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Persistent vegetative state and dementia in the elderly

Published online by Cambridge University Press:  19 January 2007

Efraim Jaul  and
Ronit Calderon-Margalit
Efraim Jaul*
Affiliation:
Skilled Geriatric Nursing Department, Herzog Hospital, Jerusalem, Israel The Hebrew University Hadassah Medical School, Jerusalem, Israel
Ronit Calderon-Margalit
Affiliation:
Hadassah-Hebrew University Braun School of Public Health and Community Medicine, Jerusalem, Israel
*
Correspondence should be addressed to: Efraim Jaul, Director, Dept. of Skilled Nursing, Herzog Hospital, PO Box 35300, Jerusalem 91351, Israel. Phone: +972 2 531 6872; Fax: +972 2 654 1410. Email: [email protected]; [email protected].
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Abstract

Background: Very few studies have approached the issue of persistent vegetative state (PVS) within the elderly population. This study aims to assess the prevalence, determinants and prognosis of elderly patients with PVS admitted to a long-term geriatric facility.

Methods: We conducted a cohort study in the setting of a Skilled Geriatric Nursing Department. All patients admitted during a 17-month period (N = 88) were included and tested for a diagnosis of PVS according to the Disability Rating Scale (DRS).

Results: A clinical diagnosis of PVS was given to 15% of patients upon admission, whereas the DRS diagnosed 30.5% of patients as having PVS. During the study period, 12 out of 31 patients with PVS died, with a median survival of 127 days (range: 1–517 days).

Conclusion: Our study suggests that PVS is an advanced stage in the natural history of dementia in the elderly. The low proportion of patients with PVS recognized as having this disorder upon admission suggests a low awareness among hospital personnel. Further studies of the prevalence and determinants of PVS in the severely disabled elderly population are warranted.

Keywords

vegetative stateelderlyterminal dementia
Type
Research Article
Information
International Psychogeriatrics , Volume 19 , Issue 6 , December 2007 , pp. 1064 - 1071
Copyright
Copyright © International Psychogeriatric Association 2007

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References

Andrews, K., Murphy, L., Munday, R. and Littlewood, C. 1996. Misdiagnosis of the vegetative state: retrospective study in a rehabilitation unit. BMJ, 313, 13–16.CrossRefGoogle Scholar
Dyer, C. 2003. Permanent loss of awareness is crucial to diagnosis of PVS. BMJ, 327, 67. doi:10.1136/bmj.327.7406.67CrossRefGoogle ScholarPubMed
Giacino, J. T., Kalmar, K. and Whyte, J. 2004. The JFK Coma Recovery Scale-Revised: measurement characteristics and diagnostic utility. Archives of Physical Medicine and Rehabilitation, 85, 2020–2029. doi:10.1016/j.apmr.2004.02.033Google Scholar
Hammond, F. M. et al. 2001. Long-term recovery course after traumatic brain injury: a comparison of the functional independence measure and disability rating scale. Journal of Head Trauma Rehabilitation, 16, 318–329.CrossRefGoogle ScholarPubMed
Higashi, K. et al. 1981. Five-year follow-up study of patients with persistent vegetative state. Journal of Neurology, Neurosurgery, and Psychiatry, 44, 552–554.CrossRefGoogle ScholarPubMed
Kaufman, D. M. and Lipton, R. B. 1992. The persistent vegetative state: an analysis of clinical correlates and costs. New York State Journal of Medicine, 92, 381–384.Google ScholarPubMed
Lavrijsen, J. C., Van Der Bosch, J. S., Koopman, R. T. and Van Weil, C. 2005. Prevalence and characteristics of patients in a vegetative state in Dutch nursing homes. Journal of Neurology, Neurosurgery, and Psychiatry, 76, 1420–1424. doi:10.1136/jnnp.2004.058198CrossRefGoogle Scholar
Lippert-Gruner, M., Wedekind, C. and Klug, N. 2003. Outcome of prolonged coma following severe traumatic brain injury. Brain Injury, 17, 49–54. doi:10.1080/0269905021000010230Google Scholar
Mann, J. L., Evans, T. S. and Ohara, L. M. 2005. An assessment of the diagnosis and management of dementia in nursing homes. The Consultant Pharmacist, 20, 306–312.CrossRefGoogle ScholarPubMed
Mitrani, V. B. et al. 2006. The role of family functioning in the stress process of dementia caregivers: a structural family framework. Gerontologist, 46, 97–105.CrossRefGoogle ScholarPubMed
Norton, D. 1989. Calculating the risk: reflections on the Norton scale. Decubitus, 2, 24–31.Google ScholarPubMed
Ouslander, J. G., Osterwick, D. and Morley, J. (eds.) 1997. Medical Care in the Nursing Home. New York: MacGraw-Hill.Google Scholar
Rappaport, M., Hall, K. M., Hopkins, K., Belleza, T. and Cope, D. N. 1982. Disability rating scale for severe head trauma patients: coma to community. Archives of Physical Medicine and Rehabilitation, 63, 118–123.Google ScholarPubMed
Royal College of Physicians 2003. The vegetative state: guidance on diagnosis and management. Clinical Medicine, 3, 249–254.CrossRefGoogle Scholar
Talbot, L. R. and Whitaker, H. A. 1994. Brain-injured persons in an altered state of consciousness: measures and intervention strategies. Brain Injury, 8, 689–699.CrossRefGoogle Scholar
Teasdale, G. and Jennett, B. 1974. Assessment of coma and impaired consciousness: practical scales. The Lancet, 2, 81–84. doi:10.1016/S0140-6736(02)93219-8CrossRefGoogle Scholar
The Multi-Society Task Force on PVS 1994. Medical aspects of the persistent vegetative state, in two parts. New England Journal of Medicine, 330, 1499–1508, 1572–1579. doi:10.1056/NEJM199405263302107Google Scholar
Tresch, D. et al. 1991. Clinical characteristics of patients in the persistent vegetative state. Archives of Internal Medicine, 151, 930–932. doi:10.1001/archinte.151.5.930CrossRefGoogle ScholarPubMed
Volicer, L., Berman, S. A., Cipolloni, P. B. and Mandell, A. 1997. Persistent vegetative state in Alzheimer's disease. Does it exist? Archives of Neurology, 54, 1382–1384.CrossRefGoogle ScholarPubMed
Volicer, L. 2001. Management of severe Alzheimer's diseases and end-of-life issues. Clinics in Geriatric Medicine, 17, 377–391. doi:10.1016/S0749-0690(05)70074-4CrossRefGoogle ScholarPubMed
Walshe, M. T. and Leonard, C. 1985 Persistent vegetative state: extension of the syndrome to include chronic disorders. Archives of Neurology, 42, 1045–1047.CrossRefGoogle ScholarPubMed
Whyte, J. et al. 2005. Predictors of outcome in prolonged posttraumatic disorders of consciousness and assessment of medication effects: a multicenter study. Archives of Physical Medicine and Rehabilitation, 86, 453–462. doi:10.1016/j.apmr.2004.05.016CrossRefGoogle ScholarPubMed