Mitchell et al developed a risk score for predicting survival for a patient with advanced dementia in a nursing home. This can help to identify a patient with a limited life expectancy. The authors are from Beth Israel Deaconess Medical Centre, Brown University and Penn State College of Medicine.
Patient selection: nursing home patient >= 65 years of age with advanced dementia
Outcomes: mortality at 6 and 12 months
Parameters:
(1) duration of time at the nursing home
(2) age in years
(3) gender
(4) dyspnea (shortness of breath)
(5) pressure ulcer(s)
(6) functional dependence (activities of daily living or ADL)
(7) time in bed
(8) oral intake
(9) bowel incontinence
(10) body mass index
(11) weight loss
(12) congestive heart failure
|
Parameter |
Finding |
Points |
|---|---|---|
|
duration of time in nursing home |
recent admission |
3.3 |
|
|
other |
0 |
|
age in years |
65 to 69.99 |
1 |
|
|
70 to 74.99 |
2 |
|
|
75 to 79.99 |
3 |
|
|
80 to 84.99 |
4 |
|
|
85 to 89.99 |
5 |
|
|
90 to 94.99 |
6 |
|
|
95 to 99.99 |
7 |
|
|
>= 100 |
8 |
|
gender |
female |
0 |
|
|
male |
3.3 |
|
dyspnea |
absent |
0 |
|
|
present |
2.7 |
|
pressure ulcer |
1 or more Stage 2 or higher |
2.2 |
|
|
none or Stage 1 |
0 |
|
functional dependence |
none or incomplete |
0 |
|
|
complete (totally dependent in 7 activities of daily living) |
2.1 |
|
time in bed |
most of or all of day |
2.1 |
|
|
other |
0 |
|
oral intake |
sufficient |
0 |
|
|
insufficient |
2.0 |
|
bowel incontinence |
continent |
0 |
|
|
incontinent |
1.9 |
|
body mass index |
>= 18.5 kg per square meter |
0 |
|
|
< 18.5 |
1.8 |
|
weight loss |
absent |
0 |
|
|
present (> 5% in past 30 days or > 10% in past 180 days) |
1.6 |
|
congestive heart failure |
absent |
0 |
|
|
present |
1.5 |
where:
• Insufficient oral intake was defined as either (not eating >= 25% of food for most meals) or (not consuming almost all liquids during the past 3 days).
total score =
= SUM(points for all 12 parameters)
Interpretation:
• minimum score: 1
• maximum score: 32.5
• The higher the score the worse the prognosis.
|
Total Score |
Probability of Death Within 6 Months |
|---|---|
|
1 |
1% |
|
2 to 15 |
(0.1798 * ((score)^2)) - (0.3158 * (score)) + 3.198 |
|
15 to 29 |
(-0.1545 * ((score)^2)) + (10.94 * (score)) - 89.21 |
|
29 to 32.5 |
100% |
|
Total Score |
Probability of Death Within 12 Months |
|---|---|
|
1 |
6% |
|
2 to 15 |
(0.1175 * ((score)^2)) + (1.756 * (score)) + 4.174 |
|
15 to 28 |
(-0.1612 * ((score)^2)) + (10.19 * (score)) - 59.73 |
|
28 to 32.5 |
100% |
Purpose: To predict survival in a nursing home patient with advance dementia using the Advanced Dementia Prognostic Tool of Mitchell et al.
Specialty: Neurology
Objective: severity, prognosis, stage
ICD-10: F00, F01, F02,
