[Quality of life in dementia: state of the knowledge]. / Qualité de vie et démence : état des connaissances.

BACKGROUND: Dementia is a chronic and evolutive disease, for which no curative treatment exists. Evaluating the quality of life of patients suffering from dementia is therefore an important component of management. AIMS: To summarise existing literature regarding quality of life instruments specific to dementia, and to identify factors associated with quality of life. METHODS: We analysed studies published between November 1996 and December 2010 and referenced in PubMed, and focusing on the development and/or validation of quality of life instruments specific to dementia, or studies having used any such instrument to evaluate a therapeutic intervention. RESULTS: Nine quality of life instruments were identified. Place of residence and level of education do not appear to play any significant role. Results were conflicting for age and sex. There appears to be a relation, albeit a weak one, with cognitive function. The factors most frequently associated with lower quality of life were behavioural disorders, dependence, and caregiver burden. Quality of life of patients under pharmacological treatment is poorly documented, while occupational therapy and cognitive stimulation appear to have moderate positive effects.

Is health-related quality of life an independent prognostic factor for 12-month mortality and nursing home placement among elderly patients hospitalized via the emergency department?

OBJECTIVES: To assess whether health-related quality of life is an independent prognostic factor for mortality or nursing home placement in frail elderly patients. DESIGN: A prospective, multicenter study with a 12-month follow-up. SETTING: Nine French hospitals. PARTICIPANTS: A total of 1306 patients aged 75 and older hospitalized through an emergency department. MEASUREMENTS: Data obtained from sociodemographic characteristics, Comprehensive Geriatric Assessment and the Duke Health Profile (DHP) were used into a Cox model to identify prognostic variables for 12-month mortality and institutionalization. RESULTS: Crude mortality and nursing home placement rates were 34.1% (n = 445) and 16.1% (n = 210), respectively. Independent prognostic factors identified for mortality were: Comorbidity level (moderate: hazard ratio [HR] [95% confidence interval (CI)] = 1.40 [1.09-1.78]; severe: 2.70 [1.63-4.46]), dependence for activities of daily living (1.68 [1.06-2.67]), pressure sore risk (1.49 [1.16-1.90]), risk of malnutrition (2.09 [1.46-3.00]), delirium (2.25 [1.75-2.90]), and 10-point increase in the DHP perceived health score (0.96 [0.93-0.99]). Independent prognostic factors identified for nursing home placement were the following: living alone at home (1.82 [1.30-2.55]), having 2 children or more (0.71 [0.51-0.99]), dependence for activities of daily living (2.48 [1.39-4.44]), dementia (1.93 [1.39-2.69]), unplanned hospital readmission during follow-up (2.05 [1.45-2.91]), and 10-point increase in the DHP social health score (0.90 [0.83-0.99]). Balance troubles and risk of malnutrition were no more significant when adjusted for the DHP scores and other clinical variables. CONCLUSION: The perceived health and social health scores of the DHP were independent prognostic factors of survival and nursing home placement among hospitalized elderly patients, respectively. When associated with Comprehensive Geriatric Assessment, they could help screen frail patients to set up as early as possible targeted interventions to restore/maintain modifiable prognostic factors, such as nutritional status, functional ability, and social support.