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Differential perceptions of quality of life (QoL) in community-dwelling persons with mild-to-moderate dementia

Published online by Cambridge University Press:  23 April 2014

Laura Tay ,
Kia Chong Chua ,
Mark Chan ,
Wee Shiong Lim ,
Yue Ying Ang ,
Evonne Koh  and
Mei Sian Chong
Laura Tay*
Affiliation:
Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore
Kia Chong Chua
Affiliation:
Institute of Psychiatry, King's College London, London, UK
Mark Chan
Affiliation:
Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore
Wee Shiong Lim
Affiliation:
Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore
Yue Ying Ang
Affiliation:
Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore
Evonne Koh
Affiliation:
Yong Loo Lin School of Medicine, National University of Singapore, Singapore
Mei Sian Chong
Affiliation:
Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore
*
Correspondence should be addressed to: Dr Laura Tay, Department of Geriatric Medicine, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore. Phone: +65-6357-7859; Fax: +65-6357-7837. Email: laura_tay@ttsh.com.sg.
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Abstract

Background:

Discordance between patient- and caregiver-reported quality of life (QoL) is well recognized. This study sought to (i) identify predictors of discrepancy between patient- and caregiver-rated QoL amongst community-dwelling persons with mild-to-moderate dementia, and (ii) differentiate between patients who systematically rate their QoL lower versus those who rate their QoL higher relative to their caregiver ratings.

Methods:

We recruited 165 patient–caregiver dyads with mild-to-moderate dementia. Quality of life in Alzheimer's disease (QoL-AD) scale was administered separately to patients and caregivers. Data on socio-demographics, interpersonal relationship, and disease-related characteristics (cognitive performance, mood, neuropsychiatric symptoms, functional ability, and caregiver burden) were collected. Patient–caregiver dyads were categorized based on whether patient-rated QoL was lower or higher than their respective caregiver ratings. Univariate analyses and multiple regression models were performed to identify predictors of dyadic rating discrepancy.

Results:

Mean patient-rated QoL was significantly higher than caregiver rating (mean difference: 3.8 ± 7.1, p < 0.001). Majority (111 (67.2%)) of patients had more positive self-perceived QoL (QoL-ADp (QoL-AD self rated by the patient) > QoL-ADc (QoL-AD proxy-rated by a caregiver)), compared with those (44 (26.7%)) with poorer self-perceived QoL (QoL-ADp < QoL-ADc). Patient's education level, depressive symptoms, and severity of neuropsychiatric symptoms predicted magnitude of discrepancy. Depression (OR = 1.17, 95% CI = 1.02–1.35) and being cared for by other relative (non-spouse/adult child; OR = 7.54, 95% CI = 1.07–53.03) predicted poorer self-perceived QoL.

Conclusions:

Dyadic rating discrepancy in QoL should draw the clinician's attention to patient depression and neuropsychiatric symptoms. Consideration should also be given to nature of patient–caregiver relationship when discordance between patient and caregiver assessments of QoL is observed.

Keywords

quality of lifedementiacaregiversagreement
Type
Research Article
Information
International Psychogeriatrics , Volume 26 , Issue 8 , August 2014 , pp. 1273 - 1282
Copyright
Copyright © International Psychogeriatric Association 2014 

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References

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.Google Scholar
Banerjee, S. et al. (2009). What do we know about quality of life in dementia? A review of the emerging evidence on the predictive and explanatory value of disease specific measures of health related quality of life in people with dementia. International Journal of Geriatric Psychiatry, 24, 15–24.Google Scholar
Brod, M., Stewart, A. L., Sands, L. and Walton, P. (1999). Conceptualization and measurement of quality of life in dementia: the dementia quality of life instrument (DQoL). The Gerontologist, 39, 25–35.CrossRefGoogle ScholarPubMed
Buckley, T. et al. (2012). Predictors of quality of life ratings for persons with demenita simultaneously reorted by patients and their caregivers: the Cache County (Utah) study. International Psychogeriatrics, 24, 1094–1102.Google Scholar
Bucks, R. S., Ashworth, D. L., Wilcock, G. K. and Siegfried, K. (1996). Assessment of activities of daily living in dementia: development of the Bristol Activities of Daily Living Scale. Age and ageing, 25, 113–120.Google Scholar
Carr, A. J., Gibson, B. and Robinson, P. G. (2001). Measuring quality of life: is quality of life determined by expectations or experience? British Medical Journal, 322, 1240–1243.Google Scholar
Cheah, W. K., Han, H. C., Chong, M. S., Anthony, P. V. and Lim, W. S. (2012). Multidimensionality of the Zarit Burden Interview across the severity spectrum of cognitive impairment: an Asian perspective. International Psychogeriatrics, 24, 1846–1854.CrossRefGoogle ScholarPubMed
Conde-Sala, J. L., Garre-Olmo, J., Turro-Garriga, O., Lopez-Pousa, S. and Vilalta-Franch, J. (2009). Factors related to perceived quality of life in patients with Alzheimer's disease: the patient's perception compared with that of caregivers. International Journal of Geriatric Psychiatry, 24, 585–594.Google Scholar
Conde-Sala, J. L. et al. (2014). Severity of dementia, anosognosia, and depression in relation to the quality of life of patients with Alzheimer disease: discrepancies between patients and caregivers. The American Journal of Geriatric Psychiatry 22, 138–147.Google Scholar
Feldman, H. H., Van Baelen, B., Kavanagh, S. M. and Torfs, K. E. (2005). Cognition, function and caregiving time patterns in patients with mild to moderate Alzheimer's disease: a 12 month analysis. Alzheimer Disease & Associated Disorders, 19, 29–36.Google Scholar
Huang, H. L., Chang, M. Y., Tang, J. S. H., Chiu, Y. C. and Weng, L. C. (2009). Determinants of the discrepancy in patient- and caregiver-rated quality of life for persons with dementia. Journal of Clinical Nursing, 18, 3107–3118.Google Scholar
Hurt, C. S. et al. (2010). Insight, cognition and quality of life in Alzheimer's disease. Journal of Neurology, Neurosurgery & Psychiatry, 81, 331–336.CrossRefGoogle ScholarPubMed
Karttunen, K. et al. (2011). Neuropsychiatric symptoms and quality of life in patients with very mild and mild Alzheimer's disease. International Journal of Geriatric Psychiatry, 26, 473–482.Google Scholar
Kashiwa, Y., Kitabayashi, Y., Narumoto, J., Nakamura, K., Ueda, H. and Fukui, K. (2005). Anosognosia in Alzheimer's disease: association with patient characteristics, psychiatric symptoms and cognitive deficits. Psychiatry and clinical neurosciences, 59, 697–704.CrossRefGoogle ScholarPubMed
Kaufer, D. I. et al. (2000). Validation of the NPI-Q, a brief clinical form of the neuropsychiatric inventory. The Journal of Neuropsychiatry and Clinical Neurosciences, 12, 233–239.Google Scholar
Lawton, M. P. (1994). Quality of life in Alzheimer disease. Alzheimer Disease & Associated Disorders, 8, 138–150.Google Scholar
Li, X. J. et al. (2012). The comparison of dementia patient's quality of life and influencing factors in two cities. Journal of Clinical Nursing, 22, 2132–2140.Google Scholar
Lim, W. S., Chin, J. J., Lam, C. K., Lim, P. P. J. and Sahadevan, S. (2005). Clinical dementia rating experience of a multi-racial Asian population. Alzheimer Disease & Associated Disorders, 19, 135–142.Google Scholar
Logsdon, R. G., 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.Google Scholar
Mack, J. L. and Whitehouse, P. J. (2001). Quality of life in dementia: state of the art – report of the International Working Group for Harmonization of Dementia Drug Guidelines and the Alzheimer's Society satellite meeting. Alzheimer Disease & Associated Disorders, 15, 69–71.CrossRefGoogle Scholar
Matsui, T. et al. (2006). Determinants of the quality of life in Alzheimer's disease as assessed by the Japanese version of the Quality of Life-Alzheimer's disease scale. Dementia and Geriatric Cognitive Disorders, 21, 182–191.Google Scholar
Morris, J. C. (1993). The Clinical Dementia Rating (CDR): current version and scoring rules. Neurology, 43, 2412–2414.Google Scholar
Naglie, G. (2007). Quality of life in dementia. The Canadian Journal of Neurological Sciences, 34, S57–S61.Google Scholar
Pfeifer, L., Drobetz, R., Fankhauser, S, Mortby, M. E., Maercker, A. and Forstmeier, S. (2013). Caregiver rating bias in mild cognitive impairment and mild Alzheimer's disease: impact of caregiver burden and depression on dyadic rating discrepancy across domains. International Psychogeriatrics, 25, 1345–1355.CrossRefGoogle ScholarPubMed
Sahadevan, S., Tan, N. J. L. and Chan, S. P. (2000). Diagnostic performance of two mental status tests in the older Chinese: influence of education and age on cut-off values. International Journal of Geriatric Psychiatry, 15, 234–241.Google Scholar
Sousa, M. F. B. et al. (2013). Quality of life in dementia: the role of non-cognitive factors in ratings of people with dementia and family caregivers. International Psychogeriatrics, 25, 1097–1105.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.Google Scholar
Vogel, A., Waldorff, F. and Waldemar, G. (2010). Impaired awareness of deficits and neuropsychiatric symptoms in early Alzheimer's disease: the Danish Alzheimer Intervention Study (DAISY). Journal of Neuropsychiatry and Clinical Neurosciences, 22, 93–99.Google Scholar
Zarit, S. H., Reever, K. E. and Bach-Peterson, J. (1980). Relatives of the impaired elderly, correlates of feelings of burden. The Gerontologist, 20, 649–655.Google Scholar
Zhao, H. et al. (2012). Factors associated with caregivers’ underestimation of life in patients with Alzheimer's disease. Dementia and geriatric cognitive disorders, 33, 11–17.CrossRefGoogle ScholarPubMed