A Risk Scoring System for the Prediction of Functional Deterioration, Institutionalization, and Mortality among Medicare Beneficiaries

Objective We sought to develop a risk scoring system for predicting functional deterioration, institutionalization, and mortality. Identifying predictors of poor health outcomes informs clinical decision-making, service provision, and policy development to address the needs of persons at greatest risk for poor health outcomes. Design Cohort study with 21,257 community-dwelling Medicare beneficiaries aged 65 years and older who participated in the 2001-2008 Medicare Current Beneficiary Survey. Derivation of the model was conducted in 60% of the sample and validated in the remaining 40%. Multinomial logistic regression model generated β-coefficients which were utilized to create a risk scoring system. Our outcome was instrumental activity of daily living stage transitions (stable/improved function and functional deterioration), institutionalization, or mortality over two years of follow-up. Results A total of 18 factors were identified for functional deterioration (p

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