Summary of Prognosis Guidelines
Please note: These are guidelines to assist with a determination of life expectancy of six months or less in a patient with a particular medical condition. Although all features need not be present, the majority of characteristics listed would be present in a patient appropriate for hospice care.
General Debility: Unspecified
- Life limiting condition
- Documentation of clinical progression of disease
- Need for frequent hospitalization, ER visits or permanent institutionalization
- Poor performance status: requires at least considerable assistance and frequent medical care
- Dependence in 3 or more activities of daily living (bathing, dressing, feeding, transfers, continence, walking)
- Impaired nutritional status (indicators might include unintentional weight loss of ≥ 10% over past 6 months or serum albumin less than 2.5 g/dl)
Failure to Thrive
- Body Mass Index < 22
- Declining weight and not responding to nutritional interventions
- Significantly disabled: Unable to care for self
- Usually multiple medical co-morbidities
End-stage Lung Disease
- Clinical evidence of severe chronic lung disease (symptomatic at rest, poor exercise tolerance)
- Recurrent hospitalization for acute exacerbations
- Cor pulmonale/right heart failure
- FEY-1 < 30 % predicted after bronchodilator use
- Room air pO2 < 55 mm Hg or O2 sat < 88% (on O2) or hypercapnea pCO2 >50 mm Hg Unintentional progressive weight loss over the last 6 months
- Persistent resting tachycardia
End-stage Heart Disease
- Functional Class III and IV NYHA
- Assessment (symptomatic with minimal exertion or worse)
- Symptomatic despite maximum medical management tolerable to the patient
- Treatment resistant arrhythmia
- Ejection fraction < 20%
- History of cardiac arrest
- Cerebral embolism of cardiac origin
- Persistent resting tachycardia
End-stage Renal Disease
- Creatinine clearance < 10 cc/min ( <15 cc/min for diabetics)
- Serum creatinine >8mg/dl (>6mg/dl for diabetics)
- Not a candidate for dialysis or renal transplant
- Signs of uremia (confusion, nausea, pruritus, lethargy)
- Oliguria < 400 cc/24 hours
- Hyperkalemia > 7 mEq/L
End-stage Dementia
- Non-ambulatory, incontinent, unable to speak more than 6 words
- Unable to dress or bathe independently
- Medical complications present: recurrent aspiration pneumonia, septicemia, pressure ulcers, fever, inability or unwillingness to take food or fluids sufficient to sustain life, weight loss
Cerebrovascular Disease
- Mainly in bed
- Unable to do work
- Requires considerable assistance for self-care
- Reduced food or fluid intake
- Inability to maintain sufficient hydration or caloric intake to sustain life
- Propensity to pulmonary aspiration with poor response to speech pathology interventions
Liver Disease
- INR> 1.5
- Ascites despite maximum diuretics
- Spontaneous bacterial peritonitis
- Hepatorenal syndrome
- Encephalopathy with asterixis, somnolence, coma
- Recurrent variceal bleeding
Parkinson's Disease
- Performance status at or below requiring considerable assistance and frequent medical care
- Wheelchair or bedbound
- Significant language deficit
- Significant dysphagia and risk of aspiration
- Progressive weight loss with or without tube feeding
- Complications (aspiration pneumonia, decubiti, contractures, un, septicemia, inpatient admissions or ER visits due to medical condition)
Amyotrophic Lateral Sclerosis
- Critically impaired breathing capacity (dyspneic at rest, VC<30% normal, O2 dependent, declines artificial ventilation
- Rapid progression of ALS (progressive neurological debility)
- Nutritional impairment (rapid weight loss, insufficient oral intake to sustain life)
- Disease complications occurring recently (aspiration pneumonia, sepsis, complicated UTI)