P.KAUR1, P.KANNAPIRAN1, SHX.NG1, JCN.CHU2, ZJ.LOW2, YY.DING3, WS.TAN1, A.HUM3
National Healthcare Group Corporate Office1, Tan Tock Seng Hospital2, Geriatric Education and Research Institute3
Challenges in prognosticating patients diagnosed with advanced dementia (AD) hinders timely referrals to palliative care. We aim to develop a pragmatic prognostic model to predict one-year mortality in patients with AD.
This is a retrospective cohort study design using administrative and clinical data from Tan Tock Seng Hospital. Participants were diagnosed with AD at inpatient/outpatient settings between 2008 and 2017. Prognostic variables were identified based on a scoping review conducted by the study team. Primary outcome was all-cause mortality within one-year of diagnosis. Models were built using logistic and Cox Regression Proportional Hazards regression. Using bootstrap validation, optimism-adjusted measures were computed. Final model was selected based on discriminative, sensitivity, specificity, and positive predictive value (PPV).
Of 1077 patients, 318 (29.5%) patients died within one-year of AD diagnosis. Variables which significantly predicted one-year mortality included increasing age (OR:1.05;95%CI:1.03-1.07), male gender (OR:1.71;95%CI:1.24-1.37), presence of pneumonia (OR:1.70;95%CI:1.20-2.40), pressure ulcers (OR: 2.58;95%CI:1.54-4.32) and dysphagia (OR:1.53;95%CI:1.10-2.12), Charlson Comorbidity Index (OR:1.06;95%CI:1.00-1.13), increasing number of dependent activities of daily living (OR: 1.10;95%CI:1.03-1.17) , referrals to community services (OR:1.48;95%CI:1.02-2.15), number of inpatient admissions (OR:1.16;95%CI:1.06-1.27) and day-surgery procedures (OR:1.62;95%CI:1.10-2.36) in the last one-year, abnormal urea (OR:2.13;95%CI:1.52-2.99) and albumin (OR:3.81;95%CI:2.10-6.92). Optimism-adjusted-area-under-the-receiver-operating-curve, sensitivity, specificity and PPV were 0.782, 42.3%, 92.0% and 68.8% respectively.
This is the first model in the literature that examined prognostication among AD patients presenting at an acute hospital, attaining acceptable accuracy. In Singapore where dementia caregiving occurs primarily at home, early identification can support proactive planning and the initiation of palliative care for AD patients at high-risk of one-year mortality.