Prediction of appropriate timing of palliative care for older adults with non-malignant life-threatening disease: a systematic review.
BACKGROUND
most people in contemporary western society die of the chronic diseases of old age. Whilst palliative care is appropriate for elderly patients with chronic, non-malignant disease, few of these patients access such care compared with cancer patients. Objective referral criteria based on accurate estimation of survival may facilitate more timely referral of non-cancer patients most appropriate for specialist palliative care.


OBJECTIVE
to identify tools and predictor variables that might aid clinicians estimate survival and assess palliative status in non-cancer patients aged 65 years and older.


METHODS
systematic review and quality assessment using criteria modified from the literature.


RESULTS
11 studies that evaluated prognoses in hospitalised and community-based older adults with non-malignant disease were identified. Key generic predictors of survival were increased dependency of activities of daily living, presence of comorbidities, poor nutritional status and weight loss, and abnormal vital signs and laboratory values. Disease-specific predictors of survival were identified for dementia, chronic obstructive pulmonary disorder and congestive heart failure. No study evaluated the relationship between survival and palliative status.


CONCLUSIONS
prognostic models that attempt to estimate survival of < or = 6 months in non-cancer patients have generally poor discrimination, reflecting the unpredictable nature of most non-malignant disease. However, a number of generic and disease-specific predictor variables were identified that may help clinicians identify older, non-cancer patients with poor prognoses and palliative care needs. Simple, well-validated prognostic models that provide clinicians with objective measures of palliative status in non-cancer patients are needed. Additionally, research that evaluates the effect of general and specialist palliative care on psychosocial outcomes in non-cancer patients and their carers is needed.
Coventry
Peter A
PA
School of Nursing, Midwifery and Social Work, The University of Manchester, Oxford Road, Manchester M13 9PL, UK.
Grande
Gunn E
GE
Richards
David A
DA
Todd
Chris J
CJ
D000368:Aged; D000465:Algorithms; D002908:Chronic Disease / Q000401:mortality / Q000628:therapy*; D003704:Dementia / Q000401:mortality; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006801:Humans; D008511:Medicine; D010166:Palliative Care; D011379:Prognosis; D029424:Pulmonary Disease, Chronic Obstructive / Q000401:mortality; D013038:Specialization; D013997:Time Factors