• Hao Luo, Lou Vivian W Q VWQ 2 Department of Social Work and Social Administration and Sau Po Centre on Ageing, The University of Hong Kong , Hong Kong, China ., Yuekang Li, and Iris Chi.
• 1 Department of Social Work and Social Administration, The University of Hong Kong , Hong Kong, China .
• J Palliat Med. 2019 Mar 1; 22 (3): 258-266.

BackgroundTo promote better care at the end stage of life in long-term care facilities, a culturally appropriate tool for identifying residents at the end of life is crucial.ObjectiveThis study aimed to develop and validate a prognostic tool, the increased risk of death (IRD) scale, based on the minimum data set (MDS).DesignA retrospective study using data between 2005 and 2013 from six nursing homes in Hong Kong.Setting/SubjectsA total of 2380 individuals were randomly divided into two equal-sized subsamples: Sample 1 was used for the development of the IRD scale and Sample 2 for validation.MeasurementsThe measures were MDS 2.0 items and mortality data from the discharge tracking forms. The nine items in the IRD scale (decline in cognitive status, decline in activities of daily living, cancer, renal failure, congestive heart failure, emphysema/chronic obstructive pulmonary disease, edema, shortness of breath, and loss of weight), were selected based on bivariate Cox proportional hazards regression.ResultsThe IRD scale was a strong predictor of mortality in both Sample 1 (HRsample1 = 1.50, 95% confidence interval [CI]: 1.37-1.65) and Sample 2 (HRsample2 = 1.31, 1.19-1.43), after adjusting for covariates. Hazard ratios (HRs) for residents who had an IRD score of 3 or above for Sample 1 and Sample 2 were 3.32 (2.12-5.21) and 2.00 (1.30-3.09), respectively.ConclusionsThe IRD scale is a promising tool for identifying nursing home residents at increased risk of death. We recommend the tool to be incorporated into the care protocol of long-term care facilities in Hong Kong.

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