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Elderly/Long-Term Care

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Several factors can quickly identify mortality risk among frail elderly persons living in the community

Community-based long-term care programs such as PACE (Program of All-Inclusive Care for the Elderly) can help frail, chronically ill elderly people who would ordinarily enter nursing homes stay in the community. Asking about certain risk factors during routine clinical care can identify which of these frail community-dwelling elderly are at risk of dying, according to a new study.

Kenneth E. Covinsky, M.D., M.P.H., of the University of California at San Francisco, and colleagues developed an index to identify mortality risk among this fragile group. The researchers studied a total of 3,899 enrollees at 11 PACE sites; they studied 2,232 participants to develop the index and 1,667 participants to validate it.

The researchers predicted time to death using data on risk factors (demographic characteristics, coexisting medical conditions, and functional status), which they obtained from a geriatric assessment performed at the time of study enrollment. The risk scoring system scored male sex as 2 points; age 75-84, 2 points; 85 and older, 3 points; dependence for help with toileting, 1 point; dependence for partial or full help with dressing, 1 and 3 points, respectively; cancer, 2 points; congestive heart failure, 3 points; chronic obstructive pulmonary disease, 1 point; and renal insufficiency, 3 points.

In the validation group, respective 1 and 3-year mortality rates were 7 and 18 percent in the lowest risk group (0-3 points), 11 and 36 percent in the middle-risk group (4-5 points), and 22 and 55 percent in the highest-risk group (more than 5 points). The eight-variable index is easy to use and includes variables that can be obtained in the course of a routine clinical exam.

The ability of the index to predict mortality risk among the frail elderly reinforces the importance of considering multiple domains in assessing the prognosis of older patients. The study was supported in part by the Agency for Healthcare Research and Quality (HS00006).

More details are in "Prediction of mortality in community living frail elderly people with long-term care needs," by Elise C. Carey, M.D., Dr. Covinsky, Li-Yung Lui, M.A., M.S., and others, in the January 2008 Journal of the American Geriatric Society 56(1), pp. 68-75.

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