Introduction
Quality of life ratings
Method
Sample and setting
Procedure
Quality of life measurements
Alzheimer’s Disease Related Quality of Life (ADRQL)
QUALIDEM
Measurements of associated factors
Statistical analysis
Results
Residents (n = 133) | |||
---|---|---|---|
Age in years; mean (SD) | 85.4 (7.2) | ||
Women in % (n) | 81.4 (105) | ||
Time being in the ward in years; mean (SD) | 2.6 (2.7) | ||
Severity of dementia (GDS) in % (n) | |||
≤4 (no to moderate cognitive decline) | 1.5 (2) | ||
5 (moderately severe cognitive decline) | 3.0 (4) | ||
6 (severe cognitive decline) | 21.8 (29) | ||
7 (very severe cognitive decline) | 73.7 (98) | ||
Challenging behavior (CMAI) in % (n) | |||
Physically nonaggressive behavior | 51.1 (68) | ||
Verbally agitated behavior | 37.6 (50) | ||
Aggressive behavior | 21.1 (28) | ||
Minimum one challenging behavior | 63.2 (84) | ||
Nurses (n = 88)
| |||
Age in years; mean (SD) | 37.2 (10.3) | ||
Women in % (n) | 88.1 (74) | ||
Profession in% (n) | |||
Nursing assistances | 47.7 (42) | ||
Registered nurses | 52.3 (46) | ||
Time of work experiences in years; mean (SD) | 7.4 (7.4) | ||
Time on the ward in years; mean (SD) | 2.5 (2.3) | ||
Attitude towards people with dementia (ADQ); mean (SD) | |||
Total (19-95) | 72.1 (7.2) | ||
Person centeredness (11-55) | 44.3 (4.7) | ||
Hope (8-40) | 27.9 (3.8) | ||
Empathy (JSPE; 20-140; mean (SD)) | 83.9 (6.0) | ||
Burnout (MBI) in % (n) | |||
Low burden | Moderate burden | Severe burden | |
Emotional exhaustion | 17.0 (15) | 37.5 (33) | 25.0 (22) |
Depersonalization | 14.8 (13) | 54.5 (48) | 11.4 (10) |
Personal accomplishment | 26.1 (23) | 42.0 (37) | 13.6 (12) |
Satisfaction with life (SWLS; 5-35; mean (SD)) | 24.4 (6.5) |
Quality of life
ADRQL | n = 1.482 |
---|---|
Total | 69.9 (18.0) |
Social interaction | 75.9 (20.8) |
Awareness of self | 63.1 (22.8) |
Enjoyment of activities | 74.5 (22.9) |
Feelings and mood | 57.3 (17.5) |
Response to surroundings | 78.0 (20.4) |
QUALIDEM
| |
Total | 70.8 (22.1) |
Care relationship | 70.5 (22.9) |
Positive affect | 73.3 (25.9) |
Negative affect | 72.0 (25.9) |
Restless tense behavior | 55.1 (29.9) |
Positive self-image* | 78.7 (24.9) |
Social relations | 74.3 (21.9) |
Social isolation | 71.5 (21.9) |
Feeling at home* | 84.2 (18.1) |
Having something to do* | 54.5 (26.3) |
Associated factors of the ADRQL
Dependent variable | p-value | R2 | Significant independent variable |
---|---|---|---|
ADRQL: Total score |
p < 0.001
| 0.244 | Challenging behavior (CMAI)★ |
Non-significant independent variable: 3, 4, 5, 6, 8, 9, 12, 13, 15 (see underline) | Severity of dementia (GDS)★★★ | ||
Burnout (MBI – EE)★★ | |||
Circumstances of ratings★★★ | |||
Time being on the ward (nurse)★★ | |||
Satisfaction with life (SWLS)★★★ | |||
ADRQL: Social interaction |
p < 0.001
| 0.170 | Severity of Dementia (GDS)★★ |
Non-significant independent variable: 1, 3, 4, 5, 7, 8, 9, 11, 12, 13, 15 (see underline) | Registered nurse (yes/no)★★ | ||
Circumstances of ratings★★ | |||
Satisfaction with life (SWLS)★ | |||
ADRQL: Awareness of self |
p < 0.001
| 0.227 | Severity of dementia (GDS)★★★ |
Non-significant independent variable: 1, 3, 4, 5, 6, 7, 8, 9, 11, 12, 13, (see underline) | Circumstances of ratings★★ | ||
Satisfaction with life (SWLS)★★ | |||
Days worked in advance of the ratings★ | |||
ADRQL: Moods and feelings |
p < 0.001
| 0.266 | Challenging behavior (CMAI)★★ |
Non-significant independent variable: 3, 4, 5, 6, 9, 12, 13, 15 (see underline) | Severity of dementia (GDS)★ | ||
Burnout (MBI – EE)★★ | |||
Burnout (MBI – PA)★★ | |||
Circumstances of ratings★★★ | |||
Time being on the ward (nurse)★★★ | |||
Satisfaction with life (SWLS)★★★ | |||
ADRQL: Enjoyment of activities |
p = 0.002
| 0.140 | Severity of dementia (GDS)★★★ |
Non-significant independent variable: 1, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 15 (see underline) | Satisfaction with life (SWLS)★★ | ||
ADRQL: Response to surroundings |
p = 0.001
| 0.168 | Challenging behavior (CMAI)★★★ |
Non-significant independent variable: 2, 3, 4, 6, 7, 8, 9, 12, 13, 14 (see underline) | Responsible nurse (yes/no)★ | ||
Circumstances of ratings★★★ | |||
Time being on the ward (nurse)★★ | |||
Days worked in advance of the ratings★ |
ADRQL: Total score | ||
---|---|---|
β | 95% CI | |
No challenging behavior (CMAI)* | 5.287 | 0.333; 10.185★ |
GDS ≤ 4*** | 11.005 | -2.464; 24.473 |
GDS = 5*** | 11.663 | 3.966; 19.359★★ |
GDS = 6*** | 8.017 | 3.171; 12.863★★ |
MBI-EE low burden** | -8.266 | -16.941; 0.408 |
MBI-EE moderate burden** | -10.536 | -17.014; -4.058★★ |
Ratings while leisure time**** | -1.152 | -8.414; 6.110 |
Ratings in advance of a shift**** | 3.504 | -4.919; 11.927 |
Ratings while the shift**** | -10.099 | -16.488; -3.709★★ |
Time being on the ward (nurse)# | 3.173 | 1.290; 5.056★★ |
SWLS (nurse)# | 1.366 | 0.679; 2.052★★★ |
ADRQL: Social interaction
| ||
β
|
95% CI
| |
GDS ≤ 4*** | 19.863 | 2.219; 37.508★ |
GDS = 5*** | 7.953 | -2.130; 18.035 |
GDS = 6*** | 6.861 | 0.513; 13.210★ |
Nursing assistance****** | 9.164 | -3.126; 9.735★ |
Ratings while leisure time**** | -7.524 | -17.038; 1.989 |
Ratings in advance of a shift**** | 3.409 | -7.626; 14.444 |
Ratings while the shift**** | -12.582 | -20.953; -4.211★★ |
SWLS (nurse)# | 0.929 | 0.030; 1.828★ |
ADRQL: Awareness of self
| ||
β
|
95% CI
| |
GDS ≤ 4*** | 22.438 | 4.826; 40.051★ |
GDS = 5*** | 17.545 | 7.481; 27.609★★ |
GDS = 6*** | 7.206 | 0.869; 13.543★ |
Ratings while leisure time**** | 9.938 | 0.442; 19.435★ |
Ratings in advance of a shift**** | 2.119 | -8.896; 13.135 |
Ratings while the shift**** | -4.609 | -12.965; 3.747 |
SWLS (nurse)# | 1.193 | 0.295; 2.090★★ |
Days worked in advance of the ratings# | 1.277 | 0.095; 2.460★ |
ADRQL: Moods and feelings
| ||
β
|
95% CI
| |
No challenging behavior (CMAI)* | 8.040 | 1.920; 14.160★★ |
GDS ≤ 4*** | 5.732 | -11.096; 22.561 |
GDS = 5*** | 9.020 | -0.596; 18.636 |
GDS = 6*** | 8.376 | 2.321; 14.341★★ |
MBI-EE low burden** | -12.872 | -23.710; -2.033★ |
MBI-EE moderate burden** | -14.062 | -22.156; -5.968★★ |
MBI-PA low burden** | -1.331 | -10.978; 8.317 |
MBI-PA moderate burden** | -11.463 | -21.939; -0.988★ |
Ratings while leisure time**** | -1.559 | -10.633; 7.515 |
Ratings in advance of a shift**** | 2.310 | -8.215; 12.835 |
Ratings while the shift**** | -12.954 | -20.938; -4.971★★ |
Time being on the ward (nurse)# | 5.320 | 2.967; 7.673★★★ |
SWLS (nurse)# | 1.537 | 0.680; 2.395★★★ |
ADRQL: Enjoyment of activities
| ||
β
|
95% CI
| |
GDS ≤ 4*** | 14.401 | -9.406; 38.207 |
GDS = 5*** | 22.707 | 9.104; 36.311★★ |
GDS = 6*** | 15.446 | 6.881; 24.012★★★ |
SWLS (nurse)# | 1.676 | 0.463; 2.889★★ |
ADRQL: Response to surroundings
| ||
β
|
95% CI
| |
No challenging behavior (CMAI)* | 12.639 | 5.622; 19.655★★★ |
Being no responsible nurse***** | 7.225 | 0.140; 14.309★ |
Ratings while leisure time**** | -4.483 | -14.435; 5.470 |
Ratings in advance of a shift**** | 2.875 | -8.885; 14.634 |
Ratings while the shift**** | -18.804 | -28.730; -8.879★★★ |
Time being on the ward (nurse)# | 4.384 | 1.341; 7.427★★ |
Days worked in advance of the ratings# | -1.381 | -2.664; -0.098★★ |
Associated factors of the QUALIDEM
Dependent variable | p-value | R2 | Significant independent variable |
---|---|---|---|
QUALIDEM: Total score | p < 0.001 | 0.165 | Challenging behavior (CMAI) ★★★ |
non-significant independent variable: 2, 3, 4, 5, 6, 7, 8, 10, 12, 13, 15 (see underline) | Burnout (MBI – D) ★ | ||
Time being on the ward (nurse) ★ | |||
Satisfaction with life (SWLS) ★★ | |||
QUALIDEM: Care relationship | p < 0.001 | 0.227 | Challenging behavior (CMAI) ★★★ |
non-significant independent variable: 3, 4, 5, 6, 7, 8, 10, 11, 12, 13, 15 (see underline) | Severity of dementia (GDS) ★ | ||
Burnout (MBI – D) ★★ | |||
Satisfaction with life (SWLS) ★★ | |||
QUALIDEM: Positive affect | p < 0.001 | 0.182 | Challenging behavior (CMAI) ★★ |
non-significant independent variable: 2, 3, 4, 5, 6, 7, 9, 11, 12, 13, 14, 15 (see underline) | Burnout (MBI-PA) ★★ | ||
Circumstances of ratings★★ | |||
QUALIDEM Negative affect | p < 0.001 | 0.209 | Sex (residents) ★★ |
non-significant independent variable: 1, 2, 4, 5, 6, 8, 11, 15 (see underline) | Burnout (MBI – EE) ★★★ | ||
Burnout (MBI – D) ★ | |||
Circumstances of ratings★ | |||
Attitude (ADQ) ★★ | |||
Empathy (JSPE) ★ | |||
Satisfaction with life (SWLS) ★★ | |||
QUALIDEM Restless tense behavior | p < 0.001 | 0.244 | Challenging behavior (CMAI) ★★★ |
non-significant independent variable: 3, 4, 6, 8, 12, 13, 15 (see underline) | Severity of dementia (GDS) ★★★ | ||
Responsible nurse (yes/no) ★ | |||
Burnout (MBI – EE) ★ | |||
Burnout (MBI – D) ★ | |||
Circumstances of ratings★★ | |||
Time being on the ward (nurse) ★ | |||
Satisfaction with life (SWLS) ★★ | |||
QUALIDEM Positive self image* | p = 0.033 | 0.486 | --- |
non-significant independent variable: 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15 (see underline) | |||
QUALIDEM Social relations | p = 0.088 | 0.099 | Satisfaction with life (SWLS) ★ |
non-significant independent variable: 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 15 (see underline) | |||
QUALIDEM Social isolation | p < 0.001 | 0.173 | Challenging behavior (CMAI) ★★★ |
non-significant independent variable: 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 15 (see underline) | Satisfaction with life (SWLS) ★★ | ||
QUALIDEM Feeling at home* | p = 0.010 | 0.532 | --- |
non-significant independent variable: 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15 (see underline) | |||
QUALIDEM Having something to do* | p = 0.759 | 0.268 | --- |
non-significant independent variable: 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15 (see underline) |
QUALIDEM total score | ||
---|---|---|
β | 95% CI | |
No challenging behavior (CMAI)* | 11.482 | 5.104; 17.859★★★ |
MBI-D low burden** | -1.743 | -20.541; 17.055 |
MBI-D moderate burden** | -12.940 | -29.927; 4.047 |
Time being on the ward (nurse)# | 2.507 | 0.078; 4.937★ |
SWLS (nurse)# | 1.423 | 0.533; 2.312★★ |
QUALIDEM: Care relationship
| ||
β
|
95% CI
| |
No challenging behavior (CMAI)* | 17.570 | 10.993; 24.147★★★ |
GDS ≤ 4*** | -27.722 | -47.329; -8.114★★ |
GDS = 5*** | -2.061 | -12.080; 7.958 |
GDS = 6*** | 0.600 | -6.329; 7.528 |
MBI-D low burden** | -5.552 | -24.938; 13.834 |
MBI-D moderate burden** | -17.252 | -34.771; 0.267 |
SWLS (nurse)# | 1.380 | 0.463; 2.297★★ |
QUALIDEM: Positive affect
| ||
β
|
95% CI
| |
No challenging behavior (CMAI)* | 8.913 | 2.251; 15.575★★ |
MBI-PA low burden** | 10.020 | -0.436; 20.475 |
MBI-PA moderate burden** | 17.057 | 5.713; 28.401★★ |
Ratings while leisure time**** | 8.737 | -0.985; 18.460 |
Ratings in advance of a shift**** | 13.491 | 2.192; 24.789★★ |
Ratings while the shift**** | -4.156 | -12.763; 5.551 |
QUALIDEM: Negative affect
| ||
β
|
95% CI
| |
Male (residents)***** | 12.852 | 5.140; 20.563★★ |
MBI-EE low burden** | -15.205 | -29.352; -1.059★ |
MBI-EE moderate burden** | 3.241 | -7.285; 13.767 |
MBI-DP low burden** | -14.903 | -38.606, 8.800 |
MBI-D moderate burden** | -24.105 | -45.525; -2.685★ |
Ratings while leisure time**** | 7.261 | -4.475; 18.998 |
Ratings in advance of a shift**** | 22.714 | 9.975; 36.354★ |
Ratings while the shift**** | 6.779 | -3.611; 17.169 |
ADQ# | -1.204 | -1.989; -0.419★★ |
JSPE# | -0.852 | -1.657; -0.046★ |
SWLS (nurse) # | 1.939 | 0.818; 3.061*★ |
QUALIDEM: Restless Tense Behavior
| ||
β
|
95% CI
| |
No challenging behavior (CMAI)* | 19.979 | 11.059; 28.899★★★ |
GDS ≤ 4*** | -6.029 | -32.621; 20.562 |
GDS = 5*** | 20.485 | 6.898; 34.074★★ |
GDS = 6*** | 15.116 | 5.720; 24.513★★ |
Being no responsible nurse****** | 9.630 | 0.723; 18.536★ |
MBI-EE low burden** | -20.363 | -36.055; -4.671★ |
MBI-EE moderate burden** | -10.023 | -21.699; 1.653 |
MBI-D low burden** | -10.641 | -36.933; 15.650 |
MBI-D moderate burden** | -21.552 | -45.311; 2.208 |
Ratings while leisure time**** | 1.334 | -4.693; 25.564 |
Ratings in advance of a shift**** | 10.436 | -4.693; 25.564 |
Ratings while the shift**** | -13.395 | -24.920; -1.871★ |
Time being on the ward (nurse)# | 3.720 | 0.322; 7.119★ |
SWLS (nurse)# | 1.689 | 0.445; 2.933★★ |
QUALIDEM: Social Isolation
| ||
β
|
95% CI
| |
No challenging behavior (CMAI)* | 14.972 | 8.035; 21.910★★★ |
SWLS (nurse)# | 1.316 | 0.349; 2.283★★ |