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November 15, 2000

Mortality From Pneumonia and Hip Fractures in Patients With Advanced Dementia

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorPhil B.FontanarosaMD, Executive Deputy Editor


Not Available

JAMA. 2000;284(19):2447. doi:10.1001/jama.284.19.2447

To the Editor: Drs Morrison and Siu1 suggested that patients with advanced dementia may not benefit from hospitalization for hip fracture or pneumonia. However, I am concerned that the authors have grouped together patients with Global Deterioration Scale (GDS)2 scores of 6 or 7 and refer to both groups as having "end-stage dementia." They do not report how many of the patients had a GDS score of 6 and how many had a score of 7.

In the original description of the GDS, patients with a score of 6 "may become incontinent and will require travel assistance, but will be able to travel to familiar locations" and "almost always recall their own name, and frequently continue to be able to distinguish familiar from unfamiliar persons in their environment,"2 so that although patients with a GDS score of 7 are in a very severe stage of the disease, those with a GDS score of 6 may still enjoy significant quality of life. Furthermore, patients may remain in stages 6 and 7 for several years.3 Experience in our Alzheimer's Disease Center suggests that such patients frequently enjoy the company of others, express preferences, are able to attend activities outside of their home, and sometimes maintain continence during the day, as well as ambulation.4 I think that it is inappropriate to classify patients with a GDS score of 6 as having "end-stage dementia" and to treat this group as if they are at the end of a meaningful life in discussions of prognosis or in deciding about palliative vs curative approaches for curable conditions.

Morrison  RSSiu  AL Survival in end-stage dementia following acute illness.  JAMA. 2000;28447- 52Google ScholarCrossref
Reisberg  BFerris  BDeleon  MJ  et al.  The Global Deterioration Scale for assessment of primary degenerative dementia.  Am J Psychol. 1982;1391138- 1139Google Scholar
Reisberg  BSclan  SGFranssen  EKluger  AFerris  S Dementia staging in chronic care populations.  Alzheimer Dis Assoc Disord. 1994;8 ((suppl 1)) S188- S205Google Scholar
Sumaira  RDoody  RSLai  EC Profoundly advanced Alzheimer's disease: patient characteristics, functional status, disease progression, and care burden.  Neurology. 2000;54 ((suppl 3)) A417Google Scholar