PredictingThe Big D

“How long do I have, Doc?”  That’s the first sentence of a recent article in USA Today.   My daughter, a palliative care social worker and an unfailing source of good ideas for posts, alerted me to it  (http://yourlife.usatoday.com/health/story/2012-02-19/Do-seniors-really-want-to-know-life-expectancy/53158420/1) The article describes a new website (eprognosis.org) that offers various indices predicting longevity for the elderly.  Although the site, developed by researchers at the University of California-San Francisco, asks you to identify yourself as a medical care professional (without verification) in order to gain access to the indices, more than a half million people visited the site within the first five weeks of its launch.  It’s unlikely that all of them were physicians.

The developers of the website hope that it will stimulate discussion between physicians and elderly patients about life expectancy, a discussion that many physicians avoid initiating.  But patients and their families know that life is finite, and a discussion of their chances of survival for a given number of years can help guide decisions as to the use of various tests, procedures, and operations.  Does it make sense, for example, for an 86-year-old woman to undergo a mammogram?  Normally the test is not recommended for a woman that old because she is more likely to die of something else before she dies of breast cancer.  But if the chances of her living for many more years are good, because she is still in excellent health, then the test might be beneficial.  At any rate, elderly patients are usually glad to learn that they need undergo no more colonoscopies. 

The indices present the chances of mortality within a given number of years, using information such as the patient’s age, history of smoking, presence of various diseases, body mass index, number of hospitalizations within the past year, and ability to carry out various tasks independently.  The indices are specific to given populations of elders: those in the general population, those in nursing homes, and those in hospitals.  Three indices, all for elders in the general population, are relevant for me, the Lee index, which predicts the odds of mortality within the next four years, and two Schonberg indices, one predicting the chances of mortality within the next five years, the second predicting the odds of death within the next nine years. 

Do I want to know what the odds are for myself?  You bet.  I’ll let you know what I find out in my next post.