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van Liempd S, Bolt S, Verbiest M, Luijkx K. Association between freedom of movement and health of nursing home residents with dementia: an exploratory longitudinal study. BMC Geriatr 2024; 24:192. [PMID: 38408921 PMCID: PMC10898030 DOI: 10.1186/s12877-024-04677-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 01/05/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Locked doors remain a common feature of dementia units in nursing homes (NHs) worldwide, despite the growing body of knowledge on the negative effects of restricted freedom on residents. To date, no previous studies have explored the health effects of opening locked NH units, which would allow residents to move freely within the building and enclosed garden. This study examines the association between increased freedom of movement and the health of NH residents with dementia. METHODS This longitudinal, pre-post study involved a natural experiment in which NH residents with dementia (N = 46) moved from a closed to a semi-open location. Data on dimensions of positive health were collected at baseline (T0; one month before the relocation), at one (T1), four (T2) and nine (T3) months after the relocation. Linear mixed models were used to examine changes in positive health over time. RESULTS Cognition, quality of life and agitation scores improved significantly at T1 and T2 compared to the baseline, while mobility scores decreased. At T3, improvements in agitation and quality of life remained significant compared to the baseline. Activities of daily living (ADL) and depression scores were stable over time. CONCLUSIONS Increasing freedom of movement for NH residents with dementia is associated with improved health outcomes, both immediately and over time. These findings add to the growing evidence supporting the benefits of freedom of movement for the overall health of NH residents with dementia.
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Affiliation(s)
- Suzan van Liempd
- Department of Tranzo, Scientific Centre for Care and Wellbeing, School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands.
- Stichting Mijzo, Waalwijk, The Netherlands.
| | - Sascha Bolt
- Department of Tranzo, Scientific Centre for Care and Wellbeing, School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | - Marjolein Verbiest
- Department of Tranzo, Scientific Centre for Care and Wellbeing, School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | - Katrien Luijkx
- Department of Tranzo, Scientific Centre for Care and Wellbeing, School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
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Item distribution, scalability and internal consistency of the QUALIDEM quality of life assessment for patients with dementia in acute hospital settings. Health Qual Life Outcomes 2023; 21:12. [PMID: 36721226 PMCID: PMC9887877 DOI: 10.1186/s12955-023-02094-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 01/17/2023] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Quality of life (QoL) of people with dementia (PwD) is an important indicator of quality of care. Studying the impact of acute hospital settings on PwD's QoL requires assessment instruments that consider environmental factors. Until now, dementia-specific QoL instruments have not yet demonstrated their feasibility in acute hospitals because their use takes up too much time or their validity depends on observation periods that usually exceed the average length of hospital stays. Therefore, validated instruments to study QoL-outcomes of patients with dementia in hospitals are needed. METHODS Data stem from a study that analyzed the impact of a special care concept on the QoL of patients with dementia in acute hospitals. Total sample size consisted of N = 526 patients. Study nurses were trained in using an assessment questionnaire and conducted the data collection from June 2016 to July 2017. QoL was assessed with the QUALIDEM. This instrument consists of nine subscales that can be applied to people with mild to severe dementia (N = 344), while six of the nine subscales are applicable for people with very severe dementia (N = 182). Scalability and internal consistency were tested with Mokken scale analysis. RESULTS For people with mild to severe dementia, seven out of nine subscales were scalable (0.31 ≤ H ≤ 0.75). Five of these seven subscales were also internally consistent (ρ ≥ 0.69), while two had insufficient reliability scores (ρ = 0.53 and 0.52). The remaining two (positive self-image, feeling at home) subscales had rather low scalability (H = 0.17/0.16) and reliability scores (ρ = 0.35/0.36). For people with very severe dementia, all six subscales were scalable (0.34 ≤ H ≤ 0.71). Five out of six showed acceptable internal consistency (ρ = 0.65-0.91). Only the item social relations had insufficient reliability (ρ = 0.55). CONCLUSIONS In comparison with a previous evaluation of the QUALIDEM in a long-term care setting, the application in a hospital setting leads to very similar, acceptable results for people with mild to severe dementia. For people with very severe dementia, the QUALIDEM seems to fit even better in a hospital context. Results suggest either a revision of unsatisfactory items or a general reduction to six items for the QUALIDEM, for all PwD. In general, the QUALIDEM can be recommended as instrument to assess the QoL for PwD in the context of hospital research. Additionally, an investigation of the inter-rater reliability is necessary because the qualification of the nurses and the length of stay of the patients in the hospital differ from the previous investigations of the inter-rater reliability of QUALIDEM in the nursing home.
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Lauridsen HH, Mau M, Midtiby SL, Dröes R, Ettema T, Kristensen HK. Validity and reliability of the Danish version of
QUALIDEM. Scand J Caring Sci 2022; 37:534-548. [PMID: 36522835 DOI: 10.1111/scs.13139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 10/26/2022] [Accepted: 11/19/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION QUALIDEM is a dementia-specific QoL instrument that allows a proxy-based Quality of Life rating in all stages of dementia. It was originally developed in The Netherlands and has later been translated into English and German. This study endeavoured to translate, cross-culturally adapt and test important psychometric properties of a Danish version in a cross-sectional validation study with a nested test-retest design. METHOD All items underwent forward and backward translation by bilingual academics. Persons with dementia were recruited from 28 healthcare units in a Danish municipality. The severity of dementia was determined using a pragmatic approach allowing the site team to trichotomise the disease (mild, moderate-severe and very severe) before scoring the QUALIDEM. Psychometric properties for QUALIDEM were determined for item characteristics, construct validity, internal consistency, test-retest reliability, measurement error and floor and ceiling effects. The study was approved by The Danish Data Protection Agency. RESULTS A total of 169 persons with dementia, aged 51-103, were included. The construct validity testing showed that the overall proportion of correctly hypothesised correlations was 83%. Testing for internal consistency, Cronbach's α ranged from 0.65 to 0.85 in mild-severe dementia with three out of nine subscales having values below 0.7. For very severe dementia, Cronbach's α ranged from 0.44 to 0.81, with three out of six subscales having insufficient values. For test-retest reliability, the intra-class correlation coefficients ranged from 0.56 to 0.86. The 'scale width' method revealed a marked ceiling effect in all subscales ranging from 30.6% to 87.7%. DISCUSSION The QUALIDEM was successfully translated and cross-culturally adapted into Danish. Most subscales show acceptable internal consistency and test-retest reliability. However, a substantial measurement error and ceiling effect was present in most subscales. CONCLUSION With few exceptions, the subscales of the Danish version of QUALIDEM have acceptable validity and reliability. Future research should address the limitations of the ceiling effects.
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Affiliation(s)
- Henrik Hein Lauridsen
- Department of Sports Science and Clinical Biomechanics University of Southern Denmark Odense Denmark
| | - Martin Mau
- Health Sciences Research Centre UCL University College London UK
- Health, Social Work and Welfare Research UCL University College London UK
- Department of Psychology University of Southern Denmark Odense Denmark
| | | | - Rose‐Marie Dröes
- Department of Psychiatry Amsterdam Public Health Research institute, Amsterdam UMC Amsterdam The Netherlands
| | - Teake Ettema
- Department of Psychiatry Amsterdam Public Health Research institute, Amsterdam UMC Amsterdam The Netherlands
| | - Hanne Kaae Kristensen
- Health Sciences Research Centre UCL University College London UK
- Department of Clinical Research University of Southern Denmark Odense Denmark
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Quality of life in people with dementia living in nursing homes: validation of an eight-item version of the QUALIDEM for intensive longitudinal assessment. Qual Life Res 2020; 29:1721-1730. [PMID: 31955375 PMCID: PMC7253522 DOI: 10.1007/s11136-020-02418-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2020] [Indexed: 01/17/2023]
Abstract
Purpose Our aim was to examine whether quality of life which was repeatedly assessed over time is related with the comprehensive assessment of quality of life (QoL) and thereby to validate a brief QoL assessment. Method This longitudinal study used a comprehensive assessment of quality of life at baseline (QUALIDEM; 37 items) to validate an eight-item version of QUALIDEM to assess momentary quality of life which was repeatedly administered using a tablet device after baseline. In all, 150 people with dementia from 10 long-term facilities participated. Momentary quality of life and comprehensive quality of life, age, gender, activities of daily living (Barthel Index), Functional assessment staging (FAST), and Geriatric Depression (GDS) have been assessed. Results Comprehensive and momentary quality of life showed good internal consistency with Cronbach’s alpha of .86 and .88 to .93, respectively. For multiple associations of momentary quality of life with the comprehensive quality of life, momentary quality of life was significantly related to comprehensive quality of life (B = .14, CI .08/.20) and GDS (B = − .13, CI − .19/− .06). More specifically, the comprehensive QUALIDEM subscales ‘positive affect’, ‘negative affect’, ‘restlessness’, and ‘social relationships’ showed significant positive associations with momentary quality of life (p < .001). Conclusion We found that momentary quality of life, reliably assessed by tablet, was associated with comprehensive measures of quality of life and depressive symptoms in people with dementia. Broader use of tablet-based assessments within frequent QoL measurements may enhance time management of nursing staff and may improve the care quality and communication between staff and people with dementia. Electronic supplementary material The online version of this article (10.1007/s11136-020-02418-4) contains supplementary material, which is available to authorized users.
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Assessing the quality of life and well-being of older adults with physical and cognitive impairments in a German-speaking setting: A systematic review of validity and utility of assessments / Die Erfassung von Lebensqualität und Wohlbefinden älterer Menschen mit psychischen und kognitiven Einschränkungen: ein systematisches Literaturreview zur Validität und Praktikabilität deutschsprachiger Assessments. INTERNATIONAL JOURNAL OF HEALTH PROFESSIONS 2019. [DOI: 10.2478/ijhp-2019-0014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Abstract
Background
For health professionals working with older adults with physical and cognitive impairments, improving or maintaining clients’ quality of life and well-being is of crucial importance. The aim of this study was to evaluate validity and utility of assessments of quality of life and well-being in German suitable for this group of clients.
Methods
In an initial literature search, we identified potentially viable assessments based on existing systematic reviews. We then conducted a systematic literature search in the databases Medline, CINAHL, and PsycINFO using keywords related to validity, utility, client group, and German. Assessments for which sufficient evidence was found were evaluated regarding their validity and utility when used with older adults with physical and cognitive impairments.
Results
For 14 of 27 initially identified assessments, sufficient evidence was found to evaluate validity and utility with this client group. WHOQOL-BREF, WHOQOL-OLD, WHO-5, EUROHIS-QOL 8, SF-36, SF-12, EQ-5D, NHP, SEIQOL-DW, SWLS, PANAS, DQOL, QOL-AD, and QUALIDEM were evaluated based on 82 studies. Of these, WHOQOL-BREF, WHO-5, SF-36, SF-12, EQ-5D, NHP, QUALIDEM, QOL-AD and DQOL are presented here.
Conclusion
Assessments differed widely in the way they operationalized quality of life/well-being, use of self-evaluation or evaluation-by-proxy, and amount of available evidence for their validity and utility. On the basis of our results in regard to the assessments’ validity, utility, and appropriateness of operationalization of quality of life/well-being to the client group, three assessments were recommended for use: WHOQOL-BREF for self-evaluation, QUALIDEM for evaluation-by-proxy in case of severe dementia, and EQ-5D for cost-utility analyses.
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Joosse P, Loggers SAI, Van de Ree CLPM, Van Balen R, Steens J, Zuurmond RG, Gosens T, Van Helden SH, Polinder S, Willems HC, Van Lieshout EMM. The value of nonoperative versus operative treatment of frail institutionalized elderly patients with a proximal femoral fracture in the shade of life (FRAIL-HIP); protocol for a multicenter observational cohort study. BMC Geriatr 2019; 19:301. [PMID: 31703579 PMCID: PMC6839183 DOI: 10.1186/s12877-019-1324-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 10/18/2019] [Indexed: 12/21/2022] Open
Abstract
Background Proximal femoral fractures are strongly associated with morbidity and mortality in elderly patients. Mortality is highest among frail institutionalized elderly with both physical and cognitive comorbidities who consequently have a limited life expectancy. Evidence based guidelines on whether or not to operate on these patients in the case of a proximal femoral fracture are lacking. Practice variation occurs, and it remains unknown if nonoperative treatment would result in at least the same quality of life as operative treatment. This study aims to determine the effect of nonoperative management versus operative management of proximal femoral fractures in a selected group of frail institutionalized elderly on the quality of life, level of pain, rate of complications, time to death, satisfaction of the patient (or proxy) and the caregiver with the management strategy, and health care consumption. Methods This is a multicenter, observational cohort study. Frail institutionalized elderly (70 years or older with a body mass index < 18.5, a Functional Ambulation Category of 2 or lower pre-trauma, or an American Society of Anesthesiologists score of 4 or 5), who sustained a proximal femoral fracture are eligible to participate. Patients with a pathological or periprosthetic fractures and known metastatic oncological disease will be excluded. Treatment decision will be reached following a structured shared decision process. The primary outcome is quality of life (Euro-QoL; EQ-5D-5 L). Secondary outcome measures are quality of life measured with the QUALIDEM, pain level (PACSLAC), pain medication use, treatment satisfaction of patient (or proxy) and caregivers, quality of dying (QODD), time to death, and direct medical costs. A cost-utility and cost-effectiveness analysis will be done, using the EQ-5D utility score and QUALIDEM score, respectively. Non-inferiority of nonoperative treatment is assumed with a limit of 0.15 on the EQ-5D score. Data will be acquired at 7, 14, and 30 days and at 3 and 6 months after trauma. Discussion The results of this study will provide insight into the true value of nonoperative treatment of proximal femoral fractures in frail elderly with a limited life expectancy. The results may be used for updating (inter)national treatment guidelines. Trial registration The study is registered at the Netherlands Trial Register (NTR7245; date 10-06-2018).
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Affiliation(s)
- Pieter Joosse
- Department of Surgery, Noordwest Ziekenhuisgroep, P.O Box 501, 1800 AM, Alkmaar, The Netherlands
| | - Sverre A I Loggers
- Department of Surgery, Noordwest Ziekenhuisgroep, P.O Box 501, 1800 AM, Alkmaar, The Netherlands.,Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - C L P Marc Van de Ree
- Department Trauma TopCare, Elisabeth-TweeSteden Ziekenhuis, P.O. Box 90151, 5000 LC, Tilburg, The Netherlands
| | - Romke Van Balen
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - Jeroen Steens
- Department of Orthopaedic Surgery, Dijklander Ziekenhuis (location Westfriesgasthuis), P.O. Box 600, 1620 AR, Hoorn, The Netherlands.,Department of Orthopaedic Surgery, Dijklanders Ziekenhuis (location Waterland Ziekenhuis), P.O. Box 250, 1440 AG, Purmerend, The Netherlands
| | - Rutger G Zuurmond
- Department of Orthopaedic Surgery, Isala, P.O. Box 10400, 8000 GK, Zwolle, The Netherlands
| | - Taco Gosens
- Department of Orthopaedic Surgery, Elisabeth-TweeSteden Ziekenhuis, P.O. Box 90151, 5000 LC, Tilburg, The Netherlands
| | - Sven H Van Helden
- Department of Surgery, Isala, P.O. Box 10400, 8000 GK, Zwolle, The Netherlands
| | - Suzanne Polinder
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Hanna C Willems
- Geriatrics Section, Department of Internal Medicine, Amsterdam UMC location AMC, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - Esther M M Van Lieshout
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
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van der Zon A, Wetzels RB, Bor H, Zuidema SU, Koopmans RTCM, Gerritsen DL. Two-Year Course of Quality of Life in Nursing Home Residents with Dementia. Am J Geriatr Psychiatry 2018; 26:754-764. [PMID: 29477831 DOI: 10.1016/j.jagp.2018.01.202] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 01/13/2018] [Accepted: 01/15/2018] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To assess the course of quality of life (QoL) in nursing home residents with dementia and to study its predictors. METHODS This longitudinal, multicenter, observational cohort study with a 2-year follow-up looked at 290 residents with dementia, who lived in 14 dementia special care units in nine nursing homes in the Netherlands. QoL was assessed with the Qualidem, providing a total score and QoL profile with nine subscales. Residents were assessed at five assessments: every 6 months during 2 years. A linear mixed model was used for data analysis. RESULTS No change was found in the Qualidem total score (range: 0-111) over 2 years. However, a significant increase of QoL over time was seen in the subscales "Care relationship," "Negative affect," "Restless tense behavior," "Positive self-image," "Social isolation," and "Feeling at home." A significant decrease of QoL was seen in the subscales "Positive affect," "Social relations," and "Having something to do." Most predictors of the course of Qol were found for the subscales "Positive self-image" (sex, Global Deterioration Scale, Severe Impairment Battery, Activities of Daily Living, and Neuropsychiatric Inventory) and "Having something to do" (Global Deterioration Scale, Severe Impairment Battery, and Activities of Daily Living). Sex and Neuropsychiatric Inventory at baseline were the predictors found most frequently. CONCLUSION The total QoL score was stable over a 2-year period. However, QoL subscales showed multidirectional changes. The largest QoL decline in the subscale "Having something to do" suggests that more attention should be given to useful activities in nursing home care.
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Affiliation(s)
- Anne van der Zon
- Department of Primary and Community Care, Radboudumc Alzheimer Center, Radboud University Medical Center, Nijmegen, The Netherlands; De Waalboog, Center for Specialized Geriatric Care "Joachim en Anna", Nijmegen, The Netherlands.
| | - Roland B Wetzels
- Department of Primary and Community Care, Radboudumc Alzheimer Center, Radboud University Medical Center, Nijmegen, The Netherlands; Pleyade, Elderly Care Organization, Arnhem, The Netherlands
| | - Hans Bor
- Department of Primary and Community Care, Radboudumc Alzheimer Center, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sytse U Zuidema
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center, Groningen, The Netherlands
| | - Raymond T C M Koopmans
- Department of Primary and Community Care, Radboudumc Alzheimer Center, Radboud University Medical Center, Nijmegen, The Netherlands; De Waalboog, Center for Specialized Geriatric Care "Joachim en Anna", Nijmegen, The Netherlands
| | - Debby L Gerritsen
- Department of Primary and Community Care, Radboudumc Alzheimer Center, Radboud University Medical Center, Nijmegen, The Netherlands
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