Colorectal cancer (CRC) screening can extend lives but can also cause significant harm. CRC screening guidelines for older adults recommend individualizing recommendations based on patient values and life expectancy. For healthy and younger older adults the benefits of colorectal cancer screening are likely to outweigh the harms and risks of screening. For others in poor health with limited life expectancy, the harms are likely to outweigh the benefits.
Those most likely to benefit have the best health and longest predicted life expectancies. The long-term goal of this research is to improve the quality of cancer screening in older adults residing in residential care facilities (RCF). The central hypothesis is that using the NSRCF, we can obtain estimates of the proportion of older adults in RCFs who are likely to benefit, who might or might not benefit, and who are not likely to benefit from colorectal cancer screening. The rationale for this project is that once the rates and quality of cancer screening are known, interventions can be developed to encourage guideline-concordant use. Therefore, we propose to examine the predicted life expectancies in older adults in RCFs using three well-validated tools for estimating mortality: the Charlson Comorbidity Index (CCI), the four-year mortality index developed by Lee et al. (Lee Index), and the nine-year mortality index developed by Schonberg et al. (Schonberg Index).