Home and Community Care Digest
Method: This is a retrospective study of Minimum Data Set (MDS) data of all Medicaid and Medicare nursing home residents aged 65 years and older with advanced dementia in New York from June 1, 1994 to December 30, 1998 and in Michigan from October 1, 1998 to July 30, 2000. Advanced dementia is defined as having a diagnosis of dementia, a low Cognitive Performance Score and very severe impairment with the activities of daily living. A model was created using mortality data from the National Death Index and MDS information in order to determine which residents were alive beyond six months of their admission to a long-term care facility. Analysis was first conducted to determine the association between six-month survival and a variety of factors, including demographic variables, functional status variables, diagnosis variables and other health conditions variables. The final model included factors such as age, sex, the presence of cancer or heart disease, the need for oxygen therapy, shortness of breath, unstable condition, and functional status. Survival curves were then derived based on these risk scores, in order to ascertain the predictability of mortality within the six-month of admission to a nursing home
Findings: In the New York and Michigan nursing home cohorts, 28.3% and 35.1% of residents with advanced dementia died within six months of admission, respectively. Based on the results from the regression analysis, all independent factors included in the equation were significantly associated with survival, except for one diagnosis variable (the presence of a fracture in the previous 180 days) and one health condition variable (the presence of hallucinations or delusions). With respect to the index, it was observed that the risk of mortality increased with higher index scores. An index score of zero is associated with a 8.9% risk of death within six month of admission to the nursing home; a score is 1-2 is associated with a 10.8% risk; a score of 3-5 is associated with a 23.3% risk; a score of 6-8 is associated with a 40.4% risk; a score of 9-11 is associated with a risk of 57%; and a score greater than 12 is associated with a risk of 70%.
Conclusions: The study determines which factors are associated with surviving beyond six-months of admission to nursing home, as well as which factors contribute to increased mortality within the six months. The model to predict mortality is easy to use with MDS data and its ability to accurately predict death was found to be very good. Many nursing home residents with advanced dementia are dying before they have the chance to receive proper end-of-life care. As of yet, MDS is not used in Ontario long-term care analysis, however if implemented, this study, can be useful in helping to predict the survival of individuals with dementia and help guide the decision-making process for the proper delivery of palliative care to individuals who require it.
Reference: Mitchell S., Kiely D., Hamel M.B., Park P., Morris J., and Fries B. "Estimating prognosis for nursing home residents with advanced dementia". Journal of the American Medical Association, 2004; 291(22):99-111.
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