Hospitalization Greatly Ups Risk of Severe Disability in Elderly
Other study suggests comfort, not prognostic estimates, be used to direct dementia palliative care
TUESDAY, Nov. 2 (HealthDay News) -- In older people, illnesses and injuries steeply increase the chances of developing new or worsening disability, and the Advanced Dementia Prognostic Tool (ADEPT), as a continuous measure, has a modest ability to identify nursing home residents with advanced dementia who are at high risk of dying within six months, according to two studies published in the Nov. 3 issue of the Journal of the American Medical Association.
In the first study, Thomas M. Gill, M.D., of the Yale University School of Medicine in New Haven, Conn., and colleagues analyzed data from 754 non-disabled people aged 70 and older, who were followed for more than 10 years. Hospitalization was linked to a steep risk of transition from no disability to severe disability (hazard ratio [HR], 168). Restricted activity was linked to transition to mild and severe disability (HRs, 2.59 and 8.03, respectively). Physical frailty accentuated the associations.
In the second study, Susan L. Mitchell, M.D., of the Institute for Aging Research in Boston, and colleagues analyzed data from 606 nursing home residents with advanced dementia. The area under the receiver operating characteristic (AUROC) curve for ADEPT's prediction of six-month mortality, as a continuous variable, was 0.67. The AUROC for Medicare guidelines for hospice eligibility was 0.55, with a specificity of 0.89 and a sensitivity of 0.20.
Referring to patients with advanced dementia, Mitchell and colleagues write that, "our study strongly suggests that delivery of palliative care to these residents should be guided by a preference for comfort as the primary goal of care and not by prognostic estimates."