School of Medicine & Public Health, University of Newcastle, Newcastle, NSW, Australia.
Int Psychogeriatr. 2012 Dec;24(12):1962-71. doi: 10.1017/S1041610212001111. Epub 2012 Jul 4.
Identification of factors associated with quality of life (QoL) in people having dementia will help develop strategies for maintenance and improvement of patient QoL. This study examined the predictors of QoL in a community-dwelling population aged 75 years and over, with or without dementia.
This was a cross-sectional study involving 169 GPs and 2,028 patients. Patients were interviewed to collect information on personal circumstances. Several instruments were administered including the WHOQOL-BREF (quality of life outcome measure), Geriatric Depression Scale, GPAQ (satisfaction with GP care), and the CAMCOG-R (cognitive function). Patients with a CAMCOG-R score < 80 were allocated to the dementia group. GPs provided an independent clinical judgment of cognitive function for each of their participating patients.
The dementia group had significantly lower QoL scores in all four domains of the WHOQOL-BREF (all p ≤ 0.002). The GDS score was negatively correlated with all four domains in the non-dementia group and with physical, psychological, and environmental QoL in the dementia group (all p < 0.001). Satisfaction with GP communication was positively associated with psychological QoL in the dementia group and all domains in the non-dementia group. Participants in the dementia group who had been given a diagnosis of a memory problem had significantly higher physical (2.05, 95% CI 0.36 to 3.74) and environmental (2.18, 95% CI 0.72 to 3.64) QoL.
Satisfaction with GP communication is associated with a higher QoL in their older patients. Diagnosis and disclosure of memory problems is associated with better QoL in people with dementia. Clinicians should not be deterred from discussing a memory diagnosis and plans for the future with patients.
确定与痴呆患者生活质量(QoL)相关的因素有助于制定维持和提高患者 QoL 的策略。本研究检查了 169 名全科医生和 2028 名患者中年龄在 75 岁及以上、有或没有痴呆的社区居民的 QoL 预测因素。
这是一项横断面研究,涉及 169 名全科医生和 2028 名患者。对患者进行访谈以收集个人情况信息。使用了几种工具,包括 WHOQOL-BREF(生活质量结果衡量标准)、老年抑郁量表、GPAQ(对全科医生护理的满意度)和 CAMCOG-R(认知功能)。CAMCOG-R 评分<80 的患者被分配到痴呆组。每位参与患者的全科医生提供了独立的认知功能临床判断。
痴呆组在 WHOQOL-BREF 的所有四个领域的 QoL 评分均显著降低(均 p≤0.002)。在非痴呆组中,GDS 评分与所有四个领域均呈负相关,在痴呆组中与身体、心理和环境 QoL 呈负相关(均 p<0.001)。与痴呆组的心理 QoL 和非痴呆组的所有领域均与对全科医生沟通的满意度呈正相关。被诊断为记忆问题的痴呆组参与者的身体(2.05,95%CI 0.36 至 3.74)和环境(2.18,95%CI 0.72 至 3.64)QoL 显著更高。
与全科医生沟通的满意度与老年患者更高的 QoL 相关。诊断和披露记忆问题与痴呆患者的 QoL 更好相关。临床医生不应回避与患者讨论记忆诊断和未来计划。