TY  - JOUR
T1  - Prognostic indices for older adults: A systematic review
AU  - Yourman LC, Lee SJ, Schonberg MA, Widera EW, Smith AK
Y1  - 2012/01/11
N1  - 10.1001/jama.2011.1966
JO  - JAMA
SP  - 182
EP  - 192
VL  - 307
IS  - 2
N2  - Context 
                  To better target services to those who may benefit, many guidelines recommend incorporating life expectancy into clinical decisions.Objective 
                  To assess the quality and limitations of prognostic indices for mortality in older adults through systematic review.Data Sources 
                  We searched MEDLINE, EMBASE, Cochrane, and Google Scholar from their inception through November 2011.Study Selection 
                  We included indices if they were validated and predicted absolute risk of mortality in patients whose average age was 60 years or older. We excluded indices that estimated intensive care unit, disease-specific, or in-hospital mortality.Data Extraction 
                  For each prognostic index, we extracted data on clinical setting, potential for bias, generalizability, and accuracy.Results 
                  We reviewed 21 593 titles to identify 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). At least 1 measure of transportability (the index is accurate in more than 1 population) was tested for all but 3 indices. By our measures, no study was free from potential bias. Although 13 indices had C statistics of 0.70 or greater, none of the indices had C statistics of 0.90 or greater. Only 2 indices were independently validated by investigators who were not involved in the index's development.Conclusion 
                  We identified several indices for predicting overall mortality in different patient groups; future studies need to independently test their accuracy in heterogeneous populations and their ability to improve clinical outcomes before their widespread use can be recommended.
SN  - 0098-7484
M3  - doi: 10.1001/jama.2011.1966
UR  - http://dx.doi.org/10.1001/jama.2011.1966
ER  -