title: Predictors of six-month survival among patients with dementia: an evaluation of hospice Medicare guidelines.
abstract: The goal of the present study was to assess the validity of the Medicare hospice eligibility guidelines for dementia patients, as well as identify predictors that could more accurately identify prognosis in dementia patients referred to hospice. A retrospective chart review was conducted, including initial assessment and longitudinal follow-up of patients until the time of death. In addition, a second validation cohort was also followed. Participants consisted of 245 patients admitted to a large community-based hospice with a diagnosis of dementia, including a validation sample of 80 patients. The Kaplan-Meier estimation of survival and a Cox regression analysis (p > 0. 05) revealed no significant relationship between the Medicare guidelines or any component of the guidelines and survival at six months for the initial and validation samples. Significant multivariate predictors of shorter survival in both the initial and validation sample include greater age (p = 0. 02) and anorexia (p < 0. 001), as well as a combination of anorexia and greater functional impairment (p = 0.005). Overall, the results indicated that the Medicare guidelines were not valid predictors of survival in hospice patients with dementia and should be altered to include empirically valid predictors. Advanced age, as well as impaired nutritional and functional status, was associated with shortened survival in these patients. The predictor variables identified are an initial step toward providing improved prognoses for advanced dementia patients, their families, and practitioners. Broader issues in improving access to hospice care for dementia patients are discussed.
authors.affiliation: Department of Internal Medicine, University of South Florida College of Medicine, LifePath Hospice and Palliative Care, Inc., Tampa, Florida, USA.
authors.forename: Ronald S
authors.initials: RS
authors.lastname: Schonwetter
authors.forename: Beth
authors.initials: B
authors.lastname: Han
authors.forename: Brent J
authors.initials: BJ
authors.lastname: Small
authors.forename: Brenda
authors.initials: B
authors.lastname: Martin
authors.forename: Kimberly
authors.initials: K
authors.lastname: Tope
authors.forename: William E
authors.initials: WE
authors.lastname: Haley
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D003704:Dementia / Q000150:complications / Q000175:diagnosis* / Q000191:economics / Q000401:mortality*; D004608:Eligibility Determination / Q000592:standards*; D005260:Female; D005431:Florida / Q000453:epidemiology; D005500:Follow-Up Studies; D015577:Geriatric Assessment; D017051:Hospice Care / Q000191:economics / Q000592:standards*; D006801:Humans; D008297:Male; D006278:Medicare / Q000592:standards*; D015999:Multivariate Analysis; D018579:Patient Selection; D017410:Practice Guidelines as Topic / Q000592:standards*; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016019:Survival Analysis; D013997:Time Factors