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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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