Quality of life and resource use in nursing homes. The effect of the COSMOS-intervention
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- Department of Economics 
Dementia is a costly disease. Future projections show a higher share of elderly, which will increase prevalence of dementia and thus health care expenditures consumed by people with dementia. In addition, comes the costs of informal care. Caring for a loved one can make informal caregivers experience a high burden of care and high opportunity costs, even after the patient is moved to a nursing home. Dementia can also negatively affect the quality of life for the diseased person. Due to these factors, interventions that can decrease costs and positively impact the affected people are of high value to society. In 2015-2016, a randomized controlled trial, the COSMOS-intervention, was implemented in various nursing homes across Norway. The main objective was to improve quality of life in nursing home patients, with secondary objectives including improving cost-effectiveness and reducing unnecessary medication and hospital admissions. This thesis evaluates how the COSMOS-intervention affects quality of life, formal- and informal time use, and use of psychotropic medication in patients with dementia. To do so, the average treatment effect on the treated is estimated using regressions with individual fixed effects. Further, the thesis aims to investigate the economic implications of the intervention. The results show no change in quality of life, but a decreased use of psychotropic medication and informal care. Formal care has increased considerably. The causality of the results is challenged due to various factors, including a small sample size. Whether the changes can be considered economically beneficial, depends on whose perspective is taken, since costs and benefits are valued differently by the patient, nursing home management, and society.