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New tool only modestly better than hospice eligibility guidelines at predicting survival in advanced dementia.

Icahn School of Medicine at Mount Sinai
Article Citation
PubMed ID: 
Clinical Bottom Lines

In this study, the ADEPT (Advanced Dementia Prognostic Tool) was successfully validated in a cohort of 660 nursing home residents in Boston, Massachusetts.  The sensitivity and specificity of the ADEPT score in predicting six-month mortality were 55.0% (95% CI, 45.2-64.4) and 71.3% (95% CI, 67.1-75.3) respectively.   The sensitivity and specificity of hospice eligibility criteria were 20.0% (95% CI 13.0-28.0) and 89.0% (95% CI, 86.0-92.0) respectively.   The ADEPT score only modestly improved prognostication as compared to the hospice eligibility requirements, which suggests that treatment decisions should be based on patient preferences rather than calculated life expectancy.

This is a review of the validity of a single study; the ‘bottom lines’ do not reflect comparison with the rest of the literature on this subject.
Other Information
Created By: 
Jennifer Reckrey, MD, Geriatric Fellow, Department of Geriatric and Palliative Medicine, Mt. Sinai School of Medicine
CAP Topics: 


Submitted by fishermd on
<p> It would be interesting and possible very relevant clinically if the ADEPT could be programmed into the MDS 3.0 so that anyone with a score of 11 or greater would be flagged. These would be particularly important patients to have a detailed goals of care and prognosis conversation with family.&nbsp;</p>