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J Am Geriatr Soc. 2011 Aug;59(8):1444-51. doi: 10.1111/j.1532-5415.2011.03523.x. Epub 2011 Jul 28.

External validation of an index to predict up to 9-year mortality of community-dwelling adults aged 65 and older.

Author information

  • 1Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA. mschonbe@bidmc.harvard.edu

Abstract

OBJECTIVES:

To further validate an index predicting mortality in community-dwelling older adults.

DESIGN:

A comparison of the performance of the index in predicting mortality among new respondents to the National Health Interview Survey (NHIS, 2001-2004) with that of respondents from the original development and validation cohorts (1997-2000) and a test of its performance over extended follow-up (up to 9 years) using the original cohorts. Follow-up mortality data were available through 2006.

SETTING:

NHIS.

PARTICIPANTS:

Twenty-two thousand fifty-seven new respondents to the NHIS (2001-2004) and 24,139 respondents from the original development and validation cohorts (1997-2000).

MEASUREMENTS:

A risk score was calculated for each respondent based on the presence or absence of 11 factors (function, illnesses, behaviors, demographics) that make up the index. Using the Kaplan-Meier method, 5-year mortality estimates were computed for the new and original cohort respondents and 9-year mortality estimates for the original cohorts.

RESULTS:

New respondents were similar to original cohort respondents but were slightly more likely to be aged 85 and older, report diabetes mellitus, and have a body mass index of 25.0 kg/m² or greater. The model performed as well in the new cohort as it had in the original cohort. New respondents with risk scores of 0 to 1 had a 2% risk of 5-year mortality, whereas respondents who scored 18 or higher had a 69% risk of 5-year mortality (range 3-71% risk of 5-year mortality in the development cohort). The index also demonstrated excellent calibration and discrimination in predicting 9-year mortality (range 7% risk for scores of 0-1 to 92% risk for scores of ≥ 18, original validation cohort extended).

CONCLUSION:

These results further justify use of this index to estimate life expectancy in clinical decision-making.

© 2011, Copyright the Authors. Journal compilation © 2011, The American Geriatrics Society.

PMID:
21797837
[PubMed - indexed for MEDLINE]
PMCID:
PMC3158286
Free PMC Article
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