Does ADEPT score predict mortality in advanced dementia patients

January 01, 0001

Does ADEPT score predict mortality in advanced dementia patients

Physicians are often asked to calculate a dementia patient’s life expectancy. These US researchers sought to prospectively validate and compare the performance of the Advanced Dementia Prognostic Tool (ADEPT) and hospice eligibility guidelines to estimate 6-month survival for advanced dementia patients in nursing home settings. They performed a prospective cohort study enrolling patients with advanced dementia (n=606) from 21 Boston nursing homes. Baseline ADEPT scores (higher scores indicate worse prognosis) and if they met Medicare hospice eligibility guidelines were calculated, and survival was followed up to 6 months.

The researchers found: "At baseline, the residents' mean ADEPT score was 10.1 points and 65 residents (10.7%) met hospice eligibility guidelines. Over 6 months, 111 residents (18.3%) died. The area under the receiver operating characteristic (AUROC) for the ADEPT score's prediction of 6-month mortality as a continuous variable was 0.67. The AUROC for Medicare hospice eligibility guidelines was 0.55, the specificity was 0.89, and the sensitivity was 0.20. Using a cutoff of 13.5 on the ADEPT score, which also had specificity of 0.89, the AUROC was 0.58 (95% CI, 0.54-0.63) and the sensitivity was 0.27"

The researchers concluded: "When prospectively validated at the bedside and used as a continuous measure, the ability of the ADEPT score to identify nursing home residents with advanced dementia at high risk of death within 6 months was modest, albeit better than hospice eligibility guidelines. Care provided to these residents should be guided by their goals of care rather than estimated life expectancy."

The ADEPT score is not particularly sensitive for 6 month mortality risk.

For the full abstract, click here.

JAMA 304(17):1929-1935, 3 November 2010 © 2010 American Medical Association
Prediction of 6-Month Survival of Nursing Home Residents With Advanced Dementia Using ADEPT vs Hospice Eligibility Guidelines. Susan L. Mitchell, Susan C. Miller, Joan M. Teno, Dan K. Kiely, Roger B. Davis, Michele L. Shaffer.

Category: N. Neurological. Keywords: dementia, ADEPT, hospice eligibility guidelines, mortality, prediction, prospective cohort study, journal watch.
Synopsis edited by Dr Paul Schaefer, Toledo, Ohio. Posted on Global Family Doctor 26 November 2010

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