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Open Access 01-12-2016 | Research article

Differences in quality of life in home-dwelling persons and nursing home residents with dementia – a cross-sectional study

Authors: Christine Olsen, Ingeborg Pedersen, Astrid Bergland, Marie-José Enders-Slegers, Nina Jøranson, Giovanna Calogiuri, Camilla Ihlebæk

Published in: BMC Geriatrics | Issue 1/2016

Abstract

Background

Dementia often eventually leads to dependency on others and finally to residential care. However, in Norway about half of the dementia population lives at home, due to individual and political wishes. There is scarce and inconclusive knowledge of how living in a nursing home differs from living at home for persons with dementia (PWDs) with regard to their quality of life (QoL). The first aim of the study was therefore to compare QoL, cognitive and physical functions, social contacts, sleep patterns, physical activity levels, exposure to light, and medication of PWDs in nursing homes and home-dwelling PWDs, and whether living in nursing homes was associated with a lower QoL than living at home for PWDs. A second aim was to examine if possible differences between residencies in QoL were consistent over time.

Methods

The cross-sectional study was based on baseline data from two RCT studies of PWDs. A total of 15 nursing homes with adapted units for PWDs and 23 adapted day care centres for home-dwelling PWDs recruited 78 and 115 participants respectively. Trained nurses scored sociodemographic data, level of dementia (on the Clinical Dementia Rating scale), amount of medication, and QoL (QUALID). Sleep patterns, physical activity levels, and light exposure were measured by actigraphy. A multiple regression analysis was used to test the association between residency and QoL. The association between residency and change in QoL over time was investigated by linear regression analysis of a subsample with follow-up data.

Results

Home-dwelling PWDs showed significantly higher QoL than PWDs in nursing homes. This difference was maintained even after stratifying on the severity of dementia. Home-dwelling PWDs with moderate dementia showed significantly less use of walking aids, more social contact, higher levels of activity and exposure to daylight, and less use of psychotropic medications. The regression model explained 28 % of the variance in QoL in persons with moderate dementia. However, only residency contributed significantly in the model. Residency also significantly predicted negative change over time in QoL.

Conclusion

The study indicated that living at home as long as possible is not only desirable for economic or health political reasons but also is associated with higher QoL for persons with moderate dementia. More studies are needed to investigate how QoL could be increased for PWDs in nursing homes.

Fratiglioni L, Launer LJ, Andersen K, Breteler MM, Copeland JR, Dartigues JF, Lobo A, Martinez-Lage J, Soininen H, Hofman A. Incidence of dementia and major subtypes in Europe: A collaborative study of population-based cohorts. Neurologic Diseases in the Elderly Research Group. Neurology. 2000;54(11 Suppl 5):S10–15.PubMed

Colantuoni E, Surplus G, Hackman A, Arrighi HM, Brookmeyer R. Web-based application to project the burden of Alzheimer’s disease. Alzheimer Dement. 2010;6(5):425–8. doi:10.1016/j.jalz.2010.01.014.CrossRef

Dementia Fact sheet N°362 [http://www.who.int/mediacentre/factsheets/fs362/en/]. 10.12. 2015.

Geldmacher DS, Frolich L, Doody RS, Erkinjuntti T, Vellas B, Jones RW, Banerjee S, Lin P, Sano M. Realistic expectations for treatment success in Alzheimer’s disease. J Nutr Health Aging. 2006;10(5):417–29.PubMed

McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM. Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer’s Disease. Neurology. 1984;34(7):939–44.CrossRefPubMed

van Iersel MB, Hoefsloot W, Munneke M, Bloem BR, Olde Rikkert MG. Systematic review of quantitative clinical gait analysis in patients with dementia. Z Gerontol Geriatr. 2004;37(1):27–32. doi:10.1007/s00391-004-0176-7.CrossRefPubMed

Hajek A, Brettschneider C, Lange C, Posselt T, Wiese B, Steinmann S, Weyerer S, Werle J, Pentzek M, Fuchs A et al. Longitudinal Predictors of Institutionalization in Old Age. PLoS One. 2015;10(12):e0144203. doi:10.1371/journal.pone.0144203.CrossRefPubMedPubMedCentral

Selbæk G, Kirkevold Ø, Engedal K. The prevalence of psychiatric symptoms and behavioural disturbances and the use of psychotropic drugs in Norwegian nursing homes. Int J Geriatr Psychiatry. 2007;22(9):843–9.CrossRefPubMed

Verbeek H, Meyer G, Challis D, Zabalegui A, Soto ME, Saks K, Leino-Kilpi H, Karlsson S, Hamers JP. Inter-country exploration of factors associated with admission to long-term institutional dementia care: evidence from the RightTimePlaceCare study. J Adv Nurs. 2015;71(6):1338–50. doi:10.1111/jan.12663.CrossRefPubMed

10.

Knapp M, Comas-Herrera A, Somani A, Banerjee S: Dementia: international comparisons: summary report for the National Audit Office. In. London; 2007: 19

11.

Lystrup LS, Lillesveen B, Nuygård A-M, Engedal K. Omsorgstilbud til hjemmeboende personer med demens. Tidsskr Nor Laegeforen. 2006;126(15):1917–20.PubMed

12.

Bharucha AJ, Pandav R, Shen C, Dodge HH, Ganguli M. Predictors of Nursing Facility Admission: A 12-Year Epidemiological Study in the United States. J Am Geriatr Soc. 2004;52(3):434–9. doi:10.1111/j.1532-5415.2004.52118.x.CrossRefPubMed

13.

Wergeland JN, Selbaek G, Bergh S, Soederhamn U, Kirkevold O. Predictors for Nursing Home Admission and Death among Community-Dwelling People 70 Years and Older Who Receive Domiciliary Care. Dement Geriatr Cogn Dis Extra. 2015;5(3):320–9. doi:10.1159/000437382.CrossRefPubMedPubMedCentral

14.

Hajek A, Brettschneider C, Ernst A, Posselt T, Wiese B, Prokein J, Weyerer S, Werle J, Fuchs A, Pentzek M et al.: Longitudinal predictors of informal and formal caregiving time in community-dwelling dementia patients. Social psychiatry and psychiatric epidemiology 2015.10.1007/s00127-015-1138-7

15.

Cohen-Mansfield J, Dakheel-Ali M, Marx MS, Thein K, Regier NG. Which unmet needs contribute to behavior problems in persons with advanced dementia? Psychiatry Res. 2015;228(1):59–64. doi:10.1016/j.psychres.2015.03.043.CrossRefPubMed

16.

Anderiesen H, Scherder EJ, Goossens RH, Sonneveld MH. A systematic review--physical activity in dementia: the influence of the nursing home environment. Appl Ergon. 2014;45(6):1678–86. doi:10.1016/j.apergo.2014.05.011.CrossRefPubMed

17.

van der Ploeg ES, Bax D, Boorsma M, Nijpels G, van Hout HP. A cross-sectional study to compare care needs of individuals with and without dementia in residential homes in the Netherlands. BMC Geriatr. 2013;13:51. doi:10.1186/1471-2318-13-51.CrossRefPubMedPubMedCentral

18.

Willemse BM, Downs M, Arnold L, Smit D, de Lange J, Pot AM. Staff-resident interactions in long-term care for people with dementia: the role of meeting psychological needs in achieving residents’ well-being. Aging Ment Health. 2015;19(5):444–52. doi:10.1080/13607863.2014.944088.CrossRefPubMed

19.

Verbeek H, Zwakhalen SM, van Rossum E, Ambergen T, Kempen GI, Hamers JP. Small-scale, homelike facilities versus regular psychogeriatric nursing home wards: a cross-sectional study into residents' characteristics. BMC Health Serv Res. 2010;10:30. doi:10.1186/1472-6963-10-30.CrossRefPubMedPubMedCentral

20.

Zimmerman S, Anderson WL, Brode S, Jonas D, Lux L, Beeber AS, Watson LC, Viswanathan M, Lohr KN, Sloane PD. Systematic Review: Effective Characteristics of Nursing Homes and Other Residential Long-Term Care Settings for People with Dementia. J Am Geriatr Soc. 2013;61(8):1399–409. doi:10.1111/jgs.12372.CrossRefPubMed

21.

Beerens HC, Sutcliffe C, Renom-Guiteras A, Soto ME, Suhonen R, Zabalegui A, Bokberg C, Saks K, Hamers JP. Quality of life and quality of care for people with dementia receiving long term institutional care or professional home care: the European RightTimePlaceCare study. J Am Med Dir Assoc. 2014;15(1):54–61. doi:10.1016/j.jamda.2013.09.010.CrossRefPubMed

22.

Beerens HC, Zwakhalen SMG, Verbeek H, Ruwaard D, Ambergen AW, Leino-Kilpi H, Stephan A, Zabalegui A, Soto M, Saks K et al. Change in quality of life of people with dementia recently admitted to long-term care facilities. J Adv Nurs. 2015;71(6):1435–47. doi:10.1111/jan.12570.CrossRefPubMed

23.

Ettema TP, Droes RM, de Lange J, Ooms ME, Mellenbergh GJ, Ribbe MW. The concept of quality of life in dementia in the different stages of the disease. Int Psychogeriatr. 2005;17(3):353–70.CrossRefPubMed

24.

Dichter MN, Halek M, Dortmann O, Meyer G, Bartholomeyczik S: Measuring the quality of life of people with dementia in nursing homes in Germany – the study protocol for the Qol-Dem Project. GMS Psycho-Social-Medicine 2013, 10:Doc06.10.3205/psm000096

25.

Lawton MP. A multidimensional view of quality of life in frail elders. In: Birren JE, Lubben JE, Cichowlas Rowe J, Deutchman DE, editors. The Concept and Measurement of Quality of Life in the Frail Elderly. San Diego: Academic Press; 1991. p. 3–27.

26.

Logsdon RG, Gibbons LE, McCurry SM, Teri L. Assessing quality of life in older adults with cognitive impairment. Psychosom Med. 2002;64(3):510–9.CrossRefPubMed

27.

Bárrios H, Narciso S, Guerreiro M, Maroco J, Logsdon R, de Mendonça A. Quality of life in patients with mild cognitive impairment. Aging Ment Health. 2012;17(3):287–92. doi:10.1080/13607863.2012.747083.CrossRefPubMed

28.

Barca ML, Engedal K, Laks J, Selbæk G. Quality of life among elderly patients with dementia in institutions. Dement Geriatr Cogn Disord. 2011;31(6):435–442.10.1159/000328969.CrossRefPubMed

29.

Nagatomo I, Kita K, Takigawa M, Nomaguchi M, Sameshima K. A study of the quality of life in elderly people using psychological testing. Int J Geriatr Psychiatry. 1997;12(6):599–608. doi:10.1002/(SICI)1099-1166(199706)12:6<599::AID-GPS505>3.0.CO;2-E.CrossRefPubMed

30.

Mjørud M, Kirkevold M, Rosvik J, Selbæk G, Engedal K. Variables associated to quality of life among nursing home patients with dementia. Aging Ment Health. 2014;18(8):1013–21. doi:10.1080/13607863.2014.903468.CrossRefPubMed

31.

Telenius EW, Engedal K, Bergland A. Physical Performance and Quality of Life of Nursing-Home Residents with Mild and Moderate Dementia. Int J Environ Res Public Health. 2013;10(12):6672–86. doi:10.3390/ijerph10126672.CrossRefPubMedPubMedCentral

32.

Hodgson N, Gitlin LN, Huang J. The influence of sleep disruption and pain perception on indicators of quality of life in individuals living with dementia at home. Geriatr Nurs. 2014;35(5):394–8. doi:10.1016/j.gerinurse.2014.08.005.CrossRefPubMedPubMedCentral

33.

Tractenberg RE, Singer CM, Kaye JA. Symptoms of sleep disturbance in persons with Alzheimer's disease and normal elderly. J Sleep Res. 2005;14(2):177–85. doi:10.1111/j.1365-2869.2005.00445.x.CrossRefPubMedPubMedCentral

34.

Dementia and Sleep [Available at: https://sleepfoundation.org/sleep-disorders-problems/dementia-and-sleep].

35.

Król-Zielińska M, Kusy K, Zieliński J, Osiński W. Physical activity and functional fitness in institutionalized vs. independently living elderly: A comparison of 70–80-year-old city-dwellers. Arch Gerontol Geriatr. 2010;53(1):e10–6. doi:10.1016/j.archger.2010.07.013.CrossRefPubMed

36.

Salguero A, Martinez-Garcia R, Molinero O, Marquez S. Physical activity, quality of life and symptoms of depression in community-dwelling and institutionalized older adults. Arch Gerontol Geriatr. 2011;53(2):152–7. doi:10.1016/j.archger.2010.10.005.CrossRefPubMed

37.

MacRae PG, Schnelle JF, Simmons SF, Ouslander JG. Physical Activity Levels of Ambulatory Nursing Home Residents. J Aging Phys Act. 1996;4(3):264–78.

38.

Bates-Jensen BM, Alessi CA, Cadogan M, Levy-Storms L, Jorge J, Yoshii J, Al-Samarrai NR, Schnelle JF. The Minimum Data Set bedfast quality indicator: differences among nursing homes. Nurs Res. 2004;53(4):260–72.CrossRefPubMed

39.

Gonzalez-Salvador T, Lyketsos CG, Baker A, Hovanec L, Roques C, Brandt J, Steele C. Quality of life in dementia patients in long-term care. Int J Geriatr Psychiatry. 2000;15(2):181–9.CrossRefPubMed

40.

Beerens HC, Zwakhalen SM, Verbeek H, Ruwaard D, Hamers JP. Factors associated with quality of life of people with dementia in long-term care facilities: a systematic review. Int J Nurs Stud. 2013;50(9):1259–70. doi:10.1016/j.ijnurstu.2013.02.005.CrossRefPubMed

41.

Folstein M, Folstein S, McHugh P. “Mini-mental state”: A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12:189–98.CrossRefPubMed

42.

Strobel C, Engedal K: Norsk revidert Mini Mental Status evaluering (MMSE-NR). In.; 2009.

43.

O’Connor DW, Pollitt PA, Treasure FP, Brook CP, Reiss BB. The influence of education, social class and sex on Mini-Mental State scores. Psychol Med. 1989;19(3):771–6.CrossRefPubMed

44.

Weiner MF, Martin-Cook K, Svetlik DA, Saine K, Foster B, Fontaine CS. The quality of life in late-stage dementia (QUALID) scale. J Am Med Dir Assoc. 2000;1(3):114–6.PubMed

45.

Røen I, Selbæk G, Kirkevold O, Engedal K, Lerdal A, Bergh S. The Reliability and Validity of the Norwegian Version of the Quality of Life in Late-Stage Dementia Scale. Dement Geriatr Cogn Disord. 2015;40(3–4):233–242.10.1159/000437093.CrossRefPubMed

46.

Hughes CP, Berg L, Danziger WL, Coben LA, Martin RL. A new clinical scale for the staging of dementia. Br J Psychiatry J Ment Sci. 1982;140:566–72.CrossRef

47.

Engedal K, Haugen PK. The prevalence of dementia in a sample of elderly Norwegians. Int J Geriatr Psychiatry. 1993;8:565–70.CrossRef

48.

Nygaard HA, Ruths S. Missing the diagnosis: senile dementia in patients admitted to nursing homes. Scand J Prim Health Care. 2003;21(3):148–52.CrossRefPubMed

49.

Natale V, Plazzi G, Martoni M. Actigraphy in the Assessment of Insomnia: A Quantitative Approach. Sleep. 2009;32(6):767–71.PubMedPubMedCentral

50.

Ancoli-Israel S, Clopton P, Klauber MR, Fell R, Mason W. Use of Wrist Activity for Monitoring Sleep/Wake in Demented Nursing-Home Patients. Sleep. 1997;20(1):24–7.PubMedPubMedCentral

51.

Freedson PS, Melanson E, Sirard J. Calibration of the Computer Science and Applications, Inc. accelerometer. Med Sci Sports Exerc. 1998;30(5):777–81.CrossRefPubMed

52.

Mjørud M, Røsvik J, Rokstad AMM, Kirkevold M, Engedal K. Variables Associated with Change in Quality of Life among Persons with Dementia in Nursing Homes: A 10 Months Follow-Up Study. PLoS ONE. 2014;9(12):e115248. doi:10.1371/journal.pone.0115248.CrossRefPubMedPubMedCentral

53.

Andersen C, Wittrup-Jensen K, Lolk A, Andersen K, Kragh-Sorensen P. Ability to perform activities of daily living is the main factor affecting quality of life in patients with dementia. Health Qual Life Outcomes. 2004;2(1):52.CrossRefPubMedPubMedCentral

54.

Nikmat AW, Hawthorne G, Al-Mashoor SH: Quality of life in dementia patients: nursing home versus home care. International psychogeriatrics/IPA 2011, 23.10.1017/s1041610211001050

55.

Logsdon RG, McCurry SM, Teri L. Evidence-Based Interventions to Improve Quality of Life for Individuals with Dementia. Alzheimers care today. 2007;8(4):309–18.PubMedPubMedCentral

56.

Risco E, Cabrera E, Jolley D, Stephan A, Karlsson S, Verbeek H, Saks K, Hupli M, Sourdet S, Zabalegui A. The association between physical dependency and the presence of neuropsychiatric symptoms, with the admission of people with dementia to a long-term care institution: a prospective observational cohort study. Int J Nurs Stud. 2015;52(5):980–7. doi:10.1016/j.ijnurstu.2015.02.01.CrossRefPubMed

57.

Wergeland JN, Selbaek G, Hogset LD, Soderhamn U, Kirkevold O. Dementia, neuropsychiatric symptoms, and the use of psychotropic drugs among older people who receive domiciliary care: a cross-sectional study. Int Psychogeriatr. 2014;26(3):383–91. doi:10.1017/s1041610213002032.CrossRefPubMed

58.

Halvorsen KH, Granas AG, Engeland A, Ruths S. Prescribing quality for older people in Norwegian nursing homes and home nursing services using multidose dispensed drugs. Pharmacoepidemiol Drug Saf. 2012;21(9):929–36. doi:10.1002/pds.2232.CrossRefPubMed

59.

Heggestad AK, Nortvedt P. Slettebo A: ‘Like a prison without bars’: dementia and experiences of dignity. Nurs Ethics. 2013;20(8):881–892.10.1177/0969733013484484.CrossRefPubMed

60.

Smit D, de Lange J, Willemse B, Twisk J, Pot AM: Activity involvement and quality of life of people at different stages of dementia in long term care facilities. Aging & mental health 2015:1–10.10.1080/13607863.2015.1049116

61.

Hancock GA, Woods B, Challis D, Orrell M. The needs of older people with dementia in residential care. Int J Geriatr Psychiatry. 2006;21(1):43–9. doi:10.1002/gps.1421.CrossRefPubMed

62.

de Rooij AH, Luijkx KG, Schaafsma J, Declercq AG, Emmerink PM, Schols JM. Quality of life of residents with dementia in traditional versus small-scale long-term care settings: a quasi-experimental study. Int J Nurs Stud. 2012;49(8):931–40. doi:10.1016/j.ijnurstu.2012.02.007.CrossRefPubMed

63.

Verbeek H, Zwakhalen SMG, van Rossum E, Kempen GIJM, Hamers JPH. Small-scale, homelike facilities in dementia care: A process evaluation into the experiences of family caregivers and nursing staff. Int J Nurs Stud. 2012;49(1):21–9. doi:10.1016/j.ijnurstu.2011.07.008.CrossRefPubMed

64.

Aggarwal N, Vass AA, Minardi HA, Ward R, Garfield C, Cybyk B. People with dementia and their relatives: personal experiences of Alzheimer's and of the provision of care. J Psychiatr Ment Health Nurs. 2003;10(2):187–97.CrossRefPubMed

65.

Mjørud M, Kirkevold M, Røsvik J, Engedal K. Principal component analysis of the Norwegian version of the quality of life in late-stage dementia scale. Dement Geriatr Cogn Disord. 2014;37(5–6):265–275.10.1159/000356497.CrossRefPubMed

66.

Martin JL, Hakim AD. Wrist actigraphy. Chest. 2011;139(6):1514–27. doi:10.1378/chest.10-1872.CrossRefPubMedPubMedCentral

67.

Kuhlmei A, Walther B, Becker T, Muller U, Nikolaus T. Actigraphic daytime activity is reduced in patients with cognitive impairment and apathy. Eur Psychiatry. 2013;28(2):94–7. doi:10.1016/j.eurpsy.2011.04.006.CrossRefPubMed

68.

Valembois L, Oasi C, Pariel S, Jarzebowski W, Lafuente-Lafuente C, Belmin J. Wrist Actigraphy: A Simple Way to Record Motor Activity in Elderly Patients with Dementia and Apathy or Aberrant Motor Behavior. J Nutr Health Aging. 2015;19(7):759–64. doi:10.1007/s12603-015-0530-z.CrossRefPubMed

Title: Differences in quality of life in home-dwelling persons and nursing home residents with dementia – a cross-sectional study
Authors: Christine Olsen
Ingeborg Pedersen
Astrid Bergland
Marie-José Enders-Slegers
Nina Jøranson
Giovanna Calogiuri
Camilla Ihlebæk
Publication date: 01-12-2016
Publisher: BioMed Central
Published in: BMC Geriatrics / Issue 1/2016
Electronic ISSN: 1471-2318
DOI: https://doi.org/10.1186/s12877-016-0312-4

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