Objective: Kamata et al. recently developed the Japanese Quality of Life Inventory for the Elderly with Dementia (QOL-D) consisting of 3 categories (the 1st, vivid communication with surroundings; the 2nd, self-expression; the 3rd, control of behavioral disturbances) and 24 items to evaluate the quality of care services for the demented elderly(Kamata K, et al., Journal of Caregiving of the Elderly, 14:1-11, 2001), based on Rabins' ADHRQL(Rabins PV, et al., Journal of Mental Health & Aging, 5:33-48, 1999). We previously reported on the procedure of Fukuyama Yuai-Outdoor Activity Care Program (FY-OACP) and its effects in the psychoneuroendocrinoimmunological aspects. FY-OACP relieved demented elderly inpatients of various indoor stressors, normalized abnormal hyperactivity of the hypothalamic-pituitary-adrenal axis, increased immune activity against infections, and, at the same time, induced a marked decrease in behavioral disturbances (Suemaru S, et al., In: Alzheimer's Disease: Biology, Diagnosis and Therapeutics, 805-813, John Wiley & Sons, Ltd., England,1997; Suemaru S, et al., Neurobiology of Aging, 19,4S: S101,1998). In the present study, effects of FY-OACP on QOL in the demented elderly was examined using QOL-D, and its correlations with other scales were also investigated to demonstrate the validity and usefulness of QOL-D.
Design & Methods: Along with levels of cognitive function, activities of daily living(ADL) and vitality which were assessed by Mini-Mental State(MMS), N-ADL Rating Scale for the Elderly(N-ADL) and Vitality Index(VI), respectively, QOL was measured using QOL-D before and after one month and a half of FY-OACP intervention in 20 demented elderly inpatients. The correlations were determined among the variables obtained by the above scales, and the data were compared between before and after the intervention.
Results: Significant and positive correlations were observed between N-ADL(total /toileting) or VI and QOL-D(the 2nd category: self-expression) scores, and also between MMS or N-ADL(total /toileting) and VI scores. Scores of MMS, N-ADL(total /toileting), VI and QOL-D(total /the 2nd category) were increased by the 1.5-month FY-OACP. The total score of all QOL-D categories was significantly increased in 11 patients who showed an improvement of toileting ability but not in 9 patients with unimproved toileting.
Conclusion: The results suggest that the nonpharmacologic intervention, FY-OACP, elevates the level of QOL simultaneously by improving cognitive function, ADL(in particular, toileting ability) and vitality, and, consequently, that FY-OACP is a greatly effective strategy for improving the comprehensive living functions of the demented elderly. The present study also has demonstrated that QOL-D is a valid and useful instrument for assessing QOL in the demented elderly.
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