Wednesday, March 1, 2006
Some of you have probably heard about this in the news.
JAMA has published an important article about the development of a 4 year mortality prognostic index for adults over 50 years old. It is based on prospectively gathered self-reported data of Americans over 50 years old. People in the study answered demographic questions, as well as ones about comorbidities and functional status. The researchers then followed these people (about 19,000 total), kept track of who died, then analyzed the original data set to see what predicted who would die in the 4 years of the study. They developed a 12 item scale, with points for each item, such that the more points one has the higher one's 4 year mortality risk is. The 12 items are in the abstract--I'm not going to repeat them all here--they are age, male sex, and then major medical morbidities and functional limitations. Those in the highest point category had the highest risk of death (64%) in the 4 years.
A few points about this. The index is nicely made up of easily identifiable qualities (demographics, diseases, easy to answer functional assessment questions). The overall study is another broad endorsement of the importance of functional status in prognostication. In the bivariate analysis the presence of functional limitations (eg. with using telephone, preparing meals, bathing, walking several block) had odds ratios of death as high or higher than most of the medical comorbidities (including smoking, diabetes, coronary heart disease, and cancer). Although the sample size was large, involved the entire US, and was relatively ethnically diverse, this is a single study and further validation is needed. However, this index gives us some of information needed to 'build care arrangements around the trajectory of dying .' By 'us' I mean people concerned with changing the way older, medically frail people are cared for, whether they are "dying" or not. Prepare for this thing to be misused of course and for confusion to reign. But it may help some physicians (& patients and families?) to understand how fragile some patients are, and plan accordingly.
I'm too young for it but have already plugged my parents in....