The index is designed to score common problems of the elderly by measuring the chronic medical illness burden while taking into consideration the severity of chronic disease in 14 individual body systems. The body systems taken into consideration include:
For each body system, the general rules for the severity rating are1:
Two scores can be derived, which allow healthcare professionals to see at a glance whether a patient’s scores reflect a few serious problems or multiple problems of moderate severity:
Total Cumulative Illness Rating Score
Co‐morbidity Index (CMI)
Level 1 – Current mild problem or past significant problem.
Any current medical problem that causes mild discomfort or disability, or has occasional exacerbations that have an overall minor impact on morbidity should be rated a "1", for example, a hiatal hernia with occasional heartburn treated with prn antacids. Medical problems that are not currently active but were significant problems in the past should also be listed as a "1", for example, passage of a kidney stone. Past childhood illnesses, minor surgery, uncomplicated healed fractures, minor injuries, teeth extractions, or events so remote without sequelae (e.g. one febrile seizure in childhood) need not be listed at all. However, if any of the above leave a suspicion of potential future complications, the rater should err on the side of inclusion, and briefly describe his/her concerns in the space provided.
Level 2 – Moderate disability or morbidity/requires "first line" therapy.
Level 3 - Severe/constant significant disability/"uncontrollable" chronic problems.
Level 2 should be endorsed for medical conditions that require daily medication of "first line" nature, for example, patients requiring daily non-steroidal anti-inflammatory drugs for arthritis or daily digoxin to control congestive heart failure. Level 3 should be endorsed for chronic conditions that are not compensated for with first line therapy, for example, requiring steroids for rheumatologic conditions or lung disease. "Constant significant disability" describes patients whose underlying pathology is not fully compensated by medical regimens, for example, patients with exertional angina would endorse a level "3" because their underlying pathology is not fully compensated by medical regimens but many less strenuous activities are possible (i.e. level "4" is not indicated).
Level 4 – Extremely Severe.
Immediate treatment required/end organ failure/severe impairment in function. This level describes the late stages of disease or disability within a category. Generally, this level reflects the failure to arrest the disease process with resulting disability, pain, or restricted activities of daily living (ADLs). Alternatively, any acute condition that requires immediate treatment e.g. bladder outlet obstruction would also qualify as a "4". Severely limited ambulation or ADLs or sensory impairment would also endorse a "4" in the appropriate category, for example blindness, deafness or being wheelchair bound.
Consistent scoring of severity ratings for various malignancies is a difficult problem. Each malignancy has its own rating system and prognostic indicators, the complexity of which would quickly exceed the scope of the intended simplicity and ease of use of this scale. The following general guidelines are intended to provide a reasonably accurate delineation of medical burden for cancer without excessive complexity.
1. Miller MD et al., Rating Chronic Medical Illness Burden in Geropsychiatric Practice and Research: Application of the Cumulative Illness Rating Scale, Psychiatry Research, 1992. 41:237-248.
References quoted in category description:
1. Linn BS, Linn MW, Gurel L. Cumulative illness rating scale. J Amer Ger Soc 1968;16:622-626.
2. Folstein MF, Folstein SE, McHugh PR. Mini-mental state: A practical method for grading the cognitive state of patients for the clinician. J Psych Res 1975;12:189-198.
3. American Psychiatric Association: Diagnostic and statistical manual of mental disorders, 3rd Edition - Revised. Washington, D.C., 1987.
4. Bray, GA, et al. Evalaution of the obese patient. I. An algorithm. JAMA 1976;235:1487.
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