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Speckemeier C, Niemann A, Weitzel M, Abels C, Höfer K, Walendzik A, Wasem J, Neusser S. Assessment of innovative living and care arrangements for persons with dementia: a systematic review. BMC Geriatr 2023; 23:464. [PMID: 37525120 PMCID: PMC10391868 DOI: 10.1186/s12877-023-04187-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 07/20/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Alternative forms of housing for persons with dementia have been developed in recent decades. These concepts offer small groups of residents familiar settings combined with efforts to provide normal daily life. The aim of this systematic review is to collate and analyze these more innovative forms of housing regarding residents' quality of life, behavioral aspects, as well as functional, cognitive and emotional aspects. METHODS Searches were conducted in PubMed, EMBASE and PsycInfo in November 2020. Studies comparing traditional and more innovative living environments for persons with dementia were eligible. Concepts are described based on the results of additional searches. Risk of bias of included studies was assessed using checklists from the Joanna Briggs Institute. RESULTS A total of 21 studies corresponding to 11 different concepts were included, namely Green Houses (USA), Group Living (Sweden), Cantou (France), Group Homes (Japan), Small-scale Group Living (Austria), Special Care Facilities (Canada), Shared-housing Arrangements (Germany), Residential Groups (Germany), Residential Care Centers / Woodside Places (USA/Canada), Small-scale Living (Netherlands/ Belgium), and Green Care Farms (Netherlands). The concepts are broadly similar in terms of care concepts, but partly differ in group sizes, staff qualifications and responsibilities. Several studies indicate that innovative forms of housing may encourage social behavior, preserve activity performance and/or positively influence emotional status compared to more traditional settings, while other studies fail to demonstrate these effects. Some studies also show increased behavioral and psychological symptoms of dementia (BPSD) in residents who live in more innovative housing concepts. The effect on cognition remains indistinct. DISCUSSION The positive effects may be attributable to the inherent characteristics, including small group sizes, a stimulating design, and altered staff roles and responsibilities. Arguably, some of these characteristics might also be the reason for increased BPSD. Studies had variable methodological quality and results have to be considered with caution. Future research should examine these effects more closely and should investigate populations' preferences with regards to housing in the event of dementia.
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Affiliation(s)
- C Speckemeier
- Institute for Healthcare Management and Research, University of Duisburg-Essen, Thea-Leymann-Str. 9, 45127, Essen, Germany.
| | - A Niemann
- Institute for Healthcare Management and Research, University of Duisburg-Essen, Thea-Leymann-Str. 9, 45127, Essen, Germany
| | - M Weitzel
- Institute for Healthcare Management and Research, University of Duisburg-Essen, Thea-Leymann-Str. 9, 45127, Essen, Germany
| | - C Abels
- Institute for Healthcare Management and Research, University of Duisburg-Essen, Thea-Leymann-Str. 9, 45127, Essen, Germany
| | - K Höfer
- Institute for Healthcare Management and Research, University of Duisburg-Essen, Thea-Leymann-Str. 9, 45127, Essen, Germany
| | - A Walendzik
- Institute for Healthcare Management and Research, University of Duisburg-Essen, Thea-Leymann-Str. 9, 45127, Essen, Germany
| | - J Wasem
- Institute for Healthcare Management and Research, University of Duisburg-Essen, Thea-Leymann-Str. 9, 45127, Essen, Germany
| | - S Neusser
- Institute for Healthcare Management and Research, University of Duisburg-Essen, Thea-Leymann-Str. 9, 45127, Essen, Germany
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Ruggero L, Croot K, Nickels L. Quality of Life Ratings and Proxy Bias in Primary Progressive Aphasia: Two Sides to the Story? Am J Alzheimers Dis Other Demen 2023; 38:15333175231177668. [PMID: 37247394 PMCID: PMC10623902 DOI: 10.1177/15333175231177668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
A valid measure of quality of life is important for clinical goal setting and for evaluating interventions. In the amnestic dementias, proxy-raters (e.g. friends, families, clinicians) typically rate quality of life lower than the self-ratings given by the person with dementia - a proxy bias. This study investigated whether the same proxy bias occurs in Primary Progressive Aphasia (PPA), a language-led dementia.Quality of life was measured in 18 individuals with PPA using self-ratings, and proxy-ratings by their main communication partner, using the Quality of Life in Alzheimer's Disease Scale.There was no strong evidence for proxy bias at a group level, with no consistent pattern across dyads, where proxy- and self-ratings did not show good levels of agreement. We suggest that self-ratings and proxy-ratings of quality of life in PPA are not interchangeable. Higher-powered investigation of the patterns observed here is warranted in future studies.
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Affiliation(s)
- Leanne Ruggero
- School of Psychological Sciences, Macquarie University, Sydney, AU -NSW, Australia
| | - Karen Croot
- School of Psychology, The University of Sydney, Sydney, AU -NSW, Australia
| | - Lyndsey Nickels
- School of Psychological Sciences, Macquarie University, Sydney, AU -NSW, Australia
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Hutchinson C, Worley A, Khadka J, Milte R, Cleland J, Ratcliffe J. Do we agree or disagree? A systematic review of the application of preference-based instruments in self and proxy reporting of quality of life in older people. Soc Sci Med 2022; 305:115046. [PMID: 35636050 DOI: 10.1016/j.socscimed.2022.115046] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 04/04/2022] [Accepted: 05/14/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE Quality of life is an important person-centred outcome in health and aged care settings. Due to an increasing prevalence of cognitive decline and dementia in ageing populations, a proportion of older people receiving health and aged care services may not be able to reliably assess their own quality of life, highlighting the need for proxy assessment. This systematic review sought to investigate the level of agreement between self and proxy-report of older people's quality of life using established preference-based instruments of quality of life suitable for economic evaluation. METHODS A systematic review was conducted following PRISMA guidelines. Eight databases were searched: Web of Science, Scopus, Medline, Econlit, PsychINFO, CINAHL, Ageline and Cochrane Library. Information was extracted on the instruments, population samples (including any cognitive thresholds applied), mean scores, type of proxy, and measures of inter-rater agreement. RESULTS A total of 50 studies using eight different preference-based quality of life instruments were identified. Most studies were cross-sectional (72%) with a wide variety of cognitive assessments and thresholds applied to define older participants with cognitive impairment. The most common proxies were family members, mostly spouses. The level of agreement between self and proxy-report was generally poor - irrespective of the instrument applied or type of proxy - with proxy-report generally indicating lower levels of quality of life than self-report. There was some evidence of stronger agreement on more observable quality of life domains e.g., physical health and mobility, relative to less observable domains e.g. emotional well-being. Few studies tracked self and/or proxy-report of quality of life longitudinally. CONCLUSIONS More research is needed to develop evidence to inform guidance on self-report versus proxy-report of quality of life for older people receiving health and aged care services. Until then, the collection of both self and proxy reports as complementary measures is indicated.
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Affiliation(s)
- Claire Hutchinson
- Health and Social Care Economics Group, College of Nursing and Health Sciences, Flinders University, Australia; Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Australia.
| | - Anthea Worley
- Health and Social Care Economics Group, College of Nursing and Health Sciences, Flinders University, Australia
| | - Jyoti Khadka
- Health and Social Care Economics Group, College of Nursing and Health Sciences, Flinders University, Australia; Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Australia; Registry of Senior Australians, South Australian Health and Medical Research Institute, Australia
| | - Rachel Milte
- Health and Social Care Economics Group, College of Nursing and Health Sciences, Flinders University, Australia; Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Australia
| | - Jenny Cleland
- Health and Social Care Economics Group, College of Nursing and Health Sciences, Flinders University, Australia; Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Australia
| | - Julie Ratcliffe
- Health and Social Care Economics Group, College of Nursing and Health Sciences, Flinders University, Australia; Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Australia
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Villars H, Cantet C, de Peretti E, Perrin A, Soto-Martin M, Gardette V. Impact of an educational programme on Alzheimer's disease patients' quality of life: results of the randomized controlled trial THERAD. ALZHEIMERS RESEARCH & THERAPY 2021; 13:152. [PMID: 34511121 PMCID: PMC8436545 DOI: 10.1186/s13195-021-00896-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 08/30/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Although educational interventions are recommended in Alzheimer's disease (AD), studies assessing the impact of interventions such as "therapeutic patient education" are scarce. Indeed, the intrinsic nature of the disease is considered a barrier to patients' involvement in such approaches. We aimed to evaluate an intervention by using a "dyadic" approach (patient and caregiver) in both intervention and assessment. METHODS THERAD is a monocentric, randomized, controlled trial assessing the effects of a 2-month educational programme in mild to moderately severe AD patients among 98 dyads (caregiver/patient) on caregiver-reported patient quality of life (QOL) at 2 months. Community-dwelling patients and their caregivers were recruited in ambulatory units of the French Toulouse University Hospital. Self-reported patient QOL, autonomy, behavioural and psychological symptoms and caregiver QOL and burden were collected at 2, 6 and 12 months. Linear mixed models were used in modified intention-to-treat populations. We also performed sensitivity analysis. RESULTS A total of 196 dyads were included, 98 in each group. The mean age of the patients was 82 years, 67.7% were women, diagnosed with AD (+/- cerebrovascular component) (mean MMSE =17.6), and 56.9% lived with a partner. The mean age of the caregivers was 65.7 years, and 64.6% were women (52.3% offspring/42.6% spouses), with a moderate burden (mean Zarit score = 30.9). The mean caregiver-reported patient QOL was lower than the self-reported QOL (28.61 vs. 33.96). We did not identify any significant difference in caregiver-reported patients' QOL (p = 0.297) at 2 months, but there was a significant difference in self-reported patients' QOL at 2 months (p = 0.0483) or 6 months (p = 0.0154). No significant difference was found for the secondary outcomes. The results were stable in the sensitivity analyses. CONCLUSIONS This randomized controlled trial assessing an educational intervention in 196 dyads (Alzheimer's disease affected patient/caregiver) highlights the need to better consider the patient's point of view, since only the self-reported QOL was improved. Additional studies using this dyadic approach are necessary in targeted subpopulations of caregivers (spouse vs. child, gender) and of patients (severity of cognitive impairment or behavioural disturbances) TRIAL REGISTRATION: THERAD study NCT01796314 . Registered on February 19, 2013.
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Affiliation(s)
- Hélène Villars
- Geriatric Department, Toulouse University Hospital, Hopital La Grave- Cité de la Santé Place Lange TSA 60 033, 31059, Toulouse Cedex 9, France.
| | - Christelle Cantet
- Inserm UMR 1295: Center for Research in Population Health (CERPOP) - Department of Epidemiology and Public Health, University of Toulouse, II F-31073, 37, allées Jules Guesde, 31073, Toulouse cedex, France
| | - Eva de Peretti
- Geriatric Department, Toulouse University Hospital, Hopital La Grave- Cité de la Santé Place Lange TSA 60 033, 31059, Toulouse Cedex 9, France
| | - Amelie Perrin
- Geriatric Department, Toulouse University Hospital, Hopital La Grave- Cité de la Santé Place Lange TSA 60 033, 31059, Toulouse Cedex 9, France
| | - Maria Soto-Martin
- Geriatric Department, Toulouse University Hospital, Hopital La Grave- Cité de la Santé Place Lange TSA 60 033, 31059, Toulouse Cedex 9, France
| | - Virginie Gardette
- Geriatric Department, Toulouse University Hospital, Hopital La Grave- Cité de la Santé Place Lange TSA 60 033, 31059, Toulouse Cedex 9, France
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Xu J, Bao H, Qi X, Wang J, Yin H, Shang C, Tan RL, Wu Q, Huang W. Family caregivers of rare disease: A survey on health-related quality of life in family caregivers for Gaucher disease patients in China. Mol Genet Genomic Med 2021; 9:e1760. [PMID: 34387413 PMCID: PMC8457695 DOI: 10.1002/mgg3.1760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 05/10/2021] [Accepted: 07/08/2021] [Indexed: 11/30/2022] Open
Abstract
Background Rare diseases affect the health‐related quality of life (HRQoL) of patients and their family caregivers (FCs). However, limited evidence is available on the HRQoL of FCs of patients with Gaucher disease (GD). This study aimed to assess HRQoL and related factors among FCs of patients with GD in China. Methods A cross‐sectional online survey was conducted with 49 FCs recruited by convenience sampling. Participants completed the Medical Outcome Study Short Form‐36 (SF‐36), Zung's Self‐Rating Anxiety Scale, Zung's Self‐Rating Depression Scale, the Multi‐dimensional Scale of Perceived Social Support, the Herth Hope Index, and a questionnaire about FCs’ and patients’ sociodemographic characteristics. Single‐sample t tests, one‐way analysis of variance, and multivariate linear regression analysis were used to analyze the data analysis. Results Participating FCs had significantly lower scores in all eight SF‐36 domains compared with the general population in China (p < 0.01). FCs’ gender, education, daily care time, anxiety, and the perceived disease severity of patients were significant predictors of SF‐36 physical component summary scores. Caregiving help from others, anxiety, perceived disease severity, and medical insurance type were significant predictors of SF‐36 mental component summary scores. Conclusion The findings showed FCs of patients with GD had lower HRQoL. There is an urgent need to address the health concerns of FCs of people with rare diseases including their HRQoL.
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Affiliation(s)
- Jiao Xu
- School of Health Management, Harbin Medical University, Harbin, Heilongjiang, China
| | - Han Bao
- Public Health College, The Inner Mongolia Medical University, Hohhot, Inner Mongolia, China
| | - Xinye Qi
- School of Health Management, Harbin Medical University, Harbin, Heilongjiang, China
| | - Jiahui Wang
- School of Health Management, Harbin Medical University, Harbin, Heilongjiang, China
| | - Hang Yin
- School of Health Management, Harbin Medical University, Harbin, Heilongjiang, China
| | - Chunyang Shang
- Department of Hepatobiliary Surgery, Peking University Care Zibo Hospital, Zibo, Shandong, China
| | - Rachel Leeyin Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Qunhong Wu
- School of Health Management, Harbin Medical University, Harbin, Heilongjiang, China
| | - Weidong Huang
- School of Health Management, Harbin Medical University, Harbin, Heilongjiang, China
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Yamada T, Nakaaki S, Sato J, Sato H, Shikimoto R, Furukawa TA, Mimura M, Akechi T. Factor structure of the Japanese version of the Quality of Life in Alzheimer's Disease Scale (QOL-AD). Psychogeriatrics 2020; 20:79-86. [PMID: 31020753 DOI: 10.1111/psyg.12459] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 02/16/2019] [Accepted: 04/01/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND The Quality of Life in Alzheimer's Disease Scale (QOL-AD) developed by Logsdon et al. in1999 is believed to be useful for evaluating responses from both patients and their caregivers. We previously confirmed both the reliability and the validity of the Japanese version of the QOL-AD. However, the factor structure of this scale should be confirmed because the QOL-AD covers multiple facets of dementia patients' lives. Thus, we performed a factor analysis of the Japanese QOL-AD. Then, we examined the correlations between each of the identified QOL factor scores and the results of other scales. METHODS The Japanese version of the QOL-AD was given to 132 AD patients and 132 caregivers. Four other tests were also performed at the same time: the Mini-Mental State Examination, the Neuropsychiatric Inventory (NPI), the Hyogo Activities of Daily Living Scale (HADL), and the Short Memory Questionnaire. A factor analysis using Varimax rotation was used to examine the dimensions underlying the QOL-AD. In addition, we examined the Pearson correlations between each of the identified QOL factor scores and the results of the other four tests. RESULTS Factor analyses of both versions of the Japanese QOL-AD (both the patients' and the caregivers' responses) revealed three factors that were named 'psychological wellbeing', 'human relationships', and 'physical and social environment'. The 'psychological wellbeing' factor was significantly correlated with the Mood factor of the NPI. The 'human relationships' factor was significantly correlated with the Psychosis factor of the NPI. The 'physical and social environment' factor was significantly correlated with the HADL. CONCLUSIONS Both the patients' and the caregivers' responses to the Japanese version of the QOL-AD were composed of three factors: 'psychological wellbeing', 'human relationships', and 'physical and social environment'. The present results support the multi-domain concept of QOL proposed by Lawton.
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Affiliation(s)
- Takahiro Yamada
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Shutaro Nakaaki
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.,Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Junko Sato
- Department of Speech-Language-Hearing Therapy, School of Rehabilitation Science Seirei Christopher University, Japan
| | - Hirofumi Sato
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Ryo Shikimoto
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Toshi A Furukawa
- Department of Health Promotion and Human Behavior (Cognitive-Behavioral Medicine), Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Tatsuo Akechi
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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Picard G, Bier JC, Capron I, De Deyn PP, Deryck O, Engelborghs S, Hanseeuw B, Lemper JC, Mormont E, Petrovic M, Salmon E, Segers K, Sieben A, Thiery E, Ventura M, Versijpt J, Ivanoiu A. Dementia, End of Life, and Euthanasia: A Survey Among Dementia Specialists Organized by the Belgian Dementia Council. J Alzheimers Dis 2019; 69:989-1001. [DOI: 10.3233/jad-181277] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Gaëtane Picard
- Department of Neurology, Clinique Saint-Pierre, Ottignies, Belgium
| | - Jean-Christophe Bier
- Department of Neurology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Isabelle Capron
- Department of Neurology, Cliniques de l’Europe – St Michel, Brussels, Belgium
| | - Peter Paul De Deyn
- Reference Center for Biological Markers of Dementia (BIODEM), Laboratory of Neurochemistry and Behavior, Institute Born-Bunge, University of Antwerp, Belgium
- Department of Neurology and Memory Clinic, Hospital Network Antwerp (ZNA) Middelheim and Hoge Beuken, Antwerp, Belgium
| | - Olivier Deryck
- Department of Neurology, Memory Clinic General Hospital Sint-Jan Brugge-Oostende Brugge, Belgium
| | - Sebastiaan Engelborghs
- Reference Center for Biological Markers of Dementia (BIODEM), Laboratory of Neurochemistry and Behavior, Institute Born-Bunge, University of Antwerp, Belgium
- Department of Neurology, Universitair Ziekenhuis Brussel (UZ Brussel), Center for Neurosciences, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Bernard Hanseeuw
- Department of Neurology, Cliniques Universitaires St Luc, Université catholique de Louvain, Brussels, Belgium
- Institute of Neuroscience (IoNS), Université catholique de Louvain, Brussels, Belgium
| | | | - Eric Mormont
- Department of Neurology, Université catholique de Louvain, CHU UCL Namur, Yvoir, Belgium
- Institute of Neuroscience (IoNS), Université catholique de Louvain, Brussels, Belgium
| | - Mirko Petrovic
- Department of Internal Medicine, Section of Geriatrics, Ghent University, Gent, Belgium
| | - Eric Salmon
- GIGA Cyclotron Research Centre Imaging, University of Liége, Liége, Belgium
- Department of Neurology, Memory Clinic, Centre Hospitalier Universitaire (CHU) Liége, Liége, Belgium
| | - Kurt Segers
- Department of Neurology, Brugmann University Hospital, Brussels, Belgium
| | - Anne Sieben
- Department of Neurology, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Evert Thiery
- Department of Neurology, Ghent University Hospital, Ghent University, Ghent, Belgium
| | | | - Jan Versijpt
- Department of Neurology, Universitair Ziekenhuis Brussel (UZ Brussel), Center for Neurosciences, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Adrian Ivanoiu
- Department of Neurology, Cliniques Universitaires St Luc, Université catholique de Louvain, Brussels, Belgium
- Institute of Neuroscience (IoNS), Université catholique de Louvain, Brussels, Belgium
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Caiels J, Rand S, Crowther T, Collins G, Forder J. Exploring the views of being a proxy from the perspective of unpaid carers and paid carers: developing a proxy version of the Adult Social Care Outcomes Toolkit (ASCOT). BMC Health Serv Res 2019; 19:201. [PMID: 30922307 PMCID: PMC6440097 DOI: 10.1186/s12913-019-4025-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 03/19/2019] [Indexed: 11/10/2022] Open
Abstract
Background Outcomes-based policy and administration of public services present a compelling argument for the value of outcomes data. However, there are a number of challenges inherent in collecting these data from people who are unable to complete a paper-based survey or interview due to cognitive or communication impairments. In this paper, we explore the views of being a proxy from the perspective of unpaid carers and paid carers who may be asked to act as a proxy on behalf of the person(s) they care for. We consider the key issues that need to be addressed when adapting an instrument designed to measure social care outcomes, the Adult Social Care Outcomes Tool (ASCOT), into a proxy-report tool. Methods Participants took part in either a focus group (35 paid carers in eight focus groups), or a one-to-one interview (eight unpaid carers). All participants were recruited via carer organisations and care providers. Transcripts, field notes and audio data collected during focus groups and interviews were analysed using a thematic framework approach. Results Participants agreed that any person acting as a proxy would need to be very familiar with the care recipient, as well as their needs and care provision. A number of provisions for proxy respondents were proposed to improve face validity and acceptability of completing a questionnaire by proxy, and to ensure that any potential bias is reduced in the design of the questionnaire. These included: providing two sets of response options for each proxy perspective (the proxy themselves and the proxy view of how they think the care recipient would respond); a comments box to help people explain why they have selected a given response option (especially where these indicate unmet need); and providing clear guidance for the proxy respondent on how they should complete the questionnaire. Conclusions This study has shown some of the challenges involved in assessing outcomes by proxy and explored some potential ways these can be mitigated. The findings highlight the benefits of developing and testing proxy measures in a robust way to widen participation in social care research. Electronic supplementary material The online version of this article (10.1186/s12913-019-4025-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- James Caiels
- Quality and Outcomes of person-centred care policy Research Unit (QORU), PSSRU Kent, University of Kent, Cornwallis Building, Canterbury, CT2 7NF, UK.
| | - Stacey Rand
- Quality and Outcomes of person-centred care policy Research Unit (QORU), PSSRU Kent, University of Kent, Cornwallis Building, Canterbury, CT2 7NF, UK
| | - Tanya Crowther
- Quality and Outcomes of person-centred care policy Research Unit (QORU), PSSRU Kent, University of Kent, Cornwallis Building, Canterbury, CT2 7NF, UK.,NatCen Social Research, 35 Northampton Square, London, EC1V 0AX, UK
| | - Grace Collins
- Quality and Outcomes of person-centred care policy Research Unit (QORU), PSSRU Kent, University of Kent, Cornwallis Building, Canterbury, CT2 7NF, UK
| | - Julien Forder
- Quality and Outcomes of person-centred care policy Research Unit (QORU), PSSRU Kent, University of Kent, Cornwallis Building, Canterbury, CT2 7NF, UK
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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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Auer SR, Höfler M, Linsmayer E, Beránková A, Prieschl D, Ratajczak P, Šteffl M, Holmerová I. Cross-sectional study of prevalence of dementia, behavioural symptoms, mobility, pain and other health parameters in nursing homes in Austria and the Czech Republic: results from the DEMDATA project. BMC Geriatr 2018; 18:178. [PMID: 30103672 PMCID: PMC6090593 DOI: 10.1186/s12877-018-0870-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 08/03/2018] [Indexed: 11/28/2022] Open
Abstract
Background This paper provides a first comparative exploratory analysis of our findings from DEMDATA, a collaborative project between Austria and the Czech Republic. Analysed here are data from the residents and the environment assessment protocol. Methods In a cross sectional study design, residents from randomly drawn and stratified nursing homes were investigated using a common study protocol. Results From a total resident pool of 1666 persons, 1085 (571 in Austria, 514 in the Czech Republic) persons signed a consent form and participated in the data collection. More than 70% of residents assessed were female and the population was on average 85 years old. A discrepancy between the presence of a medical diagnosis in the charts of the residents and the results of cognitive testing was found. In Austria, 85.2%, in the Czech Republic 53.0% of residents had cognitive impairment. In Austria 80.0%, and in the Czech Republic 56.7% had behavioural problems. With respect to pain, 44.8% in Austria, and 51.5% in the Czech Republic had mild to severe pain. 78.4% of Austrian and 74.5% of the residents had problems with mobility and both populations were in danger of malnutrition. Conclusions Most of the prevalence rates are comparable with previous studies also using direct resident assessment. Variations in prevalence rates seem to result mainly from the assessment technique (direct cognitive testing vs. medical chart review). The high prevalence rates for dementia, behavioural symptoms, pain and malnutrition indicate an immediate call for attention to further research and practice development.
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Affiliation(s)
- Stefanie R Auer
- Danube University Krems, Dr.Karl-Dorrekstrasse 30, 3500, Krems, Austria. .,MAS Alzheimerhilfe, Lindau Strasse 28, 4820, Bad Ischl, Austria.
| | - Margit Höfler
- Danube University Krems, Dr.Karl-Dorrekstrasse 30, 3500, Krems, Austria
| | | | - Anna Beránková
- Charles University, Šimůnkova 1600, 8- Kobylisy, 182 00, Prague, Czech Republic
| | - Doris Prieschl
- MAS Alzheimerhilfe, Lindau Strasse 28, 4820, Bad Ischl, Austria
| | - Paulina Ratajczak
- Danube University Krems, Dr.Karl-Dorrekstrasse 30, 3500, Krems, Austria
| | - Michal Šteffl
- Charles University, Šimůnkova 1600, 8- Kobylisy, 182 00, Prague, Czech Republic
| | - Iva Holmerová
- Charles University, Šimůnkova 1600, 8- Kobylisy, 182 00, Prague, Czech Republic
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11
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Dewitte L, Vandenbulcke M, Dezutter J. Cognitive functioning and quality of life: Diverging views of older adults with Alzheimer and professional care staff. Int J Geriatr Psychiatry 2018; 33:1074-1081. [PMID: 29869400 DOI: 10.1002/gps.4895] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 04/03/2018] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Staff ratings of quality of life (QOL) in dementia are often lower and more strongly related to the cognitive functioning of the person with dementia than self-ratings. However, cognition-related items in QOL measures and limited cognitive screening measures hamper a clear understanding of the relationship, 2 issues we addressed in the current study. METHODS We collected data of 88 pairs of older adults with Alzheimer disease and their professional caregivers in 9 residential care settings. Both self-report and staff report of the QOL of residents were assessed with the Quality of Life in Alzheimer's Disease. Cognitive functioning was assessed with the Mini-Mental State Examination and a battery of specific cognitive measures. RESULTS Intraclass correlations and a paired sample t test confirmed a discrepancy between self-rating and staff rating, with staff significantly underestimating QOL as experienced by the resident. After removing the possibly confounding memory item of the Quality of Life in Alzheimer's Disease, Mini-Mental State Examination score remained a significant predictor of staff ratings but not self-ratings in regression analyses. Exploratory analyses of specific cognitive measures showed a significant contribution of a memory test of intentional visual association learning in the prediction of staff-rated QOL. CONCLUSIONS Staff reports cannot simply substitute reports of the subjective experience of residents with Alzheimer, so both judgments should be taken into account to form an adequate picture of QOL. Staff might be guided more strongly by a cognitive point of view when evaluating QOL of residents with Alzheimer disease, while the latter might have shifted their evaluation standards to cope adequately with the challenges posed by their disease.
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Affiliation(s)
- Laura Dewitte
- KU Leuven-University of Leuven, Leuven, Belgium.,Research Foundation Flanders, Brussels, Belgium
| | - Mathieu Vandenbulcke
- KU Leuven-University of Leuven, Leuven, Belgium.,University Psychiatric Centre KU Leuven, Leuven, Belgium
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12
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Barbe C, Jolly D, Morrone I, Wolak-Thierry A, Dramé M, Novella JL, Mahmoudi R. Factors associated with quality of life in patients with Alzheimer's disease. BMC Geriatr 2018; 18:159. [PMID: 29986669 PMCID: PMC6038200 DOI: 10.1186/s12877-018-0855-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 07/02/2018] [Indexed: 11/17/2022] Open
Abstract
Background Evaluation of health-related quality of life (HRQoL) in patients with Alzheimer’s disease (AD) is necessary to ensure optimal management. Several scales for assessing HRQoL of patients with AD exist, in particular the Quality of Life in Alzheimer’s Disease (QoL-AD), which includes an evaluation by the caregiver of the patient’s HRQoL. The aim of this study was to identify factors associated with patient, caregiver and overall HRQoL as assessed by the QoL-AD. Methods Cross-sectional multicenter study in subjects aged 65 years and older, with mild to moderate AD. HRQoL scores from the QoL-AD were recorded (3 scores, corresponding to patient, caregiver and overall), as well as sociodemographic variables for the patient and the caregiver, and data from the geriatric cognitive assessment (cognitive, psycho-behavioral, functional evaluations). Caregiver burden was evaluated using the Zarit caregiver burden scale. Factors associated with each QoL-AD score were identified by multivariate linear regression using t-tests and β estimations. Study was registered in Clinical Trial.gov (NCT02814773). Results In total, 123 patients with AD were included. For the patient QoL-AD evaluation, depression was significantly associated with lower HRQoL (β = − 2.56 ± 1.28, p = 0.04), while polypharmacy (β = − 1.80 ± 0.99, p = 0.07) and anxiety (β = − 1.70 ± 1.01, p = 0.09) tended to be associated with lower HRQoL scores. In terms of caregiver evaluations, depression (β = − 3.46 ± 1.09, p = 0.002), polypharmacy (β = − 1.91 ± 0.92, p = 0.04) and the presence of caregiver burden (β = − 3.50 ± 0.91, p = 0.0002) were associated with lower HRQoL. For the overall evaluation, depression (β = − 3.26 ± 1.02, p = 0.002) and polypharmacy (β = − 1.85 ± 0.81, p = 0.03) were significantly related to lower HRQoL. Conclusions Depression and polypharmacy were two factors influencing HRQoL in patients with AD, both by patient self-report and on the caregiver report. Thus, despite the discrepancies between HRQoL as assessed by patients with AD and HRQoL as assessed by their caregiver, the caregiver’s assessment may be used to guide patient management when the patient can no longer complete QoL evaluations. Moreover, the association between caregiver burden and the caregiver’s QoL-AD score underlines the need to take caregivers into consideration in the overall management of the AD patient.
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Affiliation(s)
- Coralie Barbe
- Faculty of Medicine, EA 3797, University of Reims Champagne-Ardenne, F-51092, Reims, France. .,Department of Research and Public health, Reims University Hospitals, Robert Debré Hospital, F-51092, Reims, France.
| | - Damien Jolly
- Faculty of Medicine, EA 3797, University of Reims Champagne-Ardenne, F-51092, Reims, France.,Department of Research and Public health, Reims University Hospitals, Robert Debré Hospital, F-51092, Reims, France
| | - Isabella Morrone
- Faculty of Medicine, EA 3797, University of Reims Champagne-Ardenne, F-51092, Reims, France.,Department of Geriatrics and Internal Medicine, Reims University Hospitals, Maison Blanche Hospital, F-51092, Reims, France
| | - Aurore Wolak-Thierry
- Faculty of Medicine, EA 3797, University of Reims Champagne-Ardenne, F-51092, Reims, France.,Department of Research and Public health, Reims University Hospitals, Robert Debré Hospital, F-51092, Reims, France
| | - Moustapha Dramé
- Faculty of Medicine, EA 3797, University of Reims Champagne-Ardenne, F-51092, Reims, France.,Department of Research and Public health, Reims University Hospitals, Robert Debré Hospital, F-51092, Reims, France
| | - Jean-Luc Novella
- Faculty of Medicine, EA 3797, University of Reims Champagne-Ardenne, F-51092, Reims, France.,Department of Geriatrics and Internal Medicine, Reims University Hospitals, Maison Blanche Hospital, F-51092, Reims, France
| | - Rachid Mahmoudi
- Faculty of Medicine, EA 3797, University of Reims Champagne-Ardenne, F-51092, Reims, France.,Department of Geriatrics and Internal Medicine, Reims University Hospitals, Maison Blanche Hospital, F-51092, Reims, France
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13
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Römhild J, Fleischer S, Meyer G, Stephan A, Zwakhalen S, Leino-Kilpi H, Zabalegui A, Saks K, Soto-Martin M, Sutcliffe C, Rahm Hallberg I, Berg A. Inter-rater agreement of the Quality of Life-Alzheimer's Disease (QoL-AD) self-rating and proxy rating scale: secondary analysis of RightTimePlaceCare data. Health Qual Life Outcomes 2018; 16:131. [PMID: 29954384 PMCID: PMC6022444 DOI: 10.1186/s12955-018-0959-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 06/20/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND To assess the quality of life of people with dementia, measures are required for self-rating by the person with dementia, and for proxy rating by others. The Quality of Life in Alzheimer's Disease scale (QoL-AD) is available in two versions, QoL-AD-SR (self-rating) and QoL-AD-PR (proxy rating). The aim of our study was to analyse the inter-rater agreement between self- and proxy ratings, in terms of both the total score and the items, including an analysis specific to care setting, and to identify factors associated with this agreement. METHODS Cross-sectional QoL-AD data from the 7th Framework European RightTimePlaceCare study were analysed. A total of 1330 cases were included: n = 854 receiving home care and n = 476 receiving institutional long-term nursing care. The proxy raters were informal carers (home care) and best-informed professional carers (institutional long-term nursing care). Inter-rater agreement was investigated using Bland-Altman plots for the QoL-AD total score and by weighted kappa statistics for single items. Associations were investigated by regression analysis. RESULTS The overall QoL-AD assessment of those with dementia revealed a mean value of 33.2 points, and the proxy ratings revealed a mean value of 29.8 points. The Bland-Altman plots revealed a poor agreement between self- and proxy ratings for the overall sample and for both care settings. With one exception (item 'Marriage' weighted kappa 0.26), the weighted kappa values for the single QoL-AD items were below 0.20, indicating poor agreement. Home care setting, dementia-related behavioural and psychological symptoms, and the functional status of the person with dementia, along with the caregiver burden, were associated with the level of agreement. Only the home care setting was associated with an increase larger than the predefined acceptable difference between self- and proxy ratings. CONCLUSIONS Proxy quality of life ratings from professional and informal carers appear to be lower than the self-ratings of those with dementia. QoL-AD-SR and QoL-AD-PR are therefore not interchangeable, as the inter-rater agreement differs distinctly. Thus, a proxy rating should be judged as a complementary perspective for a self-assessment of quality of life by those with dementia, rather than as a valid substitute.
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Affiliation(s)
- Josephine Römhild
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
- Institute of General Practice and Family Medicine, Jena University Hospital, Jena, Germany
| | - Steffen Fleischer
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Gabriele Meyer
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
- School of Nursing Science, Witten/Herdecke University, Witten, Germany
| | - Astrid Stephan
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
- School of Nursing Science, Witten/Herdecke University, Witten, Germany
| | - Sandra Zwakhalen
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
| | - Helena Leino-Kilpi
- Department of Nursing Science, Faculty of Medicine, University of Turku and Turku University Hospital, Turku, Finland
| | | | - Kai Saks
- Department of Internal Medicine, Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - Maria Soto-Martin
- Geriatrics Department, Gerontôpole, Toulouse University Hospital, INSERM UMR 1027, Toulouse, France
| | - Caroline Sutcliffe
- School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | | | - Almuth Berg
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - on behalf of the RightTimePlaceCare Consortium
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
- Institute of General Practice and Family Medicine, Jena University Hospital, Jena, Germany
- School of Nursing Science, Witten/Herdecke University, Witten, Germany
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
- Department of Nursing Science, Faculty of Medicine, University of Turku and Turku University Hospital, Turku, Finland
- Hospital Clinic of Barcelona, Barcelona, Spain
- Department of Internal Medicine, Faculty of Medicine, University of Tartu, Tartu, Estonia
- Geriatrics Department, Gerontôpole, Toulouse University Hospital, INSERM UMR 1027, Toulouse, France
- School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Department of Health Sciences, Medical Faculty, Lund University, Lund, Sweden
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14
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Klapwijk MS, Caljouw MAA, Pieper MJC, Putter H, van der Steen JT, Achterberg WP. Change in quality of life after a multidisciplinary intervention for people with dementia: A cluster randomized controlled trial. Int J Geriatr Psychiatry 2018; 33:1213-1219. [PMID: 29892989 DOI: 10.1002/gps.4912] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 04/13/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The objective of this study was to examine whether implementation of a stepwise multicomponent intervention (STA OP!) for challenging behavior and pain affects quality of life (QoL) of nursing home residents with moderate to severe dementia after 3 and 6 months. METHODS A cluster randomized controlled trial was conducted in 12 nursing homes. Both control (n = 140) and intervention group (=148) received training, the intervention group was also treated using the STA OP! INTERVENTION At baseline, 3 and 6 months QoL was assessed using the 6 QUALIDEM domains applicable to moderate and severe dementia. Linear mixed models were used to compare changes in QoL domains between the 2 groups over time. RESULTS After both 3 and 6 months, there was no change, and no difference in change, between the 2 groups in the domains Care relationship, Positive affect, Negative affect, and Social relations. Between 0 and 3 months, a positive effect was seen in the domain Restless tense behavior with a regression coefficient of β: 0.95 (95% confidence interval [CI], 0.36-1.54). Between 3 and 6 months, a negative effect was seen on the domain Restless tense behavior β: -0.98 (95% CI, -1.60 to -0.36) and a positive effect in the domain Social isolation, β: 0.64 (95% CI, 0.12-1.17). CONCLUSIONS The stepwise intervention STA OP! affects the QUALIDEM domains in different ways: there was a lowering of Restless tense behavior in the short term, which reverted back to the initial level in the longer term, and a lowering of Social isolation in the longer term.
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Affiliation(s)
- Maartje S Klapwijk
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- Marente, Leiden, The Netherlands
| | - Monique A A Caljouw
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Marjoleine J C Pieper
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Hein Putter
- Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, The Netherlands
| | - Jenny T van der Steen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Wilco P Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
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15
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The association between attending specialized day care centers and the quality of life of people with dementia. Int Psychogeriatr 2017; 29:627-636. [PMID: 27852334 DOI: 10.1017/s1041610216002015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Day care that is designed for people with dementia aims to increase the users' quality of life (QoL). The objective of the study was to compare the QoL of people with dementia attending day care with those not attending day care. METHODS The study is based on baseline data from a project using a quasi-experimental design, including a group of day care users (n = 183) and a comparison group not receiving day care (n = 78). Quality of Life-Alzheimer's Disease (QoL-AD) was used as the primary outcome, to collect both self-reported and proxy-based information from family carers on the users' QoL. A linear mixed model was used to examine the differences between groups. RESULTS Attending day care was significantly associated with higher mean scores of self-reported QoL. There was no difference between the groups in proxy-reported QoL. Analyses of the interaction between group belonging and awareness of memory loss revealed that the participants with shallow or no awareness who attended day care had significant higher mean scores of QoL-AD compared to those not attending day care. CONCLUSIONS Higher self-reported QoL was found among people attending day care designed for people with dementia compared to the comparison group. The difference in QoL ratings was found in the group of day care users with shallow or no awareness of their memory loss. Hence, day care designed for people with dementia might have the potential to increase QoL as it is experienced by the users.
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16
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Conde-Sala JL, Turró-Garriga O, Piñán-Hernández S, Portellano-Ortiz C, Viñas-Diez V, Gascón-Bayarri J, Reñé-Ramírez R. Effects of anosognosia and neuropsychiatric symptoms on the quality of life of patients with Alzheimer's disease: a 24-month follow-up study. Int J Geriatr Psychiatry 2016; 31:109-19. [PMID: 25963296 DOI: 10.1002/gps.4298] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 04/15/2015] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Neuropsychiatric symptoms and anosognosia are known to influence the perceived quality of life of patients (QoL-p) with Alzheimer's disease (AD). This study analysed their impact on patient and caregiver ratings of QoL-p and how these ratings changed in relation to the severity of dementia. METHODS A baseline sample of 221 patients and caregivers was followed up over 24 months. Instruments: Neuropsychiatric Inventory (NPI), Anosognosia Questionnaire-Dementia (AQ-D), Quality of life-Alzheimer's Disease (QoL-AD) and the Global Deterioration Scale (GDS). Longitudinal data were analysed using generalized linear models. RESULTS In the multivariate analysis, greater anosognosia was always associated with higher ratings of QoL-p among patients, especially at 24 months (p < 0.001), and with more negative ratings among caregivers, especially at baseline (p < 0.001). A higher total NPI score was associated with a more negative rating of QoL-p among caregivers (p < 0.001), and it also had a smaller negative effect on patients' self-ratings (p = 0.001). The neuropsychiatric symptoms (NPI) associated with a more negative view of QoL-p were depression, for patients' self-ratings, and apathy and agitation for caregiver ratings. The discrepancy between patient and caregiver ratings increased in line with the severity of dementia. CONCLUSION Neuropsychiatric symptoms had a similarly negative effect on the QoL-p ratings of both patients and caregivers, whereas the effect of anosognosia differed according to the rater (positive for patients, negative for caregivers).
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Affiliation(s)
| | - Oriol Turró-Garriga
- Research Unit, Santa Caterina Hospital, Institut d'Assistència Sanitària, Salt, Spain
| | | | | | - Vanesa Viñas-Diez
- Dementia Unit, Department of Neurology, Bellvitge University Hospital, Hospitalet de Llobregat, Spain
| | - Jordi Gascón-Bayarri
- Dementia Unit, Department of Neurology, Bellvitge University Hospital, Hospitalet de Llobregat, Spain
| | - Ramón Reñé-Ramírez
- Dementia Unit, Department of Neurology, Bellvitge University Hospital, Hospitalet de Llobregat, Spain
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17
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Andrieu S, Coley N, Rolland Y, Cantet C, Arnaud C, Guyonnet S, Nourhashemi F, Grand A, Vellas B. Assessing Alzheimer's disease patients' quality of life: Discrepancies between patient and caregiver perspectives. Alzheimers Dement 2015; 12:427-37. [DOI: 10.1016/j.jalz.2015.09.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 07/17/2015] [Accepted: 09/03/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Sandrine Andrieu
- Inserm‐Toulouse University UMR1027 Toulouse France
- CHU Toulouse Department of Epidemiology and Public Health Toulouse France
| | - Nicola Coley
- Inserm‐Toulouse University UMR1027 Toulouse France
- CHU Toulouse Department of Epidemiology and Public Health Toulouse France
| | - Yves Rolland
- Inserm‐Toulouse University UMR1027 Toulouse France
- Gerontopole, CHU Toulouse Department of Geriatric Medicine Toulouse France
| | - Christelle Cantet
- Inserm‐Toulouse University UMR1027 Toulouse France
- Gerontopole, CHU Toulouse Department of Geriatric Medicine Toulouse France
| | - Catherine Arnaud
- Inserm‐Toulouse University UMR1027 Toulouse France
- CHU Toulouse Department of Epidemiology and Public Health Toulouse France
| | - Sophie Guyonnet
- Inserm‐Toulouse University UMR1027 Toulouse France
- Gerontopole, CHU Toulouse Department of Geriatric Medicine Toulouse France
| | - Fati Nourhashemi
- Inserm‐Toulouse University UMR1027 Toulouse France
- Gerontopole, CHU Toulouse Department of Geriatric Medicine Toulouse France
| | - Alain Grand
- Inserm‐Toulouse University UMR1027 Toulouse France
- CHU Toulouse Department of Epidemiology and Public Health Toulouse France
| | - Bruno Vellas
- Inserm‐Toulouse University UMR1027 Toulouse France
- Gerontopole, CHU Toulouse Department of Geriatric Medicine Toulouse France
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18
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Mjørud M, Kirkevold M, Røsvik J, Selbæk G, Engedal K. Variables associated to quality of life among nursing home patients with dementia. Aging Ment Health 2015; 18:1013-21. [PMID: 24911813 DOI: 10.1080/13607863.2014.903468] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To study which variables are associated with quality of life (QOL) in persons with dementia (PWD) living in nursing homes (NHs). METHODS A cross-sectional study included 661 PWD living in NH. To measure QOL the quality of life in late-stage dementia scale (QUALID) was applied. Other scales were: the clinical dementia rating scale (CDR), physical self-maintenance scale (PSMS), and neuropsychiatric inventory questionnaire (NPI-Q). RESULTS The patients' mean age was: 86.9 (SD 7.7), 472 (71.4%) were women. Of all, 22.5% had CDR 1, 33.6% had CDR 2, and 43.9% had CDR 3. The mean PSMS score was 18.2 (SD 5.0), 43.1% lived in special care units, 56.9% in regular units. In a linear regression analysis NPI-affective score (β = 0.360, p-value < 0.001), NPI-agitation score (β = 0.268, p-value < 0.001), PSMS total score (β = 0.181, p-value < 0.001), NPI-apathy (β = 0.144, p-value < 0.001), NPI psychosis (β = 0.085, p-value 0.009), CDR sum of boxes score (β = 0.081, p-value 0.026) were significantly associated with QUALID total score (explained variance 44.5%). CONCLUSION Neuropsychiatric symptoms, apathy, severity of dementia, and impairment in activities in daily living are associated with reduced QOL in NH patients with dementia.
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Affiliation(s)
- Marit Mjørud
- a Norwegian Centre for Ageing and Health , Vestfold Hospital Trust , Tønsberg , Norway
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19
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Gomez-Gallego M, Gomez-Garcia J, Ato-Lozano E. Addressing the bias problem in the assessment of the quality of life of patients with dementia: determinants of the accuracy and precision of the proxy ratings. J Nutr Health Aging 2015; 19:365-72. [PMID: 25732223 DOI: 10.1007/s12603-014-0564-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES We aimed to examine the discrepancy between patients and caregivers' ratings of quality of life in terms of accuracy and precision, and identify factors associated with it, in order to facilitate the use of this scale as dementia progresses. DESIGN Cross-sectional analytic study. SETTING Day care centres. PARTICIPANTS Community-living patients with Alzheimer's disease in early or moderate stage and their principal caregivers. MEASUREMENTS PARTICIPANTS rated patients' quality of life using DEMQOL. The discrepancy was assessed using the individual difference score and the residuals for each domain of DEMQOL. The scores on Mini-Mental State Examination, Geriatric Depression Scale, Neuropsychiatric Inventory, Clinical Insight Rating Scale, Cumulative Illness Rating Scale, Health Utilities Index Mark 3 and Zarit Burden Interview were considered as possible predictors of the discrepancy. RESULTS A total of 276 subjects participated in the study (138 patients with Alzheimer's disease and their caregivers). Discrepancy measured by individual difference score was lower than that measured by the residuals. Burden and mood-related symptoms explained the positive differences and residuals, while pain, self-perceived depression and cognition determined the negative ones. CONCLUSIONS Differences exist between patients and caregivers' perceptions about subjective states. The evaluations of each informant seem to be influenced by their own emotional state and the inner experience of the effects of the disease. Caregivers' ratings on DEMQOL could be useful to monitor the efficacy of any treatment whenever burden is low and patients have no great physical or emotional suffering.
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Affiliation(s)
- M Gomez-Gallego
- Maria Gomez-Gallego, Campus de Los Jerónimos, 30107 Murcia, Telephone: (+34) 968 27 88 00,
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20
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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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Differential perceptions of quality of life (QoL) in community-dwelling persons with mild-to-moderate dementia. Int Psychogeriatr 2014; 26:1273-82. [PMID: 24965359 DOI: 10.1017/s1041610214000660] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Discordance between patient- and caregiver-reported quality of life (QoL) is well recognized. This study sought to (i) identify predictors of discrepancy between patient- and caregiver-rated QoL amongst community-dwelling persons with mild-to-moderate dementia, and (ii) differentiate between patients who systematically rate their QoL lower versus those who rate their QoL higher relative to their caregiver ratings. METHODS We recruited 165 patient-caregiver dyads with mild-to-moderate dementia. Quality of life in Alzheimer's disease (QoL-AD) scale was administered separately to patients and caregivers. Data on socio-demographics, interpersonal relationship, and disease-related characteristics (cognitive performance, mood, neuropsychiatric symptoms, functional ability, and caregiver burden) were collected. Patient-caregiver dyads were categorized based on whether patient-rated QoL was lower or higher than their respective caregiver ratings. Univariate analyses and multiple regression models were performed to identify predictors of dyadic rating discrepancy. RESULTS Mean patient-rated QoL was significantly higher than caregiver rating (mean difference: 3.8 ± 7.1, p < 0.001). Majority (111 (67.2%)) of patients had more positive self-perceived QoL (QoL-ADp (QoL-AD self rated by the patient) > QoL-ADc (QoL-AD proxy-rated by a caregiver)), compared with those (44 (26.7%)) with poorer self-perceived QoL (QoL-ADp < QoL-ADc). Patient's education level, depressive symptoms, and severity of neuropsychiatric symptoms predicted magnitude of discrepancy. Depression (OR = 1.17, 95% CI = 1.02-1.35) and being cared for by other relative (non-spouse/adult child; OR = 7.54, 95% CI = 1.07-53.03) predicted poorer self-perceived QoL. CONCLUSIONS Dyadic rating discrepancy in QoL should draw the clinician's attention to patient depression and neuropsychiatric symptoms. Consideration should also be given to nature of patient-caregiver relationship when discordance between patient and caregiver assessments of QoL is observed.
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Søgaard R, Sørensen J, Waldorff FB, Eckermann A, Buss DV, Phung KTT, Waldemar G. Early psychosocial intervention in Alzheimer's disease: cost utility evaluation alongside the Danish Alzheimer's Intervention Study (DAISY). BMJ Open 2014; 4:e004105. [PMID: 24435893 PMCID: PMC3902512 DOI: 10.1136/bmjopen-2013-004105] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE To assess the cost utility of early psychosocial intervention for patients with Alzheimer's disease and their primary caregivers. DESIGN Cost utility evaluation alongside a multicentre, randomised controlled trial with 3 years of follow-up. SETTING Primary care and memory clinics in five Danish districts. PARTICIPANTS 330 community-dwelling patients and their primary caregivers. INTERVENTION Psychosocial counselling and support lasting 8-12 months after diagnosis and follow-up at 3, 6, 12 and 36 months in the intervention group or follow-up only in the control group. MAIN OUTCOME MEASURES The primary outcome measure was the cost of additional quality-adjusted life years (QALYs). Costs were measured from a societal perspective, including the costs of healthcare, social care, informal care and production loss. QALYs were estimated separately for the patient and the caregiver before aggregation for the main analysis. RESULTS None of the observed cost and QALY measures were significantly different between the intervention and control groups, although a tendency was noted for psychosocial care leading to cost increases with informal care that was not outweighed by the tendency for cost savings with formal care. The probability of psychosocial intervention being cost-effective did not exceed 36% for any threshold value. The alternative scenario analysis showed that the probability of cost-effectiveness increased over the range of threshold values used if the cost perspective was restricted to formal healthcare. CONCLUSIONS A multifaceted, psychosocial intervention programme was found unlikely to be cost-effective from a societal perspective. The recommendation for practice in settings that are similar to the Danish setting is to provide follow-up with referral to available local support programmes when needed, and to restrict large multifaceted intervention programmes to patients and caregivers with special needs until further evidence for cost-effectiveness emerges. TRIAL REGISTRATION The study was registered in the Clinical Trial Database as ISRCTN74848736.
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Affiliation(s)
- Rikke Søgaard
- CAST—Centre for Applied Health Services Research, University of Southern Denmark, Odense, Denmark
| | - Jan Sørensen
- CAST—Centre for Applied Health Services Research, University of Southern Denmark, Odense, Denmark
| | - Frans B Waldorff
- The Memory Disorders Research Group, Department of Neurology, Danish Dementia Research Centre, Copenhagen University Hospital, Copenhagen, Denmark
- Research Unit and Department of General Practice, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Ane Eckermann
- The Memory Disorders Research Group, Department of Neurology, Danish Dementia Research Centre, Copenhagen University Hospital, Copenhagen, Denmark
| | - Dorte V Buss
- The Memory Disorders Research Group, Department of Neurology, Danish Dementia Research Centre, Copenhagen University Hospital, Copenhagen, Denmark
| | - Kieu T T Phung
- The Memory Disorders Research Group, Department of Neurology, Danish Dementia Research Centre, Copenhagen University Hospital, Copenhagen, Denmark
| | - Gunhild Waldemar
- The Memory Disorders Research Group, Department of Neurology, Danish Dementia Research Centre, Copenhagen University Hospital, Copenhagen, Denmark
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Beerens HC, Sutcliffe C, Renom-Guiteras A, Soto ME, Suhonen R, Zabalegui A, Bökberg C, Saks K, Hamers JP. Quality of Life and Quality of Care for People With Dementia Receiving Long Term Institutional Care or Professional Home Care: The European RightTimePlaceCare Study. J Am Med Dir Assoc 2014; 15:54-61. [DOI: 10.1016/j.jamda.2013.09.010] [Citation(s) in RCA: 96] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Revised: 09/04/2013] [Accepted: 09/12/2013] [Indexed: 10/26/2022]
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Knapskog AB, Barca ML, Engedal K. A comparison of the cornell scale for depression in dementia and the Montgomery-Aasberg depression rating scale in a memory clinic population. Dement Geriatr Cogn Disord 2013; 35:256-65. [PMID: 23594823 DOI: 10.1159/000348345] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/21/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The aim of this study was to explore the correlation between the Cornell Scale for Depression in Dementia (CSDD) and the Montgomery-Aasberg Depression Rating Scale (MADRS) among memory clinic patients. METHODS The CSDD (based on an interview with the caregiver) and the MADRS (based on the patient's opinion) were filled in independently of each other among 520 patients. Principal component and correlation analyses were performed. RESULTS The mean score of the CSDD was 7.6 (SD: 6.0), and the mean MADRS score was 9.7 (SD: 6.7). The correlation between the two scales was 0.36 for the whole group, 0.22 in the group with dementia and 0.48 for those without dementia, respectively. Principal component analyses revealed four factors for the CSDD and two factors for the MADRS. CONCLUSIONS Using two different sources of information, we found a poor correlation between the two scales. We suggest that evaluation of depression among memory clinic patients should be done by interviewing both the patient and the caregiver.
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Affiliation(s)
- Anne-Brita Knapskog
- Department of Geriatric Medicine, Institute of Clinical Medicine, University of Oslo, Oslo University Hospital, Oslo, Norway
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Oguh O, Kwasny M, Carter J, Stell B, Simuni T. Caregiver strain in Parkinson's disease: National Parkinson Foundation Quality Initiative Study. Parkinsonism Relat Disord 2013; 19:975-9. [DOI: 10.1016/j.parkreldis.2013.06.015] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Revised: 05/28/2013] [Accepted: 06/25/2013] [Indexed: 11/26/2022]
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Liptak A, Tate J, Flatt J, Oakley MA, Lingler J. Humor and laughter in persons with cognitive impairment and their caregivers. J Holist Nurs 2013; 32:25-34. [PMID: 23926217 PMCID: PMC4006667 DOI: 10.1177/0898010113500075] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of this study was to describe humor and laughter in persons with cognitive impairment (PWCI) and caregivers who were recalling a shared experience in a focus group. DESIGN Twenty participants attended an Art Engagement Activity at the Andy Warhol Art Museum, which included a guided tour and an art project. All PWCI had medically diagnosed cognitive disorders and all caregiver participants did not. Four focus groups were conducted and transcripts of audio-recorded sessions were transferred to a qualitative software program. METHOD Words, phrases, and episodes of humor and laughter were used to construct codes, which were refined during group analysis using constant comparison. FINDINGS Humor and laughter were present in all four focus groups. Emerging themes of humor included silliness, sarcasm, and commenting about hardships of dementia. Laughter was identified in segments with and without humor. Some PWCI were unable to follow social cues. CONCLUSIONS Humor and laughter played a role in creating a safe social environment. PWCI were able to engage in humor during social interactions, yet some had difficulty recognizing social cues. Further study may reveal roles of humor and laughter in adaptation to cognitive decline and holistic interventions for improved quality of life.
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Bruvik FK, Ulstein ID, Ranhoff AH, Engedal K. The quality of life of people with dementia and their family carers. Dement Geriatr Cogn Disord 2013; 34:7-14. [PMID: 22854507 DOI: 10.1159/000341584] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/23/2012] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND We aimed to identify factors associated with the quality of life (QoL) of 'persons with dementia' (PWDs) and their family carers. METHOD Two-hundred and thirty dyads of PWDs and their family carers were included. The PWDs were assessed with the Neuropsychiatric Inventory (NPI-Q), two Activities of Daily Living (ADL) scales, the Cornell Scale and the QoL-Alzheimer's Disease scale (QoL-AD; self- and proxy-reported scores). The carers were assessed with the QoL-AD and the Geriatric Depression Scale. RESULTS Factors associated with self-reported QoL were depression (β = -0.26, p < 0.001) and impaired ADL (β = -0.26, p < 0.001) and with proxy-rated QoL were NPI (β = -0.18, p = 0.02), depression (β = -0.32, p < 0.001) and impaired ADL (β = -0.43, p < 0.001). Factors associated with QoL in carers living together with the PWDs were depression (β = -0.56, p < 0.001) and having a hobby (β = 0.19, p = 0.01), whereas depression was associated with QoL in those who lived separately from the PWD (β = -0.60, p < 0.001). CONCLUSION Depression and impaired ADL were associated with the self- and proxy-rated QoL of the PWDs, whereas depression in the carers negatively affected their QoL.
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