The prognostic value of the NECPAL instrument, Palliative Prognostic Index, and PROFUND index in elderly residents of nursing homes with advanced chronic condition

Abstract

Background: It is essential to assess the need for palliative care and the life prognosis of elderly nursing home residents with an advanced chronic condition, and the NECPAL ICO-CCOMS©4.0 prognostic instrument may be adequate for both purposes. The objective of this study was to examine the predictive capacity of NECPAL, the Palliative Prognosis Index, and the PROFUND index in elderly residents with advanced chronic condition with and without dementia, comparing their results at different time points. Methods: This prospective observational study was undertaken in eight nursing homes, following the survival of 146 residents with advanced chronic condition (46.6% with dementia) at 3, 6, 12, and 24 months. The capacity of the three instruments to predict mortality was evaluated by calculating the area under the receiver operating characteristic curve (AUC), with 95% confidence interval, for the global population and separately for residents with and without dementia. Results: The mean age of residents was 84.63 years (±8.989 yrs); 67.8% were female. The highest predictive capacity was found for PROFUND at 3 months (95%CI: 0.526-0.756; p=0.016), for PROFUND and NECPAL at 12 months (non-significant; AUC >0.5), and NECPAL at 24 months (close-to-significant (AUC=0.624; 95% CI: 0.499-0.750; p=0.053). The highest capacity at 12 months was obtained using PROFUND in residents with dementia (AUC=0.698; 95%CI: 0.566-0.829; p=0.003) and NECPAL in residents without dementia (non-significant; AUC=0.649; 95%CI: 0.432-0.867; p=0.178). Significant differences in AUC values were observed between PROFUND at 12 (p=0.017) and 24 (p=0.028) months. Conclusions: PROFUND offers the most accurate prediction of survival in elderly care home residents with advanced chronic condition overall and in those with dementia, especially over the short term, whereas NECPAL ICO-CCOMS©4.0 appears to be the most useful to predict the long-term survival of residents without dementia. These results support early evaluation of the need for palliative care in elderly care home residents with advanced chronic condition.