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Prognostic indices for older adults: a systematic review.

ABSTRACT: To better target services to those who may benefit, many guidelines recommend incorporating life expectancy into clinical decisions.To assess the quality and limitations of prognostic indices for mortality in older adults through systematic review.We searched MEDLINE, EMBASE, Cochrane, and Google Scholar from their inception through November 2011.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.For each prognostic index, we extracted data on clinical setting, potential for bias, generalizability, and accuracy.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.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.

SUBMITTER: Yourman LC

PROVIDER: S-EPMC3792853 | biostudies-literature | 2012 Jan

REPOSITORIES: biostudies-literature

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Prognostic indices for older adults: a systematic review.

Yourman Lindsey C LC Lee Sei J SJ Schonberg Mara A MA Widera Eric W EW Smith Alexander K AK

JAMA 20120101 2

<h4>Context</h4>To better target services to those who may benefit, many guidelines recommend incorporating life expectancy into clinical decisions.<h4>Objective</h4>To assess the quality and limitations of prognostic indices for mortality in older adults through systematic review.<h4>Data sources</h4>We searched MEDLINE, EMBASE, Cochrane, and Google Scholar from their inception through November 2011.<h4>Study selection</h4>We included indices if they were validated and predicted absolute risk o ...[more]

PMID: 22235089

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Project description:Polypharmacy, the concurrent use of multiple medications, consistently evokes a negative connotation, notably because it is associated with a plethora of adverse events. Nonetheless, the number of individuals exposed to polypharmacy is increasing steeply, especially for older people with multiple diseases. There is a need to carefully study the phenomenon at the population scale to full assess the associated health outcomes. Yet, this reveals a complex task because there exists no consensus indicator of polypharmacy. In fact, the definitions of polypharmacy are heterogeneous and its predisposing factors and associated outcomes are not well defined. The goal of this systematic review is to summarize the literature on polypharmacy in multimorbid individuals aged 65 years and over, targeting three objectives: (1) to identify the definitions of polypharmacy that are used in the context of multimorbidity among older individuals (?65 years); (2) to ascertain predisposing and concurrent factors associated with polypharmacy; and (3) to describe positive and negative outcomes of polypharmacy among older individuals, including hospitalizations, mortality and costs.We will include publications from 2004 to 2016 that target four concepts: polypharmacy, older individuals, multimorbidity and positive/negative outcomes. The search will be performed using EBM Reviews, Embase, Global Health, MEDLINE, AgeLine, CINAHL, Health Policy Reference Center, Public Affairs Index, SocINDEX and Google Scholar. Two independent reviewers will screen the articles, extract the information and evaluate the methodological quality of included studies. The results will be presented in tables and narrative summaries will be performed. We will perform meta-analyses (objective 3) if the heterogeneity is not important.This review will help describe the various ways of conceptualizing polypharmacy and how it is associated with health outcomes. We have selected outcomes most relevant for public surveillance performed with administrative databases. Other positive and negative outcomes have been associated with polypharmacy but may not be included in the review.PROSPERO CRD42014014989.

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Prognostic indices for older adults: a systematic review.

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Prognostic indices for older adults: a systematic review.

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