High mortality rate among dementia patients
02 December 2016
Irene van de Vorst was awarded a PhD on 10 November 2016 for her thesis on the prognosis of dementia. ‘At various hospitals in the Netherlands, we studied the prognosis for patients with dementia who were either admitted or attending a day clinic.'
'We demonstrated that the mortality rate of patients with dementia is high. For patients attending a day clinic, the mortality rate was actually twice as high as that for the general population. The mortality risk for admitted patients was comparable to or higher than for people admitted with other serious conditions, such as heart failure, strokes or heart attacks. In addition, we demonstrated that the mortality rate is higher among men, among patients with a prior history of cardiovascular disease and among people in lower socio-economic groups.’
No differences were found in mortality rates across different ethnic groups. The major causes of death were cardiovascular disease and dementia. The mortality rate fell in the period 2000 to 2008. Given that the prognosis for dementia is poor, it is important that the medical professionals involved pay timely attention to advance care planning.
The thesis includes a prediction model for estimating the mortality risk of patients with dementia. Although this rule still has to be validated, in the future it can constitute the basis for advance care planning. The wishes of patients and their family relating to the treatment and diagnosis of any future medical problems should be discussed when drawing up advance care plans. Subjects of discussion include treatment with antibiotics, resuscitation and admission to an intensive care unit.
In addition, a good representative for the patient should be appointed, if the patient is unable to make sound decisions due to advanced dementia. Moreover, it is important to discuss the wishes for the final stage of the dementia patient’s life.
Primary contact: Dr. Irene van de Vorst, geriatrician in training (at Slotervaart Hospital).
Secondary contact: Dr. Dineke Koek, geriatrician, UMC Utrecht.
Grant provider: Alzheimer Nederland, Dutch Heart Foundation, UMC Utrecht.