Highlights
- •Proxy-rated health for patients with mild dementia using the Euro Quality of Life Visual Analog Scale (EQ-VAS) independently predicted patient 3-year mortality with a dose–response pattern.
- •In contrast, self-rated health by patients in the earliest stage of dementia using the same scale did not independently predict patient mortality.
- •Self- and proxy-rated health for patients with dementia diverged already in the very early stage of the disease, with patients rating their own health significantly higher than proxies.
Objective
Self-assessment of health is a strong and independent predictor of mortality for cognitively
intact people. Because the ability of patients with dementia to rate their own health
is questionable, caregiver-rated health for patients may serve as a proxy. The authors
aimed to validate and compare self- and caregiver-rated health for patients with dementia
as independent predictors of patient mortality.
Methods
This was a post-hoc analysis of data from The Danish Alzheimer's Disease Intervention
Study, a randomized controlled trial of psychosocial intervention for 330 patients
with mild dementia and their caregivers with a 36-month follow-up. Patients and caregivers
rated patients' health on the Euro Quality of Life Visual Analog Scale (EQ-VAS) from
0 (worst) to 100 (best). The ability of self- and caregiver-rated health for the patient
to predict patient mortality was analyzed as hazard ratios (HRs) from Cox proportional
hazard regression models, controlling for age, depression, comorbidities, functional
level, quality of life, and randomization group.
Results
Compared with the highest scores of 80–100, caregiver-rated EQ-VAS scores < 50 had
an HR of 9.8 (95% CI: 2.9–33.1), scores between 50 and 64 had an HR of 3.8 (95% CI:
1.2–12.3), and scores between 65 and 79 had an HR of 4.6 (95% CI: 1.4–14.7). Self-rated
EQ-VAS did not statistically significantly predict mortality.
Conclusion
Caregiver-rated health for patients with mild dementia using the EQ-VAS was shown
to be an independent predictor of patient mortality with a dose–response pattern but
patient-rated EQ-VAS was not.
Key Words
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Article info
Publication history
Published online: June 07, 2017
Accepted:
June 5,
2017
Received in revised form:
June 3,
2017
Received:
March 6,
2017
Identification
Copyright
© 2017 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.
