Dementia: new tool predicts 5-year risk for death

  • CMAJ
  • 20.04.2020

  • von Susan London
  • Clinical Essentials
Der Zugang zum gesamten Inhalt dieser Seite ist nur Angehörigen medizinischer Fachkreise vorbehalten. Der Zugang zum gesamten Inhalt dieser Seite ist nur Angehörigen medizinischer Fachkreise vorbehalten.

Takeaway

  • Among community-dwelling older adults with newly diagnosed dementia, 3 readily assessable factors predict risk for death within 5 years.

Why this matters

  • Accurate estimation of prognosis can help inform decisions about care.

Key results

  • 5-year status among participants:
    • 20.5% in long-term care.
    • 55.1% deceased.
    • 24.4% still living in the community.
  • Risk for death (multivariate ORs; 95% CIs) associated with:
    • Age vs 65-69 years:
      • 70-74 years: 1.3 (1.2-1.4).
      • 75-79 years: 1.7 (1.6-1.8).
      • 80-84 years: 2.6 (2.5-2.8).
      • 85-89 years: 4.3 (4.0-4.5).
      • ≥90 years: 9.5 (8.8-10.2).
    • Male vs female sex: 1.7 (1.6-1.7).
    • Presence of ≥1 of the following:
      • Chronic obstructive pulmonary disease: 1.7 (1.7-1.8).
      • Congestive heart failure: 2.0 (1.9-2.0).
      • Renal failure: 1.7 (1.6-1.8).
  • Combinations resulted in observed 5-year risk for death ranging from 22% (women aged 65-69 years without organ failure) to 91% (men age ≥90 years with organ failure).
  • Calculator is available online.

Study design

  • Canadian population-based retrospective cohort study using linked health administrative databases.
  • 108,757 community-dwelling older adults aged ≥65 years with a first documented dementia diagnosis.
  • Main outcomes included death.
  • Funding: Canadian Institutes of Health Research; Bruyère Centre for Individualized Health.

Limitations

  • Reliance on diagnostic codes.
  • Limited generalizability.
  • Cohort selected without discernment of dementia severity, subtype.