The measurement of health: A comparison of indices of disease severity

This study compared the utility of different health indicators in frail old er people, as a component of a larger study of medical evaluations of 183 a dult day care participants in five Maryland centers. Indices examined inclu ded: number of disease categories, number of active categories, number of s evere categories, number of categories with worsening trajectory, and avera ge severity score. In predicting survival, none of the medical indicators w ithout dementia was a strong predictor of survival. When dementia was inclu ded. number of categories with worsening trajectory seemed to be the best i ndicator of survival, with average severity score being a close second. Amo ng the diagnoses, dementia and its severity were the strongest predictors o f survival. Prediction of continuous stay in the community (in contrast to death or entry into a nursing home) was significant for most indices and is easier to predict from medical indices than death. Different indicators pr ovided best utility depending on the criterion applied. (C) 2001 Elsevier s cience Inc. All rights reserved.