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Lapi F, Marconi E, Aprile PL, Magni A, Vetrano DL, Rossi A, Pilotto A, Cricelli C. Frailty, comorbidity, and multimorbidity and their relation with medications adherence in primary care older adults. Eur Geriatr Med 2025; 16:583-603. [PMID: 39699748 DOI: 10.1007/s41999-024-01098-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Accepted: 10/28/2024] [Indexed: 12/20/2024]
Abstract
PURPOSE To assess and compare, through a retrospective cohort study, the relationships between frailty, comorbidity, multimorbidity, and levels of adherence to lipid-lowering drugs (LLDs), antihypertensives and antidepressants. METHODS In a primary care database, we selected a cohort of patients aged 60 or older on December 31, 2022. The date of the first prescription of the aforementioned medications was the study index date. Patients with Variable Medication Possession Ratio (VMPR) > = 80% were classified as properly adherent. Frailty (i.e. Primary Care-Frailty Index), comorbidity (i.e. Charlson Index) and multimorbidity (i.e. disease counts) alternatively entered multivariate logistic regressions along with age and sex. Models' performances in prediction of medications adherence were compared in terms of information (AIC; BIC) and discrimination values (AUC). RESULTS Incident users of LLDs, antihypertensives or antidepressants were 4310 (mean age: 67.9 (SD: 6.9); 56.0% females), 5969 (mean age: 69.1 (SD: 7.6); 58.0% females), and 3834 (mean age: 68.7 (SD: 6.9); 66.5% females), respectively. Among users of LLDs (46% adherent) and antidepressants (22% adherent), those who were moderately or severely frail showed a significant 30-32% decrease in adherence. In contrast, users of antihypertensives (46% adherent) showed a 41% increase in adherence when multimorbid. As a whole, the three multivariate models were equally effective in informing on medication adherence, as per AIC and BIC. They also displayed similar discriminatory ability, with AUC scores ranging from 53 to 58%. Regarding the workload of GPs, the number of elderly patients classified as moderately/high frail was less than those with co-morbidities or multimorbidities. For instance, there were approximately 35 users of antihypertensive medications per GP for the moderately frail group, compared to 46 and 66 for the co-morbid and multi-morbid groups, respectively. CONCLUSIONS These findings showed similar capacity for frailty, comorbidity, and multimorbidity in capturing medications adherence. Given the existence of a validated tool in primary care that aligns well with GPs' workload, frailty seems the most suitable measure for assessing the complexity of older adults in relation to their adherence to long-term medications.
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Affiliation(s)
- Francesco Lapi
- Health Search, Italian College of General Practitioners and Primary Care, Via del Sansovino 179, 50142, Florence, Italy.
| | - Ettore Marconi
- Health Search, Italian College of General Practitioners and Primary Care, Via del Sansovino 179, 50142, Florence, Italy
| | | | - Alberto Magni
- Italian College of General Practitioners and Primary Care, Florence, Italy
| | - Davide Liborio Vetrano
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Alessandro Rossi
- Italian College of General Practitioners and Primary Care, Florence, Italy
| | - Alberto Pilotto
- Department of Interdisciplinary Medicine, "Aldo Moro" University of Bari, Bari, Italy
- Geriatrics Unit, Department of Geriatric Care, Neurology and Rehabilitation, E.O. Galliera Hospitals, Genoa, Italy
| | - Claudio Cricelli
- Italian College of General Practitioners and Primary Care, Florence, Italy
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Stegemann J, Affeldt AM, Mück L, Ferring A, Gerhards L, Pickert L, Bausch A, Benzing T, Antczak P, Polidori MC. Prognostic signature of multimorbidity, geriatric syndromes and resources cluster in older in- and outpatients: a pooled secondary analysis with a 6-month follow-up. BMJ Open 2024; 14:e086975. [PMID: 39806651 PMCID: PMC11667294 DOI: 10.1136/bmjopen-2024-086975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 11/21/2024] [Indexed: 01/16/2025] Open
Abstract
OBJECTIVE The prognosis of older adults is strongly influenced by the relation of multifactorial geriatric syndromes (GS) and their health-maintaining counterparts, geriatric resources (GR). The present analysis aimed to identify clusters of comorbidities, GS and GR, and to measure their multidimensional prognostic signature in older patients admitted to different healthcare settings. DESIGN Pooled secondary analysis of three longitudinal interventional studies with the 3- and 6-month follow-up data collection on mortality and rehospitalisation. SETTING Inpatients in an internal medicine ward (n=495), inpatients in an ageing medicine ward (n=123) and outpatients from a general practice (n=105). PARTICIPANTS A total of 734 patients with multimorbidity who aged over 60 years were recruited between August 2016 and July 2020 (mean age 77.8 years, SD 6.2 and 43% female). OUTCOME MEASURES Comprehensive Geriatric Assessment (CGA), including Cumulative Illness Rating Scale (CIRS), 17 GS and 10 GR, and the CGA-based Multidimensional Prognostic Index (MPI) as a measure of multidimensional prognosis and frailty were assessed. Based on a general linear model and a hierarchical clustering method, clusters of comorbidities, GS and GR were obtained. RESULTS The study identified five clusters of GR-related GS, namely, psychosocial, iatrogenic, neurovegetative, sensorimotor and fluid dysbalance, along with two clusters related to GR, focusing on independence achievement and requirements- circumstances. Additionally, two clusters were identified pertaining to the CIRS, encompassing sensory-vegetative and heart-kidney morbidity. Patients within the iatrogenic cluster exhibited significantly higher MPI and readmissions during follow-up compared with those outside this cluster (p<0.001). Furthermore, membership in the fluid dysbalance or psychosocial cluster was associated with a significantly increased mortality rate during follow-up (p<0.001). CONCLUSIONS A feasible combination of GR and GS in clinical routine enables the identification of clusters with clear prognostic relevance, which may improve prognosis through tailored treatment. TRIAL REGISTRATION NUMBERS DRKS00010606/DRKS00013791/DRKS00017094 MPI_InGAH, DRKS00012820 MPI_NoGeP and DRKS00015996 VNKN.
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Affiliation(s)
- Jill Stegemann
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, University Hospital Cologne, Cologne, Nordrhein-Westfalen, Germany
| | - Anna Maria Affeldt
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, University Hospital Cologne, Cologne, Nordrhein-Westfalen, Germany
| | - Luisa Mück
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, University Hospital Cologne, Cologne, Nordrhein-Westfalen, Germany
| | - Anne Ferring
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, University Hospital Cologne, Cologne, Nordrhein-Westfalen, Germany
| | - Laura Gerhards
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, University Hospital Cologne, Cologne, Nordrhein-Westfalen, Germany
| | - Lena Pickert
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, University Hospital Cologne, Cologne, Nordrhein-Westfalen, Germany
| | - Annika Bausch
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, University Hospital Cologne, Cologne, Nordrhein-Westfalen, Germany
| | - Thomas Benzing
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, University Hospital Cologne, Cologne, Nordrhein-Westfalen, Germany
- CECAD, University of Cologne, Faculty of Medicine and University Hospital Cologne, University Hospital Cologne, Koln, Germany
| | - Philipp Antczak
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, University Hospital Cologne, Cologne, Nordrhein-Westfalen, Germany
- CECAD, University of Cologne, Faculty of Medicine and University Hospital Cologne, University Hospital Cologne, Koln, Germany
| | - M Cristina Polidori
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, University Hospital Cologne, Cologne, Nordrhein-Westfalen, Germany
- CECAD, University of Cologne, Faculty of Medicine and University Hospital Cologne, University Hospital Cologne, Koln, Germany
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Polidori MC, Sieber C. [Frailty: Prevention]. Dtsch Med Wochenschr 2024; 149:15-22. [PMID: 38158202 DOI: 10.1055/a-2033-4924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
The Frailty syndrome is usually related to the aging process and chronological age, but it is not an inevitable consequence of it - at least until the final phase of life. Primary care interventions that promote physical activity and nutrition can prevent the progression from pre-frailty to frailty. This article presents the current state of knowledge on primary and secondary prevention of frailty.
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Lagolio E, Demurtas J, Buzzetti R, Cortassa G, Bottone S, Spadafora L, Cocino C, Smith L, Benzing T, Polidori MC. A rapid and feasible tool for clinical decision making in community-dwelling patients with COVID-19 and those admitted to emergency departments: the Braden-LDH-HorowITZ Assessment-BLITZ. Intern Emerg Med 2022; 17:839-844. [PMID: 34322832 PMCID: PMC8318055 DOI: 10.1007/s11739-021-02805-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 07/09/2021] [Indexed: 02/08/2023]
Abstract
There is no univocal standardized strategy to predict outcomes and stratify risk of SARS-CoV-2 infected patients, notably in emergency departments. Our aim is to develop an accurate indicator of adverse outcomes based on a retrospective analysis of a COVID-19 database established at the Emergency Department (ED) of a North-Italian hospital during the first wave of SARS-CoV-2 infection. Laboratory, clinical, psychosocial and functional characteristics including those obtained from the Braden Scale-a standardized scale to quantify the risk of pressure sores which takes into account aspects of sensory perception, activity, mobility and nutrition-from the records of 117 consecutive patients with swab-positive COVID-19 disease admitted to the Emergency Medicine ward between March 1, 2020 and April 15, 2020 were included in the analysis. Adverse outcomes included admission to the Intensive Care Unit (ICU) and in-hospital death. Among the parameters collected, the highest cutoff sensitivity and specificity scores to best predict adverse outcomes were displayed by lactate dehydrogenase (LDH) blood value at admission > 439 U/L, Horowitz Index (P/F Ratio) < 257 and Braden score < 18. The estimation power reached 93.6%. We named the assessment BLITZ (Braden-LDH-HorowITZ). Despite the retrospective and preliminary nature of the data, a multidimensional tool to assess overall functions, not chronological age, produced the highest prediction power for poor outcomes in relation to SARS-CoV-2 infection. Further analyses are now needed to establish meaningful correlations between ventilation therapies and multidimensional frailty as assessed by ad-hoc validated and standardized tools.
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Affiliation(s)
- Erik Lagolio
- Emergency Medicine (A&E), Asl2 - Hospital Santa Corona, Pietra Ligure, Italy
| | - Jacopo Demurtas
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Strada Casal Nuovo, 20 58011, Capalbio (GR), Modena, Italy.
| | | | - Giorgio Cortassa
- Emergency Medicine (A&E), Asl2 - Hospital Santa Corona, Pietra Ligure, Italy
| | - Stefania Bottone
- Emergency Medicine (A&E), Asl2 - Hospital Santa Corona, Pietra Ligure, Italy
| | - Laura Spadafora
- Emergency Medicine (A&E), Asl2 - Hospital Santa Corona, Pietra Ligure, Italy
| | - Cristina Cocino
- Emergency Medicine (A&E), Asl2 - Hospital Santa Corona, Pietra Ligure, Italy
| | - Lee Smith
- The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK
| | - Thomas Benzing
- Ageing Clinical Research, Department of Internal Medicine and Center for Molecular Medicine, Cologne, University of CologneFaculty of Medicine and University Hospital Cologne, Cologne, Germany
- Cologne Excellence Cluster on Cellular Stress-Responses in Aging-Associated Diseases (CECAD), University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Maria Cristina Polidori
- Ageing Clinical Research, Department of Internal Medicine and Center for Molecular Medicine, Cologne, University of CologneFaculty of Medicine and University Hospital Cologne, Cologne, Germany
- Cologne Excellence Cluster on Cellular Stress-Responses in Aging-Associated Diseases (CECAD), University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
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Christiansen JM, Meyer AM, Pickert L, Pfister R, Polidori MC. Challenges in the performance of real-life studies in older patients: focus on long-term care facilities. GERIATRIC CARE 2022. [DOI: 10.4081/gc.2022.10384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Research on geriatric conditions and atypical disease presentation in poorly studied patients’ groups is becoming increasingly important. Aim of the present investigation was addressing prevalence and prognostic significance of aortic valve stenosis (AVS) in older residents of long-term care facilities (LTCF). For the planned recruitment of 500 LTCF guests of a German metropolitan area, study investigators were trained and in the performance of a cardiologic examination and of the comprehensive geriatric assessment- based multidimensional prognostic index (MPI). After five attempts to obtain permission to conduct the study in 30 institutions, patients’ recruitment was stopped with 22 participants included from one institution. AVS was suspected in two patients, in agreement with the reported prevalence data. The MPI value correlated with social support (P=0.002) and geriatric syndromes (P=0.004). This structured attempt at investigating presence and prognostic signature of AVS in older LTCF guests was challenged by logistic obstacles strongly hindering diagnosis of potentially treatable conditions which, if undisclosed, negatively impact on survival and quality of life.
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The prognostic fingerprint of quality of life in older inpatients : Relationship to geriatric syndromes' and resources' profile. Z Gerontol Geriatr 2021; 55:38-43. [PMID: 34617144 DOI: 10.1007/s00391-021-01978-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 09/08/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The Comprehensive Geriatric Assessment (CGA) provides essential information about older hospitalized patients but is either not systematically adopted or not adopted at all in clinical routine. As a consequence, critical factors influencing patients' trajectories, like personal resources (geriatric resources, GR), geriatric syndromes (GS), health-related quality of life (HRQoL) and multidimensional prognosis often escape routine diagnostics. OBJECTIVE To investigate the association between HRQoL and GR/GS as well as its prognostic signature. MATERIAL AND METHODS In this study 165 inpatients older than 65 years admitted to an internal medicine department of a German large metropolitan hospital were assessed by a CGA-based calculation of the multidimensional prognostic index (MPI). Ten different GR and 17 GS, as well as HRQoL were collected. After 3, 6 and 12 months the patients were followed-up by telephone. RESULTS The HRQoL was associated with MPI (p < 0.001), number of GS (p < 0.001) and survival days after discharge (p = 0.008). Additionally, significant associations were found between HRQoL and number of GR (p < 0.001). GS displaying risk for physical dependence like instability (p < 0.001) and chronic pain (p = 0.007) and single GR/GS that influence patient's confidence like isolation (p < 0.001), depression (p < 0.001) and emotional resources (p = 0.002) were also associated with HRQoL. CONCLUSION The HRQoL is significantly associated to specific risk and protective factor profiles of GR and GS. To improve quality of life, targeted, patient-centered diagnostics and treatment of GS as well as stabilization of GR should be encouraged in the management of older, multimorbid patients outside geriatric settings.
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Bakas AT, Sewnaik A, van Straaten J, Baatenburg de Jong RJ, Mattace-Raso FUS, Polinder-Bos HA. The Multidimensional Prognostic Index as a Measure of Frailty in Elderly Patients with Head and Neck Cancer. Clin Interv Aging 2021; 16:1679-1689. [PMID: 34556980 PMCID: PMC8453644 DOI: 10.2147/cia.s323740] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 09/08/2021] [Indexed: 12/19/2022] Open
Abstract
Purpose The multidimensional prognostic index (MPI) is a prognostic model derived from the comprehensive geriatric assessment (CGA) which can predict 1-year mortality risk in elderly individuals. We hypothesized that the MPI also reflects the degree of frailty and thus will correlate with established measures of frailty. Therefore, the aim of this study is to explore whether the MPI-score is a measure of frailty in older head and neck cancer patients and is associated with several physical functioning measurements. Patients and Methods From November 2019 to July 2020, a prospective cohort study enrolled patients with head and neck cancer aged ≥70 years, and patients <70 years with an abnormal G8 score. The MPI-score ranged from 0 to 1 and was categorized in MPI-stage 1 (≤0.33, non-frail); MPI-stage 2 (0.34-0.66, mildly frail), and MPI-stage 3 (≥0.67, severe frail). Pearson's correlation coefficient and multivariable linear regression were used to study the association between MPI-score and the physical functioning measurements handgrip strength, gait speed, and the timed up and go test (TUGT). Results A total of 163 patients were included. One hundred four (63.8%) patients were categorized as non-frail according MPI-stage 1, and 59 (36.2%) patients as mildly or severe frail (n=55 MPI-stage 2; n=4 MPI-stage 3, respectively). A higher MPI-score was significantly associated with lower hand grip strength (B -0.49 [95% CI -0.71; -0.28] p<0.001), lower gait speed (B -0.41 [95% CI -0.55; -0.25] p<0.001), and a slower TUGT (B 0.53 [95% CI 0.66; 0.85] p<0.001). Conclusion Almost one-third of the included patients with head and neck cancer was mild or severe frail. A higher MPI-score, indicating higher degree of frailty, was associated with worse physical performance by lower handgrip strength, gait speed, and a slower TUGT. Thus, the MPI reflects the degree of frailty.
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Affiliation(s)
- Ajay T Bakas
- Department of Otorhinolaryngology, Erasmus MC University Cancer Institute, Rotterdam, the Netherlands
| | - Aniel Sewnaik
- Department of Otorhinolaryngology, Erasmus MC University Cancer Institute, Rotterdam, the Netherlands
| | - Jaclyn van Straaten
- Division of Geriatric Medicine, Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | | | - Francesco U S Mattace-Raso
- Division of Geriatric Medicine, Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Harmke A Polinder-Bos
- Division of Geriatric Medicine, Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
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Senesi B, Prete C, Siri G, Pinna A, Giorgeschi A, Veronese N, Sulpasso R, Sabbà C, Pilotto A. Multidimensional prognostic index (MPI) predicts successful application for disability social benefits in older people. Aging Clin Exp Res 2021; 33:1963-1969. [PMID: 32915449 DOI: 10.1007/s40520-020-01694-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 08/21/2020] [Indexed: 01/26/2023]
Abstract
AIM The economic recognition of disability is of importance in daily practice, but the tools used in older people are still limited. Therefore, we aimed to investigate the effectiveness of the multidimensional prognostic index (MPI) to identify frail older subjects to be submitted to civil invalidity application for disability benefits including Attendance Allowance (AA) indemnity, Carer's Leave (Law 104) and/or Parking Card for people with disabilities. METHODS From March 2018 to January 2019, 80 older people were included. The MPI was calculated from comprehensive geriatric assessment information including eight different domains. Civil benefits included attendance allowance (AA) indemnity by the Local Medico-Legal Committee (MLC-NHS) and by the National Institute of Social Security Committee (INPS), Carer's Leave (Law 104), and Parking Card for people with disabilities. RESULTS MPI values were associated with an increased probability to obtain a 100% civil disability, AA indemnity, Carer's Leave and a parking card for people with disabilities. MPI score showed a very good accuracy in predicting the civil invalidity benefits with a area-under-curve (AUC) of 87.3 (95% CI 80.6-97.4) to predict the release of AA indemnity, 81.3 (95% CI 68.5-91.1) to predict Care's leave and 70.7 (95% CI 59.4-84.7) to predict the Parking Card release. Moreover, data showed that a cut-off score of MPI ≥ 0.75 could identify the 100% of older subjects who successfully obtained the indemnity release. CONCLUSION MPI is an excellent predictor of social benefits' release by local and national agencies.
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Affiliation(s)
- Barbara Senesi
- Geriatrics Unit, Center for Cognitive Disorders and Dementia (CDCD), Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Galliera Hospital, Via Mura delle Cappuccine 14, 16128, Genova, Italy.
| | - Camilla Prete
- Geriatrics Unit, Center for Cognitive Disorders and Dementia (CDCD), Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Galliera Hospital, Via Mura delle Cappuccine 14, 16128, Genova, Italy
| | - Giacomo Siri
- Scientific Coordination Office, Biostatistics, Galliera Hospital, Genova, Italy
| | - Alessandra Pinna
- Geriatrics Unit, Center for Cognitive Disorders and Dementia (CDCD), Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Galliera Hospital, Via Mura delle Cappuccine 14, 16128, Genova, Italy
| | - Angela Giorgeschi
- Geriatrics Unit, Center for Cognitive Disorders and Dementia (CDCD), Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Galliera Hospital, Via Mura delle Cappuccine 14, 16128, Genova, Italy
| | - Nicola Veronese
- Geriatrics Unit, Center for Cognitive Disorders and Dementia (CDCD), Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Galliera Hospital, Via Mura delle Cappuccine 14, 16128, Genova, Italy
- Primary Care Department, Azienda ULSS3 Serenissima, District 3, Venice, Italy
| | - Roberto Sulpasso
- Department of Interdisciplinary Medicine, University of Bari, Bari, Italy
| | - Carlo Sabbà
- Department of Interdisciplinary Medicine, University of Bari, Bari, Italy
| | - Alberto Pilotto
- Geriatrics Unit, Center for Cognitive Disorders and Dementia (CDCD), Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Galliera Hospital, Via Mura delle Cappuccine 14, 16128, Genova, Italy
- Department of Interdisciplinary Medicine, University of Bari, Bari, Italy
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Pilotto A, Custodero C, Maggi S, Polidori MC, Veronese N, Ferrucci L. A multidimensional approach to frailty in older people. Ageing Res Rev 2020; 60:101047. [PMID: 32171786 PMCID: PMC7461697 DOI: 10.1016/j.arr.2020.101047] [Citation(s) in RCA: 210] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 02/13/2020] [Accepted: 03/10/2020] [Indexed: 12/13/2022]
Abstract
Frailty is an important factor determining a higher risk of adverse health outcomes in older adults. Although scientific community in the last two decades put a lot of effort for its definition, to date no consensus was reached on its assessment. The mainstream thinking describes frailty as a loss of physical functions or as accumulation of multiple deficits. Recently, a novel conceptual model of frailty has emerged based on the loss of harmonic interaction between multiple domains (also referred as dimensions) including genetic, biological, functional, cognitive, psychological and socio-economic domain that ultimately lead to homeostatic instability. Therefore, the multidimensional aspects of frailty condition could be captured by the comprehensive geriatric assessment (CGA) and its derived Multidimensional Prognostic Index (MPI). This instrument has been applied in different clinical settings and in several cohorts of older adults with specific acute and chronic diseases, showing always excellent accuracy in stratifying population according the mortality risk and other negative health outcomes, i.e. hospitalization, institutionalization or admission to homecare services. This MPI "plasticity" provides a single numerical prognostic index which could be helpful in clinical decision making for the management of frail older adults.
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Affiliation(s)
- Alberto Pilotto
- Department of Interdisciplinary Medicine, University of Bari Aldo Moro, Bari, Italy; Geriatrics Unit, Department of Geriatric Care, Orthogeriatrics and Rehabilitation, E.O. Ospedali Galliera, Genova, Italy.
| | - Carlo Custodero
- Department of Interdisciplinary Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Stefania Maggi
- National Research Council (CNR), Aging Section, Padova, Italy
| | | | - Nicola Veronese
- Geriatrics Unit, Department of Geriatric Care, Orthogeriatrics and Rehabilitation, E.O. Ospedali Galliera, Genova, Italy; Azienda ULSS 3 Serenissima, Primary Care Department, District 3, Venice, Italy
| | - Luigi Ferrucci
- National Institute on Aging, NIH, Baltimore, MD, United States
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Cruz-Jentoft AJ, Daragjati J, Fratiglioni L, Maggi S, Mangoni AA, Mattace-Raso F, Paccalin M, Polidori MC, Topinkova E, Ferrucci L, Pilotto A. Using the Multidimensional Prognostic Index (MPI) to improve cost-effectiveness of interventions in multimorbid frail older persons: results and final recommendations from the MPI_AGE European Project. Aging Clin Exp Res 2020; 32:861-868. [PMID: 32180170 DOI: 10.1007/s40520-020-01516-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 02/14/2020] [Indexed: 02/06/2023]
Abstract
MPI_AGE is a European Union co-funded research project aimed to use the Multidimensional Prognostic Index (MPI), a validated Comprehensive Geriatric Assessment (CGA)-based prognostic tool, to develop predictive rules that guide clinical and management decisions in older people in different European countries. A series of international studies performed in different settings have shown that the MPI is useful to predict mortality and risk of hospitalization in community-dwelling older subjects at population level. Furthermore, studies performed in older people who underwent a CGA before admission to a nursing home or receiving homecare services showed that the MPI successfully identified groups of persons who could benefit, in terms of reduced mortality, of specific therapies such as statins in diabetes mellitus and coronary artery disease, anticoagulants in atrial fibrillation and antidementia drugs in cognitive decline. A prospective trial carried out in nine hospitals in Europe and Australia demonstrated that the MPI was able to predict not only in-hospital and long-term mortality, but also institutionalization, re-hospitalization and receiving homecare services during the one-year follow-up after hospital discharge. The project also explored the association between MPI and mortality in hospitalized older patients in need of complex procedures such as transcatheter aortic valve implantation or enteral tube feeding. Evidence from these studies has prompted the MPI_AGE Investigators to formulate recommendations for healthcare providers, policy makers and the general population which may help to improve the cost-effectiveness of appropriate health care interventions for older patients.
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