Outcomes Studied in Nursing Home Patients With Dementia

Another study finds fall-off in functional status in nursing home residents in year after dialysis
By Eric Metcalf
HealthDay Reporter

WEDNESDAY, Oct. 14 (HealthDay News) -- Nursing home residents with advanced dementia have a high mortality rate, and residents with end-stage renal disease who begin dialysis face a high risk of functional decline in the following year, according to two studies in the Oct. 15 New England Journal of Medicine.

Susan L. Mitchell, M.D., of the Hebrew SeniorLife Institute for Aging Research in Boston, and colleagues analyzed data from 323 nursing home residents with advanced dementia (mean age, 85.3 years) for 18 months. During follow-up, 54.8 percent of subjects died. The probability of pneumonia, a febrile episode, or an eating problem was 41.1, 52.6, and 85.8 percent, respectively. During their last three months of life, 40.7 percent of those who died underwent an intervention such as parenteral therapy, hospitalization, or tube feeding.

Manjula Kurella Tamura, M.D., of the Stanford University School of Medicine in Palo Alto, Calif., and colleagues analyzed data from 3,702 nursing home residents who began dialysis treatment from June 1998 to October 2000. After a year of dialysis, 58 percent of subjects had died, and only 13 percent maintained the functional status they had before dialysis. The start of dialysis was associated with an increase of 2.8 points in the Minimum Data Set-Activities of Daily Living score, indicating more functional difficulty.

"Clinicians, patients' families, and nursing home staff need to recognize and treat advanced dementia as a terminal illness requiring palliative care," writes the author of an editorial accompanying the first study. "Patients with advanced dementia do not need to have another serious illness to qualify for hospice care -- dementia comes with a high burden of symptoms that warrant a palliative care approach."

Three co-authors of the second study reported financial relationships with several companies. Sachs reported financial relationships with CVS Caremark and two medical associations.

Abstract - Mitchell
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Abstract - Tamura
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Editorial - Sachs (subscription or payment may be required)
Editorial - Arnold (subscription or payment may be required)

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