Developing prognostic models for life expectancy and geriatric outcomes

 描述(由申请人提供)：1预后是一种状况或疾病的结果风险，例如行动不便的死亡率。2个预后指数集合了多个危险因素的风险，比单个3个因素单独预测更准确地预测结果。目前的预后指标要么不准确，要么无法解释，要么两者兼而有之。因此，临床医生无法在老年人的临床决策中准确地判断预后，这往往导致患者的预后不佳。许多老年人在死前的最后几个小时或几天内被转介到临终关怀中心，或者根本没有其他患者在没有可能活到足够长的时间受益的情况下接触到癌症筛查的危害。目前可用的预测模型估计给定时间范围内的风险，例如4年期间的死亡风险。然而，临床医生和9名患者不会以这种方式考虑风险。他们想知道“我还有多长时间？”这个项目10将通过新颖地利用全国11个有代表性的国家老龄化研究所资助的健康和退休研究中超长的后续时间来解决这一问题。项目12的目标是使用健康和退休研究(HRS)开发和验证易于使用的预后工具，这些工具13估计预期寿命和至残疾、无能力管理药物或财务的时间，或14行动障碍。预后工具将使用HRS进行内部验证，并使用英语老龄化纵向研究(ELSA)进行外部验证。这种方法利用了基于HRS的ELSA为16的事实。该项目预计将通过告知、个体化和改善老年人的临床决策而产生积极影响。

 DESCRIPTION (provided by applicant): 1 Prognosis is the risk of an outcome for a condition or disease, such as mortality of mobility impairment. A 2 prognostic index assembles the risk from multiple risk factors to predict outcome more accurately than a single 3 factor would predict on its own. Current prognostic indexes suffer either from being inaccurate, un- 4 interpretable, or both. Consequently, clinicians are unable to accurately determine prognosis in clinical 5 decision making for older adults, often leading to poor outcomes for patients. Many older adults are referred to 6 hospice in the last few hours or days before death, or never at all Other patients are exposed to the harms of 7 cancer screening without the possibility they will live long enough to benefit. Currently available prognostic 8 models estimate risk over a given time frame, such as risk of death over a 4 year period. Clinicians and 9 patients do not think of risk this way, however. They want to know "how long do I have?" This project will 10 address this question by making novel use of the exceptionally long follow up time in the nationally 11 representative National Institute of Aging-funded Health and Retirement Study. The objectives of this project 12 are to use the Health and Retirement Study (HRS) to develop and validate easy-to-use prognostic tools that 13 estimate life-expectancy and time to the onset of disability, inability to manage medications or finances, or 14 mobility impairment. Prognostic tools will be internally validated using the HRS and externally validated 15 using the English Longitudinal Study on Aging (ELSA). This approach leverages the fact that the ELSA was 16 based on the HRS. This project is expected to have a positive impact by informing, individualizing, and 17 improving clinical decision-making in older adults.