Estimating Prognosis for Nursing Home Residents With Advanced Dementia

Mitchell, Susan L.; Kiely, Dan K.; Hamel, Mary Beth; Park, Pil S.; Morris, John N.; Fries, Brant E.

doi:10.1001/jama.291.22.2734

Cited by 219 publications

(237 citation statements)

References 31 publications

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“…A Dutch study reported only 15% of nursing home residents with dementia ended their days in such condition [9]. Older age, male gender, comorbid disease, cognitive and functional status, and neuropsychiatric symptoms are all related to mortality [12,13]. Male gender and ADL dependency are the strongest predictors of 6-month mortality in patients with advanced dementia with no acute disease and also in dementia patients with pneumonia [13][14][15].…”

Section: Death With Dementiamentioning

confidence: 99%

Dying with Dementia: What We Know after More than a Decade of Research

Steen

2010

JAD

225

177

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Abstract. Death with dementia is increasingly common. Although prognostication is difficult, it is an incurable life-limiting illness for which palliative care for the patient is often appropriate. Dementia patients are otherwise at risk of overtreatment with burdensome and possibly non-beneficial interventions and undertreatment of symptoms. Although recent studies indicate encouraging trends of improved palliative care, little evidence supports effectiveness of specific treatments. As of January 2010, at least 45 studies, almost all performed after 2000, have reported on treatment, comfort, symptom burden, and families' satisfaction with care. Over half (25; 56%) of these studies were in US settings, and most were small or retrospective. Few randomized trials and prospective observational studies have been performed so far, but several promising studies have been completed recently or are underway in various countries. Guidelines for care and treatment, still mostly consensus-based, support the benefits of advance care planning, continuity of care, and family and practitioner education. Assessment tools for pain, prognosis, and family evaluations of care have been developed and some have been shown to be effective in clinical practice. With increasing numbers of well-designed, large-scale studies, research in the next decade may result in better evidence-based guidelines and practice.

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Section: Death With Dementiamentioning

confidence: 99%

Dying with Dementia: What We Know after More than a Decade of Research

Steen

2010

JAD

225

177

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“…Barriers to the provision of quality care for people with dementia at end of life include the lack of any valid measurement of quality of care and quality of life, and of appropriate interventions (Blasi et al, 2002). Studies show that, even with the use of clinical assessment tools it is difficult to recognise when someone with dementia is dying (Mitchell et al, 2004a(Mitchell et al, , 2004bBrandt and Ribe, 2005) and, also, that staff lack confidence in the assessment and management of care at the end of life for people with dementia (Moss et al, 2002).…”

Section: Dementia Care Towards the End Of Lifementioning

confidence: 99%

“…A number of studies indicate that health professionals are not skilled at recognising the end stages. A US study of 883 nursing home residents found that one per cent of people with dementia were recorded as having a life expectancy of less than six months, but 71% of them died during this period (Mitchell et al, 2004a). A Korean study (Suh et al, 2004) tested the hypothesis that mortality in people with dementia is higher in care homes than in the community and found no difference in mortality rate.…”

Section: Predicting the Approach Of Death For People With Dementiamentioning

confidence: 99%

“…Several studies tested and validated scales to predict survival. Contextual factors such as the use of tube feeding and less aggressive care plans (Hanrahan et al, 1999;Lapane et al, 2001) plus the inability of some scoring systems to discriminate between underlying morbidities and different disease trajectories, gender differences, and disabilities mean that existing tools and guidelines need further validation and refinement (Gambassi et al, 1999;Mitchell et al, 2004aMitchell et al, , 2004bMagaziner et al, 2005). A small descriptive study argued that the use of hospice guidelines for people with dementia were useful for identifying survival time of less than six months (Hanrahan et al, 1999), but a study that reviewed the notes of 165 people with dementia admitted to a community-based hospice found that only 64% of people who met criteria for hospice care died within six months of admission.…”

Section: Predicting the Approach Of Death For People With Dementiamentioning

confidence: 99%

See 1 more Smart Citation

End of life care for community dwelling older people with dementia: an integrated review

Goodman

Evans

Wilcock

et al. 2009

Int J Geriat Psychiatry

106

102

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Objective: To review the evidence for end-of-life care for community dwelling older people with dementia (including those resident in care homes). Design: An integrated review synthesised the qualitative and quantitative evidence on end-of-life care for community dwelling older people with dementia. English language studies that focused on prognostic indicators for end-of-life care, assessment, support/relief, respite and educational interventions for community dwelling older people with dementia were included. A user representative group informed decisions on the breadth of literature used. Each study selected was screened independently by two reviewers using a standardised check list. Results: Sixty eight papers were included. Only 17% (12) exclusively concerned living and dying with dementia at home. Six studies included direct evidence from people with dementia. The studies grouped into four broad categories: Dementia care towards the end of life, palliative symptom management for people with dementia, predicting the approach of death for people with dementia and decision-making. The majority of studies were descriptive. The few studies that developed dementia specific tools to guide end of life care and outcome measures specific to improve comfort and communication, demonstrated what could be achieved, and how much more needs to be done. Conclusions: Research on end-of-life care for people with dementia has yet to develop interventions that address the particular challenges that dying with dementia poses. There is a need for investigation of interventions and outcome measures for providing end-of-life care in the settings where the majority of this population live and die.

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“…[4][5][6][7][8][9][10][11] The survey includes questions on factors individually associated with mortality (e.g., age, function), but a validated prognostic index of mortality is not available for use with NHIS data. Investigators have previously developed prognostic indices within segments of the population (e.g., hospitalized elders 12 and nursing home residents 13 ). Others have examined the influence of specific comorbid diseases or functional status on mortality [14][15][16] , and one study examined the influence of laboratory measures of subclinical and clinical disease (e.g., fasting glucose level) on 5-year mortality.…”

Section: Introductionmentioning

confidence: 99%

Index to Predict 5-Year Mortality of Community-Dwelling Adults Aged 65 and Older Using Data from the National Health Interview Survey

et al. 2009

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BACKGROUND: Prognostic information is becoming increasingly important for clinical decision-making.OBJECTIVE: To develop and validate an index to predict 5-year mortality among community-dwelling older adults. DESIGN AND PARTICIPANTS:A total of 24,115 individuals aged >65 who responded to the 1997-2000 National Health Interview Survey (NHIS) with follow-up through 31 December 2002 from the National Death Index; 16,077 were randomly selected for the development cohort and 8,038 for the validation cohort.MEASUREMENTS: 39 risk factors (functional measures, illnesses, behaviors, demographics) were included in a multivariable Cox proportional hazards model to determine factors independently associated with mortality. Risk scores were calculated for participants using points derived from the final model's beta coefficients. To evaluate external validity, we compared survival by quintile of risk between the development and validation cohorts.RESULTS: Seventeen percent of participants had died by the end of the study. The final model included 11 variables: age (1 point for 70-74 up to 7 points for >85); male: 3 points; BMI <25: 2 points; perceived health (good: 1 point, fair/poor: 2 points); emphysema: 2 points; cancer: 2 points; diabetes: 2 points; dependent in instrumental activities of daily living: 2 points; difficulty walking: 3 points; smoker-former: 1 point, smoker-current: 3 points; past year hospitalizationsone: 1 point, >2: 3 points. We observed close agreement between 5-year mortality in the two cohorts; which ranged from 5% in the lowest risk quintile to 50% in the highest risk quintile in the validation cohort.CONCLUSIONS: This validated mortality index can be used to account for participant life expectancy in analyses using NHIS data.

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Estimating Prognosis for Nursing Home Residents With Advanced Dementia

Abstract: Context Survival varies for patients with advanced dementia, and accurate prognostic tools have not been developed. A small proportion of patients admitted to hospice have dementia, in part because of the difficulty in predicting survival.

Cited by 219 publications

References 31 publications

Dying with Dementia: What We Know after More than a Decade of Research

Dying with Dementia: What We Know after More than a Decade of Research

End of life care for community dwelling older people with dementia: an integrated review

Index to Predict 5-Year Mortality of Community-Dwelling Adults Aged 65 and Older Using Data from the National Health Interview Survey

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