Quality of Life and Quality of Care for People With Dementia Receiving Long Term Institutional Care or Professional Home Care: The European RightTimePlaceCare Study

Objectives: To explore how quality of life (QoL) and quality of care (QoC) for people with dementia (PwD)
vary across 8 European countries; to explore how QoL and QoC for PwD vary across living arrangements;
and to assess the association between QoL and QoC.
Design: Cross-sectional survey.
Setting: Institutional long term care and home care in 8 European countries (England, Estonia, Finland,
France, Germany, the Netherlands, Spain, and Sweden).
Participants: PwD receiving formal home care but at risk for admission to an institutional setting, and
PwD who were recently admitted.
Measurements: QoL was assessed by the PwD and by their best informed proxies using the Quality of Life-
Alzheimer’s Disease scale (QoL-AD) (range 13e52). QoC was measured using quality of care indicators
(eg, the presence of depressive symptoms, the presence of pressure ulcers).
Results: A total of 1123 PwD living at home (mean age 82.2, 63%women) and 791 PwD living in institutional
care (mean age 84.1, 74% women) participated. QoL of PwD was most often rated highest in Sweden and
Englandandlowest in Estonia andSpain.No differences inQoLwere detectedamong the settings. For theQoC
indicators, no consistent patternswere visible in such away that certain countries or settings scored "higher"
or "lower." The presence of depressive symptomswasmost consistently associated with lower QoL (P.001).
Conclusion: There is great variation in QoL and QoC scores among European countries and settings. To
gain insight into the underlying causes of these differences, more knowledge is needed about the effect
of different national health care systems and dementia strategies on QoL and QoC indicators. Depressive
symptoms were associated with QoL, and executing longitudinal studies investigating which factors are
associated with change in QoL is highly recommended.