people with dementia.
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Sopina E, Sørensen J. Decision modelling of non-pharmacological interventions for individuals with dementia: a systematic review of methodologies. HEALTH ECONOMICS REVIEW 2018; 8:8. [PMID: 29582186 PMCID: PMC6755571 DOI: 10.1186/s13561-018-0192-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 03/15/2018] [Indexed: 05/30/2023]
Abstract
OBJECTIVES The main objective of this study is to conduct a systematic review to identify and discuss methodological issues surrounding decision modelling for economic evaluation of non-pharmacological interventions (NPIs) in dementia. METHODS A systematic search was conducted for publications using decision modelling to investigate the cost-effectiveness of NPIs for individuals with dementia. Search was limited to studies in English. Studies were excluded if they evaluated interventions aimed only at caregivers of patients with dementia, or if they only included economic evaluation alongside an RCT without additional modelling. RESULTS Two primary, five secondary and three tertiary prevention intervention studies were identified and reviewed. Five studies utilised Markov models, with others using discrete event, regression-based simulation, and decision tree approaches. A number of challenging methodological issues were identified, including the use of MMSE-score as the main outcome measure, limited number of strategies compared, restricted time horizons, and limited or dated data on dementia onset, progression and mortality. Only one of the three tertiary prevention studies explicitly considered the effectiveness of pharmacological therapies alongside their intervention. CONCLUSIONS Economic evaluations of NPIs in dementia should utilise purposefully-developed decision models, and avoid models for evaluation of pharmaceuticals. Broader outcome measures could be a way to capture the wide impact of NPIs for dementia in future decision models. It is also important to account for the effects of pharmacological therapies alongside the NPIs in economic evaluations. Access to more localised and up-to-date data on dementia onset, progression and mortality is a priority for accurate prediction.
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Affiliation(s)
- Elizaveta Sopina
- Centre of Health Economics (COHERE), Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9, 5000 Odense, Denmark
| | - Jan Sørensen
- Centre of Health Economics (COHERE), Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9, 5000 Odense, Denmark
- Healthcare Outcomes Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
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Tuijt R, Livingston G, Gould RL, Jones R, Verdaguer ES, Orgeta V. IDEA intervention to prevent depressive symptoms and promote well-being in early-stage dementia: protocol for a randomised controlled feasibility study. BMJ Open 2018; 8:e021074. [PMID: 29439085 PMCID: PMC5879789 DOI: 10.1136/bmjopen-2017-021074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE Depressive symptoms are common among people with dementia, impacting quality of life and cognitive and functional decline. Currently, little is known about the acceptability and feasibility of psychological interventions for people with mild dementia, with recent reviews identifying the need for further evidence. Developing and evaluating psychological interventions to prevent and treat these symptoms is, therefore, an important clinical and research priority. This protocol describes a study testing the acceptability and feasibility of a manual-based behavioural activation (BA) intervention for preventing and treating depressive symptoms in people with mild dementia. The aim of this study is to explore the feasibility of conducting a pragmatic multicentre randomised controlled trial of clinical effectiveness of an eight-session intervention. The Intervention to prevent Depressive symptoms and promote well-being in EArly-stage dementia (IDEA) programme supports people with dementia and their family carers in identifying and scheduling enjoyable and meaningful activities. METHODS AND ANALYSIS Sixty people who have received a diagnosis of dementia of any type in the last 6 months will be recruited via memory clinics. Further criteria are a Mini-Mental State Examination score of ≥20, and a family carer who can assist with the intervention. Consenting participants will be randomised in a ratio of 2:1 to BA or to treatment as usual. Analyses will estimate parameters such as rates of recruitment, retention and number of sessions completed. Questionnaires measuring depressive symptoms and quality of life for both the person with dementia and their carer will be completed at baseline, 3 and 6 months. Qualitative interviews will explore acceptability of the intervention, study procedures and experiences of the sessions. ETHICS AND DISSEMINATION This study received a favourable ethical opinion from the London Camberwell St Giles Research Ethics Committee (16/LO/0540). We will disseminate findings at key conferences, the Alzheimer's Society and University College London websites and local stakeholder events. TRIAL REGISTRATION NUMBER ISRCTN75503960; Pre-results.
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Affiliation(s)
- Remco Tuijt
- Division of Psychiatry,
University College London, London, UK
| | - Gill Livingston
- Division of Psychiatry,
University College London, London, UK
| | - Rebecca L Gould
- Division of Psychiatry,
University College London, London, UK
| | - Rebecca Jones
- Division of Psychiatry,
University College London, London, UK
| | | | - Vasiliki Orgeta
- Division of Psychiatry,
University College London, London, UK
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Quevedo ALAD, Leotti VB, Goulart BNGD. Análise da prevalência de perda auditiva autodeclarada e fatores associados: informante primário versus proxy. CAD SAUDE PUBLICA 2017; 33:e0076216. [DOI: 10.1590/0102-311x00076216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 07/28/2016] [Indexed: 11/21/2022] Open
Abstract
O objetivo foi avaliar diferenças entre as prevalências de perda auditiva autodeclarada e fatores associados, obtidas nas respostas de informantes primário e proxy no Estudo de Distúrbios da Comunicação Humana de Base Populacional (DCH-POP). Trata-se de um estudo de métodos em epidemiologia, utilizando dados de um inquérito domiciliar do tipo transversal, com uma amostra de 1.253 indivíduos do Sul do Brasil. Para verificar diferenças de prevalências entre informantes primários e informante proxy foram utilizados os testes qui-quadrado ou exato de Fisher para variáveis categóricas, e Mann-Whitney para as contínuas. Ainda, o modelo log-binomial foi ajustado para a variável dependente perda auditiva considerando-se três conjuntos de dados: toda a amostra, apenas informantes primários e apenas informantes proxy, estimando-se as associações por meio da razão de prevalências. Nos modelos finais, apenas as variáveis independentes idade e tontura estiveram associadas com o desfecho de perda auditiva independentemente do conjunto de dados utilizado. Em geral, informantes proxy subestimaram as prevalências dos desfechos estudados em relação aos informantes primários.
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