Effect of facilities management components on the quality of life of Chinese elderly in care and attention homes

© 2017, © Emerald Publishing Limited. Purpose: Quality of life (QoL) for elderly residents of care and attention (C&A) homes has become an important consideration, given the increasingly aging population. Due to the number of hours such residents spend indoors, the quality of the facilities can contribute to their day-to-day QoL. This study aims to investigate the effect of facilities management (FM) on the QoL of Chinese elderly people living in C&A homes. Design/methodology/approach: A survey of perceived satisfaction with the components of FM and QoL was carried out with a sample of residents. A total of 18 FM components and five QoL domains, including physical health, independence, psychological health, social relationships and living environment, as well as overall QoL, were identified. Findings: The findings show that physical health is influenced by accessibility, doors and windows and signage; independence can be improved by enhancing accessibility, water supply, lighting and ventilation; accessibility, water supply, distance and doors and windows all predict psychological health; social relationships are improved by lighting and ventilation; distance impacts positively on the living environment; and overall QoL is predicted by lighting, ventilation, accessibility, doors and windows, handrails, recreation and signage. Originality/value: The study recommends that designers and facilities managers review the micro-climate settings to harness available natural lighting and ventilation, introduce bimetallic strips to the heating systems to maintain a suitable water temperature and install large, easy-to-understand and graphic signage for straightforward wayfinding in C&A homes

Predictors of quality of life ratings from persons with dementia: the role of insight

Objective: Evidence suggests that people with dementia are able to respond accurately and consistently to questions about quality of life (QoL), although large discrepancies exist between patient and proxy ratings. This may be due, in part, to the reduced insight of the person with dementia. The aim of this study was to explore the predictors of QoL ratings in a sample of people with mild dementia, with a particular focus on the role of insight. Methods: Sixty-nine participants and their caregivers were recruited from a memory clinic setting. The Bath Assessment of Subjective Quality of Life in Dementia (BASQID), Alzheimer’s Disease-Related Quality of Life Scale, Memory Functioning Scale, Alzheimer's Disease Cooperative Study Activities of Daily Living (ADL) Inventory and Mini Mental Status Examination were administered. Results: Regression analyses indicated that the strongest predictor of QoL ratings from persons with dementia was their awareness of memory function, such that lower awareness was associated with higher QoL ratings. Proxy ratings of activity performance and enjoyment of activity were also significant predictors of BASQID scores. Conclusions: Awareness of memory function impacts directly on patient QoL ratings and can also mask the effects of changes in other outcomes such as ADL function. Measures of awareness should therefore be employed alongside patient QoL ratings in order to ensure they are interpreted accurately. Discrepancies between patient and proxy QoL ratings do not necessarily occur because of patient unreliability, but may instead reflect the application of distinct modes of QoL assessment that emphasise very different outcomes

The Relative Effectiveness of Pumps Over MDI and Structured Education (REPOSE): study protocol for a cluster randomised controlled trial

Introduction People with type 1 diabetes (T1DM) require insulin therapy to sustain life, and need optimal glycaemic control to prevent diabetic ketoacidosis and serious long-term complications. Insulin is generally administered using multiple daily injections but can also be delivered using an infusion pump (continuous subcutaneous insulin infusion), a more costly option with benefits for some patients. The UK National Institute for Health and Care Excellence (NICE) recommend the use of pumps for patients with the greatest need, citing insufficient evidence to approve extension to a wider population. Far fewer UK adults use pumps than in comparable countries. Previous trials of pump therapy have been small and of short duration and failed to control for training in insulin adjustment. This paper describes the protocol for a large randomised controlled trial comparing pump therapy with multiple daily injections, where both groups are provided with high-quality structured education. Methods and analysis A multicentre, parallel group, cluster randomised controlled trial among 280 adults with T1DM. All participants attended the week-long dose adjustment for normal eating (DAFNE) structured education course, and receive either multiple daily injections or pump therapy for 2 years. The trial incorporates a detailed mixed-methods psychosocial evaluation and cost-effectiveness analysis. The primary outcome will be the change in glycosylated haemoglobin (HbA1c) at 24 months in those participants whose baseline HbA1c is at or above 7.5% (58 mmol/mol). The key secondary outcome will be the proportion of participants reaching the NICE target of an HbA1c of 7.5% (58 mmol/mol) or less at 24 months. Ethics and dissemination The protocol was approved by the Research Ethics Committee North West, Liverpool East and received Medicines and Healthcare products Regulatory Agency (MHRA) clinical trials authorisation. Each participating centre gave National Health Service R&D approval. We shall disseminate study findings to study participants and through peer reviewed publications and conference presentations, including lay user groups. Trial registration number ISRCTN 61215213