Prediction of 6-Month Survival of Nursing Home Residents With Advanced Dementia Using ADEPT vs Hospice Eligibility Guidelines
- 3 November 2010
- journal article
- research article
- Published by American Medical Association (AMA) in JAMA
- Vol. 304 (17), 1929-1935
- https://doi.org/10.1001/jama.2010.1572
Abstract
Estimating life expectancy is challenging in advanced dementia, potentially limiting the use of hospice care in these patients. To prospectively validate and compare the performance of the Advanced Dementia Prognostic Tool (ADEPT) and hospice eligibility guidelines to estimate 6-month survival in nursing home residents with advanced dementia. A prospective cohort study conducted in 21 nursing homes in Boston, Massachusetts, of 606 residents with advanced dementia who were recruited between November 1, 2007, and July 30, 2009. Data were ascertained at baseline to determine the residents’ ADEPT score (range, 1.0-32.5; higher scores indicate worse prognosis) and whether they met Medicare hospice eligibility guidelines. Survival was followed up to 6 months. Assessment and comparison of the performance of the ADEPT score and hospice guidelines to predict 6-month survival using sensitivity, specificity, and the area under the receiver operating characteristic (AUROC) curve. At baseline, the residents’ mean (SD) ADEPT score was 10.1 (3.1) points and 65 residents (10.7%) met hospice eligibility guidelines. Over 6 months, 111 residents (18.3%) died. The AUROC for the ADEPT score’s prediction of 6-month mortality as a continuous variable was 0.67 (95% confidence interval [CI], 0.62-0.72). The AUROC for Medicare hospice eligibility guidelines was 0.55 (95% CI, 0.51-0.59), the specificity was 0.89 (95% CI, 0.86-0.92), and the sensitivity was 0.20 (95% CI, 0.13-0.28). Using a cutoff of 13.5 on the ADEPT score, which also had specificity of 0.89, the AUROC was 0.58 (95% CI, 0.54-0.63) and the sensitivity was 0.27 (95% CI, 0.19-0.36). When prospectively validated at the bedside and used as a continuous measure, the ability of the ADEPT score to identify nursing home residents with advanced dementia at high risk of death within 6 months was modest, albeit better than hospice eligibility guidelines. Care provided to these residents should be guided by their goals of care rather than estimated life expectancy.Keywords
This publication has 32 references indexed in Scilit:
- The Advanced Dementia Prognostic Tool: A Risk Score to Estimate Survival in Nursing Home Residents with Advanced DementiaJournal of Pain and Symptom Management, 2010
- The Clinical Course of Advanced DementiaThe New England Journal of Medicine, 2009
- Prediction of 6-month Mortality in Nursing Home Residents with Advanced Dementia: Validity of a Risk ScoreJournal of the American Medical Directors Association, 2007
- Predictors of mortality for lower respiratory infections in nursing home residents with dementia were validated transnationallyJournal of Clinical Epidemiology, 2006
- A National Study of the Location of Death for Older Persons with DementiaJournal of the American Geriatrics Society, 2005
- Government Expenditures at the End of Life for Short‐ and Long‐Stay Nursing Home Residents: Differences by Hospice Enrollment StatusJournal of the American Geriatrics Society, 2004
- Predictors of six-month survival among patients with dementia: An evaluation of hospice Medicare guidelinesAmerican Journal of Hospice and Palliative Medicine®, 2003
- Scaling ADLs Within the MDSThe Journals of Gerontology, Series A: Biological Sciences and Medical Sciences, 1999
- Risk of Entering Nursing Homes for Long Versus Short StaysMedical Care, 1994
- Regression modelling strategies for improved prognostic predictionStatistics in Medicine, 1984