Predicting Death in the Nursing Home: Development and Validation of the 6-Month Minimum Data Set Mortality Risk Index
| Autor: | Davina Porock, Marilyn Rantz, Greg Petroski, David R. Mehr, Richard W. Madsen, Debra Parker Oliver, Steve Zweig |
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| Rok vydání: | 2005 |
| Předmět: |
Male
Aging medicine.medical_specialty Activities of daily living Poison control Risk Assessment Death Certificates Cohort Studies Feeding and Eating Disorders Sex Factors Alzheimer Disease Neoplasms Activities of Daily Living Humans Medicine Dementia Renal Insufficiency Mortality Intensive care medicine Aged Retrospective Studies Aged 80 and over Heart Failure Terminal Care Minimum Data Set Missouri business.industry Age Factors Retrospective cohort study medicine.disease Nursing Homes Dyspnea Emergency medicine Female Death certificate Geriatrics and Gerontology Cognition Disorders business Risk assessment Forecasting Cohort study |
| Zdroj: | The Journals of Gerontology Series A: Biological Sciences and Medical Sciences. 60:491-498 |
| ISSN: | 1758-535X 1079-5006 |
| DOI: | 10.1093/gerona/60.4.491 |
| Popis: | Background. Currently, 24% of all deaths nationally occur in nursing homes making this an important focus of care. However, many residents are not identified as dying and thus do not receive appropriate care in the last weeks and months of life. The aim of our study was to develop and validate a predictive model of 6-month mortality risk using functional, emotional, cognitive, and disease variables found in the Minimum Data Set. Methods. This retrospective cohort study developed and validated a clinical prediction model using stepwise logistic regressionanalysis.OurstudysampleincludedallMissourilong-term-careresidents(43,510)whohad afullMinimumData Set assessment transmitted to the Federal database in calendar year 1999. Death was confirmed by death certificate data. Results. The validated predictive model with a c-statistic of .75 included the following predictors: a) demographics (age and male sex); b) diseases (cancer, congestive heart failure, renal failure, and dementia/Alzheimer’s disease); c) clinical signs and symptoms (shortness of breath, deteriorating condition, weight loss, poor appetite, dehydration, increasing number of activities of daily living requiring assistance, and poor score on the cognitive performance scale); and d) adverse events (recent admission to the nursing home). A simple point system derived from the regression equation can be totaled to aid in predicting mortality. Conclusions. A reasonably accurate, validated model has been produced, with clinical application through a scored point system, to assist clinicians, residents, and family members in defining good goals of care around end-of-life care. |
| Databáze: | OpenAIRE |
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