Abstract
Objectives
Advance knowledge about changes in multiple dimensions of health related quality of
life (HRQoL) among older adults receiving long-term services and supports (LTSS) over
time and across settings.
Design
A prospective, observational, longitudinal cohort design.
Setting
Nursing homes (NHs), assisted living facilities (ALFs), community.
Participants
A total of 470 older adults who were first-time recipients of LTSS.
Measurement
Single-item quality-of-life measure assessed every 3 months over 2 years. HRQoL domains
of emotional status, functional status, and social support were measured using standardized
instruments.
Results
Multivariable mixed effects model with time varying covariates revealed that quality-of-life
ratings decreased over time (P < .001). Quality-of-life ratings were higher among enrollees with fewer depressive
symptoms (P < .001), higher general physical function (P < .001), enhanced emotional well-being (P < .001), and greater social support (P = .004). Ratings also were higher among those with increased deficits in activities
of daily living (P = .02). Ratings were highest among enrollees who received LTSS from ALFs, followed
by NHs, then home and community-based services (H&CBS), but only findings between
ALFs and H&CBS were statistically significant (P < .001). Finally, ratings tended to decrease over time among enrollees with greater
cognitive impairment and increase over time among enrollees with less cognitive impairment
(P < .001).
Conclusions
Findings advance knowledge regarding what is arguably the most important outcome of
elderly LTSS recipients: quality of life. Understanding associations between multiple
HRQoL domains and quality of life over time and directly from LTSS recipients represents
a critical step in enhancing care processes and outcomes of this vulnerable population.
Keywords
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Article info
Publication history
Published online: September 24, 2015
Footnotes
The authors declare no conflicts of interest.
This work was supported by the National Institute on Aging and National Institutes for Nursing Research at the National Institutes of Health (R01AG025524) and the Marian S. Ware Alzheimer Program, University of Pennsylvania.
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© 2016 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.
