What matters most to sepsis survivors: a qualitative analysis to identify specific health-related quality of life domains

Quality of Life Research - It is unknown how sepsis survivors conceptualize health-related quality of life (HRQL). We aimed to identify important HRQL domains for this population. A literature...     

Apathy and health-related quality of life in nursing home residents

Quality of Life Research - To explore the association between apathy and health-related quality of life (HRQoL) from resident and proxy perspectives and whether cognition and depression moderate...     

Vision-specific health-related quality of life: Content areas for nursing home residents

Nursing home residents have a high prevalence of remediable visual impairment and blindness. Future research on the effectiveness of providing eye care to nursing home residents will need to include a vision-targeted health-related quality of life (HRQOL) instrument appropriate for this population. The purpose of this study was to identify the core content areas for such an instrument. In-depth interviews on vision-related issues were conducted with 40 residents. Interviews were audio-taped, transcribed, and coded using a standardized protocol. Binocular distance and near visual acuity were assessed using the resident's walking around correction to examine whether one vision-specific HRQOL measure could address the needs of residents with good and poor vision. Overall 1070 vision-related comments were identified. Residents mentioned 315 problem comments that were grouped into 13 categories, including ocular symptoms (18% of comments), reading (15%), general vision (13%), psychological distress (12%), and activities of daily living (ADLs) (7%). Compared to published data on vision-specific content areas most relevant to community based persons, nursing home residents focused more on ocular symptoms and basic ADLs, with no mention of issues related to driving, home care, and finances. The majority of categories mentioned did not differ on the proportion of comments made by those with good and poor visual acuity, suggesting that one vision-specific HRQOL instrument would be appropriate for residents with varying levels of visual acuity. Future work will focus on developing a vision-specific HRQOL instrument for nursing home residents.     

Well-being in the nursing home – a methodological approach towards the quality of life

Which dimensions have a decisive influence on the quality of life in nursing homes and which objective conditions could and should be changed to improve the situation of the residents of nursing homes? Can such questions be answered within the framework of an approach based on a daily life experience when life in nursing homes is so different from the every day life outside? Although there is a pressing need for answers to these questions, very little research has been conducted in this area to date. The furthering of empirically based knowledge, the development of concepts and the refinement and adaptation of research instruments are all crucial tasks currently facing researchers in this field. There are no one-dimensional causal relationships between objective conditions and subjectively experienced life quality. The latter is multidimensional and multidirectional, it changes over time and it varies according to cognitive-psychic and physical conditions. The objective of the project reported here was to study the quality of life in nursing homes from a radical subjective perspective that is reflected in the theoretical concepts and the methodological approaches adopted. Life quality in nursing homes can be enhanced and it can be hindered – and in both cases there are objective and subjective factors to be observed. In order to fulfil two tasks simultaneously – obtaining basic empirical insights and developing concepts and methods – we established a multi-method approach within the framework of an interdisciplinary perspective. Persons in nursing homes with slight or moderate cognitive impairments can be interviewed by standardised instruments, a fact which is mainly mirrored in the orientation capacity. For random sampling purposes, a systematically developed gradation of responsiveness is a useful guiding criterion. Additionally, life quality research in the setting of nursing homes requires a methodological approach on different levels with adaptable methods and instruments. The results from this study show that the degree of responsiveness and capacity of orientation are part of the life quality dimension and influence the results in terms of well-being which, in turn, is only one dimension among others. Therefore, life quality in the nursing home can be framed on three levels: individual resources, structural resources, well-being. The explanatory power of resources for subjectively felt well-being is shown in such relevant action-contexts as, for example, home admittance.     

What matters most: an investigation of predictors of perceived stress among young mothers in Khayelitsha

Our purpose in the present study was to examine how two different sets of stressors, one representing the physical environment and the other representing the social environment, related to perceived stress among new mothers served by a health clinic in Khayelitsha, South Africa. We found that among the chronic urban poverty-environmental stressors related to water, housing, transportation, toileting, and lack of food, that lack of drinkable water in the home had the strongest correlation with perceived stress. In terms of social stressors we found that 60% of new mothers had no partner, and 43% of those with a partner reported that they currently were not coresiding. In terms of the social stressors, the inability to depend on a partner in times of trouble had the strongest relationship to perceived stress. Other findings relating to partner support are discussed as well as sample and community characteristics. Given the importance of partner support, it is argued that the conditions of poverty itself serve to destabilize relationships, which in turn contributes to the cycle of poverty experienced by many residents of periurban settlements like Khayelitsha.     

Development of a quality of life questionnaire for nursing home residents in mainland China

Objective

To develop and validate a quality of life (QOL) questionnaire for nursing home (NH) residents in mainland China.

Methods

A cross-sectional study including a development sample (n?=?176) and validation sample (n?=?371) of NH residents aged 60 and older was conducted between 2015 and 2016 in Jinan, Shandong Province, China. Resident interviews, literature reviews, expert panels, and pilot studies were used to identify QOL domains and items pertinent to NH life. Exploratory and confirmatory factor analysis were used to develop and validate a QOL questionnaire. Reliability (internal consistency, spilt-half reliability, and test–retest reliability) and validity (construct and criterion validity) were evaluated for the questionnaire.

Results

The self-report Chinese NH QOL questionnaire had 9 domains and 38 items including physical health (4 items), food enjoyment (6 items), security (3 items), environmental comfort (5 items), autonomy (2 items), meaningful activity (3 items), interrelationship (6 items), family relationships (3 items), and mood (6 items). The nine-factor model was confirmed with the following fit indices: χ²/df?=?1.872, root mean square error of approximation?=?0.049, comparative fit index?=?0.913, and Tucker-Lewis index?=?0.903. The 38-item NH QOL questionnaire showed satisfactory construct validity, criterion validity, internal consistency (Cronbach’s alpha?=?0.89, spilt-half reliability?=?0.73, test–retest reliability?=?0.76).

Conclusions

The NH QOL questionnaire appears to be a reliable and valid instrument and should be incorporated into a set of quality measures for use with NH residents in mainland China

     

Effects of dog-assisted intervention on quality of life in nursing home residents with dementia

Background: People with dementia often have a poor quality of life. Therefore, methods that can improve their life situation must be identified. One promising method is dog-assisted intervention.

Aim: This study aimed to investigate the effects of dog-assisted intervention on quality of life in nursing home residents with dementia.

Materials and methods: A one-group, pretest post-test study design was used. Quality of life was measured using the QUALID in 59 nursing home residents prior to and after a dog-assisted intervention. Non-parametric tests were used to analyze the data, and effect sizes were calculated.

Results: The participants’ total scores improved significantly between baseline and post-test 1 (p?=?<?0.001) and worsened significantly at post-test 2 (p?=?0.025). The largest effect size was found for the item ‘Verbalization suggests discomfort’ (p?=?0.001).

Conclusion: The results indicate that dog-assisted interventions can have positive effects on quality of life in nursing home residents with moderate to severe dementia.

Significance: The results contribute to a growing knowledge base about non-pharmacological methods that can be used in dementia care. Occupational therapists should consider dog-assisted interventions when planning activities that can reduce the illness burden and improve the quality of life for people with dementia.     

Organizing for nursing home quality

This article explores the relationship between job, work group, and organizational design and the quality of nursing home care. Contingency theorists contend that effective organizations develop structures that support the nature of their production processes and complement their environment. Within the same facility, units with differing care requirements should be structured differently to achieve quality outcomes. Efforts to improve quality can be integrated through the practice of total quality management and facilitated by using the Health Care Financing Administration Minimum Data Set.     

Reporting quality of nursing home care to consumers: the Maryland experience.

OBJECTIVE: To design and implement a reporting system for quality of long-term care to empower consumers and to create incentives for quality improvement. To identify a model to approach this technically and politically difficult task. APPROACH: Establishment of a credible and transparent decision process using a public forum. Development of the system based on: (1) review of the literature and existing systems, and discussions with stakeholders about strengths and weaknesses; (2) focus on consumer preferences in the design; and (3) responsiveness to industry concerns in the implementation. LESSONS LEARNED: None of the existing systems appeared to be a suitable model. We decided to develop an entirely new system based on three key design principles that allowed us to tailor the system to consumer needs: (1) designing a decision tool rather than a database; (2) summarizing rather than simplifying information; and (3) accounting for the target audience in the creative execution. Industry concerns focused on the burden of the system, the potential for errors, and the possible communication of a negative impression of the industry. As methodological and data limitations prevented us from resolving those concerns, we addressed them by using cautionary language in the presentation and by making a commitment to incorporate improvements in the future. All stakeholders regarded the final design as an acceptable compromise. CONCLUSIONS: Despite its potentially controversial nature and many methodological challenges, the system has been well received by both the public and the industry. We attribute this success to two key factors: a collaborative decision process, in which all critical design and execution choices were laid out explicitly and debated with stakeholders in a public forum, and realism and honesty regarding the limitations of the system.     

Relationship of nursing home staffing to quality of care

OBJECTIVE: To compare nursing homes (NHs) that report different staffing statistics on quality of care. DATA SOURCES: Staffing information generated by California NHs on state cost reports and during onsite interviews. Data independently collected by research staff describing quality of care related to 27 care processes. STUDY DESIGN: Two groups of NHs (n=21) that reported significantly different and stable staffing data from all data sources were compared on quality of care measures. DATA COLLECTION: Direct observation, resident and staff interview, and chart abstraction methods. PRINCIPAL FINDINGS: Staff in the highest staffed homes (n=6), according to state cost reports, reported significantly lower resident care loads during onsite interviews across day and evening shifts (7.6 residents per nurse aide [NA]) compared to the remaining homes that reported between 9 to 10 residents per NA (n=15). The highest-staffed homes performed significantly better on 13 of 16 care processes implemented by NAs compared to lower-staffed homes. CONCLUSION: The highest-staffed NHs reported significantly lower resident care loads on all staffing reports and provided better care than all other homes.     

上海市某养老院老年人生活质量的影响因素分析

目的了解上海市某养老院老年人的生活质量及其影响因素,为行业管理部门制定养老服务的相关政策提供依据。方法2011年12月应用简明健康状况调查表（SF-36）、社会支持评定量表、老年抑郁量表（GDS）和孤独量表（UCLA—LS）对养老院内160名老年人进行调查,分析影响养老院老年人生活质量的因素以及生活质量与社会支持、抑郁、孤独的相关性。结果总调查人数160名,占该养老院老人总数的76．2％,年龄分布范围为60—98岁,平均年龄（82．0±8．8）岁。逐步多元线性回归分析显示,养老院老人生活质量中与生理功能明显相关的影响因素有3个,分别是有无子女、参加体育活动频率、自我健康状况评价;与生理职能、社会功能、活力及情感职能明显相关的影响因素有3个,分别是有年龄、参加体育活动频率、自我健康状况评价;与躯体疼痛明显相关的影响因素有2个,分别是性别、自我健康状况评价;与总体健康明显相关的影响因素有4个,分别是年龄、参加体育活动频率、慢性病数目、自我健康状况评价;与精神健康明显相关的影响因素有4个,分别是年龄、居住状况、参加体育活动频率、自我健康状况评价。Spearman秩相关分析显示,养老院老人客观支持与生活质量量表中情感职能、精神健康呈正相关,其主观支持、对社会支持利用度、社会支持总分与生活质量量表各维度均呈正相关;养老院老人其抑郁分值、孤独分值与生活质量量表各维度均呈负相关。结论影响养老院内老年人生活质量的因素众多,社会及家庭应予以关注。     

Health-related quality of life of among elders in rural China: the effect of widowhood

Purpose

China has an enormous and rapidly growing population of widowed elders. Little is known about how losing a spouse affects elders’ health-related quality of life (QOL), especially in the rural areas where most Chinese elders live. This article analyzes QOL data collected in 2014 among rural Chinese elders to address this question.

Methods

SF12 questionnaires and information about individual and household characteristics were collected from 3053 elders aged 60 and above in rural China. We compared the physical component summary (PCS) and mental component summary (MCS) scores between 1925 married elders and 1060 widowed elders in a bivariate model stratifying by gender and age group and in a general factorial ANOVA multivariate analysis that examined and controlled for other predictors of PCS and MCS scores including education, chronic disease, and family and household factors.

Results

Widowed male and female elders’ physical health and mental health were in decline with age. Widowed men had lower PCS and MCS scores than married men. Widowed women also had lower PCS scores, but differences in MCS scores did not reach statistical significance. In multivariate analysis, widowhood was associated with lower PCS and MCS scores overall. Support from children was associated with better QOL and, based on interaction analysis, appeared to mitigate negative effects of widowhood.

Conclusions

Widowed rural elders in China have lower physical and mental quality of life than their married counterparts. These elders rely on their children for care, and a supportive family is associated with better QOL.

     

Finding a useful conceptual basis for enhancing the quality of life of nursing home residents

In this article it is depicted that before nursing home staff can effectively contribute to optimising the quality of life (QOL) of nursing home residents, it has to be clear what exactly QOL is and how it can be enhanced. The aim is to identify a QOL framework that provides tools for optimising QOL and can form the basis for the development of guidelines for QOL enhancement. For that purpose, a framework should meet three basic criteria: (1) it should be based on assumptions about comprehensive QOL of human beings in general; (2) it should clearly describe the contribution of each dimension to QOL and identify relationships between the dimensions; (3) it should take individual preferences into account. After the criteria are defined, frameworks identified from a literature search are discussed and evaluated according to these criteria. The most suitable framework appears to be the QOL framework of the theory of Social Production Functions. The implications of this framework in understanding the QOL of nursing home residents are described and recommendations for further research are discussed.     

Rurality and nursing home quality: results from a national sample of nursing home admissions

OBJECTIVES: We examined differences in quality of care among nursing homes in locales of varying degrees of rurality. METHODS: We classified locales into 4 classes according to rurality. We analyzed a 10% sample of nursing home admissions in the United States in 2000 (n=198613) to estimate survival models for 9 quality indicators. RESULTS: For postacute admissions, we observed significant differences in rates of decline for residents in facilities in large towns compared with urban areas, but differences in quality were both negative and positive. Among admissions for long-term or chronic care, rates of decline in 2 of 9 quality areas were lower for residents in isolated areas. CONCLUSIONS: We observed significant differences in a number of quality indicators among different classes of nursing home locations, but differences varied dramatically according to type of admission. These differences did not exhibit the monotonicity that we would have expected had they derived solely from rurality. Also, quality indicators exhibited more similarities than differences across the 4 classes of locales. The results underscore the importance, in some instances, of emphasizing the effects of specific settings rather than some continuum of rurality and of moving beyond the assumption that nursing home residents constitute a homogeneous population.     

Using WHOQOL-BREF to evaluate quality of life among Turkish elders in different residential environments

Objective  This study used the Brief Version of The World Health Organization’s Quality of Life Questionnaire (WHOQOL-BREF) to assess and compare the quality of life in older people who live at home and older people who live in public assisted-living facilities for the elderly. Design  Cross-sectional. Setting  Data were collected by a research nurse in each home and in the assisted living facility. Participants  Participants were 60 years old and older. The sample included 37 people who were living in a public assisted-living facility and 37 elderly people living in their own homes. Measurement  The WHOQOL-BREF was used to measure participants’ quality of life. Results  The groups were similar according to gender, literacy, existence of chronic diseases, and general perceived health. However, quality of life scores for social relationships and environment domains were lower in those living in an assisted living facility than those living in their own homes. The scores for elderly females staying in the assisted living facility were lower compared to the scores of males in the facility. Conclusion  The results suggest that social and environmental domains of life quality are low in elderly assisted living facilities. Social activities should be diversified for elderly people staying in assisted living facilities to improve social relationships. Physical and psychological health of females in assisted living facilities should be comprehensively supported by professionals. Alternatively, elderly people may be professionally supported to live in their own homes.