New online calculator can help predict death and need for end-of-life care for frail older adults

July 5, 2021

A new risk calculator can help predict how long an older adult will live, and support end-of-life planning. The method used to develop the tool is published in CMAJ (Canadian Medical Association Journal).

Although most Canadians die from predictable causes and have health needs that can be met at home, only 20% of people receive a physician home visit in their last year of life.

To help understand the changing care needs of older adults as they age and when they might be nearing the end of their lives, a team of researchers developed the Risk Evaluation for Support: Predictions for Elder-Life in the Community Tool (RESPECT).

The calculator, which predicts death within 6 months, is based on data from more than 491 000 community-dwelling older adults who used home care in the 6-year period between 2007 and 2013.

“The RESPECT calculator allows families and their loved ones to plan,” says 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. “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.”

Using a “big data” approach that represents a population perspective of the end-of-life experience of older adults in Ontario, RESPECT provides estimates of survival. The research team 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.

“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,” says Dr. Peter Tanuseputro, physician-scientist at The Ottawa Hospital and ICES, and investigator at the Bruyère Research Institute. “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.”

The tool was designed with patients and their care partners in mind and has been piloted in community settings in Ontario. It can also be used by physicians and home care staff, in addition to palliative care professionals.

Full reference: Predicting death in home care users: derivation and validation of the Risk Evaluation for Support: Predictions for Elder-Life in the Community Tool (RESPECT). CMAJ. Amy Hsu, Douglas Manuel, Sarah Spruin, Carol Bennett, Monica Taljaard, Sarah Beach, Yulric Sequeira, Robert Talarico, Mathieu Chalifoux, Daniel Kobewka, Andrew Costa, Susan Bronskill, Peter Tanuseputro. July 5, 2021.

Funding: The study was funded by the Canadian Institutes of Health Research and Bruyère and supported by ICES.

About The Ottawa Hospital 

The Ottawa Hospital is one of Canada’s top learning and research hospitals, where excellent care is inspired by research and driven by compassion. As the third-largest employer in Ottawa, our support staff, researchers, nurses, physicians, and volunteers never stop seeking solutions to the most complex health-care challenges. Our multi-campus hospital, affiliated with the University of Ottawa, attracts some of the most influential scientific minds from around the world. Backed by generous support from the community, we are committed to providing the world-class, compassionate care we would want for our loved ones.

About the University of Ottawa

The University of Ottawa is home to over 50,000 students, faculty and staff, who live, work and study in both French and English. Our campus is a crossroads of cultures and ideas, where bold minds come together to inspire game-changing ideas. We are one of Canada’s top 10 research universities—our professors and researchers explore new approaches to today’s challenges. One of a handful of Canadian universities ranked among the top 200 in the world, we attract exceptional thinkers and welcome diverse perspectives from across the globe.

About the Bruyère Research Institute

Bruyère Research Institute, the research arm of Bruyère, aims to find new ways to maximize quality of life and help people stay and return home. We do this by conducting rigorous, peer-reviewed research and developing and testing new technologies that help people be more mobile and independent. Our focus is largely on improving health care systems, global aging, and finding new ways to care for and treat people. We proudly partner with industry, academia, government and patient/family-led groups, and we always work through an equity lens. Our research strengths are in aging and rehabilitation; primary, palliative, and residential care, memory, and equity and effectiveness.

About ICES

ICES is an independent, non-profit research institute that uses population-based health information to produce knowledge on a broad range of health care issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting health care needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy. In October 2018, the institute formerly known as the Institute for Clinical Evaluative Sciences formally adopted the initialism ICES as its official name. For the latest ICES news, follow us on Twitter: @ICESOntario

Media contact: Stéfanie Power, Communications Advisor, Bruyère,