A model has been created that can help determine the risk of death within six months for nursing home patients with advanced
dementia, according to a study in the June 9 issue of The
Journal of the American Medical Association (JAMA).
Accurately estimating the life expectancy of persons with advanced dementia is difficult and hinders palliative care, according to background information in the article. Prognostic information is important in guiding end-of-life decision-making and, in the United States, for determining hospice eligibility. Medicare beneficiaries must have an estimated life expectancy of less than 6 months to be eligible for hospice. A small proportion of patients admitted to hospice have dementia, in part because of the difficulty in predicting survival. Accurate prognostic tools have not been developed.
Susan L. Mitchell, M.D., M.P.H., of Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, and colleagues identified factors associated with the risk of death in 6 months in newly admitted nursing home residents with advanced dementia and created a practical risk score to predict survival in this population.
The study included all Medicare or Medicaid licensed nursing homes in New York and Michigan. Participants had advanced dementia and were admitted to New York nursing homes between June 1, 1994, and December 30, 1998 (n = 6,799), and to Michigan nursing homes from October 1, 1998, through July 30, 2000 (n = 4,631). The risk score was derived in the New York population and validated in the Michigan population. The patient characteristics that were evaluated are routinely collected in nursing homes in the United States and some other countries as part of the Minimum Data Set.