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Multicenter Study
. 2010 Dec;58(12):2394-400.
doi: 10.1111/j.1532-5415.2010.03170.x. Epub 2010 Nov 4.

Quality of life in nursing home residents with advanced dementia

Zachary Cordner  1 , David M Blass, Peter V Rabins, Betty S Black
Affiliations
Multicenter Study

Quality of life in nursing home residents with advanced dementia

Zachary Cordner et al. J Am Geriatr Soc. 2010 Dec.

Abstract

Objectives: To examine quality of life (QOL) in nursing home (NH) residents with advanced dementia and identify correlates of QOL near the end of life.

Design: Cross-sectional data derived from NH records, interviews with residents' surrogate decision-makers, QOL ratings by NH caregivers, and assessment of residents' cognitive function.

Setting: Three NHs in Maryland.

Participants: A cohort of NH residents with dementia (n=119) who were receiving hospice or palliative care or met hospice criteria for dementia and their surrogates.

Measurements: QOL based on the proxy-rated Alzheimer' Disease-Related Quality of Life (ADRQL) scale administered to NH staff and validated against a single-item surrogate-rated measure of QOL, the Severe Impairment Rating Scale, to measure cognitive function and dichotomous indicators of neuropsychiatric symptoms (behavior problems, mood disorders, psychosis, delusions).

Results: Total ADRQL scores, ranging from 12.4 to 95.1 out of 100, were normally distributed and positively correlated (P<.001) with surrogate-rated QOL. Multiple regression analysis of ADRQL scores showed that residents with higher cognitive function (P<.001, 95% confidence interval (CI)=0.97-1.65) and those receiving pain medication (P=.006, 95% CI=3.30-19.59) had higher QOL, whereas residents with behavior problems (P=.01, 95% CI=-11.60 to -1.30) had lower QOL.

Conclusion: The ADRQL is a valid indicator of QOL in NH residents with advanced dementia. QOL in this population may be improved near the end of life using appropriate assessment and treatment of pain and effective management of behavior problems.

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Conflict of interest statement

Conflict of Interest:

The following is a disclosure statement for Peter Rabins that is required by the Johns Hopkins University: “Under an agreement between DEMeasure and Dr. Rabins, Dr. Rabins is entitled to a share of income received by DEMeasure from sales of the ADRQL questionnaire and scale used in the study described in this article. Dr. Rabins has an ownership interest in DEMeasure. The terms of this arrangement are being managed by the Johns Hopkins University in accordance with its conflict of interest policies.” In addition, Dr. Rabins has provided expert testimony for Janssen Pharmaceutica and received grant support from the Jewish Community Federation of Baltimore.

The following is a disclosure statement for Betty Black that is required by the Johns Hopkins University: “Under an agreement between DEMeasure and Dr. Black, Dr. Black is entitled to a share of income received by DEMeasure from sales of the ADRQL questionnaire and scale used in the study described in this article. Dr. Black has an ownership interest in DEMeasure. The terms of this arrangement are being managed by the Johns Hopkins University in accordance with its conflict of interest policies.” In addition, Dr. Black has received grant support from the Jewish Community Federation of Baltimore.

References

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    1. Whitehouse PJ, Rabins PV. Quality of life and dementia. Alzheimer Dis Assoc Disord. 1992;6:135–137. - PubMed
    1. Sachs GA, Shega JW, Cox-Hayley D. Barriers to excellent end-of-life care for patients with dementia. J Gen Intern Med. 2004;19:1057–1063. - PMC - PubMed
    1. Kane RA. Definition, measurement, and correlates of quality of life in nursing homes: Toward a reasonable practice, research, and policy agenda. Gerontologist. 2003;43(Special Issue):28–36. - PubMed
    1. Rabins PV, Kasper JD, Kleinman L, et al. Concepts and methods in the development of the ADRQL: An instrument for assessing health-related quality of life in persons with Alzheimer disease. J Ment Health Aging. 1999;5:33–48.

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