2nd World Conference on Jewish Services for the Elderly, Jerusalem, Israel, 2004.
Abstract Book, page 109
Mini-Suffering State Examination (MSSE) Scale: The First 5 Years
B.Z. Aminoff, MD, PhD; S. Noy, MD, PhD; A. Adunsky, MD
Geriatric Division, The Chaim Sheba Medical Center, Tel Hashomer, Israel
The Mini-Suffering State Examination (MSSE) scale is the first objective clinical tool for evaluation of suffering level in ESD (Aminoff, 1999). The results of our clinical experience with the MSSE scale conducted on more than 350 patients were presented at international and national congresses in Berlin (1999), Jerusalem (2000) Vancouver (2001), Stockholm (2002), Tokyo (2003), Tel Aviv (2003), Las Vegas, (2004) and published in the Archives of Gerontology and Geriatrics (2004;38:123-130). We are aware of the English, Hebrew and Dutch versions of the MSSE scale. The MSSE scale covers 10 items (range 0-10; range 7-10 indicates a high level of suffering). A high MSSE scale score reflects the severity of the medical condition in ESD and indicates a high level of suffering.
The MSSE scale is significantly reliable with Cronbach alpha = 0.736. Validity of the MSSE scale was proven by Pearson correlation with the Symptom Management with End-of-Life in Dementia (SM–EOLD) scale (r = 0.574, P < 0.0001, and the Comfort Assessment in Dying with Dementia (CAD–EOLD) scale (r = -0.796, P < 0.0001).
According to the MSSE evaluation scale, it has been proven that ESD patients are a heterogeneous group and have different levels of suffering. The results of our research showed that care in the geriatric department failed to lower the high level of suffering of these patients. The total MSSE scale score on the day of admission was 5.62± 2.31, and increased to 6.89±1.95 on the last day of life with a significant difference (P < 0.0001). The differences between the survival times of the three MSSE scale score groups was evaluated by Kaplan-Meier analysis (Log Rank P = 0.0018, Breslow P = 0.0027) and were significant. The results of the Cox proportional Hazard model of survival showed a high correlation between high MSSE scale scores and high risk of mortality and short survival of ESD patients during the last 6 months of life (P = 0.013).
A high MSSE scale score could be the key criterion for enrolling end-stage disease and dying patients in a Relief of Suffering Units for End-of-Life Dementia Patients