The RESPECT calculator predicts frail people’s survival to assist caregivers in deciding about end-of-life care and services.
Understanding the trajectory of someone’s death to provide appropriate end-of-life care is a complicated process that the researchers from Project Big Life, a Canadian health calculation research group, hope to make easier with their Risk Evaluation for Support: Predictions for Elder-Life in the Community Tool (RESPECT).
The RESPECT calculator predicts frail people’s survival to assist caregivers in deciding what type of care and services they may need at the end of their life.
“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,” Dr. Peter Tanuseputro, physician-scientist at Ottawa Hospital, investigator at Bruyère Research Institute and a developer of RESPECT, said in a statement.
“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.”
TOP-LINE DATA
In its validation study, the RESPECT calculator predicted a six-month death probability of 10.8% for the older adult cohort used in the study. The probability of death ranged from 1.54% in the lowest risk group to 98.1% in the highest risk group.
Survival time varied from 28 days in the highest risk group to over 8 years in the lowest risk group.
The top predictors of mortality were declines in a person’s ability to carry out activities of daily living, such as hygiene, using the toilet and mobility. The researchers found that these factors were more indicative of a person’s deterioration than chronic diseases they have.
METHODS
The researchers used population data over a six-year period derived from the Resident Assessment Instrument for Home Care (RAI-HC), a multidimensional clinical assessment used for care planning in the home setting in Canada. They collected data from more than 491,000 older adults between 2007 and 2013.
The majority (65%) of the cohort was female, and the average age was 79.7 years.
In addition to the data collected from the RAI-HC, which includes nearly 400 measurements, the calculator considered predictors such as physical functioning, cognitive impairment, sociodemographic factors, biological diseases, self-reported measures of health and recent symptoms.
THE LARGER TREND
Nearly every country in the world is experiencing a growing population of older adults, according to the United Nations. In 2019, there were 703 million people worldwide 65 years or older. That figure is anticipated to double to 1.5 billion in 2050, meaning that one in six people in the world will be aged 65 years or over.
The aging population places pressure on countries’ elder support systems, requiring new models to be created to care for this growing population segment, the U.N. says.
Digital health is poised to help end-of-life care with players like Papa, Spacetalk and Lively creating solutions for seniors. There’s also been a number of M&As in the space including Connect America’s acquisition of Royal Philips’ Aging and Caregiving (ACG) business and Amedisys’ purchase of Contessa Health.
ON THE RECORD
“The RESPECT calculator allows families and their loved ones to plan,” 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, said in a statement. “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.”
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