Mortality Risk Models for Persons with Dementia: A Systematic Review

Abstract

Background: Persons with dementia have higher mortality than the general population. Objective, standardized predictions of mortality risk in persons with dementia could help with planning resources for care close to the end of life. Objective: To systematically review prediction models for risk of death in persons with dementia. Methods: The Medline and PsycInfo databases were searched on November 29, 2020, for prediction models estimating the risk of death in persons with dementia. Study quality was assessed using the Prediction model Risk Of Bias ASsessment Tool. Results: The literature search identified 2,828 studies, of which 18 were included. These studies described 16 different prediction models with c statistics mostly ranging from 0.67 to 0.79. Five models were externally validated, of which four were applicable. There were two models that were both applicable and had reasonably low risk of bias. One model predicted risk of death at six months in persons with advanced dementia residing in a nursing home. The other predicted risk of death at three years in persons seen in primary care practice or a dementia specialty clinic, derived from a nationwide registry in Sweden but not externally validated. Conclusion: Valid, applicable models with low risk of bias were found in two settings: advanced dementia in a nursing home and outpatient practices. The outpatient model requires external validation. Better models are needed for persons with mild to moderate dementia in nursing homes, a common demographic. These models may be useful for educating persons living with dementia and care partners and directing resources for end of life care. Registration: The study protocol is registered on PROSPERO as RD4202018076.

Accurate Identification and Prognostication of End-of-Life State in Japan Using A Guideline-Based Diagnostic Method: A Diagnostic and Prognostic Study

“…A recent systematic review suggested that ADEPT is a reliable prognostic tool for predicting risk of death at 6 months among persons with advanced dementia in nursing homes [30]. However, our EOL diagnostic method had a higher DOR (10.32, 95% CI 4.08-26.13) than ADEPT score ≥ 18 (2.58, 95% CI 1.05-6.37) in our study populations (Table 4).…”

The Longitudinal Association of Late-Life Visual and Hearing Difficulty and Cognitive Function: The Role of Social Isolation

“…A follow-up analysis suggested that cognitive scores predicted attrition in the current sample. This could have led to an underestimation of the true rates of cognitive decline, biasing results toward the null hypothesis, as both sensory and cognitive challenges are negatively associated with survival (Ehrlich et al, 2021; Smith & Ismail, 2021).…”

Palliative care for patients with advanced dementia

“…8 However, like the FAST Stage 7c (nonambulatory), the ADEPT score alone is not very suitable for forecasting death. 9 The ADEPT tool was found to be 68% accurate in predicting death over 6 months, while the FAST scale was 55% accurate in patients living in LTC facilities. 8 Since these tools are limited, nurses must consider a patient' s goals of care as the overarching guide when making endof-life decisions with their families and surrogates.…”

“…A recent systematic review of dementia prognostic models indicated that the best validated prognostic model for advanced dementia is the 12-item Advanced Dementia Prognostic Tool (ADEPT). 9 Another study found ADEPT to be marginally better than the Medicare Hospice Guidelines and have moderate accuracy to predict 6-month survival in patients with advanced dementia. 8 However, like the FAST Stage 7c (nonambulatory), the ADEPT score alone is not very suitable for forecasting death.…”