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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Background
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MethodInfluential
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“…de la vie quotidienne (AVQ) 33 , activités instrumentales de la vie quotidienne (AIVQ) 34 , rende-ment cognitif 35 et mesure des changements de l’état de santé, des maladies en phase terminale, des signes et des symp-tômes (CHESS, pour changes in health, end-stage disease, signs and symptoms) 36 .”
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Method
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“…[40] score ≥ 3), significant cognitive impairment (RAI‐HC Cognitive Performance Scale [41] score ≥ 3), significant depressive symptoms (RAI‐HC Depression Rating Scale [42] score ≥ 3), and health instability (RAI‐HC Changes in Health, End‐Stage Disease, Signs, and Symptoms Scale [43] score ≥ 2).”
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Huttunen, H.-L., Halonen, R., & Ferreira, D. (2018) · SeGAH ... IEEE ... International Conference on Serious Games and Applications for Health/IEEE International Conference on Serious Games and Applications for Health · doi:10.1109/segah.2018.8401385 · Cited by 2
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Vu, M., Hogan, D., Patten, S. B., Jette, N., Bronskill, S., Heckman, G. A., Kergoat, M., Hirdes, J. P., Chen, X., Zehr, M., et al. (2014) · Maladies chroniques et blessures au Canada · doi:10.24095/hpcdp.34.2/3.08f · Cited by 2
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Filderman, B., Williams, N., Mofina, A., & Guthrie, D. M. (2024) · BMC Geriatrics · doi:10.1186/s12877-024-05414-2 · Cited by 3
“For each one-point increase on the CHESS scale, there is an almost two-fold increased risk of mortality [39].”
Background
Adverse Life Events: Do Home Care Clients Have Resources for Mastering Them?
Garms-Homolová, V., Declercq, A., Finne‐Soveri, H., Notthoff, N., van der Roest, H. G., & van Hout, H. P. J. (2021) · Frontiers in Medicine · doi:10.3389/fmed.2021.522410 · Cited by 2
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Pineau, E. (2016) · UWSpace (University of Waterloo) · Cited by 2
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Rahman, M., Norton, E. C., & Grabowski, D. C. (2016) · National Bureau of Economic Research · doi:10.3386/w22515 · Cited by 2
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Maxwell, C. J., Dampf, H., Squires, J., Hogan, D. B., Cotton, C. A., Youngson, E. R. E., Hsu, Z. Y., & Hoben, M. (2024) · BMC Geriatrics · doi:10.1186/s12877-024-05274-w · Cited by 1
“…Self-Performance Hierarchy Scale [ADL] [27], Cognitive Performance Scale [CPS] [28], Depression Rating Scale [DRS] [29], Changes in Health, End-Stage Disease, Signs and Symptoms Scale [CHESS; gauges health instability] [30], and Pain Scale) [31], behaviours, chronic health conditions, and frailty.”
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Cao, Y., Pang, B. Y., SILVA, G. G. D., Soh, L. L., Chen, W. T., Yang, S. Y., Leong, L., Tan, L. L. C., Leong, I. Y. O., Lim, W. S., et al. (2025) · BMC Palliative Care · doi:10.1186/s12904-025-01957-2 · Cited by 1
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Lau, C. (2017) · Scholarship@Western (Western University) · Cited by 1
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Correia, R. H., Mowbray, F., Dash, D., Katz, P. R., Moser, A. L., Strum, R. P., Jones, A., von Schlegell, A., & Costa, A. P. (2022) · BMC Geriatrics · doi:10.1186/s12877-022-03011-9 · Cited by 1
“End-stage disease is one of several indicators of the MDS-Changes in Health, End-stage Disease and Symptoms and Signs (CHESS) score, a valid predictor of mortality, and is associated with greater physician involvement and use of medical treatments [32].”
Background
Rehabilitation Therapy and Multimorbidity: A Retrospective Cohort Study
Mofina, A., Miller, J., Tranmer, J. E., Li, W., & Donnelly, C. A. (2024) · Physical & Occupational Therapy In Geriatrics · doi:10.1080/02703181.2024.2322488 · Cited by 1
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Derivation and validation of an algorithm to predict transitions from community to residential long-term care among persons with dementia—A retrospective cohort study
Li, W., Turcotte, L., Hsu, A. T., Talarico, R., Qureshi, D., Webber, C., Hawken, S., Tanuseputro, P., Manuel, D. G., & Huyer, G. (2024) · PLOS Digital Health · doi:10.1371/journal.pdig.0000441 · Cited by 1
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Kennedy, L., Hirdes, J. P., Heckman, G. A., Searle, S. D., & McArthur, C. (2024) · PLoS ONE · doi:10.1371/journal.pone.0311098 · Cited by 1
“The Changes in Health, End-Stage Disease and Signs and Symptoms (CHESS) scale was included to look at an individual’s level of frailty-related health instability [38].”
Self-citation
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“The Changes in Health, End-Stage Disease, Signs, and Symptoms (CHESS) Scale is a measure of health instability that ranges from 0 (no health instability) to 5 (very high health instability) and is predictive of mortality [29,30].”
Self-citation
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Self-citation
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“A score of 3 or more was used to indicate less favorable outcomes.(28,29) Finally, we assessed pain using a validated, 4-point pain scale varying from 0 (no pain) to 3 (excruciating daily pain), with a cutoff of 2 used to identify individuals experiencing daily pain.”
Method
Development of Life-Worldly Communication Scale for Older Persons: A Pilot Study
Fukaya, Y., Kitamura, T., Wakabayashi, R., & Kawaguchi, M. (2019) · Journal of Health and Medical Sciences · doi:10.31014/aior.1994.02.04.86 · Cited by 1
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van Beek, A. P. (2005) · Pure Amsterdam UMC · Cited by 1
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McLaughlin, K. P. (2011) · UWSpace (University of Waterloo) · Cited by 1
High-Risk Medication Use, Frailty and Hospitalization among Older Assisted Living Residents
Stock, K. J. (2015) · UWSpace (University of Waterloo) · Cited by 1
Relationships between Quality of Life and Selected Resident and Facility Characteristics in Long Term Care Facilities in Canada
Kehyayan, V. (2011) · UWSpace (University of Waterloo) · Cited by 1
Risk Factors for Falls in Home Care and Long-Term Care Settings: A Focus on Dementia and Parkinson's Disease
Bansal, S. (2013) · UWSpace (University of Waterloo) · Cited by 1
CANCER in the Long-term Care Facility: PART 2 OF 2
Wick, J. Y. (2004) · The Consultant Pharmacist · doi:10.4140/tcp.n.2004.792 · Cited by 1
Personal Characteristics and Risk Factors Associated with Economic Trade-offs and Financial Management Difficulties in Older Adult Home Care Populations
Davies, L. A. (2013) · UWSpace (University of Waterloo) · Cited by 1
Use of Medications for Management of Alzheimer’s Disease in Ontario’s Home Care Population
Jantzi, M. (2010) · UWSpace (University of Waterloo) · Cited by 1
Heart Failure among Older Home Care Clients: An Examination of Client Needs, Medication Use and Outcomes
Foebel, A. D. (2011) · UWSpace (University of Waterloo) · Cited by 1
Cost Effectiveness Analysis of Riluzole for ALS in Ontario Home Care Setting
Kim, Y. (2017) · UWSpace (University of Waterloo) · Cited by 1
Factors affecting hospice care use among long-term care facility residents in Canada
Xiong, B. (2019) · doi:10.24124/2019/58970 · Cited by 1
Factors That Influence Medicare Part A Beneficiaries' Length of Stay in the Nursing Home, After a Hospitalization
Alvine, C. (2006) · UA Campus Repository (The University of Arizona) · Cited by 1
Bladder antimuscarinics use in the veterans affairs community living centers
Moga, D. C. (2012) · doi:10.17077/etd.p2fxal2y
“The MDS Changes in Health, End-Stage Disease and Symptoms and Signs (MDS-CHESS) Scale is a score that measures instability of health status and has been shown to predict mortality among nursing home residents (Hirdes et al., 2003).”
Background
Comorbidities, Frailty, and “Pay-off Time”
Sales, A. E. (2009) · Medical Care · doi:10.1097/mlr.0b013e3181a5c629

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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