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Geriatr Gerontol Int 2015; 15: 38–44
ORIGINAL ARTICLE: EPIDEMIOLOGY, CLINICAL PRACTICE AND HEALTH
Quality of life by proxy and mortality in institutionalized older adults with dementia Abel E González-Vélez,1 María Joao Forjaz,2 Carolina Giraldez-García,3 Salomé Martín-García4 and Pablo Martínez-Martín5 on behalf of the Spanish Research Group on Quality of Life and Ageing 1
Service of Preventive Medicine, University Hospital Ramón y Cajal, 2National School of Public Health and REDISSEC, Carlos III Institute of Health, 3Service of Preventive Medicine, University Hospital La Paz, 4EULEN Socio-sanitary Services, and 5Alzheimer Disease Research Unit and CIBERNED, Alzheimer Center Reina Sofia Foundation, Carlos III Institute of Health, Madrid, Spain
Aim: This study aimed at analyzing the effect of quality of life (QoL) on mortality in older adults with dementia living in long-term care facilities. Methods: A prospective observational cohort study was carried out on 412 residents aged older than 60 years, diagnosed with dementia according to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition. Besides assessment of QoL (EQ-5D index by proxy) and perceived health status (EQ-VAS), baseline measurements included severity of dementia (Clinical Dementia Rating Scale [CDR]), comorbidity (number of self-reported chronic conditions), disability evaluation (Barthel Index), cognitive state (Mini Examen Cognoscitivo, a validated and modified Spanish version of the Mini-Mental State Examination) and depression (Cornell Depression Scale for Dementia). Sociodemographic and clinical variables were analyzed as potential effect modifiers and confounders in the relationship between QoL and mortality using a multivariate logistic regression analysis. Results: After an 18-month follow up, 138 residents had died. Adjusting for CDR and Barthel Index, the odds of mortality were multiplied by 0.25 (95% CI 0.09–0.70) and 0.79 (95% CI 0.26–2.42) for every unit of change in the EQ-5D index in the residents with Cornell score 40 (moderate dependency), the mean EQ-5D was 0.5 points higher than in those with an index of ≤40 (severe dependency; P < 0.001). The EQ-5D mean differences in terms of comorbidity and depression were not significant.
Effect of the quality of life on mortality As a result of analysis of potential confounding and modifying factors in the relationship between EQ-5D and mortality (Table 2), the reference regression model included the interaction term Cornell × EQ-5D (Fig. 1), and confounding variables of CDR and Barthel Index. After comparison of the reference model with the different reduced models resulting from eliminating each one of the confounding factors, in residents with Cornell Depression Scale 7 MEC Cornell scale (depression)
Geriatr Gerontol Int 2015; 15: 38–44
ORIGINAL ARTICLE: EPIDEMIOLOGY, CLINICAL PRACTICE AND HEALTH
Quality of life by proxy and mortality in institutionalized older adults with dementia Abel E González-Vélez,1 María Joao Forjaz,2 Carolina Giraldez-García,3 Salomé Martín-García4 and Pablo Martínez-Martín5 on behalf of the Spanish Research Group on Quality of Life and Ageing 1
Service of Preventive Medicine, University Hospital Ramón y Cajal, 2National School of Public Health and REDISSEC, Carlos III Institute of Health, 3Service of Preventive Medicine, University Hospital La Paz, 4EULEN Socio-sanitary Services, and 5Alzheimer Disease Research Unit and CIBERNED, Alzheimer Center Reina Sofia Foundation, Carlos III Institute of Health, Madrid, Spain
Aim: This study aimed at analyzing the effect of quality of life (QoL) on mortality in older adults with dementia living in long-term care facilities. Methods: A prospective observational cohort study was carried out on 412 residents aged older than 60 years, diagnosed with dementia according to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition. Besides assessment of QoL (EQ-5D index by proxy) and perceived health status (EQ-VAS), baseline measurements included severity of dementia (Clinical Dementia Rating Scale [CDR]), comorbidity (number of self-reported chronic conditions), disability evaluation (Barthel Index), cognitive state (Mini Examen Cognoscitivo, a validated and modified Spanish version of the Mini-Mental State Examination) and depression (Cornell Depression Scale for Dementia). Sociodemographic and clinical variables were analyzed as potential effect modifiers and confounders in the relationship between QoL and mortality using a multivariate logistic regression analysis. Results: After an 18-month follow up, 138 residents had died. Adjusting for CDR and Barthel Index, the odds of mortality were multiplied by 0.25 (95% CI 0.09–0.70) and 0.79 (95% CI 0.26–2.42) for every unit of change in the EQ-5D index in the residents with Cornell score 40 (moderate dependency), the mean EQ-5D was 0.5 points higher than in those with an index of ≤40 (severe dependency; P < 0.001). The EQ-5D mean differences in terms of comorbidity and depression were not significant.
Effect of the quality of life on mortality As a result of analysis of potential confounding and modifying factors in the relationship between EQ-5D and mortality (Table 2), the reference regression model included the interaction term Cornell × EQ-5D (Fig. 1), and confounding variables of CDR and Barthel Index. After comparison of the reference model with the different reduced models resulting from eliminating each one of the confounding factors, in residents with Cornell Depression Scale 7 MEC Cornell scale (depression)
