Evaluation of Underlying Causes of Death in Patients with Dementia to Support Targeted Advance Care Planning

Background: Insight in causes of death in demented patients may help physicians in end-of-life care. Objectives: To investigate underlying causes of death (UCD) in demented patients stratified by age, sex, dementia subtype [Alzheimer's disease (AD), vascular dementia (VaD)] and to compare them with UCD in the general population (GP). Methods: A nationwide cohort of 59,201 patients with dementia (admitted to a hospital or visiting a day clinic) was constructed [38.7 men, 81.4 years (SD 7.0)] from 2000 through 2010. UCDs were reported and compared to the GP by calculating relative risks (RRs). Results: During follow up [median follow up time 1.3 years (IQR 0.3- 3.0)], 64.2 of women and 69.3 of men died. Leading UCDs were dementia (17.5 in men and 23.7 in women) and cardiovascular disease (CVD) (18.7 and 19.2, respectively). When compared to the GP, dementia was a more common UCD (RR in men 4.65, 95 CI 4.43-4.88), while CVD (RR in men 0.67, 95 CI 0.65-0.68) and cancer (RR 0.40, 95 CI 0.39-0.41) were less common. These differences were more pronounced in patients aged between 60-69 as compared to those aged≥90 years. Patients with AD died less often of cerebrovascular diseases as compared to VaD (RR in men 0.53, 95 CI 0.47-0.59). Conclusion: UCDs in patients with dementia differs from that of the GP, as dementia is more often and cancer less often an UCD. Although less frequent compared to the GP, CVD also is one of the leading UCDs in patients with dementia. This information is valuable for targeted advance care planning