Dementia: new tool predicts 5-year risk for death

  • CMAJ
  • 20 Apr 2020

  • curated by Susan London
  • Clinical Essentials
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

Takeaway

  • Among community-dwelling older adults with newly diagnosed dementia, 3 readily assessable factors predict risk for death within 5 years.

Why this matters

  • Accurate estimation of prognosis can help inform decisions about care.

Key results

  • 5-year status among participants:
    • 20.5% in long-term care.
    • 55.1% deceased.
    • 24.4% still living in the community.
  • Risk for death (multivariate ORs; 95% CIs) associated with:
    • Age vs 65-69 years:
      • 70-74 years: 1.3 (1.2-1.4).
      • 75-79 years: 1.7 (1.6-1.8).
      • 80-84 years: 2.6 (2.5-2.8).
      • 85-89 years: 4.3 (4.0-4.5).
      • ≥90 years: 9.5 (8.8-10.2).
    • Male vs female sex: 1.7 (1.6-1.7).
    • Presence of ≥1 of the following:
      • Chronic obstructive pulmonary disease: 1.7 (1.7-1.8).
      • Congestive heart failure: 2.0 (1.9-2.0).
      • Renal failure: 1.7 (1.6-1.8).
  • Combinations resulted in observed 5-year risk for death ranging from 22% (women aged 65-69 years without organ failure) to 91% (men age ≥90 years with organ failure).
  • Calculator is available online.

Study design

  • Canadian population-based retrospective cohort study using linked health administrative databases.
  • 108,757 community-dwelling older adults aged ≥65 years with a first documented dementia diagnosis.
  • Main outcomes included death.
  • Funding: Canadian Institutes of Health Research; Bruyère Centre for Individualized Health.

Limitations

  • Reliance on diagnostic codes.
  • Limited generalizability.
  • Cohort selected without discernment of dementia severity, subtype.