Predictive Indices for Functional Improvement and Deterioration, Institutionalization, and Death Among Elderly Medicare Beneficiaries.
Jibby E Kurichi, Pui L Kwong, Dawei Xie and 1 others
PMID 28456694WHAT IT FOUND
A new scoring system predicts which Medicare patients aged 65 or older will deteriorate, be institutionalized, or die within two years.
It identifies risk factors like advanced age, living alone, and vision impairment to help clinicians plan care and prevent poor outcomes.
Key findings
01The study developed a prediction model using 16 factors for functional deterioration, 11 for institutionalization, and 15 for death, validated in a separate group of beneficiaries.
02The model discriminates well between stable function and institutionalization or death, but less well for functional deterioration.
03Advanced age, male gender, living alone, and having a more disabled baseline ADL stage were risk factors for all three poor outcomes.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
A high percentage of participants (6,882) were lost to follow-up, which may bias results. ADL stages were based on self-reported or proxy-reported data, which may not accurately reflect true functional limitations. The model's discrimination for functional deterioration was moderate (c-statistic 0.664), meaning it is less reliable for predicting this specific outcome compared to institutionalization or death. The study only included Medicare beneficiaries aged 65 and older, so results do not apply to younger disabled individuals.
Declared interests
The authors declared no conflicts of interest. The study was approved by the Institutional Review Board at the University of Pennsylvania.
The easy way to misread this
Do not assume this model is clinically validated for changing patient care yet. The authors state that the clinical utility of the model needs to be validated in future studies before it is adopted in health systems.