Prognostic Indices for Older Adults: A Systematic Review | Geriatrics | JAMA | JAMA Network
[Skip to Navigation]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address 35.175.212.130. Please contact the publisher to request reinstatement.
1.
Casarett D, Karlawish J, Morales K, Crowley R, Mirsch T, Asch DA. Improving the use of hospice services in nursing homes: a randomized controlled trial.  JAMA. 2005;294(2):211-21716014595PubMedGoogle ScholarCrossref
2.
Walter LC, Covinsky KE. Cancer screening in elderly patients: a framework for individualized decision making.  JAMA. 2001;285(21):2750-275611386931PubMedGoogle ScholarCrossref
3.
Mehta KM, Fung KZ, Kistler CE, Chang A, Walter LC. Impact of cognitive impairment on screening mammography use in older US women.  Am J Public Health. 2010;100(10):1917-192320075325PubMedGoogle ScholarCrossref
4.
Sima CS, Panageas KS, Schrag D. Cancer screening among patients with advanced cancer.  JAMA. 2010;304(14):1584-159120940384PubMedGoogle ScholarCrossref
5.
Holmes HM, Hayley DC, Alexander GC, Sachs GA. Reconsidering medication appropriateness for patients late in life.  Arch Intern Med. 2006;166(6):605-60916567597PubMedGoogle ScholarCrossref
6.
Vollrath AM, Sinclair C, Hallenbeck J. Discontinuing cardiovascular medications at the end of life: lipid-lowering agents.  J Palliat Med. 2005;8(4):876-88116128666PubMedGoogle ScholarCrossref
7.
Fillinger M. Who should we operate on and how do we decide: predicting rupture and survival in patients with aortic aneurysm.  Semin Vasc Surg. 2007;20(2):121-12717580250PubMedGoogle ScholarCrossref
8.
Conway KP, Byrne J, Townsend M, Lane IF. Prognosis of patients turned down for conventional abdominal aortic aneurysm repair in the endovascular and sonographic era: Szilagyi revisited?  J Vasc Surg. 2001;33(4):752-75711296328PubMedGoogle ScholarCrossref
9.
Lederle FA, Johnson GR, Wilson SE,  et al; Veterans Affairs Cooperative Study No. 417 Investigators.  Rupture rate of large abdominal aortic aneurysms in patients refusing or unfit for elective repair.  JAMA. 2002;287(22):2968-297212052126PubMedGoogle ScholarCrossref
10.
Mohan IV, Harris PL. When not to operate for abdominal aortic aneurysms.  Semin Interv Cardiol. 2000;5(1):15-1910875219PubMedGoogle Scholar
11.
Brown AF, Mangione CM, Saliba D, Sarkisian CA.California Healthcare Foundation/American Geriatrics Society Panel on Improving Care for Elders with Diabetes.  Guidelines for improving the care of the older person with diabetes mellitus.  J Am Geriatr Soc. 2003;51(5):(suppl guidelines)  S265-S28012694461PubMedGoogle ScholarCrossref
12.
Beckett NS, Peters R, Fletcher AE,  et al; HYVET Study Group.  Treatment of hypertension in patients 80 years of age or older.  N Engl J Med. 2008;358(18):1887-189818378519PubMedGoogle ScholarCrossref
13.
Walter LC, Lewis CL, Barton MB. Screening for colorectal, breast, and cervical cancer in the elderly: a review of the evidence.  Am J Med. 2005;118(10):1078-108616194635PubMedGoogle ScholarCrossref
14.
Walter LC, Lindquist K, Nugent S,  et al.  Impact of age and comorbidity on colorectal cancer screening among older veterans.  Ann Intern Med. 2009;150(7):465-47319349631PubMedGoogle ScholarCrossref
15.
US Preventive Services Task Force.  Colon cancer screening (USPSTF recommendation).  J Am Geriatr Soc. 2000;48(3):333-33510733063PubMedGoogle Scholar
16.
 Screening for colorectal cancer. US Preventive Services Task Force. http://www.uspreventiveservicestaskforce.org/uspstf08/colocancer/colors.htm. Accessed November 15, 2011
17.
Warner E. Clinical practice: breast-cancer screening.  N Engl J Med. 2011;365(11):1025-103221916640PubMedGoogle ScholarCrossref
18.
American Geriatrics Society Clinical Practice Committee.  Breast cancer screening in older women.  J Am Geriatr Soc. 2000;48(7):842-84410894327PubMedGoogle Scholar
19.
 Screening for breast cancer. US Preventive Services Task Force. http://www.uspreventiveservicestaskforce.org/uspstf09/breastcancer/brcanrs.htm. Accessed November 15, 2011
20.
Rahimtoola SH. Choice of prosthetic heart valve in adults: an update.  J Am Coll Cardiol. 2010;55(22):2413-242620510209PubMedGoogle ScholarCrossref
21.
Huang ES, Zhang Q, Gandra N, Chin MH, Meltzer DO. The effect of comorbid illness and functional status on the expected benefits of intensive glucose control in older patients with type 2 diabetes: a decision analysis.  Ann Intern Med. 2008;149(1):11-1918591633PubMedGoogle ScholarCrossref
22.
Skyler JS, Bergenstal R, Bonow RO,  et al; American Diabetes Association; American College of Cardiology Foundation; American Heart Association.  Intensive glycemic control and the prevention of cardiovascular events: implications of the ACCORD, ADVANCE, and VA Diabetes Trials: a position statement of the American Diabetes Association and a Scientific Statement of the American College of Cardiology Foundation and the American Heart Association.  J Am Coll Cardiol. 2009;53(3):298-30419147051PubMedGoogle ScholarCrossref
23.
Walter LC, Bertenthal D, Lindquist K, Konety BR. PSA screening among elderly men with limited life expectancies.  JAMA. 2006;296(19):2336-234217105796PubMedGoogle ScholarCrossref
24.
Wolf AM, Wender RC, Etzioni RB,  et al; American Cancer Society Prostate Cancer Advisory Committee.  American Cancer Society guideline for the early detection of prostate cancer: update 2010.  CA Cancer J Clin. 2010;60(2):70-9820200110PubMedGoogle ScholarCrossref
25.
Akhoundi FH, Ghorbani A, Soltani A, Meysamie A. Favorable functional outcomes in acute ischemic stroke patients with subclinical hypothyroidism.  Neurology. 2011;77(4):349-35421715712PubMedGoogle ScholarCrossref
26.
Buchholz TA. Radiation therapy for early-stage breast cancer after breast-conserving surgery.  N Engl J Med. 2009;360(1):63-7019118305PubMedGoogle ScholarCrossref
27.
Geiger AM, Thwin SS, Lash TL,  et al.  Recurrences and second primary breast cancers in older women with initial early-stage disease.  Cancer. 2007;109(5):966-97417243096PubMedGoogle ScholarCrossref
28.
Justice AC, Covinsky KE, Berlin JA. Assessing the generalizability of prognostic information.  Ann Intern Med. 1999;130(6):515-52410075620PubMedGoogle ScholarCrossref
29.
Steyerberg EW, Vickers AJ, Cook NR,  et al.  Assessing the performance of prediction models: a framework for traditional and novel measures.  Epidemiology. 2010;21(1):128-13820010215PubMedGoogle ScholarCrossref
30.
Laupacis A, Sekar N, Stiell IG. Clinical prediction rules: a review and suggested modifications of methodological standards.  JAMA. 1997;277(6):488-4949020274PubMedGoogle ScholarCrossref
31.
Laupacis A, Wells G, Richardson WS, Tugwell P.Evidence-Based Medicine Working Group.  Users' guides to the medical literature: V, How to use an article about prognosis.  JAMA. 1994;272(3):234-2378022043PubMedGoogle ScholarCrossref
32.
Braitman LE, Davidoff F. Predicting clinical states in individual patients.  Ann Intern Med. 1996;125(5):406-4128702092PubMedGoogle ScholarCrossref
33.
Randolph A, Cook DJ, Guyatt G. Prognosis. In: Guyatt GH, Rennie D, Meade MO, Cook DJ, eds. Users' Guides to the Medical Literature: A Manual for Evidence-Based Clinical Practice. 2nd ed. New York, NY: McGraw-Hill; 2008
34.
Hayden JA, Côté P, Bombardier C. Evaluation of the quality of prognosis studies in systematic reviews.  Ann Intern Med. 2006;144(6):427-43716549855PubMedGoogle ScholarCrossref
35.
McGinn TG, Guyatt GH, Wyer PC, Naylor CD, Stiell IG, Richardson WS.Evidence-Based Medicine Working Group.  Users' guides to the medical literature: XXII, How to use articles about clinical decision rules.  JAMA. 2000;284(1):79-8410872017PubMedGoogle ScholarCrossref
36.
Flacker JM, Kiely DK. Mortality-related factors and 1-year survival in nursing home residents.  J Am Geriatr Soc. 2003;51(2):213-22112558718PubMedGoogle ScholarCrossref
37.
Porock D, Oliver DP, Zweig S,  et al.  Predicting death in the nursing home: development and validation of the 6-month Minimum Data Set mortality risk index.  J Gerontol A Biol Sci Med Sci. 2005;60(4):491-49815933390PubMedGoogle ScholarCrossref
38.
Kruse RL, Parker Oliver D, Mehr DR, Petroski GF, Swenson DL, Zweig SC. Using mortality risk scores for long-term prognosis of nursing home residents: caution is recommended.  J Gerontol A Biol Sci Med Sci. 2010;65(11):1235-124120639529PubMedGoogle ScholarCrossref
39.
Lee SJ, Lindquist K, Segal MR, Covinsky KE. Development and validation of a prognostic index for 4-year mortality in older adults.  JAMA. 2006;295(7):801-80816478903PubMedGoogle ScholarCrossref
40.
Inouye SK, Bogardus ST Jr, Vitagliano G,  et al.  Burden of illness score for elderly persons: risk adjustment incorporating the cumulative impact of diseases, physiologic abnormalities, and functional impairments.  Med Care. 2003;41(1):70-8312544545PubMedGoogle ScholarCrossref
41.
Walter LC, Brand RJ, Counsell SR,  et al.  Development and validation of a prognostic index for 1-year mortality in older adults after hospitalization.  JAMA. 2001;285(23):2987-299411410097PubMedGoogle ScholarCrossref
42.
Pilotto A, Ferrucci L, Franceschi M,  et al.  Development and validation of a multidimensional prognostic index for one-year mortality from comprehensive geriatric assessment in hospitalized older patients.  Rejuvenation Res. 2008;11(1):151-16118173367PubMedGoogle ScholarCrossref
43.
Sancarlo D, D’Onofrio G, Franceschi M,  et al.  Validation of a Modified-Multidimensional Prognostic Index (m-MPI) including the Mini Nutritional Assessment Short-Form (MNA-SF) for the prediction of one-year mortality in hospitalized elderly patients.  J Nutr Health Aging. 2011;15(3):169-17321369662PubMedGoogle ScholarCrossref
44.
Hanley JA, McNeil BJ. The meaning and use of the area under a receiver operating characteristic (ROC) curve.  Radiology. 1982;143(1):29-367063747PubMedGoogle Scholar
45.
Carey EC, Covinsky KE, Lui LY, Eng C, Sands LP, Walter LC. Prediction of mortality in community-living frail elderly people with long-term care needs.  J Am Geriatr Soc. 2008;56(1):68-7518031487PubMedGoogle ScholarCrossref
46.
Carey EC, Walter LC, Lindquist K, Covinsky KE. Development and validation of a functional morbidity index to predict mortality in community-dwelling elders.  J Gen Intern Med. 2004;19(10):1027-103315482555PubMedGoogle ScholarCrossref
47.
Di Bari M, Balzi D, Roberts AT,  et al.  Prognostic stratification of older persons based on simple administrative data: development and validation of the “Silver Code,” to be used in emergency department triage.  J Gerontol A Biol Sci Med Sci. 2010;65(2):159-16419349591PubMedGoogle ScholarCrossref
48.
Dramé M, Novella JL, Lang PO,  et al.  Derivation and validation of a mortality-risk index from a cohort of frail elderly patients hospitalised in medical wards via emergencies: the SAFES study.  Eur J Epidemiol. 2008;23(12):783-79118941907PubMedGoogle ScholarCrossref
49.
Fischer SM, Gozansky WS, Sauaia A, Min SJ, Kutner JS, Kramer A. A practical tool to identify patients who may benefit from a palliative approach: the CARING criteria.  J Pain Symptom Manage. 2006;31(4):285-29216632076PubMedGoogle ScholarCrossref
50.
Flacker JM, Kiely DK. A practical approach to identifying mortality-related factors in established long-term care residents.  J Am Geriatr Soc. 1998;46(8):1012-10159706893PubMedGoogle Scholar
51.
Levine SK, Sachs GA, Jin L, Meltzer D. A prognostic model for 1-year mortality in older adults after hospital discharge.  Am J Med. 2007;120(5):455-46017466658PubMedGoogle ScholarCrossref
52.
Mazzaglia G, Roti L, Corsini G,  et al.  Screening of older community-dwelling people at risk for death and hospitalization: the Assistenza Socio-Sanitaria in Italia project.  J Am Geriatr Soc. 2007;55(12):1955-196017944891PubMedGoogle ScholarCrossref
53.
Porock D, Parker-Oliver D, Petroski GF, Rantz M. The MDS Mortality Risk Index: the evolution of a method for predicting 6-month mortality in nursing home residents.  BMC Res Notes. 2010;3:20020637076PubMedGoogle ScholarCrossref
54.
Rozzini R, Sabatini T, Trabucchi M. Prediction of 6-month mortality among older hospitalized adults.  JAMA. 2001;286(11):1315-131611560535PubMedGoogle ScholarCrossref
55.
Schonberg MA, Davis RB, McCarthy EP, Marcantonio ER. Index to predict 5-year mortality of community-dwelling adults aged 65 and older using data from the National Health Interview Survey.  J Gen Intern Med. 2009;24(10):1115-112219649678PubMedGoogle ScholarCrossref
56.
Gagne JJ, Glynn RJ, Avorn J, Levin R, Schneeweiss S. A combined comorbidity score predicted mortality in elderly patients better than existing scores.  J Clin Epidemiol. 2011;64(7):749-75921208778PubMedGoogle ScholarCrossref
57.
Teno JM, Harrell FE Jr, Knaus W,  et al.  Prediction of survival for older hospitalized patients: the HELP survival model: Hospitalized Elderly Longitudinal Project.  J Am Geriatr Soc. 2000;48(5):(suppl)  S16-S2410809452PubMedGoogle Scholar
58.
Schonberg MA, Davis RB, McCarthy EP, Marcantonio ER. External validation of an index to predict up to 9-year mortality of community-dwelling adults aged 65 and older.  J Am Geriatr Soc. 2011;59(8):1444-145121797837PubMedGoogle ScholarCrossref
59.
Youngwerth J, Fischer SM, Min S-J, Kutner JS. Who would benefit from a palliative care consult in the hospital? CARING About Prognosis (CAP) (313-C).  J Pain Symptom Manage. 2011;41(1):192-193Google ScholarCrossref
60.
Desai MM, Bogardus ST Jr, Williams CS, Vitagliano G, Inouye SK. Development and validation of a risk-adjustment index for older patients: the high-risk diagnoses for the elderly scale.  J Am Geriatr Soc. 2002;50(3):474-48111943043PubMedGoogle ScholarCrossref
61.
Hsia DC, Krushat WM, Fagan AB, Tebbutt JA, Kusserow RP. Accuracy of diagnostic coding for Medicare patients under the prospective-payment system.  N Engl J Med. 1988;318(6):352-3553123929PubMedGoogle ScholarCrossref
62.
Romano PS, Roos LL, Jollis JG. Adapting a clinical comorbidity index for use with ICD-9-CM administrative data: differing perspectives.  J Clin Epidemiol. 1993;46(10):1075-10798410092PubMedGoogle ScholarCrossref
63.
Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.  J Chronic Dis. 1987;40(5):373-3833558716PubMedGoogle ScholarCrossref
64.
van Walraven C, Austin PC, Jennings A, Quan H, Forster AJ. A modification of the Elixhauser comorbidity measures into a point system for hospital death using administrative data.  Med Care. 2009;47(6):626-63319433995PubMedGoogle ScholarCrossref
65.
Elixhauser A, Steiner C, Harris DR, Coffey RM. Comorbidity measures for use with administrative data.  Med Care. 1998;36(1):8-279431328PubMedGoogle ScholarCrossref
66.
Inouye SK, Wagner DR, Acampora D,  et al.  A predictive index for functional decline in hospitalized elderly medical patients.  J Gen Intern Med. 1993;8(12):645-6528120679PubMedGoogle ScholarCrossref
67.
 MDS 3.0 Technical Information. Centers for Medicare & Medicaid Services. http://www.cms.gov/NursingHomeQualityInits/30_NHQIMDS30TechnicalInformation.asp#TopOfPage. Accessed November 15, 2011
68.
Oliver DP, Bickel-Swenson D, Zweig S, Kruse R, Mehr D. Experience with implementation of a quality improvement project for the care of nursing home residents.  J Nurs Care Qual. 2009;24(2):100-10419287246PubMedGoogle ScholarCrossref
69.
Rietbrock S, Heeley E, Plumb J, van Staa T. Chronic atrial fibrillation: incidence, prevalence, and prediction of stroke using the congestive heart failure, hypertension, age >75, diabetes mellitus, and prior stroke or transient ischemic attack (CHADS2) risk stratification scheme.  Am Heart J. 2008;156(1):57-6418585497PubMedGoogle ScholarCrossref
70.
D’Agostino RB Sr, Grundy S, Sullivan LM, Wilson P.CHD Risk Prediction Group.  Validation of the Framingham coronary heart disease prediction scores: results of a multiple ethnic groups investigation.  JAMA. 2001;286(2):180-18711448281PubMedGoogle ScholarCrossref
71.
Antman EM, Cohen M, Bernink PJ,  et al.  The TIMI risk score for unstable angina/non-ST elevation MI: a method for prognostication and therapeutic decision making.  JAMA. 2000;284(7):835-84210938172PubMedGoogle ScholarCrossref
72.
Van Zee KJ, Manasseh DM, Bevilacqua JL,  et al.  A nomogram for predicting the likelihood of additional nodal metastases in breast cancer patients with a positive sentinel node biopsy.  Ann Surg Oncol. 2003;10(10):1140-115114654469PubMedGoogle ScholarCrossref
73.
Ross PL, Gerigk C, Gonen M,  et al.  Comparisons of nomograms and urologists' predictions in prostate cancer.  Semin Urol Oncol. 2002;20(2):82-8812012293PubMedGoogle ScholarCrossref
74.
Einhorn HJ, Hogarth RM. Behavioral decision theory: process of judgment and choice. In: Bell DE, Raiffa H, Tversky A, eds. Decision-Making: Descriptive, Normative, and Prescriptive Interactions. Cambridge, MA: Cambridge University Press; 1988:113-146
Clinical Review
January 11, 2012

Prognostic Indices for Older Adults: A Systematic Review

Author Affiliations

Author Affiliations: Division of Geriatrics, Department of Medicine, University of California, San Francisco (Drs Yourman, Lee, and Widera); San Francisco Veterans Affairs Medical Center, San Francisco (Drs Lee, Widera, and Smith); and Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr Schonberg).

JAMA. 2012;307(2):182-192. doi:10.1001/jama.2011.1966
Abstract

Context To better target services to those who may benefit, many guidelines recommend incorporating life expectancy into clinical decisions.

Objective To assess the quality and limitations of prognostic indices for mortality in older adults through systematic review.

Data Sources We searched MEDLINE, EMBASE, Cochrane, and Google Scholar from their inception through November 2011.

Study Selection We included indices if they were validated and predicted absolute risk of mortality in patients whose average age was 60 years or older. We excluded indices that estimated intensive care unit, disease-specific, or in-hospital mortality.

Data Extraction For each prognostic index, we extracted data on clinical setting, potential for bias, generalizability, and accuracy.

Results We reviewed 21 593 titles to identify 16 indices that predict risk of mortality from 6 months to 5 years for older adults in a variety of clinical settings: the community (6 indices), nursing home (2 indices), and hospital (8 indices). At least 1 measure of transportability (the index is accurate in more than 1 population) was tested for all but 3 indices. By our measures, no study was free from potential bias. Although 13 indices had C statistics of 0.70 or greater, none of the indices had C statistics of 0.90 or greater. Only 2 indices were independently validated by investigators who were not involved in the index's development.

Conclusion We identified several indices for predicting overall mortality in different patient groups; future studies need to independently test their accuracy in heterogeneous populations and their ability to improve clinical outcomes before their widespread use can be recommended.

×