Mood and behavioral problems are important predictors of quality of life of nursing home residents with moderate to severe dementia: A cross-sectional study.

OBJECTIVES: To examine the predictors associated with quality of life of nursing home residents with dementia, in order to identify which predictors are most important and hold most promise for future intervention studies. METHODS/DESIGN: This cross-sectional analysis of data collected in two intervention trials included 143 participants with moderate to severe dementia who resided in 40 psychogeriatric wards in 13 nursing homes. The outcome measure quality of life was assessed with the Qualidem. Predictors examined were demographic factors, cognition, mood, behavioral problems, and comorbid conditions. RESULTS: Linear mixed regression analyses showed that all nine domains of quality of life showed independent (negative) associations with either depression, agitation, apathy, or a combination of these predictors. Agitation, apathy, depression, and the presence of neurological disease explained 50% of the variance in total quality of life. Male gender, psychiatric/mood disorders, and having one or more comorbid conditions was associated with worse social relations, while the presence of comorbid neurological diseases was associated with more social isolation and a worse care relationship. The presence of endocrine/metabolic disorders and pulmonary disorders was associated with less restless tense behavior. CONCLUSIONS: Different domains of quality of life showed different associations, confirming the multidimensionality of quality of life in nursing home residents with dementia. Quality of life is independently associated with mood and behavioral problems, comorbid conditions, and gender. This knowledge may help to identify older persons at risk of a lower quality of life, and to offer targeted interventions to improve quality of life. TRIAL REGISTRATION: Dutch Trial registration NTR5641.

Predictors of care dependency in nursing home residents with moderate to severe dementia: A cross-sectional study.

BACKGROUND: Nursing home residents with dementia show a rapid decline in their ability to perform activities of daily living. This decline is linked to a greater care dependency, which is associated with a reduced quality of life. Care dependency is influenced by multiple predictors, yet current research often focuses on the contribution of a single or a small number of predictors of care dependency. OBJECTIVES: To examine the contribution of multiple predictors in predicting care dependency. DESIGN: The present study analyzed baseline data from a 6-month double-parallel randomized controlled trial which examined the effect of three physical activity interventions on multiple outcomes. SETTING: This study was conducted in eleven nursing homes in Bergen op Zoom, the Netherlands. PARTICIPANTS: In total, 85 nursing home residents with moderate to severe dementia were included in the study, of which 75 were included for analysis. METHODS: Predictors considered were cognitive, physical, neuropsychiatric, demographic, and disease related factors. The outcome measure care dependency was assessed with the Care Dependency Scale and the Erlangen Test of Activities of Daily Living. Linear multilevel regression analyses were used to identify the most important predictors of care dependency. RESULTS: Apathy, physical endurance, number of comorbidities, and global cognition were significant predictors of care dependency. The model explained 66% of the variance in care dependency. Global cognition was a significant predictor of ability to perform activities of daily living and explained 60% percent of its variance. CONCLUSION: The present study shows that multiple predictors (i.e., apathy, cognitive and physical abilities, and disease-related factors) contribute to predicting care dependency. Future research could focus on the effectiveness of multifactorial interventions to maintain the highest possible level of independence in nursing home residents with dementia.

The effects of movement stimulation on activities of daily living performance and quality of life in nursing home residents with dementia: a randomized controlled trial.

BACKGROUND: Nursing home (NH) residents with dementia experience a reduced quality of life (QoL), in part, due to a dependence in performing activities of daily living (ADL). Stimulating movement is associated with improvements in ADL performance. Therefore, movement stimulating interventions, such as ADL training and exercise, focus on optimizing ADL performance to improve QoL. This study aimed to evaluate the effect of three movement stimulating interventions on QoL and ADL performance in NH residents with dementia. METHODS: In this 6-month double parallel randomized controlled trial, the effects of ADL training, a multicomponent aerobic and strength exercise training, and a combined ADL and exercise training were analyzed in 87 NH residents with dementia. The Global Deterioration Scale was used to classify the severity of dementia. Participants were screened at baseline using the 6 minute walk test and Mini-Mental State Examination. The Qualidem, and the Care Dependency Scale and Erlangen ADL test were evaluated at baseline, and after 3 and 6 months to measure QoL and ADL, respectively. Multilevel analyses were adjusted for baseline performance, age, and gender. RESULTS: A 6-month ADL training positively affected overall QoL (p = 0.004) and multiple aspects of QoL, including care relationship (p = 0.004), positive self-image (p = 0.002), and feeling at home (p = 0.001), compared to care-as-usual. No benefits were observed of exercise on QoL. No benefits were observed of a combined ADL and exercise intervention on QoL. No effects were found of the three movement interventions on ADL performance. CONCLUSION: The results indicate that ADL training can improve QoL. The results contribute to the limited knowledge regarding the effect of movement stimulation on resident outcomes. Further large-scale studies are recommended.