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Factors Associated With Nursing Assistant Quality-of-Life Ratings for Residents With Dementia in Long-Term Care Facilities

Correspondence: Address correspondence to Gary S. Winzelberg, MD, MPH, Division of Geriatric Medicine, University of North Carolina at Chapel Hill School of Medicine, 141 MacNider Bldg, CB 7550, Chapel Hill, NC 27599-7550. E-mail: garywinz{at}med.unc.edu

Purpose: We identify resident, nursing assistant, and facility factors associated with nursing assistant quality-of-life ratings for residents with dementia in long-term care. Design and Methods: We used a cross-sectional survey of 143 nursing assistants providing care to 335 residents in 38 residential care/assisted living (RC/AL) facilities and nursing homes in four states. We assessed resident quality of life by using the Quality of Life–Alzheimer's Disease Scale (QOL-AD). Results: Scores on the quality-of-life scale were most strongly associated with resident clinical conditions, including severity of cognitive and functional impairments, depression, and behavioral symptoms of dementia. There was also an independent positive association between nursing assistants' ratings of resident quality of life and their own attitudes regarding dementia-person-centered care as well as training. However, the results of hierarchical linear modeling suggest that some sources of nursing assistant variability in quality-of-life ratings remain unidentified. Implications: Quality-of-life ratings by nursing assistants may be influenced by their attitudes about dementia and their confidence in addressing residents' fundamental care needs.

Key Words: Assisted living • Nursing home • Training • Attitudes • Care provider

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