Predictability of death in end-stage dementia: Patient characteristics and work-load associated with the condition

Criteria for end-stage dementia (ESD) were constructed from the variables of Minimum Data Set 1.0 (MDS). Every resident (n = 656) in a large geriatric hospital mainly serving one geographical district in Helsinki, Finland, was analysed and the mortality was recorded for 34 months. The work-load of the staff was determined by measuring the time addressed to each resident. Of the subjects 11% (n = 71) filled the criteria for ESD and were assumed to have short survival prognosis. However of the patients with ESD, 66% (n = 47) survived 6 months, 55% (n = 39) 1 year and 24% (n = 17) were still alive after 34 months. Comorbidity was practically non-existent. The patients with ESD were focused significantly more nursing-time than other patients living at the institution and as much attention as other patients with similar disability, indicating that the terminally ill demented subjects demand and receive a great deal of nursing efforts. Nevertheless, the patients with ESD suffered from contractures, daily pain and constipation. Palliative care in the final stage of dementia could be justified but not the attempts to predict death.