Identifying Older Adults with Serious Illness: A Critical Step toward Improving the Value of Health Care

Health Serv Res. 2017 Feb;52(1):113-131. doi: 10.1111/1475-6773.12479. Epub 2016 Mar 18.


Objective: To create and test three prospective, increasingly restrictive definitions of serious illness.

Data sources: Health and Retirement Study, 2000-2012.

Study design: We evaluated subjects' 1-year outcomes from the interview date when they first met each definition: (A) one or more severe medical conditions (Condition) and/or receiving assistance with activities of daily living (Functional Limitation); (B) Condition and/or Functional Limitation and hospital admission in the last 12 months and/or residing in a nursing home (Utilization); and (C) Condition and Functional Limitation and Utilization. Definitions are increasingly restrictive, but not mutually exclusive.

Data collection: Of 11,577 eligible subjects, 5,297 met definition A; 3,151 definition B; and 1,447 definition C.

Principal findings: One-year outcomes were as follows: hospitalization 33 percent (A), 44 percent (B), 47 percent (C); total average Medicare costs $20,566 (A), $26,349 (B), and $30,828 (C); and mortality 13 percent (A), 19 percent (B), 28 percent (C). In comparison, among those meeting no definition, 12 percent had hospitalizations, total Medicare costs averaged $7,789, and 2 percent died.

Conclusions: Prospective identification of older adults with serious illness is feasible using clinically accessible criteria and may be a critical step toward improving health care value. These definitions may aid clinicians and health systems in targeting patients who could benefit from additional services.

Keywords: Medicare; geriatrics; palliative medicine; population health.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Activities of Daily Living
  • Aged
  • Aged, 80 and over
  • Critical Illness / economics
  • Critical Illness / epidemiology
  • Critical Illness / therapy*
  • Early Diagnosis*
  • Female
  • Health Care Costs / statistics & numerical data
  • Hospitalization / statistics & numerical data
  • Humans
  • Male
  • Medicare / statistics & numerical data
  • Nursing Homes / statistics & numerical data
  • Prospective Studies
  • Quality Improvement* / organization & administration
  • Quality Improvement* / standards
  • United States