Comorbidity and Its Effect on Mortality in Nursing Home Patients with Dementia

The relation between comorbidity and survival was investigated in an 8-year follow-up study of 606 nursing home dementia patients by means of proportional hazards analysis. Two-year survival rates for women (N = 437) and men (AT = 169) were 60% and 39%, respectively. Parkinsonism, atrial fibrillation, pulmonary infection, and malignancies were powerful predictors: they more or less doubled the mortality chances. Stroke patients with a pulmonary infection had a particularly poor prognosis. More severely demented patients had more comorbidity than less severely demented patients, but the impact of comorbidity on survival did not depend on severity of dementia. Patients coming from a hospital had more comorbidity and were more severely demented than patients coming from home, but this did not modify the effects of age, gender, and comorbidity in a multivariate survival model. It was concluded that comorbidity and severity of dementia independently influence mortality. Thus a better prognostic judgment is obtained from their combination than from each separately.

[1]  J. Habbema,et al.  A behavioral rating scale as a predictor for survival of demented nursing home patients. , 1994, Archives of gerontology and geriatrics.

[2]  J. Concato,et al.  The Risk of Determining Risk with Multivariable Models , 1993, Annals of Internal Medicine.

[3]  A. Detsky,et al.  Evidence-based medicine. A new approach to teaching the practice of medicine. , 1992, JAMA.

[4]  J. Habbema,et al.  The nature of excess mortality in nursing home patients with dementia. , 1992, Journal of gerontology.

[5]  J. Habbema,et al.  Survival of Patients with Dementia , 1991, Journal of the American Geriatrics Society.

[6]  H. Welch,et al.  Survival of outpatients with Alzheimer-type dementia. , 1990, Annals of internal medicine.

[7]  D. Berlowitz,et al.  The Short‐Term Outcome of Pressure Sores , 1990, Journal of the American Geriatrics Society.

[8]  R Simon,et al.  Measures of explained variation for survival data. , 1990, Statistics in medicine.

[9]  Matti Haavisto,et al.  Blood pressure and five year survival in the very old , 1988, British medical journal.

[10]  P. Mölsä,et al.  Survival and cause of death in Alzheimer's disease and multi‐infarct dementia , 1986, Acta neurologica Scandinavica.

[11]  V. Chandra,et al.  Patterns of mortality from types of dementia in the United States, 1971 and 1973–1978 , 1986, Neurology.

[12]  B. Schoenberg,et al.  Epidemiology of Alzheimer's disease and other dementing illnesses. , 1986, Journal of chronic diseases.

[13]  B. Reisberg,et al.  The Global Deterioration Scale for assessment of primary degenerative dementia. , 1982, The American journal of psychiatry.

[14]  Diesfeldt Hf.  10 years of BOP Rating Scale for the Elderly , 1981 .

[15]  S. Matsuyama,et al.  Organic brain syndrome and aging. A six-year follow-up of surviving twins. , 1980, Archives of general psychiatry.

[16]  A. Peck,et al.  Mortality of the Aged with Chronic Brain Syndrome: Further Observations in a Five‐Year Study , 1978, Journal of the American Geriatrics Society.

[17]  B. Meer,et al.  The Stockton Geriatric Rating Scale. , 1966, Journal of gerontology.

[18]  J. Hd.  BLOOD AND BONES. , 1964, Lancet.

[19]  M. Roth,et al.  Physical accompaniments of mental disorder in old age. , 1955, Lancet.