Does Cognitive Impairment Influence Quality of Life Among Nursing Home Residents?
Open accessAbstract
PURPOSE: We investigated the relationship between cognitive status and quality of life (QOL) of Minnesota nursing home (NH) residents and the relationship between conventional or Alzheimer's special care unit (SCU) placement and QOL. The study may inform development of dementia-specific quality measures. DESIGN AND METHODS: Data for analyses came from face-to-face interviews with a representative sample of 13,130 Minnesota NH residents collected through the 2007 Minnesota NH Resident Quality of Life and Consumer Satisfaction survey. We examined 7 QOL domains: comfort, meaningful activities, privacy, environment, individuality, autonomy, relationships, and a positive mood scale. We applied multilevel models (resident and facility) to examine the relationship between the resident's score on each QOL domain and the resident's cognitive impairment (CI) level and SCU placement after controlling for covariates, such as activities of daily living dependency, pain, depression or psychiatric diagnosis, and length of stay. RESULTS: Residents with more severe CI reported higher QOL in the domains of comfort and environment and lower QOL in activities, individuality, privacy and meaningful relationships, and the mood scale. Residents on SCU reported higher QOL in the meaningful activities, comfort, environment, and autonomy domains but had lower mood scores. IMPLICATIONS: Our findings point to QOL domains that show significant variation by CI and thus may be of greatest interest to consumers, providers, advocacy groups, and other stakeholders committed to improving dementia care. Findings are particularly applicable to the development of NH quality indicators that more accurately represent the QOL of NH residents with CI.
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Better functional abilities in the SCU group at baseline compared to the n-SCU group were found in 6 studies with large, moderate and small effect sizes or significant p values.
“Better functional abilities in the SCU group at baseline compared to the n-SCU group were found in 6 studies with large [8], moderate [9] and small [27,34,35] effect sizes or significant p values [44].”
From Special Care Units and Traditional Care in Dementia: Relationship with Behavior, Cognition, Functional Status and Quality of Life - A Review (2013) · cites this paper as [35]
The Findings (p. 4) report that SCU residents had significantly greater activities-of-daily-living dependency than conventional-unit residents, indicating worse—not better—functional ability. The paper compares residents at the time of its survey; it does not describe this comparison as a baseline finding. (LLM, conf=0.90)
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Experimental — accuracy not yet measuredIn 5 studies, effect sizes (large, moderate, small) indicated more challenging behavior in SCUs compared to n-SCUs.
“In 5 studies, large [33], moderate [9,34,35] and small [20,36] effect sizes with a more challenging behavior in SCUs as compared to n-SCUs were found.”
From Special Care Units and Traditional Care in Dementia: Relationship with Behavior, Cognition, Functional Status and Quality of Life - A Review (2013) · cites this paper as [35]
The Background (p. 2) says SCUs are more likely to have residents with behavioral problems, supporting the direction of the comparison. The paper does not report an effect size for challenging behavior; its Findings (p. 4) compare quality of life and other resident characteristics instead. It therefore does not substantiate the small effect size attributed to this citation. (LLM, conf=0.84)
Experimental — accuracy not yet measuredGlobal behavior and mood, e.g. depression, did not change significantly over time in 3 n-SCU/SCU studies and 4 small-scale, homelike SCU/SCU studies.
“‘Global behavior’ and mood, e.g. depression, did not change significantly over time in 3 n-SCU/SCU studies [20,35,46] and 4 small-scale, homelike SCU/SCU studies [10,12,13,15].”
From Special Care Units and Traditional Care in Dementia: Relationship with Behavior, Cognition, Functional Status and Quality of Life - A Review (2013) · cites this paper as [35]
The Data and Sample section (p. 4) describes an analysis of residents’ quality-of-life and mood scores by cognitive impairment and SCU placement. The Findings (p. 4) compare mood scores between groups, but neither passage reports change over time in mood or global behavior. Searches for longitudinal change and small-scale homelike SCUs found no such result in our copy. (LLM, conf=0.78)
Experimental — accuracy not yet measuredNo differences over time in global cognitive functioning were shown in 4 n-SCU/SCU and 2 small-scale, homelike SCU/SCU studies.
“With respect to global cognitive functioning, no differences over time were shown in 4 n-SCU/SCU [9,25,35,46] and 2 small-scale, homelike SCU/SCU studies [13,15].”
From Special Care Units and Traditional Care in Dementia: Relationship with Behavior, Cognition, Functional Status and Quality of Life - A Review (2013) · cites this paper as [35]
The study description (p. 1) and Data and Sample (p. 3) describe a 2007 survey, with cognitive status taken from the assessment closest to the survey date. Our copy does not report changes in global cognitive functioning over time or a longitudinal comparison between conventional and special care units; searches for those outcomes found no supporting passage. (LLM, conf=0.76)
Experimental — accuracy not yet measuredThe majority of studies showed no differences over time in ADL between SCUs and n-SCUs, SCUs and small-scale SCUs, or n-SCU and small-scale, homelike SCUs.
“Although the majority of the studies showed no differences over time in ADL between SCUs and n-SCUs [20,35,45,46], SCUs and small-scale SCUs [12] or n-SCU and small-scale, homelike SCUs [15], a greater decline in ADL was observed in the SCU group compared to the n-SCU group [25].”
From Special Care Units and Traditional Care in Dementia: Relationship with Behavior, Cognition, Functional Status and Quality of Life - A Review (2013) · cites this paper as [35]
The Data and Sample section (p. 3) measures ADL from the assessment closest to a single survey date, and the Findings (p. 4) report greater ADL dependency among SCU residents. Neither passage assesses changes in ADL over time or compares longitudinal ADL outcomes across the unit types named in the claim. Searches for ADL decline and longitudinal unit comparisons found no such analysis in our copy. (LLM, conf=0.76)
Experimental — accuracy not yet measured
Eighty-six percent of the studies included patients with different types of dementia, but the remaining 14% investigated only patients with Alzheimer's disease.
“Eighty-six percent of the studies included patients with different types of dementia, but the remaining 14% investigated only patients with Alzheimer's disease [35,38,41].”
From Special Care Units and Traditional Care in Dementia: Relationship with Behavior, Cognition, Functional Status and Quality of Life - A Review (2013) · cites this paper as [35]
The study description (p. 1) concerns cognitive impairment and quality of life among Minnesota nursing-home residents. Data and Sample (p. 3) measures cognitive status and Alzheimer’s/dementia special-care-unit placement, but does not classify residents by dementia type. Our copy does not report the claimed 86%/14% split among studies. (LLM, conf=0.76)
Experimental — accuracy not yet measured
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- Authors
- Abrahamson, K., Clark, D., Perkins, A., & Arling, G.
- Affiliations
- Western Kentucky University (US)
- Regenstrief Institute (US)
- Corresponding author
- Abrahamson, K.
- Venue
- The Gerontologist
- Publisher
- Oxford University Press (OUP)
- Published
- 2012-01-09
- Volume
- 52
- Issue
- 5
- Pages
- 632-640
- ISSN
- 0016-9013 (ISSN-L)
- 1758-5341
- PMC
- PMC3463417
- OpenAlex
- W2168644655
- Semantic Scholar
- 2229ef786dd4f435fcae489ad04cc1c0141d5acf
- Cited by
- 83
- References
- 24
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 6 · 2023: 1 · 2022: 8 · 2021: 5 · 2020: 3 · 2019: 11 · 2018: 9 · 2017: 6 · 2016: 4 · 2015: 8 · 2014: 11 · 2013: 8
- FWCI
- 15.34
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Gerontologist (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute on Aging (P30AG024967)
- Topics
- Health Sciences › Health Professions › General Health Professions › Geriatric Care and Nursing Homes
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Aging, Health, and Disability
- Keywords
- cognitive impairment, quality of life, nursing home residents, Alzheimer's disease, special care units, dementia care, quality indicators, autonomy, meaningful activities, mood
- MeSH terms
- Activities of Daily Living, Aged, Consumer Behavior, Female, Homes for the Aged, Humans, Interviews as Topic, Male, Minnesota, Nursing Homes, Quality of Life, Social Environment, Logistic Models, Sickness Impact Profile, Health Care Surveys, Cognitive Dysfunction
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