Cited by 736Frailty in Older AdultsPalliative Care and End-of-Life IssuesInsurance, Mortality, Demography, Risk Management

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Prognostic Indices for Older Adults: A Systematic Review

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Yourman, Lindsey C., Lee, Sei J., Schonberg, Mara A., Widera, Eric W., Smith, Alexander K.·2012·JAMA

DOI 10.1001/jama.2011.1966PMC PMC3792853

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Abstract

CONTEXT: To better target services to those who may benefit, many guidelines recommend incorporating life expectancy into clinical decisions. OBJECTIVE: To assess the quality and limitations of prognostic indices for mortality in older adults through systematic review. DATA SOURCES: We searched MEDLINE, EMBASE, Cochrane, and Google Scholar from their inception through November 2011. STUDY SELECTION: We included indices if they were validated and predicted absolute risk of mortality in patients whose average age was 60 years or older. We excluded indices that estimated intensive care unit, disease-specific, or in-hospital mortality. DATA EXTRACTION: For each prognostic index, we extracted data on clinical setting, potential for bias, generalizability, and accuracy. RESULTS: We reviewed 21,593 titles to identify 16 indices that predict risk of mortality from 6 months to 5 years for older adults in a variety of clinical settings: the community (6 indices), nursing home (2 indices), and hospital (8 indices). At least 1 measure of transportability (the index is accurate in more than 1 population) was tested for all but 3 indices. By our measures, no study was free from potential bias. Although 13 indices had C statistics of 0.70 or greater, none of the indices had C statistics of 0.90 or greater. Only 2 indices were independently validated by investigators who were not involved in the index's development. CONCLUSION: We identified several indices for predicting overall mortality in different patient groups; future studies need to independently test their accuracy in heterogeneous populations and their ability to improve clinical outcomes before their widespread use can be recommended.

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Self-citation
Risk Factors for Home Care Discontinuation Among Older People With Dysphagia: A Two‐Year Retrospective Cohort Study
Furuya, H., Kikutani, T., Sakazume, T., Nakazawa, Y., Tanaka, K., Kato, Y., Ichikawa, Y., Hatano, A., Ozeki, M., Tohara, T., et al. (2025) · Journal of Oral Rehabilitation · doi:10.1111/joor.13999 · Cited by 2
Prediction of in-hospital mortality with the 6-item Brief Geriatric Assessment tool: An observational prospective cohort study
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Prediction of 11-year incidence of psychophysically dependent status or death among community-dwelling younger elderlies: from an age-specified community-based cohort study (the NISSIN project)
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Diabetes and Aging
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Approach to Evaluating the Multimorbid Patient with Cardiovascular Disease Undergoing Noncardiac Surgery
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Age, Comorbidity, and Breast Cancer Severity: Impact on Receipt of Definitive Local Therapy and Rate of Recurrence among Older Women with Early-Stage Breast Cancer
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Measuring frailty in population-based healthcare databases: multi-dimensional prognostic indices for the improvement of geriatric care
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How to Perform a House Call
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Care transitions in a changing healthcare environment
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Decline of Physical Activity in Terminally Ill Patients Could Be Useful for Predicting Short-Term Survival
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Cancer in the Elderly
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“Similarly, the Schonberg index predicts five-year mortality in a heterogeneous sample of adults over the age of 65, who completed the National Health Interview Survey between 1997 and 2000 [3].”
BackgroundMethod
CGA and Clinical Decision-Making: The Multidimensional Prognostic Index
Pilotto, A., Daragjati, J., & Veronese, N. (2017) · Practical issues in geriatrics · doi:10.1007/978-3-319-62503-4_8 · Cited by 2
Drug Prescriptions in Nursing Home Residents during their Last 6 Months of Life: Data from the IQUARE Study
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“Recommendation 3 This question on the probability of survival for the next 5–10 years can be answered using validated tools established for large cohorts of US citizens aged 50+ or 65+ after 2000, e.g. the Lee Schonberg Index [21, 22], available at https:// eprognosis.ucsf.edu/leeschonberg.php.”
Method
Patient-Centered Surgical Decision Making
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Comprehensive Geriatric Assessment
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The Role of p16Ink4a as an Early Predictor of Physiological Decline during Natural AgingPreprint
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Clinician estimates of prognosis: accuracy and impact—a retrospective inpatient hospice study
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Neoadjuvant Chemotherapy and Endocrine Therapy for Older Patients with Estrogen Receptor Positive Breast Cancer: Comparison of Approaches
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Predicting all-cause mortality and premature death using interpretable machine learning among a middle-aged and elderly Chinese population
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“Given the changing circumstances, it became paramount to precisely discern risk stratification and implement timely interventions [3,4].”
Background
Demographic Perspective on the Study of Aging
García-Chanes, R. E., & Huerta, A. V. R. (2024) · Springer eBooks · doi:10.1007/978-3-031-76469-1_4 · Cited by 1

Authors: Yourman, L. C., Lee, S. J., Schonberg, M. A., Widera, E. W., & Smith, A. K.
Affiliations: University of California, San Francisco (US)
San Francisco VA Medical Center (US)
Beth Israel Deaconess Medical Center (US)
Corresponding author: Smith, Alexander K.
ORCID: Yourman, Lindsey C.
Lee, Sei J.
Schonberg, Mara A.
Widera, Eric W.
Smith, Alexander K.
Venue: JAMA
Publisher: American Medical Association (AMA)
Published: 2012-01-11
Volume: 307
Issue: 2
Pages: 182
ISSN: 0002-9955 (ISSN-L)
0098-7484
DOI: 10.1001/jama.2011.1966
PMC: PMC3792853
OpenAlex: W2025056766
Cited by: 736
References: 74
Citations by year: 2026: 25 · 2025: 18 · 2024: 26 · 2023: 42 · 2022: 50 · 2021: 53 · 2020: 65 · 2019: 62 · 2018: 57 · 2017: 60 · 2016: 74 · 2015: 57 · 2014: 59 · 2013: 45 · 2012: 42
FWCI: 31.93
Type: journal article
Language: en
Open access: green
europepmc.org
Locations: JAMA (publishedVersion)
PubMed (publishedVersion)
Europe PMC (PubMed Central) (acceptedVersion)
PubMed Central (acceptedVersion)
Funders: National Institute on Aging (K23AG040772, K23AG040779, T32AG000212)
National Center for Research Resources (UL1RR024131, KL2RR024130)
Topics: Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
Social Sciences › Demography › Insurance, Mortality, Demography, Risk Management
Keywords: prognostic score, mortality prediction, older adults, life expectancy, risk stratification, generalizability, transportability, index validation, concordance index, nursing homes, in-hospital mortality, community-dwelling older adults
MeSH terms: Aged, Aged, 80 and over, Decision Making, Patient Care, Humans, Life Expectancy, Middle Aged, Mortality, Predictive Value of Tests, Prognosis, Risk

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Prognostic Indices for Older Adults: A Systematic Review

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