title: Survival of people with dementia after unplanned acute hospital admission: a prospective cohort study.
abstract: OBJECTIVE
  To examine the effect of dementia on longer term survival after hospital admission, and to assess whether dementia is an independent predictor of mortality. This information is vital for the provision of appropriate care.
  
  
  METHODS
  A prospective cohort study, in a large urban acute general hospital, of 616 people (70 years and older) with unplanned medical admission. The principal exposure was DSM-IV dementia and main outcome mortality risk. Dementia severity was analysed by using the Functional Assessment Staging scale. We examined a range of modifying variables: acute physiological disturbance (Acute Physiology and Chronic Health Evaluation), chronic comorbidity (Charlson Comorbidity Index, CCI) and pressure sore risk (Waterlow score).
  
  
  RESULTS
  A total 42.4% of the cohort had dementia. Nearly half (48.3%) had died 12 months after admission (median survival time 1.1 years compared with 2.7 years in people without dementia). Unadjusted hazard ratios for mortality in people with dementia was 1.66 (95% CI 1.35-2.04) and for people with moderately severe/severe dementia 2.01 (95% CI 1.57-2.57). After sequential adjustment (age, gender, Acute Physiology and Chronic Health Evaluation score, Charlson Comorbidity Index and Waterlow score), patients with dementia had a mortality risk of 1.24 (95% CI 0.95-1.60) and those with moderately severe/severe dementia 1.33 (0.97-1.84).
  
  
  CONCLUSIONS
  People with dementia had half the survival time of those without dementia. The effect of dementia on mortality was reduced after adjustment, particularly by the Waterlow score, a marker of frailty. The median survival of 1 year suggests clinicians should consider adopting a supportive approach to the care of older people with moderate/severe dementia who have an emergency hospital admission.
authors.affiliation: Marie Curie Palliative Care Research Unit, UCL Mental Health Sciences Unit, University College London Medical School, London, UK; Barnet Enfield and Haringey Mental Health Trust, London, UK.
authors.forename: Elizabeth L
authors.initials: EL
authors.lastname: Sampson
authors.forename: Baptiste
authors.initials: B
authors.lastname: Leurent
authors.forename: Martin R
authors.initials: MR
authors.lastname: Blanchard
authors.forename: Louise
authors.initials: L
authors.lastname: Jones
authors.forename: Michael
authors.initials: M
authors.lastname: King
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D003704:Dementia / Q000175:diagnosis / Q000401:mortality*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008131:London / Q000453:epidemiology; D008297:Male; D011446:Prospective Studies; D012044:Regression Analysis; D012720:Severity of Illness Index; D016019:Survival Analysis
keywords: acute hospital; dementia; mortality; palliative care; prognosis