4 nikmat-qol of dementia patients in malaysia 09052012
Upcoming SlideShare
Loading in...5
×
 

4 nikmat-qol of dementia patients in malaysia 09052012

on

  • 413 views

 

Statistics

Views

Total Views
413
Views on SlideShare
409
Embed Views
4

Actions

Likes
0
Downloads
0
Comments
0

2 Embeds 4

http://ifa.local.estetica-hosting.cz 3
http://www.mefeedia.com 1

Accessibility

Categories

Upload Details

Uploaded via as Adobe PDF

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment

4 nikmat-qol of dementia patients in malaysia 09052012 Presentation Transcript

  • 1. Azlina Wati Nikmat1,2 Graeme Hawthorne1, Sam Korn1 1Department of Psychiatry, The University of Melbourne 2Department of Psychiatry, University Teknologi MARA11th Global Conference on Ageing "Ageing Connects”11th Global Conference on Ageing "Ageing Connects”
  • 2.  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”
  • 3. Source: Jorm et al (1987)11th Global Conference on Ageing "Ageing Connects”
  • 4. Disabling Low and middle income High income countries Worldcondition countries 0-59 Years 60 years and 0-59 Years 60 years and All age over overHearing loss 54.3 43.9 7.4 18.5 124.2Glaucoma 5.7 7.9 0.4 1.5 15.5Alzheimer and 1.3 7.0 0.4 6.2 14.9other dementiasCerebro- 4.0 4.9 1.4 2.2 12.6vascularDiseaseRheumatoid 5.9 3.0 1.3 1.7 11.9arthritis * WHO THE GLOBAL BURDEN OF DISEASE – 2004 UPDATE, 2008
  • 5.  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”
  • 6. Literature review – I: search  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.11th Global Conference on Ageing "Ageing Connects”
  • 7. Literature review – II: N. papers 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 5 343 5 AND Nursing home/home care 12 related papers; 5 shared papers and 7 unique papers11th Global Conference on Ageing "Ageing Connects”
  • 8. Literature review – III: outcomes  Quality of life of the caregiver  eg: Alonso et. al, 2004; Bruce, 2005; Kurz, 2003;Thomas et. al, 2006, te Boekhorst et. al, 2008  Measuring quality of life  Context of measures  eg: Etema et. al, 2005; Inouye et. al, 2009; Smith et. al, 2005; Wolak et. al, 2009  Reliability of measurement  eg: Gerritsen et. al, 2007; Kavirajan et. al, 2009; Thorgrimsen et. al, 2003; Trigg et. al, 2007; Logsdon et. al, 2002; Wolak et. al, 200911th Global Conference on Ageing "Ageing Connects”
  • 9. Literature review – III: outcomes (cont.)  Proxy versus self report  eg: Arlt et. al, 2008; Huang et. al, 2009; Moyle et. al, 2007; Ready et. al 2004)  Factors associated with quality of life  Living arrangement  eg: Hoe et. al, 2006; te Boekhorst et. al, 2008  Cognitive decline  eg: Missotten et. al, 2008  Health functions  eg: Murray & Boyd, 2009  Pharmacotherapy in dementia  eg: Ward et. al., 2008; Hughes & Medina-Walpole, 2000; Kirby et. al, 200611th Global Conference on Ageing "Ageing Connects”
  • 10. Literature review – IV: conclusions  Lack of study comparing the QoL of dementia patients in nursing home and home care  Various instruments used in assessing QoL –  Different construct  eg: Anderson et. al, 1999; Farquhar, 1995; Grewal et. al, 2006; Brown et. al. 2004; WHOQoL group, 1998  Generic vs Specific  eg: Pettit et. al, 2001; Power et. al, 2005; Selai & Trimble, 1999; Smith et. al, 2005  Self report vs proxy report  eg: Brod et. al, 1999; Thorgrimsen et. al, 2003; Ready et. al, 2002; Logsdon, 1999; Magaziner, 1997; Rabins et. al, 1999; Selai, 2001)11th Global Conference on Ageing "Ageing Connects”
  • 11. The study protocol  Aims: Methodology  To identify and compare the quality of life of dementia patients in nursing home and those in community (cared by family members)11th Global Conference on Ageing "Ageing Connects”
  • 12.  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”
  • 13.  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”
  • 14. Mental health/ psychological Physical Social relationship QoL functions/ activities Environmental11th Global Conference on Ageing "Ageing Connects”
  • 15. • 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 Buloh11th Global Conference on Ageing "Ageing Connects”
  • 16. Review medical record for inclusion and exclusion criteria and exclusion criteria Meet criteria Does not meet criteria Consent form and provide participant information sheet Consent Non-consent Exit SMMSE score ≥11Administer SMMSE Administration of other SMMSE score <11 assessments
  • 17. Inclusion criteria Exclusion criteria - Consented respondents age 60- - Respondents aged less than 60 or 89 years old more than 90 years old - Sufficient command of the Malay - Cannot speak or poor or English language (able to understanding of Malay or English complete a questionnaire or language interview) - Score ≥11 in the Short Mini - Score <11 in the Short Mini Mental State Examination Mental State Examination (SMMSE) (SMMSE) - Physically challenged patients (eg; - No use of antipsychotic blind, stroke) medications - Psychosis11th Global Conference on Ageing "Ageing Connects”
  • 18. Measurements  Measurements :  Socio-demographic information,  WHO-8,  AQoL-8,  FS,  CSDD,  CANE-S,  Barthel Index  An average of 60-90 minutes to administer the questionnaires11th Global Conference on Ageing "Ageing Connects”
  • 19. • Nursing Homes: Mean = 21.22, SD = 4.64 • Home Care: Mean = 23.29, SD = 4.56 ( sd n  sd ne )( Z  Z1  ) 2 2 2 n e   ne 2 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”
  • 20. 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 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”
  • 21. 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%.11th Global Conference on Ageing "Ageing Connects”
  • 22. Demographic results Ethnicity Mean age : 70.4 (7.44) Female : 55.1 % 10% Education : Primary school (46.9 % ) Malay 27% Chinese High school (28.6 %) 63% Indian Financial status : Average (36.7 %) Slightly below average (51 %) Marital status Relationship satisfaction : Very satisfied 8.2 % 12% Single Satisfied 28.6 % 45% Married Neither 10.2 % 31% Separated Dissatisfied 10.2 % Widowed 12% Very dissatisfied 65.3 %
  • 23. Health results  Self reported health : Healthy (65.3%)  On medication : 83.7%  Psychiatry meds : 38.8%  No. of comorbidities 2% 29% 0 to 3 4 to 7 69% more than 7
  • 24. Logistic regression Uni-variate analysis Table 1: Demographic profiles of dementia patients in home care and nursing homes Study cohort Statistics Home care Nursing home N (%) N (%) Relationship Satisfied 14 (82.40) 4 (26.70) satisfaction with children 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<0.0111th Global Conference on Ageing "Ageing Connects”
  • 25. Table 2: Health status of participants by study cohort Study cohort Home care Nursing home Statistics (a) Months since Mean (SD) 26.83 (32.0) 33.82 (15.94) t=0.65, df=21, p=0.52 diagnosis Health condition Not healthy 5 (26.30) 12 (40.00) Healthy 14 (73.70) 18 (60.00) χ2=0.96, df=1, p=0.33 Co-morbidities Mean (SD) 2.95 (1.68) 2.77 (1.99) t=0.33, df =47, p=0.75 Medication used No 3 (15.80) 5 (16.70) Discussion Yes 16 (84.20) 25 (83.30) Fisher Exact, p = 1.00 SMMSE Mean (SD) 6.63 (3.11) 5.20 (2.28) t=1.86, df=47, p=0.07 CSDD Mean (SD) 6.89 (4.27) 7.20 (4.11) t=0.29, df=47, p=0.80 BI Mean (SD) 90.26 (13.59) 77.50 (15.63) t=2.93, df = 47, p<0.01 Notes: SMMSE = Short Mini Mental State Examination; CSDD = Cornell Scale of Depression in Dementia; BI = Barthel Index; FS = Friendship Scale a = t = independent t-test11th Global Conference on Ageing "Ageing Connects”
  • 26. Table 3: Quality of life, social isolation and needs of dementia patients by study cohort Study cohort Scales Home care Nursing Home Statistics (a) WHO-8 19.63 (3.53) 16.07 (3.71) t=3.34, df=47, p<0.01 AQOL-8 0.43 (0.18) 0.30 (0.20) t=2.28, df=47, p=0.03 FS 15.11 (3.63) 10.80 (3.68) t=4.01, df=47, p<0.01 CANE 8.21 (6.27) 6.19 (1.13) t=3.14, df=47, p<0.01 Notes: WHO-8 = EUROHIS-QOL; AQoL-8 = Short Assessment of Quality of Life; FS = Friendship Scale Means and standard deviations shown. a = independent t-test11th Global Conference on Ageing "Ageing Connects”
  • 27. Multivariate analysis – multiple regressionTable 4: Predictors of QoL in dementia patients Unstandardized Coefficients B Std. Error B R2(Constant) 28.332 3.125Living arrangement -1.644 1.574 -.209Health condition 2.035 1.386 .225Financial status -1.975 1.038 -.356Cornell Scale for Depression -.301 .133 -.325*Satisfaction with children -.035 .549 -.012 0.48*p<0.05
  • 28.  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”
  • 29. Acknowledgement  Research Management Institute of Universiti Teknologi MARA, Malaysia.  The University of Melbourne. Acknowledgeme nt  Ministry of Higher Education of Malaysia.11th Global Conference on Ageing "Ageing Connects”
  • 30. THANK YOU THANK YOU11th Global Conference on Ageing "Ageing Connects”