A 13-item caregiver questionnaire helps estimate the probability of admittance to a residential care facility and death for patients with advanced dementia.
TORONTO—Changes in level of dependence are an important predictor of risk for nursing home placement and death in patients with Alzheimer’s disease, according to research presented at the 62nd Annual Meeting of the American Academy of Neurology.
Daniel L. Murman, MD, Director, Memory Disorders and Behavioral Neurology Program, University of Nebraska Medical Center, Omaha, and colleagues investigated the impact of unique levels of dependence on risk of nursing home placement or death in a cohort of 133 patients with Alzheimer’s disease. The investigators found that the probability of patients being placed in a nursing home or dying during follow-up correlated with subjects’ scores on the Dependence Scale, a 15-point caregiver assessment of a patient’s need for assistance on 13 items. Higher scores indicate an increased need for assistance from others.
Patients were between ages 50 and 85 and met the NINDS/Alzheimer’s Disease and Related Disorders Association criteria for Alzheimer’s disease. The mean age of study participants was 77; 54% were women and 64% were married. Patients and caregivers were assessed via phone interviews every 12 months for up to three years.
During the three-year follow-up period, 69 patients were moved into a nursing home, 41 patients died, and one patient did not complete the study and was not included in the analysis. Using Cox proportional hazard models, the investigators found that the probability of nursing home placement for baseline Dependence Scale scores of 4, 8, and 12 was 0.56, 0.72, and 0.86, respectively, for subjects who were not married and 0.35, 0.49, and 0.65, respectively, in subjects who were married. The probability of dying during follow-up was 0.14, 0.23, and 0.37, respectively.
“This study shows the importance of patient dependence in predicting important outcomes in patients with Alzheimer’s disease, including risk of nursing home placement and death,” Dr. Murman told Neurology Reviews.
In addition to the Dependence Scale, patients were also assessed using the Mini Mental Status Examination, Neuropsychiatric Inventory, Modified Columbia University Parkinson’s Disease Rating Scale, and Comorbid Illnesses With Cumulative Illness Rating Scale. The researchers noted that both the Parkinson’s scale and the Neuropsychiatric Inventory were also significant predictors of time to death.
“A simple questionnaire on the level of a patient’s dependence can be used in predictive statistical models to better understand the prognosis for risk of nursing home placement and death,” Dr. Murman said. “This information can be used in the development of pharmacoeconomic models of disease progression and health care utilization.”
—Rebecca K. Abma