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Hubert H Fernandez, Kate L Lapane
Med Sci Monit 2002; 8(4): CR241-246
BACKGROUND: Little is known about predictors of mortality among Parkinsonpatients living in long term care. MATERIAL/METHODS: We conducted a 3-year follow-up study on 15,237PD residents aged 65 years and older using the Systematic Assessment in Geriatric drug use via Epidemiology(SAGE) database. The SAGE database consists of the Minimum Data Set (MDS) data collected on over 400,000nursing home residents in 5 U. S. states, including demographic characteristics, dementia severity, comorbidityand other clinical variables. Information on death was derived through linkage to Medicare files. Baselinecharacteristics were used to predict survival using univariate and multivariate Cox proportional hazardmodels. RESULTS: The overall 3-year mortality rate was 50%. Advanced age (relative rate (RR) 2.22; 95%confidence interval (CI) 1.99-2.47, for patients 85+ years), male gender (RR 1.73; 95% CI 1.60-1.87),severe functional (RR 1.81; 95% CI 1.53-2.13) and cognitive (RR 1.54; 95% CI 1.38-1.72) impairment, thepresence of vision problems (RR 1.25; 95% CI 1.20-1.57), pressure ulcers (RR 1.25; 95% 1.14-1.37), anda diagnosis of congestive heart failure (RR 1.49; 95% CI 1.35-1.65), diabetes mellitus (RR 1.22; 95%1.11-1.35) and pneumonia (RR 1.39; 95% CI 1.09-1.77) were independent predictors of death. The specificpresence of aspiration pneumonia had the highest mortality risk ratio among all comorbidities (RR 1.58;CI 0.97-2.56). African-Americans and other minority groups were less likely to die relative to whitePD residents. CONCLUSIONS: Age, sex, functional and cognitive impairment and the diagnosis of pneumoniaor congestive heart failure were the strongest predictors of death. Minority groups have a reduced riskof death relative to white PD nursing home residents.