Improving Quality of Life for Older People in Long-Stay Care ...

expressing their preferences or views on the quality of their lives. Cognitiveimpairment, memory loss and the inability to communicate do pose difficultiesin obtaining self-report measures of quality of life (Lawton, 1997; Bond, 1999).Therefore, relying on self-reported measures of quality of life alone poses the riskof excluding the perspective of a sizeable proportion of the nursing home population(Kane, 2003a; 2003c). Strategies adopted to assess the quality of life of people withdementia must be extended to include direct observation and proxy reports, as wellas self-reporting (Lawton, 1991; Hubbard et al., 2003; Kane, 2003a; 2003c). Lawton(1997) believes that proxy measures of quality of life can be obtained for objectivequality of life domains such as activities of daily living, behaviour, social interaction,affect states and environmental quality. Proxy measures include direct observationand attribute ratings. Direct observation entails directly monitoring behaviour inorder to capture occurrences of particular events. Attribute ratings are single ratingsof quality of life based on observations of a resident over an extended time period.While direct observation may be more time consuming, it may be more reliablethan attribute ratings which can be subject to observer bias.70Hubbard et al. (2003) utilised interview and observational methods to elicit theperceptions of nursing home residents suffering from dementia. The researchersfound that the observation technique provided a more spontaneous and lessconstrained means of ascertaining what influenced a resident’s quality of life.The observational method also granted more control to the participant. Althoughthe participants were unable to thoroughly articulate their feelings and perceptionsregarding quality of life, the researchers were able to establish specific domainsby observing and analysing the resident’s behaviour and casual conversation. Thestudy also highlighted the importance of flexibility in measuring quality of life ofdementia sufferers. The unpredictable and volatile nature of the disease means thatthe lucidness and ability of sufferers to communicate will vary from day to day and,indeed, from hour to hour (Hubbard et al., 2003). According to Lawton et al. (1999),while residents suffering from moderate to severe dementia may no longer be ableto verbally communicate their opinions on quality of life, they may still be able toexpress their preferences through their emotions. By observing and interpretingresidents’ displays of emotions, nursing home staff and care givers can adapt thenature of their care giving in order to influence and improve the quality of life ofthe patient (Lawton et al., 1999).Kane (2003c) found that significant numbers of residents who scored poorly ona cognitive score were able to answer a long quality of life interview. This findinghas been supported by other researchers (Brod et al., 1999; Logsdon et al., 1999).In a study by Coen et al. (1993), patients suffering from mild dementia were able toImproving Quality of Life for Older People in Long-Stay Care Settings in Ireland