PRESS-NEWS.org - Press Release Distribution
PRESS RELEASES DISTRIBUTION

Study examines accuracy of prognostic tools used to predict mortality among older adults

2012-01-11
(Press-News.org) CHICAGO – A review of 16 prognostic indices used to predict risk of death in older adults in a variety of clinical settings, such as in nursing homes and hospitals, found that there is insufficient evidence to recommend the widespread use of these indices in clinical practice, according to a study in the January 11 issue of JAMA.

"Failure to consider prognosis in the context of clinical decision making can lead to poor care. Hospice is underutilized for patients with nonmalignant yet life-threatening diseases. Healthy older patients with good prognosis have low rates of cancer screening. Older adults with advanced dementia or metastatic cancer are screened for slow-growing cancers that are unlikely to ever cause them symptoms but may lead to distress from false-positive results, invasive workups, and treatments," according to background information in the article. "In recognition of these phenomena, guidelines increasingly incorporate life expectancy as a central factor in weighing the benefits and the burdens of tests and treatments. Prognostic indices offer a potential role for moving beyond arbitrary age-based cutoffs in clinical decision making for older adults. However, little is known about the quality of prognostic indices for older adults, limiting their clinical use."

Lindsey C. Yourman, M.D., of the University of California, San Francisco, and colleagues conducted a systematic review to examine the quality and limitations of validated non-disease-specific prognostic indices that predict absolute risk of all-cause mortality in patients whose average age was 60 years or older. A review of the medical literature identified 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; 5 were intended for use in the emergency department or on hospital admission and 3 after hospital discharge). Studies were abstracted for information about index quality, including potential for bias, generalizability, and accuracy.

All indices were developed using secondary analysis of existing data sets of participants from the United States and western Europe. The most common final predictors of mortality included functional status and co-existing illnesses. The researchers found that at least 1 measure of transportability (the index is accurate in more than 1 population) was tested for all but 3 indices. By the measures used, no study was free from potential bias. Only 2 indices were independently validated by investigators who were not involved in the development of the index. No index had been prospectively tested and found to be accurate in a large diverse sample. "These factors limit a clinician's ability to assess the accuracy of these indices across patient groups that differ according to severity of illness, methodology of data collection, geographic location, and time," the authors write.

The researchers add that even if quality barriers are overcome, important limitations remain, such as indices requiring collection of information that may not be routinely assessed in elderly patients, like activities of daily living. They add that many of these indices rely on clinical information from administrative data sets, and the accuracy of certain codes has been called into question.

"Ultimately, an index will be judged not only on its accuracy across diverse settings, but also on its clinical effect. Studies that demonstrate effect on prognostic estimates, clinician behavior, and patient outcomes have a higher level of evidence for use in clinical decision making. We are aware of only 2 small studies that tested the effect of these indices on clinical outcomes. The highest level of evidence, however, would come from large prospective trials that randomize clinicians to using the index or not, evaluating the effect of the index on prognostic estimates, clinical decision making, and patient outcomes. Such large randomized trials have not been performed," the authors write.

"While neither a clinician nor an index can predict with absolute certainty how long an older adult will live, validated prognostic indices might improve the accuracy of the prognostic assumptions that influence clinical decisions. However, further research is needed before general prognostic indices for elderly individuals can be recommended for routine use. Future research should focus on prospectively testing the validity of these indices across diverse clinical settings and analyzing their effect on clinical decision making and patient outcomes."

(JAMA. 2012;307[2]:182-192. Available pre-embargo to the media at www.jamamedia.org)

Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

Editorial: The Central Role of Prognosis in Clinical Decision Making

"From a research perspective, new prognostic indices should be developed and validated based on life expectancy rather than mortality risk," writes Thomas M. Gill, M.D., of the Yale School of Medicine, New Haven, Conn., in an accompanying editorial.

"The clinical utility of the most promising life expectancy indices should be evaluated in well-designed studies. When developing a new prognostic index, investigators should focus on data elements that are readily accessible and recordable in the electronic medical record, allowing for real-time estimates of life expectancy. The incremental benefit of factors beyond age, sex, smoking history, and body mass index, which are included in most mortality prognostic indices, should be carefully evaluated to determine whether the gain in accuracy outweighs the added burden of data collection."

(JAMA. 2012;307[2]:199-200. Available pre-embargo to the media at www.jamamedia.org)

Editor's Note: Please see the article for additional information, including financial disclosures, funding and support, etc.

###

To contact corresponding author Alexander K. Smith, M.D., M.P.H., call Leland Kim at 415-502-6397 or email leland.kim@ucsf.edu. To contact editorial author Thomas M. Gill, M.D., call Karen Peart at 203-432-1326 or email karen.peart@yale.edu.

END



ELSE PRESS RELEASES FROM THIS DATE:

Persons with dementia have higher rate of hospitalizations

2012-01-11
CHICAGO – Compared to individuals without dementia, persons who developed dementia subsequently had a significantly higher rate of hospital admissions for all causes and admissions for ambulatory care-sensitive conditions for which proactive care may have prevented hospitalizations, according to a study in the January 11 issue of JAMA. "Nonelective hospitalization of older people, particularly those with dementia, is not a trivial event. Among older persons without dementia, hospitalization for serious illness is associated with subsequent cognitive decline, and frail ...

Study evaluates blood potassium levels after heart attack and risk of in-hospital mortality

2012-01-11
CHICAGO – Patients hospitalized after a heart attack who had blood potassium levels of between 3.5 and less than 4.5 mEq/L (milliEquivalents per liter) had a lower risk of death than patients with potassium levels that were higher or lower than this range, according to a study in the January 11 issue of JAMA. Clinical practice guidelines recommend maintaining serum potassium levels between 4.0 and 5.0 mEq/L in patients after a heart attack. "Potassium homeostasis [equilibrium] is critical to prevent adverse events in patients with cardiovascular disease. Several studies ...

VLBA, RXTE team up to pinpoint black hole's outburst

2012-01-11
Astronomers have gained an important clue about a ubiquitous cosmic process by pinpointing the exact moment when gigantic "bullets" of fast-moving material were launched from the region surrounding a black hole. They made this breakthrough by using the ultra-sharp radio "vision" of the National Science Foundation's Very Long Baseline Array (VLBA), along with NASA's Rossi X-ray Timing Explorer (RXTE) satellite, to study an outburst from a system including a black hole and its companion star in 2009. Black holes in such binary-star systems can pull material from their companions. ...

People with dementia have more preventable hospitalizations

People with dementia have more preventable hospitalizations
2012-01-11
SEATTLE–Compared to individuals without dementia, people who subsequently developed dementia had a significantly higher rate of hospital admissions for all causes. They also had more admissions for "ambulatory care-sensitive" conditions, for which proactive care may have prevented hospitalizations. This suggests opportunities for improving outpatient care of seniors with dementia, according to research in the January 11 Journal of the American Medical Association. "Nonelective hospitalization of older people, particularly those with dementia, is not a trivial event," ...

Global study sheds light on role of exercise, cars and televisions on the risk of heart attacks

2012-01-11
A worldwide study has shown that physical activity during work and leisure time significantly lowers the risk of heart attacks in both developed and developing countries. Ownership of a car and a television was linked to an increased risk of heart attacks, particularly in low- and middle-income countries. The findings come from the INTERHEART study, a case-control study of over 29,000 people from 262 centres in 52 countries in Asia, Europe, the Middle East, Africa, Australia, North and South America. It is published online today (Wednesday) in the European Heart Journal ...

Predators hunt for a balanced diet

Predators hunt for a balanced diet
2012-01-11
An international team of scientists from the Universities of Exeter and Oxford in the UK, University of Sydney (Australia), Aarhus University (Denmark) and Massey University (New Zealand) based their research on the ground beetle, Anchomenus dorsalis, a well-known garden insect that feasts on slugs, aphids, moths, beetle larvae and ants. The team collected female beetles from the wild and split them into two groups in the laboratory. Half of the beetles were offered a choice of foods, some that were high in protein and some that were high in fat. The other half were not ...

Smokers 'salivate' to cigarettes: The physiological reactions to associated images

2012-01-11
It is commonly known that, much like Pavlov's dogs salivating in response to hearing the bell they associate with dinner time, smokers feel cravings and have physiological reactions to pictures they associate with smoking. New research published in BioMed Central's open access journal BMC Neuroscience has shown that a smoker's cravings can also be trained to non-smoking related stimuli. Classical conditioning experiments link a neutral stimulus, such as a sound or a picture, to an event, like eating or smoking. Higher order, sometimes called second order conditioning, ...

New educational program helps the siblings of children with cancer

2012-01-11
Having a brother or sister with newly diagnosed cancer can be a distressing and difficult time for a child. While most children eventually cope, there can be a period of adjustment when their school work and social functioning suffer. New research published in BioMed Central's open access journal Child and Adolescent Psychiatry and Mental Health shows that a teaching program, designed to improve the child's knowledge about their sibling's disease and to give them coping skills, was able to improve their adjustment and psychological well being in this early time period after ...

Surgeons aged between 35 and 50 provide the safest care

2012-01-11
Surgeons aged between 35 and 50 years provide the safest care compared with their younger or older colleagues, finds a study published on bmj.com today. The findings raise concerns about ongoing training and motivation of surgeons during their careers. Typically, experts reach their peak performance between the ages of 30 and 50 years or after about 10 years' experience in their specialty, but few studies have measured the association between clinicians' experience and performance. So a team, led by Drs Antoine Duclos and Jean-Christophe Lifante from the University ...

New UK Finance Website Provides Short Term Loans - Paydayloansuk.org.uk

2012-01-11
With Christmas over for another year and many people feeling the pinch after overspending, it seems that the solution to their problems will be a little short term financial help. A new company called Paydayloansuk.org.uk has been set up and could help people in this sector to get themselves back on track in the short term. This provider has been set up to give customers financial help quicker than a lot of other companies. By taking customers needs and details quickly, they can help them out without delay. In most straightforward scenarios, money can be available to ...

LAST 30 PRESS RELEASES:

Study tracks chromium chemistry in irradiated molten salts

Scientists: the beautiful game is a silver bullet for global health

Being physically active, even just a couple of days a week, may be key to better health

High-fat diet promote breast cancer metastasis in animal models

A router for photons

Nurses and AI collaborate to save lives, reduce hospital stays

Multi-resistance in bacteria predicted by AI model

Tinker Tots: A citizen science project to explore ethical dilemmas in embryo selection

Sensing sickness

Cost to build multifamily housing in California more than twice as high as in Texas

Program takes aim at drinking, unsafe sex, and sexual assault on college campuses

Inability to pay for healthcare reaches record high in U.S.

Science ‘storytelling’ urgently needed amid climate and biodiversity crisis

KAIST Develops Retinal Therapy to Restore Lost Vision​

Adipocyte-hepatocyte signaling mechanism uncovered in endoplasmic reticulum stress response

Mammals were adapting from life in the trees to living on the ground before dinosaur-killing asteroid

Low LDL cholesterol levels linked to reduced risk of dementia

Thickening of the eye’s retina associated with greater risk and severity of postoperative delirium in older patients

Almost one in ten people surveyed report having been harmed by the NHS in the last three years

Enhancing light control with complex frequency excitations

New research finds novel drug target for acute myeloid leukemia, bringing hope for cancer patients

New insight into factors associated with a common disease among dogs and humans

Illuminating single atoms for sustainable propylene production

New study finds Rocky Mountain snow contamination

Study examines lactation in critically ill patients

UVA Engineering Dean Jennifer West earns AIMBE’s 2025 Pierre Galletti Award

Doubling down on metasurfaces

New Cedars-Sinai study shows how specialized diet can improve gut disorders

Making moves and hitting the breaks: Owl journeys surprise researchers in western Montana

PKU Scientists simulate the origin and evolution of the North Atlantic Oscillation

[Press-News.org] Study examines accuracy of prognostic tools used to predict mortality among older adults