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Prognostic indices for older adults: a systematic review
Lindsey C Yourman1, Sei J Lee, Mara A Schonberg
1Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, CA 94121, USA.
JAMA
|January 12, 2012
Summary
This systematic review found several prognostic indices for predicting mortality in older adults. However, none were independently validated or free from bias, indicating a need for further testing before widespread clinical use.
Area of Science:
- Gerontology
- Clinical Epidemiology
- Biostatistics
Background:
- Guidelines recommend using life expectancy to target services for older adults.
- Accurate prognostic indices are crucial for clinical decision-making and resource allocation.
Purpose of the Study:
- To systematically review and assess the quality and limitations of prognostic indices for mortality in adults aged 60 years and older.
- To identify validated indices predicting absolute mortality risk in community, nursing home, and hospital settings.
Main Methods:
- Systematic search of MEDLINE, EMBASE, Cochrane, and Google Scholar (inception–November 2011).
- Inclusion criteria: validated indices predicting mortality risk (6 months–5 years) in adults aged ≥60 years.
- Exclusion criteria: intensive care unit, disease-specific, or in-hospital mortality indices.
Main Results:
- 16 prognostic indices identified from 21,593 titles, predicting mortality in various settings.
- All but 3 indices had at least one measure of transportability tested.
- No study was free from potential bias; 13 indices had C statistics ≥0.70, but none reached ≥0.90. Only 2 indices were independently validated.
Conclusions:
- Several indices predict overall mortality in older adults across different settings.
- Future research must independently validate these indices in diverse populations.
- Further studies are needed to assess their ability to improve clinical outcomes before recommending widespread adoption.
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