View Full Version : Fail this health test and you're dead - maybe

02-15-2006, 08:30 AM
CHICAGO - In what sounds like a perfect parlor game for baby boomers suddenly confronting their own mortality, researchers have come up with 12 risk factors for people older than 50 to answer the question: What are your chances of dying within four years?

This is one game where you want a low score. Zero to 5 points says your risk of dying in four years is less than 4 percent. With 14 points, your risk rises to 64 percent.

Just being male gives you 2 points. So does having diabetes, being a smoker, and getting pooped trying to walk several blocks.

The quiz is designed "to try to help doctors and families get a firmer sense for what the future may hold," to help plan health care accordingly, said Dr. Sei Lee, a geriatrics researcher at the San Francisco Veterans Affairs Medical Center who helped develop it and lead author of the report that appears in today's Journal of the American Medical Association.

"We know that patients and families want more prognostic information from doctors," Lee said. "It's a very natural human question of, "What's going to happen to me?' " This test is roughly 81 percent accurate and can give older people a reasonable idea of their survival chances, Lee and his colleagues say.

Of course, it isn't foolproof. Other experts note it ignores family history and is much less meaningful for those at the young end of the spectrum. The researchers even warn: Don't try this at home, saying a doctor can help you put things into perspective.

"Even if somebody looks at their numbers and finds they have a 60 percent risk of death, there could be other mitigating factors," said Dr. Kenneth Covinsky, a Veterans Affairs researcher and co-author of the medical journal report.

You can improve your chances, he notes, by quitting smoking or taking up exercise.

The test is based on data involving 11,701 Americans over 50 who took part in a national health survey in 1998. Funded by a grant from the National Institute on Aging, the researchers analyzed participants' outcomes during a four-year follow-up. They based their death-risk survey on the health characteristics that seemed to predict death within four years.

Dr. Donald Jurivich, geriatrics chief at the University of Illinois at Chicago, praised the survey for measuring people's ability to function - such as being able to move a piece of furniture or keep track of expenses - which can be more telling than other health factors.

Dr. George Lange, 57, an internist at Columbia-St. Mary's Hospital in Milwaukee, faulted the test for not measuring blood pressure or cholesterol. Lange got a healthy low score on the test, but was surprised he didn't get points for being overweight.

That's one of the most puzzling aspects of the test. People with a body-mass index of less than 25 - which includes normal weight people - get a point while those who are overweight aren't penalized.

Covinsky, one of the test designers, said that BMI measurement includes underweight people - those who have lost weight because of illness, a risk factor for the elderly.

As to obesity, Lee noted diabetes and difficulty walking several blocks - both associated with excess weight - get more points.

The researchers say their mortality predictor might be a useful tool in the "pay for performance" trend in the nation's health care system. Medicare and other insurers are increasingly basing reimbursement rates on how patients fare, Covinsky said.

"One health plan can look better just by cherry-picking health care patients" and accepting only the most robust patients, Covinsky said. This test could give a more accurate assessment of health plans, he said, so that "you can actually see which ones are taking sicker patients and compare that" when measuring performance.

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