Psychotic Symptoms Impact Quality of Life of Nursing Home Residents With Dementia

Researchers sought to assess whether psychotic symptoms in patients with dementia living in nursing homes were associated with reduced quality of life.

Psychotic symptoms in people with dementia in nursing homes are associated with poorer quality of life, according to study findings published in JAMDA.

Patients with dementia who live in nursing homes often have more severe cognitive and functional challenges and higher rates of psychosis compared with individuals with dementia who live in the community. Psychotic symptoms among these patients often cooccur with anxiety and depression. Studies have shown neuropsychiatric symptoms comorbid with psychotic symptoms are associated with lower quality of life among this patient population. Yet, the nature of causation is unclear.

This is the first study to assess how agitation, anxiety, and depression influence the relationship between psychiatric symptoms and quality of life in patients with dementia, according to the researchers.

The researchers analyzed data of 971 patients with dementia (aged 84.57±8.98 years; 70.1% women) in 69 nursing homes in England. Clinicians assisted researchers in obtaining data regarding patients’ quality of life, pain, depression, anxiety, psychotic symptoms, dementia severity, and antipsychotic prescriptions.

About 17.5% of patients experienced delusions and about 14.6% of them had hallucinations. A total of 1 in 5 participants was prescribed atypical antipsychotics.

Delusions and hallucinations were each associated with lower proxy-rated quality of life scores (DEMQOL-Proxy) scores in unadjusted (P <.001; B=-8.39 and P <.001; B=-7.78, respectively) and adjusted models. The model explained 29% of the variance. Depression was most likely to predict lower quality of life.

Delusions and hallucinations each had indirect effects on quality of life mediated via agitation, anxiety, and depression. Antipsychotic medications were not associated with impaired quality of life.

Study limitations included proxy measure of quality of life, use of dichotomized delusion and hallucination variable, the cross-sectional nature of the study, and the inability to establish directionality.

The findings reveal the need for clinicians to implement safe and effective treatment and management strategies for nursing home residents with dementia presenting psychotic symptoms.

“Additionally, the findings of the mediation analyses provide clearer insight into the role of comorbid neuropsychiatric symptoms and in turn will bolster future development of nonpharmacologic treatments for psychotic symptoms and other concurrent neuropsychiatric symptoms in [people with dementia] PwD,” the researchers concluded.


Choi A, Martyr A, Clare L, et al. Impact of psychotic symptoms and concurrent neuropsychiatric symptoms on the quality of life of people with dementia living in nursing homes. JAMDA. Published online May 6, 2022. doi: 10.1016/j.jamda.2022.03.017