“To help prevent overtesting and overtreatment of older patients — or undertreatment for those who remain robust at advanced ages — medical guidelines increasingly call for doctors to consider life expectancy as a factor in their decision-making.”

January 11th, 2012

Can you say death panels?

Now, researchers at the University of California, San Francisco, have identified 16 assessment scales with “moderate” to “very good” abilities to determine the likelihood of death within six months to five years in various older populations. Moreover, the authors have fashioned interactive tools of the most accurate and useful assessments.

On Tuesday, the researchers published a review of these assessments in The Journal of the American Medical Association and posted the interactive versions at a new Web site calledePrognosis.org, the first time such tools have been assembled for physicians in a single online location.

This is one type of prediction that I am somewhat leery of.

Plugging individual variables — age, health conditions, cognitive status, functional ability — into one of the new online tools produces a percentage indicating the likelihood of death within a particular time frame. Some assessments are used for hospital patients or nursing home residents, others for elderly people still living at home. . .  .

At ePrognosis.org, physicians can consult the Porock index, used for assessing life expectancy in long-term nursing home residents. The index indicates, for example, that a man in his late 80s with congestive heart failure, failing kidneys, weight and appetite loss, declining cognitive ability and the need for extensive assistance has a 69 percent chance of dying within six months.

Some aren’t happy this is open to the public.

The authors debated whether to give the public access to ePrognosis, fearing that nonprofessionals might misinterpret the information or fail to consider how their own situations vary from those of various study populations.

The tools are available to anyone who checks a box saying he or she is a health care professional; there is no verification.

“As with any scientific data,” cautioned Dr. Mitchell of Hebrew SeniorLife, “it needs some explanation of the accuracy of these prognostic tools. Some are better than others, and none are perfect. The public needs to understand that.”

In the end, the authors decided that creating barriers to public use would make ePrognosis less useful for physicians as well. They also wanted to bring the public into the discussion.

“This is a philosophical question,” said Dr. Lee, who described a trend toward better-informed patients participating in health care decisions. “In general, patients having more information is a good thing.”

These concerns will likely mirror Harlan. I think the same applies to the law.