Development and Validation of a Functional Morbidity Index to Predict Mortality in Community-Dwelling Elders

TitleDevelopment and Validation of a Functional Morbidity Index to Predict Mortality in Community-Dwelling Elders
Publication TypeJournal Article
Year of Publication2004
AuthorsCarey, EC, Walter, LC, Lindquist, K, Covinsky, KE
JournalJournal of General Internal Medicine
Call Numberpubs_2004_carey_etal.pdf
KeywordsHealth Conditions and Status, Methodology

OBJECTIVE: Functional measures have a great appeal for prognostic instruments because they are associated with mortality, they represent the end-impact of disease on the patient, and information about them can be obtained directly from the patient. However, there are no prognostic indices that have been developed for community-dwelling elders based primarily on functional measures. Our objective in this study was to develop and validate a prognostic index for 2-year mortality in community-dwelling elders, based on self-reported functional status, age, and gender. DESIGN: Population-based cohort study from 1993 to 1995. SETTING: Community-dwelling elders within the United States. PARTICIPANTS: Subjects, age 70 and over (N= 7,393), from the Asset and Health Dynamics Among the Oldest Old study. We developed the index in 4,516 participants (mean age 78, 84 white, 61 female), and validated it in 2,877 different participants (mean age 78, 73 white, 61 female). MAIN OUTCOME MEASURES: Prediction of 2-year mortality using risk factors such as activities of daily living, instrumental activities of daily living, additional measures of physical function, age, and gender. RESULTS: Overall mortality was 10 in the development cohort and 12 in the validation cohort. In the development cohort, 6 independent predictors of mortality were identified and weighted, using logistic regression models, to create a point scale: male gender, 2 points; age (76 to 80, 1 point; 80, 2 points); dependence in bathing, 1 point; dependence in shopping, 2 points; difficulty walking several blocks, 2 points; and difficulty pulling or pushing heavy objects, 1 point. We calculated risk scores for each patient by adding the points of each independent risk factor present. In the development cohort, 2-year mortality was 3 in the lowest risk group (0 to 2 points), 11 in the middle risk group (3 to 6 points), and 34 in the highest risk group ( 7 points). In the validation cohort, 2-year mortality was 5 in the lowest risk group, 12 in the middle risk group, and 36 in the highest risk group. The c-statistics for the point system were 0.76 and 0.74 in the development and validation cohorts, respectively. CONCLUSIONS: This prognostic index, which relies solely on self-reported functional status, age, and gender, provides a simple and accurate method of stratifying communitydwelling elders into groups at varying risk of mortality.

Endnote Keywords

Activities of Daily Living/Survival/Mortality

Endnote ID


Citation Key6973