CLINICIAN’S CORNERCLINICAL REVIEW Prognostic Indices for Older Adults A Systematic Review

FAILURE TO CONSIDER PROGNO-sis in the context of clinical de-cision making can lead to poorcare. Hospice is underutilized for patients with nonmalignant yet life-threatening diseases.1 Healthy older pa-tients with good prognosis have low rates of cancer screening.2 Older adults with advanced dementia or metastatic cancer are screened for slow-growing cancers that are unlikely to ever cause them symptoms but may lead to distress from false-positive results, in-vasive workups, and treatments.3,4 In recognition of these phenomena, guide-lines increasingly incorporate life ex-pectancy as a central factor in weigh-ing the benefits and the burdens of tests and treatments (TABLE 1). Prognostic indices offer a potential role for mov-ing beyond arbitrary age-based cutoffs in clinical decision making for older adults.2 However, little is known about the quality of prognostic indices for older adults, limiting their clinical use. We performed a systematic review to describe the quality and limitations of validated non–disease-specific prog-nostic indices that predict absolute risk of all-cause mortality in older adults. Recognizing that older adults are more likely to have more than 1 chronic ill-ness than younger adults, we focused on non–disease-specific indices. METHOD