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Deaths in dementia: a scoping review of prognostic variables
  1. Palvinder Kaur1,
  2. Woan Shin Tan1,2,
  3. Pradeep Paul George Gunapal1,
  4. Yew Yoong Ding3,4,
  5. Reuben Ong1,
  6. Huei Yaw Wu2,5 and
  7. Allyn Hum2,5
  1. 1 Health Services and Outcomes Research, National Healthcare Group, Singapore
  2. 2 Palliative Care Centre for Excellence in Research and Education, Singapore
  3. 3 Geriatric Education and Research Institute, Singapore
  4. 4 Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore
  5. 5 Department of Palliative Medicine, Tan Tock Seng Hospital, Singapore
  1. Correspondence to Dr Allyn Hum, Department of Palliative Medicine, Tan Tock Seng Hospital, Singapore 308433, Singapore; allyn_hum{at}


Objectives To identify the types of factors included in research examining mortality in patients with dementia, and to stratify the identified factors by care settings.

Design We systematically searched PubMed, Embase, PsycINFO and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases, and identified grey literature from the Networked Digital Library of Theses and Dissertations, Open Grey and Grey Literature Report. Two authors independently screened for eligibility of studies. Independent reviewers extracted relevant study information. We conducted a narrative synthesis of the data.

Results We identified 8254 articles, of which 94 met the inclusion criteria. More than half (n=53) were published between 2009 and 2018 with half from Europe. Studies were conducted across hospices/nursing homes (n=25), hospital (n=23), outpatient clinics (n=21), mixed settings (n=15) and in the community (n=10). Nearly 60% adopted a prospective cohort study design with 87% performing multivariable analysis. Overall, 239 variables were identified and classified into six themes—individual factors, health status, functional ability, cognition and mental health, treatments and health system factors. Although a general set of factors were common across all studies, when stratified by care settings, variations were seen in the specific variables included.

Conclusion Identifying prognostic variables relevant to the dementia population in each setting is key to facilitate appropriate care plans and to ensure timely access to palliative care options. Future research should also focus on ensuring the replicability of prognostic models and to generate a better understanding of the direct and interacting influence of the identified factors on mortality.

  • end of life care
  • neurological conditions
  • prognosis

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  • PK and WST are joint senior authors.

  • PK and WST contributed equally.

  • Contributors AH, HYW, PPGG, WST and YYD conceived, obtained funding and designed the study. PPGG, WST, PK and RO collected, analysed and interpreted the data. PK and WST prepared the first draft of the manuscript. AH, HYW and YYD interpreted the data and revised the article. All authors critically reviewed the manuscript for intellectual content and give final approval of the revision to be published.

  • Funding The authors disclosed receipt of the following financial support for the research, authorship and/or publication of this article: this study is funded by the Geriatric Education and Research Institute (Reference no.: GERI1620), which receives public funding from the Ministry of Health of the Singaporean Government.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.