“The prognostic indicators in an older community-dwelling palliative population”

Co-morbidity and functional disability, with frailty are the key inter-related determinants of vulnerability for decline and death in older people1-2, The presence of these factors is key for determining outcomes for elderly people yet many prognostic tools are focussed on single disease entities, lack validation and are not designed for community dwelling patients3. Despite the recognition of the importance of these factors the relationship between the trajectory of functional decline, co-morbidity and death are incompletely understood4-6. More complete understanding of these relationships has the potential to benefit individual patients with more accurate prognostication. Service delivery may also be enhanced with more targeted allocation of resources to this population.

This study aims to clarify the relationship between agel functional impairment, co-morbidity and death in a community -dwelling palliative population.

This study entailed a retrospective assessment of consecutive admissions older than 65yrs over a six-month period to a community palliative care service. Patient data including age, diagnoses, and functional data derived from KPS, RUG-ADL, and residence and care level descriptors at admission were collected from PCOC data and the Palcare database. These factors were compared with outcomes of time until death and site of death by multi-variate and cox regression analyses.

The results of this -study will be presented. Further planned research through a prospective assessment of the functional disability, co-morbidity and a determination of frailty using the Vulnerable Elders Survey to predict outcomes in a community-dwelling palliative population will also be outlined'.

1.    Fried LP, Ferrucci L, Darer J, Williamson JD, Anderson G. Untangling the concepts of disability,
       frailty and comorbidity: Implications for improved targeting and care.
       J Gerontal A Bioi Sci Med Sci. 2004;59:255-263.
2.    Evers MM, Meier DE, Morrison RS. Assessing differences in care needs and service utilisation
       in geriatric palliative care patients. Journal of Pain and Symptom Management 2002;23[5J:424-432
3.    Cevntry PA, Grande GE, Richards DA, Todd CJ. Prediction of appropriate timing of palliative care
       for older adults with non-malignant life-threatening disease: a systematic review. Age and ageing
       2005;34:218-227
4.    Oliver D, Porock D, 2weig S et al. End of life care in US nursing homes: A review of the Evidence.
       ]AMDA 2004; 5: 147-155
5.    Gill TM, Gahbauer EA, Han L, Allore HG. Trajectories of disability in the last year of life.
       NEJM 2010; 362[13J:1173-80.
6.    Covinsky KE, Eng C, Lui LY, Sands LP, Yaffe K. The last 2 years of life: Functional trajectories of
       frail older people. JAGS 2003;51
7.    Saliba D et al. The Vulnerable Elders Survey: A tool for identifying vulnerable older people in the
       community. JAGS 2001;49:1691-99