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A validated risk score to estimate mortality risk in patients with dementia and pneumonia: barriers to clinical impact


van der Steen, Jenny T., Albers, Gwenda, Licht-Strunk, Els, Muller, Martien T., Ribbe, Miel W.


International Psychogeriatrics / IPA, Volume: 23, No.: 1, Pages.: 31-43

Year of Publication



Background: The clinical impact of risk score use in end-of-life settings is unknown, with reports limited to technical properties.; Methods: We conducted a mixed-methods study to evaluate clinical impact of a validated mortality risk score aimed at informing prognosis and supporting clinicians in decision-making in dementia patients with pneumonia. We performed a trial (n = 69) with physician-reported outcomes referring to the score’s aims. Subsequently, physician focus group discussions were planned to better understand barriers to clinical impact, and we surveyed families (n = 50) and nurses practicing in nursing homes (n = 29). We finally consulted with experts and key persons for implementation.; Results: Most (71%) physicians who used the score considered it useful, but mainly for its learning effects. Families were never informed of numerical risk estimates. Two focus group discussions revealed a reluctance to use a numerical approach, and physicians found that outcomes conditional on antibiotic treatment were inadequate to support decision-making. Nurses varied in their perceived role in informing families. Most families (88%) wished to be informed, preferring a numerical (43%), verbalized (35%), or other approach (18%) or had no preference (5%). Revising the score, we added an ethical framework for decision-making to acknowledge its complexity, an explanatory note addressing barriers related to physicians’ attitudes, and a nurses’ form.; Conclusion: The combined quantitative and qualitative studies elicited: substantial barriers to a numerical approach to physicians’ end-of-life decision-making; crucial information for revisions and further score development; and a need for implementation strategies that focus on education.;

Bibtex Citation

@article{van_der_Steen_2010, doi = {10.1017/s1041610210001079}, url = {}, year = 2010, month = {jul}, publisher = {Cambridge University Press ({CUP})}, volume = {23}, number = {01}, pages = {31--43}, author = {Jenny T. van der Steen and Gwenda Albers and Els Licht-Strunk and Martien T. Muller and Miel W. Ribbe}, title = {A validated risk score to estimate mortality risk in patients with dementia and pneumonia: barriers to clinical impact}, journal = {Int. Psychogeriatr.} }


adult, aged, aged, 80 and over, anti-bacterial agents, complications, decision making, dementia, drug therapy, female, homes for the aged, humans, male, middle aged, mortality, nurses, nursing homes, physicians, pneumonia, prognosis, risk assessment, severity of illness index, terminal care, therapeutic use

Countries of Study


Types of Dementia

Dementia (general / unspecified)

Types of Study

Focus Group, Non randomised controlled trial, Survey

Type of Outcomes

Risk reduction (of dementia and co-morbidities)


Nursing Homes

Type of Interventions

End of Life Care, Treatment/prevention of co-morbidities or additional risks

End of Life Care