The Impact of COVID-19 on Nursing Homes: Study Design and Population Description.

Nursing homes for the elderly in Spain have experienced high rates of infection and mortality from COVID-19, although rates have varied from one region to another. Madrid is the region where most institutionalized older adults have died from the coronavirus. However, there is little known about the psychosocial and environmental factors involved in the high incidence of COVID-19 among the institutionalised population in this region. This article describes the protocol of a study on nursing homes during the SARS-CoV-2 pandemic in the Autonomous Community of Madrid (hereafter: Region of Madrid or Madrid Region) and provides information on the study design, measures used, and characteristics of the population studied. A questionnaire about life in nursing homes during the COVID-19 pandemic was designed and a total of 447 persons over 60 years of age without cognitive impairment-220 in private nursing homes and 227 in public nursing homes-participated by answering questions about different topics: personal situations during the pandemic, feelings and methods of coping, residential environment, health, quality of life, ageism, and self-perception of ageing. The institutionalised person profile discussed in this study was an old woman, widowed, without children, with a low level of education, with multimorbidity, and who perceived her health and quality of life positively. Most of the participants were very concerned about COVID-19 and its effects. In fact, 38% had been diagnosed with COVID-19, of whom 20% were admitted to hospital and 20% had suffered negative impacts, such as pain and neurological problems. In addition, 70% of the residents remained confined to their rooms, which increased their perceptions of loneliness and social isolation. The worst-rated aspects of the nursing home resulted from the restrictive measures imposed on nursing homes during the pandemic. This research offers useful material for understanding the pandemic and its consequences from the perspective of the older institutionalised population, which could provide insights for designing public policies.

[Quality of life and health status in institutionalized elderly with dementian]. / Calidad de vida y estado de salud en personas mayores de 60 años con demencia institucionalizadas.

BACKGROUND: Studies that deepen in the aspects related to quality of life (QoL) of elderly with dementia living in nursing homes in Spain are needed. The aim of this study is to describe the QoL and related aspects in this population. METHODS: Sample of 525 people with dementia older than 60 years in 14 nursing homes. QoL was assessed with EQ-5D (both index and visual analogue Scale, EQ-VAS) and Quality of Life in Alzheimer's Disease(QoL-AD, resident and caregiver versions). Other scales were also applied: Clinical Dementia Rating Scale (CDR), Barthel Index, Cornell Scale for Depression in Dementia (CSDD), modified version of the Cumulative Illness Rating Scale for Geriatrics (CIRS-G), Short Portable Mental Status Questionnaire (SPMSQ) and Cognitive Mini-exam (MEC). To determine the relationship between the variables of interest, Pearson's correlation coefficient and the analysis of variance (Student's t test) were used. RESULTS: QoL scales displayed correlations from 0.17 to 0.50 between them. Qol-AD-caregiver scored higher in men with lower disability and depression 28.94 ± 4.91, 29.91 ± 4.74 and 28.44 ± 4.94, respectively;(p < 0.01), and correlated 0.45 with Barthel Index and -0.36 with CSDD. Qol-AD-resident scored higher in absence of depression (29.29 ± 6.03). EQ-5D Index scored higher in men (0.19 ± 0.33) with less disability (0.42 ± 0.32) and its coefficient of correlation with Barthel Index was 0.79. CONCLUSIONS: Functional state and depression are associated with quality of life in older people with dementia living in nursing homes.

Calidad de vida y estado de salud en personas mayores de 60 años con demencia institucionalizadas / Quality of Life and Health Status in Institutionalized Elderly with Dementian

Fundamentos: Es necesario profundizar en los distintos aspectos que componen la calidad de vida (CdV) en las personas con demencia que viven en residencias. El objetivo de este estudio fue describir la CdV e identificar los factores relacionados con ella. Métodos: Muestra compuesta por 525 personas con demencia mayores de 60 años en 14 residencias de España. La CdV se evaluó mediante el EQ-5D (índice y escala visual analógica, EQ-EVA) y Quality of Life in Alzheimer’s Disease (QoL-AD versiones residente y cuidador). También se utilizaron Clinical Dementia Rating Scale (CDR), el índice de Barthel, la escala Cornell de depresión en demencia (CSDD), una versión adaptada de la Cumulative Illness Rating Scale for Geriatrics (CIRS-G), Short Portable Mental Status Questionnaire (SPMSQ) y el Mini Examen Cognoscitivo (MEC). Para determinar la asociación entre variables se utilizó el coeficiente de correlación de Pearson y la prueba t de Student. Resultados: Las escalas presentaron entre ellas correlaciones de 0,17 a 0,50. La puntuación QoL-AD cuidador fue mejor en varones con menos discapacidad y depresión (28,94±4,91, 29,91±4,74 y 28,44±4,94, respectivamente; (p<0,01) y correlacionó con el índice de Barthel 0,45 y con la CSDD -0,36. El QoL-AD residente fue mejor en ausencia de depresión (29,29±6,03). El índice EQ-5D fue mayor en varones (0,19±0,33) con menos discapacidad (0,42±0,32) y su coeficiente de correlación con el índice de Barthel fue de 0,79. Conclusiones: En personas mayores con demencia institucionalizadas en residencias la calidad de vida se relaciona con el estado funcional y la depresión (AU)

Background: Studies that deepen in the aspects related to quality of life (QoL) of elderly with dementia living in nursing homes in Spain are needed. The aim of this study is to describe the QoL and related aspects in this population. Methods: Sample of 525 people with dementia older than 60 years in 14 nursing homes. QoL was assessed with EQ-5D (both index and visual analogue Scale, EQ-VAS) and Quality of Life in Alzheimer’s Disease (QoL-AD, resident and caregiver versions). Other scales were also applied: Clinical Dementia Rating Scale (CDR), Barthel Index, Cornell Scale for Depression in Dementia (CSDD), modified version of the Cumulative Illness Rating Scale for Geriatrics (CIRS-G), Short Portable Mental Status Questionnaire (SPMSQ) and Cognitive Mini-exam (MEC). To determine the relationship between the variables of interest, Pearson’s correlation coefficient and the analysis of variance (Student’s t test) were used. Results: QoL scales displayed correlations from 0.17 to 0.50 between them. Qol-AD-caregiver scored higher in men with lower disability and depression 28.94±4.91, 29.91±4.74 and 28.44±4.94, respectively; (p<0.01), and correlated 0.45 with Barthel Index and -0.36 with CSDD. Qol-AD-resident scored higher in absence of depression (29.29±6.03). EQ-5D Index scored higher in men (0.19±0.33) with less disability (0.42±0.32) and its coefficient of correlation with Barthel Index was 0.79. Conclusions: Functional state and depression are associated with quality of life in older people with dementia living in nursing homes (AU)

Active ageing and quality of life: factors associated with participation in leisure activities among institutionalized older adults, with and without dementia.

OBJECTIVES: Active ageing, considered from the perspective of participation in leisure activities, promotes life satisfaction and personal well-being. The aims of this work are to define and explain leisure activity profiles among institutionalized older adults, considering their sociodemographic characteristics and objective and subjective conditions in relation to their quality of life. METHODS: Two samples of institutionalized people aged 60 and over were analysed together: 234 older adults without dementia and 525 with dementia. Sociodemographic, economic, family and social network, and health and functioning variables were selected. Cluster analysis was applied to obtain activity profiles according to the leisure activities, and ordinal regression models were performed to analyse factors associated to activity level. RESULTS: The sample was clustered into three groups of people: active (27%), moderately active (35%) and inactive people (38%). In the final regression model (Nagelkerke pseudo R(2) = 0.500), a higher level of activity was associated with better cognitive function (Pfeiffer scale), self-perceived health status and functional ability, as well as with a higher frequency of gathering with family and friends, and higher educational level. CONCLUSION: The decline in physical and mental health, the loss of functional capabilities and the weakening of family and social ties represent a significant barrier to active ageing in a context of institutionalization.

Quality of life by proxy and mortality in institutionalized older adults with dementia.

AIM: This study aimed at analyzing the effect of quality of life (QoL) on mortality in older adults with dementia living in long-term care facilities. METHODS: A prospective observational cohort study was carried out on 412 residents aged older than 60 years, diagnosed with dementia according to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition. Besides assessment of QoL (EQ-5D index by proxy) and perceived health status (EQ-VAS), baseline measurements included severity of dementia (Clinical Dementia Rating Scale [CDR]), comorbidity (number of self-reported chronic conditions), disability evaluation (Barthel Index), cognitive state (Mini Examen Cognoscitivo, a validated and modified Spanish version of the Mini-Mental State Examination) and depression (Cornell Depression Scale for Dementia). Sociodemographic and clinical variables were analyzed as potential effect modifiers and confounders in the relationship between QoL and mortality using a multivariate logistic regression analysis. RESULTS: After an 18-month follow up, 138 residents had died. Adjusting for CDR and Barthel Index, the odds of mortality were multiplied by 0.25 (95% CI 0.09-0.70) and 0.79 (95% CI 0.26-2.42) for every unit of change in the EQ-5D index in the residents with Cornell score <6 and ≥ 6, respectively. CONCLUSION: The present study suggests that the effect of QoL on mortality in institutionalized adults with dementia should take into account the presence or absence of depression. In addition, residents with a greater disability and more advanced dementia should be a target for interventions in rehabilitation care.

Quality of life in older people with dementia: a multilevel study of individual attributes and residential care center characteristics.

AIM: To analyze how the characteristics of institutionalized older people with dementia and residential care centers are associated with the individual's quality of life (QoL). METHODS: Data were collected from a survey carried out on 525 elderly people aged 60 years or older in 14 nursing care homes across Spain. Multilevel linear analysis to assess the differences in QoL level between centers and individuals was carried out. RESULTS: The characteristics of the individuals that were associated with a higher QoL were functional independence, health status and gathering with family, friends or neighbors. In contrast, higher levels of dementia, depression and the length of institutionalization had a negative effect on QoL. In relation to the residential care center characteristics, the availability of geriatricians was associated with higher QoL, compared with those centers with no geriatricians on staff. In addition, public centers (public ownership and publicly-funded residents) were also associated with higher QoL than private/mixed centers. The multilevel analysis showed that the 16.4% of the differences in QoL was related to residence factors. CONCLUSION: These results reflect the importance of the functional, social, mental and residential dimensions in the QoL of older adults with dementia. Actions devoted to improving these key dimensions would contribute to promote the well-being of this vulnerable population.

Which factors are associated with mortality in institutionalized older adults with dementia?

Residential facilities are increasingly used as a resource for dependent older adults and a high percentage of patients with dementia die there. Information about the leading medical causes and exposures to risk factors of mortality in institutionalized older patients with dementia could guide the development of clinical management interventions. The data of 387 institutionalized adults aged over 60, diagnosed with dementia, was analyzed retrospectively. Information about sociodemographic, comorbidities, quality of life and leisure and free time variables was collected in a survey answered by caregivers; after 19 months, information was collected on the result variable (living vs. deceased). A multivariate logistic regression model was created to determine the factors associated with mortality, which were: age (odds ratio (OR)=1.986; 95% confidence interval (CI): 1.229-3.209); diabetes (OR=2.322; 1.350-3.996); hypertension (OR=1.695; 1.044-2.752); diseases of the genitourinary system (OR=2.455;1.419-4.248), worsening of health over last twelve months (OR=1.653; 1.018-2.685) and not performing passive (OR=1.616; 0.968-2.700) or social (OR=2.242; 1.170-4.299) leisure activities. Besides age, the number of comorbid illnesses and the inability to perform leisure activities predicted mortality in institutionalized adults with dementia. These predictors might be useful clinical markers for identifying patients at increased risk for mortality.

Comorbidity, health status, and quality of life in institutionalized older people with and without dementia.

BACKGROUND: Comorbidity in older adults may lead to lower perceived health status and a decrease in quality of life (QoL). The objective of this study is to analyze the relationship between comorbidity, health status, QoL, and dementia in institutionalized older adults. METHODS: Cross-sectional, multicenter study in residential care settings in Spain. Two groups of institutionalized older adults of 60 years of age and older were compared: 234 persons with normal cognitive function and 525 with dementia according to DSM-IV-TR criteria. Assessments included: sociodemographic questionnaire, EQ-5D index for health-related QoL, Visual Analogue Scale (EQ-VAS) for health status, number of chronic medical conditions (comorbidity), Barthel Index for functional independence, and Short Portable Mental Status Questionnaire. RESULTS: The group with dementia presented significantly worse QoL, health, and functional status than people without dementia. The most prevalent chronic medical conditions were musculoskeletal (72.3%), followed by genito-urinary disorders (60.2%). Controlling for age and sex, people with dementia and higher comorbidity exhibited lower EQ-VAS scores; however, no significant difference was found for the EQ-5D index. The health conditions that contributed the most to the EQ-VAS differences between the dementia and non-dementia groups were sight, oral, and genito-urinary problems. CONCLUSIONS: When compared to older adults with no dementia, people with dementia and high comorbidity reported the most compromised health status, especially in those with sight, oral, and genito-urinary problems. These differences should be taken into consideration when selecting strategies to maintain and improve the health status of older adults in residential care settings.