Cited by 477Frailty in Older AdultsPalliative Care and End-of-Life IssuesGeriatric Care and Nursing Homes

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The MDS-CHESS scale: a new measure to predict mortality in institutionalized older people

Hirdes, John P., Frijters, Dinnus H., Teare, Gary F.·2003·Journal of the American Geriatrics Society

DOI 10.1034/j.1601-5215.2002.51017.x

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Abstract

OBJECTIVES: To develop a scale predicting mortality and other adverse outcomes associated with frailty. DESIGN: Observational study based on Minimum Data Set (MDS) 2.0 and mortality data. SETTING: Ontario chronic hospitals. PARTICIPANTS: All chronic hospital patients (N = 28,495) assessed with the MDS 2.0 after mandatory implementation in July 1996 followed until May 1999. MEASUREMENTS: MDS 2.0 assessments done as part of normal practice mainly by registered nurses or multidisciplinary teams in a chronic hospital. Mortality data are available from the accompanying discharge tracking form. RESULTS: The MDS‐Changes in Health, End‐stage disease and Symptoms and Signs (CHESS) score is a composite measure addressing changes in health, end‐stage disease, and symptoms and signs of medical problems. It is a strong predictor of mortality ( P < . 0001) independent of the effects of age, sex, activities of daily living impairment, cognition, and do‐not‐resuscitate orders. It is also strongly associated with physician activity, complex medical procedures, and pain ( P < . 001 for each dependent variable). CONCLUSIONS: The CHESS score provides a useful new MDS‐based test to predict mortality and to measure instability in health as a clinical outcome.

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Fletcher, P. C., Berg, K., Dalby, D. M., & Hirdes, J. P. (2009) · Journal of Patient Safety · doi:10.1097/pts.0b013e3181a551ed · Cited by 71
Self-citation
Clinical Characteristics and Service Needs of Alternate-Level-of-Care Patients Waiting for Long-Term Care in Ontario Hospitals
Costa, A., & Hirdes, J. (2010) · Healthcare Policy | Politiques de Santé · doi:10.12927/hcpol.2010.21899 · Cited by 71
“…(morris et al. 1994), the depression Rating scale (dRs) (Burrows et al. 2000; Koehler et al. 2005; martin et al. 2008), the Changes in Health, End-stage disease, and signs and symptoms (CHEss) scale (Hirdes et al. 2003) and the method for Assigning Priority Levels (mAPLe) (Hirdes et al. 2008b).”
MethodSelf-citation
Effects of Hurricane Katrina on Nursing Facility Resident Mortality, Hospitalization, and Functional Decline
Dosa, D. M., Feng, Z., Hyer, K., Brown, L. M., Thomas, K. S., & Mor, V. (2010) · Disaster Medicine and Public Health Preparedness · doi:10.1001/dmp.2010.11 · Cited by 71
Predictors of Nursing Home Placement from Assisted Living Settings in Canada
Maxwell, C. J., Soo, A., Hogan, D. B., Wodchis, W. P., Gilbart, E., Amuah, J. E., Eliasziw, M., Hagen, B. F., & Strain, L. A. (2013) · Canadian Journal on Aging / La Revue canadienne du vieillissement · doi:10.1017/s0714980813000469 · Cited by 70
“A higher score has been shown to predict mortality, institutionalization, and hospitalization among seniors (Hirdes et al., 2003 , Hogan et al., 2012 ).”
Background
Patient–physician language concordance and quality and safety outcomes among frail home care recipients admitted to hospital in Ontario, Canada
Seale, E., Reaume, M., Batista, R., Eddeen, A. B., Roberts, R. L., Rhodes, E., McIsaac, D. I., Kendall, C., Sood, M. M., Prud’homme, D., et al. (2022) · Canadian Medical Association Journal · doi:10.1503/cmaj.212155 · Cited by 69
The Effect of Wheelchair Use on the Quality of Life of Persons with Multiple Sclerosis
Devitt, R., Chau, B., & Jutai, J. W. (2004) · Occupational Therapy In Health Care · doi:10.1080/j003v17n03_05 · Cited by 69
Do hospital-owned skilled nursing facilities provide better post-acute care quality?
Rahman, M., Norton, E. C., & Grabowski, D. C. (2016) · Journal of Health Economics · doi:10.1016/j.jhealeco.2016.08.004 · Cited by 69
Pain among the oldest old in community and institutional settings
Życzkowska, J., Szczerbińska, K. E., Jantzi, M., & Hirdes, J. P. (2007) · Pain · doi:10.1016/j.pain.2006.12.009 · Cited by 68
“The CHESS scale (Changes in Health, End-stage disease, and Signs and Symptoms) identifies individuals at risk of mortality or serious decline in health using scores ranging from 0 to 5 to depict the level of instability in health (Hirdes et al., 2003).”
Self-citation
Good News and Bad News: Depressive Symptoms Decline and Undertreatment Increases With Age in Home Care and Institutional Settings
Szczerbińska, K. E., Hirdes, J. P., & Życzkowska, J. (2011) · American Journal of Geriatric Psychiatry · doi:10.1097/jgp.0b013e3182331702 · Cited by 66
Self-citation
COVID-19 excess mortality among long-term care residents in Ontario, Canada
Akhtar‐Danesh, N., Baumann, A. O., Crea‐Arsenio, M., & Antonipillai, V. (2022) · PLoS ONE · doi:10.1371/journal.pone.0262807 · Cited by 67
“The following variables were included in the analysis for each resident: result of last COVID19 test (positive or negative from March 2020); region of Ontario (Central, Southwest, East, North); income quintile based on postal code of the LTC home; frailty index (classified as robust, pre-frail, frail); ownership categ…”
Method
Minimum Data Set Changes in Health, End‐Stage Disease and Symptoms and Signs Scale: A Revised Measure to Predict Mortality in Nursing Home Residents
Ogarek, J. A., McCreedy, E. M., Thomas, K. S., Teno, J. M., & Gozalo, P. L. (2018) · Journal of the American Geriatrics Society · doi:10.1111/jgs.15305 · Cited by 66
“In addition to updating the score to include items available in the current version of the MDS, our methods addressed 2 of the limitations previously identified.(1) First, the original scale was developed using a cohort of fewer than 30,000 people being treated in complex continuing care (CCCs) hospitals in Ontario, C…”
MethodInfluential
Rehabilitation in Home Care Is Associated With Functional Improvement and Preferred Discharge
Cook, R. J., Berg, K., Lee, K., Poss, J. W., Hirdes, J. P., & Stolee, P. (2013) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2012.12.024 · Cited by 64
Self-citation
Survival prediction in nursing home residents using the Minimum Data Set subscales: ADL Self-Performance Hierarchy, Cognitive Performance and the Changes in Health, End-stage disease and Symptoms and Signs scales
Lee, J. S. W., Chau, P. H., Hui, E., Chan, F. H.-W., & Woo, J. (2009) · European Journal of Public Health · doi:10.1093/eurpub/ckp006 · Cited by 63
A frailty index derived from a standardized comprehensive geriatric assessment predicts mortality and aged residential care admission
Burn, R., Hubbard, R. E., Scrase, R. J., Abey‐Nesbit, R., Peel, N. M., Schlüter, P. J., & Jamieson, H. A. (2018) · BMC Geriatrics · doi:10.1186/s12877-018-1016-8 · Cited by 66
Predictors of caregiver distress among palliative home care clients in Ontario: Evidence based on the interRAI Palliative Care
Hirdes, J. P., Freeman, S., Smith, T. F., & Stolee, P. (2012) · Palliative & Supportive Care · doi:10.1017/s1478951511000824 · Cited by 60
“The Changes in Health, End Stage disease, Signs and Symptoms (CHESS) scale is a measure of medical instability with scores ranging from 0 ¼ no instability to 5 ¼ highly unstable, and it has been shown to be highly predictive of mortality (Hirdes et al., 2003).”
BackgroundSelf-citation
Prognostic predictors relevant to end-of-life palliative care in Parkinson’s disease and related disorders: a systematic review
Akbar, U., McQueen, R. B., Bemski, J., Carter, J., Goy, E., Kutner, J. S., Johnson, M. J., Miyasaki, J. M., & Kluger, B. M. (2021) · Journal of Neurology Neurosurgery & Psychiatry · doi:10.1136/jnnp-2020-323939 · Cited by 59
Incidence and Predictors of Incontinence-Associated Skin Damage in Nursing Home Residents With New-Onset Incontinence
Bliss, D. Z., Mathiason, M. A., Gurvich, O. V., Savik, K., Eberly, L. E., Fisher, J. M., Wiltzen, K. R., Akermark, H., Hildebrandt, A., Jacobson, M., et al. (2017) · Journal of Wound Ostomy and Continence Nursing · doi:10.1097/won.0000000000000313 · Cited by 59
Prevalence of Incontinence by Race and Ethnicity of Older People Admitted to Nursing Homes
Bliss, D. Z., Harms, S. L., Garrard, J. M., Cunanan, K. M., Savik, K., Gurvich, O. V., Mueller, C., Wyman, J. F., Eberly, L. E., & Virnig, B. A. (2013) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2013.03.007 · Cited by 58
Mortality in Nursing Homes Following Emergency Evacuation: A Systematic Review
Willoughby, M., Kipsaina, C., Ferrah, N., Blau, S., Bugeja, L. C., Ranson, D., & Ibrahim, J. (2017) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2017.02.005 · Cited by 58
Association Between Exposure to Hurricane Irma and Mortality and Hospitalization in Florida Nursing Home Residents
Dosa, D. M., Skarha, J., Peterson, L. J., Jester, D. J., Sakib, N., Ogarek, J. A., Thomas, K. S., Andel, R., & Hyer, K. (2020) · JAMA Network Open · doi:10.1001/jamanetworkopen.2020.19460 · Cited by 58
Delivery of institutional long-term care under two social insurances: Lessons from the Korean experience
Kim, H., Jung, Y., & Kwon, S. (2015) · Health Policy · doi:10.1016/j.healthpol.2015.07.009 · Cited by 54
Post–Acute Care Data for Predicting Readmission After Ischemic Stroke: A Nationwide Cohort Analysis Using the Minimum Data Set
Fehnel, C. R., Lee, Y., Wendell, L. C., Thompson, B., Potter, N., & Mor, V. (2015) · Journal of the American Heart Association · doi:10.1161/jaha.115.002145 · Cited by 54
“The cognitive performance scale is a 7-category hierarchical scale, which correlates closely with the Mini-Mental State Exam, as well as diagnoses of dementia.(37) The CHESS score is a 6-point ordinal scale ranging between 0 (no instability) to 5 and is an indicator of mortality and clinical stability among nursing ho…”
Method
Fracture Risk in Nursing Home Residents Initiating Antipsychotic Medications
Rigler, S. K., Shireman, T. I., Cook‐Wiens, G., Ellerbeck, E. F., Whittle, J., Mehr, D. R., & Mahnken, J. D. (2013) · Journal of the American Geriatrics Society · doi:10.1111/jgs.12216 · Cited by 57
“Widely used, validated MDS scales were used to characterize cognitive performance (MDS Cognitive Performance Scale),(29) activities of daily living (the MDS hierarchical activities of daily living scale),(30) aggressive behavior (the MDS Aggressive Behavior Scale),(31) and mortality risk (the MDS CHESS mortality risk…”
Method
Relationship between restraint use, engagement in social activity, and decline in cognitive status among residents newly admitted to long‐term care facilities
Freeman, S., Spirgienė, L., Martin‐Khan, M., & Hirdes, J. P. (2016) · Geriatrics and gerontology international/Geriatrics & gerontology international · doi:10.1111/ggi.12707 · Cited by 53
Self-citation
K-Means Cluster Analysis of Rehabilitation Service Users in the Home Health Care System of Ontario: Examining the Heterogeneity of a Complex Geriatric Population
Armstrong, J. J., Zhu, M., Hirdes, J. P., & Stolee, P. (2012) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2012.05.026 · Cited by 50
Self-citation
The social and recreational characteristics of adults with intellectual disability and pica living in institutions
Ashworth, M., Hirdes, J. P., & Martin, L. (2008) · Research in Developmental Disabilities · doi:10.1016/j.ridd.2008.07.010 · Cited by 48
Self-citation
The Impact of Hospital‐Based Skilled Nursing Facility Closures on Rehospitalizations
Rahman, M., Zinn, J. S., & Mor, V. (2012) · Health Services Research · doi:10.1111/1475-6773.12001 · Cited by 48
“…stay in a SNF, including the outcome of rehospitalization and various MDS-based clinical characteristics (e.g., the CHESS comorbidity index) (Hirdes, Frijters, and Teare 2003), activity of daily living (ADL) score (Morris, Fries, and Morris 1999), and case mix index (CMI) using resource…”
Racial and ethnic disparities in the healing of pressure ulcers present at nursing home admission
Bliss, D. Z., Gurvich, O. V., Savik, K., Eberly, L. E., Harms, S. L., Mueller, C., Garrard, J. M., Cunanan, K. M., & Wiltzen, K. R. (2017) · Archives of Gerontology and Geriatrics · doi:10.1016/j.archger.2017.06.009 · Cited by 47
“Time-to-healing for pressure ulcers has been reported as ranging from a mean (sd) of 28 (20) days for Stage 2 pressure ulcers to 42 (Bergstrom et al., 2008) days for Stage 4 pressure ulcers (Horn et al., 2002).”
Urinary incontinence as a marker of higher mortality in patients receiving home care services
John, G., Gerstel, E., Jung, M., Dällenbach, P., Faltin, D. L., Petoud, V., Zumwald, C., & Rutschmann, O. (2013) · British Journal of Urology · doi:10.1111/bju.12359 · Cited by 46
Nutrition Status Among Residents Living in a Veterans’ Long-Term Care Facility in Western Canada: A Pilot Study
Boström, A., Soest, D. V., Kolewaski, B., Milke, D. L., & Estabrooks, C. A. (2010) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2010.07.005 · Cited by 46
Elevated Hospitalization Risk of Assisted Living Residents With Dementia in Alberta, Canada
Maxwell, C. J., Amuah, J. E., Hogan, D. B., Cepoiu‐Martin, M., Gruneir, A., Patten, S. B., Soo, A., Clair, K. L., Wilson, K., Hagen, B. F., et al. (2015) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2015.01.079 · Cited by 45
Health status utilities and the impact of pressure ulcers in long-term care residents in Ontario
Thein, H., Gomes, T., Krahn, M. D., & Wodchis, W. P. (2009) · Quality of Life Research · doi:10.1007/s11136-009-9563-2 · Cited by 45
“CHESS, Changes in Health, End-stage disease and Symptoms and Signs—higher values indicate higher levels of clinical instability and risk of death [ 31 ] Qual Life Res (2010) 19:81–89 85”
Constipation and Laxative Use among Nursing Home Patients: Prevalence and Associations Derived from the Residents Assessment Instrument for Long-Term Care Facilities (interRAI LTCF)
Blekken, L. E., Nakrem, S., Vinsnes, A. G., Norton, C. S., Mørkved, S., Salvesen, Ø. O., & Gjeilo, K. H. (2016) · Gastroenterology Research and Practice · doi:10.1155/2016/1215746 · Cited by 43
“(iv) Patients’ instability in health/frailty was measured by the Changes in Health, End-Stage Disease, Signs, and Symptoms Scale (CHESS) [44].”
MethodInfluential
Predicting heart failure mortality in frail seniors: Comparing the NYHA functional classification with the Resident Assessment Instrument (RAI) 2.0
Tjam, E. Y., Heckman, G. A., Smith, S., Arai, B., Hirdes, J. P., Poss, J. W., & McKelvie, R. S. (2011) · International Journal of Cardiology · doi:10.1016/j.ijcard.2011.01.031 · Cited by 44
“In addition, the CHESS scale has been shown to predict increased physician activity and the use of medical procedures, such as the use of suctioning, parenteral intravenous (IV) access, and the use of IV antibiotics in LTC residents, and is therefore considered a reliable and valid measure of health instability in suc…”
BackgroundMethodInfluentialSelf-citation
Development and Psychometric Properties of a Standardized Assessment for Adults who are Deaf-Blind
Dalby, D. M., Hirdes, J. P., Stolee, P., Strong, J. G., Poss, J. W., Tjam, E. Y., Bowman, L. C., & Ashworth, M. (2009) · Journal of Visual Impairment & Blindness · doi:10.1177/0145482x0910300103 · Cited by 44
Self-citation
Osteoporosis management among residents living in long-term care
Giangregorio, L., Jantzi, M., Παπαϊωάννου, Α., Hirdes, J. P., Maxwell, C. J., & Poss, J. W. (2009) · Osteoporosis International · doi:10.1007/s00198-009-0837-x · Cited by 43
“Our analyses also included four health index measures previously developed and validated for use with the RAI 2.0 tool: (1) the Activities of Daily Living (ADL) self-performance hierarchy scale (range 0–6) [26]; (2) the Changes in Health, End-stage disease and Signs and Symptoms (CHESS) score (range 0–5) [ 27 ]; (3) t…”
MethodInfluentialSelf-citation
Greater Independence in Activities of Daily Living is Associated with Higher Health-Related Quality of Life Scores in Nursing Home Residents with Dementia
Chan, C., Slaughter, S. E., Jones, C. A., & Wagg, A. (2015) · Healthcare · doi:10.3390/healthcare3030503 · Cited by 42
Comparative effectiveness of implementing evidence-based education and best practices in nursing homes: Effects on falls, quality-of-life and societal costs
Teresi, J. A., Ramirez, M. M., Remler, D. K., Ellis, J. M., Boratgis, G. D., Silver, S. A., Lindsey, M., Kong, J., Eimicke, J. P., & Dichter, E. (2011) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2011.07.003 · Cited by 42
Adverse events among Ontario home care clients associated with emergency room visit or hospitalization: a retrospective cohort study
Doran, D. M., Hirdes, J. P., Blais, R., Baker, G. R., Poss, J. W., Li, X., Dill, D., Gruneir, A., Heckman, G. A., Lacroix, H., et al. (2013) · BMC Health Services Research · doi:10.1186/1472-6963-13-227 · Cited by 42
Self-citation
Emergency Department Use by Nursing Home Residents: Effect of Severity of Cognitive Impairment
Stephens, C. E., Newcomer, R., Blegen, M., Miller, B. L., & Harrington, C. A. (2011) · The Gerontologist · doi:10.1093/geront/gnr109 · Cited by 42
Effect of Bisphosphonates on Fracture Outcomes Among Frail Older Adults
Zullo, A. R., Zhang, T., Lee, Y., McConeghy, K. W., Daiello, L. A., Kiel, D. P., Mor, V., & Berry, S. D. (2018) · Journal of the American Geriatrics Society · doi:10.1111/jgs.15725 · Cited by 43
End-of-life outcomes with or without early palliative care: a propensity score matched, population-based cancer cohort study
Seow, H. Y., Sutradhar, R., Burge, F., McGrail, K. M., Guthrie, D. M., Lawson, B. J., Oz, U. E., Chan, K., Peacock, S. J., & Barbera, L. C. (2021) · BMJ Open · doi:10.1136/bmjopen-2020-041432 · Cited by 42

Authors: Hirdes, J. P., Frijters, D. H., & Teare, G. F.
Affiliations: University of Waterloo (CA)
Vrije Universiteit Amsterdam (NL)
University of Toronto (CA)
Corresponding author: Hirdes, John P.
ORCID: Hirdes, John P.
Teare, Gary F.
Venue: Journal of the American Geriatrics Society
Publisher: Wiley
Published: 2003-01
Volume: 51
Issue: 1
Pages: 96-100
ISSN: 0002-8614 (ISSN-L)
1532-5415
DOI: 10.1034/j.1601-5215.2002.51017.x
OpenAlex: W1997637125
Cited by: 477
References: 20
Citations by year: 2026: 22 · 2025: 22 · 2024: 32 · 2023: 18 · 2022: 22 · 2021: 24 · 2020: 41 · 2019: 23 · 2018: 24 · 2017: 26 · 2016: 29 · 2015: 23 · 2014: 28 · 2013: 26 · 2012: 17
FWCI: 4.44
Type: journal article
Language: en
Open access: closed
Licence: onlinelibrary.wiley.com/termsAndConditions#vor (vor, 13 d)
Locations: Journal of the American Geriatrics Society (publishedVersion)
PubMed (publishedVersion)
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
Health Sciences › Medicine › Geriatrics and Gerontology › Geriatric Care and Nursing Homes
Keywords: mortality prediction, frailty, institutionalized elderly, end-stage disease, symptoms and signs, activities of daily living, do-not-resuscitate orders, pain, nursing assessment
MeSH terms: Activities of Daily Living, Aged, Aged, 80 and over, Canada, Chronic Disease, Female, Humans, Institutionalization, Male, Middle Aged, Mortality, Severity of Illness Index, Geriatric Assessment, Comorbidity, Proportional Hazards Models, Frail Elderly

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The MDS-CHESS scale: a new measure to predict mortality in institutionalized older people

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