S.NG1, P.KAUR1, J.CHU2, Z.J.LOW2, P.KANNAPIRAN1, Y.Y.DING3, W.S.TAN1, A.HUM4
National Healthcare Group Corporate Office1, Tan Tock Seng Hospital2, Yishun Community Hospital3, Palliative Care Centre for Excellence in Research and Education4
Timely referral to palliative care for patients with dementia is challenging with the complex nature of the disease pathway1. We aimed to identify patient characteristics that would differentiate decedents and survivors of advanced dementia (AD) at one-year, to facilitate development of a prognostic model.
Patients admitted to TTSH from July 2016 to October 2017 and diagnosed with either dementia, delirium, pneumonia or enteral feeding were identified from administrative databases. Subsequently, those with characteristics consistent with Functional Assessment Staging Tool stage 72, Mini Mental State Examination score ≤ 103, or a clinical diagnosis of AD in medical notes were classified to have AD. Baseline characteristics at the time of AD classification were compared between decedents and survivors using t-tests and Chi-square tests for continuous and categorical data respectively.
Among the included 1,077 patients, decedents were older than survivors (mean=87.4 vs 83.9;p<0.001) and a larger proportion was male (40.3% vs 33.9%;p=0.04). A larger proportion of decedents had pneumonia (61.9% vs 16.9%;p<0.001), pressure ulcers (18.6% vs 4.2%;p<0.001) and dysphagia (64.2% vs 42.2%;p<0.001), and exhibited abnormal values for several biomarkers. Decedents also had higher comorbidity scores (9.0 vs 8.0;p<0.001) and a greater number of dependencies in activities of daily living (2.9 vs 1.6;p<0.001). Referral to community services was more common among decedents (26.4% vs 17.8%;p=0.001), and they had more inpatient admissions (2.3 vs 1.9;p=0.001) and day surgeries (2.0 vs 1.2;p=0.033) within the year prior.
We identified characteristics differentiating decedents and survivors of AD, which will be highlighted as candidate predictors for one-year mortality.