14 DAY TRIAL // If you are 50 years or older, a doctor can now tell you what's the likelihood of your death within the next 4 years with 81 percent accuracy. This information can be gathered with the help of a 12-question form that "could be completed in a few minutes by a patient or medical office receptionist," said Sei J. Lee, MD, a geriatric specialist at San Francisco VA Medical Center and lead author of the test. This test provides the first quantitative index of how healthy is someone.
"There's a real need for this kind of prognostic index, for several reasons," says Lee. "For example, is it worth it to order a Pap smear or colonoscopy for a particular patient? Those sorts of screening interventions generally don't help patients until five to eight years after they are given. Doctors need to get a sense of who will survive long enough to benefit."
Such data could also be used for comparing the quality of health care provided by different hospitals. This could influence their reputation and could also have an impact on the sums of money they receive from the state. Moreover, insurance companies will probably want to have access to such data.
Another important application of the test is that it can describe quantitatively the health differences between two groups. "If one group is healthier, this index can capture how much healthier they are. This can help researchers isolate the effect of a treatment from the baseline differences between the two groups."
Finally, and of course most importantly, this quiz can help doctors and families plan health care better. "Even if somebody looks at their numbers and finds they have a 60 percent risk of death, there could be other mitigating factors,'' said co-author and VA researcher Dr. Kenneth Covinsky. There are things you can do to improve your chances, he notes, such as quitting smoking or taking up exercise.
To create the index, the researchers looked at data collected between 1998 and 2002 from 19,710 adults aged 50 and older who participated in the nationwide Health and Retirement Survey (HRS). The researchers classified participants according to three broad classes of variables: demographics (gender and age); illnesses (such as cancer, diabetes, heart disease, and hypertension); and ability to perform activities of daily living (such as washing, dressing, shopping, and managing finances). They then noted who had died by December 31, 2002 and analyzed to what extent the different variables had predicted mortality.
"The fact that we account for different kinds of risk factors, functional as well as disease-related, allows the scale to be accurate over a very wide range of ages, as well as in all kinds of different people," says Lee. "It gives you the flavor of the relative importance of each risk factor. For example, being unable to walk several blocks is as many points off as having heart failure."
One of the most surprising facts discovered was that overweight people, in spite of their increase risk of heart failure, are in fact more likely to survive than thin people. This doesn't mean that being fat is healthy but that older people are often thin as a consequence of illness. Dr. Lee noted however, that diabetes and the difficulty of walking several blocks - both associated with excess weight - do decrease your chances of survival. So, although overweight in itself didn't come up in the test as a relevant factor, it did enter the picture in an indirect way.
Ideally, says Lee, "I see the index being used as part of a standard intake form in the doctor's office, when the doctor sees the patient for the first time."
It remains to be seen how many people would want such information.