Factors associated with quality of life of people with dementia in long-term care facilities: A systematic review

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Abstract

Background

Quality of life has become an important outcome measure in dementia research. Currently there is no convincing evidence about which factors are associated with quality of life of people with dementia living in long-term care facilities.

Objective

This study aims to investigate which factors are associated with quality of life, including factors associated with change over time, of people with dementia living in long-term care facilities.

Design

A systematic literature review was performed.

Data sources

Cochrane, Pubmed, CINAHL, Web of Science, and PsycINFO were searched.

Review methods

Three researchers independently assessed studies for eligibility. The inclusion criteria were: (1) the primary focus was on factors related to quality of life; (2) the study was performed in long-term care facilities; (3) the study regarded quality of life as multidimensional construct. Methodological quality of studies included in the review was assessed with a quality criteria checklist.

Results

Ten cross-sectional and three longitudinal articles were included in the review. In cross-sectional studies, depressive symptoms were negatively related to self-rated quality of life of people with dementia. The association between depressive symptoms and proxy-rated quality of life was less clear. Behavioural disturbances, especially agitation, appeared to be negatively related to proxy-rated quality of life. There appeared to be a negative relation between quality of life, activities of daily living and cognition, although this could not be confirmed in all studies. In longitudinal studies, depressive symptoms were negatively related and cognition was positively related to self-rated quality of life, whereas dependency and depressive symptoms were negatively related to proxy-rated quality of life.

Conclusions

There are only few high quality studies that investigate associations of (change in) quality of life of people with dementia living in long-term care facilities. Our results suggest that depressive symptoms and agitation are related to lower quality of life. Perspective of quality of life measurement, i.e. self- or proxy rating, may influence its associations. Longitudinal studies are needed to determine which factors are related to change in quality of life over time. This information is essential for the development of interventions that aim to improve quality of life.

Section snippets

Background

Dementia affects an increasing number of people each year. It is estimated that in Europe the number of people with dementia will increase to reach 13 million in 2040. This is important because these people are heavy consumers of health care (Ferri et al., 2005). As there is no sign yet of a cure for the syndrome, dementia care should focus on contributing to maximizing quality of life (QoL). Therefore, over the last decade QoL has become a highly important outcome measure in dementia research (

Search strategy

A literature search was performed. Relevant articles published between January 2000 and May 2012 were obtained by searching in five electronic databases: Cochrane, Pubmed, CINAHL, Web of Science, and PsycINFO. Additional articles were searched by exploring references from retrieved publications.

The main outcome measure ‘quality of life’ was used as a search term and combined with the Boolean operator ‘AND’ with other search terms with respect to the disease (dementia OR Alzheimer), the place of

Search results

The electronic database search yielded 2178 publications. After removal of duplicates, 1505 articles remained. Stepwise screening resulted in the inclusion of ten cross-sectional articles and three longitudinal articles, which were all written in English. No additional articles could be obtained via reference tracking. Fig. 1 gives an overview of the selection process from initial search to final retrieved articles.

Methodological quality

Assessments of the publications are shown in Table 1. Eight cross-sectional

Discussion

From the findings of this systematic review it can be concluded that mood, and especially depressive symptoms, is a consistent factor which is negatively related to self-rated QoL of people with dementia living in long-term care facilities, indicating that more depressive symptoms are related to lower QoL. The association between proxy-rated QoL and depressive symptoms is less clear. There are also reasonable indications that behavioural disturbances, and especially agitation, are negatively

Conclusion

This review provides evidence for nurses and other caregivers working in long-term care facilities who aim to improve QoL of people with dementia and shows that attention to depressive symptoms and agitated behaviour should have priority. This could for example be realized in the development and execution of psychosocial interventions, but it is recommended that associations of QoL be further explored. In particular, longitudinal studies are needed in order to determine which factors are

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