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This study assesses whether colorectal cancer screening varied by predicted life expectancy in a national sample of Veterans Affairs patients aged 76 to 85 years. [ABSTRACT FROM AUTHOR]

A study was conducted to investigate the relationship between the Leapfrog Hospital Surveys conducted by hospitals and risk-adjusted inpatient mortality rates. Results indicated that survey scores were not significantly associated with inpatient mortality.

An attempt is made to develop and validate a prognostic index for 4-year mortality using information that can be obtained from patient report. This prognostic index, incorporating age, sex, self-reported comorbid conditions, and functional measures, accurately stratifies community-dwelling older adults into groups of varying risk of mortality.

Importance: There is substantial uncertainty about optimal glycemic control in older adults with type 2 diabetes mellitus.Observations: Four large randomized clinical trials (RCTs), ranging in size from 1791 to 11,440 patients, provide the majority of the evidence used to guide diabetes therapy. Most RCTs of intensive vs standard glycemic control excluded adults older than 80 years, used surrogate end points to evaluate microvascular outcomes and provided limited data on which subgroups are most likely to benefit or be harmed by specific therapies. Available data from randomized clinical trials suggest that intensive glycemic control does not reduce major macrovascular events in older adults for at least 10 years. Furthermore, intensive glycemic control does not lead to improved patient-centered microvascular outcomes for at least 8 years. Data from randomized clinical trials consistently suggest that intensive glycemic control immediately increases the risk of severe hypoglycemia 1.5- to 3-fold. Based on these data and observational studies, for the majority of adults older than 65 years, the harms associated with a hemoglobin A1c (HbA1c) target lower than 7.5% or higher than 9% are likely to outweigh the benefits. However, the optimal target depends on patient factors, medications used to reach the target, life expectancy, and patient preferences about treatment. If only medications with low treatment burden and hypoglycemia risk (such as metformin) are required, a lower HbA1c target may be appropriate. If patients strongly prefer to avoid injections or frequent fingerstick monitoring, a higher HbA1c target that obviates the need for insulin may be appropriate.Conclusions and Relevance: High-quality evidence about glycemic treatment in older adults is lacking. Optimal decisions need to be made collaboratively with patients, incorporating the likelihood of benefits and harms and patient preferences about treatment and treatment burden. For the majority of older adults, an HbA1c target between 7.5% and 9% will maximize benefits and minimize harms. [ABSTRACT FROM AUTHOR]

The article discusses a systematic review of prognostic indices for mortality in older people. Data on clinical setting, potential for bias and accuracy were extracted for each prognostic index. Six indices for community-dwelling older people were identified under the review. Two indices using the Minimum Data Set (MDS) were developed for nursing home residents. Eight indices estimating the risk of mortality in hospitalized older adults were identified. According to the authors, future studies need to independently test the accuracy of prognostic indices in heterogeneous populations and their potential to enhance clinical outcomes before recommending their widespread use.

Context Both comorbid conditions and functional measures predict mortality in older adults, but few prognostic indexes combine both classes of predictors. Combining easily obtained measures into an accurate predictive model could be useful to clinicians advising patients, as well as policy makers and epidemiologists interested in risk adjustment. Objective To develop and validate a prognostic index for 4-year mortality using information that can be obtained from patient report. Design, Setting, and Participants Using the 1998 wave of the Health and Retirement Study (HRS), a population-based study of community-dwelling US adults older than 50 years, we developed the prognostic index from 11 701 individuals and validated the index with 8009. Individuals were asked about their demographic characteristics, whether they had specific diseases, and whether they had difficulty with a series of functional measures. We identified variables independently associated with mortality and weighted the variables to create a risk index. Main Outcome Measure Death by December 31, 2002. Results The overall response rate was 81%. During the 4-year follow-up, there were 1361 deaths (12%) in the development cohort and 1072 deaths (13%) in the validation cohort. Twelve independent predictors of mortality were identified: 2 demographic variables (age: 60-64 years, 1 point; 65-69 years, 2 points; 70-74 years, 3 points; 75-79 years, 4 points; 80-84 years, 5 points, >85 years, 7 points and male sex, 2 points), 6 comorbid conditions (diabetes, 1 point; cancer, 2 points; lung disease, 2 points; heart failure, 2 points; current tobacco use, 2 points; and body mass index <25, 1 point), and difficulty with 4 functional variables (bathing, 2 points; walking several blocks, 2 points; managing money, 2 points, and pushing large objects, 1 point. Scores on the risk index were strongly associated with 4-year mortality in the validation cohort, with 0 to 5 points predicting a less than 4% risk, 6 to 9 points predicting a 15% risk, 10 to 13 points predicting a 42% risk, and 14 or more points predicting a 64% risk. The risk index showed excellent discrimination with a c statistic of 0.84 in the development cohort and 0.82 in the validation cohort. Conclusion This prognostic index, incorporating age, sex, self-reported comorbid conditions, and functional measures, accurately stratifies community-dwelling older adults into groups at varying risk of mortality. [ABSTRACT FROM AUTHOR]

The article discusses a research that was conducted to examine whether a four-year mortality index can predict 10-year mortality. The study used the 1998 wave of the Health and Retirement Study (HRS) of community-dwelling U.S. adults aging 50-plus. It adds that a risk score was calculated for each participant by adding the points for each risk factor present.

The authors offer views on how guidelines are using age as a marker for life expectancy and show how accounting for life expectancy could improve prevention decisions. They outline ways to determine lag time to benefit and life expectancy. They also demonstrate how this framework could be applied for a hypothetical patient during a Medicare Annual Wellness visit.

Two letters to the editor are presented in response to an article about the prognostic indices for older adults in the January 11, 2012 issue.

The authors highlight the unintended harms that may arise from health care quality indicators. They point out that inappropriate care is not discouraged by all quality indicators. They cite the necessity for differing implementation strategies in life expectancy-based quality indicators based on the electronic medical record (EMR) system. They argue that patient care can be improved by health care quality indicators.

The article looks at the factors to consider in identifying the goals of glycemic control in frail and diabetic older people. It is said that tight glycemic control usually leads to substantial burdens in frail people such as dietary restriction, insulin injections and polypharmacy. It is noted that the most appropriate glycemic target for a frail older person should be based on the degree of frailty and the most significant outcomes for the patient. Life expectancy is also another factor to consider in determining glycemic target.

The letter replies to readers' comments on research methods used in a study concerning a prognostic index for 4-year mortality in older adults.