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?
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

  • 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.


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