Factors associated with quality of life in dementia patients in long-term care.

Background: The aim of this study is to describe and determine the factors associated with the quality of life (QoL) of patients with dementia living in nursing homes as perceived by themselves and by proxies (both family and staff).

Method: Data on residents with dementia were collected in 11 nursing homes. The Quality of Life-Alzheimer's Disease Scale (QoL-AD) residential version was directly applied to residents with dementia diagnosis and Mini-Mental State Examination score of less than 27, randomly selected in each center. Residents' QoL was further assessed from the perspective of some close relative and staff member. Altogether, 102 data sets from residents, 184 from relatives, and 197 from staff members were collected.

Results: Stepwise multiple linear regression analysis showed that depression and cognitive function were the best predictors of self-rated QoL. Predictors of family-rated QoL were resident's functional capacity to carry out activities of daily living (ADL), the family member paying for the nursing home fees, and use of feeding tubes as part of the resident's care. Predictors of staff-rated QoL were resident's functional capacity to carry out ADL, cognitive impairment and depression, staff-member's work pattern of shifts (rotating vs. permanent) and type of center administration (public vs. private). Explained variance for the three models was 42%, 25% and 41% respectively.

Conclusions: The QoL perception by persons with dementia living in a nursing home is mainly affected by their emotional state (depression level), while proxies' perceptions (both family and staff) are mainly associated with patients' functional autonomy in daily living. Therefore, perspectives of persons with dementia and their informants are not congruent. Moreover, facility features and family and staff members' personal features do not affect QoL ratings.