Abstract
Objectives
Assisted living (AL) is an expanding site of end-of-life (EOL) care in the United
States. Understanding determinants of quality of life (QoL) for AL residents near
EOL is vital to optimize care for this growing population, most of whom have some
degree of cognitive impairment (CI). This analysis aimed to identify factors associated
with QoL in a diverse sample of AL residents with CI approaching EOL.
Design
Observational cross-section design.
Setting and participants
Data are from a 5-year study funded by the National Institute on Aging examining EOL
care of residents in 7 diverse AL communities in metropolitan Atlanta (n = 67).
Methods
CI was assessed with the Montreal Cognitive Assessment (scores ≤ 26) and QoL was determined
with the self-reported QoL in Alzheimer's disease survey adapted for use in AL. Psychological
distress was assessed using the Patient Health Questionnaire–4 and fatigue was assessed
using the 13-item Functional Assessment of Chronic Illness Therapy Fatigue Scale.
Initial descriptive analyses were followed by backward stepwise regression analyses
to select a best-fitting model of QoL.
Results
The final model predicted 27% of the variance in QoL. CI was not significantly correlated
with QoL and was not retained in the final model. Pain and functional limitation also
did not meet inclusion criteria (P ≤ .10) and were sequentially removed, producing a final model of QoL in terms of
psychological distress (β = −0.28, P = .032), fatigue (β = −0.26, P = .048), and race (β = 0.21, P = .063).
Conclusions and Implications
The lack of a significant correlation between degree of CI and self-reported QoL suggests
that AL residents have the potential to experience high QoL, despite CI. Interventions
to reduce psychological distress and manage fatigue could be implemented during EOL
care to attempt to improve QoL for AL residents with CI. The correlation between race
and QoL warrants investigation into possible racial disparities in AL and EOL care.
Keywords
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Article info
Publication history
Published online: November 26, 2019
Footnotes
Funding Sources: This work was supported by the National Institutes of Health's National Institute on Aging (R01AG047408 awarded to M. M. Perkins).
The authors declare no conflicts of interest.
Identification
Copyright
© 2019 Published by Elsevier Inc. on behalf of AMDA - The Society for Post-Acute and Long-Term Care Medicine.
