Will-to-Live and Self-Rated Health in Older Hospitalized Patients Are Not Predictive for Short-Term Mortality.

Abstract

<b><i>Background:</i></b> Self-assessed will-to-live and self-rated health are associated with long-term survival in community-dwelling older persons but have not been examined in frailer older patients in relation to short-term prognosis. The aim was to explore whether will-to-live and self-rated health are predictive for six-month mortality and can guide ceiling of treatment decisions in hospitalized patients in an acute geriatric ward. We included the Surprise Question as reference, being a well-established clinical tool for short-term prognostication. <b><i>Methods:</i></b> This multicentric prospective study included patients of 75 years and older admitted at acute geriatric wards of two Belgian hospitals. Will-to-live and self-rated health were scored on a Likert scale (0-5, 0-4) and assessed by junior geriatricians. The senior geriatricians answered the Surprise Question for clinical judgment of prognosis. Receiver-operator characteristic (ROC) curves were constructed to determine diagnostic accuracy. For time-dependent analysis, Cox regression was performed with adjustment for age and gender. <b><i>Results:</i></b> Of 93 included patients in the study, 69 were still alive after six months and 24 died, resulting in a six-month mortality of 26%. The mean age was 86 years (range 75-100), 67% of the patients were women. Median will-to-live and self-rated health were 3 (moderate and good). Both will-to-live and self-rated health were not predictive for six-month mortality (area under the ROC curve [AUC] 0.496, <i>p</i> = 0.951 for will-to-live; 0.447, <i>p</i> = 0.442 for self-rated health) as opposed to Surprise Question (AUC 0.793, <i>p</i> < 0.001). After correction for sex and age, the hazard ratio of six-month mortality was 0.92 for will-to-live (<i>p</i> = 0.667), 0.86 for self-rated health (<i>p</i> = 0.548), and 10.28 for Surprise Question (<i>p</i> < 0.001). <b><i>Conclusion:</i></b> Will-to-live and self-rated health are not predictive for six-month mortality in patients admitted to the acute geriatric ward, unlike prognostic tools such as Surprise Question. <b><i>Clinical Trial Registration Number:</i></b> B670202100792.