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P4–211: Who best to rate an Alzheimer's disease (AD) patient's quality of life: Patient or caregiver? The case for a mixed perspective
Author(s) -
Zbrozek Arthur S.,
Karlawish Jason,
Kinosian Bruce,
Glick Henry
Publication year - 2006
Publication title -
alzheimer's and dementia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.713
H-Index - 118
eISSN - 1552-5279
pISSN - 1552-5260
DOI - 10.1016/j.jalz.2006.05.1951
Subject(s) - mood , quality of life (healthcare) , perspective (graphical) , cognition , psychology , caregiver burden , clinical psychology , medicine , disease , psychiatry , dementia , psychotherapist , artificial intelligence , computer science , pathology
Background: Health preference measures such as the Health Utilities Index II (HUI) have an essential role in assessing the overall value of an AD intervention. Unfortunately, persons with AD have impairments in their awareness of both cognitive and functional disabilities. Hence, their HUI self-assessments may not adequately capture the extent of their disabilities. Caregiver reports may address this shortcoming, but caregivers may not adequately report patient experiences of pain, mood, mobility and sensation. Objective(s): To examine the validity of a HUI scoring algorithm that mixes patient and caregiver subscales. Methods: Data were used from 110 community dwelling persons with very mild to moderate AD and their family caregivers to create a mixed HUI using patient self rated pain, mood, mobility and sensation; and caregiver rated cognition and usual care. This HUI score was compared to patient self rated and caregiver rated HUI scores and relevant co-variates. Results: Inspection of mean HUI scores showed that the mixed perspective produced HUI scores of 0.78 ( 0.16). These are intermediate between the patients’ self-ratings 0.88 ( 0.15) and the caregivers’ direct ratings 0.72 ( 0.18) of the patient. Whereas 32 (29%) patients rated themselves without any disability (a HUI score of 1.0), the mixed perspective produced no score of 1.0. Univariate correlations showed that the mixed perspective was well correlated with both the patient (r 0.74, p 0.0001) and caregiver rated (r 0.76, p 0.0001) HUI. The following table shows associations between the three perspectives and patient cognition (3MSE), patient and caregiver ratings of patient activities of daily living (IADL), and patient mood (GDS). Asterisks indicate correlations with a p-value less than 0.05. Conclusions: A HUI scoring algorithm that combines patients’ self-ratings of mood and pain with characteristics caregivers typically assess, cognition and usual care, produces HUI scores that generally reflect the presence of at least some disability in persons with AD. In addition, only the mixed perspective has associations with measures of cognition, function and mood.