Objective: To investigate the determinants of survival to late dementia in Dutch nursing home patients.
Design: Observational analysis of a cohort of patients with a prospective follow-up.
Materials and Methods: The study population consisted of 890 dementia patients who were admitted between 1980 and 1989. All patients were followed until death. Age, gender, severity of dementia on admission and type of dementia were analyzed as determinants of survival to late dementia. Late dementia was operationally defined as total impairment on 20 items of the functional status questionnaire.
Results: The mean disease duration of the study population was 7.0 years, with a wide range. Some died soon after dementia was diagnosed, while others lived more than 25 years after onset of the disease. One hundred and twenty-six patients (14.2%) reached the phase of late dementia, most of whom were women (90%) with Alzheimer’s disease (60%). For most of the patients, this phase lasted one year or less. Age, gender, type of dementia and severity of dementia on admission all contributed significantly to predicting survival to late dementia.
Conclusion: One out of seven nursing home patients with dementia survived to late dementia. Nursing home physicians can use these findings to inform relatives about the prognosis.
Objective: To assess the prevalence of late dementia in a group of nursing home patients with dementia.
Design: Prospective survey
Materials and Methods: The study population consisted of 216 dementia patients who resided in two Dutch nursing homes. Late dementia was operationally defined as stage 7 of the Global Deterioration Scale of Reisberg. In those patients who met GDS 7 several characteristics were assessed like paratonia, contractures, weight, and epilepsia. Treatment was also registered like medication, physiotherapy, occupational therapy, and nutrition. Finally, the advanced directives were registered.
Results: Main result of this study was that the prevalence of late dementia was 12% (26 patients). This group was heterogeneous in terms of characteristics, treatment aspects, and advanced directives.
Conclusion: From both studies we conclude that more research needs to be done to study late dementia. Dementia researchers should reach international consensus about the terminology and operational definition of late dementia, to compare studies. Designs should be developed to follow-up dementia patients until late dementia and assessment scales should be constructed, which can measure slight changes in this phase of the disease, such as changes in emotional expression or responding to stimulation.
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