The MDS-CHESS Scale: A New Measure to Predict Mortality in Institutionalized Older People

Authors

  • John P. Hirdes PhD,

    1. Department of Health Studies and Gerontology, University of Waterloo, Waterloo, Ontario, Canada;
    2. Homewood Research Institute, Guelph, Ontario, Canada;
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  • Dinnus H. Frijters PhD,

    1. Prismant, Utrecht, Netherlands;
    2. Vrije Universiteit, Amsterdam, Netherlands;
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  • Gary F. Teare PhD

    1. Toronto Rehabilitation Institute, Toronto, Ontario, Canada; and
    2. Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
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  • A preliminary version of this paper was presented at the May 1999 interRAI meeting in Oslo, Norway.

Address correspondence to John P. Hirdes, PhD, Department of Health Studies and Gerontology, University of Waterloo, Waterloo, Ontario, Canada, N2L 3G1. E-mail: hirdes@uwaterloo.ca

Abstract

OBJECTIVES: To develop a scale predicting mortality and other adverse outcomes associated with frailty.

DESIGN: Observational study based on Minimum Data Set (MDS) 2.0 and mortality data.

SETTING: Ontario chronic hospitals.

PARTICIPANTS: All chronic hospital patients (N = 28,495) assessed with the MDS 2.0 after mandatory implementation in July 1996 followed until May 1999.

MEASUREMENTS: MDS 2.0 assessments done as part of normal practice mainly by registered nurses or multidisciplinary teams in a chronic hospital. Mortality data are available from the accompanying discharge tracking form.

RESULTS: The MDS-Changes in Health, End-stage disease and Symptoms and Signs (CHESS) score is a composite measure addressing changes in health, end-stage disease, and symptoms and signs of medical problems. It is a strong predictor of mortality (P < .0001) independent of the effects of age, sex, activities of daily living impairment, cognition, and do-not-resuscitate orders. It is also strongly associated with physician activity, complex medical procedures, and pain (P < .001 for each dependent variable).

CONCLUSIONS: The CHESS score provides a useful new MDS-based test to predict mortality and to measure instability in health as a clinical outcome.

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