부산대학교 도서관

Background: A third of people with dementia in the UK live in care homes and there has been an increasing focus on the quality of care provided to them. One possible strategy to monitor and improve care is by routinely measuring and therefore understanding better the quality of life (QoL) of residents, but this is seldom done in practice. In this thesis the potential of routine measurement of QoL in care homes is investigated. Method: The study had four iterative stages. (i) Qualitative interviews with care staff and focus groups with care home managers were carried out to understand staff views about measuring QoL as a part of routine care. Brief guidance for implementing routine QoL measurement into care practice was developed. (ii) The ability of care staff to use a QoL instrument without the need for interviewer-administration was then assessed. (iii) Based on these findings, DEMQOL-Proxy was adapted into a new version, DEMQOL-CH, for use in care homes. This instrument was tested to determine if care staff could use it appropriately. (iv) In the final stage, a preliminary assessment of routine QoL measurement was completed including a limited assessment of the psychometric properties of DEMQOL-CH when used in routine care practice by care staff. Results: The qualitative interviews and focus groups showed that staff were positive about measuring QoL and fitting a QoL instrument into routine practice. There was a belief that measuring QoL could provide beneficial outcomes for staff and residents with the potential for positive impacts on the quality of care provided to residents. Systematic error was identified when staff self-completed the DEMQOL-Proxy without an interviewer. The DEMQOL-Proxy was modified to create DEMQOL-CH, this reduced the error, producing a version that could be used more accurately by care staff. Care staff were able to rate resident QoL routinely in care practice with an average frequency of monthly ratings for each resident. In a limited evaluation, when used in care homes by care staff DEMQOL-CH showed acceptable psychometric properties with satisfactory reliability and validity and a clear factor structure. Conclusions: The research presents preliminary data on the acceptability, feasibility and performance of routine QoL measurement in care homes using an adapted version of DEMQOL-Proxy called DEMQOL-CH. Results provide a proof of the concept that routine measurement of QoL may be possible in care homes. Research is needed to refine and test the methodology further and to explore the potential for benefits to residents, staff, and care homes in more representative populations.