Skip to main content

PROGNOSIS

Clinicians should routinely incorporate prognosis into clinical decision making for older adults. Alex Smith, Sei Lee, and I are seeking your insights to help inform a web-based prognostic calculator and systematic review for prognosis in older adults. We thank you in advance for any feedback on either of the following two questions!:

1) systematic review: what prognostic indices do you use for your patients, or have you read about? There is no Medical Subject Heading (Mesh in PubMed) for Prognostic Model. I am now soliciting Geripal advice to supplement our exhaustive literature search. We are especially interested in prognostic indices that use a multivariate algorithm to predict life expectancy via a risk score, but if in doubt, please still send your suggestion.

2) prognostic calculator: any opinions on a catchy and simple name for a website that contains a prognosis calculator for older adults? This calculator would utilize the prognostic indices we identify in the systematic review above. Special Geripal recognition will be given to the best proposal! Some initial ideas include: geriprog, prognosisweb, or gericalc.

By Lindsey Yourman

Comments

Eric Widera said…
My top 5:

1) Hospitalized elderly: Louise Walter's Index (JAMA 2001)

2) Community Elderly: Sei Lee's Index (JAMA 2004)

3) COPD: BODE score

4) CHF in the community: Seattle Heart Failure Model

5) Dementia in a nursing home: Susan Mitchell's MDS index (JAMA 2004)
Anonymous said…
My suggested name:
Horizonview
or Horizonscope

My experience with prognosis and my awareness of the literature (which I don't have systematically indexed or filed) is that progressive loss of ADLs and related nutritional decline are key, no matter what the specific Dx. There are various relevant studies, that I'm sure you know well. Recent important references that impressed me were the JAMA ICU survivor outcome study and the NEJM Disease trajectory report.
Thanks for your excellent and entertaining blog.

Brad Miller MD
Medical Director
Hospice of the Foothills and
Part-time Attending MD, UCSF Palliative Care Service
Anonymous said…
Be sure to include spiritual practice as one of your indicators - people with strong religious beliefs and a regular spiritual practice tend to live longer and healthier lives.
Thanks for this good work,

Rev. Jill Bowden, chaplain
Anonymous said…
How about "How long have I got, doc?" .com??
Eric Widera said…
Bob Arnold emailed me the best title yet - "IC Future".
Lindsey Yourman said…
I just wanted to thank everyone for all of these great thoughts, ideas, and references. We really appreciate it!

Popular posts from this blog

Lost in Translation: Google’s Translation of Palliative Care to ‘Do-Nothing Care’

by: Cynthia X. Pan, MD, FACP, AGSF (@Cxpan5X)

My colleagues often ask me: “Why are Chinese patients so resistant to hospice and palliative care?” “Why are they so unrealistic?” “Don’t they understand that death is part of life?” “Is it true that with Chinese patients you cannot discuss advance directives?”

As a Chinese speaking geriatrician and palliative care physician practicing in Flushing, NY, I have cared for countless Chinese patients with serious illnesses or at end of life.  Invariably, when Chinese patients or families see me, they ask me if I speak Chinese. When I reply “I do” in Mandarin, the relief and instant trust I see on their faces make my day meaningful and worthwhile.

At my hospital, the patient population is about 30% Asian, with the majority of these being Chinese. Most of these patients require language interpretation.  It becomes an interesting challenge and opportunity, as we often need to discuss advance directives, goals of care, and end of life care options…

Elderhood: Podcast with Louise Aronson

In this week's podcast we talk with Louise Aronson MD, MFA, Professor of Geriatrics at UCSF about her new book Elderhood, available for purchase now for delivery on the release date June 11th.

We are one of the first to interview Louise, as she has interviews scheduled with other lesser media outlets to follow (CBS This Morning and Fresh Air with Terry...somebody).

This book is tremendously rich, covering a history of aging/geriatrics, Louise's own journey as a geriatrician facing burnout, aging and death of family of Louise's members, insightful stories of patients, and more.

We focus therefore on the 3 main things we think our listeners and readers will be interested in.

First - why the word "Elder" and "Elderhood" when JAGS/AGS and others recently decided that the preferred terminology was "older adult"?

Second - Robert Butler coined the term ageism in 1969 - where do we see ageism in contemporary writing/thinking?  We focus on Louise's…

Psychedelics: Podcast with Ira Byock

In this week's podcast, we talk with Dr. Ira Byock, a leading palliative care physician, author, and public advocate for improving care through the end of life.

Ira Byock wrote a provocative and compelling paper in the Journal of Pain and Symptom Management titled, "Taking Psychedelics Seriously."

In this podcast we challenge Ira Byock about the use of psychedelics for patients with serious and life-limiting illness.   Guest host Josh Biddle (UCSF Palliative care fellow) asks, "Should clinicians who prescribe psychedelics try them first to understand what their patient's are going through?" The answer is "yes" -- read or listen on for more!

While you're reading, I'll just go over and lick this toad.

-@AlexSmithMD





You can also find us on Youtube!



Listen to GeriPal Podcasts on:
iTunes Google Play MusicSoundcloudStitcher
Transcript
Eric: Welcome to the GeriPal Podcast. This is Eric Widera.

Alex: This is Alex Smith.

Eric: Alex, I spy someone in our …