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 Quality of life of Dementia Patients in Malaysia: What did we believe and what did we found? 11th Global Conference on Ageing "Ageing Connects” 11th Global Conference on Ageing "Ageing Connects”
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Quality of life of Dementia Patients in Malaysia: What did we believe and what did we found?
Quality of life of Dementia Patients in Malaysia: What did we believe and what did we found?. 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. - PowerPoint PPT Presentation
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Azlina Wati Nikmat1,2 Graeme Hawthorne1, Sam Korn1
1Department of Psychiatry, The University of Melbourne2Department of Psychiatry, University Teknologi MARA
Quality of life of Dementia Patients in Malaysia:
What did we believe and what did we found?
11th Global Conference on Ageing "Ageing Connects”11th Global Conference on Ageing "Ageing Connects”
Predicted future prevalence of dementia
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”
Why aging matters: dementia is a function of age
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
Dementia prevalence compared with other common medical conditions (millions)
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”
Dementia & caregiving
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
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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 lifeAND Nursing home/home care 5 343 5
12 related papers; 5 shared papers and 7 unique papers
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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
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Literature review – IV: conclusions
Methodology
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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)
Objectives
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”
Significance of the study
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.
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Conceptual framework of study
QoLMental health/psychological
Physical functions/activities
Environmental
Social relationship
11th Global Conference on Ageing "Ageing Connects”
Research design and Sampling
• 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”
Procedure
Review medical record for inclusion and exclusion criteria and exclusion
criteria
Meet criteria Does not meet criteria
Consent form and provide participant information sheet
An average of 60-90 minutes to administer the questionnaires
11th Global Conference on Ageing "Ageing Connects”
Measurements
Sample size calculation – based on estimates
• Nursing Homes: Mean = 21.22, SD = 4.64 • Home Care: Mean = 23.29, SD = 4.56
22
122 ))((
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”
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
MalayChineseIndian
12%
31%
12%
45%
Marital status
SingleMarriedSeparatedWidowed
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 34 to 7more than 7
Logistic regression
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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
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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 CoefficientsB 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.
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Conclusion
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 YOUTHANK YOU
11th Global Conference on Ageing "Ageing Connects”