Skip to main content Accessibility help

Predictors of self- and caregiver-rated quality of life for people with dementia living in the community and in nursing homes in northern Taiwan

  • Hsiu-Li Huang (a1) (a2), Li-Chueh Weng (a1), Yu-Hsia Tsai (a1), Yi-Chen (Yulanda) Chiu (a1) (a2), Kang-Hua Chen (a1), Chin-Chang Huang (a3) (a4), John Sai-Hung Tang (a5) and Woan-Shyuan Wang (a1)...



Factors affecting quality of life (QOL) ratings for people with dementia (PWD) have been well studied, but few studies have examined the effect of residence on PWD- and caregiver-rated QOL for PWDs. We designed this study to determine the factors related to PWD- and caregiver-rated QOL in dementia as well as factors related to the discrepancy in these ratings.


For this cross-sectional study, we analyzed data from a convenience sample of 106 PWD-family caregiver dyads (58 community-dwelling dyads and 48 nursing-home dyads). PWDs’ data included socio-demographic variables, QOL (assessed by the Quality of Life-Alzheimer's Disease [QOL-AD] scale), cognition, dementia severity, depression, comorbidities, and quality of the dyadic relationship. Caregivers’ data included socio-demographic variables, depressive symptoms, and mutuality of the dyadic relationship.


QOL-AD scores were lower when rated by caregivers than by PWDs. The key factors positively related to both PWD- and caregiver-rated QOL for PWDs were fewer PWD depressive symptoms and higher quality of the PWD-caregiver relationship. The key factors related to the discrepancy in PWD- and caregiver-rated QOL in dementia were PWD residence in a nursing home and lower dementia severity, as well as higher caregiver depression, being an adult child caregiver, and lower caregiver-PWD mutuality.


Caregiver-rated QOL for PWDs and the discrepancy in rated QOL were significantly associated with PWD residence. If caregiver-rated QOL is needed, the effect of residence of PWD should be taken into consideration. Caregivers’ depressive status and mutuality with PWD must be also carefully assessed.


Corresponding author

Correspondence should be addressed to: Hsiu-Li Huang, No. 259, Wen-Hwa 1st Road, Kwei-Shen, Taoyuan 33302, Taiwan. Phone: +886-3-2118800; ext. 5183; Fax: +886-3-2118800-5326. Email:


Hide All
Abrahamson, K., Lewis, T., Perkins, A., Clark, D., Nazir, A. and Arling, G. (2013). The Influence of cognitive impairment, special care unit placement, and nursing facility characteristics on resident quality of life. Journal of Aging & Health, 25, 574588. doi: 10.1177/0898264313480240.
Albert, S. M. (2004). The special care unit as a quality-of-life intervention for people with dementia. [comment]. Journal of the American Geriatrics Society, 52, 12141215.
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, 13421347.
Alexopoulos, G. A., Abrams, R. C., Young, R. C. and Shamoian, C. A. (1988). Cornell scale for depression in dementia. Biological Psychiatry, 23, 271284.
Alzheimer's Disease International (2013). Policy Brief for Heads of Government: the Global Impact of Dementia 2013–2050. Available at:; last accessed 1 October 2014.
Archbold, P. G., Stewart, B. J., Greenlick, M. R. and Harvath, T. A. (1990). Mutuality and preparedness as predictors of caregiver role strain. Research in Nursing & Health, 12, 375384.
Arlt, S., Hornung, J., Eichenlaub, M., Jahn, H., Bullinger, M. and Petersen, C. (2008). The patient with dementia, the caregiver and the doctor: cognition, depression and quality of life from three perspectives. International Journal of Geriatric Psychiatry, 23, 604610.
Ball, V. et al. (2010). Quality of relationships as a predictor of psychosocial functioning in patients with dementia. Journal of Geriatric Psychiatry and Neurology, 23, 109114. DOI:10.1177/0891988710363709.
Beerens, H. C. et al. (2014). Quality of life and quality of care for people with dementia receiving long term institutional care or professional home care: the European RightTimePlaceCare Study. Journal of the American Medical Directors Association, 15, 5461.
Behuniak, S. M. (2011). The living dead? The construction of people with Alzheimer's disease as zombies. Ageing & Society, 31, 7092.
Black, B. S., Johnston, D., Morrison, A., Rabins, P. V., Lyketsos, C. G. and Samus, Q. M. (2012). Quality of life of community-residing persons with dementia based on self-rated and caregiver-rated measures. Quality of Life Research, 21, 13791389. doi: 10.1007 /s11136-011-0044-z.
Bosboom, P. R., Alfonso, H., Eaton, J. and Almeida, O. P. (2012). Quality of life in Alzheimer's disease: different factors associated with complementary ratings by patients and family carers. International Psychogeriatrics, 24, 708721.
Bruvik, F. K., Ulstein, I. D., Ranhoff, A. H. and Engedal, K. (2012). The quality of life of people with dementia and their family carers. Dementia and Geriatric Cognitive Disorders, 34, 714. doi: 10.1159/000341584.
Buckley, T. et al. (2012). Predictors of quality of life ratings for persons with dementia simultaneously reported by patients and their caregivers: the cache county (Utah) study. International Psychogeriatrics, 24, 10941102.
Conde-Sala, J. L., Garre-Olmo, J., Turró-Garriga, O., Vilalta-Franch, J. and López-Pousa, S. (2010). Quality of life of patients with Alzheimer's disease: differential perceptions between spouse and adult child caregivers. Dementia and Geriatric Cognitive Disorders, 29, 97108. doi: 10.1159/000272423.
Conde-Sala, J. L. et al. (2014). Severity of dementia, anosognosia, and in relation to the quality of life of patients with Alzheimer disease: discrepancies between patients and caregivers. American Journal of Geriatric Psychiatry, 22, 138147. doi: 10.1016/j.jagp.2012.07.001.
Crespo, M., de Quirós, M., Gómez, M. M. and Hornillos, C. (2012). Quality of life of nursing home residents with dementia: a comparison of perspectives of residents, family, and staff. Gerontologist, 52, 5665.
Faul, F., Erdfelder, E, Lang, A. G. and Buchner, A. (2007). G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods, 39, 175191.
Fleiss, J. L. (1986). Reliability of Measurement: The Design and Analysis of Clinical Experiments. New York, NJ: Wiley.
Giebel, C. M. et al. (2014). Deterioration of basic activities of daily living and their impact on quality of life across different cognitive stages of dementia: a European study. International Psychogeriatrics, 26, 12831293.
Hoe, J., Katona, C., Orrell, M. and Livingston, G. (2007). Quality of life in dementia: care recipient and caregiver perceptions of quality of life in dementia: the LASER-AD study. International Journal of Geriatric Psychiatry, 22, 10311036.
Hsu, H. C., Lew-Ting, C. Y. and Wu, S. C. (2001). Age, period, and cohort effects on the attitude toward supporting parents in Taiwan. Gerontologist, 41, 742750.
Huang, H., Yeh, C. M., Tang, J. S., Chiu, Y. and Weng, L. (2009). Determinants of the discrepancy in patient-rated and caregiver-rated quality of life for persons with dementia. Journal of Clinical Nursing, 18, 31073117.
Lee, H. C. B. et al. (1993). Chinese elderly and the GDS short form: a preliminary study. Clinical Gerontologist: The Journal of Aging and Mental Health, 14, 3742.
Lin, J. N. and Wang, J. J. (2008). Psychometric evaluation of the Chinese version of the Cornell Scale for Depression in Dementia. Journal of Nursing Research, 16, 202210.
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, 510519.
Morris, J. C. (1997). Clinical Dementia Rating: a reliable and valid diagnostic and staging measure for dementia of the Alzheimer type. International Psychogeriatrics, 9, 173176. doi:10.1017/S1041610297004870.
Moyle, W., Murfield, J. E., Griffiths, S. G. and Venturato, L. (2012). Assessing quality of life of older people with dementia: a comparison of quantitative self-report and proxy accounts. Journal of Advanced Nursing, 68, 22372246. doi: 10.1111/j.1365–2648.2011.05912.x.
Ready, R. E., Ott, B. R. and Grace, J. (2006). Insight and cognitive impairment: effects on quality-of-life reports from mild cognitive impairment and Alzheimer's disease patients. American Journal of Alzheimers Disease Other Dementias, 21, 242 –248.
Schiffczyk, C., Romero, B., Jonas, C., Lahmeyer, C., Muller, F. and Riepe, M. W. (2010). Generic quality of life assessment in dementia patients: a prospective cohort study. BMC Neurology, 10, 18.
Sheikh, J. I. and Yesavage, J. A. (1986). Geriatric depression scale (GDS): recent evidence and development of a shorter version. Clinical Gerontologist, 5, 165173.
Shyu, Y. I. and Yip, P. K. (2001). Factor structure and explanatory variables of the Mini-Mental State Examination (MMSE) for elderly persons in Taiwan. Journal of the Formosan Medical Association, 100, 676683.
Shyu, Y. L., Yang, C., Huang, C., Kuo, H., Chen, S. and Hsu, W. (2010). Influences of mutuality, preparedness, and balance on caregivers of patients with dementia. Journal of Nursing Research, 18, 155163.
Trigg, R., Watts, S., Jones, R. and Tod, A. (2011). Predictors of quality of life ratings from persons with dementia: the role of insight. International Journal of Geriatric Psychiatry, 26, 8391.
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, 11321138.
Weintraub, D., Saboe, K. and Stern, M. B. (2007). Effect of age on geriatric depression scale performance in Parkinson's disease. Movement Disorders, 22, 13311335.
World Health Organization QOL Group (1995). World Health Organization Quality of Life-100. Geneva, Switzerland: World Health Organization Division of Mental Health.



Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed