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J Am Med Dir Assoc. 2007 Sep;8(7):464-8. Epub 2007 Aug 13.

Prediction of 6-month mortality in nursing home residents with advanced dementia: validity of a risk score.

Author information

  • 1Department of Nursing Home Medicine, EMGO Institute of the VU University Medical Center, Amsterdam, The Netherlands. j.vandersteen@vumc.nl

Abstract

OBJECTIVE:

Prognostic information is important for guiding palliative care planning for patients with dementia. We aim to validate a risk score that uses Minimum Data Set (MDS) to estimate 6-month mortality for nursing home residents with advanced dementia.

DESIGN:

Two cohort studies.

SETTING:

Six nursing homes in The Netherlands, and 35 nursing homes in Missouri.

PARTICIPANTS:

Long-term stay residents with advanced dementia: 288 Dutch residents and 269 residents from Missouri who also had a lower respiratory tract infection (LRI).

MEASUREMENTS:

Patient risk factors and 6-month mortality.

RESULTS:

Six-month mortality rates were 24.3% for Dutch residents, and 36.8% for US residents. The risk score's AUROC was 0.65 (CI 0.58-0.72), and 0.64 (CI 0.58-0.71), respectively. For the large majority of residents, observed mortality in the 2 validation cohorts were comparable to the development cohort. Among the few residents identified as at very high risk according to the risk score, observed mortality was lower than expected.

CONCLUSION:

The original mortality risk score predicted 6-month mortality with reasonable accuracy in 2 validation cohorts of nursing home residents with advanced dementia. Thus, the performance of the risk score, at least over the range of low to moderate risk (up to around 40% risk of mortality), can be generalized to long-stay (versus recently admitted) residents with advanced dementia, and to those with LRI.

PMID:
17845950
[PubMed - indexed for MEDLINE]
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