Trajectories of Quality of Life by the Elderly in Early Phase of Dementia

Introduction In the Czech Republic, there are about 120 -150 thousand people living with dementia. The most common form of dementia is the Alzheimer's disease, which constitutes about 50 -70 % of all dementia cases and its prevalence in the population is on the rise with the increasing proportion of population over 60 years of age. In 2012, patients with dementia in Alzheimer's disease (AD), who were treated with this disease for the first time, comprised more than 28 % of total number of outpatients treated for dementia. Number of treated patients with dementia increased by 5 % between years 2012 and 2013. According to the World Health Organisation, dementia has become a priority for the health care system. Maintaining or improving the quality of life (QoL) amongst the elderly with dementia is currently one of the key aims of health care. Foreign literature points out the fact that QoL amongst the elderly with dementia (EwD) has not yet been sufficiently examined, particularly in the long-term perspective. This may stem from the fact that QoL amongst the EwD was examined in relation to a relatively limited group of factors. We see an attempt to define each of the factors affecting the quality of life amongst EwD. Among factors with direct impact on the assessment of QoL amongst the EwD is attitude to aging. Social and interpersonal factors also play an important role in the subjective perception of QoL. This includes a decreased ability to communicate which deepens the social isolation at an early-phase dementia, which is reflected negatively in the subjectively perceived QoL amongst EwD. QoL amongst the elderly with slight cognitive impairment and dementia is significantly affected by fear of falling. Other factors include dignity, chronic pain and depression. Another major factor connected with age is frailty, which impairs the ability of the organism to react to stressors and affects QoL. For this reason the relation between frailness and cognitive impairment is studied today. One of the factors affecting QoL amongst EwD is also functional condition. The EwD need an increased amount of supervision and help with activity daily living (ADL) and this dependence negatively affects their QoL. The relation between comorbidity and QoL amongst EwD has not been clearly proved in earlier studies. However, an important aspect of comorbidity is its relation to QoL and health status of the elderly. An early-phase dementia is primarily characterised by memory impairment with a relatively maintained self-sufficiency requiring only minor attention and help by family caregivers. Older adults are usually aware of their condition which may cause depression, anxiety and insecurity. Self-assessment of QoL amongst people with early-phase dementia is supported in the latest research abroad. Cross-sectional studies but a mainly long-term observation of QoL trajectory is important in individuals with dementia. When investigating the trajectory of QoL amongst EwD, it is necessary to examine the factors which might affect QoL. So far, there have been few longitudinal studies focusing on changes in QoL in connection with progressing dementia and contributing factors. This may be due to the fact that the QoL amongst EwD was examined in relation to a relatively limited group of factors, even though previous research recommended to examine the changes in QoL amongst EwD in the long run and in a larger group of respondents.

Project Objectives In order to maintain the maximum possible quality of life in people suffering from a disease of the nervous system, an early diagnosis and therapy is necessary, as well as nursing and psychosocial care.

The aim is not only to improve the quality of life with a lower frequency and length of hospitalisations, but also to enhance individual's resilience.

The chance to express the quality of life subjectively shifts the assessment of health care results from a solely medical perspective to an assessment from the perspective of a concrete individual.

The objective of the project is a monitoring of the trajectory of subjectively perceived quality of life amongst the elderly with early-phase dementia in the long run. Identifying the factors and their effect on the quality of life may help to enhance resilience of the elderly and to have a positive effect on the physical, psychosocial and social dimension of the quality of life with early-phase dementia in home care and thus lower the frequency and length of hospitalisations as well as costs in health care and social care.