Development and Validation of a Prognostic Index for 4-Year Mortality in Older Adults
Abstract
CONTEXT: Both comorbid conditions and functional measures predict mortality in older adults, but few prognostic indexes combine both classes of predictors. Combining easily obtained measures into an accurate predictive model could be useful to clinicians advising patients, as well as policy makers and epidemiologists interested in risk adjustment. OBJECTIVE: To develop and validate a prognostic index for 4-year mortality using information that can be obtained from patient report. DESIGN, SETTING, AND PARTICIPANTS: Using the 1998 wave of the Health and Retirement Study (HRS), a population-based study of community-dwelling US adults older than 50 years, we developed the prognostic index from 11,701 individuals and validated the index with 8009. Individuals were asked about their demographic characteristics, whether they had specific diseases, and whether they had difficulty with a series of functional measures. We identified variables independently associated with mortality and weighted the variables to create a risk index. MAIN OUTCOME MEASURE: Death by December 31, 2002. RESULTS: The overall response rate was 81%. During the 4-year follow-up, there were 1361 deaths (12%) in the development cohort and 1072 deaths (13%) in the validation cohort. Twelve independent predictors of mortality were identified: 2 demographic variables (age: 60-64 years, 1 point; 65-69 years, 2 points; 70-74 years, 3 points; 75-79 years, 4 points; 80-84 years, 5 points, >85 years, 7 points and male sex, 2 points), 6 comorbid conditions (diabetes, 1 point; cancer, 2 points; lung disease, 2 points; heart failure, 2 points; current tobacco use, 2 points; and body mass index <25, 1 point), and difficulty with 4 functional variables (bathing, 2 points; walking several blocks, 2 points; managing money, 2 points, and pushing large objects, 1 point. Scores on the risk index were strongly associated with 4-year mortality in the validation cohort, with 0 to 5 points predicting a less than 4% risk, 6 to 9 points predicting a 15% risk, 10 to 13 points predicting a 42% risk, and 14 or more points predicting a 64% risk. The risk index showed excellent discrimination with a cstatistic of 0.84 in the development cohort and 0.82 in the validation cohort. CONCLUSION: This prognostic index, incorporating age, sex, self-reported comorbid conditions, and functional measures, accurately stratifies community-dwelling older adults into groups at varying risk of mortality.
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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 estimates.
“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 [108]
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- Authors
- Lee, S. J.
- Affiliations
- San Francisco VA Medical Center (US)
- Corresponding author
- Lee, Sei J.
- ORCID
- Lee, Sei J.
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2006-02-15
- Volume
- 295
- Issue
- 7
- Pages
- 801
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- OpenAlex
- W2150346360
- Cited by
- 809
- References
- 2
- Citations by year
- 2026: 13 · 2025: 30 · 2024: 30 · 2023: 31 · 2022: 39 · 2021: 49 · 2020: 41 · 2019: 41 · 2018: 49 · 2017: 40 · 2016: 50 · 2015: 41 · 2014: 35 · 2013: 45 · 2012: 55
- FWCI
- 20.56
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- JAMA (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Agency for Healthcare Research and Quality (K02HS00006)
- National Institute on Aging (U01 AG 09740, R01AG023626, U01AG009740)
- Topics
- Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Aging, Health, and Disability
- Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
- Keywords
- prognostic score, mortality prediction, older adults, comorbidities, functional status, risk index, mortality risk, risk adjustment, community-dwelling older adults, Health and Retirement Study, patient-reported outcomes, diabetes mellitus, heart failure, lung disease, tobacco use, body mass index, activities of daily living, walking ability, sex differences in mortality, age differences in mortality, risk stratification
- MeSH terms
- Aged, Aged, 80 and over, Female, Health Status Indicators, Humans, Male, Middle Aged, Mortality, Prognosis, Logistic Models, Risk Assessment
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