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Quality of life in dementia patients in Athens, Greece: predictive factors and the role of caregiver-related factors

Published online by Cambridge University Press:  12 August 2010

Antonis A. Mougias ,
Antonis Politis ,
Constantine G. Lyketsos  and
Venetsanos G. Mavreas
Antonis A. Mougias
Affiliation:
Alzheimer Center of the Greek Psychogeriatric Association “Nestor”, Athens, Greece
Antonis Politis
Affiliation:
Department of Psychiatry, Athens University Medical School, Eginition Hospital, Athens, Greece
Constantine G. Lyketsos
Affiliation:
Department of Psychiatry, Johns Hopkins Bayview, Baltimore, MD, U.S.A.
Venetsanos G. Mavreas*
Affiliation:
Department of Psychiatry, Medical School, University of Ioannina, Ioannina, Greece
*
Correspondence should be addressed to: Professor Venetsanos Mavreas, Department of Psychiatry, Medical School, University of Ioannina, 45110 Ioannina, Greece. Phone and Fax: +302651097322. Email: [email protected].
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Abstract

Background: Quality of life (QOL) is increasingly recognized as the main target of currently available dementia care. Its assessment has grown exponentially in the dementia field, but few studies have examined predictive factors for QOL taking caregiver variables into account. We examined patient and caregiver factors related to the QOL of dementia patients.

Methods: The study design was cross-sectional. 161 couples of community residing dementia patients and their primary caregivers were interviewed. QOL was measured by the ADRQL, a proxy-rated, dementia-specific QOL instrument. Demographic factors were collected and clinical characteristics assessed using validated scales.

Results: In univariate analyses several patient and caregiver characteristics appeared associated with patient QOL. In multivariate analyses, independent predictors of worse patient QOL were behavioral and depressive symptoms of dementia patients, dependency in basic activities of daily living, poorer cognitive function, use of antipsychotic medication, caregiver burden, and caregiver not being an adult child. The adjusted R2 of the final, seven-factor model was 0.598.

Conclusions: QOL for a person with dementia is a complex issue that is associated with several patient and caregiver factors. Efforts to improve patients’ QOL should be addressed for both patients and caregivers. The measurement of QOL should be included, when possible, as a standard measurement tool, in everyday dementia clinical practice.

Keywords

Alzheimer's diseaseADRQLburden
Type
Research Article
Information
International Psychogeriatrics , Volume 23 , Issue 3 , April 2011 , pp. 395 - 403
Copyright
Copyright © International Psychogeriatric Association 2010

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References

Albert, S. M. et al. (1996). Quality of life in patients with Alzheimer's disease as reported by patient proxies. Journal of the American Geriatrics Society, 44, 1342–1347.CrossRefGoogle ScholarPubMed
Albert, S. M. et al. (2001). Longitudinal study of quality of life in people with advanced Alzheimer disease. American Journal of Geriatric Psychiatry, 9, 160–168.CrossRefGoogle Scholar
Alexopoulos, G. S., Abrams, R. C., Young, R. C. and Shamoian, C. A. (1988). Cornell Scale for Depression in Dementia. Biological Psychiatry, 23, 271–284.CrossRefGoogle ScholarPubMed
Allan, L., McKeith, I., Ballard, C. and Kenny, R. A. (2006). The prevalence of autonomic symptoms in dementia and their association with physical activity, activities of daily living and quality of life. Dementia and Geriatric Cognitive Disorders, 22, 230–237.CrossRefGoogle ScholarPubMed
American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders (4th edn, text revision). Washington, DC: American Psychiatric Association.Google Scholar
Andersen, C. K., Wittrup-Jensen, K. U., Lolk, A., Andersen, K. and Kragh-Sørensen, P. (2004). Ability to perform activities of daily living is the main factor affecting quality of life in patients with dementia. Health Quality of Life Outcomes, 21, 52.CrossRefGoogle Scholar
Ballard, C. et al. (2001). Quality of life for people with dementia living in residential and nursing home care: the impact of performance on activities of daily living, behavioral and psychological symptoms, language skills, and psychotropic drugs. International Psychogeriatrics, 13, 93–106.CrossRefGoogle ScholarPubMed
Black, B. and Rabins, P. V. (2005). Quality of life in dementia: conceptual and practical issues. In Burns, A., O'Brien, J. and Ames, D. (eds.), Dementia. Hobber Arnold, 215–228.Google ScholarPubMed
Boström, F., Jönsson, L., Minthon, L. and Londos, E. (2007). Patients with dementia with Lewy bodies have more impaired quality of life than patients with Alzheimer disease. Alzheimer Disease and Associated Disorders, 21, 150–154.CrossRefGoogle ScholarPubMed
Brodaty, H., Green, A. and Koschera, A. (2003). Meta-analysis of psychosocial interventions for caregivers of people with dementia. Journal of the American Geriatrics Society, 51, 657–664.CrossRefGoogle ScholarPubMed
Cummings, J. L., Mega, M., Gray, K., Rosenberg-Thompson, S., Carusi, D. A. and Gornbein, J. (1994). The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia. Neurology, 44, 2308–2314.CrossRefGoogle ScholarPubMed
Donaldson, C. and Burns, A. (1999). Burden of Alzheimer's disease: helping the patient and caregiver. Journal of Geriatric Psychiatry and Neurology, 12, 21–28.CrossRefGoogle ScholarPubMed
Edelman, P., Fulton, B. R., Kuhn, D. and Chang, C. H. (2005). A comparison of three methods of measuring dementia-specific quality of life: perspectives of residents, staff, and observers. The Gerontologist, 45, 27–36.CrossRefGoogle ScholarPubMed
Folstein, M. F., Folstein, S. and McHugh, P. R. (1975). “Mini-mental state”: a practical method for grading the cognitive status of patients for the clinician. Journal of Psychiatric Research, 12, 189–98.CrossRefGoogle ScholarPubMed
Fountoulakis, C., Tsolaki, M., Chazi, H. and Kazis, A. (1994). Mini-mental State Examination (MMSE): a validation study in demented patients from the elderly Greek population. Encephalos, 31, 93–102.Google Scholar
Fountoulakis, K. et al. (2001). Reliability, validity and psychometric properties of the Greek translation of the Center for Epidemiological Studies-Depression (CES-D) scale. BioMed Central Psychiatry, 1, 3.CrossRefGoogle Scholar
Fredman, L., Daly, M. P. and Lazur, A. M. (1995). Burden among white and black caregivers to elderly adults. Journal of Gerontology: Social Sciences, 50, 110–118.CrossRefGoogle ScholarPubMed
Fuh, J. L. and Wang, S. J. (2006). Assessing quality of life in Taiwanese patients with Alzheimer's disease. International Journal of Geriatric Psychiatry, 21, 103–107.CrossRefGoogle ScholarPubMed
Gonzales-Salvador, T. et al. (2000). Quality of life in dementia patients in long-term care. International Journal of Geriatric Psychiatry, 15, 181–189.3.0.CO;2-I>CrossRefGoogle Scholar
Jönsson, L. et al. (2006). Patient- and proxy-reported utility in Alzheimer disease using the EuroQoL. Alzheimer Disease and Associated Disorders, 20, 49–55.CrossRefGoogle ScholarPubMed
Karlawish, J. H., Casarett, D., Klocinski, J. and Clark, C. M. (2001). The relationship between caregivers’ global ratings of Alzheimer's disease patients’ quality of life, disease severity, and the caregiving experience. Journal of the American Geriatrics Society, 49, 1066–1070.CrossRefGoogle ScholarPubMed
Katz, S., Down, T. D., Cash, H. R. and Grotz, R. C. (1970). Progress in the development of the index of ADL. The Gerontologist, 10, 20–30.CrossRefGoogle ScholarPubMed
Lawton, M. P. and Brody, E. M. (1969). Assessment of older people: self-maintaining and instrumental activities of daily living. The Gerontologist, 9, 179–186.CrossRefGoogle ScholarPubMed
Logsdon, R., Gibbons, L. E., McCurry, S. M. and Teri, L. (1999). Quality of life in Alzheimer's disease: patient and caregiver reports. Journal of Mental Health and Aging, 5, 21–32.Google Scholar
Logsdon, R., Gibbons, L. E., McCurry, S. M. and Teri, L. (2002). Assessing quality of life in older adults with cognitive impairment. Psychosomatic Medicine, 64, 510–519.CrossRefGoogle ScholarPubMed
Lyketsos, C. K. et al. (2003). Follow-up study of change in quality of life among persons with dementia residing in a long-term care facility. International Journal of Geriatric Psychiatry, 18, 275–281.CrossRefGoogle ScholarPubMed
Marriott, A. et al. (2000). Effectiveness of cognitive-behavioural family intervention in reducing the burden of care in carers of patients with Alzheimer's disease. British Journal of Psychiatry, 176, 557–562.CrossRefGoogle ScholarPubMed
Matsui, T. et al. (2006). Determinants of the quality of life in Alzheimer's disease patients as assessed by the Japanese version of the Quality of Life-Alzheimer's disease scale. Dementia Geriatrics and Cognitive Disorders, 21, 182–191.CrossRefGoogle ScholarPubMed
McKeith, I. G. et al. (1996). Consensus guidelines for the clinical and pathologic diagnosis of dementia with Lewy bodies (DLB): report of the consortium on DLB International Workshop. Neurology, 47, 1113–1124.CrossRefGoogle Scholar
Missotten, P. et al. (2008). Quality of life in older Belgian people: comparison between people with dementia, mild cognitive impairment, and controls. International Journal of Geriatric Psychiatry, 23, 1103–1109.CrossRefGoogle ScholarPubMed
Neary, D. et al. (1998). Frontotemporal lobar degeneration: a consensus on clinical diagnostic criteria. Neurology, 51, 1546–1554.CrossRefGoogle ScholarPubMed
Papastavrou, E., Kalokerinou, A., Papacostas, S. S., Tsangari, H. and Sourtzi, P. (2007). Caring for a relative with dementia: family caregiver burden. Journal of Advanced Nursing, 58, 446–457.CrossRefGoogle ScholarPubMed
Patrick, D. L. and Erickson, P. (1993). Health Status and Health Policy. New York: Oxford University Press.Google Scholar
Patrick, D. L., Starks, H. E., Cain, K. C., Uhlmann, R. F. and Pearlman, R. A. (1994). Preferences for health states worse than death. Medical Decision Making, 14, 9–18.CrossRefGoogle ScholarPubMed
Pinquart, M. and Sörensen, S. (2003). Associations of stressors and uplifts of caregiving with caregiver burden and depressive mood: a meta-analysis. Journals of Gerontology, Series B: Psychological Sciences and Social Sciences, 58, 112–128.CrossRefGoogle ScholarPubMed
Pinquart, M. and Sörensen, S. (2006). Gender differences in caregiver stressors, social resources, and health: an updated meta-analysis. Journals of Gerontology, Series B: Psychological Sciences and Social Sciences, 61, 33–45.CrossRefGoogle ScholarPubMed
Politis, A. M., Mayer, L. S., Passa, M., Maillis, A. and Lyketsos, C. G. (2004). Validity and reliability of the newly translated Hellenic Neuropsychiatric Inventory (H-NPI) applied to Greek outpatients with Alzheimer's disease: a study of disturbing behaviors among referrals to a memory clinic. International Journal of Geriatric Psychiatry, 19, 203–208.CrossRefGoogle ScholarPubMed
Politis, A. et al. (2006). Validity and reliability of the newly translated Cornell Scale for Depression in Dementia (CSDD) applied to Greek outpatients with depression and depression and Alzheimer's disease. Annals of General Psychiatry, 5, 245.CrossRefGoogle Scholar
Rabins, P. V., Kasper, J. D., Kleinman, L., Black, B. S. and Patrick, D. L. (1999). Concepts and methods in the development of the ADRQL: an instrument for assessing health-related quality of life in persons with Alzheimer's disease. Journal of Mental Health and Aging, 5, 33–48.Google Scholar
Rabins, P. V., Lyketsos, C. G. and Steele, C. D. (2006). Practical Dementia Care. New York: Oxford University Press.CrossRefGoogle Scholar
Radloff, L. S. (1977). The CES-D scale: a self report depression scale for research in the general population. Applied Psychological Measurement, 1, 385–401.CrossRefGoogle Scholar
Ready, R. E., Ott, B. R. and Grace, J. (2004). Patient versus informant perspectives of quality of life in mild cognitive impairment and Alzheimer's disease. International Journal of Geriatric Psychiatry, 19, 256–265.CrossRefGoogle ScholarPubMed
Reisberg, B., Ferris, S. H., De Leon, M. J. and Crook, T. (1982). The Global Deterioration Scale for assessment of primary degenerative dementia. American Journal of Psychiatry, 139, 9.Google ScholarPubMed
Saddichha, S. and Pandey, V. (2008). Alzheimer's and non-Alzheimer's dementia: a critical review of pharmacological and nonpharmacological strategies. American Journal of Alzheimer's Disease and Other Dementias, 23, 150–161.CrossRefGoogle ScholarPubMed
Sands, L., Ferreira, P., Stewart, A., Brod, M. and Yaffe, K. (2004). What explains differences between patients’ and their caregivers’ ratings of patients’ quality of life. American Journal of Geriatric Psychiatry, 12, 272–280.CrossRefGoogle ScholarPubMed
Sloane, P. D. et al. (2005). Evaluating the quality of life of long-term care residents with dementia. Gerontologist, 45, 37–49.CrossRefGoogle ScholarPubMed
Thomas, P. et al. (2006). Dementia patients caregivers’ quality of life: the PIXEL study. International Journal of Geriatric Psychiatry, 21, 50–56.CrossRefGoogle ScholarPubMed
Triantafillou, J. et al. (2006). Eurofamcare. Family Care of Dependent Older People in Europe. Luxembourg: Office for Official Publications of the EC.Google Scholar
Vogel, A., Mortensen, E. L., Hasselbalch, S. G., Andersen, B. B. and Waldemar, G. (2006). Patient versus informant reported quality of life in the earliest phases of Alzheimer's disease. International Journal of Geriatric Psychiatry, 21, 1132–1138.CrossRefGoogle ScholarPubMed
Wlodarczyk, J. H., Brodaty, H. and Hawthorne, G. (2004). The relationship between quality of life, Mini-mental State Examination, and the Instrumental Activities of Daily Living in patients with Alzheimer's disease. Archives of Gerontology and Geriatrics, 39, 25–33.CrossRefGoogle ScholarPubMed
Zarit, S. H., Reever, K. E. and Bach-Peterson, J. (1980). Relatives of the impaired elderly: correlates of feelings of burden. Gerontologist, 20, 649–655.CrossRefGoogle ScholarPubMed