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Amrollah Majdabadi Kohne Z, Ebadi A, Ashghali-Farahani M, Tajali S, Keyvanloo Shahrestanaki S. Psychometric of the Persian version of Quality of Life in Late-Stage Dementia (QUALID) in the elderly with Alzheimer's disease. BMJ Open Qual 2024; 13:e002673. [PMID: 38964884 PMCID: PMC11227812 DOI: 10.1136/bmjoq-2023-002673] [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: 10/31/2023] [Accepted: 06/23/2024] [Indexed: 07/06/2024] Open
Abstract
BACKGROUND Improving the quality of life (QoL) is a significant healthcare priority, and it is an important health outcome for elderly individuals with Alzheimer's disease. Quality of Life in Late-Stage Dementia (QUALID) is a specific scale used to measure the QoL in elderly individuals with Alzheimer's. So far, limited quantitative research has been conducted on the psychometric properties of this scale. AIMS This study was conducted to translate the QUALID Scale into Persian and evaluate its psychometric properties among family and professional caregivers of elderly individuals with Alzheimer's disease in Tehran. METHODS A cross-sectional methodological study was conducted among family and professional caregivers of elderly individuals with Alzheimer's in Tehran, Iran in 2022. The questionnaire was translated into Persian using the forward-backward method. Face and content validity were assessed. Additionally, construct validity was examined using exploratory factor analysis (EFA) with Equamax rotation (n=210) and confirmatory factor analysis (CFA) (n=155). Cronbach's alpha and interclass correlation coefficient (ICC) were estimated to determine reliability. RESULTS A total of 365 caregivers with a mean age of 14.18±42.60 years participated in this study. In the face and content validity phase, all 11 items were retained. To determine the construct validity, two factors were extracted in the EFA phase, including behavioural signs of discomfort and behavioural signs of social interaction. The findings of the CFA also indicated that all goodness of fit indices supported the final model. The Cronbach's alpha was excellent for both factors (0.814), and the ICC was calculated as 0.98. CONCLUSION Based on the findings of this study, it can be concluded that the Persian version of the QUALID Scale has sufficient validity and reliability for measuring the QoL in elderly Iranian individuals with Alzheimer's.
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Affiliation(s)
- Zahra Amrollah Majdabadi Kohne
- Nursing and Midwifery Care Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran
- Department of Community Health and Geriatric Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Abbas Ebadi
- Behavioral Sciences Research Center, Life style institute, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mansoureh Ashghali-Farahani
- Nursing and Midwifery Care Research Center, Health Management Research Institute, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Saleheh Tajali
- Department of Pediatric Nursing, School of nursing and midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Sahar Keyvanloo Shahrestanaki
- Department of Community Health Nursing and Geriatric Nursing, Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
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Brennan S, Doan T, Osada H, Hashimoto Y. Validation of the Japanese version of the quality of life-Alzheimer's disease for nursing homes. Aging Ment Health 2023; 27:281-291. [PMID: 35585714 DOI: 10.1080/13607863.2022.2076209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVES This study aims to validate the Japanese version of Quality of Life-Alzheimer's Disease for Nursing Homes (QOL-AD NH). This is the modified version of QOL-AD, initially developed for residents living with dementia in long-term care settings. METHODS Psychometric assessment was conducted in a sample of 101 residents and their professional care staff to obtain self-ratings and proxy-ratings of QOL, respectively. Residents' behavior was observed using Dementia Care Mapping (DCM) method, and their mood/engagement (ME) value was evaluated as a proxy measure of QOL. RESULTS Self-ratings were higher than proxy-ratings (t = 10.22, p<.001), with moderate correlation (r=.51, p<.001) and strong internal consistency (α=.87 for both). The exact agreement between the two groups was 38.23%. Convergent validity was confirmed with ME value and positive engagements of DCM. Exploratory factor analysis was performed for further validity testing. Three factors - self and life overall, social environment, and physical and psychological health, accounted for 85.9% of the total variance with Cronbach's α of .87, .73, .90, respectively. CONCLUSION Using a validated Japanese version of the QOL-AD NH may help assess the QOL of older residents living in long-term care settings to improve the continuum of care for dementia.
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Affiliation(s)
- Sumiyo Brennan
- Institute for Gerontology, J. F. Oberlin University, Tokyo, Japan
| | - Therese Doan
- School of Nursing, San Francisco State University, CA, USA
| | - Hisao Osada
- J. F. Oberlin University, Graduate School of International Advanced Studies MA&PhD Programs in Gerontology, Tokyo, Japan
| | - Yumiko Hashimoto
- Institute for Gerontology, J. F. Oberlin University, Tokyo, Japan
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Strength and endurance exercises on balance impairment, gait disturbance, and quality of life of persons living with HIV-related distal symmetrical polyneuropathy: A study protocol. ADVANCES IN INTEGRATIVE MEDICINE 2021. [DOI: 10.1016/j.aimed.2021.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Alexander CM, Martyr A, Gamble LD, Savage SA, Quinn C, Morris RG, Collins R, Clare L. Does awareness of condition help people with mild-to-moderate dementia to live well? Findings from the IDEAL programme. BMC Geriatr 2021; 21:511. [PMID: 34563135 PMCID: PMC8467163 DOI: 10.1186/s12877-021-02468-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 09/06/2021] [Indexed: 01/07/2023] Open
Abstract
Background People living with dementia vary in awareness of their abilities. We explored awareness of the condition and diagnosis in people with mild-to-moderate dementia, and how this relates to quality of life, well-being, life satisfaction, and caregiver stress. Methods This study was a cross-sectional exploratory analysis of data from the IDEAL cohort, which recruited people with dementia living at home and available caregivers from 29 research sites in Great Britain. Our study included 917 people with mild-to-moderate dementia and 755 carers. Low and high awareness groups were derived from self-reported responses to a dementia representation measure. Logistic regression was used to explore predictors of awareness of condition and diagnosis using demographic, cognitive, functional and psychological measures, and the relationship with quality of life, well-being and life satisfaction (‘living well’), and caregiver stress. Results There were 83 people with low awareness of their condition. The remaining 834 people showed some awareness and 103 of these had high awareness of their condition and diagnosis. Psychosocial factors were stronger predictors of awareness than cognitive and functional ability. Those with higher awareness reported lower mood, and lower scores on indices of living well as well as lower optimism, self-efficacy and self-esteem. Low awareness was more likely in those aged 80y and above, and living in more socially deprived areas. No relationship was seen between caregiver stress and awareness. Conclusions Awareness of the condition and diagnosis varies in people with mild-to-moderate dementia and is relevant to the capability to live well. Awareness should be considered in person-centered clinical care. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02468-4.
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Affiliation(s)
- Catherine M Alexander
- REACH: The Centre for Research in Ageing and Cognitive Health, College of Medicine and Health, University of Exeter Medical School, University of Exeter, South Cloisters, St Luke's Campus, Exeter, EX1 2LU, UK.
| | - Anthony Martyr
- REACH: The Centre for Research in Ageing and Cognitive Health, College of Medicine and Health, University of Exeter Medical School, University of Exeter, South Cloisters, St Luke's Campus, Exeter, EX1 2LU, UK
| | - Laura D Gamble
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Sharon A Savage
- School of Psychology, The University of Newcastle, Australia, Newcastle, Australia
| | - Catherine Quinn
- Centre for Applied Dementia Studies, University of Bradford, Bradford, UK
| | - Robin G Morris
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Rachel Collins
- REACH: The Centre for Research in Ageing and Cognitive Health, College of Medicine and Health, University of Exeter Medical School, University of Exeter, South Cloisters, St Luke's Campus, Exeter, EX1 2LU, UK
| | - Linda Clare
- REACH: The Centre for Research in Ageing and Cognitive Health, College of Medicine and Health, University of Exeter Medical School, University of Exeter, South Cloisters, St Luke's Campus, Exeter, EX1 2LU, UK.,National Institute for Health Research Applied Research Collaboration South-West Peninsula, Exeter, UK
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Parlak MM, Babademez MA, Alicura Tokgöz S, Bizpınar Ö, Saylam G. Evaluation of Swallowing Function according to the Stage of Alzheimer's Disease. Folia Phoniatr Logop 2021; 74:186-194. [PMID: 34469898 DOI: 10.1159/000519263] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 08/26/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Alzheimer's disease (AD) is a progressive neurodegenerative disease, and swallowing difficulties may occur as the disease progresses. Dysphagia has many consequences, such as aspiration and pneumonia. In particular, in the advanced stage, approximately 70% of the causes of death in AD involve aspiration pneumonia. Therefore, it is vital to assess the presence or absence of dysphagia in AD. OBJECTIVE This study aims to describe swallowing difficulty across the stages of AD. METHODS Thirty-five AD patients were evaluated. The Mini-Mental State Examination was conducted. A bedside water swallow test (BWST) and the Eating Assessment Tool (EAT-10) were administered. Finally, fiberoptic endoscopic evaluation of swallowing was used to evaluate residual, aspiration and penetration conditions. RESULTS EAT-10 scores, BWST results, and penetration-aspiration status were statistically significantly different according to AD stage (p < 0.05). Among all patients, 74.3% had residue, 25.7% had penetration, and 2.9% had aspiration. CONCLUSIONS This study has demonstrated that swallowing dysfunction begins at a mild stage and progressively worsens toward the advanced stage in patients with AD. At all stages of AD, residue was observed, and this poses a risk for the development of penetration-aspiration. Therefore, it is necessary to evaluate the early dysphagia of individuals.
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Affiliation(s)
- Mümüne Merve Parlak
- Department of Speech and Language Therapy, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
| | - Mehmet Ali Babademez
- Department of Otolaryngology, Faculty of Medicine, Yıldırım Beyazıt Unıversıty, Ankara, Turkey
| | - Sibel Alicura Tokgöz
- Department of Otolaryngolgy, Dışkapı Research and Training Hospital, Ankara, Turkey
| | - Özlem Bizpınar
- Department of Neurology, Dışkapı Research and Training Hospital, Ankara, Turkey
| | - Güleser Saylam
- Department of Otolaryngolgy, Dışkapı Research and Training Hospital, Ankara, Turkey
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Heuer S, Willer R. How Is Quality of Life Assessed in People With Dementia? A Systematic Literature Review and a Primer for Speech-Language Pathologists. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 29:1702-1715. [PMID: 32492356 DOI: 10.1044/2020_ajslp-19-00169] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Purpose The purpose of this study was to determine how quality of life (QoL) is measured in people with dementia involved in interventions designed to improve well-being and to explore how those measures align with principles of person-centered care. Method A systematic literature review was conducted utilizing PsychInfo, CINAHL, and PubMed and combinations of the search terms: "dementia," "outcome measure," "creative engagement," "creative intervention," "TimeSlips," "art," "quality of life," and "well-being." The search was limited to studies published in peer-reviewed journals that reported outcomes for people with dementia in response to a creative intervention. Results Across the 24 reviewed studies, 30 different outcome measures were reported including eight self-reported, nine observational, and 13 proxy-reported measures. Self-report of QoL was elicited 16 times, observational measures were reported 17 times, and proxy-reported measures were used 28 times. All measures were used with participants across the dementia severity spectrum. Conclusion Current clinical practice of QoL evaluation does not align well with person-centered care principles of self-determination based on the low proportion of self-report. The previously reported limitations of proxy-report have been in part confirmed with this study. Implications of the findings for speech-language pathologists are discussed.
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Gentry MT, Lapid MI, Syrjanen J, Calvert K, Hughes S, Brushaber D, Kremers W, Bove J, Brannelly P, Coppola G, Dheel C, Dickerson B, Dickinson S, Faber K, Fields J, Fong J, Foroud T, Forsberg L, Gavrilova R, Gearhart D, Ghoshal N, Goldman J, Graff-Radford J, Graff-Radford N, Grossman M, Haley D, Heuer H, Hsiung GY, Huey E, Irwin D, Jones D, Jones L, Kantarci K, Karydas A, Knopman D, Kornak J, Kramer J, Kukull W, Lucente D, Lungu C, Mackenzie I, Manoochehri M, McGinnis S, Miller B, Pearlman R, Petrucelli L, Potter M, Rademakers R, Ramos EM, Rankin K, Rascovsky K, Sengdy P, Shaw L, Tatton N, Taylor J, Toga A, Trojanowski J, Weintraub S, Wong B, Wszolek Z, Boeve BF, Boxer A, Rosen H. Quality of life and caregiver burden in familial frontotemporal lobar degeneration: Analyses of symptomatic and asymptomatic individuals within the LEFFTDS cohort. Alzheimers Dement 2020; 16:1115-1124. [PMID: 32656921 PMCID: PMC7534513 DOI: 10.1002/alz.12095] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The Longitudinal Evaluation of Familial Frontotemporal Dementia Subjects evaluates familial frontotemporal lobar degeneration (FTLD) kindreds with MAPT, GRN, or C9orf72 mutations. Objectives were to examine whether health-related quality of life (HRQoL) correlates with clinical symptoms and caregiver burden, and whether self-rated and informant-rated HRQoL would correlate with each other. METHODS Individuals were classified using the Clinical Dementia Rating (CDR® ) Scale plus National Alzheimer's Coordinating Center (NACC) FTLD. HRQoL was measured with DEMQOL and DEMQOL-proxy; caregiver burden with the Zarit Burden Interview (ZBI). For analysis, Pearson correlations and weighted kappa statistics were calculated. RESULTS The cohort of 312 individuals included symptomatic and asymptomatic individuals. CDR® plus NACC FTLD was negatively correlated with DEMQOL (r = -0.20, P = .001), as were ZBI and DEMQOL (r = -0.22, P = .0009). There was fair agreement between subject and informant DEMQOL (κ = 0.36, P <.0001). CONCLUSION Lower HRQoL was associated with higher cognitive/behavior impairment and higher caregiver burden. These findings demonstrate the negative impact of FTLD on individuals and caregivers.
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Affiliation(s)
| | | | | | | | | | | | | | - Jessica Bove
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Patrick Brannelly
- Tau Consortium, Rainwater Charitable Foundation, Fort Worth, Texas, USA
| | | | | | | | - Susan Dickinson
- Association for Frontotemporal Degeneration, Radnor, Pennsylvania, USA
| | - Kelley Faber
- National Cell Repository for Alzheimer's Disease (NCRAD), Indiana University, Indianapolis, Indiana, USA
| | | | | | - Tatiana Foroud
- National Cell Repository for Alzheimer's Disease (NCRAD), Indiana University, Indianapolis, Indiana, USA
| | | | | | | | | | | | | | | | | | | | | | - Ging-Yuek Hsiung
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Edward Huey
- Columbia University, New York, New York, USA
| | - David Irwin
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Lynne Jones
- Washington University, St. Louis, Missouri, USA
| | | | | | | | | | | | - Walter Kukull
- National Alzheimer's Coordinating Center (NACC), University of Washington, Seattle, Washington, USA
| | | | - Codrin Lungu
- National Institute of Neurological Disorders and Stroke (NINDS), Bethesda, Maryland, USA
| | - Ian Mackenzie
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | | | | | - Madeline Potter
- National Cell Repository for Alzheimer's Disease (NCRAD), Indiana University, Indianapolis, Indiana, USA
| | | | | | | | | | - Pheth Sengdy
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Leslie Shaw
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nadine Tatton
- Association for Frontotemporal Degeneration, Radnor, Pennsylvania, USA
| | | | - Arthur Toga
- Laboratory of Neuroimaging (LONI), USC, Los Angeles, California, USA
| | | | | | - Bonnie Wong
- Harvard University/MGH, Boston, Massachusetts, USA
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Song EO, Jang HY. Predictors of Satisfaction with Care Services among Family Members of Older Adult Residents of Long-Term Care Facilities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17093298. [PMID: 32397383 PMCID: PMC7246666 DOI: 10.3390/ijerph17093298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 04/23/2020] [Accepted: 05/07/2020] [Indexed: 11/16/2022]
Abstract
This study identified predictors of satisfaction with care services among family members of older adults residing in long-term care facilities (LTCFs). In this cross-sectional descriptive study, the participants were 330 family members of older adult residents of LTCFs in Seoul, Gyeonggi, Gangwon, Gyeongbuk, and Chungnam, Korea. Data were collected from July to October 2018 using a structured self-report questionnaire. Data were analyzed using descriptive statistics, independent t-testing, one-way ANOVA, Kruskal-Wallis testing, Pearson's correlation coefficients, and hierarchical multiple regressions. The most important predictors of satisfaction with care services were satisfaction with the physical housing environment (β = 0.49, p < 0.001), caregiving stress (β = -0.30, p < 0.001), the facility's size (β = -0.13, p = 0.001), the number of visits to the facility (β = -0.10, p = 0.024), and the number of family members who participated in the decision to place the relative in a facility (β = 0.09, p = 0.033). This study is significant because it provides fundamental data for qualitatively improving care services in LTCFs. Based on the results, strategies should be developed to relieve caregiving stress among family members and improve satisfaction with the physical housing environment.
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Arneson L, Bender AA, Robert MN, Perkins MM. Optimizing Quality of Life With Cognitive Impairment: A Study of End-of-Life Care in Assisted Living. J Am Med Dir Assoc 2020; 21:692-696. [PMID: 31784190 PMCID: PMC7186142 DOI: 10.1016/j.jamda.2019.10.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 10/05/2019] [Accepted: 10/20/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Assisted living (AL) is an expanding site of end-of-life (EOL) care in the United States. Understanding determinants of quality of life (QoL) for AL residents near EOL is vital to optimize care for this growing population, most of whom have some degree of cognitive impairment (CI). This analysis aimed to identify factors associated with QoL in a diverse sample of AL residents with CI approaching EOL. DESIGN Observational cross-section design. SETTING AND PARTICIPANTS Data are from a 5-year study funded by the National Institute on Aging examining EOL care of residents in 7 diverse AL communities in metropolitan Atlanta (n = 67). METHODS CI was assessed with the Montreal Cognitive Assessment (scores ≤ 26) and QoL was determined with the self-reported QoL in Alzheimer's disease survey adapted for use in AL. Psychological distress was assessed using the Patient Health Questionnaire-4 and fatigue was assessed using the 13-item Functional Assessment of Chronic Illness Therapy Fatigue Scale. Initial descriptive analyses were followed by backward stepwise regression analyses to select a best-fitting model of QoL. RESULTS The final model predicted 27% of the variance in QoL. CI was not significantly correlated with QoL and was not retained in the final model. Pain and functional limitation also did not meet inclusion criteria (P ≤ .10) and were sequentially removed, producing a final model of QoL in terms of psychological distress (β = -0.28, P = .032), fatigue (β = -0.26, P = .048), and race (β = 0.21, P = .063). CONCLUSIONS AND IMPLICATIONS The lack of a significant correlation between degree of CI and self-reported QoL suggests that AL residents have the potential to experience high QoL, despite CI. Interventions to reduce psychological distress and manage fatigue could be implemented during EOL care to attempt to improve QoL for AL residents with CI. The correlation between race and QoL warrants investigation into possible racial disparities in AL and EOL care.
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Affiliation(s)
- Laura Arneson
- Division of General Medicine & Geriatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Alexis A Bender
- Division of General Medicine & Geriatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Maggi N Robert
- Division of General Medicine & Geriatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Molly M Perkins
- Division of General Medicine & Geriatrics, Emory University School of Medicine, Atlanta, GA, USA; Birmingham/Atlanta VA Geriatric Research, Education, and Clinical Center (GRECC), Atlanta, GA, USA.
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Yakasai AM, Maharaj SS, Kaka B, Danazumi MS. Does exercise program of endurance and strength improve health-related quality of life in persons living with HIV-related distal symmetrical polyneuropathy? A randomized controlled trial. Qual Life Res 2020; 29:2383-2393. [PMID: 32306301 DOI: 10.1007/s11136-020-02500-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2020] [Indexed: 01/21/2023]
Abstract
BACKGROUND The most common HIV neurological comorbidity, Distal Symmetrical Peripheral Neuropathy (DSPN), is characterized by severe symptoms and reduced quality of life. Exercise has consistently been mentioned as one of the non-pharmacological therapies for the rehabilitation of individuals with HIV, but little is known about an exercise program to recommend to people living with HIV (PLWHIV)-related DSPN. The purpose of this study was to investigate the effectiveness of aerobic (AE) or progressive resisted exercise (PRE) on quality of life (QOL) in a person living with HIV-related DSPN. METHOD A randomized controlled trial was conducted with 136 persons living with HIV-related Neuropathy, including 6 domains of QOL within WHOQOL-BREF, 45 in the AE (used ergometer), 44 in the PRE (used quadriceps bench), and 47 in the control group (CG). The outcome measures (QOL) data were analyzed using the inferential statistic of Friedman for within-group with post hoc analysis of Wilcoxon signed Test. A Kruskal-Wallis test was carried out for between-groups with post hoc analysis of Mann-Whitney to find where significant differences exist. RESULTS The results indicated significant differences within experimental groups in all six domains p < 0.05. Similarly, the result indicated significant differences within the CG in Physical, level of independence, and Spirituality/Religions domains (p = 0.002, p = 0.035, p = 0.006). However, the results indicated significant differences between experimental groups and CG. CONCLUSION These findings indicated that strength and endurance exercise of moderate intensity have a positive effect on QOL in PLWHIV-related DSPN. Clinical trial No. http://apps.who.int/trialsearch/default.aspx (PACTR201707002173240).
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Affiliation(s)
- Abdulsalam Mohammed Yakasai
- Department of Physiotherapy, College of Health Science, University of KwaZulu-Natal, Westville Campus, Durban, South Africa. .,Medical Rehabilitation Therapists Board of Nigeria, Federal Government Secretariat Complex, rooms 738-741, Kano Zonal Office, Kano, Nigeria.
| | - Sonill Sooknunan Maharaj
- Department of Physiotherapy, College of Health Science, University of KwaZulu-Natal, Westville Campus, Durban, South Africa
| | - Bashir Kaka
- Department of Physiotherapy, College of Health Science, University of KwaZulu-Natal, Westville Campus, Durban, South Africa.,Department of Physiotherapy, College of Allied Health Sciences, Bayero University, kano, Nigeria
| | - Musa Sani Danazumi
- Department of Physiotherapy, College of Allied Health Sciences, Bayero University, kano, Nigeria.,Deaprtment of Physiotherapy, Federal Medical Center, Nguru, Nigeria
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O'Shea E, Hopper L, Marques M, Gonçalves-Pereira M, Woods B, Jelley H, Verhey F, Kerpershoek L, Wolfs C, de Vugt M, Stephan A, Bieber A, Meyer G, Wimo A, Michelet M, Selbaek G, Portolani E, Zanetti O, Irving K. A comparison of self and proxy quality of life ratings for people with dementia and their carers: a European prospective cohort study. Aging Ment Health 2020; 24:162-170. [PMID: 30381955 DOI: 10.1080/13607863.2018.1517727] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Objectives: To identify correlates of self-rated and proxy-rated quality of life (QoL) in people with dementia on (i) a dementia-specific and (ii) a capability-wellbeing QoL measure at baseline and 12-month follow-up, and to consider such factors in the context of QoL intervention development.Method: Prospective clinical and demographic data were collected from 451 community-dwelling dyads (mild-moderate dementia) across eight European countries. QoL was measured using the QOL-AD and the ICECAP-O. Multivariate modelling identified correlates of self- and proxy-rated QoL at baseline and at 12-month follow-up.Results: Carer's proxy-ratings of QoL were significantly lower than self-ratings at all time-points for both measures. Proxy-ratings declined over time, but self-ratings remained stable. Baseline predictors of greater self-rated QoL were education, and greater functional ability and relationship quality. Greater proxy-rated QoL was associated with education and greater functional ability, relationship quality, carer social support and carer QoL, lower carer anxiety/depression and less severe neuropsychiatric symptoms in people with dementia. At follow-up, greater self-rated QoL was predicted by greater functional ability, relationship quality, carer social support and having a spousal carer. Greater proxy-rated QoL at follow-up was associated with the same factors as at baseline; however, the dyad living together was an additional predictive factor.Conclusion: Both proxy-ratings and self-ratings of QoL should be interpreted with caution and in the context of each individual caregiving relationship. Different functional, psychosocial, relational and contextual factors influence self- and proxy-ratings, and both sets of factors should be considered in the context of QoL intervention development for the dyad.
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Affiliation(s)
- E O'Shea
- School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland
| | - L Hopper
- School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland
| | - M Marques
- CEDOC, Chronic Diseases Research Centre, Nova Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal
| | - M Gonçalves-Pereira
- CEDOC, Chronic Diseases Research Centre, Nova Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal
| | - B Woods
- Dementia Services Development Centre, Bangor University, Bangor, UK
| | - H Jelley
- Dementia Services Development Centre, Bangor University, Bangor, UK
| | - F Verhey
- School for Mental Health and Neuroscience, Alzheimer Center Limburg, Department of Psychiatry and Neuropsychology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - L Kerpershoek
- School for Mental Health and Neuroscience, Alzheimer Center Limburg, Department of Psychiatry and Neuropsychology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - C Wolfs
- School for Mental Health and Neuroscience, Alzheimer Center Limburg, Department of Psychiatry and Neuropsychology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - M de Vugt
- School for Mental Health and Neuroscience, Alzheimer Center Limburg, Department of Psychiatry and Neuropsychology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - A Stephan
- Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - A Bieber
- Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - G Meyer
- Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - A Wimo
- Department of Neurobiology, Care sciences and Society, Karolinska Institut, Stockholm, Sweden
| | - M Michelet
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
| | - G Selbaek
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
| | - E Portolani
- Alzheimer's Research Unit-Memory Clinic, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - O Zanetti
- Alzheimer's Research Unit-Memory Clinic, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - K Irving
- School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland
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12
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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: 18] [Impact Index Per Article: 4.5] [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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13
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Factors Related to Agreement Between Child and Caregiver Report of Child Functioning With Chronic Pain. Clin J Pain 2019; 36:203-212. [DOI: 10.1097/ajp.0000000000000794] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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14
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Kahanpää A, Noro A, Perälä ML. Quality of care reported by proxies – Does resident cognition count? DEMENTIA 2019; 18:2543-2555. [DOI: 10.1177/1471301217751227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Resident self-reports are considered the primary source of quality of care information, but proxy reports by family or staff can also be used to supplement or substitute resident reports. This study analyses how the results of proxy reports vary according to residents’ cognition level. The data set used covers proxy reports of family ( n = 558) and staff ( n = 801), divided by the availability of resident self-reports (family yes n = 289, no n = 269; staff yes 393, no = 408). Family and staff proxies assessed residents’ quality of care as better when resident self-reports were also available, and quality of care tended to be assessed as poorer among those with higher cognitive decline. The results of this methodological study indicate the importance of using several proxy evaluations; however, these can only supplement resident self-reports, not replace them. The interpretation rules acknowledging dependency between residents’ cognition and proxy assessments could be used as a basis for future comparisons of quality improvement in long-term care and for painting a more comprehensive picture of service quality.
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Affiliation(s)
- Anja Kahanpää
- Department of Ageing, Disability and Functioning, National Institute for Health and Welfare, Finland; School of Health Sciences, University of Tampere, Finland
| | - Anja Noro
- National Institute for Health and Welfare, Finland
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15
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Schumann C, Alexopoulos P, Perneczky R. Determinants of self- and carer-rated quality of life and caregiver burden in Alzheimer disease. Int J Geriatr Psychiatry 2019; 34:1378-1385. [PMID: 31025764 DOI: 10.1002/gps.5126] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 04/20/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVE We aimed to investigate factors associated with self- and carer-rated quality of life (QoL) and caregiver burden related to very mild to severe clinical Alzheimer disease (AD). METHODS One hundred patient-carer dyads were recruited, and assessments of relevant outcomes were performed, including sociodemographic characteristics, QoL, activities of daily living (ADL), cognitive performance, behavioural and psychological symptoms of dementia (BPSD), caregiver burden, and health resource utilisation. RESULTS There was a strong correlation between carer- and self-rated QoL, with patients consistently rating their QoL higher than caregivers. Duration of illness did not affect the QoL ratings. There was an inverse association between both self- and carer-rated QoL with age, age at symptom onset, impairment of ADL, time spent on assisting the patient, and depression. Both self- and carer-rated QoL ratings were higher if the caregiver was a spouse vs a child. Carer-rated QoL was inversely associated with severity of dementia, BPSD, caregiver burden, and requirement to supervise the patient. The variables age at symptom onset, ADL, and living together with the primary caregiver explained 34.50% of the variance in self-rated QoL, whereas age at symptom onset, ADL, and BPSD explained 48.20% of the variance in carer-rated QoL. For caregiver burden, 26% of the variance was explained by the variables ADL, living together with the primary caregiver, and agitation. CONCLUSION Our study highlights the need for a stronger focus on QoL in clinical AD research by providing further pieces of evidence on the key determinants, including the important aspect of caregiver burden.
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Affiliation(s)
- Christin Schumann
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Panagiotis Alexopoulos
- Department of Psychiatry, University Hospital of Rion, Faculty of Medicine, University of Patras, Patras, Greece.,Department of Psychiatry and Psychotherapy, Technische Universität München, Munich, Germany
| | - Robert Perneczky
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany.,German Center for Neurodegenerative Diseases (DZNE) Munich, Munich, Germany.,Ageing Epidemiology (AGE) Research Unit, School of Public Health, Imperial College, London, UK.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
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16
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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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17
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Chen EE, Pu CT, Bernacki RE, Ragland J, Schwartz JH, Mutchler JE. Surrogate Preferences on the Physician Orders for Life-Sustaining Treatment Form. THE GERONTOLOGIST 2019; 59:811-821. [PMID: 29788197 DOI: 10.1093/geront/gny042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The purpose of this study is to compare treatment preferences of patients to those of surrogates on the Physician Orders for Life-Sustaining Treatment (POLST) forms. RESEARCH DESIGN AND METHODS Data were collected from a sequential selection of 606 Massachusetts POLST (MOLST) forms at 3 hospitals, and corresponding electronic patient health records. Selections on the MOLST forms were categorized into All versus Limit Life-Sustaining Treatment. Multivariable mixed effects (grouped by clinician) logistic regression models estimated the impact of using a surrogate decision maker on choosing All Treatment, controlling for patient characteristics (age, severity of illness, sex, race/ethnicity), clinician (physician vs non-physician), and hospital (site). RESULTS Surrogates signed 253 of the MOLSTs (43%). A multivariable logistic regression model taking into consideration patient, clinician, and site variables showed that surrogate decision makers were 60% less likely to choose All Treatment than patients who made their own decisions (odds ratio = 0.39 [95% confidence interval = 0.24-0.65]; p < .001). This model explained 44% of the variation in the dependent variable (Pseudo-R2 = 0.442; p < .001); mixed effects logistic regression grouped by clinician showed no difference between the models (LR test = 4.0e-13; p = 1.00). DISCUSSION AND IMPLICATIONS Our study took into consideration variation at the patient, clinician, and site level, and showed that surrogates had a propensity to limit life-sustaining treatment. Surrogate decision makers are frequently needed for hospitalized patients, and nearly all states have adopted the POLST. Researchers may want study decision-making processes for patients versus surrogates when the POLST paradigm is employed.
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Affiliation(s)
| | | | - Rachelle E Bernacki
- Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, Massachusetts
| | | | | | - Jan E Mutchler
- Gerontology Department and Institute, University of Massachusetts Boston
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18
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Hvidsten L, Engedal K, Selbæk G, Wyller TB, Bruvik F, Kersten H. Quality of Life in People with Young-Onset Alzheimer's Dementia and Frontotemporal Dementia. Dement Geriatr Cogn Disord 2018; 45:91-104. [PMID: 29694972 DOI: 10.1159/000487263] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 01/30/2018] [Indexed: 12/12/2022] Open
Abstract
AIMS The aims of this study were to compare quality of life (QOL) in people with young-onset Alzheimer's (AD) and frontotemporal (FTD) dementia, explore variables associated with QOL, and compare QOL in young-onset dementia (YOD) and late-onset dementia (LOD). METHODS Cross-sectional data from a Nordic multicenter study of 50 community-dwelling participants with AD and 38 with FTD were included. A comparison group consisted of 100 people with LOD. QOL was measured using self-reported Euro-QOL 5-Dimension and the proxy version of Quality of Life in Alzheimer's Disease (QOL-AD) questionnaire. Neuropsychiatric symptoms and needs were assessed using the Cornell Scale for Depression in Dementia (CSDD), Neuropsychiatric Inventory (NPI), and Camberwell Assessment of Needs in the Elderly. Multiple linear regression and multilevel modeling was used to determine variables associated with QOL. RESULTS We found no differences between the two YOD groups in QOL. The variables associated with QOL were scores on the CSDD, NPI, and unmet needs. The proxy QOL-AD score in YOD was significantly higher compared to LOD (median 36.0 [IQR 10.0] vs. 33.0 [IQR 9.0]). CONCLUSION The QOL in Nordic people with YOD was better compared to people with LOD. Our results show depressive symptoms to be associated with QOL irrespective of age and diagnosis.
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Affiliation(s)
- Lara Hvidsten
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Division of Mental Health and Addiction, Vestfold Hospital Trust, Tønsberg, Norway
| | - Knut Engedal
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Geir Selbæk
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Torgeir Bruun Wyller
- Faculty of Medicine, University of Oslo, Oslo, Norway.,Oslo University Hospital, Department of Geriatric Medicine, Oslo, Norway
| | - Frøydis Bruvik
- Haraldsplass Deaconess Hospital, Bergen, Norway.,Centre for Elderly and Nursing Home Medicine, University of Bergen, Bergen, Norway.,Dignity Center, Bergen, Norway
| | - Hege Kersten
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Pharmaceutical Bioscience, School of Pharmacy, University of Oslo, Oslo, Norway.,Department of Research and Development, Telemark Hospital Trust, Skien, Norway
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19
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Kamitani H, Umegaki H, Okamoto K, Kanda S, Asai A, Shimojima T, Nomura H, Hattori A, Kimata T, Suzuki Y, Ohshima H, Kuzuya M. [Agreement in the responses to self-reported and proxy-reported versions of QOL-HC: a new quality-of-life scale for patients receiving home-based medical care]. Nihon Ronen Igakkai Zasshi 2018; 55:98-105. [PMID: 29503374 DOI: 10.3143/geriatrics.55.98] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIM We developed quality-of-life (QOL) scales for patients receiving home medical care. The objective of this study was to examine the agreement between the scores of the scales answered by patients and those answered by their proxy, as cognitive decline may interfere with one's ability to understand complex topics, such as the QOL. METHODS Participants were pairs of patients receiving home medical care and their proxy. The patients were asked to complete self-reported QOL scales (QOL-HC), and their proxies were asked to complete proxy-reported versions of the QOL scales (QOL-HC for caregivers). We then statistically examined the extent of agreement between the self- and proxy-reported QOL-HC scores using contingency tables and Spearman's rank correlation coefficient. The SPSS software program, version 24, was used for all statistical analyses. RESULTS The concordance rate between patients and caregivers for questions 1 ( "Do you have peace of mind?" ), 2 ( "Do you feel satisfied with your life when you reflect on it?" ), 3 ( "Do you have someone that you spend time talking with?" ), and 4 ( "Are you satisfied with the home care service system?" ) were 52.3%, 52.3%, 79.5%, and 81.8%, respectively. The total scores for the patients and caregivers were significantly correlated (Spearman's ρ=0.364*). CONCLUSIONS We created the first QOL scale for patients receiving home-based medical care and for caregivers. The findings of this study suggest that the QOL-HC can be used in clinical practice for the assessment of patients receiving professional home care.
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Affiliation(s)
- Hiroko Kamitani
- Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine
| | - Hiroyuki Umegaki
- Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine
| | - Kazushi Okamoto
- Department of Public Health, Aichi Prefectural College of Nursing and Health
| | | | | | | | | | | | | | - Yusuke Suzuki
- Centre for Community Liaison and Patient Consultation
| | - Hiroko Ohshima
- National Center for Geriatrics and Gerontology, Section for Nursing and Care
| | - Masafumi Kuzuya
- Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine
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20
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Kinderman P, Butchard S, Bruen AJ, Wall A, Goulden N, Hoare Z, Jones C, Edwards R. A randomised controlled trial to evaluate the impact of a human rights based approach to dementia care in inpatient ward and care home settings. HEALTH SERVICES AND DELIVERY RESEARCH 2018. [DOI: 10.3310/hsdr06130] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundAlthough it is widely recognised that adopting a person-centred approach is beneficial in the care of people living with dementia, a gap remains between the rhetoric and the reality of quality care. Some widely adopted care practices can result in the personhood of this group being threatened and their human rights being undermined.ObjectivesTo evaluate the impact of applying a human rights based approach in dementia inpatient wards and care homes on the quality of care delivered and the well-being of the person living with dementia.DesignA cluster randomised design was employed to compare the impact of implementing a human rights based approach intervention (i.e. training, applying the ‘Getting It Right’ assessment tool and receiving booster sessions) at 10 intervention sites with 10 control sites.SettingEight NHS dementia inpatient wards and 12 care homes in the north-west of England.ParticipantsPeople living with dementia who were residing on dementia inpatient wards or in care homes, and staff working at these sites. The aim was to recruit 280 people living with dementia.InterventionsA sample of staff (an average of 8.9 per site) at each of the sites was trained in a human rights based approach to care, including the application of the ‘Getting It Right’ assessment tool. The tool was then introduced at the site and monthly booster sessions were delivered.Main outcome measuresThe primary outcome measure used in the research was the Quality of Life in Alzheimer’s Disease scale to assess the subjective well-being of the person with dementia. Secondary outcome measures included measures of the quality of care provided (dementia care mapping) and direct measures of the effectiveness of the training in increasing knowledge of and attitudes towards human rights. The study also included an economic evaluation utilising the EuroQol-5 Dimensions, three-level version, and the Adult Social Care Outcomes Toolkit measure.ResultsThe study recruited 439 people living with dementia: 213 to the intervention arm and 226 to the control arm. Primary outcome data were analysed using a linear mixed model. There were no significant differences found in the reported quality of life of residents between the control and intervention groups after the intervention [F(1,16.51) = 3.63;p = 0.074]. The mean difference between the groups was 1.48 (95% confidence interval –7.86 to 10.82).ConclusionsDespite the fact that the training increased staff knowledge of and positive attitudes towards human rights, and although there were some changes in staff decision-making strategies in clinical situations, there was no change in the quality of care provided or in the reported well-being of people living with dementia in these settings. This led to questions about the efficacy of training in bringing about cultural change and improving care practices.LimitationsThere was limited uptake of the training and booster sessions that were integral to the intervention.Future workFuture work could usefully focus on understanding the difficulty in translating change in attitude and knowledge into behaviour.Trial registrationCurrent Controlled Trials ISRCTN94553028.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full inHealth Services and Delivery Research; Vol. 6, No. 13. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Peter Kinderman
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | | | - Ashley J Bruen
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Abbie Wall
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Nia Goulden
- North Wales Organisation for Randomised Trials in Health (NWORTH), School of Healthcare Sciences, Bangor University, Bangor, UK
| | - Zoe Hoare
- North Wales Organisation for Randomised Trials in Health (NWORTH), School of Healthcare Sciences, Bangor University, Bangor, UK
| | - Carys Jones
- Centre for Health Economics and Medicines Evaluation, Institute of Medical and Social Care Research, Bangor University, Bangor, UK
| | - Rhiannon Edwards
- Centre for Health Economics and Medicines Evaluation, Institute of Medical and Social Care Research, Bangor University, Bangor, UK
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21
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Chen YL, Yang CY, Chen SJ, Chen YC, Su CY. Everyday memory problems in alcohol abuse and dependence: Frequency, patterns and patient-proxy agreement. Psychiatry Res 2018; 261:488-497. [PMID: 29360054 DOI: 10.1016/j.psychres.2018.01.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 11/01/2017] [Accepted: 01/08/2018] [Indexed: 11/16/2022]
Abstract
Using self-report to assess everyday memory in alcoholics presents challenges given the presence of both memory and metamemory deficits. Accordingly, evaluation of the reliability and validity of proxy ratings as well as the frequency of these memory lapses are of clinical importance. In the present study, 180 patient-proxy dyads completed the Prospective and Retrospective Memory Questionnaire (PRMQ). 31.7% of proxy-rated versus 2.8% of patient-rated prospective memory scores fell in the impaired to below average range. 15% of proxy-rated retrospective memory scores were below average, whereas none of the patients reported problems in this regard. Longer delays between intention formation and action yielded better prospective memory performance, while the opposite was true for retrospective memory. Agreement between patients and proxies was generally poor to fair across severity levels and the magnitude of observed differences was large (standardized response mean > 0.8). For all PRMQ items, exact agreement occurred in 45.3% of the cases. Larger patient-proxy discrepancy was associated with older age, less education and greater disease severity. Proxy ratings were internally consistent, significantly correlated with objective memory performance, and were sensitive to differences in overall PRMQ performance between severity groups. Caution should be used in the interpretations of patients' reports.
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Affiliation(s)
- Yen-Liang Chen
- Department of Psychiatry, Taitung MacKay Memorial Hospital, Taitung, Taiwan
| | - Chung-Yuan Yang
- Department of Psychiatry, Taitung MacKay Memorial Hospital, Taitung, Taiwan
| | - Shaw-Ji Chen
- Department of Psychiatry, Taitung MacKay Memorial Hospital, Taitung, Taiwan
| | - Yen-Cheng Chen
- Department of Applied Science of Living, Chinese Cultural University, Taiwan
| | - Chwen-Yng Su
- Department of Occupational Therapy, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
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22
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Sossong B, Felder S, Wolff M, Krüger K. Evaluating the consequences of rheumatoid arthritis. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2017; 18:685-696. [PMID: 27468889 DOI: 10.1007/s10198-016-0818-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 07/05/2016] [Indexed: 06/06/2023]
Abstract
Patients and non-patients tend to attach different utility values to the state of suffering from specific illnesses. This observation naturally leads to the question whose utility values should be used as the basis in cost-effectiveness analysis (CEA). Intuitively, one would presume that patients are better informed about the consequences of their illness, and public authorities should, therefore, use the patients' utility values in CEA. Contrary to this presumption, it has been argued that society at large should determine which values are to be used and not the patients because, in the end, it is societal resources that are to be allocated. Against this background, we use data from a discrete choice experiment (DCE) that was completed by patients of rheumatoid arthritis (RA) and non-patients to explore the discrepancies between the two groups' utility estimates for typical consequences of RA. Our results indicate that both groups attach remarkably similar part-worth utilities to the symptoms pain, fatigue, and functional limitations. However, non-patients significantly undervalue the ability to work when compared to patients.
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Affiliation(s)
- Björn Sossong
- Ruhr Graduate School in Economics and University of Duisburg-Essen, Dorothea-Bernstein-Weg 13, 22081, Hamburg, Germany.
| | | | - Malte Wolff
- AbbVie Deutschland GmbH & Co. KG, Ludwigshafen, Germany
| | - Klaus Krüger
- LMU Munich and Rheumazentrum München, Munich, Germany
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23
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Verhofstede R, Smets T, Cohen J, Eecloo K, Costantini M, Van Den Noortgate N, Deliens L. End-of-Life Care and Quality of Dying in 23 Acute Geriatric Hospital Wards in Flanders, Belgium. J Pain Symptom Manage 2017; 53:693-702. [PMID: 28042062 DOI: 10.1016/j.jpainsymman.2016.10.363] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 10/18/2016] [Accepted: 10/30/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To describe the nursing and medical interventions performed in the last 48 hours of life and the quality of dying of patients dying in acute geriatric hospital wards. METHODS Cross-sectional descriptive study between October 1, 2012 and September 30, 2013. Twenty-three acute geriatric wards in 13 hospitals in Flanders, Belgium. Patients hospitalized for more than 48 hours before dying in the participating wards. Structured after-death questionnaires, filled out by the nurse, the physician, and the family carer most involved in end-of-life care. Main outcome measures were several nursing and medical interventions reported to be performed in the last 48 hours of life and the quality of dying. RESULTS Of 993 patients, we included 338 (mean age 85.7 years; 173 women). Almost 58% had dementia and nearly half were unable to communicate in the last 48 hours of their life. The most frequently continued or started nursing and medical interventions in the last 48 hours of life were measuring temperature (91.6%), repositioning (83.3%), washing (89.5%), oxygen therapy (49.7%), and intravenous fluids and nutrition (30%). Shortness of breath, lack of serenity, lack of peace, and lack of calm were symptoms reported most frequently by nurses and family carers. CONCLUSION Many nursing and medical interventions are continued or started in the last hours of a patient's life, which may not always be in their best interests. Furthermore, patients dying in acute geriatric wards are often affected by several symptoms.
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Affiliation(s)
- Rebecca Verhofstede
- End-of-Life Care Research Group, Vrije Universiteit Brussel & Ghent University, Brussels, Belgium
| | - Tinne Smets
- End-of-Life Care Research Group, Vrije Universiteit Brussel & Ghent University, Brussels, Belgium.
| | - Joachim Cohen
- End-of-Life Care Research Group, Vrije Universiteit Brussel & Ghent University, Brussels, Belgium
| | - Kim Eecloo
- End-of-Life Care Research Group, Vrije Universiteit Brussel & Ghent University, Brussels, Belgium
| | - Massimo Costantini
- Palliative Care Unit, IRCCS Arcispedale S. Maria Nuova, Reggio Emilia, Italy
| | | | - Luc Deliens
- End-of-Life Care Research Group, Vrije Universiteit Brussel & Ghent University, Brussels, Belgium; Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium
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Abstract
BACKGROUND Quality of life (QoL) is an important outcome for people with dementia living in care homes but usually needs to be rated by a proxy. We do not know if relative or paid carer proxy reports differ. We conducted the first systematic review and meta-analysis of data investigating whether and how these proxy reports of QoL differ. METHODS We searched four databases: Medline, Embase, PsychInfo, and CINAHL in October 2015 with the terms: dementia, QoL, proxy, and care home. Included studies either compared proxy QoL ratings or investigated the factors associated with them. We meta-analyzed data comparing staff and family proxy rated QoL. RESULTS We included 17/105 papers identified. We found no difference between global proxy ratings of QoL (n = 1,290; pooled effect size 0.06 (95% CI = -0.08 to 0.19)). Studies investigating factors associated with ratings (n = 3,537) found family and staff ratings correlated with the resident's physical and mental health. Staff who were more distressed rated resident QoL lower. Relatives rated it lower when the resident had lived in the care home for longer, when they observed more restraint, or contributed more to fees. CONCLUSIONS Relatives and staff proxy QoL ratings share a clear relationship to resident health and overall ratings were similar. Rater-specific factors were, however, also associated with scores. Understanding why different raters consider the QoL of the same person differently is an important consideration when evaluating the meaning of proxy rated QoL. Proxy raters' backgrounds may affect their rating of QoL.
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Howland M, Allan KC, Carlton CE, Tatsuoka C, Smyth KA, Sajatovic M. Patient-rated versus proxy-rated cognitive and functional measures in older adults. Patient Relat Outcome Meas 2017; 8:33-42. [PMID: 28352208 PMCID: PMC5358991 DOI: 10.2147/prom.s126919] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Patients with cognitive impairment may have difficulty reporting their functional and cognitive abilities, which are important clinical outcomes. Health care proxies may be able to corroborate patient self-reports. Several studies reported discrepancy between patient and proxy ratings, though the literature is sparse on changes over time of these ratings. Our goals in this 12-month study were to compare patient and proxy reports on functioning, cognition, and everyday executive function, and to further elucidate correlates of patient-proxy discrepancy. METHODS This was a prospective cohort study of individuals older than 70 years who ranged from having no cognitive impairment to having moderate dementia who had a proxy available to complete instruments at baseline (N=76). Measurements included Alzheimer's Disease Cooperative Study-Activities of Daily Living Inventory (ADCS-ADLI), Neuro-QOL Executive Function, PROMIS Applied Cognition (PROMIS-Cog), Mini-Mental State Examination (MMSE), and Geriatric Depression Scale. RESULTS Patient- and proxy-rated ADCS-ADLI were correlated at baseline and at 1-year follow-up. Patient and proxy ratings were discrepant on Neuro-QOL Executive Function and PROMIS-Cog. Greater patient-proxy discrepancy on PROMIS-Cog was associated with younger age and less depression, and greater patient-proxy discrepancy on Neuro-QOL Executive Function was associated with less depression and worse cognitive impairment. Patient-proxy discrepancy increased over time for everyday executive function. Changes in proxy-rated but not patient-rated ADCS-ADLI correlated with MMSE changes. CONCLUSION Patients and proxies generally agree in reporting on activities of daily living. Patient and proxy reports differ in their respective evaluation of cognitive functioning and everyday executive function. Ratings from both sources may be preferred for these two domains, though studies using gold standard measures are necessary. It is important that clinicians are aware of the differences between patient and proxy perspective to create an accurate clinical picture and guide treatment.
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Affiliation(s)
| | | | | | - Curtis Tatsuoka
- Neurological and Behavioral Outcomes Center, University Hospitals Case Medical Center
- Department of Epidemiology and Biostatistics
- Department of Neurology
| | | | - Martha Sajatovic
- Case Western Reserve University School of Medicine
- Neurological and Behavioral Outcomes Center, University Hospitals Case Medical Center
- Department of Neurology
- Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, OH, USA
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Feasibility and Psychometric Properties of the Adjusted DSWAL-QoL Questionnaire for Dysphagic Patients with Additional Language and/or Cognitive Impairment: Part I. Dysphagia 2017; 32:401-419. [DOI: 10.1007/s00455-016-9770-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 12/15/2016] [Indexed: 02/08/2023]
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Reliability of health-related quality-of-life assessments made by older adults and significant others for health states of increasing cognitive impairment. Health Qual Life Outcomes 2017; 15:4. [PMID: 28069027 PMCID: PMC5220615 DOI: 10.1186/s12955-016-0579-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Accepted: 12/13/2016] [Indexed: 11/17/2022] Open
Abstract
Background Older adults are encouraged by many organizations to engage in advance care planning in the event of decisional incapacity. Planning for future health care often involves anticipating health-related quality of life (HRQoL) in states of reduced cognitive functioning. No study has yet examined whether anticipated HRQoL is stable over time. The accuracy with which significant others can predict how an older adult envisions HRQoL in a future state of cognitive impairment is also unknown. We investigated the extent to which health-related quality-of-life ratings made by older adults and designated proxies for health states of increasing cognitive impairment are consistent over time and agree with each other. Methods Results are based on HRQoL ratings made on a 5-point Likert scale by 235 community-based elder-proxy dyads on three occasions. Ratings were obtained for the older adult’s current health state as well as under the assumption that he/she had a mild to moderate stroke, incurable brain cancer or severe dementia. Data were analyzed using both traditional approaches (e.g., intraclass correlation coefficients, Bland-Altman plots) and the theory of generalizability. Results We found ratings to be reasonably consistent over time and in good agreement within dyads, even more so as implied cognitive functioning worsened. Across health states, ratings over time or within elder-proxy dyads were no more than one category apart in over 87% of cases. Using the theory of generalizability, we further found that, of the two facets investigated, rater had a greater influence on score variability than occasion. Conclusions These findings underscore the importance of discussing health-related quality-of-life issues during advance care planning and involving designated proxies in the discussion to enhance their understanding of the role that HRQoL should play in actual decision-making situations. Medical decision-making may be influenced by healthcare providers’ and family members’ assessments of an incapacitated patient’s health-related quality of life, in addition to that of the designated proxy. Future studies should investigate whether these two groups of individuals share the views of the patient and the designated proxy on anticipated HRQoL. Electronic supplementary material The online version of this article (doi:10.1186/s12955-016-0579-3) contains supplementary material, which is available to authorized users.
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Chua KC, Brown A, Little R, Matthews D, Morton L, Loftus V, Watchurst C, Tait R, Romeo R, Banerjee S. Quality-of-life assessment in dementia: the use of DEMQOL and DEMQOL-Proxy total scores. Qual Life Res 2016; 25:3107-3118. [PMID: 27318488 PMCID: PMC5102947 DOI: 10.1007/s11136-016-1343-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE There is a need to determine whether health-related quality-of-life (HRQL) assessments in dementia capture what is important, to form a coherent basis for guiding research and clinical and policy decisions. This study investigated structural validity of HRQL assessments made using the DEMQOL system, with particular interest in studying domains that might be central to HRQL, and the external validity of these HRQL measurements. METHODS HRQL of people with dementia was evaluated by 868 self-reports (DEMQOL) and 909 proxy reports (DEMQOL-Proxy) at a community memory service. Exploratory and confirmatory factor analyses (EFA and CFA) were conducted using bifactor models to investigate domains that might be central to general HRQL. Reliability of the general and specific factors measured by the bifactor models was examined using omega (ω) and omega hierarchical (ω h) coefficients. Multiple-indicators multiple-causes models were used to explore the external validity of these HRQL measurements in terms of their associations with other clinical assessments. RESULTS Bifactor models showed adequate goodness of fit, supporting HRQL in dementia as a general construct that underlies a diverse range of health indicators. At the same time, additional factors were necessary to explain residual covariation of items within specific health domains identified from the literature. Based on these models, DEMQOL and DEMQOL-Proxy overall total scores showed excellent reliability (ω h > 0.8). After accounting for common variance due to a general factor, subscale scores were less reliable (ω h < 0.7) for informing on individual differences in specific HRQL domains. Depression was more strongly associated with general HRQL based on DEMQOL than on DEMQOL-Proxy (-0.55 vs -0.22). Cognitive impairment had no reliable association with general HRQL based on DEMQOL or DEMQOL-Proxy. CONCLUSIONS The tenability of a bifactor model of HRQL in dementia suggests that it is possible to retain theoretical focus on the assessment of a general phenomenon, while exploring variation in specific HRQL domains for insights on what may lie at the 'heart' of HRQL for people with dementia. These data suggest that DEMQOL and DEMQOL-Proxy total scores are likely to be accurate measures of individual differences in HRQL, but that subscale scores should not be used. No specific domain was solely responsible for general HRQL at dementia diagnosis. Better HRQL was moderately associated with less depressive symptoms, but this was less apparent based on informant reports. HRQL was not associated with severity of cognitive impairment.
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Affiliation(s)
- Kia-Chong Chua
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK.
| | - Anna Brown
- School of Psychology, University of Kent, Canterbury, UK
| | - Ryan Little
- Croydon Memory Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - David Matthews
- Croydon Memory Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Liam Morton
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Vanessa Loftus
- Kingston Integrated Health and Social Care Community Mental Health Team for Older People, South West London and St George's NHS Trust, London, UK
| | - Caroline Watchurst
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Rhian Tait
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Renee Romeo
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Sube Banerjee
- Brighton and Sussex Medical School, University of Sussex, Brighton, UK
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Moon H, Townsend AL, Dilworth-Anderson P, Whitlatch CJ. Predictors of Discrepancy Between Care Recipients With Mild-to-Moderate Dementia and Their Caregivers on Perceptions of the Care Recipients' Quality of Life. Am J Alzheimers Dis Other Demen 2016; 31:508-15. [PMID: 27287464 PMCID: PMC10852685 DOI: 10.1177/1533317516653819] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2024]
Abstract
PURPOSE The goal of this study was to explore predictors of discrepancy between reports of caregivers (CGs) and care recipients (CRs) with mild-to-moderate dementia about CRs' quality of life (QOL). DESIGN AND METHODS This study was a secondary analysis of cross-sectional data drawn from a study of 200 care dyads of CRs with mild-to-moderate dementia and their primary family CGs. Paired t test, ordinary least squares multiple regression, and binary logistic regression were used for the analyses. RESULTS Caregivers rated CRs' QOL significantly lower (worse) than CRs did. Ordinary least square regression results showed that greater incongruence in perceptions of CRs' decision-making involvement (DMI) and higher level of CR impairment in activities of daily living were significantly related to higher absolute discrepancy between CG and CR about CRs' QOL. In the logistic models, when the dyad had more DMI incongruence, or CG reported higher relationship strain, the CG was more likely to report a lower CR QOL than CR reported. IMPLICATIONS Practitioners should consider incorporating CRs' perspective when planning care instead of solely depending on CGs' perspective. Also, practitioners should pay attention to any gap between perceptions of CGs and CRs, particularly with regard to CRs' QOL.
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Affiliation(s)
- Heehyul Moon
- Raymond A. Kent School of Social Work, University of Louisville, Louisville, KY, USA
| | - Aloen L Townsend
- Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Peggye Dilworth-Anderson
- Gillings School of Global Public Health, The University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - Carol J Whitlatch
- Benjamin Rose Institute on Aging/Center for Research and Education, Cleveland, OH, USA
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Shippee TP, Henning-Smith C, Gaugler JE, Held R, Kane RL. Family Satisfaction With Nursing Home Care. Res Aging 2016; 39:418-442. [PMID: 26534835 DOI: 10.1177/0164027515615182] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article explores the factor structure of a new family satisfaction with nursing home care instrument and determines the relationship of resident quality of life (QOL) and facility characteristics with family satisfaction. Data sources include (1) family satisfaction interviews ( n = 16,790 family members), (2) multidimensional survey of resident QOL ( n = 13,433 residents), and (3) facility characteristics ( n = 376 facilities). We used factor analysis to identify domains of family satisfaction and multivariate analyses to identify the role of facility-level characteristics and resident QOL on facility-mean values of family satisfaction. Four distinct domains were identified for family satisfaction: "care," "staff," "environment," and "food." Chain affiliation, higher resident acuity, more deficiencies, and large size were all associated with less family satisfaction, and resident QOL was a significant (albeit weak) predictor of family satisfaction. Results suggest that family member satisfaction is distinct from resident QOL but is associated with resident QOL and facility characteristics.
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Affiliation(s)
- Tetyana P Shippee
- 1 Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Carrie Henning-Smith
- 1 Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Joseph E Gaugler
- 2 School of Nursing, University of Minnesota, Minneapolis, MN, USA
| | - Robert Held
- 3 Minnesota Department of Human Services, Minneapolis, MN, USA
| | - Robert L Kane
- 1 Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, USA
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O’Connor D, Phinney A, Smith A, Small J, Purves B, Perry J, Drance E, Donnelly M, Chaudhury H, Beattie L. Personhood in dementia care. DEMENTIA 2016. [DOI: 10.1177/1471301207075648] [Citation(s) in RCA: 127] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Dementia has been understood primarily as a biomedical phenomenon with a trajectory of irrevocable decline related to neurodegenerative changes. However, growing evidence suggests that the performance and behaviour of persons with dementia are not exclusively determined by neuropathology but are also influenced by personal histories, social interactions and social contexts. This evidence shifts attention from the disease process to the need for a more in-depth understanding of the place of personhood in dementia care. Despite its intuitive appeal however, there is limited empirical research grounding this approach to care. This article articulates a framework for organizing research in this area that is based on a critical review and synthesis of research. It encompasses three interrelated and intersecting domains of inquiry: the subjective experience of the person with dementia, the immediate interactional environment and the broader socio-cultural context. Each domain encapsulates a unique but interrelated dimension of a person-centred approach to dementia care.
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Abstract
People with dementia represent a significant and growing proportion of patients, but little is known about their involvement in making choices about their health or social care. This study explored the experiences of French older patients with dementia and their caregivers about their participation in decision-making. Individual semi-directive interviews were conducted with patients ( n= 21) and their primary carer focusing on a recently made decision (to accept professional help at home, to attend a day centre, or to move into residential care). Five aspects of decision-making were explored: information received; being listened to; expression of opinion; time allowed to reflect on decision; and possibility of changing one's mind. Carers tended to be more satisfied than patients on most criteria. Many patients felt they had not been listened to sufficiently, and had limited freedom to participate in decision-making. Continuing education may help professionals to improve their ability to involve patients with dementia in decision-making concerning their care arrangements.
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Abstract
Although we know that quality of life (QOL) can greatly influence a person's well-being, the measurement of QOL in individuals with dementia has, unfortunately, been largely ignored as a result of conceptual, logistical and measurement difficulties inherent in this population. To enable the voice of the person with dementia to be heard, a triangulated approach was adopted using survey data that aimed to assess the quality of life-Alzheimer's disease (QOL-AD) in Australian residential aged care and unstructured interviews with a small sample of participants ( n = 33). This article presents the survey results and demonstrates there were significant differences in QOL-AD scores between length of stay in the care setting groups, interpersonal relationship quality and self-esteem. Groups with greater physical impairment had lower QOL scores. It is concluded that the participants in this study were able to provide meaningful commentary on their QOL and that the findings may be useful when planning education of care staff and may contribute to theoretical models of dementia care.
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Simpelaere I, White A, Bekkering GE, Geurden B, Van Nuffelen G, De Bodt M. Patient-reported and proxy-reported outcome measures for the assessment of health-related quality of life among patients receiving enteral feeding. ACTA ACUST UNITED AC 2016; 14:45-75. [DOI: 10.11124/jbisrir-2016-002982] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Grimaldi Capitello T, Fiorilli C, Placidi S, Vallone R, Drago F, Gentile S. What factors influence parents' perception of the quality of life of children and adolescents with neurocardiogenic syncope? Health Qual Life Outcomes 2016; 14:79. [PMID: 27188269 PMCID: PMC4869310 DOI: 10.1186/s12955-016-0476-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 04/30/2016] [Indexed: 11/17/2022] Open
Abstract
Background Health-related quality of life, which can be investigated using self-reports or parental reports, could help healthcare providers understand the subjective perception of well-being of children suffering from recurrent syncopal episodes. Quality of life is not only a measure of health but is also a reflection of patients’ and parents’ perceptions and expectations of health. This study assessed: 1) the consistency and agreement between pediatric patients’ self-reports and parents’ proxy-reports of their child’s quality of life; 2) whether this patient-parent agreement is dependent on additional demographic and clinical or distress factors; 3) whether the parents’ psychological distress influences children’s and parents’ responses to questionnaires on quality of life. Methods One hundred and twenty-five Italian children aged 6-18 years old (Mean age 12.75, SD 2.73, 48 % female) and their parents completed the Pediatric Quality of Life inventory with self-reports and parent-proxy reports, the Parenting Stress Index - Short Form questionnaire and the Child Behavior Checklist for ages 6-18. Patients’ and parents’ scores on quality of life were analyzed via an intra-class correlation coefficient, Spearman’s correlation coefficient, Wilcoxon signed-rank test, and Bland-Altman plot. Results Child-rated quality of life was lower than parent-rated quality of life. However, there were no statistically significant differences between pediatric patients’ self-reports and their parents’ proxy-reports of on quality of life. Clinically significant patient-parent variation in pediatric health-related quality of life was observed. Differences in patient-parent proxy Pediatric Quality of Life inventory Total Scale Score scores were significantly associated with patient age. Conclusion Concerning parents’ proxy-ratings of their children’s quality of life on the Pediatric Quality of Life inventory, parental stress was found to be negatively associated with their perceptions of their child’s psychological quality of life. Indeed, childhood illness is a source of stress for the whole family, and exposes family members to a greater risk of developing psychosocial difficulties. In conclusion, this study invites reflection on the use of cross-informants in investigating the quality of life of young patients with neurocardiogenic syncope and the psychological factors that influence how quality of life is perceived.
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Affiliation(s)
- Teresa Grimaldi Capitello
- Department of Neuroscience and Neurorehabilitation, Clinic Psychology Unit, Bambino Gesù Children's Hospital, Rome, Italy. .,Libera Università Maria Santissima Assunta, Rome, Italy.
| | | | - Silvia Placidi
- Department of Paediatric Cardiology and Cardiac Surgery, Paediatric Arrhythmia and Syncope Unit, Bambino Gesù Children's Hospital, Rome, Italy
| | - Roberta Vallone
- Department of Neuroscience and Neurorehabilitation, Clinic Psychology Unit, Bambino Gesù Children's Hospital, Rome, Italy
| | - Fabrizio Drago
- Department of Paediatric Cardiology and Cardiac Surgery, Paediatric Arrhythmia and Syncope Unit, Bambino Gesù Children's Hospital, Rome, Italy
| | - Simonetta Gentile
- Department of Neuroscience and Neurorehabilitation, Clinic Psychology Unit, Bambino Gesù Children's Hospital, Rome, Italy
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Patomella AH, Sandman PO, Bergland Å, Edvardsson D. Characteristics of residents who thrive in nursing home environments: a cross-sectional study. J Adv Nurs 2016; 72:2153-61. [PMID: 27144469 DOI: 10.1111/jan.12991] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2016] [Indexed: 11/30/2022]
Abstract
AIM To describe what characterizes residents with higher levels compared with those with lower levels of thriving in nursing homes using the Thriving of Older People Assessment Scale. BACKGROUND Thriving is conceptualized as people's experiences of well-being in relation to the environment where they live. Thriving has the potential to emphasize health-promotion and positive experiences in nursing home residents in addition to current focus on illness and symptoms. DESIGN Cross-sectional design. METHODS Data from a total sample of 191 residents in a large Swedish nursing home facility were separated into two groups; rated as having high and low thriving based on a median split of thriving total score for each participating resident. The characteristics of residents with higher and lower levels of thriving were compared using bivariate analyses to investigate differences. Data were collected in 2013. RESULTS Residents with higher levels of thriving had shorter length of stay at the facility, higher functioning in Activities of Daily Living and less cognitive impairment, lower frequency of behavioural and psychological symptoms and higher assessed quality of life. The ability to walk and possibilities to spend time outdoors were higher among those with higher levels of thriving. CONCLUSION Nursing home residents who experience thriving have a higher level of functioning in activities of daily living, a higher quality of life and are less physically and cognitively impaired.
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Affiliation(s)
- Ann-Helen Patomella
- Division of Occupational Therapy, Department of Neurobiology, Health Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Per-Olof Sandman
- Department of Nursing, Umeå University, Sweden.,Department of Neurobiology, Health Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Department of Health Sciences, University of Technology, Lulea, Sweden
| | - Ådel Bergland
- Lovisenberg Diaconal University College, Oslo, Norway
| | - David Edvardsson
- Department of Nursing, Umeå University, Sweden.,School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia
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Votruba KL, Persad C, Giordani B. Patient Mood and Instrumental Activities of Daily Living in Alzheimer Disease: Relationship Between Patient and Caregiver Reports. J Geriatr Psychiatry Neurol 2015; 28:203-9. [PMID: 26071443 DOI: 10.1177/0891988715588829] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2009] [Accepted: 01/28/2015] [Indexed: 11/15/2022]
Abstract
This retrospective study investigated the relationship between self-reports and caregiver perceptions of patients' depressive symptoms and the respective ability of these reports to predict instrumental activities of daily living (IADLs) beyond what is accounted for by cognitive abilities in 71 patients with mild Alzheimer disease. Patients completed the Geriatric Depression Scale-Short Form, and caregivers completed the Behavior Rating Scale for Dementia assessing their perception of patients' depressive symptoms. Caregivers also completed IADL items from the Alzheimer's Disease Cooperative Study Activities of Daily Living Inventory. Cognitive measures included the Mini-Mental State Examination, Logical Memory from the Wechsler Memory Scale III, and Trail Making Test, Part B. The relationship between self-reported depressive symptoms and caregiver report of patients' depressive symptoms showed a trend toward significance (r = .22, P = .06). Measures of depressive symptoms significantly predicted 12.5% of the variance in IADLs performance, beyond that accounted for by patient demographics and cognitive functioning. Interestingly, patients' reports, rather than caregivers', were particularly useful in this prediction.
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Affiliation(s)
- Kristen L Votruba
- Department of Psychiatry, Neuropsychology Section, University of Michigan Medical Center, Ann Arbor, MI, USA
| | - Carol Persad
- Department of Psychiatry, Neuropsychology Section, University of Michigan Medical Center, Ann Arbor, MI, USA Michigan Alzheimer's Disease Center (MADC), Ann Arbor, MI, USA
| | - Bruno Giordani
- Department of Psychiatry, Neuropsychology Section, University of Michigan Medical Center, Ann Arbor, MI, USA Michigan Alzheimer's Disease Center (MADC), Ann Arbor, MI, USA
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Calvo V, Bianco F, Benelli E, Sambin M, Monsurrò MR, Femiano C, Querin G, Sorarù G, Palmieri A. Impact on children of a parent with ALS: a case-control study. Front Psychol 2015; 6:288. [PMID: 25852606 PMCID: PMC4362044 DOI: 10.3389/fpsyg.2015.00288] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 02/27/2015] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Numerous studies have explored how patients and their caregivers cope with amyotrophic lateral sclerosis (ALS), but the literature completely lacks research on the psychological impact of the disease on patients' children. The aim of our study was to investigate the emotional and psychological impact of a parent with ALS on school-age children and adolescents in terms of problem behavior, adjustment, and personality characteristics. METHODS The study involved 23 children (mean age = 10.62 years, six females) with a parent suffering from ALS, and both their parents. Children were matched for age, gender, and birth-order with a control group of children with healthy parents. They were administered the Youth Self Report (YSR) questionnaire and the Rorschach Comprehensive System, and their healthy parent completed the Child Behavior Checklist (CBCL). RESULTS Findings clearly showed that, compared with controls, children with a parent who had ALS had several clinically significant adverse emotional and behavioral consequences, with emotional and behavioral problems, internalizing problems, anxiety and depressive symptoms. Children of a parent with ALS scored higher than controls for the Total Problems, Internalizing Problems, Anxious/Depressed and Withdrawn/Depressed scales in the YSR. A relevant percentage of children fell within the clinical range (42.9%) and borderline range (28.6%) for Internalizing Problems. The Rorschach CS confirmed the substantial impact of ALS in a parent on their offspring in terms of internalizing behavior and depression, with adjustment difficulties, psychological pain, and thought problems. CONCLUSION Our findings indicate that school-aged children and adolescents with a parent who has ALS are vulnerable and carry a substantially higher risk of internalizing behavior, depressive symptoms, and reactive problems than children with healthy parents. Families affected may need support to cope with such an overwhelming disease.
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Affiliation(s)
- Vincenzo Calvo
- Department of Philosophy, Sociology, Pedagogy and Applied Psychology, University of Padova Padova, Italy
| | - Francesca Bianco
- Department of Philosophy, Sociology, Pedagogy and Applied Psychology, University of Padova Padova, Italy
| | - Enrico Benelli
- Department of Philosophy, Sociology, Pedagogy and Applied Psychology, University of Padova Padova, Italy
| | - Marco Sambin
- Department of Philosophy, Sociology, Pedagogy and Applied Psychology, University of Padova Padova, Italy
| | - Maria R Monsurrò
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, Second University of Naples Naples, Italy
| | - Cinzia Femiano
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, Second University of Naples Naples, Italy
| | - Giorgia Querin
- Department of Neurosciences, University of Padova Padova, Italy
| | - Gianni Sorarù
- Department of Neurosciences, University of Padova Padova, Italy
| | - Arianna Palmieri
- Department of Philosophy, Sociology, Pedagogy and Applied Psychology, University of Padova Padova, Italy
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Abstract
RÉSUMÉLa qualité de vie (QV) dont bénéficient les résidents des centres d'hébergement de soins de longue durée (SLD) est un résultat important des soins. Cette étude descriptive transversale a examiné la qualité de vie auto-declarée de résidents des établissements de SLD au Canada, tout en utilisant l'auto-évaluation interRAI Nursing Home Quality of Life Survey. Un objectif secondaire était de tester les propriétés pschométriques de l'instrument. Les tests psychométriques de l'instrument ont soutenu sa fiabilité et la validité de sa convergence et de son contenu pour l'évaluation de QV des résidents. Les résultats ont montré que les résidents ont évalués positivement plusieurs aspects de leur vie, comme d'avoir la vie privée lors des visites (76,9%) et l'honnêteté du personnel en traitant avec eux (73,6%). Les résidents ont accordé des taux inférieures à d'autres aspects, comme l'autonomie, la liaison entre le personnel et les résidents, et les relations personnelles. Les résultats suggèrent des lacunes importantes entre les philosophies de soins dans les établissements et leur traduction dans un environnement de soins ou les soins sont vraiment dirigés aux résidents. En outre, les résultats ont des implications potentielles pour la planification de soins aux résidents, la programmation de l'installation, le développement de la politique sociale et de la recherche future.
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Shell L. The picture of happiness in Alzheimer's disease: Living a life congruent with personal values. Geriatr Nurs 2015; 36:S26-32. [PMID: 25771956 DOI: 10.1016/j.gerinurse.2015.02.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Mjørud M, Kirkevold M, Røsvik J, Engedal K. Principal component analysis of the Norwegian version of the quality of life in late-stage dementia scale. Dement Geriatr Cogn Disord 2015; 37:265-75. [PMID: 24356496 DOI: 10.1159/000356497] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/18/2013] [Indexed: 11/19/2022] Open
Abstract
AIMS To investigate which factors the Quality of Life in Late-Stage Dementia (QUALID) scale holds when used among people with dementia (pwd) in nursing homes and to find out how the symptom load varies across the different severity levels of dementia. METHODS We included 661 pwd [mean age ± SD, 85.3 ± 8.6 years; 71.4% women]. The QUALID and the Clinical Dementia Rating (CDR) scale were applied. A principal component analysis (PCA) with varimax rotation and Kaiser normalization was applied to test the factor structure. Nonparametric analyses were applied to examine differences of symptom load across the three CDR groups. RESULTS The mean QUALID score was 21.5 (±7.1), and the CDR scores of the three groups were 1 in 22.5%, 2 in 33.6% and 3 in 43.9%. The results of the statistical measures employed were the following: Crohnbach's α of QUALID, 0.74; Bartlett's test of sphericity, p <0.001; the Kaiser-Meyer-Olkin measure, 0.77. The PCA analysis resulted in three components accounting for 53% of the variance. The first component was 'tension' ('facial expression of discomfort', 'appears physically uncomfortable', 'verbalization suggests discomfort', 'being irritable and aggressive', 'appears calm', Crohnbach's α = 0.69), the second was 'well-being' ('smiles', 'enjoys eating', 'enjoys touching/being touched', 'enjoys social interaction', Crohnbach's α = 0.62) and the third was 'sadness' ('appears sad', 'cries', 'facial expression of discomfort', Crohnbach's α 0.65). The mean score on the components 'tension' and 'well-being' increased significantly with increasing severity levels of dementia. CONCLUSION Three components of quality of life (qol) were identified. Qol decreased with increasing severity of dementia.
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Affiliation(s)
- Marit Mjørud
- Norwegian Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
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42
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Orgeta V, Orrell M, Hounsome B, Woods B. Self and carer perspectives of quality of life in dementia using the QoL-AD. Int J Geriatr Psychiatry 2015; 30:97-104. [PMID: 24789766 DOI: 10.1002/gps.4130] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Accepted: 03/26/2014] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Quality of life (QoL) is one of the most important outcomes in improving well-being in people with dementia (PwD). The primary aim of the present study was to compare self and carer ratings of QoL in PwD and to identify the most important factors influencing self and carer ratings. METHODS We conducted a cross-sectional analytic study of 488 dyads using the Quality of Life in Alzheimer's Disease scale, demographics, data on self-rated health, and clinical characteristics. RESULTS Higher levels of self-rated health in PwD were associated with higher self-rated QoL after controlling for depression and activities of daily living. When the carer experienced less stress related to caregiving, the PwD reported better QoL. Higher carer-rated QoL was associated with less carer stress, better health for the family carer, and the PwD being of younger age. When carers lived with the PwD, and reported lower levels of depression and better functional ability for their relative, carer-rated QoL was higher. CONCLUSIONS The self-rated health of PwD and carers influences the ratings they make of the QoL of the PwD indicating that it is an important influence on QoL in this population.
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Affiliation(s)
- Vasiliki Orgeta
- Division of Psychiatry, University College London, London, UK
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Bergland Å, Kirkevold M, Sandman PO, Hofoss D, Edvardsson D. The Thriving of Older People Assessment Scale: validity and reliability assessments. J Adv Nurs 2014; 71:942-51. [DOI: 10.1111/jan.12593] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2014] [Indexed: 11/27/2022]
Affiliation(s)
- Ådel Bergland
- Lovisenberg Diaconal University College; Oslo Norway
| | - Marit Kirkevold
- Department of Nursing Science; Faculty of Medicine; Institute of Health and Society; University of Oslo; Norway
| | - Per-Olof Sandman
- Department of Neurobiology; Care Sciences and Society; Karolinska Institutet; Sweden
- Department of Nursing; Umeå University; Sweden
| | - Dag Hofoss
- Department of Nursing Science; Faculty of Medicine; Institute of Health and Society; University of Oslo; Norway
| | - David Edvardsson
- Department of Nursing; Umeå University; Sweden
- School of Nursing and Midwifery; La Trobe University; Melbourne Victoria Australia
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Feldman HH, Gauthier S, Chertkow H, Conn DK, Freedman M, Chris M. PROGRESS IN CLINICAL NEUROSCIENCES: Canadian Guidelines for the Development of Antidementia Therapies: A Conceptual Summary. Can J Neurol Sci 2014; 33:6-26. [PMID: 16583717 DOI: 10.1017/s0317167100004649] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The magnitude of the problems faced by an aging Canadian society has been clearly identified. Perhaps the single most important problem is the increasing incidence of dementia. Alzheimer's disease (AD) accounts for 50-60% of the dementias in later life within a spectrum of other contributing dementias. Regulatory approval has been given to Acetylcholinesterase inhibitors for the symptomatic treatment of mild to moderate AD, and conditional approval to memantine for the symptoms of moderate to severe AD. There has been no regulatory approval for the treatment of the degenerative dementias beyond AD. The very rapid progress in the past decade in biotechnology and in the molecular biology of the dementias is supporting a new generation of innovative treatment strategies that will more directly target the underlying disease pathogenic mechanisms. Such treatments will foreseeably include immunotherapies, anti-aggregants that may prevent misfolding and deposition of proteins, and neuroregenerative interventions. These Guidelines follow the 2nd Canadian Conference on the Development of Antidementia Therapies, held in 2004, which covered a range of design, methodological and ethical issues facing clinical researchers and regulatory authorities. They are intended to provide a common point of reference and guidance in Canada for therapeutic development of the dementias.
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Affiliation(s)
- Howard H Feldman
- Division of Neurology, University of British Columbia, Clinic for Alzheimer's Disease and Related Disorders, Vancouver, BC, Canada
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45
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Abstract
There is a growing consensus that quality of life (QOL) is an important outcome for assessing the effectiveness of interventions for dementia, but there is no agreement about how to best measure it. Various approaches to QOL assessment have been employed to measure the QOL of persons with dementia, including patient self-report, caregiver proxy report and observational assessment by trained observers. Furthermore, several dementia-specific measures of QOL have been developed, and several generic measures of QOL have been used to assess QOL in dementia. However, to date, QOL has rarely been included as an outcome measure in clinical trials of pharmacotherapy for dementia. This manuscript reviews the current state of knowledge about QOL assessment in dementia.
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Affiliation(s)
- Gary Naglie
- Division of General Internal Medicine, University Health Network, Canada
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Pandya R, Krentz HB, Gill MJ, Power C. HIV-Related Neurological Syndromes Reduce Health-Related Quality of Life. Can J Neurol Sci 2014; 32:201-4. [PMID: 16018155 DOI: 10.1017/s0317167100003978] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
ABSTRACT:Background:Human immunodeficiency virus (HIV) infection frequently results in neurological complications but the impact of different neurological syndromes on patients' quality of life remains unknown.Methods:We investigated health-related quality of life (HRQoL) parameters among HIV/Acquired Immune Deficiency Syndrome (AIDS) patients with and without neurological disease, including 11 dimensions of HRQoL within the Medical Outcomes Short-form Health Survey-HIV.Results:Comparisons of sociodemographic and systemic clinical variables did not differ between HIV/AIDS patients with (n=94) and without (n=75) neurological disease. However, patients with neurological diseases exhibited significantly lower HRQoL scores compared to matched controls, which was most evident among HIV/AIDS patients with cognitive impairment and sensory neuropathy. Prospective analysis revealed diminishing HRQoL scores prior to neurological diagnosis followed by a progressive and sustained improvement in HRQoL scores after intervention over a 96-week period.Conclusions:These studies indicate that while HIV-related neurological diseases are associated with reduced HRQoL scores, enhanced neurological care has a positive impact on HIV/AIDS patients' overall well-being.
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Affiliation(s)
- Rupang Pandya
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
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Orgeta V, Edwards RT, Hounsome B, Orrell M, Woods B. The use of the EQ-5D as a measure of health-related quality of life in people with dementia and their carers. Qual Life Res 2014; 24:315-24. [PMID: 25129054 PMCID: PMC4317511 DOI: 10.1007/s11136-014-0770-0] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2014] [Indexed: 11/27/2022]
Abstract
PURPOSE To assess the acceptability, validity and inter-rater agreement of self- and family carer proxy ratings of the EQ-5D as a generic health-related quality of life (HRQOL) measure, in people with mild to moderate dementia (PwD) living in the community. A secondary aim was to identify the most important factors influencing self- and family carer proxy ratings of HRQOL, distinguishing between spouse and adult child caregiver ratings. METHODS Cross-sectional study of 488 dyads using the EQ-5D. Inter-rater agreement was examined using weighted kappa scores, and validity by investigating the association of self- and family carer ratings with clinical variables. Factors affecting HRQOL ratings were analysed using multivariate regression. RESULTS The response rate of the EQ-5D was satisfactory; however, agreement between self- and family carer ratings was poor. The most important predictors of PwD and carer ratings of the PwD's HRQOL were family carer ratings of activities of daily living and mood. Anxiety experienced by the PwD was a significant predictor of self-rated HRQOL, whereas depressive symptoms independently predicted family carer ratings. The type of the caregiving relationship influenced carer ratings of HRQOL, whereby sons and daughters rated HRQOL lower for the PwD compared with spousal caregivers. CONCLUSIONS People with mild to moderate dementia are able to rate their own HRQOL through a brief generic instrument; however, self-ratings consistently differ from family carer ratings, which should be acknowledged in cost-effectiveness analyses. Spouse caregivers rate HRQOL for the PwD more positively compared to adult children.
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Affiliation(s)
- Vasiliki Orgeta
- Division of Psychiatry, University College London, 67-73 Riding House Street, 2nd Floor, Charles Bell House, London, W1W 7EJ, UK,
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Measuring the quality of life in mild to very severe dementia: testing the inter-rater and intra-rater reliability of the German version of the QUALIDEM. Int Psychogeriatr 2014; 26:825-36. [PMID: 24507554 DOI: 10.1017/s1041610214000052] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Quality of life (Qol) is an increasingly used outcome measure in dementia research. The QUALIDEM is a dementia-specific and proxy-rated Qol instrument. We aimed to determine the inter-rater and intra-rater reliability in residents with dementia in German nursing homes. METHODS The QUALIDEM consists of nine subscales that were applied to a sample of 108 people with mild to severe dementia and six consecutive subscales that were applied to a sample of 53 people with very severe dementia. The proxy raters were 49 registered nurses and nursing assistants. Inter-rater and intra-rater reliability scores were calculated on the subscale and item level. RESULTS None of the QUALIDEM subscales showed strong inter-rater reliability based on the single-measure Intra-Class Correlation Coefficient (ICC) for absolute agreement ≥ 0.70. Based on the average-measure ICC for four raters, eight subscales for people with mild to severe dementia (care relationship, positive affect, negative affect, restless tense behavior, social relations, social isolation, feeling at home and having something to do) and five subscales for very severe dementia (care relationship, negative affect, restless tense behavior, social relations and social isolation) yielded a strong inter-rater agreement (ICC: 0.72-0.86). All of the QUALIDEM subscales, regardless of dementia severity, showed strong intra-rater agreement. The ICC values ranged between 0.70 and 0.79 for people with mild to severe dementia and between 0.75 and 0.87 for people with very severe dementia. CONCLUSIONS This study demonstrated insufficient inter-rater reliability and sufficient intra-rater reliability for all subscales of both versions of the German QUALIDEM. The degree of inter-rater reliability can be improved by collaborative Qol rating by more than one nurse. The development of a measurement manual with accurate item definitions and a standardized education program for proxy raters is recommended.
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Quality of life of nursing home residents with dementia: validation of the German version of the ICECAP-O. PLoS One 2014; 9:e92016. [PMID: 24632775 PMCID: PMC3954837 DOI: 10.1371/journal.pone.0092016] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 02/18/2014] [Indexed: 11/19/2022] Open
Abstract
Objectives To validate the ICECAP-O capability wellbeing measure’s German translation in older people with dementia living in a nursing home, and to investigate the influence of proxy characteristics on responses. Method Cross-sectional study. For 95 residents living in a German nursing home, questionnaires were completed by nursing professionals serving as proxy respondents. We investigated the convergent validity of the ICECAP-O with other Quality of Life (Qol) measures, the EQ-5D extended with a cognitive dimension (EQ-5D+C), the Alzheimer’s Disease Related Quality of Life (ADRQL) measures, and the Barthel-index measure of Activities of Daily Living (ADL). Discriminant validity was investigated using bivariate and multivariate stepwise regression analysis, comparing ICECAP-O scores between subgroups varying in dementia severity, care dependency, ADL status and demographic characteristics. Results Convergent validity between the ICECAP-O, EQ-5D+C, ADRQL and Barthel-Index scores was moderate to good (with correlations of 0.72, 0.69 and 0.53 respectively), but differed considerably between dimensions of the instruments. Discriminant validity was confirmed by finding differences in ICECAP-O scores between subgroups based on ADL scores (0.58 below 65 points on the Barthel-index and 0.80 above 65 points) and other characteristics. The ICECAP-O scores based on available tariffs were related to proxy characteristics gender (0.52 males versus 0.65 females) and work experience (0.61 below 2 years of experience versus 0.68 above 2 years). Discussion The results of this study suggest that the ICECAP-O is a promising generic measure for general Qol and capability of people with dementia living in a nursing home. Validity tests generally yielded favorable results. Work experience and gender appeared to influence proxy response, which raises questions regarding appropriate proxies, especially since the ICECAP-O may be completed by proxies relatively often. Further research is necessary to validate the German version of the ICECAP-O, with specific attention to proxy completion for people with dementia.
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Krattenmacher T, Kühne F, Halverscheid S, Wiegand-Grefe S, Bergelt C, Romer G, Möller B. A comparison of the emotional and behavioral problems of children of patients with cancer or a mental disorder and their association with parental quality of life. J Psychosom Res 2014; 76:213-20. [PMID: 24529040 DOI: 10.1016/j.jpsychores.2013.11.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Revised: 11/28/2013] [Accepted: 11/29/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To compare the emotional and behavioral problems of children of patients suffering from cancer or a mental disorder and their association with parental quality of life. METHODS A total of 223 children from 136 families and their 160 parents were investigated from multiple perspectives in a cross-sectional study. The consistency of different adjustment reports between family members was examined. Through mixed models, the differences between parental HRQoL and the children's symptomatology were studied with regard to the type of parental illness. The prediction of children's adjustment through parental HRQoL was further examined. Additionally, gender and age of the children were considered. RESULTS Half of the children exhibited psychosocial problems. Gender and age differences were independent of the type of parental disease. In families with parental cancer, the reports of children's adjustment were more consistent between family members than in families where a parental mental disorder was present. We found differences in HRQoL between families with mentally ill parents and those with parental cancer patients. Specifically, the healthy partners of mentally ill parents showed worse HRQoL compared with healthy partners of cancer patients. Healthy parents' reduced HRQoL was associated with worse adjustment in their children, regardless of the type of parental illness, but this result was not found for ill parents. CONCLUSION Family members confronted with parental cancer or mental disorders are more burdened compared with those from the "normal" population, independently of the type of disease. Our results indicate that the type of a parental disease has no direct effect on children's adjustment. However, there are disease-specific effects on parental HRQoL, which are associated with children's adjustment.
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Affiliation(s)
- Thomas Krattenmacher
- University Medical Center Hamburg-Eppendorf, Department of Child Adolescent Psychiatry, Psychotherapy and Psychosomatics, Germany.
| | - Franziska Kühne
- University Medical Center Hamburg-Eppendorf, Department of Child Adolescent Psychiatry, Psychotherapy and Psychosomatics, Germany
| | - Susanne Halverscheid
- University Medical Center Hamburg-Eppendorf, Department of Child Adolescent Psychiatry, Psychotherapy and Psychosomatics, Germany
| | - Silke Wiegand-Grefe
- University Medical Center Hamburg-Eppendorf, Department of Child Adolescent Psychiatry, Psychotherapy and Psychosomatics, Germany
| | - Corinna Bergelt
- University Medical Center Hamburg-Eppendorf, Department of Medical Psychology, Germany
| | - Georg Romer
- University Medical Center Hamburg-Eppendorf, Department of Child Adolescent Psychiatry, Psychotherapy and Psychosomatics, Germany
| | - Birgit Möller
- University Medical Center Hamburg-Eppendorf, Department of Child Adolescent Psychiatry, Psychotherapy and Psychosomatics, Germany
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