Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
J Alzheimers Dis. 2021;80(1):103-111. doi: 10.3233/JAD-201364.
Persons with dementia have higher mortality than the general population. Objective, standardized predictions of mortality risk in persons with dementia could help with planning resources for care close to the end of life.
To systematically review prediction models for risk of death in persons with dementia.
The Medline and PsycInfo databases were searched on November 29, 2020, for prediction models estimating the risk of death in persons with dementia. Study quality was assessed using the Prediction model Risk Of Bias ASsessment Tool.
The literature search identified 2,828 studies, of which 18 were included. These studies described 16 different prediction models with c statistics mostly ranging from 0.67 to 0.79. Five models were externally validated, of which four were applicable. There were two models that were both applicable and had reasonably low risk of bias. One model predicted risk of death at six months in persons with advanced dementia residing in a nursing home. The other predicted risk of death at three years in persons seen in primary care practice or a dementia specialty clinic, derived from a nationwide registry in Sweden but not externally validated.
Valid, applicable models with low risk of bias were found in two settings: advanced dementia in a nursing home and outpatient practices. The outpatient model requires external validation. Better models are needed for persons with mild to moderate dementia in nursing homes, a common demographic. These models may be useful for educating persons living with dementia and care partners and directing resources for end of life care.Registration:The study protocol is registered on PROSPERO as RD4202018076.
痴呆患者的死亡率高于一般人群。对痴呆患者的死亡风险进行客观、标准化的预测，可以帮助在接近生命终点时规划护理资源。
系统回顾痴呆患者死亡风险预测模型。
于 2020 年 11 月 29 日检索 Medline 和 PsycInfo 数据库，以评估预测痴呆患者死亡风险的预测模型。使用预测模型风险偏倚评估工具评估研究质量。
文献检索确定了 2828 项研究，其中 18 项研究包括在内。这些研究描述了 16 个不同的预测模型，其 C 统计值大多在 0.67 至 0.79 之间。有 5 个模型进行了外部验证，其中 4 个是适用的。有两个模型既适用，又具有合理的低风险偏差。一个模型预测了居住在养老院的晚期痴呆患者在六个月内的死亡风险。另一个模型预测了在初级保健实践或瑞典全国登记处的痴呆专科诊所就诊的患者在三年内的死亡风险，但未进行外部验证。
在两个环境中发现了具有低风险偏差的有效、适用的模型：养老院中的晚期痴呆和门诊实践。门诊模型需要外部验证。在疗养院中，轻度至中度痴呆的患者需要更好的模型，这是一个常见的人群。这些模型可能有助于对痴呆患者及其护理伙伴进行教育，并指导临终关怀资源的分配。
该研究方案在 PROSPERO 上注册，注册号为 RD4202018076。
