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A mortality risk index for men in a Veterans Administration extended care facility
D Rudman1, D E Mattson, A G Feller
1Medical Service, Veterans Administration Medical Center, Chicago, Illinois.
Insights
A new mortality risk index (MRI) was developed for nonpsychiatric male patients in extended care. This index, using hematocrit and serum cholesterol, effectively predicts mortality risk in this population.
Area of Science:
- Gerontology
- Clinical Medicine
- Biostatistics
Background:
- Veterans Administration extended care facilities house diverse patient populations, including those with chronic medical and psychiatric conditions.
- Accurate mortality prediction is crucial for resource allocation and patient care planning in long-term care settings.
Purpose of the Study:
- To develop and validate a mortality prognostic index for male residents in a Veterans Administration extended care facility.
- To identify key clinical attributes predictive of mortality in nonpsychiatric and psychiatric patient groups.
Main Methods:
- Phase I involved collecting 70 clinical attributes from 123 male residents (nonpsychiatric and psychiatric groups).
- Deaths were tracked over 14 months to determine mortality rates.
- Univariate and multivariate analyses were used to identify significant predictors of mortality.
Main Results:
- Mortality rates differed significantly: 33.3% in nonpsychiatric vs. 1.7% in psychiatric groups.
- Hematocrit and serum cholesterol were significant predictors of mortality in nonpsychiatric men.
- A mortality risk index (MRI) was derived: MRI = [hematocrit] + 10% [serum cholesterol], showing a strong correlation with observed death rates.
Conclusions:
- The developed mortality risk index (MRI) is a valuable tool for predicting mortality in nonpsychiatric male patients in extended care.
- Hematocrit and serum cholesterol levels are key indicators for assessing mortality risk in this demographic.
- Further validation (Phase II) is planned to confirm the index's utility across broader populations.
Abstract:
the purpose of this study was to develop (phase I) and validate (phase II) a mortality prognostic index, based on the annual clinical data base, for the men of this Veterans Administration extended care facility. The study population during phase I consisted of 123 men who were residing in three of the seven wards of the facility in August 1984. Sixty-six of these individuals were institutionalized because of a chronic neurologic (50) or medical (15) disorder ("nonpsychiatric group"). In 57 men, the reason for institutionalization was a chronic psychosis (schizophrenia, 53; manic depressive illness, 4) ("psychiatric group"). During August to October 1984, a comprehensive clinical data base comprising 70 attributes (including diagnoses and drugs) was collected. Deaths were recorded during the next 14 months. Death rate during the 14 months of observation was 33.3% in the nonpsychiatric group, and only 1.7% in the psychiatric group. In the nonpsychiatric men, univariate analysis yielded six attributes significantly correlated with death rate: serum cholesterol level, hematocrit, hemoglobin, midarm muscle circumference, triceps skinfold, and number of morbidity episodes. After serum cholesterol and hematocrit had been entered into a multivariate analysis model, none of the other four attributes contributed significant information about death rate. The multivariate analysis led to a mortality risk index (MRI) for nonpsychiatric patients, MRI = [hematocrit in %] + 10% [serum cholesterol in mg/dl]. As MRI varied from less than 50 to greater than 65, death rate in the nonpsychiatric group varied in parallel from 86-11%.(ABSTRACT TRUNCATED AT 250 WORDS)