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局风险，如活动障碍的死亡率。一个2预后指数集合了多个危险因素的风险，比一个3因素单独预测结果更准确。目前的预后指标要么不准确，无法解释，或两者兼而有之。因此，临床医生无法在老年人的临床决策中准确地确定预后，通常导致患者的预后不良。许多老年人在死亡前的最后几个小时或几天内被转诊到临终关怀中心，或者根本没有被转诊到临终关怀中心。目前可用的预后模型估计给定时间范围内的风险，例如4年内的死亡风险。然而，临床医生和9名患者并不认为这种风险。他们想知道“我还能活多久？“这个项目将通过新颖地利用全国11个代表性的国家老龄化研究所资助的健康和退休研究中异常长的随访时间来解决这个问题。该项目的目标12是利用健康和退休研究（HRS）开发和验证易于使用的预测工具，13估计预期寿命和发生残疾的时间，无法管理药物或财务，或14移动障碍。将使用HRS对预后工具进行内部确认，并使用英国老龄化纵向研究（艾尔莎）对预后工具进行外部确认。该方法利用了基于HRS的艾尔莎为16的事实。该项目预计将通过提供信息，个性化和改善老年人的临床决策产生积极影响。

 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.