- TAP CHI NGHIEN CU'U Y HOC
DAC DIEM LAM SANG BENH ALZHEIMER GIAI DOAN CUOI, CHAT L U g N G CUOC SONG CUA NGUOI BENH
VA NGU'ai CHAM SOC
Nguyin Thanh Binh, Nguyin Trong Hu-ng, Pham Thing Benh vien Lao khoa Trung wang Sa sut tri tue do bdnh Alzheimer giai doan cudi biiu hidn lam sang nang ne gay anh hw&ng din chit Iwang cuoc sdng benh nhan va ngw&i cham sdc Nghien ciru nay nhim md ta dac diem iam sang,- chit iwang CUQC sdng cua benh nhan Aiziieimer giai doan cudi dwac diiu tn tai Benh vien Lao khoa Trung wang tw thang 10 nam 2014 din thang 7 nam 2016 va chit iwang cudc song cua ngwai ciiSm sdc ho Nghien CLPU md ta cat ngang 73 cap benh nhan/ngwai cham sdc Kit qua nghien ciru cho thiy biiu hien lam sang thwang gap la thiiu can (29.6 %). viem phdi (19,2 %), kho nuit (17,8 %). Co 83,5 % benh nhan cd tren mdt tneu chimg loan thin va cac tneu chirng hay gap la hoang tw&ng, lo au. kich ddng, rdi loan hanh vi ban dem.
Benh nhan va ngwai cham soc c6 chit iuang cudc sdng thip Chit iwang cuoc sdng cua benh nhan lien quan din suy giam hoat ddng hang ngay va nguy ca ioet Chat iwang cudc song cua nguai cham soc lien quan den tudi ngwai cham sdc, trieu ehii'ng loan than cua benh nhan Di cai thien chit Iwang cuoc sing cin can thiep yeu td nguy ca
TIP khoa: Oac dilm lam sang, chit lu'O'ng cuoc song, benh Alzheimer, giai doan cuoi
I. DAT VAN DE
Ting d i l u tra dan s l nam 2009 cho thly dan s6 nude ta dang d thdi ky co uu the ve luc luang lao dong, ggi la thdi ky cua "eg c l u dan s l vang", do la thdi ky ma ty le tre em dudi 15 t u l i g mire dudi 30 % va ngudi gia tu 65 tuli trg len d mire dudi 15 % trong ting dan s l Thdi ky trgn se ket thuc vao nam 2040 khi ty lg ngudi trgn 65 t u l i b i t d l u vuat qua 15%. Nam 2014, dan sd tren 65 tuoi chigm 7,1%, dy kiln den nam 2049, ti le nay se la 18,1 % [1 ] Su gia hda cua dan s6 keo theo su gia tang cua nhom benh ly ung thu, tim mach cung nhu benh ly thoai hda Trong so cac benh ly thoai hoa, sa siit tri tue la benh iy suy giam tri nhd tiln t n l n gay anh hudng d i n
Bia chf lien h$ Nguyen Thanh Binh, Benh vi Trung wong
Email lhanhbinh04@yahoo com Ngaynhan 07/11/2016 Ng^y duac chip Ihuan 26/2/2017
boat ddng hang ngay eiia ngudi benh Q Viet Nam, theo mdt nghign ciru nam 2005, ty lg hign m l c sa siit tri tug ciia ngudi trgn 60 tuoi la 4,5%, con theo s l lieu nam 2009, ty le nay la 7,9% [2, 3] Benh Alzheimer chilm 60 - 80%
nguygn nhan gay sa siit tri tug Benh trai qua ba giai doan tien lam sang, suy giam nhan thirc nhe va sa sut tri tug Sa siit tri tug t i l n t n l n theo cac mire do nhe, trung binh va nang 6" giai doan nang, benh nhan m i t h i t kha nang t i l p xiie va hoan toan phu thude vao ngudi ehan sdc vdi cac bieu hien lam sang nang n l Tneu chung viem phoi do sac gap tCr 53 d i n 70,6 % [4, 5] Cac tneu chung khac la loet do ty de, tneu ehii'ng tieu hda va dinh dudng [6] 89 % benh nhan Alzheimer giai doan nang co tren mdt tneu chirng r l i loan hanh vi va tam than. Cac tneu ehii'ng hay gap la kich ddng, t r i m cam, vd cam [7]. Tngu chirng dau gap trong khoang 50 % den 64,8
% benh nhan sa siit tri tue [5, 8, 9]
TCNCYH 106(1)-2017
TAP CHI NGHIEN CU'U Y HOC - Nhung rdi loan hanh vi va tam t h i n cua bgnh nhan nhat la tneu chung tram cam va kich ddng anh hudng len ehlt lugng cudc sdng cua ca bgnh nhan va ngudi cham sdc [10] Ngoai ra, tinh trang vd cam va nhirng han c h l trong hoat ddng the ehlt hang ngay cung la y l u to lien quan d i n chit luong cudc sing [11]
Hilu duge eae dae d i l m lam sang, nhung yeu t l anh hudng d i n chat lugng cudc sing bgnh nhan va ngudi cham sdc d giai doan cull giiip ed them thdng fin n h l m dua ra nhO'ng tra giiip n h l m cai thien chit lugng eude sing eho ho Tuy nhien, d Viet Nam chua c6 nghign cuu nao danh gia nhirng van d l neu tren Vi vay, nghien cuu nay duge thue hign nhlm mue tigu
1 Md ta dac diem iam sang bgnh nhan Alzheimer giai doan euli.
2, Danh gia chit lugng cupc sing benh nhan, ehlt lugng cudc s6ng ngudi cham soc va cac y l u Ed lien quan
II. D 6 | TU'gNG VA PHU'aNG PHAP
I.OdI tu'ang
1.1. Benh nhan sa sut tri tue do benh Alzheimer giai doan cuoi
T i t ea eac benh nhan sa siit tri tue giai doan cudi d i n kham va d i l u tri tai Benh vign Lao khoa Trung uang
Benh nhan duac ehln doan benh Alzheimer theo tieu chuin eua C i m nang c h i n doan va thdng ke cac R l i loan Tam t h i n lln thu IV sua doi (DSM IV - TR) cua Hdi Tam t h i n hoc Hoa Ky d i n kham, dilu tn tai Benh vign Lao khoa Trung uong va dang duac Cham sdc tai nha Giai doan euli duge chin doan bdi cac bac sy chuyen khoa thin kinh cua Benh vign Lao khoa Trung ugng khi
diem oanh gia tinh trgng tam t h i n t l i thilu (Mini Mental Status Exammatign - MMSE) tu 0 din 10
1.2. Ngw&i cham soc
Ngudi trgng gia dinh, tren 18 tuoi, cham sdc bgnh nhan tren 6 thgng, giiip dd bgnh nhan trong hoat ddng hang nggy, dua di kham chCra bgnh va khdng duae tra tiln Ngudi cham soc chinh la ngudi cd trach nhiem cao nhlt trong viec dua ra cae quylt dmh v l cham sdc ehc bgnh nhan
2. Phitgng phap
Md ta e l t ngang, l l y m l u thuan tidn Cdng cu nghien cieu
Cae tneu ehung lam sang cua bgnh nhgn duac thu thap theo benh an m l u ,
Roi loan tam t h i n tren benh nhan danh gia theo bang k i l m danh gia tam ly thin kmh (NeuroPsychiatric Inventory-NPI)
Hoat ddng hang ngay thang diem danh gia hoat dong hang ngay cua Barthel
oanh gia dau theo thang d i l m danh gia dau trong sa siit tri tug nang -PAINAD (Pain Assessement in Advanced Dementia),
Danh gia nguy eg loet theo thang dilm Waterlow
Ganh nang cham sdc benh nhan duoc danh gia theg thang diem ZBI (thang ganh nang Zant - Zarit Burden Inventory) gom 22 cau hdi, moi cau tra Idi ed 5 lua chon tir 0 den 4
Chit lugng cudc s i n g eua bgnh nhan va ngudi nha duge danh gia blng thang diem Chit lugng cudc s i n g trong bdnh Alzheimer (Quality Of Life in Alzheimer's Disease- QOLAD) gdm 13 cau hdi do ngudi nha benh nhan tra Idi Tong diem tir 13 d i n 52, d i l m so
156 TCNCYH 106(1)-2017
- TAP CHI NGHIEN CU'U Y HOC cao hon tuang irng vdi ehlt lugng eude song
t i t hgn
2.3. PhU'O'ng phap thu th$p thong tin Ngudi cham sdc ciing bgnh nhan duae phong v l n va kham bdi nghign cuu vign la bae sy chuyen khoa t h i n kinh theo bgnh an m i u Thdi gian thu thgp s l lidu t u thang 10 nam 2014 d i n h i t thang 7 nam 2016
3.Xu'ly s6 lieu .
So lieu duac thu thap va xw ly tren phln m l m thing kd SPSS phign ban 16 0 So sanh dua vao test t-student, p < 0,05 duae cho la cd >? nghTa Ap dung md hlnh hoi quy da biln
de phan tich mdi lign quan giua ehlt luang cudc sdng va eae y l u td thude benh nhan va ngudi cham sde Nghien edu su dung mue y nghla a=0,05 va khoang tin cay 95 %
4. Dao du'c trong nghien cieu Chiing tdi thdng bao ro muc dfch nghign cuu vdi gia dinh bgnh nhgn va ehi dua vao danh sach nghign euu khi kl xac nhan tham gia nghign ciru T i t ca eae thdng tin ca nhan va benh tat duac giu bi mat,
III. KET QUA
1. Dac d i l m nhan k h I u - xa hoi cua benh nhan va ngindi cham sdc
Bang 1. Dac diem nhan khau - xa hoi cua benh nhan va n g i f d i cham sdc Dac diem
TUOI trung binh Bien do tuoi G\&\
Nam Ntt
Benh nhan n,(%) 74.01 ± 9,44
5 4 - 9 6 25 (34,2) 48 (65,8)
Ngu'O'i Cham n2(%) 52,82 ±12,80
2 5 - 7 8 30(41,1) 43(58,9) 71 (97,2) Tinh trang
hdn nhan 1 ( 1 4 )
Ll dl, khdng ket hdn 1(1,4)
Pho thdng(eap 1,2) 23(31,5)
Trinh dd
vSin hoa Cap 3, eao dang, trung cap 22(30,1) 26 (35,6)
Dai hoe, sau dai hoc 24 (32,9)
22(30,1) 10(13,7)
Tinh trang nghg nghigp
Cdng nhan vien chuc
Nghi huu 27 (37) 7 (9,6)
Ndi trg. nghg t u dg 3(4,1)
Vg, chdng 23(31,5)
Quan he giQ'a ngudi cham va benh nhan
Con trai, con ggi 41(56,1)
Con dau, con re 5 (6,8)
Chau, hg hang 4 (5,5)
TCNCYH 106(1)-2017
TAP CHI NGHIEN CU'U Y HOC -
Ty lg nCr gidi trgn bgnh nhan va ngudi cham sde deu ehiem uu thg han nam gidi, ngudi cham sdc la nd chilm 58,9 %, da s l la cdng nhan vien chirc ed gia dinh, ngudi cham sdc ehu y l u la ban ddi hoac con rudt (88,9 %)
2. Dac d i l m lam sang
S l nSm mac bdnh 3,55 ± 2,74 nam, thdi gian m l e benh lau nhlt la 13 nam.
2.1. Cac trieu chu'ng la bien chieng cua sa sut tri tue
Bang 2. Cac trieu chipng la b i l n chu>ng cua sa sut tri tue Trieu
Kho nu6t Vi§m plloi Gay xirong sut cgn Thi6u can (BMI Loet
chirng
<18,5)
n 13 14 1 10 24 9
Tin s u i t (%) 17,8 19,2 1,4 13,7 32,9 12,3 Cae trieu chung hay gap nhat la thilu can, vigm phoi va khd nudt 2.2. Trieu chirng loan than
61 trong so 73 bgnh nhan cd it nhlt mdt tneu chCrng loan thin, chilm 83.5 % Bang 3. Ty le gap cac trieu chirng loan t h i n
Trieu chu'ng n
%
R6i toan tu'duy Hoang ti^ong Ao giac
29 25
47,5 41 Rdi ioan cam xuc
Loau Vocam Tram cam Hung ptiln
32 24 18 13
52,5 39,3 29,5 21,3 Rdi ioan hanh vi
Kicti dong
R6I loan tianh vi ban {J6m R6I [oan van dong Mat U'cch6 R6] loan an uong
34 32 31 23 15
55,7 52,5 50,8 37,7 24,6
TCNCYH 106(1)-2017
- TJCIP CHI NGHIEN CU'U Y HOC cac trigu Chung loan t h i n hay gap nhlt la lo au (52,5 %) va hoang tudng (47,5 %), cac rdi logn hanh vi hay gap la kich ddng (55,7 %) va rdi loan hgnh vi ban dem (52,5 %)
2.3. Trieu chieng dau
Cd 27/73 ehilm 37 % benh nhan cd trigu chung dau Trong sd 27 benh nhan. phgn loai dau theo thang diem Danh gia dau trong sa sut tri tug nang (Pain Assessement IN Advanced Demen- tia-PAINAID) l l n lugt la dau nhe (59,3 %). dau vira (25,9%) va dau ngng (14,8 %).
3. C h i t lu'O'ng cugc sdng cua benh nhan, ngu'd'i cham sdc va cac y l u t d lien quan 3.1. Chat Iwang cupc s6ng
C h i t iu'crng cuoc sdng B&nh nhgn
Ngu-oi Cham soc
Trung binh 19,18 31,19
Do iech 3,01 5,55
Trung vi 18 30
lUlin 13 21
Max 29 30 Chit lugng cudc s i n g ciJa benh nhan a mue thlp, ehlt luang cudc sdng cua ngudi cham sde d muc trung binh so vdi ehi s l QOLAD (13-52).
3.2 Cac yeu to lien quan din chat iwang cupc sPng ciia benh nhan Bang 4. Cac y l u t d lien quan d i n chat lipgng cuoc sdng cua benh nhan
Y 4 u t 6 Kicti dong
Diem Waterlow Diem ganh nang cham soc Chgt luong cuoc s6ng nguoi chi am soc
He so -0,341 -0,268 -0,262 0,395
95 % ifhoang tin cay -1,758;-0,288 -0,294, -0,024 -0,087, -0,006 0,096, 0,334
P 0,007 0,022 0,026 0,001 Trong s l cac trieu chung loan t h i n va r l i loan hanh vi, chit lugng cudc s i n g benh nhan ehi phu thudc vao tneu chung kich ddng Chit luang eude sdng benh nhan cung phu thude vao nguy ca loet, diem ganh nang cham sdc va ehlt luang eude s i n g ciJa ngudi cham sdc-
3.3. Cac yeu tP iien quan den chat iwang cupc song ngw&i cham soc Bang 5. Cac y l u t d lien quan d i n chat lu'O'ng cuoc sdng ngu'di cham soc
Yluta Diem NPI
Chgt luong cuoc s6ng benh nhan Diem ganh nang cham soc Tuoi nguoi chgm soc Thoi gian chgm soc hang ngay
He so -0,28 0,395 -0,53 -0,569 -0,32
95 % dp tin cay -0,434,-0,019
0,324, 1,129 -0,24,-0,107 -0,331, -0,16 -1,207, -0,209
P 0,033 0,001
< 0,001
< 0,001
< 0,006 TCNCYH 106(1)-2017
TAP CHI NGHIEN CU'U Y HOC •
Trigu chirng loan than cua benh nhan anh hudng d i n chit luang cudc song cua ngudi cham sdc Chat lugng cudc sdng t j Id nghich vdi tuoi, ty \$ thuan vdl ganh nang cham sdc va thdi gian cham sdc.
IV. BAN LUAN
Biln ehdng ciJa sa sOt tri tue la nguyen nhan tu veng va nhap vien eua benh nhan.
T i n suit khd nult 17,8%, vigm phli 19,2% va loet do ty dg 12,3%i, Tan suit gap eac biln ehung eua sa sut tri tue treng nghign euu nay thlp hgn cac nghien euu eua tae gia khac Vigm phoi do sac gap t u 53 d i p 70,6%, trigu Chung khae nhu s i t {64%i), khd thd (40%i), loet do ty dg (47%) [2; 3, 12]. Cd t h i do d l i tuang eua nhung tac gia trdn n i m trong nha dudng lao, thudng la nhung benh nhan da n i m liet giudng, trong khi nghign cuu nay khao sat cac benh nhan s i n g tai edng ding, cdn kha nang van ddng Cac y l u td nguy eg eiia viem phoi do sac trgn bgnh nhan Alz- heimer la tinh trang nhan thue, nhli mau ygn lang tgi hgeh n l n , sir dung thulc chlng loan thin, gidi nam Khuyin eao su dung lieu thlp nhlt thuoc chong loan t h i n trgn bgnh nhan Alzheimer kem nhdi mau nao hach n l n , ngay khi cae trigu chirng rdi loan tam thin va hanh vi dugc khdng c h l , nen giam va ngung thule chcng loan t h i n d l d u phdng viem phli nang do sac [14]
Theo nghign cuu nay, cac tngu chirng loan t h i n hay gap nhat la lo au (52,5%) va hoang tudng (47,5%), eac rdi foan hanh vi hay gap la kieh ddng (55,7%i) va r l i loan hanh vi ban dgm (52,5%)- K i t qua nay gilng vdi mdt nghign cuu nam 2008 v l eac trigu chirng tam thin cua 123 benh nhan Alzheimer giai doan nang ket lu$n 89 % bgnh nhan cd trgn mdt tneu ehung rdi loan tam than va eac tneu chirng hay gap la ktch ddng (50%), tram cam (46%), vd cam (43%) [7]
Nghien euu nay diing thang PAINAD dgnh gia thly ty le bgnh nhan cd trigu chung dau chilm 37% N l u khdng d u g c d i l u tri, tneu chung dau cung la mdt y l u t l gay nen nhung trieu ehung loan t h i n nhu kich ddng va anh hudng d i n e h l t luang cudc sdng cua benh nhan cung nhu ganh nang cham sdc Cd tac gia khuyin cao thuoc giam dau nen duae ke dmh kl, dau nhe d i l u tn bang acetaminophen hoae khang viem khdng steroid, dau vira duac khlng e h l blng cpigid tae dung nhanh (vi du codein, morphine) va dau nang ndn duac d i l u tn thudng xuygn bdi opioid tac dung nhanh cho den khi dau dugc khdng c h l hoac tae dyng khdng mong muln xult hien [14]
"Tinh trang thilu can" dugc dinh nghla khi chi s l khdi eg the (Body Mass Index-BMl) dudi 18,5, eung thudng gap trgn bgnh nhan Alzheimer Manno dung thang danh gia dmh dudng tdi thilu (Mini Nutntional Assessement - MNA) k i t luan 43,7 % bgnh nhan Alzheimer bi thilu can theo tigu chuin BMI [15]. Nghign eiru nay eho k i t qua 32,9 % bgnh nhan thieu can Chl s l BMI eao la y l u t l lam giam nguy eg tu' vong, benh nhgn thilu can (BMI < 18,5) ed nguy eg tCr vong eao nhlt VI vay eai thign dmh dudng eho bgnh nhgn Alzheimer giai doan cull se lam giam nguy ca tu vong [16]
Theo nghien euu nay, ehlt lugng cudc sing bgnh nhan phu thudc vSo tngu ehung kich ddng, nguy ea logt, d i l m ggnh ngng cham sdc va ehlt lugng cudc sing ciia ngudi cham sde Ve anh hudng cua tinh trang nhan
TCNCYH 106(1)-2017
- TAP CHf NGHIEN CU'U Y HOC thirc va boat ddng hang ngay ciJa bgnh nhan,
cae k i t qua edn chua thdng nhat Theo Leon- Salas, chit lugng cudc sdng ngudi cham sde lien quan d i n NPI, chuc nang va tinh trang nhan thdc cua bgnh nhan [17] Wcrlae - Thiery lai cho ring chat lugng cudc s i n g eiia bgnh nhan cQng nhu ngudi cham sdc cd lign quan den tinh trang t r i m cam va d i l m NPt ciia bgnh nhan [18], Diem chung ciJa eac nghien cii'U la chit luang cudc s i n g eua ngudi cham sde phu thudc vao tneu chirng loan t h i n cua bgnh nhan, ed the la tneu chung kich -ddng, trim cam hay vd cam
Ben canh vide d i l u trj trigu chirng logn thin cho benh nhan, phdng chdng logt thi cai thign ehlt luang cugc sdng cho ngudt cham sde cung gdp p h l n nang eao ehlt luang cudc sing cho chinh benh nhan,
V. KET LUAN
Benh nhan Alzheimer giai doan cudi thudng cd roi loan nult d i n d i n vigm phoi do sac cac tngu chirng rdi bgn tam t h i n va hanh vi hay gap nhlt la tneu ehung hgang tudng, lg au, kieh ddng va r l i loan hanh vi ban dem.
Chit lugng eude sdng cua benh nhan phu thudc vao trieu chirng dau, tngu chung loan thin Ngudi cham sdc cao t u l i , khdng duac tra giiip cd ehlt luong cudc sdng thap nhlt Nhgn bilt, phdng ngira va d i l u trj cac tneu chirng ciia benh nhan, nhan bilt ngudi cham sdc d l bl ton thuang giiip dua ra cac can thiep lam cai thien ehlt luang cudc sdng cho bgnh nhan va ngudi cham sdc ho
Lo'i c a m e n
Nhdm tac gia xin tran trong cam an nhdng ngudi cham sde bgnh nhgn Alzheimer da tham gia tra Idi phdng van va giup dd chiing tdi hoan thanh nghign cdu nSy,
TAI LIEU THAM KHAO
1. Tdng cue thdng ke (2014). Du bao dan s6 Vidt Nam 2014 -2049. Nha xuit ban thong tin, 29
2. Pham Thing (2010) Nghign ciru dich t l ve sa silt tri tug g ngudi eao t u l i tai edng ddng V hoc thwc hanh. 715(5), 53 - 55
3. Nguyin Kim Viet (2009) Nghign cuu dac diem sa siit tri tue tai edng d i n g Y hoc thwc hanh. 10(679), 1 6 - 1 8
4. Lamberg JL., Chen Y C , Chen JH (2006). Occurence and treatment of suspected pneumonia in long-term care residents dying .with advanced dementia J Am Geriatro Soc,
54, 2 9 0 - 2 9 5
5. Lloyd-Williams Wl (1996) An audit of palliative care in dementia", Eu J Cancer Care. 5(A), 53 - 55
6. Black BS, Finucane T, Baker A.
(2006) Health problems and correlates of pain in nursing home residents with advanced dementia Alzheimer Dis Assoc Disord, 20, 283 - 290-
7. Karan S. Kverno (2008). Neurcpsy- chiatric Symptom Patterns in Hospiee-Eligible Nursing Home Residents with Advanced De- mentia J Am Med Dir Assoc. 9(7), 509-515
8. Achterberg WP, Pieper MJ, Van Dalen -Kok AH (2013). Pain management in patients with dementia Cim Inten/Aging 2013,8 1471 doi 10 2147/CIA,S36739 Cim Interv Aging.
8, 1471 - 1482
9. Mc Carthy Wl, Addington - Hall J, Altmann D (1997). The experience of dying with dementia a retrospective study Interna- tional Journal of Geriatric Psychiatry, 12, 404 -409
10. Hurt C, Bhattacharyya S, Burns A (2008) Patient and caregiver perspectives of quality of life m dementia An investigation of the relationship to behavioural and psyehologi-
TCNCYH 106 (1) - 2017 161
TAP CHl NGHIEN CU'U Y HOC -
cal symptoms in dementia Dement Geriatr Cogn Disord, 26(2), 138 - 146.
11. Hoe J, Katona C (2005)- Use of the QOL-AD for measuring quality of life in people with severe dementia-the LASER-AD study.
Age and Aging. 34, 130 - 135
12. Toscani F Di Giulio P, Villani D (2008). Dying with advanced dementia in long- term care genatne institution a retrospective stydy J Palliat Med. 11, 1023 -1028.
13. Black BS, Finucane T, Baker A (2006) Health problems and correlates of pain in nursing home residents with advanced de- mentia Alzheimer Dis Assoc Disord, 20(4), 283 - 290
14. Wada H, Nakajoh K, Satoh- Nakagawa (2001) Risk factors of aspiratign pneumonia m Alzheimer's disease patients.
Gerontology, 47(5), 271 - 276
15. Marino LV, Ramos, Chiarello PG.
(2015). Nutritional status according to the stages of Alzheimer's disease Aging Clin Exp Res, 27(4), 5 0 7 - 5 1 3
16. Garcia-Ptacek S, Kareholt I, Farah- mand B (2014), Body-mass index and niortal- ity in incident dementia a cohort study on 11,398 patients from SveDem, the Swedish Dementia Registry J Am Med Dir Assoc, 15 (6), 447 e l - 7
17. Leon Salas B, Logsdon RG, Olazaran J (2011), Psychometric properties of the Spanish QoL-AD VL^ith institutionalized de- mentia patients and their family caregivers in Spam Aging Ment Health. 15(6), 775 - 783
18. Wolak-Thierrya A, Novellaa J L , Barbe C (2015). Companson of QoL-AD and DQoL in elderly with Alzheimer's disease. Ag- ing & Mental Health. 19(3), 274 - 278
Summary
CLINICAL FEATURES IN ADVANCED ALZHEJIVIER'S DISEASE, THE QUALITY OF- LIFE OF PATIENTS AND THEIR CAGIVERS
Alzheimer's disease In advanced stage with severe features affects on the quality of life of the patients and their caregivers The objective of this study was to desenbe the clinical features of advanced stage Alzheimer's patients at the National Genatne Hospital, the quality of life of patients and their cagivers This was an observational study ccnsistmg gf 73 dyads patient/
cargiver frcm October 2014 to July 2016. The results showed that common symtoms were underweight (29 6%), pneumonia (19 2%), dysphagia (17 8%) 83 5% patients had at least one psychological symptom and frequent symptoms, they were delusion, anxiety, irritability and nighttime behaviors. Advanced Alzheimer'disease patients and their caregiver had a low quality gf life Patient's quality of life related to the irritability and ulcer risks Caregiver's quality of life related to the age, and the patients' psychiatric symptoms Risk factors need to be intervened to improve theirquality of life,"
Keywords: clintcal features, quality of life, Alzheimer's disease, advanced stage
TCNCYH 106(1)-2017
