Flacker 1 Year Newly Admitted Revised Index

  • Population: Newly admitted nursing home residents aged 65 and old
  • Outcome: All cause 1 year mortality
  • Scroll to the bottom for more detailed information

Risk Calculator
1. What is the sex of your patient?
 
2. Does your patient have shortness of breath?
 
3. Does your patient have congestive heart failure?
 
4. Does your patient have a condition or disease that causes fluctuation, instability or decline in their activities of daily living (ADL), cognitive, or behavioral status?
 
5. Does your patient leave more than 25% of their food uneaten?
 
• Which of the following best describes how your patient moves and turns his or her body while in bed?
• Which of the following best describes how your patient moves between surfaces such as a bed and a chair?
• Which of the following best describes how your patient moves between locations such as from their room to the hallway outside their room?
• Which of the following best describes how your patient puts on, fastens, and takes off his or her every day clothing?
• Which of the following best describes how your patient eats and drinks or intakes nourishment (i.e. in the case of tube feeding)?
• Which of the following best describes how your patient uses a toilet, commode, bedpan, or urinal and transfers on and off the toilet?
• Which of the following best describes how your patient maintains personal hygiene, including combing hair, brushing teeth, washing and drying face and hands (but excluding baths and showers)?
Total ADL Points: 0
7. Is your patient’s total ADL score (as shown above) less than the median ADL score from your patient’s Minimum Data Set? (If you divide your nursing home into a more functional half and less functional half, would your patient be in the more functional half?)
 
8. Does your patient have a BMI ≤ 23?
BMI calculator
 
9. Does your patient have a history of cancer?
 
10. Is your patient confined to bed?
 
11. Does your patient have problems swallowing?
 
12. Does your patient display complete or frequent bowel incontinence?
 
Total Points: 0
Your best guess of one year mortality risk

  • This index was developed in 22,749 nursing home residents from New York State in the 1990s (49% >84 years old, 74% female, 83% white, 21% 1-year mortality)
  • The index was internally validated in 40,328 nursing home residents from the same sample (46%>84 years old, 73% female, 82% white, 22% 1-year mortality)
  • This index was externally validated in 130 nursing home resident in 2007 (mean age 83, 61% female).
  • Discrimination: This risk calculator sorts patients who died from patients who lived correctly 71% of the time (c-statistic). The discrimination was the same in the independent validation study.
  • Calibration: For patients within low and intermediate risk levels the calibration was very good, with less than 7% difference between estimated and actual mortality rates. At the highest risk level the risk calculator's calibration was not as good, with a 20% difference between estimated and actual mortality.
  • Citation: Flacker JM, Kiely DK. Mortality-related factors and 1-year survival in nursing home residents. JAGS. 2003;51:213-221.

DISCLAIMER

The information provided on ePrognosis is designed to complement, not replace, the relationship between a patient and his/her own medical providers. ePrognosis was created with the support of the Division of Geriatrics at the University of California San Francisco. However, its content is strictly the work of its authors and has no affiliation with any organization or institution. This web site does not accept advertisements. If you reproduce the material on the website please cite appropriately. For feedback and questions regarding the site please email Sei Lee, MD (sei.lee@ucsf.edu), Alex Smith, MD (aksmith@ucsf.edu) or Eric Widera, MD (eric.widera@ucsf.edu).