New online calculator can help predict death and end-of-life care needs for older adults
Although most Canadians die from predictable causes and have health needs that can be met at home, only 20% of people receive a physician home visit in their last year of life.
To help understand the changing care needs of older adults as they age and when they might be nearing the end of their lives, a team of researchers developed the Risk Evaluation for Support: Predictions for Elder-Life in the Community Tool (RESPECT).
The calculator, which predicts death within 6 months, is based on data from more than 491 000 community-dwelling older adults who used home care in the 6-year period between 2007 and 2013.
"The RESPECT calculator allows families and their loved ones to plan," says Dr. Amy Hsu, investigator at the Bruyère Research Institute, affiliate investigator at The Ottawa Hospital, and faculty in the Department of Family Medicine at the University of Ottawa. "For example, it can help an adult child plan when to take a leave of absence from work to be with a parent or decide when to take the last family vacation together."
Using a "big data" approach that represents a population perspective of the end-of-life experience of older adults in Ontario, RESPECT provides estimates of survival. The research team found that declines in a person's ability to carry out activities of daily living, such as hygiene, using the toilet, and locomotion, were stronger predictors of 6-month mortality than the diseases that a person has.
"Knowing how long a person has to live is essential in making informed decisions about what treatments they should get and where they should get them," says Dr. Peter Tanuseputro, physician-scientist at The Ottawa Hospital and ICES, and investigator at the Bruyère Research Institute. "As a person gets closer to death, the balance shifts from having curative care as the primary goal, to care that maximizes a person's quality of remaining life."
The tool was designed with patients and their care partners in mind and has been piloted in community settings in Ontario. It can also be used by physicians and home care staff, in addition to palliative care professionals.
More information: Amy T. Hsu et al, Predicting death in home care users: derivation and validation of the Risk Evaluation for Support: Predictions for Elder-Life in the Community Tool (RESPECT), Canadian Medical Association Journal (2021). DOI: 10.1503/cmaj.200022