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New test measures risk of dying for those older than 50

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CHICAGO (AP) _ There's a new test for baby boomers and their parents, and it's one where you definitely want a low score.

The 12-question test measures risk of dying within four years, and the more points you get, the greater your risk.

Created for people older than 50 by researchers at the San Francisco Veterans Affairs Medical Center, the quiz is designed ``to try to help doctors and families get a firmer sense for what the future may hold,'' to help plan health care accordingly, says lead author Dr. Sei Lee.

``We know that patients and families want more prognostic information from doctors,'' said Lee, who helped develop the test. ``It's a very natural human question of, 'What's going to happen to me?'''

The report appears in Wednesday's Journal of the American Medical Association.

While many people are morbidly curious, 74-year-old Willie Hood Jr. isn't one of them.

``I don't know when I'm going to die and nobody else'' does either, said Hood, who lives in the Chicago area.

The test measures risk factors linked with mortality, and Hood gets 2 points just for being male.

Diabetes, smoking, and getting pooped trying to walk several blocks each also get two points, and points accrue with each four-year increment after age 60.

Zero to 5 points says your risk of dying in four years is less than 4 percent. With 14 points, your risk rises to 64 percent.

The test doesn't ask what you eat, but it does ask if you can push a living room chair across the floor.

Roughly 81 percent accurate, the test can give older people a reasonable idea of their survival chances, the researchers say.

Of course, it isn't foolproof. Other experts note it ignores family history and it's much less meaningful for those at the young end of the spectrum.

The researchers even warn not to try it at home, saying a doctor can help you put things into perspective.

``Even if somebody looks at their numbers and finds they have a 60 percent risk of death, there could be other mitigating factors,'' said co-author and VA researcher Dr. Kenneth Covinsky.

There are things you can do to improve your chances, he said, such as quitting smoking or taking up exercise.

The test is based on data involving 11,701 Americans over 50 who took part in a national health survey in 1998. Funded by a grant from the National Institute on Aging, the researchers analyzed participants' outcomes during a four-year follow-up. They based their death-risk survey on the health characteristics that seemed to predict death within four years.

Dr. Donald Jurivich, geriatrics chief at the University of Illinois at Chicago, took the test and got a nice low score. Jurivich is 52. He said he'd feel better about his score if both his parents hadn't died prematurely.

He praised the survey for measuring people's ability to function _ such as being able to move a piece of furniture or keep track of expenses _ signs that can be more telling than other health factors.

Dr. George Lange, a 57-year-old internist at Columbia-St. Mary's Hospital in Milwaukee, faulted the test for not measuring blood pressure or cholesterol. Lange got a healthy low score on the test, too, but he's overweight. He was surprised he didn't get points for that.

In fact, that's one of the most puzzling aspects of the test. People with a body-mass index of less than 25 _ which includes normal weight people _ get a point while those who are overweight aren't penalized.

Covinsky, one of the test designers, said that BMI measurement includes underweight people _ those who have lost weight because of illness, a particularly disturbing sign for the elderly.

Lee noted there are more points for diabetes and for difficulty walking several blocks _ both associated with excess weight.

The researchers think their mortality predictor might be a useful tool in the ``pay for performance'' trend that is part of the nation's health care system. Medicare and other insurers are increasingly basing reimbursement rates on how patients fare, said Covinsky.

``One health plan can look better just by cherry-picking health care patients'' and accepting only the most robust patients, Covinsky said. This test could give a more accurate assessment of health plans, so that ``you can actually see which ones are taking sicker patients and compare that'' when measuring performance.
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