Dementia, pain, depression, behavioral disturbances, and ADLs: toward a comprehensive conceptualization of quality of life in long-term care




Quality of life in long-term care settings is a multidimensional construct that includes functional, cognitive, behavioral, and psychological variables. Quality of life variables have been found to be related to one another, but directional influences have not been tested.


The purpose of this study was to develop and compare two competing path models composed of quality of life variables, including dementia, pain, behavioral disturbances, and ADLs.


Path analytic results revealed that cognitive, emotional, and behavioral variables interact with one another to predict patients' activities of daily living. Pain levels did not influence activities of daily living directly, but rather influenced behavioral disturbances and depression, which in turn influenced activities of daily living.


These preliminary findings suggest that in order to assist long-term care residents in improving their activities of daily living, decreasing pain is likely to yield the greatest overall improvements. Future research on the relationships between quality of life variables is recommended to further develop multidimensional treatment models for healthcare providers in long-term care. Copyright © 2004 John Wiley & Sons, Ltd.