Criteria for Enrolling Dementia Patients in Hospice

Objective: to study possible interrelations existing between the Mini-Suffering State Examination (MSSE) scale and survival of end-stage dementia patients. Methods: a cohort study of 252 end-stage dementia patients with a 6-month follow-up period, conducted in a Division of Geriatric Medicine of a general hospital. We included 134 consecutive bedridden end-stage dementia patients admitted during a 36-month period, and surviving in the ward for <6 months. Interrelations between survival and admission MSSE scores were studied. Results: compared with patients surviving ≥6 months, those dying within 6 months were significantly older (P = 0.014). Mean survival time was 57.76 ± 9.73 days for the low MSSE score group (29 patients, MSSE 2.24 ± 0.99), 44.70 ± 5.99 days for the intermediate MSSE score group (53 patients, MSSE 4.92 ± 0.83) and 27.54 ± 4.16 days for the high MSSE score group (52 patients, MSSE 8.06 ± 1.00). Differences between the survival times of these three MSSE score groups were statistically significant (Kaplan-Meier Analysis Log Rank P = 0.0018, Breslow P = 0.0027). The Cox proportional hazard model of survival showed a significant interrelation of high MSSE scores and shorter survival (P = 0.013). Conclusions: documentation of a high-suffering level by the MSSE scale helps in identifying end-stage dementia patients expected to benefit from enrolment into a palliative care setting.

show abstract

“…Several studies have investigated the 6-month survival of persons with a primary diagnosis of advanced dementia [8,9].…”

Section: Introductionmentioning

confidence: 99%

Their last 6 months: suffering and survival of end-stage dementia patients

2006

View full text Add to dashboard Cite

show abstract

“…10,11,[20][21][22] With a 6-month mortality rate of 25% and a median survival of 1.3 years, advanced dementia is associated with a life expectancy similar to that for more commonly recognized end-of-life conditions, such as metastatic breast cancer 23 and stage IV congestive heart failure. 24 The idea that dementia is a terminal illness is further supported by our finding that most of the deaths were not precipitated by devastating acute events (e.g., myocardial infarction), other terminal diseases (e.g., cancer), or the decompensation of chronic conditions (e.g., congestive heart failure).…”

Section: Discussionmentioning

confidence: 99%

The Clinical Course of Advanced Dementia

Genao¹,

White²,

Twersky³

2010

N Engl J Med

View full text Add to dashboard Cite

show abstract

“…23 For example, mental confusion occurs in 83%, urinary incontinence in 72%, pain in 64%, 8 swallowing problems in 72% and malnutrition in 50%. 38 Antibiotic treatment of intercurrent infections is less effective in dementia 39 because several risk factors (e.g. an inability to report symptoms, decreased immune responses to infections and loss of ability to ambulate) make infections an unavoidable consequence of advanced dementia.…”

Section: Routine Clinical Carementioning

confidence: 99%

End-of-life care and dementia

Robinson

Hughes

Daley

et al. 2005

Rev. Clin. Gerontol.

View full text Add to dashboard Cite

In the UK, research continues to confirm that people with certain chronic illnesses, such as chronic lung disease and cardiac failure, represent the ‘disadvantaged dying’ compared to those with terminal cancer. But what is the situation for people dying with advanced dementia and what is the experience of their carers? Practical guidance for clinicians is scarce. In Standard 7 of the National Service Framework for Older People, which covers mental health, there is mention neither of how care should be provided nor of how patient choice should be ensured for people with dementia at the end of life. In the UK, 5% of the population aged 65 and over and 20% of those aged 80 and over have dementia similar prevalence figures are found in the USA. Current predictions suggest that the number of people with dementia will increase by 40% by 2026 and will double by 2050. The increased demand for end-of-life care for people with dementia will be associated with major social and economic costs, but what is the current standard of such care? How can the quality be improved? And how should future services be configured to cope with this increasing need? In this paper, we review current knowledge around end-of-life care in dementia, discuss the clinical challenges and ethical dilemmas presented to carers, consider the difficulties in delivering such care and suggest practical approaches to improve the quality of such care.

show abstract

Criteria for Enrolling Dementia Patients in Hospice

Cited by 132 publications

References 21 publications

Their last 6 months: suffering and survival of end-stage dementia patients

Their last 6 months: suffering and survival of end-stage dementia patients

The Clinical Course of Advanced Dementia

End-of-life care and dementia

Contact Info

Product

Resources

About