Home › Research › How common it is
Development and validation of a prognostic index for 1-year mortality in older adults after hospitalization
Walter LC, Brand RJ, Counsell SR, Palmer RM, Landefeld CS, Fortinsky RH, Covinsky KE.. JAMA, 2001-06-01
Topic: Risk, prevention and care in population studies
Context For many elderly patients, an acute medical illness requiring hospitalization is followed by a progressive decline, resulting in high rates of mortality in this population during the year following discharge. However, few prognostic indices have focused on predicting posthospital mortality in older adults. Objective To develop and validate a prognostic index for 1 year mortality of older adults after hospital discharge using information readily available at discharge. Design Data analyses derived from 2 prospective studies with 1-year of follow-up, conducted in 1993 through 1997. Setting and patients We developed the prognostic index in 1495 patients aged at least 70 years who were discharged from a general medical service at a tertiary care hospital (mean age, 81 years; 67% female) and validated it in 1427 patients discharged from a separate community teaching hospital (mean age, 79 years; 61% female). Main outcome measure Prediction of 1-year mortality using risk factors such as demographic characteristics, activities of daily living (ADL) dependency, comorbid conditions, length of hospital stay, and laboratory measurements. Results In the derivation cohort, 6 independent risk factors for mortality were identified and weighted using logistic regression: male sex (1 point); number of dependent ADLs at discharge (1-4 ADLs, 2 points; all 5 ADLs, 5 points); congestive heart failure (2 points); cancer (solitary, 3 points; metastatic, 8 points); creatinine level higher than 3.0 mg/dL (265 micromol/L) (2 points); and low albumin level (3.0-3.4 g/dL, 1 point; 6 points). In the validation cohort, 1-year mortality was 4% in the lowest-risk group, 19% in the group with 2 or 3 points, 34% in the group with 4 to 6 points, and 64% in the highest-risk group. The area under the receiver operating characteristic curve for the point system was 0.75 in the derivation cohort and 0.79 in the validation cohort. Conclusions Our prognostic index, which used 6 risk factors known at discharge and a simple additive point system to stratify medical patients 70 years or older according to 1-year mortality after hospitalization, had good discrimination and calibration and generalized well in an independent sample of patients at a different site. These characteristics suggest that our index may be useful for clinical care and risk adjustment.
Key findings
- Results In the derivation cohort, 6 independent risk factors for mortality were identified and weighted using logistic regression: male sex (1 point); number of dependent ADLs at discharge (1-4 ADLs, 2 points; all 5 ADLs, 5 points); congestive heart failure (2 points); cancer (solitary, 3 points; metastatic, 8 points); creatinine level higher than 3.0 mg/dL (265 micromol/L) (2 points); and low albumin level (3.0-3.4 g/dL, 1 point; <3.0 g/dL, 2 points).
- These characteristics suggest that our index may be useful for clinical care and risk adjustment.
Why it matters
This study developed and validated an index using factors such as male sex, dependence in daily activities, heart failure and cancer to predict one-year mortality in older adults after hospital discharge. It is about predicting death after hospitalization and has no bearing on treating, curing or preventing Alzheimer's disease.
New to this subject? Start with our plain-English guide: Alzheimer's in numbers →
Study details
- Participants1,495
- Evidence strengthModerate
How this study scored 60/100
Published in a top-tier journal. Scored zero for study design, effect reported and randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 10 / 10 | Tier 1 — top-tier general journal (JAMA) |
| Journal's citation record | 4 / 4 | JAMA: journal h-index 1,011 (OpenAlex, 2026-10-29) |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 3 / 5 | Rated “moderate” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 1 / 5 | 2001 — older than 20 years, still counted |
| Sample size | 3 / 4 | 1,495 participants |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 6 / 7 | Cited 674 times (OpenAlex, 2026-10-10) |
| Citations per year | 4 / 5 | 25.0 citations a year over 27 year(s) since 2001 |
| Impact for its field and year | 4 / 6 | Cited 10.9× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 2 / 6 | Cited by 4 other studies in this library |
| Still being cited | 2 / 4 | Cited 44 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 3 / 4 | Last-listed author Louise Christie Walter: h-index 55 (OpenAlex, whole career) |
| Institution's track record | 2 / 3 | University of California, San Francisco: institution h-index 1,915 (OpenAlex) |
| Multi-centre collaboration | 1 / 3 | OpenAlex lists 2 institution(s) in 1 country |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 11410097) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Total | 60 / 100 | — |
What each of these 20 components measures, and what this score is not →
Read the original
May need a subscription OpenAlex found no free copy of the full text (checked 6 Feb 1020), so the publisher may charge for it. The PubMed abstract is free.
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. The record names 7 authors; APA and Vancouver show the first six, BibTeX and the downloads carry all of them. Check the citation against the original before you use it.
APA 7th
Walter, L. C., Brand, R. J., Counsell, SR., Palmer, R. M., Landefeld, C. S., Fortinsky, R. H., et al. (2001). Development and validation of a prognostic index for 1-year mortality in older adults after hospitalization. JAMA. https://doi.org/10.1001/jama.285.23.2987
Vancouver
Walter LC, Brand RJ, Counsell SR, Palmer RM, Landefeld CS, Fortinsky RH, et al. Development and validation of a prognostic index for 1-year mortality in older adults after hospitalization. JAMA. 2001. doi:10.1001/jama.285.23.2987. PMID: 11410097.
BibTeX
@article{walter2001-11410097,
author = {Walter, L. C. and Brand, R. J. and Counsell, SR. and Palmer, R. M. and Landefeld, C. S. and Fortinsky, R. H. and Covinsky, K. E.},
title = {{Development and validation of a prognostic index for 1-year mortality in older adults after hospitalization}},
journal = {JAMA},
year = {2001},
doi = {10.1001/jama.285.23.2987},
pmid = {11410097},
url = {https://doi.org/10.1001/jama.285.23.2987}
}
Later studies that cite this one
4 studies in the alzhub library list this one in their references.
Related studies in How common it is
Also tagged “delirium”
858 studies in the library carry the topic tag “delirium”; these are this study's neighbours in a fixed, alphabetical-by-hash tour of them, not the closest in content. All 858 tagged studies.