Skip to main content

A New Tool for Estimating Prognosis in the Elderly

"What if your doctor, making use of a Web site that collected a number of tested geriatric scales, could enter information about your history and your health, and then predict with reasonable accuracy your odds of living another year, or four, or nine?
What if you, with a slight fib, could log onto that same site and find that information yourself?"

This is the start of Paula Span's most recent New Old Age article in the NY Times titled 'Figuring the Odds'. The question she poses to her audience is whether the general public should have access to geriatric prognostic indexes. This is not some farfetched proposal, but rather a discussion that is coming on anticipated launch a new website created by some GeriPal contributors that will list 18-20 geriatric prognostic indexes.

Why bother with creating a website that can help with prognosticating? Well, although lots of geriatric prognostic indexes have been published, their use has been limited as there is no one place for health care providers to easily access them. The goals of this new service are to create a repository of published geriatric prognostic indexes where clinicians can go to obtain evidence-based information on patients’ prognosis.

But what about the general public? In its current form, the new website is only intended as a rough guide to inform clinicians about possible mortality outcomes. It is not meant to be used as the only basis for making care decisions, nor should it be viewed as a definitive means of predicting prognosis. As when using any prognostic tool, every patient should be considered as an individual, and other factors beyond those listed in the tool may influence a patient's prognosis.

Will the general public understand this? For that matter, will physicians understand this?

So far the comments on the post are very pro open access. Nearly all feel that the general public is savvy enough to understand the nuances of prognostication. Here is an exerpt of one comment:

"Yes, as a reasonably educated woman in my early 70's, I would definitely wish to have access to the site to help guide my own medical (and life) choices. My goal is to remain active and independent as long as possible, yet not burden our creaky medical system any more than necessary, I understand that the site deals in population statistics, rather than clairvoyance, and would be outraged if such potentially critical information were restricted to "medical professionals"…"
Do you agree?  Share your opinion. Go to Paula Span's New York Times article [click here] and comment. 

by: Eric Widera


DocKJ said…
"But doctor, you're LYING, the government is making you tell mom she's only got a 10% chance of living a year..."

(Snippet from an actual recent encounter with a patient's family.)

Rational discussion is hard when you are being accused as a liar and shill for the government and insurance.

An open access, evidence based site, run independent of any .gov or .com influence, could be a good tool to help families understand just how sick mom is.

HenryF said…
name suggestions: "tell me when" or "timeline".

Popular posts from this blog

Practical Advice for the End of Life: A Podcast with BJ Miller

This week we talk with BJ Miller, hospice and palliative care physician, public speaker, and now author with Shoshana Berger of the book "A Beginner's Guide to the End."

As we note on the podcast, BJ is about as close as we get to a celebrity in Hospice and Palliative Care.  His TED Talk "What Really Matters at the End of Life" has been viewed more than 9 million times.  As we discuss on the Podcast, this has changed BJ's life, and he spends most of his working time engaged in public speaking, being the public "face" of the hospice and palliative care movement.

The book he and Berger wrote is filled to the brim with practical advice.  I mean, nuts and bolts practical advice.  Things like:
How to clean out not only your emotional house but your physical house (turns out there are services for that!)Posting about your illness on social media (should you post to Facebook)What is the difference between a funeral home and mortuaryCan I afford to die?  …

Improving Advance Care Planning for Latinos with Cancer: A Podcast with Fischer and Fink

In this week's GeriPal podcast we talk with Stacy Fischer, MD and Regina Fink, RN, PhD, both from the University of Colorado, about a lay health navigator intervention to improve advance care planning with Latinos with advanced cancer.  The issue of lay health navigators raises several issues that we discuss, including:
What is a lay health navigator?What do they do?  How are they trained?What do lay health navigators offer that specialized palliative care doesn't?  Are they replacing us?What makes the health navigator intervention particularly appropriate for Latinos and rural individuals?  For advance care planning? Eric and I had fun singing in French (yes French, not Spanish, listen to the podcast to learn why).
Enjoy! -@AlexSmithMD

You can also find us onYoutube!

Listen to GeriPal Podcasts on:
iTunes Google Play MusicSoundcloudStitcher


Eric: Welcome to the GeriPal podcast. This is Eric Widera.

Alex: This is Alex Smith.

Eric: And Alex, I'm really excited about toda…

The Dangers of Fleet Enemas

The dangers of oral sodium phosphate preparations are fairly well known in the medical community. In 2006 the FDA issued it’s first warning that patients taking oral sodium phosphate preparations are at risk for potential for acute kidney injury. Two years later, over-the-counter preparations of these drugs were voluntarily withdrawn by the manufacturers.  Those agents still available by prescription were given black box warnings mainly due to acute phosphate nephropathy that can result in renal failure, especially in older adults. Despite all this talk of oral preparations, little was mentioned about a sodium phosphate preparation that is still available over-the-counter – the Fleet enema.

Why Oral Sodium Phosphate Preparations Are Dangerous 

Before we go into the risks of Fleet enemas, lets spend just a couple sentences on why oral sodium phosphate preparations carry significant risks. First, oral sodium phosphate preparations can cause significant fluid shifts within the colon …