title: Progress towards predicting 1-year mortality in older people living in residential long-term care.
abstract: BACKGROUND
  frail older people living in residential long-term care (LTC) have limited life expectancy. Identifying those with poor prognosis may improve management and facilitate transition to a palliative approach to care.
  
  
  OBJECTIVE
  to develop methods for predicting mortality in LTC.
  
  
  METHODS
  a population-based cohort study.
  
  
  METHODS
  LTC facilities, Auckland, New Zealand.
  
  
  METHODS
  five hundred randomly selected older people in a census-type survey of those living in LTC in 2008.
  
  
  METHODS
  mortality data were obtained from New Zealand Ministry of Health. Two methods for assessing mortality risk were developed using demographic, functional and health service information: (i) two geriatricians blinded to identifying data and to mortality, independently reviewed survey, medications and pre-survey hospitalisations data, and grouped residents according to perceived risk of death within 12 months; (ii) multivariate logistic regression model used the same survey and medication items as the geriatricians.
  
  
  RESULTS
  for the geriatricians' assessment, each quintile of perceived risk was associated with a significant increase in mortality (P < 0.001). Area under the curve (AUC) for both physicians was 0.64. The logistic regression model included age, gender, assistance with feeding and requiring night attention, all variables which are easily available from LTC records. AUC for the model was 0.70, but when validated against the entire OPAL cohort, it was 0.65. When either or both geriatrician and the model together predicted high risk of death, 1-year mortality was >50%.
  
  
  CONCLUSIONS
  two methods with the potential to identify older people with limited prognosis are described. Use of these methods allowed identification of over half of those who died within 12 months.
authors: Department of Medicine, University of Otago, Christchurch, 1st Floor, Princess Margaret Hopital, PO Box 800, Christchurch 8140, New Zealand.
authors: Claire Patricia
authors: CP
authors: Heppenstall
authors: Freemasons Department of Geriatric Medicine, University of Auckland, Auckland 0740, New Zealand.
authors: Joanna B
authors: JB
authors: Broad
authors: Freemasons Department of Geriatric Medicine, University of Auckland, Auckland 0740, New Zealand Waitemata District Health Board, Auckland, New Zealand Department of Nursing, University of Auckland, Auckland, New Zealand.
authors: Michal
authors: M
authors: Boyd
authors: Department of Health Sciences, University of Auckland, Auckland, New Zealand.
authors: Merryn
authors: M
authors: Gott
authors: Freemasons Department of Geriatric Medicine, University of Auckland, Auckland 0740, New Zealand Waitemata District Health Board, Auckland, New Zealand.
authors: Martin J
authors: MJ
authors: Connolly
mesh_terms: D000367:Age Factors; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D016015:Logistic Models; D008297:Male; D009026:Mortality; D009520:New Zealand / Q000453:epidemiology; D012372:ROC Curve; D012112:Residential Facilities / Q000706:statistics & numerical data*; D012307:Risk Factors; D012737:Sex Factors
keywords: end of life care; long-term care; older people; predictive modelling