Prognostic Indices for Older Adults A Systematic Review

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. JAMA. 2012; 307(2):182-192 www.jama.com