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Quality of life of institutionalized older adults by dementia severity

  • Emilia Castro-Monteiro (a1), Mohammed Alhayek-Aí (a2), Alicia Diaz-Redondo (a3), Alba Ayala (a4), Carmen Rodriguez-Blazquez (a5), Fermina Rojo-Perez (a6), Pablo Martinez-Martin (a5) and Maria João Forjaz (a4)...



The goal of the study was to analyze the factors associated with quality of life (QoL) in institutionalized older adults with dementia, based on self and proxy ratings, and if these characteristics differ by dementia severity.


Cross-sectional study of 525 people with dementia (PwD) and their caregivers (professional or family caregivers). Two different QoL questionnaires, leading to three measures, were used: QoL in Alzheimer's disease scale (QOL-AD), self and proxy-rated, and QoL in late-stage dementia scale (QUALID), proxy-rated. Multivariate linear regression models were tested for each QoL measure and for mild/moderate and severe stages of dementia.


Multiple regression analyses showed a significant association between the three QoL measures and depression. Functional ability was significantly associated with QoL when assessed by proxy. Other factors such as education level, leisure activities and frequency of visits were significantly related with QOL-AD by proxy. The associated factors that differed by dementia severity were education level for moderate dementia, and frequency of visits and who answered the questionnaire (professional vs. family member) for severe dementia.


QoL was consistently associated with depressive symptoms independently of the measures as well as functional ability and social leisure activities when the QoL questionnaire was rated by proxy. Treating depressive symptoms, increasing social activities and maintaining the functional ability may decrease the deterioration of QoL in institutionalized older adults with dementia.


Corresponding author

Correspondence should be addressed to: M. J. Forjaz, National School of Public Health and REDISSEC, Carlos III Institute of Health, Monforte de Lemos 5, 28029 Madrid, Spain. Phone: +34-91 822 2062; Fax: +34-91 387 7862. Email:


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Albrecht, G. L. and Devlieger, P. J. (1999). The disability paradox: high quality of life against all odds. Social Science and Medicine, 48, 977988.
American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR. American Psychiatric Publishing.
Beer, C. et al. (2010). Factors associated with self and informant ratings of the quality of life of people with dementia living in care facilities: a cross sectional study. PLoS One, 5, e15621. doi:10.1371/journal.pone.0015621.
Beerens, H. C., Zwakhalen, S. M. G., Verbeek, H., Ruwaard, D. and Hamers, J. P. H. (2013). Factors associated with quality of life of people with dementia in long-term care facilities: a systematic review. International Journal of Nursing Studies, 50, 12591270. doi:10.1016/j.ijnurstu.2013.02.005.
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. doi:10.1017/S1041610212000063.
Cid-Ruzafa, J. and Damian-Moreno, J. (1997). Disability evaluation: barthel's index. Revista Española de Salud Pública, 71, 127.
Clare, L., Quinn, C., Hoare, Z., Whitaker, R. and Woods, R. T. (2014). Care staff and family member perspectives on quality of life in people with very severe dementia in long-term care: a cross-sectional study. Health and Quality of Life Outcomes, 12, 175. doi:10.1186/s12955-014-0175-3.
Cohen, J. (1988). Statistical Power Analysis for the Behavioral Sciences. L. Erlbaum Associates.
Conde Sala, J. L., Garre Olmo, J., Turre 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, 585594. doi:10.1002/gps.2161.
Conde-Sala, J. L. et al. (2014a). 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, 138147. doi:10.1016/j.jagp.2012.07.001.
Conde-Sala, J. L., Turró-Garriga, O., Garre-Olmo, J., Vilalta-Franch, J. and Lopez-Pousa, S. (2014b). Discrepancies regarding the quality of life of patients with Alzheimer's disease: a three-year longitudinal study. Journal of Alzheimer's Disease, 39, 511525. doi:10.3233/JAD-131286.
Crespo, M., Bernaldo 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. The Gerontologist, 52, 5665. doi:10.1093/geront/gnr080.
Crespo, M., Hornillos, C. and de Quiros, M. B. (2013). Factors associated with quality of life in dementia patients in long-term care. International Psychogeriatrics, 25, 577585. doi:10.1017/S1041610212002219.
De Pedro-Cuesta, J. et al. (2009). Prevalence of dementia and major dementia subtypes in Spanish populations: a reanalysis of dementia prevalence surveys, 1990–2008. BMC Neurology, 9, 55. doi:10.1186/1471-2377-9-55.
Diaz-Redondo, A., Rodriguez-Blazquez, C., Ayala, A., Martinez-Martin, P. and Forjaz, M. J.; Spanish Research Group on Quality of Life and Aging (2014). EQ-5D rated by proxy in institutionalized older adults with dementia: psychometric pros and cons. Geriatrics and Gerontology International, 14, 346353. doi:10.1111/ggi.12108.
Fernandez-Mayoralas, G. et al. (2007). El significado de la salud en la Calidad de Vida de los Mayores. The Meaning of Health in the Quality of Life of Older People. Madrid: Portal Mayores.
Garre-Olmo, J. et al. (2010). Cross-cultural adaptation and psychometric validation of a Spanish version of the quality of life in late-stage Dementia scale. Quality of Life Research, 19, 445453. doi:10.1007/s11136-010-9594-8.
Giebel, C. M., Sutcliffe, C. and Challis, D. (2015). Activities of daily living and quality of life across different stages of dementia: a UK study. Aging and Mental Health, 19, 6371. doi:10.1080/13607863.2014.915920.
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. doi:10.1017/S1041610214000775.
Hoe, J., Hancock, G., Livingston, G., Woods, B., Challis, D. and Orrell, M. (2009). Changes in the quality of life of people with dementia living in care homes. Alzheimer Disease and Associated Disorders, 23, 285290. doi:10.1097/WAD.0b013e318194fc1e.
Huang, H.-L. et al. (2015). Predictors of self- and caregiver-rated quality of life for people with dementia living in the community and in nursing homes in northern Taiwan. International Psychogeriatrics, 27, 825836. doi:10.1017/S1041610214002506.
Hughes, C. P., Berg, L., Danziger, W. L., Coben, L. A. and Martin, R. L. (1982). A new clinical scale for the staging of dementia. The British Journal of Psychiatry: The Journal of Mental Science, 140, 566572.
Lawton, M. P. (1994). Quality of life in Alzheimer disease. Alzheimer Disease and Associated Disorders, 8 (Suppl. 3), 138150.
Leon-Salas, B., Logsdon, R. G., Olazaran, J. and Martinez-Martin, P. (2011). Psychometric properties of the Spanish QoL-AD with institutionalized dementia patients and their family caregivers in Spain. Aging and Mental Health, 15, 775783. doi:10.1080/13607863.2011.562183.
Lobo, A. et al. (1999). Revalidation and standardization of the cognition mini-exam first Spanish version of the mini-mental status examination in the general geriatric population. Medicina clínica, 112, 767.
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.
López Mongil, R., López Trigo, J. A., Castrodeza Sanz, F. J., Tamames Gómez, S. and León Colombo, T. (2009). Prevalence of dementia in institutionalized patients. The RESYDEM study. Revista española de geriatría y gerontología, 44, 511. doi:10.1016/j.regg.2008.06.001.
Lucas-Carrasco, R., Gómez-Benito, J., Rejas, J. and Ott, B. R. (2013). The Cornell-Brown scale for quality of life in dementia: Spanish adaptation and validation. Alzheimer Disease and Associated Disorders, 27, 4450. doi:10.1097/WAD.0b013e318242040b.
Moyle, W. and O’Dwyer, S. (2012). Quality of life in people living with dementia in nursing homes. Current Opinion in Psychiatry, 25, 480484.
Naglie, G. et al. (2006). Utility-based quality of life measures in Alzheimer's disease. Quality of Life Research, 15, 631643. doi:10.1007/s11136-005-4364-8.
Seeley, W. W. and Miller, B. L. (2012). Chapter 371. Dementia. In Longo, D. L., Fauci, A. S., Kasper, D. L., Hauser, S. L., Jameson, J. L. and Loscalzo, j., (eds.), Harrison's Principles of Internal Medicine 18th. New York, USA: McGraw-Hill.
Siedlecki, K. L. et al. (2009). Comparison of patient and caregiver reports of patient activity participation and its relationship to mental health in patients with Alzheimer's disease. The Journals of Gerontology, 64, 687695. doi:10.1093/geronb/gbp071.
Strober, L. B. and Arnett, P. A. (2009). Assessment of depression in three medically ill, elderly populations: Alzheimer's disease, Parkinson's disease, and stroke. The Clinical Neuropsychologist, 23, 205230. doi:10.1080/13854040802003299.
Wang, H.-X., Xu, W. and Pei, J.-J. (2012). Leisure activities, cognition and dementia. Biochimica et Biophysica Acta (BBA)-Molecular Basis of Disease, 1822, 482491.
WHOQOL Group (1994). Development of the WHOQOL: Rationale and current status. International Journal of Mental Health, 23, 2456.
World Health Organization (2012). Dementia: a Public Health Priority. World Health Organization.


Quality of life of institutionalized older adults by dementia severity

  • Emilia Castro-Monteiro (a1), Mohammed Alhayek-Aí (a2), Alicia Diaz-Redondo (a3), Alba Ayala (a4), Carmen Rodriguez-Blazquez (a5), Fermina Rojo-Perez (a6), Pablo Martinez-Martin (a5) and Maria João Forjaz (a4)...


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