Kann Lebensqualität bei Demenzkranken valide bestimmt werden?

 

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Zusammenfassung

Anliegen Überblick über Möglichkeiten und Probleme der Lebensqualitäts(LQ)-Bestimmung bei Demenz. Methode Durch Literaturrecherchen wurden zwölf demenzspezifische LQ-Messinstrumente identifiziert. Ergebnisse Die LQ-Beurteilung kann bei leichter bis mittelschwerer Demenz durch die Patienten selbst erfolgen. Bei zunehmender Krankheitsschwere muss auf Beurteilungen von Betreuungspersonen zurückgegriffen werden. Dabei sollte der Einfluss von Depressivität und versorgungsbedingten Belastungen auf die LQ-Beurteilungen kontrolliert werden. Schlussfolgerungen Da LQ-Messungen im Längsschnitt sinnvoller als im Querschnitt sind, sollten Instrumente ausgewählt werden, die bei allen Demenzschweregraden einsetzbar sind. Da Betreuungspersonen die LQ Demenzkranker anders beurteilen als Betroffene, muss die Perspektive der Erkrankten so lange wie möglich berücksichtigt werden.

Abstract

Objective The measurement of quality of life (QoL) in dementia is a methodological challenge because of the patients' cognitive impairment and anosognosia. This review gives an overview of the possibilities and methodological problems of QoL measurement in dementia patients. Methods With literature searches conducted in PubMed and Web of Sciene 12 dementia-specific QoL-measures were identified. Results Most authors agreed that patients with mild to moderate dementia themselves can validly and reliably estimate their QoL. But with increasing severity of the disease, patient ratings must mostly be replaced by proxy ratings. The latter are especially essential in longitudinal studies, but are not a satisfying substitute for the patients' perspective. Thus, the influcence of depression and care-related burden on the proxies' QoL-ratings should be controlled. Conclusions QoL-instruments, applicable to all stages of dementia should be preferred, because longitudinal QoL-measures are more meaningful than cross sectional analyses. The patients' perspective should be taken into consideration as long as possible, since proxies assess the QoL of dementia patients differently from the persons affected.

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Dr. med. Christiane Roick, MPH

Universität Leipzig, Klinik und Poliklinik für Psychiatrie

Johannisallee 20

04317 Leipzig

Email: christiane.roick@medizin.uni-leipzig.de