Although most elderly adults in developed nations die of predictable causes, only a small fraction of people receive a physician home visit in their last year of life. In order to meet the changing care needs of older adults, researchers from Canada have developed a robust online tool that allows physicians to calculate how long seniors have left to live.
The calculator, known as Risk Evaluation for Support: Predictions for Elder-Life in the Community Tool (RESPECT), can predict death within six months and was validated on a dataset involving 491,000 community-dwelling older adults who used home care between 2007 and 2013.
The tool aggregates numerous risk factors and then employs a ‘big data’ approach to estimate the odds of survival of an elderly person. These factors include a person’s comorbidities such as hypertension (60.8% of respondents suffered from this illness), coronary artery disease (26.8% of respondents), and Alzheimer’s or other dementias (23.4% of respondents). The average age of the respondents was 79.7 years and 65% identified as female.
However, the researchers 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.
When the calculator was applied to a cohort of 435,009 adults, the researchers were able to identify 122,823 deaths within six months of assessment with 95% confidence. In another cohort representing 139,388 adults, the tool identified 20,015 deaths within six months of assessment.
Estimated median survival varied from 28 days (11 to 84 days at the 25th and 75th percentiles) in the highest risk group to over 8 years (1925 to 3420 days) in the lowest risk group.
“The RESPECT calculator allows families and their loved ones to plan,” says Dr. Amy Hsu, investigator at the Bruyère Research Institute in Canada, 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.”
Knowing how long a person has left to live may help family, caretakers, and physicians make more informed decisions. Doctors may want to change treatments while the family could use the notice to prepare emotionally for their dearly beloved impending death. For instance, knowing that your parents or grandparents only have six months to live would motivate you to plan and embark on the last family vacation together.
However, there may also be important downsides and ethical dilemmas to knowing the timeline of a person’s final moments. If a person is informed of how long they have left to live, they may change their behavior for the better or worse.
“We have learned before the pandemic and particularly with the pandemic, that there’s tremendous inherent biases within health care, access, distribution and algorithms for vulnerable people, racialized people, lower socioeconomic classes,” said Kerry BOwman, a bioethicist at the University of Toronto.
“Using a tool like this without doing due diligence with social, cultural, and ethical analysis is not a smart thing to do.”
You can use the RESPECT tool by visiting the official website.