The measurement of health: a comparison of indices of disease severity.
This study compared the utility of different health indicators in frail older people, as a component of a larger study of medical evaluations of 183 adult day care participants in five Maryland centers. Indices examined included: number of disease categories, number of active categories, number of severe categories, number of categories with worsening trajectory, and average severity score. In predicting survival, none of the medical indicators without dementia was a strong predictor of survival. When dementia was included, number of categories with worsening trajectory seemed to be the best indicator of survival, with average severity score being a close second. Among the diagnoses, dementia and its severity were the strongest predictors of survival. Prediction of continuous stay in the community (in contrast to death or entry into a nursing home) was significant for most indices and is easier to predict from medical indices than death. Different indicators provided best utility depending on the criterion applied.
Cohen-Mansfield
J
J
Research Institute, Hebrew Home of Greater Washington, Rockville, MD 20852, USA. cohen-mansfield@hebrew-home.org
Pawlson
G
G
Lipson
S
S
Volpato
S
S
D000368:Aged; D000369:Aged, 80 and over; D003704:Dementia; D005260:Female; D016330:Frail Elderly; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D016019:Survival Analysis