International Psychogeriatrics

Research Article

Assessing quality of life of nursing home residents with dementia: feasibility and limitations in patients with severe cognitive impairment

María Crespoa1 c1, Carlos Hornillosa1 and M. Mar Gómeza1

a1 Clinical Psychology Department, Complutense University, Madrid, Spain


Background: The Quality of Life-Alzheimer's Disease Scale (QOL-AD) is a reliable and valid self-report measure for assessing quality of life (QoL) in people with dementia in long-term care settings, but little is known yet about the number of patients with severe cognitive impairment who are able to complete this measure, and the characteristics of those unable to do so. The aim of the study is to advance knowledge of these issues.

Methods: Data on residents with dementia were collected from 11 nursing homes. The QOL-AD residential version was directly applied to residents with dementia diagnosis and Mini-Mental State Examination scores under 27, randomly selected in each center. Residents’ QoL was further assessed from the perspective of some close relative and some staff member. Altogether, 102 data sets from residents, 184 from relatives, and 197 from staff members were collected. An analysis of the characteristics of completers versus non-completers regarding levels of cognitive impairment was carried out.

Results: People with dementia in long-term care are able to report their QoL. The QOL-AD completion rate decreases as the cognitive impairment level increases; non-completion is associated with greater overall impairment. About 30% of residents with severe cognitive impairment could self-report on their QoL with acceptable reliability.

Conclusions: QoL self-rating should be the first-line option when assessing residents with severe cognitive impairment. For those that are not able to complete self-report measures, proxies’ report could be an alternative, although the development of other assessment procedures (e.g. observational) should be considered.

(Received March 24 2013)

(Reviewed May 04 2013)

(Revised May 06 2013)

(Accepted May 11 2013)

(Online publication June 10 2013)

Key words:

  • quality of life;
  • dementia;
  • psychological assessment;
  • cognitive impairment;
  • long-term care


c1 Correspondence should be addressed to: María Crespo, PhD, Facultad de Psicología, Universidad Complutense de Madrid, Campus de Somosaguas s/n, 28223, Madrid, Spain. Phone: +34-913943122; Fax: +34 91-394-31-89. Email: