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

TitlePrediction of 6-month mortality in nursing home residents with advanced dementia: validity of a risk score
Publication TypeJournal Article
Year of Publication2007
Authorsvan der Steen J.T, Mitchell S.L, Frijters D.H, Kruse R.L, Ribbe M.W
JournalJournal of the American Medical Directors Association
Date PublishedSep
Accession Number17845950
Keywords*Activities of Daily Living, *Dementia/mo [Mortality], *Long-Term Care, *Nursing Homes, Aged, Aged, 80 and over, Female, Health Status, Humans, Logistic Models, Male, Netherlands, Prognosis, Risk Factors, United States

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.

Short TitleJ Am Med Dir Assoc
Alternate JournalJ Am Med Dir Assoc