Abstract
Background: One third of older people are estimated to die with dementia, which is a principal cause of death in developed countries. While it is assumed that people die with severe dementia this is not based on evidence. Methods: Cohort study using a large secondary mental healthcare database in North London, UK. We included people aged over 65 years, diagnosed with dementia between 2008 and 2016, who subsequently died. We estimated dementia severity using mini-mental state examination (MMSE) scores, adjusting for the time between last score and death using the average annual MMSE decline in the cohort (1.5 points/year). We explored the association of sociodemographic and clinical factors, including medication use, with estimated MMSE score at death using linear regression. Results: In 1400 people dying with dementia, mean estimated MMSE at death was 15.3 (standard deviation 7.0). Of the cohort, 22.2% (95% confidence interval 20.1, 24.5) died with mild dementia; 50.4% (47.8, 53.0) moderate; and 27.4% (25.1, 29.8) with severe dementia. In fully adjusted models, more severe dementia at death was observed in women, Black, Asian and other ethnic minorities, agitated individuals, and those taking antipsychotic medication. Conclusions: Only one quarter of people who die with dementia are at the severe stage of the illness. This finding informs clinical and public understanding of dementia prognosis. Provision of end-of-life services should account for this and healthcare professionals should be aware of high rates of mild and moderate dementia at end of life and consider how this affects clinical decision-making.
Original language | English |
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Article number | 355 |
Journal | BMC Psychiatry |
Volume | 18 |
Issue number | 1 |
DOIs | |
State | Published - 1 Nov 2018 |
Externally published | Yes |
Bibliographical note
Publisher Copyright:© 2018 The Author(s).
Funding
All authors have completed the ICMJE uniform disclosure form at www.icmje.org and declare: GL2 was funded by a grant from the UK Department of Health, AS was funded by a fellowship from the Wellcome trust (200,163/Z/15/Z), and NW, GL1, GL2 and AS were supported by the University College London Hospitals National Institute of Health Research Biomedical Research Centre during the conduct of the submitted work. All authors declare no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work. During the conduct of this study, AS was funded by a Wellcome Trust fellowship (200163/Z/15/Z). The data resource is funded by a grant from the Department of Health. NW, GL1, GL2 and AS were supported by the University College London Hospitals National Institute of Health Research Biomedical Research Centre.
Funders | Funder number |
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University College London Hospitals National Institute of Health Research Biomedical Research Centre | |
Wellcome Trust | 200,163/Z/15/Z |
Department of Health and Social Care |
Keywords
- Death
- Dementia
- Epidemiology
- Health records
- Mortality
- Prognosis