Everyone's Health

Test estimates the risk of dying within four years

Lindsey Tanner

It sounds like a perfect parlor game for baby boomers confronting their own mortality: What are your chances ofdying within four years?

Researchers have come up with 12 risk factors to try to answer that for people who are 50 and older. (See The List below.)

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.

Points accrue with each four-year increment after age 60.

The test doesn't ask what you eat, but it does ask if you can push a living room chair across the floor.

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 lead author Dr. Sei Lee, a geriatrics researcher at the San Francisco Veterans Affairs Medical Center who helped develop it.

“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?' We also know that doctors are very cautious about giving prognostic information because they don't want to be wrong.”

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 that it ignores family history and that it's much less meaningful for those at the young end of the spectrum.

The researchers even warn not to 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 co-author and VA researcher Dr. Kenneth Covinsky.

There are things you can do to improve your chances, he notes, such as 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.

Their report appears in today's Journal of the American Medical Association.

Dr. Donald Jurivich, geriatrics chief at the University of Illinois at Chicago, took the test and got a low score. Jurivich is 52. He said he'd feel better about his score if both his parents hadn't died prematurely.

He 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 – signs that can be more telling than other health factors.

Dr. George Lange, a 57-year-old 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, too, but he's overweight. He was surprised he didn't get points for that.

In fact, 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 particularly disturbing sign for the elderly.

As to obesity, Lee noted there are more points for diabetes and for difficulty walking several blocks – both associated with excess weight.

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

If you're 50 or older, this test attempts to calculate your risk of death within four years.

• 1. Age:
  60-64 years old, 1 point
  65-69, 2 points
  70-74, 3 points
  75-79, 4 points
  80-84, 5 points
  85 and older, 7 points
  
  
• 2. Male or Female:
  Male, 2 points
  
  
• 3. Body-Mass Index:
  Less than 25 (normal weight or less), 1 point.
  (Calculate by multiplying height in inches times height in inches; then divide weight in pounds by that total; then multiply the total by 703.)
  
  
• 4. Diabetes: 2 points
  
  
• 5. Cancer (excluding minor skin cancers): 2 points
  
  
• 6. Chronic lung disease that limits activities or requires oxygen use at home: 2 points
  
  
• 7. Congestive heart failure: 2 points
  
  
• 8. Cigarette smoking in the past week: 2 points
  
  
• 9. Difficulty bathing because of a health or memory problem: 2 points
  
  
• 10. Difficulty managing money, paying bills, keeping track of expenses because of a health or memory problem: 2 points
  
  
• 11. Difficulty walking several blocks because of a health problem: 2 points
  
  
• 12. Difficulty pushing or pulling large objects like a living room chair because of a health problem: 1 point
  
  Score:
  
  
• 0 to 5 points: less than a 4% risk of dying
  
• 6-9 points, 15% risk
• 10-13 points, 42% risk
• 14 or more points, 64% risk

Note: Researchers say the 1-point penalty for having a body-mass index under 25 (normal weight or less) is based on findings that being underweight is a health risk for elderly people.

Source: San Francisco Veterans Affairs Medical Center

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