| Title | Predicting death in home care users: derivation and validation of the Risk Evaluation for Support: Predictions for Elder-Life in the Community Tool (RESPECT) |
| Publication Type | Journal Article |
| Year of Publication | 2021 |
| Authors | Hsu AT, Manuel DG, Spruin S, Bennett C, Taljaard M, Beach S, Sequeira Y, Talarico R, Chalifoux M, Kobewka D, Costa AP, Bronskill SE, Tanuseputro P |
| Journal | CMAJ |
| Volume | 193 |
| Issue | 26 |
| Pagination | E997-E1005 |
| Date Published | Jul 5 |
| ISBN Number | 1488-2329 (Electronic)<br/>0820-3946 (Print)<br/>0820-3946 (Linking) |
| Accession Number | 34226263 |
| Keywords | *Advance Care Planning, *Terminal Care, Aged, Death, Geriatric Assessment/*methods, Humans, Kaplan-Meier Estimate, Middle Aged, Proportional Hazards Models, Risk Assessment/*methods |
| Abstract | BACKGROUND: Prognostication tools that report personalized mortality risk and survival could improve discussions about end-of-life and advance care planning. We sought to develop and validate a mortality risk model for older adults with diverse care needs in home care using self-reportable information - the Risk Evaluation for Support: Predictions for Elder-Life in the Community Tool (RESPECT). METHODS: Using a derivation cohort that comprised adults living in Ontario, Canada, aged 50 years and older with at least 1 Resident Assessment Instrument for Home Care (RAI-HC) record between Jan. 1, 2007, and Dec. 31, 2012, we developed a mortality risk model. The primary outcome was mortality 6 months after a RAI-HC assessment. We used proportional hazards regression with robust standard errors to account for clustering by the individual. We validated this algorithm for a second cohort of users of home care who were assessed between Jan. 1 and Dec. 31, 2013. We used Kaplan-Meier survival curves to estimate the observed risk of death at 6 months for assessment of calibration and median survival. We constructed 61 risk groups based on incremental increases in the estimated median survival of about 3 weeks among adults at high risk and 3 months among adults at lower risk. RESULTS: The derivation and validation cohorts included 435 009 and 139 388 adults, respectively. We identified a total of 122 823 deaths within 6 months of a RAI-HC assessment in the derivation cohort. The mean predicted 6-month mortality risk was 10.8% (95% confidence interval [CI] 10.7%-10.8%) and ranged from 1.54% (95% CI 1.53%-1.54%) in the lowest to 98.1% (95% CI 98.1%-98.2%) in the highest risk group. Estimated median survival spanned from 28 days (11 to 84 d at the 25th and 75th percentiles) in the highest risk group to over 8 years (1925 to 3420 d) in the lowest risk group. The algorithm had a c-statistic of 0.753 (95% CI 0.750-0.756) in our validation cohort. INTERPRETATION: The RESPECT mortality risk prediction tool that makes use of readily available information can improve the identification of palliative and end-of-life care needs in a diverse older adult population receiving home care. |
| DOI | 10.1503/cmaj.200022 |
| Custom 1 | Competing interests: Spruin has received support as a research assistant from Bruyere Research Institute. No other competing interests were declared. |
| PMCID | PMC8248571 |
| Link |
