Quality of life of people with dementia in residential care homes
Hoe J, Hancock G, Livingston G, Orrel M;
Commented by , 23 May 2006
Background
Quality of life is difficult to quantify, particularly in people with dementia. The literature suggests family caregivers consistently rate it lower than people with dementia themselves, possibly because of family caregiver's depression/burden.
Aim
The aim of this study was to compare the views of quality of life of people with dementia in residential homes with the view of staff in these homes, and to identify factors influencing these views.
Methods
238 people over 60 living in residential homes were recruited from 24 residential homes in England, as part of a wider study examining the needs in dementia. Information on consenting residents was obtained through interview, observation and review of care home documentation. Residents and staff members were interviewed separately.
The 13-item Quality of Life in Alzheimer’s Disease (QoL-AD) was the main outcome measure used. It contains domains of physical and mental health, personal relationships, finances and overall quality of life. Severity of dementia and co-morbidity were assessed by the Mini Mental State Examination, Clinical Dementia Rating, Cornell Scale for Depression in Dementia, Camberwell Assessment of Need for the Elderly, the Challenging Behaviour Scale and the Barthell Index. Data was subjected to multivariate regression analysis.
Results
238 residents participated, mean age 86 years with 80% white female. 5 % were married, 20% had never married, 75% were widowed or divorced. Rating scales confirmed widespread co-morbidity in people with multiple disabilities and quite advanced dementia.
123 residents (52%) and 224 staff (94%) completed the QoL-AD. The residents’ mean score was 33.1 and the staff-rated mean score was 29.9. Resident ratings of higher quality of life (i.e., a higher score on QoL-AD) correlated with less depressed mood and anxiety. Staff ratings of better quality of life correlated with less physical disability, less cognitive impairment, fewer neuropsychiatric symptoms, less depression and fewer unmet needs.
Using multiple linear regression, residents’ perception of their quality of life was significantly predicted by depression and anxiety only, accounting for 34% of the variance. For staff-rated quality of life, physical disability accounted for 43% of the variance.
Dr Seymour's comments
This study is of interest because of the mismatch in assessing quality of life between residents and staff. Mood was the main predictor for residents, physical dependency the main predictor for staff.
If the findings of this study are generalisable, it has implications for management; both clinical management and how residential homes are managed. Care home staff can often do little to improve levels of disability of their residents, but could potentially do a lot to improve their mood. This appears to be what residents with dementia need, though the authors acknowledge that only 50% of the participants were able to complete the study.
At the very least, this study should alert families, care home staff and health professionals visiting care homes, that we should not assume that high levels of dependency necessarily mean poor subjective quality of life.