Azlina Wati Nikmat 1,2 Graeme Hawthorne 1 , Sam Korn 1 1 Department of Psychiatry, The University of Melbourne 2 Department of Psychiatry, University Teknologi MARA 11th Global Conference on Ageing "Ageing Connects” 11th Global Conference on Ageing "Ageing Connects”
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4 nikmat-qol of dementia patients in malaysia 09052012
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Azlina Wati Nikmat1,2
Graeme Hawthorne1, Sam Korn1
1Department of Psychiatry, The University of Melbourne 2Department of Psychiatry, University Teknologi MARA
11th Global Conference on Ageing "Ageing Connects” 11th Global Conference on Ageing "Ageing Connects”
Worldwide:
Predicted 2 billion people over the age of 60 in 2050 (WHO, 2006)
Malaysia –
It is predicted that older adults will increase from :
1,032,300 people (5.9%) in 1991 to
3,439,600 people (9.9%) by the year 2020 (PALA, J. 2005)
11th Global Conference on Ageing "Ageing Connects”
Source: Jorm et al (1987)
11th Global Conference on Ageing "Ageing Connects”
Disabling
condition
Low and middle income
countries
High income countries World
0-59 Years 60 years and
over
0-59 Years 60 years and
over
All age
Hearing loss 54.3 43.9 7.4 18.5 124.2
Glaucoma 5.7 7.9 0.4 1.5 15.5
Alzheimer and
other dementias
1.3 7.0 0.4 6.2 14.9
Cerebro-
vascular
Disease
4.0 4.9 1.4 2.2 12.6
Rheumatoid
arthritis
5.9 3.0 1.3 1.7 11.9
* WHO THE GLOBAL BURDEN OF DISEASE – 2004 UPDATE, 2008
Home care has become the preferred option among the elderly and their caregivers (Iwarsson et. al, 2007; Suh et. al, 2005)
Care giving - source of burden and distress for the family caregiver (Burns & Rabins, 2000; Chene, 2006)
Nursing home often becomes an option when the caregivers are no longer able to cope with the disease (Moyle et. al, 2007; Rigaud et. al, 2003)
Various studies on dementia patients in nursing homes - it is remains unclear to whether placement of dementia patient in nursing home will make a difference in their QOL (Moyle et al., 2007).
11th Global Conference on Ageing "Ageing Connects”
A comprehensive search in the electronic databases of CINAHL, MEDLINE, Science Direct and PsychINFO from November 2009 to March 2010
Keywords : “quality of life”, “health related quality of life”, “dementia”, “nursing homes”, “home nursing”, “residential care” and “home care”
Other keywords : living arrangement, cognitive impairment, physical impairment, depression, social isolation and needs.
Literature review – I: search
11th Global Conference on Ageing "Ageing Connects”
Keyword CINAHL PsycINFO Medline
Dementia
7995
64722
21777
Quality of life
8890
13486
4648
Dementia AND Quality of life
111
1210
152
29 related papers; 24 shared papers and 5 unique papers
Dementia AND Quality of life AND Nursing home/home care
5
343
5
12 related papers; 5 shared papers and 7 unique papers
11th Global Conference on Ageing "Ageing Connects”
Literature review – II: N. papers
Quality of life of the caregiver
eg: Alonso et. al, 2004; Bruce, 2005; Kurz, 2003;Thomas et. al, 2006, te Boekhorst et. al, 2008
11th Global Conference on Ageing "Ageing Connects”
Literature review – IV: conclusions
Methodology
11th Global Conference on Ageing "Ageing Connects”
The study protocol
Aims:
To identify and compare the quality of life of dementia patients in nursing home and those in community (cared by family members)
To provide a profile of dementia patients in the nursing home and home care
To compare the QoL of dementia patients in the nursing home and home care
To identify factors that differentiate the QoL of dementia patients in these two settings (if any exists)
11th Global Conference on Ageing "Ageing Connects”
Provide a better life for the demented patients (understanding their needs - proper management plan can be addressed to reduce the burden of the caregivers and provide a better life for the demented patient).
Provide information about health care in dementia to Government, clinicians and managers regarding the preferred options for support of older adults with dementia.
11th Global Conference on Ageing "Ageing Connects”
QoL
Mental health/
psychological
Physical functions/
activities
Environmental
Social relationship
11th Global Conference on Ageing "Ageing Connects”
• Research design : Quasi experimental design - cross sectional study
Sampling population
- Nursing homes (dementia patients residing in government nursing homes)
- Rumah Ehsan and Rumah Sri Kenangan
- Home care (dementia patients who live with a carer and get services from the memory clinic in government hospitals)
- Hospital Selayang, Hospital Kuala Lumpur and Hospital Sungai Buloh
11th Global Conference on Ageing "Ageing Connects”
Review medical record for inclusion and exclusion criteria and exclusion
criteria
Meet criteria Does not meet criteria
Consent form and provide participant information sheet
11th Global Conference on Ageing "Ageing Connects”
Measurements :
Socio-demographic information,
WHO-8,
AQoL-8,
FS,
CSDD,
CANE-S,
Barthel Index
An average of 60-90 minutes to administer the questionnaires
11th Global Conference on Ageing "Ageing Connects”
Measurements
• Nursing Homes: Mean = 21.22, SD = 4.64
• Home Care: Mean = 23.29, SD = 4.56
2
2
1
22))((
nee
nen ZZsdsdn
Assumes:
• Test size = 0.05 (α) Zα = 1.96; Power = 0.80 (1-β), Z 1-β = 0.84
• Calculated n = 105 in each study group.
Source of reference: • DAVIDSON AG, FAYERS PM, NUNN AJ, VENABLES KM & TAYLOR AJ. (1986). Number of patients required in lung function studies. Thorax. 41 (11): 830-832. • POWER et al (2005). Development of the WHOQOL-OLD module. Quality of Life Research. 14 (10): 2197-214. Based on re-analysis of the Melbourne WHOQOL-OLD study data, N = 758 cases. 11th Global Conference on Ageing "Ageing Connects”
Stratified sampling procedure
Location/ Nursing homes Home care TOTAL
Gender Cognitive severity Cognitive severity
Mild a Moderate b Mild a Moderate b
Male 60-75 14 14 14 14 56
76-89 14 14 14 14 56
Female 60-75 14 14 14 14 56
76-89 14 14 14 14 56
56 56 56 56
TOTAL 112 112 224
Cognitive severity measured by SMMSE a = SMMSE 6-10 b = SMMSE 0-5
11th Global Conference on Ageing "Ageing Connects”
Source of reference: POWER et al (2005). Development of the WHOQOL-OLD module. Quality of Life Research. 14 (10): 2197-214. Based on re-analysis of the Melbourne WHOQOL-OLD study data, N = 758 cases.
11th Global Conference on Ageing "Ageing Connects”
The preliminary findings
31 dementia patients from nursing homes and 82 from home care were invited
62 agreed to participate
49 (30: NH, 19: HC) met the study entry criteria and completed the questionnaire -participation rate of 44%.
Mean age : 70.4 (7.44)
Female : 55.1 %
Education : Primary school (46.9 % )
High school (28.6 %)
Financial status :
Average (36.7 %)
Slightly below average (51 %)
Relationship satisfaction :
Demographic results
63%
27%
10%
Ethnicity
Malay
Chinese
Indian
12%
31%
12%
45%
Marital status
Single
Married
Separated
Widowed
Very satisfied 8.2 %
Satisfied 28.6 %
Neither 10.2 %
Dissatisfied 10.2 %
Very dissatisfied 65.3 %
Self reported health : Healthy (65.3%)
On medication : 83.7%
Psychiatry meds : 38.8%
No. of comorbidities
Health results
69%
29%
2%
0 to 3
4 to 7
more than 7
Logistic regression
11th Global Conference on Ageing "Ageing Connects”
Table 1: Demographic profiles of dementia patients in home care and nursing homes
Study cohort Statistics
Home care Nursing home
N (%) N (%)
Relationship satisfaction with children
Satisfied 14 (82.40) 4 (26.70)
Neither 2 (11.80) 2 (13.30)
Dissatisfied 1 (5.90) 9 (60.0) Fisher Exact =12.06, p =0.01
Financial status Average 15 (78.90) 4 (13.30)
Below average 4 (21.10) 26 (86.70) χ2=21.10, df=1, p<0.01
Uni-variate analysis
Discussion
11th Global Conference on Ageing "Ageing Connects”
Table 2: Health status of participants by study cohort
Study cohort
Home care Nursing home Statistics (a)
Months since
diagnosis
Mean (SD) 26.83 (32.0) 33.82 (15.94) t=0.65, df=21, p=0.52
WHO-8 = EUROHIS-QOL; AQoL-8 = Short Assessment of Quality of Life; FS = Friendship Scale
Means and standard deviations shown.
a = independent t-test
Multivariate analysis – multiple regression
Table 4: Predictors of QoL in dementia patients
Unstandardized Coefficients
B R2 B Std. Error
(Constant) 28.332 3.125
Living arrangement -1.644 1.574 -.209
Health condition 2.035 1.386 .225
Financial status -1.975 1.038 -.356
Cornell Scale for Depression -.301 .133 -.325*
Satisfaction with children -.035 .549 -.012 0.48
*p<0.05
The key findings (pilot study) :
1. Dementia patients living at home:
have more income
good relationship with children
more socially connected
have better physical functions
Have their needs fulfilled
have better overall QoL.
2. Suggested predictor for QoL = Depression
Conclusion: Home care – better overall QOL. Health care plans promoting community care for dementia patients supported by initiatives to reduce the burden of the caregivers.
11th Global Conference on Ageing "Ageing Connects”
Research Management Institute of Universiti Teknologi MARA,
Malaysia.
The University of Melbourne.
Ministry of Higher Education of Malaysia.
Acknowledgement
11th Global Conference on Ageing "Ageing Connects”
Acknowledgement
THANK YOU
THANK YOU
11th Global Conference on Ageing "Ageing Connects”