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Open Access Highly Accessed Research article

The MDS Mortality Risk Index: The evolution of a method for predicting 6-month mortality in nursing home residents

Davina Porock123*, Debra Parker-Oliver4, Gregory F Petroski5 and Marilyn Rantz6

Author Affiliations

1 School of Nursing, Midwifery and Physiotherapy, The University of Nottingham, Nottingham, UK

2 Sinclair School of Nursing, University of Missouri-Columbia, Columbia, Missouri, USA

3 School of Nursing, Edith Cowan University, Perth, Western Australia, Australia

4 Department of Family and Community Medicine, University of Missouri-Columbia, Missouri USA

5 Office of Medical Research, University of Missouri-Columbia, Missouri, USA

6 Sinclair School of Nursing, University of Missouri-Columbia, Missouri, USA

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BMC Research Notes 2010, 3:200  doi:10.1186/1756-0500-3-200

Published: 16 July 2010



Accurate prognosis is vital to the initiation of advance care planning particularly in a vulnerable, at risk population such as care home residents. The aim of this paper is to report on the revision and simplification of the MDS Mortality Rating Index (MMRI) for use in clinical practice to predict the probability of death in six months for care home residents.


The design was a secondary analysis of a US Minimum Data Set (MDS) for long term care residents using regression analysis to identify predictors of mortality within six months.


Using twelve easy to collect items, the probability of mortality within six months was accurately predicted within the MDS database. The items are: admission to the care home within three months; lost weight unintentionally in past three months; renal failure; chronic heart failure; poor appetite; male; dehydrated; short of breath; active cancer diagnosis; age; deteriorated cognitive skills in past three months; activities of daily living score.


A lack of recognition of the proximity of death is often blamed for inappropriate admission to hospital at the end of an older person's life. An accurate prognosis for older adults living in a residential or nursing home can facilitate end of life decision making and planning for preferred place of care at the end of life. The original MMRI was derived and validated from a large database of long term care residents in the USA. However, this simplification of the revised index (MMRI-R) may provide a means for facilitating prognostication and end of life discussions for application outside the USA where the MDS is not in use. Prospective testing is needed to further test the accuracy of the MMRI-R and its application in the UK and other non-MDS settings.