Mitchell et al developed a prognostic score for predicting mortality within 6 months for patients in nursing homes with advanced dementia. This can help triage patients into short and long term survivors. The authors are from Beth Israel Deaconess Medical Center in Boston and the University of Michigan.
Parameters:
(1) age
(2) gender
(3) activities in daily living based on 7 functional activities (mobility out of bed, dressing, toileting, transfer, eating, grooming and locomotion)
(4) bedfast (bed bound)
(5) bowel continence
(6) time awake during the day (time asleep during the day)
(7) oxygen therapy requirements
(8) amount of food consumed
(9) comorbid conditions
|
Parameter |
Finding |
Points |
|---|---|---|
|
age of the patient |
<= 83 years |
0 |
|
|
> 83 years |
1.4 |
|
gender |
female |
0 |
|
|
male |
1.9 |
|
activities of daily living (ADL) |
not totally dependent in all 7 activities |
0 |
|
|
totally dependent in all 7 activities |
1.9 |
|
bedfast |
no |
0 |
|
|
yes |
1.5 |
|
bowel continence |
continent |
0 |
|
|
incontinent |
1.5 |
|
time awake during the day |
all or most |
0 |
|
|
not awake most of day |
1.4 |
|
oxygen therapy during the last 14 days |
no |
0 |
|
|
yes |
1.6 |
|
percent food eaten at most meals |
>= 25% |
0 |
|
|
< 25% |
1.5 |
|
Comorbid Conditions |
Points |
|---|---|
|
cancer |
1.7 |
|
congestive heart failure |
1.6 |
|
dyspnea (shortness of breath) |
1.5 |
|
unstable medical condition |
1.5 |
where:
• Each activity of daily living is graded from 0 (independent) to 4 (totally dependent). The total score indicating total dependence in all 7 ADL would be 28.
• An unstable condition is one that causes the patient's usual cognitive, functional or behavioral pattern to fluctuate, be precarious or deteriorate.
• Being bedfast is being totally dependent in locomotion ADL.
total points =
= SUM(points for parameters) + SUM(points for all comorbid conditions present)
Interpretation:
• minimum score: 0
• maximum score: 19
• The higher the score, the greater the mortality rate in the next 6 months.
|
Total Score |
Percent Mortality within 6 Months |
|
0 |
9% (rounded) |
|
1 or 2 |
11% (rounded) |
|
3 to 5 |
23% (rounded) |
|
6 to 8 |
40% (rounded) |
|
9 to 11 |
57% |
|
>= 12 |
70% |
Purpose: To determine the risk of mortality within 6 months for a patient with advanced dementia using the prognostic score of Mitchell et al.
Specialty: Neurology
Objective: severity, prognosis, stage
ICD-10: F00, F01, F02, F03,
