Age and Ageing Advance Access originally published online on August 22, 2006
Age and Ageing 2006 35(6):597-601; doi:10.1093/ageing/afl067
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Their last 6 months: suffering and survival of end-stage dementia patients
Geriatric Division, Sheba Medical Center, Tel-Hashomer 52621, Israel
Address correspondence to: A. Adunsky. Tel: (+972) 52 6666550. Fax: (+972) 3 5303411. Email: eadunsky{at}hotmail.com
Objective: to study possible interrelations existing between the Mini-Suffering State Examination (MSSE) scale and survival of end-stage dementia patients.
Methods: a cohort study of 252 end-stage dementia patients with a 6-month follow-up period, conducted in a Division of Geriatric Medicine of a general hospital. We included 134 consecutive bedridden end-stage dementia patients admitted during a 36-month period, and surviving in the ward for <6 months. Interrelations between survival and admission MSSE scores were studied.
Results: compared with patients surviving 
6 months, those dying within 6 months were significantly older (P = 0.014). Mean survival time was 57.76 ± 9.73 days for the low MSSE score group (29 patients, MSSE 2.24 ± 0.99), 44.70 ± 5.99 days for the intermediate MSSE score group (53 patients, MSSE 4.92 ± 0.83) and 27.54 ± 4.16 days for the high MSSE score group (52 patients, MSSE 8.06 ± 1.00). Differences between the survival times of these three MSSE score groups were statistically significant (Kaplan–Meier Analysis Log Rank P = 0.0018, Breslow P = 0.0027). The Cox proportional hazard model of survival showed a significant interrelation of high MSSE scores and shorter survival (P = 0.013).
Conclusions: documentation of a high-suffering level by the MSSE scale helps in identifying end-stage dementia patients expected to benefit from enrolment into a palliative care setting.
Keywords: dementia, end-of-life, hospice, suffering, survival, elderly
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