Quality of Life and Dementia

Cognitive impairment due to age-related dementia such as Alzheimer’s disease will present considerable challenges to health and social care services as populations age worldwide. As well as expanding services to meet increased numbers of people with dementia, the challenge will also involve providing care that will ensure a good quality of life (QoL) for people who are vulnerable and dependent. Dementia also presents considerable challenges in terms of developing frameworks for evaluating the quality of care. The Care Keys approach emphasises the need to incorporate measures of QoL and well-being in the evaluation of care, while also ‘giving a voice’ to the client by eliciting their views on their own well-being and satisfaction with the services they receive. However, this is problematic with cognitively impaired people who may be unable to comprehend questions, formulate coherent answers and articulate and communicate their views. This has often resulted in people with dementia being excluded from research into QoL (cf. Balcombe, Ferry, & Saweirs, 2001). Recent research on QoL in dementia has attempted to address this situation (Torrington, 2006), arguing that the views and responses of people with dementia should still be taken seriously. However, there are limits to this when the severity of the dementia may prevent meaningful verbal communication and, in these situations, alternative approaches are required.

Unfortunately, approaches to assessing QoL for people with dementia remain conceptually and methodologically weak. A traditional biomedical perspective generally frames the experience of dementia in terms of cognitive decline and associated functional impairment. However, alternative perspectives suggest that QoL in dementia is more than just cognition (Banerjee et al., 2006) and that a wider perspective encompassing aspects of the person, context and care (Sixsmith & Gibson, 2006) need to be considered. As far as the concept of crQoL is concerned, a number of key theoretical and methodological issues need to be resolved. Firstly, are the concepts underlying the crQoL model appropriate to people with dementia? Secondly, are ideas of subjective well-being that have been developed particularly in respect to non-demented people, applicable to people with dementia? Finally, can care make a difference to the QoL of people with dementia? In this context, this chapter presents some of the results of work carried out within the Care Keys project that specifically addressed the needs of people with dementia.