Advanced Dementia

Warrillow, Stephen; Moran, Juli; Weickhardt, Andrew

doi:10.1056/nejmc1509349

Cited by 17 publications

(17 citation statements)

References 56 publications

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“…The prevalence of cardiac failure, like that of dementia, increases with increasing age [ 55 , 56 ], and this may have contributed to the high prevalence of cardiac failure in the present sample. Many patients with advanced dementia also suffer from dysphagia [ 57 ], which may make fluid intake much more difficult. This can lead to dehydration and prerenal kidney failure.…”

Section: Discussionmentioning

confidence: 99%

Place of death in patients with dementia and the association with comorbidities: a retrospective population-based observational study in Germany

2018

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BackgroundDue to increasing life expectancy, more and more older people are suffering from dementia and comorbidities. To date, little information is available on place of death for dementia patients in Germany. In addition, the association of place of death and comorbidities is unknown.MethodsA population-based cross-sectional survey was conducted in Westphalia–Lippe (Germany), based on the analysis of death certificates from 2011. Individuals with dementia ≥ 65 years were identified using the documented cause of death. In this context, all mentioned causes of death were included. In addition, ten selected comorbidities were also analyzed. The results were presented descriptively. Using multivariate logistic regression, place of death was analyzed for any association with comorbidities.ResultsA total of 10,364 death certificates were analyzed. Dementia was recorded in 1646 cases (15.9%; mean age 86.3 ± 6.9 years; 67.3% women). On average, 1.5 ± 1.0 selected comorbidities were present. Places of death were distributed as follows: home (19.9%), hospital (28.7%), palliative care unit (0.4%), nursing home (49.5%), hospice (0.9%), no details (0.7%). The death certificates documented cardiac failure in 43.6% of cases, pneumonia in 25.2%, and malignant tumour in 13.4%. An increased likelihood of dying in hospital compared to home or nursing home, respectively, was found for the following comorbidities (OR [95%-CI]): pneumonia (2.96 [2.01–4.35], p = 0.001); (2.38 [1.75–3.25], p = 0.001); renal failure (1.93 [1.26–2.97], p = 0.003); (1.65 [1.18–2.32], p = 0.003); and sepsis (13.73 [4.88–38.63], p = 0.001); (7.34 [4.21–12.78], p = 0.001).ConclusionThe most common place of death in patients with dementia is the retirement or nursing home, followed by hospital and home. Specific comorbidities, such as pneumonia or sepsis, correlated with an increased probability of dying in hospital.

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Section: Discussionmentioning

confidence: 99%

Place of death in patients with dementia and the association with comorbidities: a retrospective population-based observational study in Germany

2018

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“…People who develop advanced dementia face a reduced survival duration, particularly due to an impaired swallowing function and complications associated with aspiration pneumonia. These issues raise concerns on the increased mortality associated with the disease 1,6 . Thus, as the number of patients with dementia has increased, end-of-life care has become a globally important subject 7 .…”

Section: Introductionmentioning

confidence: 99%

Place of death trends among patients with dementia in Japan: a population-based observational study

Koyama

Sasaki

Hagiya

et al. 2019

Sci Rep

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Dementia is a major public health concern in ageing societies. Although the population of Japan is among the most aged worldwide, long-term trends in the place of death (PoD) among patients with dementia is unknown. In this Japanese nationwide observational study, we analysed trends in PoD using the data of patients with dementia who were aged ≥65 years and died during 1999–2016. Trends in the crude death rates and PoD frequencies were analysed using the Joinpoint regression model. Changes in these trends were assessed using the Joinpoint regression analysis in which significant change points, the annual percentage change (APC) and average APCs (AAPC) in hospitals, homes, or nursing homes were estimated. During 1999–2016, the number of deaths among patients with dementia increased from 3,235 to 23,757 (total: 182,000). A trend analysis revealed increased mortality rates, with an AAPC of 8.2% among men and 9.3% among women. Most patients with dementia died in the hospital, although the prevalence of hospital deaths decreased (AAPC: -1.0%). Moreover, the prevalence of nursing home deaths increased (AAPC: 5.6%), whereas the prevalence of home deaths decreased (AAPC: -5.8%). These findings support a reconsideration of the end-of-life care provided to patients with dementia.

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“…Finally, we did not have information on if decedents had an advanced directive or other documents indicating their preferences for EOL care. Advanced care planning has positive outcomes such as greater family satisfaction, better alignment with patient wishes, fewer unnecessary hospital admissions, and lower health care costs in nursing homes (36).…”

Section: Discussionmentioning

confidence: 99%

End-of-Life Healthcare Utilization of Older Mexican Americans With and Without a Diagnosis of Alzheimer’s Disease and Related Dementias

Nguyen¹,

Downer²,

Chou

et al. 2019

The Journals of Gerontology: Series A

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Background Little is known about the patterns of end-of-life health care for older Mexican Americans with or without a diagnosis of Alzheimer’s disease and related dementias (ADRD). Our objective was to investigate the frequency of acute hospital admissions, intensive care unit use, and ventilator use during the last 30 days of life for deceased older Mexican American Medicare beneficiaries with and without an ADRD diagnosis. Methods We used Medicare claims data linked with survey information from 1,090 participants (mean age of death 85.1 years) of the Hispanic Established Populations for the Epidemiologic Studies of the Elderly. Multivariable logistic regression models were used to estimate the odds for hospitalization, intensive care unit use, and ventilator use in the last 30 days of life for decedents with ADRD than those without ADRD. Generalized linear models were used to estimate the risk ratio (RR) for length of stay in hospital. Results Within the last 30 days of life, 64.5% decedents had an acute hospitalization (59.1% ADRD, 68.3% no ADRD), 33.9% had an intensive care unit stay (31.3% ADRD, 35.8% no ADRD), and 17.2% used a ventilator (14.9% ADRD, 18.8% no ADRD). ADRD was associated with significantly lower hospitalizations (odds ratio [OR] = 0.67, 95% confidence interval [CI] = 0.50–0.89) and shorter length of stay in hospital (RR = 0.77, 95% CI = 0.65–0.90). Conclusion Hospitalization, intensive care unit stay, and ventilator use are common at the end of life for older Mexican Americans. The lower hospitalization and shorter length of stay in hospital of decedents with ADRD indicate a modest reduction in acute care use. Future research should investigate the impact of end-of-life planning on acute-care use and quality of life in terminally ill Mexican American older adults.

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Advanced Dementia

Cited by 17 publications

References 56 publications

Place of death in patients with dementia and the association with comorbidities: a retrospective population-based observational study in Germany

Place of death in patients with dementia and the association with comorbidities: a retrospective population-based observational study in Germany

Place of death trends among patients with dementia in Japan: a population-based observational study

End-of-Life Healthcare Utilization of Older Mexican Americans With and Without a Diagnosis of Alzheimer’s Disease and Related Dementias

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