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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.

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Quality of life of Dementia Patients in Malaysia: What did we believe and what did we found?

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  1. Quality of life of Dementia Patients in Malaysia: What did we believe and what did we found? AzlinaWatiNikmat1,2 Graeme Hawthorne1, Sam Korn1 1Department of Psychiatry, The University of Melbourne 2Department of Psychiatry, University Teknologi MARA 11th 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) Predicted future prevalence of dementia 11th Global Conference on Ageing "Ageing Connects”

  3. Source: Jorm et al (1987) Why aging matters: dementia is a function of age 11th Global Conference on Ageing "Ageing Connects”

  4. Dementia prevalence compared with other common medical conditions (millions) * WHO THE GLOBAL BURDEN OF DISEASE – 2004 UPDATE, 2008

  5. Dementia & caregiving • 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 11th 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, teBoekhorst 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, 2009 11th 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; teBoekhorst 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, 2006 11th 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: • To identify and compare the quality of life of dementia patients in nursing home and those in community (cared by family members) Methodology 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) Objectives 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. Significanceof the study 11th Global Conference on Ageing "Ageing Connects”

  14. Conceptual framework of study 11th 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) • RumahEhsan 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 Research design and Sampling 11th Global Conference on Ageing "Ageing Connects”

  16. 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 Consent Non-consent Exit SMMSE score ≥11 Administer SMMSE Administration of other assessments SMMSE score <11

  17. Inclusion criteria • Consented respondents age 60-89 years old • Sufficient command of the Malay or English language (able to complete a questionnaire or interview) • Score <11 in the Short Mini Mental State Examination (SMMSE) • No use of antipsychotic medications Exclusion criteria Respondents aged less than 60 or more than 90 years old Cannot speak or poor understanding of Malay or English language Score ≥11 in the Short Mini Mental State Examination (SMMSE) Physically challenged patients (eg; blind, stroke) Psychosis 11th 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 questionnaires 11th Global Conference on Ageing "Ageing Connects”

  19. Sample size calculation – based on estimates • Nursing Homes: Mean = 21.22, SD = 4.64 • Home Care: Mean = 23.29, SD = 4.56 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. 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 • 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 :

  23. Health results • Self reported health : Healthy (65.3%) • On medication : 83.7% • Psychiatry meds : 38.8% • No. of comorbidities

  24. Uni-variate analysis Logistic regression 11th Global Conference on Ageing "Ageing Connects”

  25. Discussion 11th Global Conference on Ageing "Ageing Connects”

  26. 11th Global Conference on Ageing "Ageing Connects”

  27. Multivariate analysis – multiple regression *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. Conclusion 11th Global Conference on Ageing "Ageing Connects”

  29. Acknowledgement • Research Management Institute of UniversitiTeknologi MARA, Malaysia. • The University of Melbourne. • Ministry of Higher Education of Malaysia. Acknowledgement 11th Global Conference on Ageing "Ageing Connects”

  30. THANK YOU THANK YOU 11th Global Conference on Ageing "Ageing Connects”

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