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Systematic review of prognostic factors for poor outcome in people living with dementia that can be determined from primary care medical records

Marshall, Michelle; Jordan, Joanne L.; Bajpai, Ram; Nimmons, Danielle; Smith, Tilli M.; Campbell, Paul; Jordan, Kelvin P.

Authors

Danielle Nimmons

Tilli M. Smith



Abstract

Background: Dementia has a major impact on individuals, their families and caregivers, and wider society. Some individuals experience a faster decline of their function and health compared to others. The objective of this systematic review was to determine prognostic factors, measurable in primary care, for poor outcome in people living with dementia. Methods: Cohort studies set in the community or primary care, and examining prognostic factors for care home admission, cognitive decline, or palliative care were included. Databases were searched from inception to 17th June 2022. Identified papers were screened, the risk of bias assessed using Quality in Prognostic Studies (QUIPS) tool, and data extracted by 2 reviewers, with disagreements resolved by consensus or a 3rd reviewer. A narrative synthesis was undertaken, informed by GRADE, taking into consideration strength of association, risk of bias and precision of evidence. Patient and Public Involvement and Engagement (PPIE) and stakeholder input was obtained to prioritise factors for further investigation. Results: Searches identified 24,283 potentially relevant titles. After screening, 46 papers were included, 21 examined care home admission investigating 94 factors, 26 investigated cognitive decline as an outcome examining 60 factors, and 1 researched palliative care assessing 13 factors. 11 prognostic factors (older age, less deprived, living alone, white race, urban residence, worse baseline cognition, taking dementia medication, depression, psychosis, wandering, and caregiver’s desire for admission) were associated with an increased risk of care home admission and 4 prognostic factors (longer duration of dementia, agitation/aggression, psychosis, and hypercholesterolaemia) were associated with an increased risk of cognitive decline. PPIE and other stakeholders recommended further investigation of 22 additional potential prognostic factors. Conclusions: Identifying evidence for prognostic factors in dementia is challenging. Whilst several factors highlighted as of relevance by our stakeholder groups need further investigation, inequalities may exist in care home admission and there is evidence that several prognostic factors measurable in primary care could alert clinicians to risk of a faster progression. Registration: PROSPERO CRD42019111775.

Citation

Marshall, M., Jordan, J. L., Bajpai, R., Nimmons, D., Smith, T. M., Campbell, P., & Jordan, K. P. (2024). Systematic review of prognostic factors for poor outcome in people living with dementia that can be determined from primary care medical records. BMC Geriatrics, 24(1), Article 801. https://doi.org/10.1186/s12877-024-05389-0

Journal Article Type Article
Acceptance Date Sep 17, 2024
Online Publication Date Oct 1, 2024
Publication Date Oct 1, 2024
Deposit Date Oct 7, 2024
Publicly Available Date Oct 7, 2024
Journal BMC Geriatrics
Publisher Springer Verlag
Peer Reviewed Peer Reviewed
Volume 24
Issue 1
Article Number 801
DOI https://doi.org/10.1186/s12877-024-05389-0
Keywords Dementia, Primary care, Prognosis, Systematic review, Care home admission, Cognitive decline, Palliative care
Public URL https://keele-repository.worktribe.com/output/948652
Publisher URL https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-024-05389-0

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Systematic review of prognostic factors for poor outcome in people living with dementia that can be determined from primary care medical records (2.2 Mb)
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Licence
https://creativecommons.org/licenses/by/4.0/

Publisher Licence URL
https://creativecommons.org/licenses/by/4.0/

Copyright Statement
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.





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