Dementia is a major predictor of death among the Italian elderly

Background: Neurologic diseases are rarely listed on death certificates bec ause death is more often attributed to cardiovascular and pneumonic events occurring during terminal stages. Objective: To evaluate the effect of majo r age-associated neurologic and non-neurologic diseases on survival in a co hort of Italian elderly. Methods: A population-based multicenter survey, ca rried out in eight Italian municipalities, with a sample of 5,632 individua ls aged 65 to 84 years. The entire sample was screened for all the diseases under study, and all individuals were interviewed about risk factors. Thos e who screened positive underwent clinical assessments by specialists. Two years after the baseline survey, the study population was followed up to de termine the vital status either directly from the individuals or from proxy respondents. A copy of the death certificate was obtained for each individ ual who had died. The risk of dying (mortality risk ratio [MRR]) was calcul ated using the Cox proportional hazards model in which we included all the diseases under study, age, gender, and years of education. Results: At foll ow-up (mean duration 26.7 +/- 5.4 months) 444 individuals had died. The Cox proportional hazards model selected the following as significant predictor s of death: age (for year of age MRR = 1.12; 95% confidence interval [CI], 1.08 to 1.15), male gender (MRR = 1.72; 95% CI, 1.27 to 2.34), institutiona lization (MRR = 4.17; 95% CI, 2.20 to 7.94), dementia (MRR = 3.61; 95% CI, 2.55 to 5.11), neoplasm (MRR = 2.01; 95% CI, 1.20 to 3.38), heart failure ( MRR = 1.87; 95% CI, 1.27 to 2.76), and diabetes (MRR = 1.62; 95% CI, 1.12 t o 2.34). Conclusions: These data provide further evidence on the malignancy of dementia, which proved the major predictor of death in the elderly, wit h an MRR higher than neoplastic diseases and other severe age-associated co nditions.