Relationships between Quality of Life and Selected Resident and Facility Characteristics in Long Term Care Facilities in Canada.

TitleRelationships between Quality of Life and Selected Resident and Facility Characteristics in Long Term Care Facilities in Canada.
Publication TypeThesis
Year of Publication2011
AuthorsKehyayan V.
Academic DepartmentHealth Studies and Gerontology - Aging, Health & Well-Being
DegreePh.D.
Number of Pages273
UniversityUniversity of Waterloo
CityWaterloo, ON
Abstract

Background: Quality of life (QoL) of long term care facility (LTC) residents is beingrecognized as an important outcome of care by LTC providers, researchers, and policy makers.For residents, measurement of QoL is a valued opportunity to express their perception of thequality of their daily life in the LTC facility. For clinicians, self-reported QoL provides usefulinformation in planning and implementing resident-centred care.Purpose: The purposes of this study were: (1) to examine the distributional and psychometricproperties of the interRAI Self-Report Nursing Home Quality of Life Survey (interRAI_QoLSurvey); and (2) to explore the relationship of selected socio-demographic and clinicalcharacteristics of residents and LTC facility attributes with residents’ self-reported QoL.Methodology: This was a cross-sectional observational study. A convenience sample of 48volunteer LTC facilities from six Canadian provinces was involved in this study. Nine hundredand twenty eight (928) residents agreed to participate in this study. Resident inclusion requiredan interRAI Cognitive Performance Scale score of 0 (intact) to 3 (moderate impairment).Residents’ self-reported QoL was measured by trained surveyors using the interRAI_QoL Surveyinstrument. Residents’ socio-demographic and clinical characteristics were obtained from themost recentResident Assessment Instrument –Minimum Data Set 2.0 prior to the QoLinterviews. LTC facility attributes were measured by a survey form specifically designed for thispurpose. Descriptive statistics were used to describe the participating LTC facilities, the sampleof residents, and residents’ self-reported QoL. Psychometric tests for reliability (test-retest andinternal consistency) and validity (content and convergent) were conducted. Bivariate analyseswere conducted to examine the relatioships between QoL and resident and facility charateristics.Multivariate linear and logistic regression analyses were conducted to identify predictors of residents’ QoL.Results: The study confirmed the feasibility of assessing LTC facility residents’ self-reportedQoL. The findings showed positive ratings of some aspects of residents’ daily lives whilenegative ratings in other aspects. Psychometric tests showed that the interRAI_QoL Surveyinstrument had test-retest reliability, internal consistency, content validity and construct(convergent) validity. Several resident and facility characteristics were associated with selfreportedQoL. Religiosity and highest education level attained were significantly and positivelyassociated with QoL. Other resident characteristics such as age, gender and marital status werenot. Mild cognitive impairment, depression, aggressive behaviour, hearing impairment, boweland bladder incontinence, and extensive assistance in activities of daily living were significantlybut negatively associated with QoL. LTC facility ownership showed significant association withQoL. Residents in municipal LTC facilities followed by private LTC facilities reported higerQoL in contrast to charitable LTC facilities. Profit status, accreditation and leadership stabilitywere not associated with QoL. Residents in rural settings reported significantly higher QoL thanthose in urban settings. Facility size (measured in number of beds), registered nurse hours ofcare, nursing staff turnover, and ratios of registered to non-registered nursing staff did not have asignificant association with QoL. However, higher management hours and total hours of care hadsignificant and positive associations with residents’ overall QoL. Multiple linear regressionshowed that residents’ religiosity, degree of social engagement, post secondary education,dependence in activities of daily living, and positive global disposition, and LTC facilitiessituated in rural settings and ownership type together accounted for 24% (adjusted R2=0.24) ofthe variance in overall QoL (the dependent variable). In logistic regression, low QoL was used as the binary dependent variable. Residents who were religious, were socially engaged and had apositive global disposition were less likely to report low QoL. In contrast, residents withdependence in activities of daily living and post secondary education were more likely to reportlow QoL. Residents in LTC facilities located in rural settings and operated by municipal orprivate operators were less likely to report low QoL compared to charitable facilities.Strengths and Limitations: This study had several strengths, including a sample of 928residents who self-reported on their QoL and the use of RAI-MDS 2.0 for objective, externalindicators of QoL. This study had several limitations, including response bias due to method ofsample selection, inability to draw causal inferences due to study design; limited generalizabilitydue to use of a convenience sample, lack of monitoring of surveyors for the integrity of residentinterviews, and exclusion of residents with cognitive performance scale scores of more than threeor inability to communicate in English. Future research should address these limitations. As well,future research should conduct more stringent psychometric analyses such as factor analysis anduse multi-level modeling procedures.Implications: The findings of this study have implications for improving residents’ QoL, LTCfacility programming, future research, and social policy development.Conclusion: QoL can be measured from resident self-reports in LTC facilities. Self-reports fromresidents may be used by clinicians to plan and implement resident-centred care. There aresignificant associations of residents’ QoL with select resident socio-demographic and clinicalcharacteristics and facility attributes. Some of these resident characteristics and facility attributesmay serve as predictors of QoL.