Factors associated with self and informant ratings of the quality of life of people with dementia living in care facilities: a cross sectional study.
Factors associated with self and informant ratings of the quality of life of people with dementia living in care facilities: a cross sectional study.
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DOI：
10.1371/journal.pone.0015621
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发表时间：
2010-12-13
期刊：
影响因子：
3.7
通讯作者：
Almeida OP
中科院分区：
文献类型：
--
作者：
Beer C;Flicker L;Horner B;Bretland N;Scherer S;Lautenschlager NT;Schaper F;Almeida OP
对于评估痴呆症患者生活质量的最佳方法，目前还没有达成共识。我们开展了这项研究，以描述和确定与居住在家庭护理机构的痴呆症患者队列的生活质量评级相关的因素。居住在养老院的351名痴呆症患者及其工作人员和家庭告密者参加了这项横断面观察性研究。生活质量的测量使用SELF(阿尔茨海默病生活质量量表)和告密者(QOL-AD和阿尔茨海默病相关的QOL量表)报告。226名(%)痴呆症患者(MMSE中位数为17；12-21)能够自评QOL-AD量表，并将这些受试者的评分与工作人员和家人的评分进行比较。QOL-AD的工作人员和家庭告密者评分都低估了自我评价(QOL-AD工作人员的平均差值−7.8，95%CI−8.8，−6.7；家庭QOL-AD的平均差值−7.2，95%CI−8.5，−6.0)。在内向、跌倒或有疼痛的人中，QOL的自我评级较低。对于患有严重认知障碍、已经跌倒、存在神经精神症状或存在照顾者痛苦的人，痴呆症参与者的告密者的生活质量评分一直明显较低。在多变量模型中，记录的约束、报告的疼痛和神经精神症状与较低的QOL-AD自我评级独立相关。认知障碍、病例讨论、住院和神经精神症状被发现与ADRQL评级的工作人员独立相关。居住在养老院的大多数痴呆症患者可以对自己的生活质量进行评估。告密者的评分低估了痴呆症患者的自我生活质量评分，而且似乎与与自我评分无关的因素有关。
There is no consensus regarding the optimal approach to assessment of the quality of life of people with dementia. We undertook the present study to describe and determine the factors associated with ratings of the quality of life of a cohort of people with dementia living in a residential care facility. 351 people with dementia living in residential care facilities, and their staff and family informants participated in this cross sectional observational study. Quality of life was measured using self (Quality of Life in Alzheimer's Disease [QoL-AD] scale), and informant (QoL-AD and Alzheimer's Disease Related QoL Scale) reports. 226 people (64%) with dementia (median MMSE 17; 12–21) were able to self rate the QoL-AD scale and these subjects' ratings were compared to ratings by staff and family. Both staff and family informant ratings of the QoL-AD underestimated self ratings (mean difference −7.8, 95% CI −8.8, −6.7 for staff rated QoL-AD; and mean difference −7.2, 95% CI −8.5, −6.0 for family rated QoL-AD). Self ratings of QoL were lower among people who were restrained, had fallen or had pain. Informant ratings of the QoL of the participants with dementia were consistently and significantly lower for people with severe cognitive impairment, who had fallen, had presence of neuropsychiatric symptoms, or where care giver distress was present. Documented restraint, reported pain and neuropsychiatric symptoms were independently associated with lower self rating of the QoL-AD in multivariate models. Cognitive impairment, case conferencing, hospitalizations and neuropsychiatric symptoms were found to be independently associated with staff rated ADRQL. The majority of people with dementia living in residential care facilities can rate their own QoL. Informant ratings underestimate self ratings of QoL of people with dementia, and appear to be associated with factors which are not associated with self ratings.
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