Context Survival varies for patients with advanced dementia, and accurate prognostic
tools have not been developed. A small proportion of patients admitted to
hospice have dementia, in part because of the difficulty in predicting survival.
Objectives To identify factors associated with 6-month mortality in newly admitted
nursing home residents with advanced dementia and to create a practical risk
score to predict 6-month mortality in this population.
Design, Setting, and Participants This was a retrospective cohort study of data from the Minimum Data
Set (MDS). All Medicare or Medicaid licensed nursing homes in New York and
Michigan were included. Participants had advanced dementia and were admitted
to New York nursing homes between June 1, 1994, and December 30, 1998 (derivation
cohort, n = 6799), and to Michigan nursing homes from October 1, 1998, through
July 30, 2000 (validation cohort, n = 4631).
Main Outcome Measures MDS factors associated with 6-month mortality were determined in the
derivation group, and the resulting mortality risk score was evaluated in
the validation cohort. Risk score performance was compared with the cut point
of 7c on the Functional Assessment Staging (FAST) scale.
Results Among residents with advanced dementia, 28.3% (n = 1922) died within
6 months of nursing home admission in the derivation cohort; 35.1% (n = 1626)
died in the validation cohort. The 6-month mortality rate increased across
risk scores (possible range, 0-19): 0 points, 8.9% mortality; 1 to 2, 10.8%;
3 to 5, 23.2%; 6 to 8, 40.4%; 9 to 11, 57.0%; and at least 12, 70.0% in the
validation cohort. The area under the receiver operating characteristic (AUROC)
curve for predicting 6-month mortality was 0.74 and 0.70 in the derivation
and validation cohorts, respectively. Our risk score demonstrated better discrimination
to predict 6-month mortality (AUROC, 0.64 for a cutoff of ≥6 points vs
0.51 for FAST stage 7c).
Conclusion A risk score based on 12 variables from the MDS estimates 6-month mortality
for nursing home residents with advanced dementia with greater accuracy than
existing prognostic guidelines.