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Prognostic Indices for Older Adults: A Systematic Review
Open accessAbstract
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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“Mortality prediction models that account for variables such as comorbidities and functional status can serve as the basis for making more refined life expectancy estimates107–109.”
From Diabetes in Older Adults: A Consensus Report (2012) · cites this paper as [107]
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“Prognostic indices of life expectancy may play a central role in moving beyond arbitrary age-based cut-offs (14).”
Metadata
- 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.
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2012-01-11
- Volume
- 307
- Issue
- 2
- Pages
- 182
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- 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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