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Predictor Index of Mortality in Dementia Patients Upon Entry Into Long-term Care

^a Neuropsychiatry and Memory Group, Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, Maryland
^b Department of Mental Hygiene, The Johns Hopkins University School of Hygiene and Public Health, Baltimore, Maryland
^c Center on Aging and Health, The Johns Hopkins University School of Hygiene and Public Health, Baltimore, Maryland
^d Copper Ridge Institute, Sykesville, Maryland
^e Gertrude Sergievsky Center, Columbia University College of Physicians and Surgeons, New York, New York

Michelle C. Carlson, Center on Aging and Health, 2024 E. Monument St., Suite 2-700, Baltimore, MD 21205 E-mail: mcarlson{at}jhsph.edu.

Decision Editor: John E. Morley, MB, BCh

Abstract

Background. The purpose of this study was to develop an algorithm that predicts survival in patients with dementia upon entry into long-term care. There are, as yet, no predictive equations developed for those in the late stages of Alzheimer's disease (AD).

Methods. This was a prospective, observational study of 132 patients with dementia (61% with AD) followed for up to 5.0 years (median of 41.0 months) after admission to a long-term care facility for dementia patients. Information on demographic characteristics, physical health, and cognitive, emotional, and behavioral characteristics was collected shortly after admission and entered as predictors of time until death in Cox regressions. Findings were used to derive an index predicting mortality.

Results. There were 60 deaths among the 132 patients (45.4% mortality), with an average survival of 22.4 months in those who died. Better physical health and the presence of delusions were associated with longer survival. These two variables were aggregated into the Copper Ridge Index (CRI). Each one-point increase on the CRI was associated with a four-fold greater likelihood of death over 5 years.

Conclusions. A predictive equation incorporating measures of general physical health and delusions accurately predicted time to death in dementia patients in long-term care.

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