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Learning Objective 1: The learner will be able to understand that elderly patients with disabilities can experience a relatively high quality of life
Learning Objective 2: The learner will be able to understand that neuropsychiatric symptoms are associated with elderly patients’ quality of life.
Background
The objective of this study was to identify the determinants of quality of life of home dwelling patients with amputation or stroke three months after rehabilitation in a skilled nursing facility.
Method
This study is part of the Geriatric Rehabilitation in AMPutation and Stroke study (1), which is a prospective, multi- centre, cohort study aimed at identifying determinants of rehabilitation outcomes. Quality of life was the primary outcome (RAND-36). Neuropsychiatric symptoms, depressive complaints, (instrumental) activities of daily living and balance were the possible determinants of quality of life. Additional, for amputation we assessed walking ability and for stroke we assessed arm function. Linear regression analysis was used to identify the possible determinants.
Results
Twenty-seven out of 48 patients with amputation and 123 out of 186 patients with stroke were discharged to their homes or to an assisted living situation. On the eight quality of life domains (range 0-100) the main scores varied between 22 and 87 for patients with amputation and between 48 and 85 for stroke patients, with the lowest scores in both groups for the domain Physical Functioning. For both groups, low quality of life on the domains Role Limitations Emotional, Social Functioning, Mental Health and Vitality were primarily explained by neuropsychiatric symptoms and depressive complaints. Stroke patients also experienced lower quality of life on the domain Role Limitations Physical.
Conclusion
The presence of neuropsychiatric symptoms (2) and depressive complaints negatively affect quality of life of patients with amputation or stroke. The two groups of patients had severe disabilities. These patients may experience a good quality of life. This phenomenon is known as the disability paradox (3), suggesting that quality of life is about finding a proper balance between several factors, even when important life domains are severely affected.
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