Prediction of Mortality in Community‐Living Frail Elderly People with Long‐Term Care Needs

摘要: OBJECTIVES: To develop and validate a prognostic index for mortality in community-living, frail elderly people. DESIGN: Cohort study of Program All-Inclusive Care the Elderly (PACE) participants enrolled between 1988 1996. SETTING: Eleven PACE sites, community-based long-term care program that cares frail, chronically ill people who meet criteria nursing home placement. PARTICIPANTS: Three thousand eight hundred ninety-nine enrollees. The was developed 2,232 validated 1,667. MEASUREMENTS: Time to death predicted using risk factors obtained from geriatric assessment performed by interdisciplinary team at time enrollment. Risk included demographic characteristics, comorbid conditions, functional status. RESULTS: development cohort had mean age 79 (68% female, 40% white). validation (76% 65% In cohort, independent were identified weighted, Cox regression, create score: male sex, 2 points; (75–79, 80–84, ≥85, 3 points); dependence toileting, 1 point; dressing (partial dependence, full malignant neoplasm, congestive heart failure, chronic obstructive pulmonary disease, renal insufficiency, points. respective 1- 3-year rates 6% 21% lowest-risk group (0–3 points), 12% 36% middle-risk (4–5 54% highest-risk (>5 points). 7% 18% group, 11% 22% 55% group. area under receiver operating characteristic curve point score 0.66 0.69 cohorts, respectively. CONCLUSION: A multidimensional age, status, comorbidities effectively stratifies community-living into groups varying mortality.