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Background: 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., Methods: 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., Results: 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., Conclusions: 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.

Purpose: This study aims to assess the change in and predictive factors of the quality of life (QoL) of institutionalized older adults with dementia over a 20-month period., Methods: Information was used from a follow-up study conducted over an average period of 19.61 ± 1.93 months on a sample of 274 institutionalized older adults aged 60 or over, diagnosed with dementia. Two linear regression models were built to predict change in the EQ-5D index and the quality of life in Alzheimer's disease (QOL-AD) scale, taking as independent variables: sociodemographic characteristics and measures of functional ability (Barthel Index), depression in dementia (Cornell Scale), number of chronic health problems, cognitive level (MEC, the Spanish Mini-Mental State Examination) and severity of dementia (Clinical Dementia Rating) at baseline., Results: The majority of the participants were women (81.75 %) with an average age of 84.70 ± 6.51 years, single (78.15 %), with severe dementia and moderate functional dependence. There was a significant decrease on the EQ-5D, EQ-VAS and QOL-AD between baseline and follow-up scores. The main predictors of QoL of the institutionalized older adults with dementia were the number of chronic problems and baseline scores of the QoL measures., Conclusions: A significant decrease in the QoL of institutionalized older adults was observed over a 20-month period. Results suggest that interventions aimed at reducing the number of chronic medical conditions may have a beneficial effect on older adults' QoL.

Residential facilities are increasingly used as a resource for dependent older adults and a high percentage of patients with dementia die there. Information about the leading medical causes and exposures to risk factors of mortality in institutionalized older patients with dementia could guide the development of clinical management interventions. The data of 387 institutionalized adults aged over 60, diagnosed with dementia, was analyzed retrospectively. Information about sociodemographic, comorbidities, quality of life and leisure and free time variables was collected in a survey answered by caregivers; after 19 months, information was collected on the result variable (living vs. deceased). A multivariate logistic regression model was created to determine the factors associated with mortality, which were: age (odds ratio (OR)=1.986; 95% confidence interval (CI): 1.229-3.209); diabetes (OR=2.322; 1.350-3.996); hypertension (OR=1.695; 1.044-2.752); diseases of the genitourinary system (OR=2.455;1.419-4.248), worsening of health over last twelve months (OR=1.653; 1.018-2.685) and not performing passive (OR=1.616; 0.968-2.700) or social (OR=2.242; 1.170-4.299) leisure activities. Besides age, the number of comorbid illnesses and the inability to perform leisure activities predicted mortality in institutionalized adults with dementia. These predictors might be useful clinical markers for identifying patients at increased risk for mortality., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Aim: Measurement of health-related quality of life in people with dementia is a challenge, because of their special characteristics and the difficulties that this term entails itself. The present study aimed at assessing the psychometric properties of the EQ-5D rated by a familiar or a professional caregiver of institutionalized older adults with dementia., Methods: We analyzed the EQ-5D psychometric properties from 525 questionnaires rated by proxy, in a sample of institutionalized older adults with dementia., Results: The mean EQ-5D index score was 0.11 ± 0.38, and 51.54 ± 21.47 for the visual analog scale. The intraclass correlation coefficient was 0.72. Regarding internal consistency, Cronbach's alpha was 0.64, and the item-total correlation ranged from 0.33 to 0.53. Exploratory factor analysis identified a functional and a subjective factor, accounting for 67.35% of the variance. Convergent validity of EQ-5D with Quality of Life Alzheimer's Disease by proxy and Quality of Life in Late-stage Dementia scales was satisfactory (r = 0.36-0.58). The EQ-5D showed appropriate discriminative validity among patients grouped into several categories. Multiple linear regression models, using EQ-index and visual analog scale as dependent variables, identified dependence level, proxy characteristics, leisure and comorbidity as determinants of quality of life., Conclusions: Despite some limitations in the more subjective dimensions, the proxy-rated EQ-5D showed satisfactory psychometric properties in the present study, suggesting that it is a valid and alternative instrument to assess quality of life in institutionalized older people with dementia., (© 2013 Japan Geriatrics Society.)

Background: Physical activity (PA) is a health determinant among middle-aged and older adults. In contrast, poor health is expected to have a negative impact on PA. This study sought to assess to what extent specific International Classification of Functioning, Disability and Health (ICF) health components were associated with PA among older adults.Methods: We used a sample of 864 persons aged ≥50 years, positively screened for disability or cognition in a cross-sectional community survey in Spain. Weekly energy expenditure during PA was measured with the Yale Physical Activity Survey (YPAS) scale. The associations between body function impairment, health conditions or World Health Organization Disability Assessment Schedule (WHODAS 2.0) disability scores and energy expenditure were quantified using negative-binomial regression, and expressed in terms of adjusted mean ratios (aMRs).Results: Mean energy expenditure was 4542 Kcal/week. A lower weekly energy expenditure was associated with: severe/extreme impairment of mental functions, aMR 0.38, 95% confidence interval, CI (0.21-0.68), and neuromusculoskeletal and movement functions, aMR 0.50 (0.35-0.72); WHODAS 2.0 disability, aMR 0.55 (0.34-0.91); dementia, aMR 0.45 (0.31-0.66); and heart failure, aMR 0.54 (0.34-0.87). In contrast, people with arthritis/osteoarthritis had a higher energy expenditure, aMR 1.27 (1.07-1.51).Conclusion: Our results suggest that there is a strong relationship between selected body function impairments, mainly mental, and PA. Although more research is needed to fully understand causal relationships, strategies to improve PA among the elderly may require targeting mental, neuromusculoskeletal and movement functions, disability determinants (including barriers), and specific approaches for persons with dementia or heart failure. [ABSTRACT FROM AUTHOR]

Background Health-related quality of life ( HRQOL) in older adults is determined by personal conditions, as well as by the social and physical environment. The purpose of the present study was to describe the factors related to health conditions and residential environment that influence HRQOL of older adults. Methods Data from 1815 cases came from three cross-sectional surveys on quality of life in older adults in Spain: non-institutionalized older adults ( n = 1106), institutionalized older adults without dementia ( n = 234) and institutionalized older adults with dementia ( n = 475). Assessment instruments used were: Barthel Index, Short Portable Mental Status Questionnaire, Comorbidity Index, EQ- 5D- 3L (5 dimensions, EQ-index and EQ-VAS), and information about sociodemographic characteristics and social networks. Partial correlation and multivariate logistic regression analyses were carried out. Results In group comparisons, institutionalized older adults showed a higher percentage of problems in the EQ- 5D- 3L dimensions than the non-institutionalized ones. Also, older adults with dementia presented less pain/discomfort and anxiety/depression than the other groups, but showed more problems in mobility, self-care and usual activities. EQ-Index showed a high association with functional independence, perceived health status and comorbidity. According to the logistic regression models, the Barthel Index was the most common determinant for most of EQ- 5D- 3L dimensions in all groups. Conclusion Institutionalized older adults with dementia presented lower HRQOL than the other groups. Functional independence, comorbidity and cognitive status were the main HRQOL determinants in all groups. Maintenance and improvement of the functional condition might be translated into a higher HRQOL of older adults. Geriatr Gerontol Int 2015; 15: 627-635. [ABSTRACT FROM AUTHOR]