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Hutchinson C, Khadka J, Crocker M, Lay K, Milte R, Whitehirst DG, Engel L, Ratcliffe J. Examining interrater agreement between self-report and proxy-report responses for the quality of life-aged care consumers (QOL-ACC) instrument. J Patient Rep Outcomes 2024; 8:28. [PMID: 38436803 PMCID: PMC10912388 DOI: 10.1186/s41687-024-00705-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 02/18/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND Quality of life is an important quality indicator for health and aged care sectors. However, self-reporting of quality of life is not always possible given the relatively high prevalence of cognitive impairment amongst older people, hence proxy reporting is often utilised as the default option. Internationally, there is little evidence on the impact of proxy perspective on interrater agreement between self and proxy report. OBJECTIVES To assess the impacts of (i) cognition level and (ii) proxy perspective on interrater agreement using a utility instrument, the Quality of Life-Aged Care Consumers (QOL-ACC). METHODS A cross-sectional study was undertaken with aged care residents and family member proxies. Residents completed the self-report QOL-ACC, while proxies completed two proxy versions: proxy-proxy perspective (their own opinion), and proxy-person perspective (how they believe the resident would respond). Interrater agreement was assessed using quadratic weighted kappas for dimension-level data and concordance correlation coefficients and Bland-Altman plots for utility scores. RESULTS Sixty-three residents (22, no cognitive impairment; 41, mild-to-moderate cognitive impairment) and proxies participated. In the full sample and in the mild-to-moderate impairment group, the mean self-reported QOL-ACC utility score was significantly higher than the means reported by proxies, regardless of perspective (p < 0.01). Agreement with self-reported QOL-ACC utility scores was higher when proxies adopted a proxy-person perspective. CONCLUSION Regardless of cognition level and proxy perspective, proxies tend to rate quality of life lower than residents. Further research is needed to explore the impact of such divergences for quality assessment and economic evaluation in aged care.
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Affiliation(s)
- Claire Hutchinson
- Caring Futures Institute, College of Nursing and Health Science, Flinders University, Adelaide, South Australia, Australia.
| | - Jyoti Khadka
- Caring Futures Institute, College of Nursing and Health Science, Flinders University, Adelaide, South Australia, Australia
- ROSA, Adelaide, South Australia, Australia
| | - Matthew Crocker
- Caring Futures Institute, College of Nursing and Health Science, Flinders University, Adelaide, South Australia, Australia
| | - Kiri Lay
- Caring Futures Institute, College of Nursing and Health Science, Flinders University, Adelaide, South Australia, Australia
| | - Rachel Milte
- Caring Futures Institute, College of Nursing and Health Science, Flinders University, Adelaide, South Australia, Australia
| | - David Gt Whitehirst
- Faculty of Health Sciences, Simon Fraser University, British Columbia, Burnaby, Canada
| | - Lidia Engel
- School of Public Health and Preventive Medicine, Monash University Health Economics Group, Monash University, Melbourne, VIC, Australia
| | - Julie Ratcliffe
- Caring Futures Institute, College of Nursing and Health Science, Flinders University, Adelaide, South Australia, 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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Raes S, Vandepitte S, De Smedt D, Wynendaele H, DeJonghe Y, Trybou J. The relationship of nursing home price and quality of life. BMC Health Serv Res 2020; 20:987. [PMID: 33161901 PMCID: PMC7650205 DOI: 10.1186/s12913-020-05833-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 10/20/2020] [Indexed: 11/21/2022] Open
Abstract
Background Knowledge about the relationship between the residents’ Quality of Life (QOL) and the nursing home price is currently lacking. Therefore, this study investigates the relationship between 11 dimensions of QOL and nursing homes price in Flemish nursing homes. Methods The data used in this cross-sectional study were collected by the Flemish government from years 2014 to 2017 and originates from 659 Flemish nursing homes. From 2014 to 2016, data on the QOL of 21,756 residents was assessed with the InterRAI instrument. This instrument contains 11 QOL dimensions. Multiple linear regression analyses were conducted to examine the research question. Results The multiple linear regressions indicated that a 10 euro increase in the daily nursing home price is associated with a significant decrease (P < 0.001) of 0.1 in 5 dimensions of QOL (access to services, comfort and environment, food and meals, respect, and safety and security). Hence, our results indicate that the association between price and QOL is very small. When conducting a subgroup analysis based on ownership type, the earlier found results remained only statistically significant for private nursing homes. Conclusion Our findings show that nursing home price is of limited importance with respect to resident QOL. Contrary to popular belief, our study demonstrates a limited negative effect of price on QOL. Further research that includes other indicators of QOL is needed to allow policymakers and nursing home managers to improve nursing home residents’ QOL.
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Affiliation(s)
- Sarah Raes
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
| | - Sophie Vandepitte
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Delphine De Smedt
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Herlinde Wynendaele
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Yannai DeJonghe
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Jeroen Trybou
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
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van de Beek M, van Steenoven I, Ramakers IHGB, Aalten P, Koek HL, Olde Rikkert MGM, Manniën J, Papma JM, de Jong FJ, Lemstra AW, van der Flier WM. Trajectories and Determinants of Quality of Life in Dementia with Lewy Bodies and Alzheimer's Disease. J Alzheimers Dis 2020; 70:389-397. [PMID: 31177218 PMCID: PMC6839497 DOI: 10.3233/jad-190041] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background: Quality of Life (QoL) is an important outcome measure in dementia, particularly in the context of interventions. Research investigating longitudinal QoL in dementia with Lewy bodies (DLB) is currently lacking. Objective: To investigate determinants and trajectories of QoL in DLB compared to Alzheimer’s disease (AD) and controls. Methods: QoL was assessed annually in 138 individuals, using the EQ5D-utility-score (0–100) and the health-related Visual Analogue Scale (VAS, 0–100). Twenty-nine DLB patients (age 69±6), 68 AD patients (age 70±6), and 41 controls (age 70±5) were selected from the Dutch Parelsnoer Institute-Neurodegenerative diseases and Amsterdam Dementia Cohort. We examined clinical work-up over time as determinants of QoL, including cognitive tests, neuropsychiatric inventory, Geriatric Depression Scale (GDS), and disability assessment of dementia (DAD). Results: Mixed models showed lower baseline VAS-scores in DLB compared to AD and controls (AD: β±SE = -7.6±2.8, controls: β±SE = -7.9±3.0, p < 0.05). An interaction between diagnosis and time since diagnosis indicated steeper decline on VAS-scores for AD patients compared to DLB patients (β±SE = 2.9±1.5, p < 0.1). EQ5D-utility-scores over time did not differ between groups. Higher GDS and lower DAD-scores were independently associated with lower QoL in dementia patients (GDS: VAS β±SE = -1.8±0.3, EQ5D-utility β±SE = -3.7±0.4; DAD: VAS = 0.1±0.0, EQ5D-utility β±SE = 0.1±0.1, p < 0.05). No associations between cognitive tests and QoL remained in the multivariate model. Conclusion: QoL is lower in DLB, while in AD QoL shows steeper decline as the disease advances. Our results indicate that non-cognitive symptoms, more than cognitive symptoms, are highly relevant as they impact QoL.
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Affiliation(s)
- Marleen van de Beek
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Inger van Steenoven
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Inez H G B Ramakers
- Department of Psychiatry and Neuropsychology, Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Pauline Aalten
- Department of Psychiatry and Neuropsychology, Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Huiberdina L Koek
- Department of Geriatric Medicine, University Medical Center Utrecht, Utrecht, Netherlands
| | - Marcel G M Olde Rikkert
- Department of Geriatrics & Radboud UMC Alzheimer Center, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Janne M Papma
- Department of Neurology and Alzheimer Center, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Frank Jan de Jong
- Department of Neurology and Alzheimer Center, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Afina W Lemstra
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Wiesje M van der Flier
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
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Kudlicka A, Martyr A, Bahar-Fuchs A, Woods B, Clare L. Cognitive rehabilitation for people with mild to moderate dementia. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2019. [DOI: 10.1002/14651858.cd013388] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
| | - Anthony Martyr
- University of Exeter; REACH: The Centre for Research in Ageing and Cognitive Health; South Cloisters, St Luke's Campus, Heavitree Road Exeter UK EX1 2LU
| | - Alex Bahar-Fuchs
- University of Melbourne; Academic Unit for Psychiatry of Old Age, Department of Psychiatry; 34-54 Poplar Road Parkville Melbourne Victoria Australia 3052
| | - Bob Woods
- Bangor University; Dementia Services Development Centre Wales; Ardudwy, Holyhead Road Bangor Gwynedd UK LL57 2PZ
| | - Linda Clare
- University of Exeter; REACH: The Centre for Research in Ageing and Cognitive Health; South Cloisters, St Luke's Campus, Heavitree Road Exeter UK EX1 2LU
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Martyr A, Nelis SM, Quinn C, Rusted JM, Morris RG, Clare L. The relationship between perceived functional difficulties and the ability to live well with mild-to-moderate dementia: Findings from the IDEAL programme. Int J Geriatr Psychiatry 2019; 34:1251-1261. [PMID: 31034650 PMCID: PMC6767698 DOI: 10.1002/gps.5128] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 04/19/2019] [Indexed: 01/07/2023]
Abstract
OBJECTIVES The objectives of the study are to investigate how different levels of functional ability relate to quality of life, well-being, and satisfaction with life, conceptualised as reflecting capability to "live well" in people with dementia. METHODS/DESIGN Participants were 1496 people with mild-to-moderate dementia and 1188 informants who completed baseline assessments in the Improving the experience of Dementia and Enhancing Active Life (IDEAL) cohort study. Total self-rated and informant-rated scores on the Functional Activities Questionnaire were split into six ability levels to monitor how poorer functioning impacts the ability to live well. We also investigated the potential influence of sociodemographic and diagnostic variables, depression, cognition, and carer stress. RESULTS Multivariate multiple regression models found that people with dementia who had the greatest functional impairment according to self-ratings and informant ratings had poorer living well scores than those with the least functional impairment. Sociodemographic and diagnostic factors and cognition had little impact on effect sizes. For self-ratings, depression attenuated the relationship between functional ability and living well, whereas carer stress attenuated informant ratings. CONCLUSIONS People with dementia with the least functional impairments had greater capability to live well than those with the most functional impairment. Even subtle perceived difficulties in functional ability had a detrimental effect on the ability of people with dementia to live well. Depression in people with dementia and carer stress in informants influenced these associations, and therefore, these factors should be routinely included in future research studies and clinical assessments.
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Affiliation(s)
- Anthony Martyr
- Centre for Research in Ageing and Cognitive Health, School of PsychologyUniversity of Exeter Medical School and College of Life and Environmental Sciences, St Luke's CampusExeterUK
| | - Sharon M. Nelis
- Centre for Research in Ageing and Cognitive Health, School of PsychologyUniversity of Exeter Medical School and College of Life and Environmental Sciences, St Luke's CampusExeterUK
| | - Catherine Quinn
- Centre for Research in Ageing and Cognitive Health, School of PsychologyUniversity of Exeter Medical School and College of Life and Environmental Sciences, St Luke's CampusExeterUK
- Centre of Applied Dementia StudiesUniversity of BradfordBradfordUK
| | | | - Robin G. Morris
- Department of PsychologyInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
| | - Linda Clare
- Centre for Research in Ageing and Cognitive Health, School of PsychologyUniversity of Exeter Medical School and College of Life and Environmental Sciences, St Luke's CampusExeterUK
- Wellcome Centre for Cultures and Environments of HealthUniversity of ExeterExeterUK
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Factors Associated with Having a Will, Power of Attorney, and Advanced Healthcare Directive in Patients Presenting to a Rural and Remote Memory Clinic. Can J Neurol Sci 2019; 46:319-330. [PMID: 30907330 DOI: 10.1017/cjn.2019.10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND A Will, Power of Attorney, and Advanced Healthcare Directive are critical to guide decision-making in patients with dementia. We identified characteristics that are associated with the existence of these documents in patients who presented to a rural and remote memory clinic (RRMC). METHODS Ninety-five consecutive patients were included in this study. Patients and caregivers completed questionnaires on initial presentation to the RRMC and patients were asked if they had legal documents. Patients also completed neuropsychological testing. Statistical analysis (t-test and χ2 test) was performed to identify significant variables. RESULTS Seventy (73.7%) patients had a Will, 62 (65.3%) had a Power of Attorney, and 21 (22.1%) had an Advanced Healthcare Directive. Having a Will was associated with good quality of life (p = 0.001), living alone or with a spouse or partner only (p = 0.034), poor verbal fluency (p = 0.055), and European ethnicity (p = 0.028). Factors associated with having a Power of Attorney included good quality of life (p = 0.031), living alone or with a spouse or partner only (p = 0.053), and poor verbal fluency (p = 0.015). Old age (p = 0.015), poor verbal fluency (p = 0.023), and greater severity of cognitive and functional impairment (p = 0.023) were associated with having an Advanced Healthcare Directive. CONCLUSIONS Our results indicate that poor quality of life, good performance on verbal fluency, Indigenous ethnicity, and living with others are associated with a lower likelihood of legal documents in patients with dementia. These factors can help physicians identify patients at risk of leaving their legal affairs unattended to. Physicians should discuss the creation of legal documents early on in patients with signs of dementia.
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Abstract
UNLABELLED ABSTRACTObjective:To study longitudinal changes in the quality of life (QoL) in persons with and without dementia, and explore the factors associated with baseline QoL and changes of QoL over the follow-up period. DESIGN Prospective longitudinal study. SETTING Data were collected from 17 municipalities in Norway in the period from January 2009 to August 2012. A total of 412 persons were included, 254 (61.7 %) persons without dementia and 158 (38.3 %) with dementia at baseline. SUBJECTS Persons 70 years of age or older, receiving municipal care services. Main outcome measures include the following: self-rated and proxy-rated QoL over a period of 18 months, cognitive status, functional status, neuropsychiatric symptoms, and demographics. RESULTS Longitudinal changes in QoL were small, despite changes in clinical variables. Proxy ratings of patients QoL were lower than the patients' own ratings. Belonging to a group with low QoL trajectory was associated with symptoms of depression, reduced physical and instrumental functioning, and more severe dementia. CONCLUSION Patients and proxies evaluated the patients' QoL differently and QoL did not necessarily correspond with deterioration in clinical parameters. To prevent impaired QoL, we need to address identified factors and keep an approach open to the individual perceptions of QoL.
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Stites SD, Harkins K, Rubright JD, Karlawish J. Relationships Between Cognitive Complaints and Quality of Life in Older Adults With Mild Cognitive Impairment, Mild Alzheimer Disease Dementia, and Normal Cognition. Alzheimer Dis Assoc Disord 2018; 32:276-283. [PMID: 29944474 PMCID: PMC6249095 DOI: 10.1097/wad.0000000000000262] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
PURPOSE To examine in persons with varying degrees of cognitive impairment the relationship between self-reports of cognitive complaints and quality of life (QOL). METHODS Older adults (n=259) with normal cognition, mild cognitive impairment (MCI), and mild stage Alzheimer disease (AD) dementia completed tests of cognition and self-report questionnaires about QOL and 3 kinds of cognitive complaints: cognitive difficulties, distress from cognitive difficulties, and believing you had more memory problems than most people. Bivariate, multivariable, and multivariate regression analyses assessed relationships between domains of QOL and each cognitive complaint. RESULTS Bivariate and multivariable analyses controlling for severity of cognitive and functional impairment found that cognitive complaints were related to relatively lower quality of daily life (QOL-AD, Dementia Quality of Life Scale), greater depression (GDS), more anxiety (BAI), higher perceived stress (PSS), and lower general mental well-being (SF-12 MCS). DISCUSSION Cognitive complaints have robust associations with QOL. These findings have implications for AD prevention trials and management of clinical populations.
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Affiliation(s)
- Shana D Stites
- Department of Medical Ethics and Health Policy, Perlman School of Medicine
| | | | | | - Jason Karlawish
- Medicine, Medical Ethics and Health Policy, and Neurology, Penn Memory Center, University of Pennsylvania
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Jacob L, Han JW, Kim TH, Park JH, Lee SB, Lee JJ, Ryu SH, Kim SK, Yoon JC, Jhoo JH, Kim JL, Kwak KP, Moon SW, Kim BJ, Lee DY, Kim KW. How Different are Quality of Life Ratings for People with Dementia Reported by Their Family Caregivers from Those Reported by the Patients Themselves? J Alzheimers Dis 2018; 55:259-267. [PMID: 27662302 DOI: 10.3233/jad-160538] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Measurements of patient quality of life (QoL) play a major role in the management of dementia. OBJECTIVE We investigated the self-proxy discrepancy of QoL ratings in the elderly and the impact of dementia severity on the discrepancy. METHODS QoL of 718 patients with dementia and 651 non-demented elderly were rated by themselves and their caregivers (CG) using the Quality of Life-Alzheimer's Disease (QoL-AD). The impact of the rater on the total and item scores of QoL-AD was analyzed using repeated measures ANOVA and differential response patterns between self and proxy were analyzed using differential item functioning (DIF) analysis. RESULTS Self-rated scores were higher than CG-rated scores in all diagnostic groups. The interaction between rater and diagnostic group was significant in total QoL-AD score and 5 item scores ('memory', 'marriage', 'chores around the house', 'do things for fun', and 'life as a whole'). The strength of the DIF increased with advancing dementia in these items. CONCLUSION Self-proxy rating discrepancy of QoL was influenced by the presence and severity of dementia only in five items.
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Affiliation(s)
- Louis Jacob
- Department of Biology, École Normale Supérieure de Lyon, Lyon, France
| | - Ji Won Han
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-do, Korea
| | - Tae Hui Kim
- Department of Psychiatry, Yonsei University Wonju Severance Christian Hospital, Wonju-si, Gangwon-do, Korea
| | - Joon Hyuk Park
- Department of Neuropsychiatry, Jeju National University Hospital, Jeju Self-Governing Province, Korea
| | - Seok Bum Lee
- Department of Psychiatry, Dankook University Hospital, Cheonan-si, Chungcheongnam-do, Korea
| | - Jung Jae Lee
- Department of Psychiatry, Dankook University Hospital, Cheonan-si, Chungcheongnam-do, Korea
| | - Seung-Ho Ryu
- Department of Psychiatry, School of Medicine, Konkuk University, Konkuk University Medical Center, Gwangjin-gu, Seoul, Korea
| | - Shin-Kyeom Kim
- Department of Neuropsychiatry, Soonchunhyang University Bucheon Hospital, Wonmi-gu, Bucheon-si, Gyeonggi-do, Korea
| | - Jong Chul Yoon
- Department of Neuropsychiatry, Kyunggi Provincial Hospital for the Elderly, Giheung-gu, Yongin-si, Gyeonggi-do, Korea
| | - Jin Hyeong Jhoo
- Department of Neuropsychiatry, Kangwon National University Hospital, Chuncheon-si, Gangwon-do, Korea
| | - Jeong Lan Kim
- Department of Psychiatry, Chungnam National University Hospital, Jung-gu, Daejeon, Korea
| | - Kyung Phil Kwak
- Department of Psychiatry, Dongguk Medical Center, Seokjang-dong, Gyeongju-si, Gyeongsangbuk-do, Korea
| | - Seok Woo Moon
- Department of Psychiatry, Konkuk University Chungju Hospital, Chungju-si, Chungcheongbuk-do, Korea
| | - Bong Jo Kim
- Department of Psychiatry, Gyeongsang National University, School of Medicine, Jinju-si, Gyeongnam-do, Korea
| | - Dong Young Lee
- Department of Psychiatry, Seoul National University, College of Medicine, Jongno-gu, Seoul, Korea
| | - Ki Woong Kim
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-do, Korea.,Department of Psychiatry, Seoul National University, College of Medicine, Jongno-gu, Seoul, Korea.,Department of Brain and Cognitive Science, Seoul National University College of Natural Sciences, Gwanak-gu, Seoul, Korea
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Garzón-Maldonado F, Gutiérrez-Bedmar M, García-Casares N, Pérez-Errázquin F, Gallardo-Tur A, Martínez-Valle Torres M. Calidad de vida relacionada con la salud en cuidadores de pacientes con enfermedad de Alzheimer. Neurologia 2017; 32:508-515. [DOI: 10.1016/j.nrl.2016.02.023] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 02/27/2016] [Indexed: 11/26/2022] Open
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Health-related quality of life in caregivers of patients with Alzheimer disease. NEUROLOGÍA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.nrleng.2016.02.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Reliability of health-related quality-of-life assessments made by older adults and significant others for health states of increasing cognitive impairment. Health Qual Life Outcomes 2017; 15:4. [PMID: 28069027 PMCID: PMC5220615 DOI: 10.1186/s12955-016-0579-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Accepted: 12/13/2016] [Indexed: 11/17/2022] Open
Abstract
Background Older adults are encouraged by many organizations to engage in advance care planning in the event of decisional incapacity. Planning for future health care often involves anticipating health-related quality of life (HRQoL) in states of reduced cognitive functioning. No study has yet examined whether anticipated HRQoL is stable over time. The accuracy with which significant others can predict how an older adult envisions HRQoL in a future state of cognitive impairment is also unknown. We investigated the extent to which health-related quality-of-life ratings made by older adults and designated proxies for health states of increasing cognitive impairment are consistent over time and agree with each other. Methods Results are based on HRQoL ratings made on a 5-point Likert scale by 235 community-based elder-proxy dyads on three occasions. Ratings were obtained for the older adult’s current health state as well as under the assumption that he/she had a mild to moderate stroke, incurable brain cancer or severe dementia. Data were analyzed using both traditional approaches (e.g., intraclass correlation coefficients, Bland-Altman plots) and the theory of generalizability. Results We found ratings to be reasonably consistent over time and in good agreement within dyads, even more so as implied cognitive functioning worsened. Across health states, ratings over time or within elder-proxy dyads were no more than one category apart in over 87% of cases. Using the theory of generalizability, we further found that, of the two facets investigated, rater had a greater influence on score variability than occasion. Conclusions These findings underscore the importance of discussing health-related quality-of-life issues during advance care planning and involving designated proxies in the discussion to enhance their understanding of the role that HRQoL should play in actual decision-making situations. Medical decision-making may be influenced by healthcare providers’ and family members’ assessments of an incapacitated patient’s health-related quality of life, in addition to that of the designated proxy. Future studies should investigate whether these two groups of individuals share the views of the patient and the designated proxy on anticipated HRQoL. Electronic supplementary material The online version of this article (doi:10.1186/s12955-016-0579-3) contains supplementary material, which is available to authorized users.
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Conde-Sala JL, Turró-Garriga O, Portellano-Ortiz C, Viñas-Diez V, Gascón-Bayarri J, Reñé-Ramírez R. Self-Perceived Quality of Life Among Patients with Alzheimer’s Disease: Two Longitudinal Models of Analysis. J Alzheimers Dis 2016; 52:999-1012. [DOI: 10.3233/jad-160040] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Josep L. Conde-Sala
- Faculty of Psychology, University of Barcelona, Spain
- Aging, Disability and Health Research Group, Biomedical Research Institute of Girona (IdIBGi), Catalonia, Spain
| | - Oriol Turró-Garriga
- Aging, Disability and Health Research Group, Biomedical Research Institute of Girona (IdIBGi), Catalonia, Spain
| | | | - Vanesa Viñas-Diez
- Department of Neurology, Dementia Unit, Bellvitge University Hospital, Hospitalet de Llobregat, Spain
| | - Jordi Gascón-Bayarri
- Department of Neurology, Dementia Unit, Bellvitge University Hospital, Hospitalet de Llobregat, Spain
| | - Ramón Reñé-Ramírez
- Department of Neurology, Dementia Unit, Bellvitge University Hospital, Hospitalet de Llobregat, Spain
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Jing W, Willis R, Feng Z. Factors influencing quality of life of elderly people with dementia and care implications: A systematic review. Arch Gerontol Geriatr 2016; 66:23-41. [PMID: 27176488 DOI: 10.1016/j.archger.2016.04.009] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Revised: 04/08/2016] [Accepted: 04/14/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Identifying factors associated with Quality of Life (QoL) of elderly people with dementia could contribute to finding pathways to improve QoL for elderly people in dementia. AIM This paper systematically reviews all possible factors that influence QoL of elderly people with dementia, identifies how these factors are different by different stages of dementia and living settings, and explores how the influencing factors could be perceive differently by elderly people with dementia, family members, and caregivers. METHOD PubMed, PsycINFO, Web of Science and DelphiS searches from 2000 to 2015 and hand searches of publication lists, reference lists and citations were used to identify primary studies on 'quality of life' and 'dementia' elderly people. RESULTS The results suggest that there are a complex variety of factors influencing QoL of elderly people with dementia, and the factors cover demographic, physical, psychological, social, and religious aspects. And the factors influencing QoL of elderly people with dementia are different in different living settings (care institutions and communities) as well as different people's perspectives (elderly people with dementia, family members and care staff). Environmental factors and quality of care are important for elderly people in care institutions; while religious seem to only affect QoL of those living in communities. However, this review fails to comprehensively identify unique or common factors associated QoL in dementia across three stages. Further study should pay more attention to comparing factors associated with QoL in dementia across three stages of dementia.
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Affiliation(s)
- Wenbo Jing
- Centre for Research on Ageing, Faculty of Social, Human and Mathematical Sciences, University of Southampton, SO17 1BJ, United Kingdom; Nursing School, Zhengzhou University, China
| | - Rosalind Willis
- Centre for Research on Ageing, Faculty of Social, Human and Mathematical Sciences, University of Southampton, SO17 1BJ, United Kingdom
| | - Zhixin Feng
- Centre for Research on Ageing, Faculty of Social, Human and Mathematical Sciences, University of Southampton, SO17 1BJ, United Kingdom.
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Trigg R, Jones RW, Knapp M, King D, Lacey LA. The relationship between changes in quality of life outcomes and progression of Alzheimer's disease: results from the dependence in AD in England 2 longitudinal study. Int J Geriatr Psychiatry 2015; 30:400-8. [PMID: 24920081 DOI: 10.1002/gps.4150] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Revised: 04/28/2014] [Accepted: 05/08/2014] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The relationship between conventional indicators of Alzheimer's disease (AD) progression and quality of life (QoL) outcomes is unclear. Dependence on others has been recommended as a unifying construct in defining AD severity. This study examined the relationship between indicators of disease severity (including dependence) and changes in QoL and utility over 18 months. METHODS A multi-centre, cohort study was conducted across 18 UK sites. One hundred and forty-five patients with possible/probable AD and their caregivers completed assessments of disease severity (Dependence Scale, Mini-mental state examination, Neuropsychiatric Inventory, Disability Assessment for Dementia), dementia-specific QoL (DEMQOL, DEMQOL-Proxy) and generic health-related utility (EQ-5D) at both time points. RESULTS There was evidence of individual change in QoL over 18 months, with over 50% of patients reporting either maintenance or improvement of life quality. The EQ-5D proxy suggested a mean decline in QoL, whereas the DEMQOL-Proxy indicated overall improvement. In the subsample of people who self-reported QoL and utility, no mean change was evident. Changes in dependence did not explain changes on any QoL or utility outcome. There was a weak association between the EQ-5D proxy and changes in cognition, whereas changes on the DEMQOL-Proxy were partly explained by changes in behavioural disturbance. CONCLUSIONS The natural progression of AD over 18 months does not lead to inevitable decline in QoL or utility. There are no clear or consistent direct relationships between changes in disease severity and QoL outcomes. The impact of increasing dependence and worsening disease severity is likely buffered by a combination of psychological, social and environmental factors.
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Bosboom PR, Almeida OP. Cognitive Domains and Health-Related Quality of Life in Alzheimer's Disease. J Gerontol B Psychol Sci Soc Sci 2014; 71:275-87. [PMID: 25098526 DOI: 10.1093/geronb/gbu090] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 06/14/2014] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The nature of the association between the cognitive decline and quality of life (QoL) during the course of Alzheimer's disease (AD) has not been studied in detail. We designed this study to determine if the association between cognitive domains in AD and health-related quality of life (HRQoL) changed over 18 months. METHODS We recruited 80 community-dwelling older adults with mild to moderate AD and 61 healthy elderly controls as well as their next-of-kin. The primary outcome measure was the QoL-AD. Specific cognitive functions were assessed with a broad range of neuropsychological measures, which were later grouped into cognitive domains following factor analyses at the baseline and 18-month assessments. Other explanatory variables included demographics, psychopathology, burden of care, and use of medication. RESULTS Self-reported QoL-AD scores were not associated with any of the identified cognitive domains at either assessment. The cognitive domains of people with AD changed between baseline and the 18-month assessment, as did the association of these factors with carer-rated HRQoL. The HRQoL scores assigned by the next-of-kin declined alongside a general measure of cognitive function. DISCUSSION These results indicate that HRQoL is not consistently associated with specific cognitive domains in AD and that cognitive-enhancing focused therapies may fail to affect the HRQoL of people with AD.
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Affiliation(s)
- Pascalle R Bosboom
- Western Australian Centre for Health and Ageing, Centre for Health Research and School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, Australia.
| | - Osvaldo P Almeida
- Western Australian Centre for Health and Ageing, Centre for Health Research and School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, Australia
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