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SURVIVAL IN END-STAGE DEMENTIA FOLLOWING ACUTE ILLNESS
Patients with advanced dementia and a hip fracture or pneumonia have very poor prognoses. Therefore more attention should be focused on efforts to enhance comfort for those patients. The prospective cohort study with six months of follow-up included patients aged 70 or older who were hospitalized with a hip fracture (cognitively intact, n = 59; with end-stage dementia, n = 38) or pneumonia (cognitively intact, n = 39; with end-stage dementia, n = 80). These patients were hospitalized in New York, NY, between Sept 1, 1996, and March 1, 1998. the study measured mortality, treatment of symptoms, and application of distressing and painful procedures in cognitively intact patients versus those with end-stage dementia. Six-month mortality for patients end-stage dementia and pneumonia was 54% (95% confidence interval, 41 - 64%) compared with 12% (95% confidence interval, 4-27%) for cognitively intact patients (adjusted hazard ratio, 4.6; 95% confidence interval, 1.8-11.8%). Six-month mortality for patients with end-stage dementia and a hip fracture was 55% (95% confidence interval, 42-75%) compared with 12% (95% confidence interval, 5-24%) for cognitively intact patients (adjusted hazard ratio, 5.8; 95% confidence interval, 1.7-20.4%). Only 24% of the patients with end-stage dementia and hip fracture had a standing order for analgesics.
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