elderly patients' morality risk
A Yale researcher has developed a new method for assessing the risk of mortality in elderly patients.
According to the new method -- Burden of Illness Score for Elderly Persons (BISEP), developed by Dr. Sharon Inouye, professor of medicine and geriatrics at the School of Medicine -- functional impairment and laboratory abnormalities, combined with diseases, offer the most accurate prediction of which elderly persons are most likely to die within one year after being hospitalized.
Inouye was the principal investigator for the study, which was published this month in the journal Medical Care. The Yale researcher says the BISEP is an alternative to the traditional risk adjustment index. The existing systems are generally limited to a list of diagnoses, but just as important in calculating the risk of mortality, she says, is functional impairment, such as difficulty walking, and physiological impairment, as reflected by laboratory abnormalities.
"There really are no measures that have looked at functional impairment in older people, yet study after study shows functional impairment is an even more important determinant of the outcome than diagnoses," Inouye says. "If patients can't walk, can't feed themselves, can't bathe when they leave the hospital, they are not going to do well when they go home."
Her article offers a new way to conceptualize the current method of assessing mortality risk, and all of the new information is readily available in hospital database systems, in discharge information and in medical records.
Inouye's study forecasts the outcomes for 525 patients age 70 and older at one university hospital. This group was compared with outcomes for 1,246 patients 65 years and older from 27 hospitals. The researchers examine diagnoses, laboratory tests and functional status in light of five risk factors: high-risk diagnoses, levels of albumin and creatinine, dementia and walking impairment. BISEP demonstrated superior performance when compared with several other risk measures.
The new approach is timely, notes the researcher. Medicare now mandates that the functional status of certain patients be assessed before they leave the hospital.
Inouye says the index is not intended to predict mortality in individual patients. BISEP is recommended for risk adjustment in populations or patient groups for the purpose of identifying high-risk groups, comparing treatment effectiveness between groups or evaluating clinical performance across health sytems.
-- By Jacqueline Weaver
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