Yale Bulletin and Calendar

March 15, 2002

Volume 30, Number 22

Two-Week Issue

Researcher's index assesses
mortality risk for elderly patients

In order to foster sound health care programs and policies concerning an aging population, a Yale researcher has devised a new index that forecasts which patients are most likely to die within
one year after being discharged from the hospital.

"It's very important to be able to compare how sick patients are across populations, across hospitals and across studies," says Dr. Sharon Inouye, associate professor of internal medicine and geriatrics at the School of Medicine and senior author of the study published this month in the Journal of the American Geriatrics Society. "Any time we are looking at the outcome of treatment and quality of care, it all impinges on understanding how comparable patients are."

What she and her co-researchers found were that elderly patients with 10 conditions were at higher risk for dying within one year of being hospitalized. Those conditions, in descending order of risk, are: congestive heart failure; pneumonia; chronic lung disease; solid tumor cancer that is localized; metastatic cancer; lymphoma/leukemia; major stroke; acute renal failure; chronic renal failure; and diabetes with end organ damage.

The study included 524 patients age 70 and older with a comparison group of 852 patients of the same age who also were hospitalized. The researchers first identified 16 high-risk medical diagnoses for older patients, based on a review of medical literature and expert opinion. The experts added six more diagnoses. From this group, the 10 final diagnoses were selected.

Inouye cautioned that the risk assessment is not for use with individuals.

"Given the potential for misuse, or misinterpretation, we do not advocate use of this index at the bedside for individual patients," she says. "The index is recommended for mortality prediction in patient groups or populations."

She says some examples of clinical usefulness might include identification of high risk groups that would benefit from early intervention or case management services; comparisons of treatment effectiveness or outcomes between patient groups; and evaluation of clinical performance or quality of care across health systems.

Other risk assessment systems, she says, either do not apply to the elderly because they do not address the elderly's multiple chronic diseases and high burden of illness. Still other risk assessments were targeted for the elderly, but required extensive physicals or reviewing charts in great detail.

"We wanted to come up with a system that is based on administrative data that is readily available, identifies high risk diagnoses and indicates which segments of the elderly population are at high risk for mortality," says Inouye. "We're hoping this will be useful to people who do research with older patients or develop new systems to care for older patients."

Co-authors include Mayur Desai, Dr. Sidney Bogardus, Christianna Williams and Dr. Gail Vitagliano. The research was supported in part by grants from the National Institute on Aging with in-kind support from the Claude D. Pepper Older Americans Independence Center.

-- By Jacqueline Weaver

T H I SW E E K ' SS T O R I E S

Soros Fellowships for New Americans

American Academy of Arts and Letters Awards

Poll reveals how 'deliberative' discussion can shift public opinion

Men's basketball team concludes record-setting season

Nobel Prize-winning economist James Tobin dies at 84

In Focus: Molecular, Cellular & Developmental Biology

Silviculturalist Oliver named to Pinchot chair

Berkeley and Yale Divinity Schools renew their affiliation

Erikson and Timmons awarded DeVane Medals

Alumnus describes how engineers 'cook up' new products

Haller and Henrich reappointed as college masters

Levin visits with alumni across the nation and beyond

Exhibit documents volunteers' role in Spanish Civil War

Event explores role of faith, gender in fighting AIDS in Africa

Team develops rules for identifying unseen problems in elderly

Researcher's index assesses mortality risk for elderly patients

Drama School actors gang up for 'Serious Money'

Students' new adaptation of 'The Trial' takes to the stage

Work of architect on view in 'Zaha Hadid Laboratory'

Conference will examine the changing notions of beauty

Panel looks at ethical issues nurses face

Yale Books in Brief

Campus Notes