The objectives of this study were to identify the characteristics associated with hospice enrollment, to determine whether enrollment in hospice was associated with less pain and psychiatric symptoms, and to assess caregiver satisfaction with care near death in a sample of patients with dementia and mild cognitive impairment (MCI). Participants included decedents with dementia or MCI and other medical illnesses whose deaths were expected (n = 81) during a 3-year prospective, longitudinal, community-based cohort study. A total of 29.6% (n = 24) of participants received hospice care prior to death. Participants in hospice experienced less pain compared to those not in hospice, but this did not reach statistical significance (41.7% vs. 62.5%, P = 0.085). They were 65% more likely to be free of psychiatric symptoms (including restlessness, sleep problems, agitation, nervousness, and aggression toward others) during their final illness prior to death (OR = 0.35; 95% CI 0.13-0.96). In this cohort of people with dementia and MCI who died, several markers of quality of care suggest that hospice care can be beneficial for patients with dementia or MCI.

Over the course of 3 years, the authors investigated the relationship between severity of cognitive impairment and mortality in a community sample of 498 elders at high risk for cognitive impairment. Subjects were classified as having no cognitive disorder, mild cognitive impairment, or dementia, based on a validated battery of four neuropsychological tests. Severity of impairment was based on Mini-Mental State Examination scores. Additional data were obtained from subjects' knowledgeable informants and Medicare records. Kaplan-Meier survival estimates and Cox hazard proportion analysis of the sample revealed that presence of cognitive impairment increases mortality in a fashion that parallels the severity of the impairment.

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