Economic burden and quality of life of patients with dementia in China: a systematic review and meta-analysis

BACKGROUND

China has the largest number of dementia patients worldwide. The prolonged course of dementia has a serious negative impact on the economy and quality of life of patients and their families.

OBJECTIVE

The purpose of this study was to conduct a systematic review and meta-analysis of the existing literature about economic burden and quality of life of people with dementia in China.

METHODS

Six databases were systematically searched for observational studies of the economic burden or quality of life of dementia that were published before June 30, 2024. This review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines.

RESULTS

A total of 36,411 papers were identified, and 21 studies met the inclusion criteria. The annual economic burden of dementia was 20,893 RMB (3,104 USD). The total costs associated with mild, moderate, and severe dementia were 16,619 RMB (2,469 USD), 22,283 RMB (3,311 USD), and 34,611 RMB (5,143 USD), respectively, indicating that the cost increased significantly with increasing dementia severity. In terms of the quality of life, the combined total score for the Quality of Life-Alzheimer's Disease scale was 30.11, with lower scores for the Housekeeping, Recreation, and Memory items.

CONCLUSIONS

Dementia imposes a significant economic and quality of life burden on Chinese patients. The government should pay more attention to dementia and develop a comprehensive prevention and treatment system to reduce the heavy burden of dementia.

TRIAL REGISTRATION

This systematic review has the registration number CRD42022374470 on PROSPERO.

Quality of life in patients with mild Alzheimer disease: the mediator role of mindfulness and spirituality

OBJECTIVES

This study examined the mediator role of mindfulness and spirituality in the relationship between psychological morbidity, awareness of the disease, functionality, social support, family satisfaction, and quality of life (QoL) in patients with mild AD.

METHOD

The sample consisted of 128 patients who answered the Cognitive and Affective Mindfulness Scale-Revised (CAMS-R), the Assessment Scale of Psychosocial Impact of the Diagnosis of Dementia (ASPIDD), the Hospital Anxiety and Depression Scales (HADS), the Satisfaction with Social Support Scale (SSSS), the Family Satisfaction Scale (FSS), the Spiritual and Religious Attitudes in Dealing with Illness (SpREUK), the Index of Barthel, and the Quality of Life-Alzheimer's Disease (QoL-AD).

RESULTS

Mindfulness and spirituality mediated the relationship between functionality, awareness of the disease, family satisfaction and QoL. Psychological morbidity had a direct negative impact on QoL and was negatively associated with awareness of the disease, family satisfaction and social support. Mindfulness was negatively associated with spirituality and the latter was negatively associated with QoL. More social support was associated with greater awareness of the disease and family satisfaction. More functionality, awareness of the disease and family satisfaction contributed to more QoL and this relationship was mediated by mindfulness and spirituality.

CONCLUSION

Interventions directed at the promotion of the QoL of patients with mild AD should focus on the promotion of mindfulness skills in AD patients, in addition to the reduction of psychological morbidity and the promotion of functionality, awareness of the disease, family relationships and social support.

Path analysis from physical activity to quality of life among dementia patients: A dual-path mediating model

AIMS

To clarify the specific impact paths among physical activity, activity of daily living, depression and quality of life among dementia patients.

DESIGN

A descriptive, cross-sectional design.

METHODS

Dementia patients and their caregivers from five tertiary general hospitals and one dementia patients' club were recruited. A total of 216 valid questionnaires were collected from November 2018 - March 2019. Path analysis was performed by Mplus 7.0 to test the casual relationship among physical activity, activity of daily living, depression and quality of life.

RESULTS

Most patients with dementia presented a low level of physical activity and suffered from impaired quality of life. The modified model presented a good model fit and revealed that physical activity had indirect positive effects on quality of life mediated by activity of daily living and depression.

CONCLUSION

The results showed that physical activity was a promising non-pharmacological method to improve the performance of activity of daily living and reduce depressive symptoms and then enhance the quality of life among dementia patients.

IMPACT

The findings were beneficial to elevate the awareness of physical activity among patients and professionals. This study was helpful to understand how physical activity exerted effects on life quality of dementia patients. This study provided a new perspective for researchers to elucidate the causal relationship of variables among dementia patients.

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)

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.

Naturalistic Assessment using a Simulated Environment: Cognitive Correlates and Relationship to Functional Status in Individuals with Neurologic Conditions

Objective

Research has shown that neurologic conditions, such as traumatic brain injury and multiple sclerosis, result in a number of cognitive and functional deficits. However, little is known about the relationship between various cognitive domains and ability to perform everyday activities. The Community Shopping Task (CST), a naturalistic assessment task conducted in a simulated environment, was used to examine functional abilities and cognitive correlates of everyday functioning in individuals with neurologic conditions.

Method

Thirty-four participants with neurologic conditions and 34 healthy controls completed the CST as well as traditional paper-pencil measures of cognition. In addition, all participants completed a questionnaire assessing instrumental activities of daily living (IADLs).

Results

The results indicated that participants with neurologic conditions required significantly more cues and time to complete the CST compared to control participants and that immediate memory and executive functioning were important predictors of CST performance. Furthermore, time to complete the CST accounted for a significant amount of variance in IADL performance, over and beyond the traditional measures of cognition.

Conclusions

These results provide evidence that a naturalistic task completed in an everyday environment can enhance our understanding of how daily functioning is impacted in individuals with neurologic conditions and subsequently inform rehabilitation strategies.

Inter-rater agreement of the Quality of Life-Alzheimer's Disease (QoL-AD) self-rating and proxy rating scale: secondary analysis of RightTimePlaceCare data

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.

Cognitive and physical factors affecting daily function in Alzheimer's disease: A cross-sectional analysis

Understanding the factors affecting activities of daily living (ADL) is important in Alzheimer's disease (AD), because decline in ADL contributes to many poor health outcomes. Existing studies often investigate the factors in isolation without a theoretical framework. The purpose of the present study was to provide preliminary results on how cognition, physical performance, and behavioral and psychological symptoms of dementia mediate the relationship of aerobic fitness and ADL in AD. A cross-sectional analysis was used (n = 28: average age 78 [8] years, education 16 (3) years, Mini-Mental State Examination scores 20 [4]). The results showed that aerobic fitness is not linked to ADL directly, and its association with ADL was mediated by physical performance and global cognition. Our findings provide preliminary support for aerobic fitness as a potential therapeutic target, as enhanced aerobic fitness could simultaneously modify other factors affecting ADL. Nurses are in a unique position for coordinating exercise safety assessment and prescription and educating older adults with AD about exercise participation.

Developing a proxy version of the Adult social care outcome toolkit (ASCOT)

BACKGROUND

Social care-related quality of life is a key outcome indicator used in the evaluation of social care interventions and policy. It is not, however, always possible to collect quality of life data by self-report even with adaptations for people with cognitive or communication impairments. A new proxy-report version of the Adult Social Care Outcomes Toolkit (ASCOT) measure of social care-related quality of life was developed to address the issues of wider inclusion of people with cognitive or communication difficulties who may otherwise be systematically excluded. The development of the proxy-report ASCOT questionnaire was informed by literature review and earlier work that identified the key issues and challenges associated with proxy-reported outcomes.

METHODS

To evaluate the acceptability and content validity of the ASCOT-Proxy, qualitative cognitive interviews were conducted with unpaid carers or care workers of people with cognitive or communication impairments. The proxy respondents were invited to 'think aloud' while completing the questionnaire. Follow-up probes were asked to elicit further detail of the respondent's comprehension of the format, layout and content of each item and also how they weighed up the options to formulate a response.

RESULTS

A total of 25 unpaid carers and care workers participated in three iterative rounds of cognitive interviews. The findings indicate that the items were well-understood and the concepts were consistent with the item definitions for the standard self-completion version of ASCOT with minor modifications to the draft ASCOT-Proxy. The ASCOT-Proxy allows respondents to rate the proxy-proxy and proxy-patient perspectives, which improved the acceptability of proxy report.

CONCLUSIONS

A new proxy-report version of ASCOT was developed with evidence of its qualitative content validity and acceptability. The ASCOT-Proxy is ready for empirical testing of its suitability for data collection as a self-completion and/or interview questionnaire, and also evaluation of its psychometric properties.

Greater Independence in Activities of Daily Living is Associated with Higher Health-Related Quality of Life Scores in Nursing Home Residents with Dementia

Health-related quality of life (HRQL) for nursing home residents is important, however, the concept of quality of life is broad, encompasses many domains and is difficult to assess in people with dementia. Basic activities of daily living (ADL) are measured routinely in nursing homes using the Resident Assessment Instrument-Minimum Data Set Version 2.0 (RAI-MDS) and Functional Independence Measure (FIM) instrument. We examined the relationship between HRQL and ADL to assess the future possibility of ADL dependency level serving as a surrogate measure of HRQL in residents with dementia. To assess ADL, measures derived from the RAI-MDS and FIM data were gathered for 111 residents at the beginning of our study and at 6-month follow-up. Higher scores for independence in ADL were correlated with higher scores for a disease-specific HRQL measure, the Quality of Life-Alzheimer's Disease Scale. Preliminary evidence suggests that FIM-assessed ADL is associated with HRQL for these residents. The associations of the dressing and toileting items with HRQL were particularly strong. This finding suggests the importance of ADL function in HRQL. The RAI-MDS ADL scales should be used with caution to evaluate HRQL.

Employment as a Social Determinant of Health: A Systematic Review of Longitudinal Studies Exploring the Relationship Between Employment Status and Physical Health

Purpose:To explore employment as a social determinant of health through examining the relationship between employment status and physical health.

Method:The authors explored the causal relationship between employment status and physical health through conducting a systematic review of 22 longitudinal studies conducted in Finland, France, the Netherlands, Nigeria, Sweden, United Kingdom, and the United States.

Results:Five common trajectories were identified as employment, unemployment, job loss, reemployment, and retired. Unemployment and job loss were associated with poorer physical health. Employment and reemployment were associated with better physical health.

Conclusion:To enhance employment outcomes, it is important for service providers to acknowledge the interaction between the client’s physical health and employment status, and assess client physical functioning. Additional research is necessary to further elucidate this interaction.

Factors associated with quality of life among family members of patients with dementia in Cyprus

BACKGROUND

Numerous studies have reported that caring for a person with dementia is a stressful experience. Nevertheless, quality of life (QoL) measures have commonly focused on patients, while factors that influence caregivers' QoL have not been clearly identified. In order to contribute to the understanding of caregivers' QoL, we explored how QoL among caregivers is related to their perceived level of burden, their reported number of depressive symptoms, and the level of care recipients' dependency.

METHODS

Seventy-six caregivers referred by the two main referral centers of patients with dementia in Cyprus participated in a cross-sectional survey with a descriptive correlational design. Caregivers completed four instruments, measuring burden (ZBI), depression (CES-D), quality of life-Alzheimer's disease (QoL-AD), and activities of daily living (ADL) of the care recipients and provided socio-demographic information.

RESULTS

The majority of the participants scored high levels of burden (M = 43.32/SD = 15.23) and depression (59.2% scored over the cut-off point of 16). QoL was only moderate (M = 30.89/SD = 8.21) and negatively correlated with burden (r = -32, p = 0.01) and depression (r = -0.296, p < 0.05). Only a weak correlation was observed between QoL and ADL (r = 0.167, p = 0.15). Hierarchical multiple regression analyses revealed that overall burden scores and income were associated with QoL, explaining 20% of the overall variance of the caregiver's QoL.

CONCLUSION

Further research is necessary to investigate which additional domains determine QoL and further our understanding of the factors that may reduce the burden imposed on dementia caregivers.