 |
|
Development and Validation of a Prognostic Index for 4-Year Mortality in Older Adults
Sei J. Lee, MD;
Karla Lindquist, MS;
Mark R. Segal, PhD;
Kenneth E. Covinsky, MD, MPH
JAMA. 2006;295:801-808.
Context Both comorbid conditions and functional measures predict mortality in older adults, but few prognostic indexes combine both classes of predictors. Combining easily obtained measures into an accurate predictive model could be useful to clinicians advising patients, as well as policy makers and epidemiologists interested in risk adjustment.
Objective To develop and validate a prognostic index for 4-year mortality using information that can be obtained from patient report.
Design, Setting, and Participants Using the 1998 wave of the Health and Retirement Study (HRS), a population-based study of community-dwelling US adults older than 50 years, we developed the prognostic index from 11 701 individuals and validated the index with 8009. Individuals were asked about their demographic characteristics, whether they had specific diseases, and whether they had difficulty with a series of functional measures. We identified variables independently associated with mortality and weighted the variables to create a risk index.
Main Outcome Measure Death by December 31, 2002.
Results The overall response rate was 81%. During the 4-year follow-up, there were 1361 deaths (12%) in the development cohort and 1072 deaths (13%) in the validation cohort. Twelve independent predictors of mortality were identified: 2 demographic variables (age: 60-64 years, 1 point; 65-69 years, 2 points; 70-74 years, 3 points; 75-79 years, 4 points; 80-84 years, 5 points, >85 years, 7 points and male sex, 2 points), 6 comorbid conditions (diabetes, 1 point; cancer, 2 points; lung disease, 2 points; heart failure, 2 points; current tobacco use, 2 points; and body mass index <25, 1 point), and difficulty with 4 functional variables (bathing, 2 points; walking several blocks, 2 points; managing money, 2 points, and pushing large objects, 1 point. Scores on the risk index were strongly associated with 4-year mortality in the validation cohort, with 0 to 5 points predicting a less than 4% risk, 6 to 9 points predicting a 15% risk, 10 to 13 points predicting a 42% risk, and 14 or more points predicting a 64% risk. The risk index showed excellent discrimination with a cstatistic of 0.84 in the development cohort and 0.82 in the validation cohort.
Conclusion This prognostic index, incorporating age, sex, self-reported comorbid conditions, and functional measures, accurately stratifies community-dwelling older adults into groups at varying risk of mortality.
Author Affiliations: Division of Geriatrics, San Francisco Veterans Affairs Medical Center (Drs Lee and Covinsky and Ms Lindquist) and Division of Geriatrics (Drs Lee and Covinsky and Ms Lindquist) and Department of Epidemiology and Biostatistics (Dr Segal), University of California, San Francisco.
RELATED LETTERS
Prognostic Index for 4-Year Mortality in Older Adults
Steven Taylor
JAMA. 2006;296(6):648.
EXTRACT
| FULL TEXT
Prognostic Index for 4-Year Mortality in Older Adults
Anton J. M. de Craen and Rudi G. J. Westendorp
JAMA. 2006;296(6):648.
EXTRACT
| FULL TEXT
Prognostic Index for 4-Year Mortality in Older Adults—Reply
Sei J. Lee and Kenneth E. Covinsky
JAMA. 2006;296(6):648-649.
EXTRACT
| FULL TEXT
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Journal of Clinical Oncology: The Next 25 Years
Balducci
JCO 2008;26:e4-e4.
FULL TEXT
Management of the elderly patient with aortic stenosis
Iung
Heart 2008;94:519-524.
FULL TEXT
Development and Validation of an All-Cause Mortality Risk Score in Type 2 Diabetes: The Hong Kong Diabetes Registry
Yang et al.
Arch Intern Med 2008;168:451-457.
ABSTRACT
| FULL TEXT
Screening Mammography in Older Women: Effect of Wealth and Prognosis
Williams et al.
Arch Intern Med 2008;168:514-520.
ABSTRACT
| FULL TEXT
Development of an easy prognostic score for frailty outcomes in the aged
Ravaglia et al.
Age Ageing 2008;37:161-166.
ABSTRACT
| FULL TEXT
A Framework for Tailoring Clinical Guidelines to Comorbidity at the Point of Care
Braithwaite et al.
Arch Intern Med 2007;167:2361-2365.
ABSTRACT
| FULL TEXT
Effectiveness of Influenza Vaccine in the Community-Dwelling Elderly
Nichol et al.
NEJM 2007;357:1373-1381.
ABSTRACT
| FULL TEXT
Frailty in Relation to the Accumulation of Deficits
Rockwood and Mitnitski
J. Gerontol. A Biol. Sci. Med. Sci. 2007;62:722-727.
ABSTRACT
| FULL TEXT
Time-dependent prognostic factors of 6-month mortality in frail elderly patients admitted to post-acute care
Espaulella et al.
Age Ageing 2007;36:407-413.
ABSTRACT
| FULL TEXT
Diabetes Care in Extended-Care Facilities: Appropriate intensity of care?
Holt et al.
Diabetes Care 2007;30:1454-1458.
ABSTRACT
| FULL TEXT
Adjuvant Therapy in the Elderly: Making the Right Decision
Muss et al.
JCO 2007;25:1870-1875.
ABSTRACT
| FULL TEXT
Effects of comorbidity and hospital care on 6-month mortality in patients with elevated cardiac troponin T
Wong et al.
Postgrad. Med. J. 2007;83:332-337.
ABSTRACT
| FULL TEXT
Octogenarians and Nonagenarians Starting Dialysis in the United States
Kurella et al.
ANN INTERN MED 2007;146:177-183.
ABSTRACT
| FULL TEXT
Enhancement of Claims Data to Improve Risk Adjustment of Hospital Mortality
Pine et al.
JAMA 2007;297:71-76.
ABSTRACT
| FULL TEXT
Development of a Clinical Prediction Rule for Guiding Treatment of a Subgroup of Patients With Neck Pain: Use of Thoracic Spine Manipulation, Exercise, and Patient Education
Cleland et al.
ptjournal 2007;87:9-23.
ABSTRACT
| FULL TEXT
Risk Factors for Mortality in Middle-aged Women
Tice et al.
Arch Intern Med 2006;166:2469-2477.
ABSTRACT
| FULL TEXT
Palliative care for frail older adults: "there are things I can't do anymore that I wish I could . . . ".
Boockvar and Meier
JAMA 2006;296:2245-2253.
ABSTRACT
| FULL TEXT
Metabolic Syndrome: Prevalence and prediction of mortality in elderly individuals.
Ravaglia et al.
Diabetes Care 2006;29:2471-2476.
ABSTRACT
| FULL TEXT
Sharpen Your Prognostic: Acumen Try the Destiny Dozen
Alspach
Crit Care Nurse 2006;26:8-9.
FULL TEXT
Prognostic index for 4-year mortality in older adults.
Taylor
JAMA 2006;296:648-648.
FULL TEXT
Prognostic index for 4-year mortality in older adults.
de Craen and Westendorp
JAMA 2006;296:648-648.
FULL TEXT
The evolving treatment of aortic stenosis: do new procedures provide new treatment options for the highest-risk patients?
Carroll
Circulation 2006;114:533-535.
FULL TEXT
Obesity, physical activity, and mortality in a prospective chinese elderly cohort.
Schooling et al.
Arch Intern Med 2006;166:1498-1504.
ABSTRACT
| FULL TEXT
Using clinical guidelines designed for older adults with diabetes mellitus and complex health status.
Durso
JAMA 2006;295:1935-1940.
ABSTRACT
| FULL TEXT
|
