title: Utility of Hippocrates' prognostic aphorism to predict death in the modern era: prospective cohort study.
abstract: OBJECTIVE
  To determine if one of Hippocrates' aphorisms, identifying good cognition and good appetite as two prognostic factors, predicts death in community living older adults in the modern era.
  
  
  METHODS
  Secondary analysis of an existing population based cohort study.
  
  
  METHODS
  Manitoba Study of Health and Aging.
  
  
  METHODS
  1751 community living adults aged more than 65 enrolled in the Manitoba Study of Health and Aging in 1991 and followed over five years.
  
  
  METHODS
  Time to death.
  
  
  METHODS
  We recreated the hippocratic prognosticator using an item that measures appetite drawn from the Center for Epidemiologic Studies-depression subscale, and the mini-mental state examination, with a score of >25 being considered as normal. People with normal cognition and appetite were compared with those with either poor cognition or poor appetite. We constructed Cox regression models, adjusted for age, sex, education, and functional status.
  
  
  RESULTS
  The prognostic aphorism predicted death, with an unadjusted hazard ratio of 2.37 (95% confidence interval 1.93 to 2.88) and a hazard ratio of 1.71 (1.37 to 2.12) adjusted for age, sex, and education. Both poor appetite and poor cognition predicted death. The sensitivity and specificity were not, however, sufficient for the measure to be used alone.
  
  
  CONCLUSIONS
  An aphorism devised by Hippocrates millennia ago can predict death in the modern era.
authors.affiliation: Section of Geriatric Medicine, Department of Medicine, and the Centre on Aging, University of Manitoba, GE 547 Health Sciences Centre, 820 Sherbrook St, Winnipeg, MB, Canada R3A 1R9 pstjohn@hsc.mb.ca.
authors.forename: Philip D
authors.initials: PD
authors.lastname: St John
authors.affiliation: Vancouver Island Health Authority Geriatric Services Memorial Pavilion, Victoria, British Columbia, Canada.
authors.forename: Patrick R
authors.initials: PR
authors.lastname: Montgomery
mesh_terms: D000368:Aged; D001045:Aphorisms and Proverbs as Topic; D001066:Appetite / Q000502:physiology; D003071:Cognition / Q000502:physiology; D003072:Cognition Disorders / Q000401:mortality*; D004812:Epidemiologic Methods; D001068:Feeding and Eating Disorders / Q000401:mortality*; D005260:Female; D015577:Geriatric Assessment / Q000379:methods*; D006801:Humans; D008297:Male; D008350:Manitoba / Q000453:epidemiology; D011379:Prognosis; D018570:Risk Assessment