Self-reported quality of life ratings of people with dementia: the role of attitudes to aging.

BACKGROUND: Attitudes to aging have not previously been assessed in people with dementia. The possession of positive life attitudes into older age has the potential to induce resilience to health changes and may explain the discrepancy between self-reported and proxy ratings of quality of life (QoL). The aim of this study was to explore the attitudes of people with dementia to determine the main factors that predict these attitudes and any relationship that exists with self-reported QoL. METHODS: Fifty-six participants with dementia were recruited from a memory clinic setting. The Bath Assessment of Subjective Quality of Life in Dementia, Attitudes to Aging Questionnaire (AAQ), Memory Functioning Scale, Alzheimer's Disease Cooperative Study Activities of Daily Living Inventory, and Mini-Mental State Examination were administered. The AAQ was also completed by 86 community-dwelling older adults without dementia. RESULTS: Participants with dementia displayed a significantly stronger endorsement of the negative attitude that aging is a time of psychosocial loss than those without dementia. Regression analyses suggest this negative attitude acts as a partial mediator in the relationship between the person's level of insight and self-reported QoL. CONCLUSIONS: Negative attitudes to aging had a direct impact on the self-reported QoL ratings of people with dementia. The view of aging as a time of psychosocial loss was most significant for people with dementia and suggests that negative stereotypes of dementia need to be challenged. In order to promote QoL, care should focus on abilities that the person retains rather than what has been lost.

Predictors of quality of life ratings from persons with dementia: the role of insight.

OBJECTIVE: Evidence suggests that people with dementia are able to respond accurately and consistently to questions about quality of life (QoL), although large discrepancies exist between patient and proxy ratings. This may be due, in part, to the reduced insight of the person with dementia. The aim of this study was to explore the predictors of QoL ratings in a sample of people with mild dementia, with a particular focus on the role of insight. METHODS: Sixty-nine participants and their caregivers were recruited from a memory clinic setting. The Bath Assessment of Subjective Quality of Life in Dementia (BASQID), Alzheimer's Disease-Related Quality of Life Scale, Memory Functioning Scale, Alzheimer's Disease Cooperative Study Activities of Daily Living (ADL) Inventory and Mini Mental State Examination were administered. RESULTS: Regression analyses indicated that the strongest predictor of QoL ratings from persons with dementia was their awareness of memory function, such that lower awareness was associated with higher QoL ratings. Proxy ratings of activity performance and enjoyment of activity were also significant predictors of BASQID scores. CONCLUSIONS: Awareness of memory function impacts directly on patient QoL ratings and can also mask the effects of changes in other outcomes such as ADL function. Measures of awareness should therefore be employed alongside patient QoL ratings in order to ensure they are interpreted accurately. Discrepancies between patient and proxy QoL ratings do not necessarily occur because of patient unreliability, but may instead reflect the application of distinct modes of QoL assessment that emphasise very different outcomes.