A Prognostic Model for 1-Year Mortality in Older Adults after Hospital Discharge

Section of Geriatrics, Department of Medicine, University of Chicago, Chicago, Ill 60637, USA.
The American journal of medicine (Impact Factor: 5). 06/2007; 120(5):455-60. DOI: 10.1016/j.amjmed.2006.09.021
Source: PubMed


To develop and validate a prognostic index for 1-year mortality of hospitalized older adults using standard administrative data readily available after discharge.
The prognostic index was developed and validated retrospectively in 6382 older adults discharged from general medicine services at an urban teaching hospital over a 4-year period. Potential risk factors for 1-year mortality were obtained from administrative data and examined using logistic regression models. Each risk factor associated independently with mortality was assigned a weight based on the odds ratios, and risk scores were calculated for each patient by adding the points of each independent risk factor present. Patients in the development cohort were divided into quartiles of risk based on their final risk score. A similar analysis was performed on the validation cohort to confirm the original results.
Risk factors independently associated with 1-year mortality included: aged 70 to 74 years (1 point); aged 75 years and greater (2 points); length of stay at least 5 days (1 point); discharge to nursing home (1 point); metastatic cancer (2 points); and other comorbidities (congestive heart failure, peripheral vascular disease, renal disease, hematologic or solid, nonmetastatic malignancy, and dementia, each 1 point). In the derivation cohort, 1-year mortality was 11% in the lowest-risk group (0 or 1 point) and 48% in the highest-risk group (4 or greater points). Similarly, in the validation cohort, 1-year mortality was 11% in the lowest risk group and 45% in the highest-risk group. The area under the receiver operating characteristic curve was 0.70 for the derivation cohort and 0.68 for the validation cohort.
Reasonable prognostic information for 1-year mortality in older patients discharged from general medicine services can be derived from administrative data to identify high-risk groups of persons.

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    • "In addition, the mortality risk after hospitalization among older patients has been found to be associated with having malnutrition at admission to hospital, the length of the hospital stay, and being discharged to assisted living after hospitalization [18-21,24]. Even though the follow-up time in these studies of mortality varied from six weeks [18] to 5 years [17], most of the studies had a one-year follow-up perspective [16,20,21,24-26]. Studies of the long- term mortality over three or more years among older adults from general medical hospitalized samples are rare [15,17]. "
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    BMC Geriatrics 02/2013; 13(1):17. DOI:10.1186/1471-2318-13-17 · 1.68 Impact Factor
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    • "Death in long-term ECF 0.05 0.02–0.10 Published estimates (median, range) [13] [14] Death in "
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    ABSTRACT: To estimate the survival and quality-adjusted life-years (QALYs) of Full Code versus Do Not Intubate (DNI) advance directives in patients with severe chronic obstructive pulmonary disease and to evaluate how patient preferences and place of residence influence these outcomes. A Markov decision model using published data for COPD exacerbation outcomes. The advance directives that were modeled were as follows: DNI, allowing only noninvasive mechanical ventilation, or Full Code, allowing all forms of mechanical ventilation including invasive mechanical ventilation with endotracheal tube (ETT) insertion. In community-dwellers, Full Code resulted in a greater likelihood of survival and higher QALYs (4-year survival: 23% Full Code, 18% DNI; QALYs: 1.34 Full Code, 1.24 DNI). When considering patient preferences regarding complications, however, if patients were willing to give up >3 months of life expectancy to avoid ETT complications, or >1 month of life expectancy to avoid long-term institutionalization, DNI resulted in higher QALYs. For patients in long-term institutions, DNI resulted in a greater likelihood of survival and higher QALYs (4-year survival: 2% DNI, 1% Full Code; QALYs: 0.29 DNI, 0.24 Full Code). In sensitivity analyses, the model was sensitive to the probabilities of ETT complication and noninvasive mechanical ventilation failure and to patient preferences about ETT complications and long-term institutionalization. Our model demonstrates that patient preferences regarding ETT complications and long-term institutionalization, as well as baseline place of residence, affect the advance directive recommendation when considered in terms of both survival and QALYs. Decision modeling can demonstrate the potential trade-off between survival and quality of life, using patient preferences and disease-specific data, to inform the shared advance directive decision.
    Value in Health 03/2012; 15(2):357-66. DOI:10.1016/j.jval.2011.10.015 · 3.28 Impact Factor
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    • "Thus, the care of these patients is a serious challenge for health care systems in Western countries [3]. The prognostic evaluation of these patients plays a key role in the decision analyses of care processes including the organization of social health care system, the support to families, caregivers, and patients as well as the choice of appropriate treatment [4]. Since in older subjects mortality results from a combination of biological , functional, psychological, and environmental factors, tools that effectively identify patients with different life expectancies should be multidimensional in nature [5] [6]. "
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    Journal of Alzheimer's disease: JAD 08/2009; 18(1):191-9. DOI:10.3233/JAD-2009-1139 · 4.15 Impact Factor
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