Caregivers’ understanding of dementia predicts patients’ comfort at death: a prospective observational study

Table 2 Characteristics of patients (n = 161), their families and physicians, outcome and potential confounders ^a

Patients
Female gender,%	69
Age at death (mean, SD)	86.0 (6.3)
Length of stay in nursing home (mean number of years, SD)	1.0 (0.7)
Dementia severity (mean BANS-S score, SD)
- at baseline	14.3 (4.2)
- at last semi-annual assessment before death^b	15.7 (4.2)
Advanced dementia (GDS 7 and (CPS 5 or 6)),%
- at baseline	13
- one month before death	41
Families
Female gender,%	64
Age at baseline assessment (mean, SD)	60.3 (11.7)
Relationship to deceased resident,%
- child (including child and legal representative or other combinations)	59
- spouse	19
- other	22
Highest completed education,%^c
- none or primary/elementary school	6
- (high school preparing for) technical/trade school	56
- high school preparing for BSc or MSc	10
- BSc or MSc degree	28
Physicians (weighted for number of patients they treated)
Female gender,%	61
Age at assessment of perception of dementia	43.1 (8.6)
Experience as a physician in nursing home (mean number of years, SD)	11.5 (8.1)
Full time equivalent (mean, SD)	0.78 (0.17)
Outcome and potential confounders ^c
EOLD-CAD score for comfort (mean, SD)^d	34.1 (5.6)
Assessment of EOLD-CAD by physician (versus nurse under supervision of physician),%	47
Time between patient’s death, mean number of years (SD), and	0.80 (0.67)
- baseline assessment (family, and most physician understanding variables)
- physician’s assessment of perception of dementia	0.18 (0.74)
- death of the first subject in study	1.93 (0.72)

BANS-S, Bedford Alzheimer Nursing Severity-Scale (possible range 7 to 28; scores of 17 and higher represent severe dementia [29]); CPS, Cognitive Performance Scale; EOLD-CAD, End-of-life in Dementia-Comfort Assessment in Dying scale (possible range: 14 to 42, higher scores represent better comfort); GDS, Global Deterioration Scale; SD, standard deviation.
^aMissing values were 3 for both BANS-S assessments, 11 for advanced dementia at baseline, 1 for relationship family to deceased resident, 2 for family education, 8 for physician demographics, 17 for physician experience, 21 for full time equivalent, 8 for assessment of EOLD-CAD by physician, 8 for time between death and physician’s assessment of perception of dementia, and there were no missing values for the other characteristics.
^bThe last assessment before death was the baseline assessment in 50% of cases, and a semi-annual assessment (the first through the fifth) in the other 50% of cases.
^cHighest completed education was also a potential confounder.
^dNurses’ mean EOLD-CAD scores were not significantly lower than physician’s mean ratings of different patients in the DEOLD study (33.8 SD 6.7 versus 34.4 SD 4.4; P = 0.53; no pairwise comparison possible; adjusted for in analyses even though it did not change results).

ISSN: 1741-7015