Determining Dementia Prognosis

The best care for persons with advanced dementia is hindered because of the difficulty in estimating their prognosis with accuracy — until now. Researchers have created a model to help determine the risk of death within six months for these patients. The results are published in the issue of The Journal of the American Medical Association.

Study authors say the prognosis of patients with advanced dementia is important in guiding end-of-life decisions and for determining hospice eligibility. To be eligible for hospice in the United States, Medicare beneficiaries must have an estimated life span of less than six months. Because of the difficulty in predicting the life expectancy for dementia patients, few of them are admitted to hospice.

The authors identified factors associated with the risk of death within six months for patients with advanced dementia and created a risk score to predict survival among this group.

The variables with prognostic value include cancer, being male, the need for oxygen therapy, congestive heart failure, shortness of breath, no more than 25 percent of food eaten at most meals, an unstable condition, bowel incontinence, bedfast, older than 83 years, and not awake most of the day. The more of these variables a patient has, the higher the risk of death within six months.

“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 readily available Data Set assessments,” say the authors.