Prognosis | Condition | Clinical decision to be considered |
<4 to 6 weeks | Depression at end of life | Use methylphenidate to treat depression instead of a selective serotonin reuptake inhibitor (SSRI) as SSRIs require 4 to 6 weeks to take effect[1] |
<3 months | Hyperlipidemia | Discontinuation of statins[2,3] |
>3 months | Spinal metastases | Surgery for spinal cord compression due to metastatic cancer[4] |
<6 months | Hospice | Referral to hospice |
<1 year | Bisphosphonates for osteoporosis | Bisphosphonates for prevention of fracture unlikely to benefit in patients' remaining lifetime[5] |
<1 to 2 years | Asymptomatic abdominal aortic aneurysm | Nonoperative management of asymptomatic abdominal aortic aneurysm[6-9] |
<2 to 3 years | Prevention of macrovascular complications in diabetes mellitus | Blood pressure/lipid control in diabetes mellitus unlikely to prevent macrovascular complications[10] |
<2 to 3 years | Hypertension | Lowering blood pressure <140/80 unlikely to improve cardiovascular outcomes[2,11] |
<5 years | Screening for breast cancer | Discontinuation of breast cancer screening[12-15] |
<5 years | Heart valve replacement | Stented bioprosthetic heart valve may be preferable to a metallic valve[16] |
<10 years[17] | Glycemic control in diabetes | Limited benefit to lowering target for A1C to <8%[2,10] |
<7 years | Screening for colorectal cancer | Discontinuation of colorectal cancer screening[12,18-20] |
<8 years | Prevention of microvascular complications in diabetes | Tight glycemic control in diabetes mellitus is unlikely to prevent microvascular complications[2,10,21,22] |
Adapted from: Yourman LC, Lee SJ, Schonberg MA, et al. Prognostic indices for older adults. A systematic review. JAMA 2012; 307:182.
Do you want to add Medilib to your home screen?