Factors Associated with the Quality of Life of People with Dementia and with Quality of Life-Improving Interventions: Scoping Review.

OBJECTIVES: To synthesise current research exploring the factors and interventions associated with the quality of life of people with dementia. BACKGROUND: Dementia is a progressive condition affecting an estimated 40 million people worldwide. The illness has a significant impact on the lives of the persons affected and their loved ones, and may thus impair the quality of life of both. As it progresses, dementia weakens the patients' ability to express their own views about their quality of life and the factors associated with it. DESIGN: Scoping review. DATA SOURCES: Electronic database search of MEDLINE, CINAHL, PsycINFO, Joanna Briggs Institute Library, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects (DARE), EMBASE, Medic published up to March 2016; and incremental hand search. Review method: Systematic or other kinds of reviews and single studies were included for the review if they met the inclusion criteria. Results: A total of 20 reviews and 7 primary studies were retained for synthesis. Key findings were abstracted and a themes matrix was generated to identify patterns of meaning. The factors associated with the quality of life of people with dementia were sociodemographic factors, factors related to dementia and social and caring environment. Interventions supporting quality of life focused on the activation of people with dementia. Conclusions: This scoping review identified a large body of knowledge exploring the factors and interventions associated with the quality of life of people with dementia. The interventions were heterogeneous and the sample sizes small, which is why more research is needed.

Timely diagnosis of dementia? Family carers' experiences in 5 European countries.

OBJECTIVES: Timely diagnosis of dementia is recommended in national strategies. To what extent is it occurring across Europe, what factors are associated with it, and what is the impact on carers emotions of quality of diagnostic disclosure? METHODS/DESIGN: Survey of family carers recruited through 5 Alzheimer's associations (Czech Republic, Finland, Italy, the Netherlands, and Scotland). One thousand four hundred and nine carers participated, 84% completing online. Fifty-two percent were adult children, and 37% were spouses, with median age 57. Most (83%) were female. RESULTS: Nearly half (47%) of carers reported that an earlier diagnosis would have been preferable. Delaying factors included reluctance of the person with dementia, lack of awareness of dementia, the response of professionals, and delays within health systems. Recent diagnoses were no more likely to be considered timely, although professional responses appeared to be improving. Delayed diagnoses were more often reported by adult child carers and where the diagnosis was made in the later stages of dementia, or another condition had been previously diagnosed. In all countries except Italy, the diagnosis was shared with the person with dementia in the majority of cases. Timely diagnoses and higher quality diagnostic disclosure are associated with better adjustment and less negative emotional impact on carers in the short and medium term. CONCLUSIONS: Although the study sample were well educated and likely to be in touch with an Alzheimer organisation, many continued to experience the diagnosis of dementia as coming too late, and further work on public awareness, as well as on professional responses, is needed.

Family support, living alone, and subjective health of a patient in connection with a coronary artery bypass surgery.

OBJECTIVE: The study's objective was to evaluate the connections among family support, living alone, and subjective health after coronary artery bypass surgery (CABS). DESIGN: This was a prospective and comparative follow-up study. SETTING: The study took place in surgical clinics in two university hospitals in Finland. PATIENTS: A total of 279 patients underwent CABS. The sample comprised consecutive patients who were willing to participate. INTERVENTION: The patients were asked to evaluate their subjective health before surgery (initial phase) and 6 months after surgery (follow-up phase). OUTCOME MEASURES: Outcome was measured by the Chest Pain and Dyspnea Scale, Modified Beck Depression Inventory, Endler Anxiety Scale, Family Support Scale, and Hopelessness items. RESULTS: Subjective health improved significantly after CABS. Those who had lower family support before surgery had more depressive symptoms, anxiety, and hopelessness than those who had more support. In the group with low family support, the subjective health of women was poorer than that of men, and those who had no vocational education described poorer health than others. In the group with high family support, those who had no vocational education had more chest pain and dyspnea than others. Patients who were living alone had initially more depressive symptoms and hopelessness compared with patients living with someone. At follow-up, those living alone reported more chest pain and depressive symptoms than those living with someone. Patients aged less than 65 years and living alone reported more depressive symptoms, anxiety, and hopelessness than the oldest age group during the follow-up. In those patients living with someone, the subjective health of female patients, patients aged less than 65 years, and patients who had no vocational education was poorer than others. CONCLUSIONS: High family support seemed to protect health and promote recovery. In nursing it is important to take care of those who receive only limited amount of family support or who live alone. These results suggest that women, patients aged less than 65 years, and patients with no vocational education may need additional support and care.