Predictors of mortality among nursing home residents with a diagnosis of Parkinson's disease.

BACKGROUND: Little is known about predictors of mortality among Parkinson patients living in long term care. MATERIAL/
METHODS: We conducted a 3-year follow-up study on 15,237 PD residents aged 65 years and older using the Systematic Assessment in Geriatric drug use via Epidemiology (SAGE) database. The SAGE database consists of the Minimum Data Set (MDS) data collected on over 400,000 nursing home residents in 5 U. S. states, including demographic characteristics, dementia severity, comorbidity and other clinical variables. Information on death was derived through linkage to Medicare files. Baseline characteristics were used to predict survival using univariate and multivariate Cox proportional hazard models.
RESULTS: The overall 3-year mortality rate was 50%. Advanced age (relative rate (RR) 2.22; 95% confidence interval (CI) 1.99-2.47, for patients 85+ years), male gender (RR 1.73; 95% CI 1.60-1.87), severe functional (RR 1.81; 95% CI 1.53-2.13) and cognitive (RR 1.54; 95% CI 1.38-1.72) impairment, the presence of vision problems (RR 1.25; 95% CI 1.20-1.57), pressure ulcers (RR 1.25; 95% 1.14-1.37), and a diagnosis of congestive heart failure (RR 1.49; 95% CI 1.35-1.65), diabetes mellitus (RR 1.22; 95% 1.11-1.35) and pneumonia (RR 1.39; 95% CI 1.09-1.77) were independent predictors of death. The specific presence of aspiration pneumonia had the highest mortality risk ratio among all comorbidities (RR 1.58; CI 0.97-2.56). African-Americans and other minority groups were less likely to die relative to white PD residents.
CONCLUSIONS: Age, sex, functional and cognitive impairment and the diagnosis of pneumonia or congestive heart failure were the strongest predictors of death. Minority groups have a reduced risk of death relative to white PD nursing home residents.