New Prognostic Tool Helps Predict 6-Month Mortality in Advanced Dementia Patients
Boston researchers have created and validated a practical risk score for predicting 6-month mortality in nursing home patients with advanced dementia, according to their report in the Journal of the American Medical Association.
“Our risk score offers an improvement over existing prognostic guidelines used in this population because it is based on empiric data, has greater predictive power, and uses standardized, readily available MDS [Minimum Data Set] assessments,” write the investigators, led by Susan L. Mitchell, MD, of the Hebrew Rehabilitation Center for Aged Research and Training Institute and the Harvard Medical School, Boston.
The team conducted a retrospective cohort study of patients with advanced dementia admitted to all Medicare- and Medicaid-certified nursing facilities in New York (derivation cohort, n = 6799) and Michigan (validation cohort, n = 4631) during 1994-1998 and 1998-2000, respectively.
A mortality risk score based on 12 MDS factors associated with 6-month mortality risk identified in the derivation cohort was evaluated in the validation cohort. Six categories of risk of mortality within 6 months were calculated. The authors provide within their report a score sheet for estimating 6-month prognosis and stratifying patients into levels of risk.
When the researchers compared their risk score performance with that of the existing guideline for enrolling patients with a primary diagnosis of dementia into hospice — the cutoff point of 7c (nonambulatory) on the Functional Assessment Staging scale — their risk score was found to demonstrate better discrimination to predict 6-month mortality in these patients.
“Advanced dementia is an incurable, progressive condition for which palliation is often the primary goal of care, regardless of life expectancy,” state the authors. “High quality palliative care should be available to the large proportion of persons with advanced dementia who will be cared for in nursing homes.”
Source: “Estimating Prognosis for Nursing Home Residents with Advanced Dementia,” Journal of the American Medical Association; June 9, 2004; 291(22):2734-2740. Mitchell S, Kiely D, Hamel M, et al; Hebrew Rehabilitation Center for Aged Research and Training Institute; Department of Medicine and Division of Medicine and Primary Care, Beth Israel Deaconess Medical Center; and Division on Aging, Harvard Medical School, Boston.
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Identified risk factors to be scored for 6-month mortality include: |
Note from BB: These are the factors they use to determine if a patient suffering dementia will live less than 6 months, so they can be admitted to hospice where treatment for their condition is forbidden, and death becomes imminent.
My turn to throw up. Excuse me please!