The MDS-CHESS scale: a new measure to predict mortality in institutionalized older people

J Am Geriatr Soc. 2003 Jan;51(1):96-100. doi: 10.1034/j.1601-5215.2002.51017.x.


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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Activities of Daily Living
  • Aged
  • Aged, 80 and over
  • Canada
  • Chronic Disease
  • Comorbidity
  • Female
  • Frail Elderly*
  • Geriatric Assessment*
  • Humans
  • Institutionalization*
  • Male
  • Middle Aged
  • Mortality*
  • Proportional Hazards Models
  • Severity of Illness Index