Predicting time to nursing home placement based on activities of daily living scores--a modelling analysis using data on Alzheimer's disease patients receiving rivastigmine or donepezil.
OBJECTIVE
To quantify the impact of activities of daily living (ADL) scores on the risk of nursing home placement (NHP) in Alzheimer's disease (AD) patients.


METHODS
Models predicting NHP for AD patients have depended on cognitive deterioration as the primary measure. However, there is increased recognition that both patient functioning and cognition are predictive of disease progression.


METHODS
Using the database from a prospective, randomised, double-blind trial of rivastigmine and donepezil, two treatments indicated for AD, Cox regression models were constructed to predict the risk of NHP using age, gender, ADL and MMSE (Mini-Mental State Examination) scores as independent variables.


METHODS
Patients aged 50-85 years, with MMSE scores of 10-20, and a diagnosis of dementia of the Alzheimer type.


RESULTS
Cox regression analyses indicated that being female, older age, lower ADL score at baseline, and deterioration in ADL all significantly increased the risk of NHP. Over 2 years, risk of NHP increased by 3% for each 1-point deterioration in ADL score independent of cognition.


CONCLUSIONS
Data analyses from this long-term clinical trial established that daily functioning is an important predictor of time to NHP. Further research may be required to confirm whether this finding translates to the real world.
Hatoum
Hind T
HT
Center for Pharmacoeconomic Research, the University of Illinois at Chicago (UIC), Chicago, IL, USA. HTHatom@sbcglobal.net
Thomas
Simu K
SK
Lin
Swu-Jane
SJ
Lane
Roger
R
Bullock
Roger
R
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use*; D018450:Disease Progression; D000077265:Donepezil; D005260:Female; D005544:Forecasting; D006801:Humans; D007189:Indans / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D018696:Neuroprotective Agents / Q000627:therapeutic use*; D009735:Nursing Homes; D010360:Patient Transfer; D048448:Phenylcarbamates / Q000627:therapeutic use*; D010880:Piperidines / Q000627:therapeutic use*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011594:Psychometrics; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D000068836:Rivastigmine; D012720:Severity of Illness Index
D002800:Cholinesterase Inhibitors; D007189:Indans; D018696:Neuroprotective Agents; D048448:Phenylcarbamates; D010880:Piperidines; D000077265:Donepezil; D000068836:Rivastigmine