Table 1

Category 2 of the NECPAL CCOMS-ICO tool: general indicators of severity and progression

DomainSeverityProgression (in the last 6 months)
Functional markersSerious established functional dependence (Barthel Score <25, ECOG >2 or Karnofsky Score <50%)Loss of two or more ADLs even though there is adequate therapeutic intervention or clinical perception of functional decline (sustained, intense/severe, progressive, irreversible) not related to concurrent conditions
Nutritional markersSerum albumin <2.5 g/dL, not related to acute episodes of unbalanceWeight loss >10% or clinical perception of nutritional decline (sustained, intense/severe, progressive, irreversible) not related to concurrent conditions
CognitiveUnable to dress, wash or eat without assistance (GDS/FAST 6c), urinary and faecal incontinence (GDS/FAST 6d–e) or unable to communicate meaningfully—six or less intelligible words (GDS/FAST 7)Loss of two or more ADLs in the last 6 months, despite adequate therapeutic intervention (invaluable in hyperacute situation due to concurrent processes) or difficulty swallowing, or denial to eat, in patients who will not receive enteral or parenteral nutrition
EmotionalPresence of emotional distress with psychological symptoms (sustained, intense/severe, progressive) not related to acute concurrent conditions
Geriatric syndromes (in the last 6 months)Persistent pressure ulcers (stages III–IV), recurrent infections (>1), delirium, persistent dysphagia, falls (>2)
ComorbidityCharlson Index
Additional factors on use of resources
  • Two or more urgent (unplanned) hospital (or skilled nursing facilities) admissions due to chronic disease in the last year

  • Need of complex/intense continuing care, either at an institution or at home

  • ADL, activities of daily living; ECOG, Eastern Cooperative Oncology Group; GDS/FAST, Global Deterioration Scale/Functional Assessment Staging.