NU4025: Critical Appraisal of Articles on Dementia Quality of Life

This report presents a critical appraisal of three articles focused on the quality of life of dementia patients. It begins with an introduction highlighting the challenges in healthcare and society regarding dementia, followed by a description of the search strategy employed to identify relevant literature from databases like CINAHL, PubMed, and Medline. The report then formulates a research question concerning whether assistance can improve the condition of dementia patients. The core of the report consists of a detailed critical appraisal of two articles, one quantitative and one qualitative, examining aspects such as study design, participant selection, data collection methods, statistical analysis, and interpretation of results. The quantitative study by Giebel, Sutcliffe, and Challis is analyzed for its methodology, data analysis techniques, and interpretation of findings, including the use of ANOVA and correlation measures. The qualitative study is evaluated for its appropriateness, participant selection, data collection methods, and analysis techniques. The report also discusses the researcher's perspective, the methods used for data collection and analysis, and the quality control measures implemented. The report concludes by summarizing the key findings and implications of the appraised articles.

Running head: Critical Appraisal of Articles
Critical Appraisal of Articles
Name of the Student
Name of the University
Author Note

Critical Appraisal of Articles 1
Introduction
The quality of life of the patients suffering from the problem of dementia is one of the
greatest challenges for the health care providers and also for society. In this regard, it can be
stated that the cases of dementia are very common among the older age people around the
different countries of the world. In this regard, it can be stated that this issue of poor quality
of life among dementia patients is mainly associated with the altered activities of daily livings
(Kamimura et al., 2014). According to the study of Giebel et al. (2014), it is stated that
among the older adults suffering from the problem of dementia is very common and as a
result, they become dependent on the other people of their family and friends (Spindel et al.,
2015). Hence, it is very important to improve the quality of life of those patients suffering
from the problem of dementia in their life (Al Hayek et al., 2014).
In this essay, three articles based on the problem of quality of life of dementia patients
are discussed. Along with this, the search strategy used to find the articles for the critical
appraisal is also mentioned in a brief manner.
Search Strategy
For searching the proper literature for the analysis of the selected topic, the
researchers carried out a search process in the online databases of the literature. The literature
searching process was carried out in between the month of January 2020. While searching the
literature in the online databases the researchers used the most appropriate keywords related
to the identified topic. For searching the appropriate literature for this present study, the
online databases like CINAHL, Pub Med, and Medline were used. Therefore, the primary
keywords that were used by the researchers were mainly “dementia”, “quality of life”,
“lifecare”, “depression”, “depression and dementia”, “association of depression and
dementia”, “older adults”, “older adults with problems of dementia”. Research articles

2Critical Appraisal of Articles
without the above-mentioned words were excluded from the final analysis of the study.
Therefore, it can be stated that only 3 articles were chosen by the authors for the final critical
appraisal process.
Research Question
Can assistance to the dementia patients improve the condition of the dementia?
Critical Appraisal of the Articles
Critical Appraisal of Quantitative Study
The study of Giebel, Sutcliffe and Challis examined the quality of life and activities
of daily life across different stages of life while suffering from the problems of dementia. In
this regard, the authors have identified that people with dementia generally require a higher
level of assistance during their entire life.
From this study, it was reported that the researchers had set the research scene in a
proper manner. In this study, almost 122 patients suffering from the problem of dementia and
their caregivers were included. All of the patients lived in their own house and a few
participants were recently shifted to the long term care. However, a group of patients was
created by the authors and all the data were collected in North West England. In one of the
groups, patients with dementia under the age group of 65 years or more were recruited. In the
first group, the patients had the risk of admission in the care home and on another hand, in
another group; the patients were already admitted to the care home on a permanent basis in
the last three months (Giebel, Sutcliffe & Challis, 2015). As a part of the inclusion criteria of
the study participants of the study, it can be stated that in order to be included into the final
study analysis, the participants must have the problem of dementia, a score of 24 or less in

3Critical Appraisal of Articles
the Mini-Mental State Examination (S-MMSE) and presence of informal carer living with the
patients with dementia (Oyebode et al., 2019).
For collecting the data the researchers mainly used face to face structured interview in
the house of the patients suffering from dementia and along with this, the interview was also
conducted among the caregivers of the patients. As a part of the data collection, the MSME
tool was used by the researchers. In this present study, a score of 20 to 24 out of 30 was used
to determine the level of dementia among the patients (mild dementia). Patients with
moderate dementia had a score of 10 to 19. In the case of the high level of dementia, the
patients had a score of 0 to 9 (Giebel, Sutcliffe & Challis, 2015). In the case of measuring the
activities of daily livings, the authors used the Katz Index of Independence as it measures the
six activities of the daily life of the patients. This tool is used to measure toileting, bathing,
continence, dressing, transfer and feeding activities of the patients. The quality of life or QoL
was measured by using the Quality of Life in Alzheimer’s disease (QoL-AD) rating scale that
has a very good level of psychometric properties that is this tool is validated and proven to
be reliable in various other studies (Nguyen et al., 2019).
While discussing the method of statistical tests, it can be stated that the authors used
the proper measure for this study. In this study the authors used ANOVA and as per the study
of Curtis, Comiskey and Dempsey (2016), the use of ANOVA is appropriate for quantitative
study analysis.
Yes, the data were analysed by using the original study protocol. As per the protocol
of the quantitative study, the data and the result should be presented in a tabular format. In
this study, the authors presented the data and the result in a tabular manner. Not only was
this, but the graphical representation of the data also present in the study according to the
original protocol of a quantitative study (Clemence, Doise, & Lorenzi-Cioldi, 2014).

4Critical Appraisal of Articles
While analysing the analysis section of the articles, it can be stated that no such paired
test was performed by the researchers and in this regard, it is also evident that the researchers
had not performed any type of two-tailed test for the analysis of the final result (Giebel,
Sutcliffe, & Challis, 2015).
Yes, the outliers were analysed by using the statistical measures. As a part of this, it
can be stated that the demographic information of the patients such as age gender, living
situation, health status and type of dementia were analysed by the researchers before the final
analysis of the study result (Giebel, Sutcliffe, & Challis, 2015).
Yes, the correlation and regression scores were distinguished in a proper manner and
in the study. The authors properly mentioned the p-value and the r-value of the collected data.
While discussing the interpretation of the r-value of the study it can be observed that the r-
value of the collected data was interpreted in a correct manner (Martyr et al., 2018). The
direction of causality was also interpreted by the authors (Janssen et al., 2018). And as a part
of this, it can be mentioned that the overall single regression was capable of showing that
there was a significant correlation in between activities of daily life and severity of dementia
(Giebel, Sutcliffe, & Challis, 2015). However, the researchers failed to identify any type of
direct correlation between the ADLtotal and QoL-AD-C of the patients (Giebel, Sutcliffe, &
Challis, 2015).
In the study, the confidence interval was not mentioned in the study at all. However,
the values of the study were calculated properly and along with this the authors also
interpreted in a proper (Giebel, Sutcliffe, & Challis, 2015).
In this study, the researchers did not mention any measures such as risk reduction,
treatment process and relative risk reduction (Giebel, Sutcliffe, & Challis, 2015).
Qualitative research paper appraisal:

5Critical Appraisal of Articles
1. Did the article describe an important clinical problem addressed via a clearly
formulated question?
The main purpose of the study was to analyse the understanding of the individuals
of their quality of life and how they could implement strategies which could be
implemented by them for further improving their health condition (Moyle et al., 2011). In
addition, it was also required to understand the factors that influence the quality of life of
the patients who have participated in the study. Long term care is provided to the patients
to understand their perception of how they are valued. Hence, it can be understood that
the article has described the clinical problem of dementia. However, there was no
presence of a formulated question in collaboration with the clinical problem like dementia
(Dichter et al., 2018).
2. Was a qualitative approach appropriate?
The study adopted a qualitative approach for the analysis of the data that was
gathered from the participants of the research study. However, it is not highly appropriate
as the data cannot be generalized and the smaller number of participants for the study is a
limitation. For the long term care of the patients being diagnosed with dementia, high
attention is required for integrative research to be conducted on the patients and
understand their perspective.
3. How were (i) the setting and (ii) the participants selected?
The settings selected for the study are the care homes for the elderly who are
diagnosed with medical conditions. However, there are certain care homes which provide
dementia-specific care to its patients (Horton et al., 2019). Hence, they are also selected
in the circumstance where the study could be conducted (Farina et al., 2017). The
participants were mainly the patients that have been identified to be part of the study by
the care managers of the facility (Stringer et al., 2017). A convenience sampling method

6Critical Appraisal of Articles
for the selection of the participants was chosen. Residents who stay in the vicinity of the
care home are selected such that they are eligible for the eligibility criteria (Jing, Willis &
Feng, 2016). Proper approval from the participants in the form of consent was undertaken
from the participants for the study to be conducted (Ballard et al., 2018).
4. What was the researcher’s perspective, and has this been taken into account?
The researcher had the perspective after thorough research that there has been
very fewer evidence which encircles around the cure of dementia and its impact on the
evaluation of the components for their overall wellbeing. Hence, they found the need to
conduct research which primarily focuses on this research such that a great emphasis and
understanding is established among the physicians and patients (Broadened et al., 2018).
5. What methods did the researcher use for collecting data – and are these described in
enough detail?
For the collection of the data for the research to be conducted, a semi-structured
interview was designed and constructed. A discussion ensued about the quality of life of
the participants of the study and also was used to identify the needs and values of the
individuals for improving their quality of life (Panca et al., 2019). In addition, the
opportunities that are presently present near the residences of the individuals are also
enquired for understanding the situation of the patients (Fleming et al., 2016). However,
there is not much information about the process by which the data was collected. There
was no critical emphasis on the presence of bias in acquiring the information of the
patients.
6. What methods did the researcher use to analyse the data – and what equality
control measures were implemented?
For the appropriate analysis of the research study designed by the researcher, a
concept map was utilized for the analysis of the data that is obtained and collected from

7Critical Appraisal of Articles
the participants of the research study (Daley et al., 2019). Interviews had been conducted
on the participants which dealt with the relationship of the individuals which was inputted
in the software (Rokstad et al., 2017). The software for the concept map generator helps
in prioritizing the factors which should be given ultimate importance when compared to
other factors. A ranked list of the concepts that were collectively found in the responses
of the individuals under the study was evaluated and observed that family, wife, daughter
and friends were the most profoundly used concepts and hence, merged into one. The
second stage of the analysis involves the constructing of a concept map of the relationship
between the concepts that have been analysed and evaluated from the information and the
data that has been obtained from the patients (Olsen et al., 2016).
7. Are the results credible, and if so, are they clinically important?
The results that have been obtained from the research that has been conducted by
the authors are credible and can be used in clinical settings to improve the health outcome
of dementia patients. In clinical settings, it is crucial for caregivers to understand the
importance of family relationships and their influence in the quality of life of individuals.
8. What conclusions were drawn, and are they justified by the results?
From the study that has been conducted, it could be concluded that the study
correlates with the results of the previous studies that have been conducted on the same
research objective (Stringer et al., 2017). In addition, this study emphasis on the
importance of family relationships and their role in enhancing the quality of life of the
individuals who have been diagnosed to suffer from dementia (Robertson et al., 2017). It
is also crucial for the patients to feel that their needs are likely to be addressed by the
caregivers such that a better health outcome is established (Milte et al., 2016)
9. Are the findings of the study transferable to other clinical settings?

8Critical Appraisal of Articles
Yes. The findings of the study are transferable to other clinical settings as there
are many illnesses for which the quality of life is influenced for the patients. Hence, it is
right to conclude that the findings obtained can be utilized in other clinical settings.
Mixed methods study
1. Why was the study performed (what clinical question did it address)?
The study named, “Intergenerational volunteering and quality of life: mixed-
methods evaluation of a randomized control trial involving persons with mild to moderate
dementia” was conducted by George, (2011) to see the implementation of
intergenerational volunteering in enhancing the quality of life of individuals who are
suffering from mild to moderate level of dementia (Algar, Woods & Windle, 2016).
However, in the past, the quality of life of individuals have been ignored because of
which a disproportionate amount of focus has been laid upon the treatment and measures
for the prevention of dementia for most of the countries for the illness, dementia (de Boer
et al., 2017). Hence, this research study was conducted for which the primary focus was
given on measures that could be implemented in the intergenerational volunteering by
dementia patients which could increase the quality of life (Goyal et al., 2018) and
improve their health. The building of relationships with children by dementia patients
could help in observing increased activity and cognitive ability, increase in the social
capital and enhanced levels of self-esteem (van Santen et al., 2017).
2. What type of study was performed?
The study that was performed was principally a primary based research like a
randomized control trial. The participants who were undertaken for the study were
randomized into groups of the interventions and controls that have been designed to
assess the quality of life improvement with the help of a computerized random number
generator. The study comprised of school children of the age 5-6 and 11-14 and over 50-

9Critical Appraisal of Articles
years old individuals who have been diagnosed to suffer from mild to moderate dementia.
The control group was given the usual measure that is normally given to individuals like
collective meetings with the children (Lamb et al., 2018). However, the intervention
group was provided with the regular meetings with the children of the age 5-6 with hour-
long visits and indulging in singing activities to help in establishing a substantial
relationship with the child (Poole et al., 2018).
3. Was the study design appropriate to the broad field of research addressed (therapy,
diagnosis, screening, prognosis, causation)?
The study design that has been implemented in this study is the randomized
control trial of the intervention and the control group that is being administered to the
participants of the study (Dow et al., 2018). The research had been conducted to collect
both qualitative and quantitative data for its critical analysis and establishing a result. For
the appropriate design to be structured, it is crucial to understand the benefits of the
therapy that is to be administered to the intervention group of the study. Several pieces of
evidence have been gathered prior to the design of the study was constructed which
revealed that when an intervening group is administered an activity for the dementia
patients, there has been an increased enhancement of quality of life in the individuals who
have participated for the study (Sleeman et al., 2018) Hence, it can be deduced that the
study did incorporate the therapy and diagnosis of the illness that had been selected.
However, depending upon the broad research that had been selected by the researchers,
there is no substantial mention of the screening procedures that would have been
implemented by the researchers for the successful evaluation of the medical condition. In
addition, there have been no mention of the prognosis and the causative factors that have
been associated with dementia that should have been normally shared with the readers

10Critical Appraisal of Articles
such that a better evaluation of the results could be established and also the reasoning for
the research could be understood better.
4. Did the study meet expected standards of ethics and governance?
For the efficient and ethical conduct of the research study, it was important for the
researchers to receive ethical approval from the healthcare administration and the school
authorities for the children to be part of the research. It was crucial to get approval from
the school authorities because of the intervening symptoms of dementia (Cooper et al.,
2018). Various research of literature has been gathered in which it can be observed that
the patients who have been diagnosed with dementia have a high likeliness of suffering
from depression, anxiety and extreme anger-related issues (Moon et al., 2017). Hence, it
is mandatory for the school authorities to ensure the safety of the children while
undertaking them for the research to be conducted while collaborating with dementia
patients. For the approval of the research to be conducted, the researchers had approached
the Inter-Divisional Research Ethics Committee at Oxford University which passed the
approval after careful examination of the study. Appropriate governance of the students
and the patients was ensured by making them sign written consent forms after all the
information of the research was provided. In addition, the potential benefits and risks
associated with this kind of research were also conveyed to each and every participant of
the research such that they could make an informed decision.
Alternative Research Design
While discussing the alternative research designs of the study, it can be stated that the
in case of the quantitative study, the authors may use a different strategy such groups of
different age group people in their study as it will enhance the scattering of the collected data
in terms of the age group differentiation. According to the study of Halsey et al., (2015), it is
reported that the nature of scatter data can enhance the reliability of the study. In this study,

11Critical Appraisal of Articles
no such reliability was reported by the authors. In the qualitative study, a semi-structured
interview method was used. Therefore, it can be stated that the use of a structured interview
in the qualitative study can improve the quality of the study as well. However, the use of
demographic data in the study also enhances the reliability of the study (Grossoehme, 2014).
In the randomized control mixed-method study, the number of study participants can easily
be enhanced. According to the study of Spindel et al., (2015), a number of sample
populations are correlated with the improved quality of the study. In this regard, it can be
stated that in this study number of samples can be included easily in order to enhance the
acceptance of the study (Funder et al., 2014).
Conclusion
Therefore, it can be concluded that the issue of quality life among dementia patients is
one of the serious issues around the different countries of the world. In this context, it can be
stated that the quality of life and activities of daily living are greatly altered for the patients
suffering from depression and dementia. In the above discussed it was reported that there was
a positive correlation between the quality of life and poor condition of the patients suffering
from dementia. Not only this, but it is also true that the quality of life of the patients suffering
from the disease condition is altered due to the poor activities of the daily life of the patients.
However, in all the cases the presence of caregiver along with the patients is also reported by
the authors. Therefore, it can be depicted that the poor quality of life of the patients with
dementia and depression does not allow the patients to live independently and so this kind of
dependability of the patients reduces the overall wellbeing of the patients in terms of
psychologically and physically.

12Critical Appraisal of Articles
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18Critical Appraisal of Articles
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department attendance by people with dementia in their last year of life: retrospective
cohort study using linked clinical and administrative data. Alzheimer's & Dementia, 14(1),
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(2015). Genomic selection and association mapping in rice (Oryza sativa): effect of trait
genetic architecture, training population composition, marker number and statistical model
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(2017). 39 A qualitative study of family carer's attitudes towards agitation in people with
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19Critical Appraisal of Articles
Records identified
through Medline
database searching
(n=37)
Records after duplicates removed
(n = 49)
Records screened
(n = 49)
Records screened
(n = 198)
Records excluded
(n = 48)
Records excluded
(n = 186)
Full-text articles assessed
for eligibility
(n = 37)
Full text articles excluded,
with reasons
(n = 34)
Full-text articles excluded,
with reasons
(n = 6)
Included studies in this
investigation for qualitative
synthesis
(n = 3)
Included
Screening
Eligibility
Identification Records identified
through CINAHL
database searching
(n = 29)
Records identified
through Pub Med
database searching
(n = 31)
Appendix
Appendix 1
Figure 1: PRISMA Diagram for this research investigation