LAUSR

Key summary pointsAimThe aim was to investigate the association of severity of neuropsychiatric symptoms and health-related quality of life and their interaction with dementia severity among institutionalized older people with dementia.FindingsNeuropsychiatric symptom burden was associated with higher health-related quality of life in residents with severe dementia, whereas among those residents with mild–moderate dementia this association was not seen. Very low functional capacity was linked to both low number of neuropsychiatric symptoms and low health-related quality of life among those with severe dementia.MessageIn severe dementia, higher neuropsychiatric symptom burden and better health-related quality of life indicate better functioning and higher vitality.AbstractPurposeThe primary focus in long-term care is to maintain quality of life. The aim of this study was to investigate the association of severity of neuropsychiatric symptoms (NPS) and health-related quality of life (HRQoL) and their interaction with dementia severity among institutionalized older people with dementia.Methods352 long-term care residents aged 65 years or over with dementia participated in this cross-sectional study. NPS were measured with Neuropsychiatric Inventory (NPI). HRQoL was measured with 15D. Dementia severity was measured with Clinical Dementia Rating (CDR).ResultsThe severity of NPS was significantly associated with better HRQoL in 15D. Residents with severe dementia (CDR 3) had worse HRQoL than residents with mild–moderate dementia (CDR < 3). There was a significant interaction between NPI and CDR (p = 0.037 for NPI, p < 0.001 for CDR, p < 0.001 for interaction). HRQoL correlated positively with all NPS subgroups in residents with severe dementia, but in residents with mild–moderate dementia, no significant correlation existed. In severe dementia, higher NPI correlated positively with such dimensions of 15D as mobility, vision, eating, speech, excretion, usual activities, mental functions, and vitality, whereas in residents with mild–moderate dementia only with mobility. In mild–moderate dementia, NPI correlated negatively with depression, distress and vitality.ConclusionDementia severity and NPS burden are important determining factors of HRQoL in long-term care. NPS have a distinct impact on HRQoL at different stages of dementia. In severe dementia, higher NPS and better HRQoL indicate better functioning and higher vitality.