RT Journal Article
SR Electronic
T1 Development and validation of a life expectancy estimator for multimorbid older adults: a cohort study protocol
JF BMJ Open
JO BMJ Open
FD British Medical Journal Publishing Group
SP e048168
DO 10.1136/bmjopen-2020-048168
VO 11
IS 8
A1 Viktoria Gastens
A1 Cinzia Del Giovane
A1 Daniela Anker
A1 Martin Feller
A1 Lamprini Syrogiannouli
A1 Nathalie Schwab
A1 Douglas C Bauer
A1 Nicolas Rodondi
A1 Arnaud Chiolero
YR 2021
UL http://bmjopen.bmj.com/content/11/8/e048168.abstract
AB Background Older multimorbid adults have a high risk of mortality and a short life expectancy (LE). Providing high-value care and avoiding care overuse, including of preventive care, is a serious challenge among multimorbid patients. While guidelines recommend to tailor preventive care according to the estimated LE, there is no tool to estimate LE in this specific population. Our objective is therefore to develop an LE estimator for older multimorbid adults by transforming a mortality prognostic index, which will be developed and internally validated in a prospective cohort.Methods and analysis We will analyse data of the Optimising Therapy to Prevent Avoidable Hospital Admissions in Multimorbid Older People cohort study in Bern, Switzerland. 822 participants were included at hospitalisation with age of 70 years or older, multimorbidity (three or more chronic medical conditions) and polypharmacy (use of five drugs or more for >30 days). All-cause mortality will be assessed during 3 years of follow-up. We will apply a flexible parametric survival model with backward stepwise selection to identify the mortality risk predictors. The model will be internally validated using bootstrapping techniques. We will derive a point-based risk score from the regression coefficients. We will transform the 3-year mortality prognostic index into an LE estimator using the Gompertz survival function. We will perform a qualitative assessment of the clinical usability of the LE estimator and its application. We will conduct the development and validation of the mortality prognostic index following the Prognosis Research Strategy (PROGRESS) framework and report it following the Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis (TRIPOD) statement.Ethics and dissemination Written informed consent by patients themselves or, in the case of cognitive impairment, by a legal representative, was required before enrolment. The local ethics committee (Kantonale Ethikkommission Bern) has approved the study. We plan to publish the results in peer-reviewed journals and present them at national and international conferences.