title: Prognostic indicators of 6-month mortality in elderly people with advanced dementia: a systematic review.
abstract: BACKGROUND
  For end-of-life dementia patients, palliative care offers a better quality of life than continued aggressive or burdensome medical interventions. To provide the best care options to dementia sufferers, validated, reliable, sensitive, and accurate prognostic tools to identify end-of-life dementia stages are necessary.
  
  
  OBJECTIVE
  To identify accurate prognosticators of mortality in elderly advanced dementia patients consistently reported in the literature.
  
  
  METHODS
  Systematic literature review.
  
  
  METHODS
  PubMed, Embase, and PsycINFO databases were searched up to September 2012. Reference lists of included studies were also searched. Inclusion criteria were studies measuring factors specifically related to 6-month outcome in patients diagnosed with dementia in any residential or health-care setting.
  
  
  RESULTS
  Seven studies met the inclusion criteria, five of which were set in the United States and two in Israel. Methodology and prognostic outcomes varied greatly between the studies. All but one study found that Functional Assessment Staging phase 7c, currently widely used to assess hospice admission eligibility in the United States, was not a reliable predictor of 6-month mortality. The most common prognostic variables identified related to nutrition/nourishment, or eating habits, followed by increased risk on dementia severity scales and comorbidities.
  
  
  CONCLUSIONS
  Although the majority of studies agreed that the Functional Assessment Staging 7c criterion was not a reliable predictor of 6-month mortality, we found a lack of prognosticator concordance across the literature. Further studies are essential to identify reliable, sensitive, and specific prognosticators, which can be applied to the clinical setting and allow increased availability of palliative care to dementia patients.
authors.affiliation: Department of Neuroscience, College of Letters, Arts, and Sciences, University of Southern California, Los Angeles, CA, USA.
authors.forename: Meghan A
authors.initials: MA
authors.lastname: Brown
authors.forename: Elizabeth L
authors.initials: EL
authors.lastname: Sampson
authors.forename: Louise
authors.initials: L
authors.lastname: Jones
authors.forename: Anna M
authors.initials: AM
authors.lastname: Barron
mesh_terms: D000368:Aged; D003704:Dementia / Q000175:diagnosis / Q000401:mortality*; D015577:Geriatric Assessment / Q000379:methods; D006801:Humans; D011237:Predictive Value of Tests; D011379:Prognosis