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Nursing Home Residents’ Assessments of Their Quality of Life with Dementia Should Be Considered Along With Effectiveness of Care

If your loved one resides in a nursing home and has dementia, you should work with the medical staff to ensure that your loved one lives in conditions that facilitate a good quality of life.

According to the recent article titled Quality of Life of Nursing Home Residents With Dementia: A Comparison of Perspectives of Residents, Family, and Staff, published in The Gerontologist, since dementia currently has no cure, quality of life (QoL) is recognized as a meaningful indicator of the course of illness and the effectiveness of interventions. It is possible for a resident to receive good care at a long-term care facility, yet not experience good QoL.

Measuring QoL is inherently subjective–it is defined in terms of individuals’ perceptions on their well-being in the context of the culture and values in which they live compared to their goals, expectations, and standards. For residents with dementia, measuring QoL is more complex because the residents’ self-assessment may be affected by cognitive impairment, including issues involving memory and reasoning, and noncognitive ailments, such as depression and psychosis, which are not uncommon in individuals with dementia. Because of these cognitive and noncognitive concerns, measuring QoL for patients with dementia involves a consideration of the views of both the patients and proxies, including the family and nursing home staff.

The authors discuss a study conducted in Spain where the views of nursing home residents with dementia with regard to QoL were directly compared to the views of family and nursing home staff. To measure QoL, residents, family, and staff completed a questionnaire where the individual completing the questionnaire rated various factors comprising QoL in the nursing home environment, including physical health, energy, memory, family, and staff.

Nursing home residents with dementia view their QoL more favorably than their family members and nursing home staff. Residents view many aspects of QoL more favorably than family and staff: energy, mood, friends, ability to keep busy, ability to take care of oneself, ability to do things for fun, ability to make choices in one’s life, ability to live with others, and their life overall. Among all the participants in the study, the people working in the nursing home rated the highest, and memory was rated the worst. For family members and staff, the resident’s abilities for independence and making choices rated among the worst.

Family members and nursing home staff tended to rate the residents’ QoL similarly, but less favorably than the residents, including mood, memory, and physical health. Several reasons for this less favorable assessment include (1) the role that the subjective view of residents play in assessing QoL, (2) the lack of understanding of dementia in family members and staff, (3) the residents’ partial awareness of their declining capabilities, and (4) the external observers’ tendency to weigh negative information more heavily than positive information when forming opinions about other people.

In evaluating the outcome of care, it is challenging to determine whether the proxies’ viewpoint or the residents’ viewpoint into QoL is more valid. However, the study suggests that the residents’ assessment of their QoL should be considered because it provides a different perspective from that of the proxies. Thus, it is increasingly recognized that QoL should be a primary outcome of interest in the care given to residents with dementia.

If you have a loved one with dementia and are deciding which nursing home to place them in, you should look at what interventions, programs, and actions of care are used to increase the QoL of residents and make a difference in their lives. The residents that participated in this study were fortunate enough that the people working in the nursing home were not a primary detriment to QoL. Often, this is not the case.

If your loved one resides in a nursing home in Thousand Oaks, Camarillo, Newbury Park, Moorpark, or Simi Valley, and you suspect that the lack of proper care is causing your loved one injury, please contact us to see how your loved one can receive the care he or she needs.