Patient suffering is a pathological syndrome traditionally viewed as encompassing psychological distress, spiritual concerns, and various aspects of physical pain. There is insufficient clinical evidence for suffering in dying dementia patients, which may lead to inappropriate evaluation and insufficient palliative treatment. Our objective was to evaluate the suffering of terminal dementia patients over time, from admission to a geriatric ward to the last day of life. The study included consecutive end-stage dementia patients in a general geriatric department of a tertiary hospital. Patients were evaluated weekly by the Mini Suffering State Examination scale (MSSE) which measures many domains related to suffering. Seventy-one patients were studied. Mean survival of patients was 38.0 +/- 5.1 days. MSSE increased during hospital stay from 5.62 +/- 2.31 to 6.89 +/- 1.95 (p < 0.001). According to MSSE scale, 63.4 percent and 29.6 percent of patients died with a high and intermediate level of suffering, respectively. Only 7 percent of the patients died with a low level of suffering. In particular, patients were restless (p < 0. 001), had pressure sores (p = 0.01), and were considered medically unstable (p < 0.001). We concluded that, despite traditional medical and nursing care, a large proportion of dying dementia patients experience an increasing amount of suffering as they approach death. New palliative treatment approaches should be developed for these patients.
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.
Six months of survival as a key criterion is extremely important for decision making in enrollment of critically ill patients to palliative settings. This was a prospective cohort study with 6 months of follow-up during a 24-month period performed in the Division of Geriatric Medicine in a tertiary general hospital. One-hundred three consecutively admitted, bedridden patients with end-stage dementia were evaluated. The Mini-Suffering State Examination scale was performed. Interrelations between the Mini-Suffering State Examination score at admission and 6-month survival and mortality were evaluated. A significant difference was proven among survival curves of subgroups of patients according to the mini scores (0-3, 4-6, 7-10). Survival was shorter and mortality higher in patients with a high Mini-Suffering State Examination score, as shown by the Kaplan-Meier method using the log rank (P=.001) and Breslow tests (P=.001). The Mini-Suffering State Examination scale is useful for predicting the last 6 months of survival and mortality of end-stage dementia patients.
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