The MDS Mortality Risk Index: The evolution of a method for predicting 6-month mortality in nursing home residents.
The MDS Mortality Risk Index: The evolution of a method for predicting 6-month mortality in nursing home residents.
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DOI：
10.1186/1756-0500-3-200
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发表时间：
2010-07-16
影响因子：
1.8
通讯作者：
Rantz, Marilyn
中科院分区：
文献类型：
--
作者：
Porock, Davina;Parker-Oliver, Debra;Rantz, Marilyn
背景：准确的预后对于启动预先护理计划至关重要，特别是对于护理院居民等弱势、高危人群。本文的目的是报告 MDS 死亡率评级指数 (MMRI) 的修订和简化，用于临床实践，以预测疗养院居民六个月内的死亡概率。方法：该设计是对美国长期护理居民最小数据集 (MDS) 的二次分析，使用回归分析来确定六个月内死亡率的预测因素。结果：使用 12 个易于收集的项目，在 MDS 数据库中准确预测了六个月内的死亡概率。这些项目是： 三个月内进入疗养院；过去三个月内无意中体重减轻；肾功能衰竭;慢性心力衰竭；食欲不佳；男性;脱水；呼吸急促；积极的癌症诊断；年龄;过去三个月认知能力恶化；结论：缺乏对死亡临近的认识常常被归咎于老年人在生命结束时不恰当地入院治疗。对居住在住宅或疗养院的老年人进行准确的预后可以促进临终决策和规划临终时的首选护理地点。最初的 MMRI 源自美国长期护理居民的大型数据库并经过验证。然而，修订后的指数 (MMRI-R) 的这种简化可能会为未使用 MDS 的美国境外的应用提供一种促进预测和寿命终止讨论的方法。需要进行前瞻性测试，以进一步测试 MMRI-R 的准确性及其在英国和其他非 MDS 设置中的应用。
BACKGROUND: Accurate prognosis is vital to the initiation of advance care planning particularly in a vulnerable, at risk population such as care home residents. The aim of this paper is to report on the revision and simplification of the MDS Mortality Rating Index (MMRI) for use in clinical practice to predict the probability of death in six months for care home residents.METHODS: The design was a secondary analysis of a US Minimum Data Set (MDS) for long term care residents using regression analysis to identify predictors of mortality within six months.RESULTS: Using twelve easy to collect items, the probability of mortality within six months was accurately predicted within the MDS database. The items are: admission to the care home within three months; lost weight unintentionally in past three months; renal failure; chronic heart failure; poor appetite; male; dehydrated; short of breath; active cancer diagnosis; age; deteriorated cognitive skills in past three months; activities of daily living score.CONCLUSION: A lack of recognition of the proximity of death is often blamed for inappropriate admission to hospital at the end of an older person's life. An accurate prognosis for older adults living in a residential or nursing home can facilitate end of life decision making and planning for preferred place of care at the end of life. The original MMRI was derived and validated from a large database of long term care residents in the USA. However, this simplification of the revised index (MMRI-R) may provide a means for facilitating prognostication and end of life discussions for application outside the USA where the MDS is not in use. Prospective testing is needed to further test the accuracy of the MMRI-R and its application in the UK and other non-MDS settings.