Clinical, social, and home-level factors associated with the quality of life of residents living with dementia in Canadian nursing homes: a cross-sectional, multi-province study.

BACKGROUND: Quality of life (QoL) is a central priority in dementia care, yet most nursing homes (NHs) in Canada rely on clinical indicators that do not capture the emotional and social dimensions of residents’ well-being. Little is known about how clinical, social, and NH factors jointly shape QoL for residents living with dementia. This study examined the associations of resident social characteristics, clinical conditions, and NH factors with resident QoL. METHODS: This cross-sectional study included publicly funded NHs in the Canadian provinces of Alberta, British Columbia, Manitoba, Nova Scotia, and Ontario. QoL was measured using staff-proxy interviews to complete the DEMQOL-CH. Staff also provided information about resident social characteristics. Clinical data were obtained from routinely collected, standardized resident assessments. NH characteristics were reported by administrators. We used linear regression with robust standard errors to assess associations of social, clinical, and NH variables with resident QoL. Multiple imputation addressed missing data, and model fit was compared using the Akaike Information Criterion. RESULTS: The final sample included 2,950 residents in 67 NHs. Older age was also associated with lower QoL (-0.009 per standard-deviation increase in age, 95%CI: −0.016; −0.002). Clinical factors that were significantly associated with lower QoL were: depressive symptoms (coefficient=-0.066, 95%CI: -0.082; -0.050), responsive behaviours (-0.034, 95%CI: -0.054; -0.015), and health instability (-0.027, 95%CI: -0.045; -0.010). More severe cognitive impairment was associated with higher staff-rated QoL (0.039, 95%CI: 0.023; 0.055). Compared with Ontario, residents in British Columbia (− 0.059, 95%CI: −0.079; −0.040) and Manitoba (− 0.039, 95%CI: −0.061; −0.017) had lower QoL. Living in a large NH was associated with lower quality-of-life scores relative to small homes (− 0.034, 95%CI: −0.051 to − 0.016). The combined model, which incorporated social, clinical, and facility factors, had the best fit. CONCLUSIONS: QoL in Canadian NHs appears to be shaped primarily by resident clinical conditions and facility environments rather than individual social characteristics. Interventions that address mental health, behavioural symptoms, and environmental stressors may yield the greatest improvements in resident well-being.