“Good Enough” Prognostication

January 2018 – The point of prognostication is not to be right, but to help people prepare.

Avoid the trap of exact numbers. Develop a prognosis that is good enough to allow for important decisions to be made around advanced planning, therapeutic interventions, and important personal work. We give prognostic ranges such as “days to a few weeks” or “weeks to a few months”.

There are several tools to help with prognostication. One example is the Mitchell Mortality Index. It has been tested in patients with dementia and in patients newly admitted to nursing homes. See the index below:

Mortality Risk Index Score (Mitchell)

Points   Risk factor

1.9      Complete dependence with ADLs
1.9      Male gender
1.7      Cancer
1.6      Congestive heart failure
1.6      O2  therapy needed w/in 14 day
1.5      Shortness of breath
1.5      <25% of food eaten at most meals 1.5      Unstable medical condition 1.5      Bowel incontinence 1.5      Bedfast 1.4      Age > 83 y
1.4      Not awake most of the day

Risk estimate of death within 6 months

Score                           Risk %
0                                    8.9
1-2                                  10.8
3-5                                  23.2
6-8                                  40.4
9-11                                 57.0             HOSPICE ELIGIBLE
= 12                                 70.0

For more information contact Dr. Leslie Estep or Dr. Anita Meyer at Hospice of the Northwest,
360-814-5550, or lestep@hospicenw.org  or ameyer@hospicenw.org

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