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Barbagelata M, Morganti W, Seminerio E, Camurri A, Ghisio S, Loro M, Puleo G, Dijk B, Nolasco I, Costantini C, Cera A, Senesi B, Ferrari N, Canepa C, Custodero C, Pilotto A. Resilience improvement through a multicomponent physical and cognitive intervention for older people: the DanzArTe emotional well-being technology project. Aging Clin Exp Res 2024; 36:72. [PMID: 38488883 PMCID: PMC10942916 DOI: 10.1007/s40520-023-02678-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 12/08/2023] [Indexed: 03/17/2024]
Abstract
BACKGROUND Resilience is a crucial component of successful aging. However, which interventions might increase resilience in older adults is yet unclear. AIMS This study aims to assess the feasibility and the physical and psychological effects of a technology-based multicomponent dance movement intervention that includes physical, cognitive, and sensory activation in older people living in community-dwelling and nursing home. METHODS DanzArTe program consists of four sessions on a weekly basis, using a technological platform that integrates visual and auditory contents in real time. 122 participants (mean age = 76.3 ± 8.8 years, 91 females = 74.6%) from seven nursing homes and community-dwelling subjects were assessed, before and after the intervention, with the Resilience Scale-14 items (RES-14), the Multidimensional Prognostic Index (MPI), the Psychological General Well-Being Index (PGWBI-S), and the Client Satisfaction Questionnaire-8 (CSQ-8). Mann-Whitney and Wilcoxon signed-ranks tests were used for statistical analyses. RESULTS At baseline significant differences in MPI and RES-14 between community-dwelling and nursing home residents were observed (p < 0.001 for both analyses). After the intervention, resilience significantly increased in total sample (RES-14 mean T1 = 74.6 Vs. T2 = 75.7) and in the nursing home residents (RES-14 mean T1 = 68.1 Vs. T2 = 71.8). All participants showed high overall satisfaction for DanzArTe program (CSQ-8 mean = 23.9 ± 4.4). No differences in MPI and PGWBI-S were observed. DISCUSSION DanzArTe was a feasible intervention and high appreciated by all older adults. Nursing home residents revealed improvements in resilience after DanzArTe program. CONCLUSION The DanzArTe technology-based multi-component intervention may improve resilience in older people living in nursing homes.
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Affiliation(s)
- Marina Barbagelata
- Department Geriatric Care, Neurology and Rehabilitation, Galliera Hospital, Genoa, Italy.
| | - Wanda Morganti
- Department Geriatric Care, Neurology and Rehabilitation, Galliera Hospital, Genoa, Italy
| | - Emanuele Seminerio
- Department Geriatric Care, Neurology and Rehabilitation, Galliera Hospital, Genoa, Italy
| | - Antonio Camurri
- Department of Informatics, Bioengineering, Robotics and Systems' Engineering (DIBRIS), University of Genova, Genoa, Italy
| | - Simone Ghisio
- Department of Informatics, Bioengineering, Robotics and Systems' Engineering (DIBRIS), University of Genova, Genoa, Italy
| | - Mara Loro
- Foundation "Fondazione Piemonte dal Vivo", Turin, Italy
| | - Gianluca Puleo
- Department Geriatric Care, Neurology and Rehabilitation, Galliera Hospital, Genoa, Italy
| | - Babette Dijk
- Ligurian Health Agency, Memory Clinic, Chiavari, Italy
| | | | | | - Andrea Cera
- Department of Informatics, Bioengineering, Robotics and Systems' Engineering (DIBRIS), University of Genova, Genoa, Italy
| | - Barbara Senesi
- Department Geriatric Care, Neurology and Rehabilitation, Galliera Hospital, Genoa, Italy
| | - Nicola Ferrari
- Department of Italianistics, Romanistics, Antiquities, Arts and Performing Arts, University of Genova, Genoa, Italy
| | - Corrado Canepa
- Department of Informatics, Bioengineering, Robotics and Systems' Engineering (DIBRIS), University of Genova, Genoa, Italy
| | - Carlo Custodero
- Department of Interdisciplinary Medicine, "Aldo Moro" University of Bari, Bari, Italy
| | - Alberto Pilotto
- Department Geriatric Care, Neurology and Rehabilitation, Galliera Hospital, Genoa, Italy
- Department of Interdisciplinary Medicine, "Aldo Moro" University of Bari, Bari, Italy
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Veronese N, Gallo U, Boccardi V, Demurtas J, Michielon A, Taci X, Zanchetta G, Campbell Davis SE, Chiumente M, Venturini F, Pilotto A. Efficacy of deprescribing on health outcomes: An umbrella review of systematic reviews with meta-analysis of randomized controlled trials. Ageing Res Rev 2024; 95:102237. [PMID: 38367812 DOI: 10.1016/j.arr.2024.102237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 02/06/2024] [Accepted: 02/14/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND Deprescribing is an important intervention across different settings in medicine, but the literature supporting such a practice is still conflicting. Therefore, we aimed to capture the breadth of outcomes reported and assess the strength of evidence of the use of deprescribing for health outcomes. METHODS Umbrella review of systematic reviews of the use of deprescribing searching in Medline, Scopus, and Web of Science until 01 November 2023. The grading of evidence was carried out using the GRADE for intervention studies, whilst data regarding systematic reviews were reported as narrative findings. RESULTS Among 456 papers, 12 systematic reviews (six with meta-analysis) for a total of 231 RCTs and 44,193 patients were included. In any setting, deprescribing was able to significantly reduce the number of total and of potentially inappropriate medications (PIMs) in older patients (low certainty of evidence) and to reduce the proportion of participants potentially having several or PIMs (moderate certainty of evidence). In community, supported by a high certainty of evidence, deprescribing was not more effective than standard care in decreasing injurious falls, any falls or number of fallers. In nursing home, deprescribing was associated with a significantly lower PIMs than standard care (very low certainty of evidence). In end-of-life situations, deprescribing significantly reduced mortality rate of approximately 41% (high certainty of evidence). CONCLUSIONS Deprescribing is a promising intervention across different settings and situations, but a notable gap in the literature concerning its effects on substantial outcomes still exists.
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Affiliation(s)
- Nicola Veronese
- Geriatrics Section, Department of Internal Medicine, University of Palermo, Palermo, Italy.
| | - Umberto Gallo
- Pharmaceutical Department, Local Health Unit n. 6 Euganea, Padua, Italy
| | - Virginia Boccardi
- Department of Medicine and Surgery, Institute of Gerontology and Geriatrics, University of Perugia, Perugia, Italy
| | - Jacopo Demurtas
- Family Medicine Department, USL Sud Est Toscana, Grosseto, Italy
| | - Alberto Michielon
- School of Specialization in Hospital Pharmacy, University of Siena, Siena, Italy
| | - Xhoajda Taci
- School of Specialization in Hospital Pharmacy, Università degli Studi di Padova, Padua, Italy
| | - Giulia Zanchetta
- School of Specialization in Hospital Pharmacy, Università degli Studi di Padova, Padua, Italy
| | | | - Marco Chiumente
- Scientific Direction, SIFaCT - Società Italiana di Farmacia Clinica e Terapia, Turin, Italy
| | | | - Alberto Pilotto
- Geriatrics Unit, Department Geriatric Care, Orthogeriatrics and Rehabilitation, E.O. Galliera Hospital, Genoa, Italy; Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", Bari, Italy
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Pilotto A, Barbagelata M, Morganti W, Seminerio E, Iaccarino G, Genazzani A, Trompetto C, Arabia G, Illario M, Volta E, Custodero C, Cella A. Development and implementation of multicomponent homecare interventions for multimorbid and frail older people based on Information and Communication Technologies: The MULTIPLAT_AGE project. Arch Gerontol Geriatr 2024; 117:105252. [PMID: 37972433 DOI: 10.1016/j.archger.2023.105252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 10/24/2023] [Accepted: 10/26/2023] [Indexed: 11/19/2023]
Abstract
The prevention and treatment of frailty condition among multimorbid older adults, in community and hospital settings, is becoming a healthcare priority. Growing evidence suggests that a multidimensional approach could help not only in the early identification of older patients' needs but also in designing personalized preventive interventions. However, in clinical practice, the effectiveness of such interventions is limited by a lack of continuity of care and poor compliance of patients. The widespread diffusion of the information and communication technology (ICT) could offer an excellent way to implement and monitor multidimensional and personalized interventions for multimorbid older adults. In this scenario, the MULTIPLAT_AGE, is a network project involving five research centers with the main objective to supply multidimensional interventions targeted to cognitive, motor, pharmacological, and functional domains including ICT-based: i) transitional care model from the hospital to a protected home area; ii) automatic home-care system to improve activities of daily living; iii) program to improve appropriate drug prescription in nursing-home residents; iv) tele-rehabilitation program to reduce the risk of falls and v) cognitive stimulation delivered by remote in older adults with neurological disorders. Each project is linked to the others by employing a shared online platform, in a perspective of technological-supplied multicomponent interventions according to the concept of "aging in place" as the best solution for the treatment and healthcare of older people. Here we describe the general framework of the MULTIPLAT_AGE, and we examine every single project, pointing out innovative aspects, and discussing the expected results.
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Affiliation(s)
- Alberto Pilotto
- Geriatrics Unit, Department Geriatric Care, Orthogeriatrics and Rehabilitation, E.O. Galliera Hospital, Genoa, Italy; Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", Bari, Italy.
| | - Marina Barbagelata
- Geriatrics Unit, Department Geriatric Care, Orthogeriatrics and Rehabilitation, E.O. Galliera Hospital, Genoa, Italy
| | - Wanda Morganti
- Geriatrics Unit, Department Geriatric Care, Orthogeriatrics and Rehabilitation, E.O. Galliera Hospital, Genoa, Italy
| | - Emanuele Seminerio
- Geriatrics Unit, Department Geriatric Care, Orthogeriatrics and Rehabilitation, E.O. Galliera Hospital, Genoa, Italy
| | - Guido Iaccarino
- Department of Clinical Medicine and Surgery, University "Federico II" of Naples, Naples, Italy
| | - Armando Genazzani
- Department of Pharmaceutical Sciences, Università del Piemonte Orientale, Novara, Italy
| | - Carlo Trompetto
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Gennarina Arabia
- Neurologic Department, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Maddalena Illario
- Public Health Department, University Federico II of Naples, Naples, Italy
| | - Erica Volta
- Geriatrics Unit, Department Geriatric Care, Orthogeriatrics and Rehabilitation, E.O. Galliera Hospital, Genoa, Italy
| | - Carlo Custodero
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", Bari, Italy
| | - Alberto Cella
- Geriatrics Unit, Department Geriatric Care, Orthogeriatrics and Rehabilitation, E.O. Galliera Hospital, Genoa, Italy
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Padovani A, Caratozzolo S, Benussi A, Galli A, Rozzini L, Cosseddu M, Turrone R, Pilotto A. Vortioxetine Treatment for Depression in Patients with Prodromal vs Mild Alzheimer's Disease: A Six-Month, Open-Label, Observational Study. J Prev Alzheimers Dis 2024; 11:375-381. [PMID: 38374744 DOI: 10.14283/jpad.2023.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
BACKGROUND Depressive symptoms are common in Alzheimer disease (AD) from the prodromal stage. The benefits of antidepressants have been investigated in patients with AD dementia with mixed results. OBJECTIVES This study aimed to compare the efficacy of vortioxetine in prodromal and mild-to-moderate AD patients with depression, and to assess the comparative effect on secondary measures, including behavioral disturbances, cognitive function, and activities of daily living. PARTICIPANTS All subjects with AD at a single-center dementia center underwent a standard evaluation with mini-mental state examination (MMSE), basic and instrumental activities of daily living (BADL and IADL), geriatric depression scale (GDS), neuropsychiatric inventory (NPI), and clinical evaluation every six months. MEASUREMENTS The study specifically assessed patients on vortioxetine with available six-month follow-up data. The changes in GDS, NPI, MMSE, BADL/IADL at six months in the entire AD population and mild-to-moderate AD vs prodromal population were analyzed using repeated measure multivariate analyses. Linear regression analyses were implemented to evaluate baseline demographics and clinical characteristics associated with depressive and cognitive improvements at six months. RESULTS Out of 680 AD patients, 115 were treated with vortioxetine, and 89 with six-month follow-up data were included in the analyses. A significant improvement at follow-up was observed for GDS, NPI total and sub score items (mood, anxiety, apathy, sleep disturbances, eating abnormalities). Both mild-to-moderate and prodromal AD showed a positive GDS response, whereas mild-to-moderate AD showed a better improvement on total NPI and apathy/nighttime behaviors subitems compared to prodromal AD. Higher baseline GDS score was the only variable associated with higher responses in linear regression analyses. MMSE showed a significant improvement at six months in the entire cohort, with a greater effect in prodromal vs mild-to-moderate AD. Cognitive improvement (i.e., MMSE changes) was associated with cognitive status at baseline but independent of the antidepressant/behavioral changes (i.e., GDS/NPI). CONCLUSIONS Our results suggest that vortioxetine is highly tolerable and clinically effective in both prodromal and mild-to-moderate AD with depression. Patients with mild-to-moderate AD benefited more from a wide range of behavioral disturbances. The study also showed significant improvement in global cognitive measures, especially in prodromal AD subjects. Further studies are needed to investigate the independent beneficial effect of vortioxetine on depression and cognition in AD.
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Affiliation(s)
- A Padovani
- Alessandro Padovani, Department of Clinical and Experimental Sciences, Neurology Unit, University of Brescia, Italy, Piazzale Spedali CIvili 1, 25123, Brescia, Italy, , Tel: +390303995632
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Zanetti M, Veronese N, Riso S, Boccardi V, Bolli C, Cintoni M, Francesco VD, Mazza L, Onfiani G, Zenaro D, Pilotto A. Polypharmacy and malnutrition in older people: A narrative review. Nutrition 2023; 115:112134. [PMID: 37453210 DOI: 10.1016/j.nut.2023.112134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 06/05/2023] [Accepted: 06/13/2023] [Indexed: 07/18/2023]
Abstract
Polypharmacy is the simultaneous use of multiple medicines, usually more than five. Polypharmacy is highly prevalent among older individuals and is associated with several adverse health outcomes, including frailty. The role of polypharmacy in nutritional status seems to be crucial: although a clear association between polypharmacy and malnutrition has been widely reported in older people, the magnitude of the effect of increased number of drugs in combination with their type on the risk for malnutrition remains to be largely explored. Therefore, this review aims to discuss the association between polypharmacy and malnutrition in older people and to provide suggestions for its management. Polypharmacy is prevalent among malnourished frail patients, and the relative contribution of comorbidities and polypharmacy to malnutrition is difficult to be determined. Several mechanisms by which commonly used medications have the potential to affect nutritional status have been identified and described. Deprescribing (i.e., a systematic process of identification and discontinuation of drugs or a reduction of drug regimens) could be an essential step for minimizing the effects of polypharmacy on malnutrition. In this regard, the literature suggests that in older patients taking several medications, the best method to solve this problem is the comprehensive geriatric assessment, based on a holistic approach, including drug review, to find potential unnecessary and inappropriate medications. Nutritional and deprescribing interventions must be tailored to patient needs and to the local context to overcome barriers when applied in different settings.
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Affiliation(s)
- Michela Zanetti
- Geriatric Clinic, Maggiore Hospital of Trieste, Azienda Sanitaria Universitaria Integrata Giuliano Isontina, Trieste, Italy; Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy.
| | - Nicola Veronese
- Department of Internal Medicine and Geriatrics, University of Palermo, Palermo, Italy
| | - Sergio Riso
- Clinical Nutrition and Dietetics Unit, Maggiore della Carità Hospital, University of Eastern Piedmont, Novara, Italy
| | - Virginia Boccardi
- Institute of Gerontology and Geriatrics, Department of Medicine and Surgery, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Carolina Bolli
- Clinical Nutrition Unit, Presidio Ospedaliero "San Filippo Neri", Rome, Italy
| | - Marco Cintoni
- Clinical Nutrition Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | | | - Liliana Mazza
- Department of Integration, Azienda USL di Bologna, Bologna, Italy
| | - Giovanna Onfiani
- Clinical Nutrition Unit, Complex Structure of Endocrinology, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Davide Zenaro
- Direzione Tecnica Socio Sanitaria Coopselios, Reggio Emilia, Italy
| | - Alberto Pilotto
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Galliera Hospital, Genoa, Italy; Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", Bari, Italy
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Pilotto A, Volta E, Barbagelata M, Argusti A, Camurri A, Casiddu N, Berutti‐Bergotto C, Custodero C, Cella A. The PRO-HOME Project. A multicomponent intervention for the protected discharge from the hospital of multimorbid and polytreated older individuals by using innovative technologies: A pilot study. Health Expect 2023; 27:e13872. [PMID: 37890856 PMCID: PMC10768857 DOI: 10.1111/hex.13872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 08/18/2023] [Accepted: 09/05/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUD Discharge planning from the hospital of frail older patients is an important step to avoid inappropriate long-stay hospitalizations and to prevent the risks related to the prolonged hospitalization. In this frame, we developed an experimental trial-'PRO-HOME', a multicomponent programme of interventions for multimorbid and polytreated hospitalized older patients. AIM The main aim of the study was to develop a protected discharge facility using a mini apartment equipped with advanced architectural and technological components to reduce the length of hospital stay of older participants (aged 65+ years old) admitted to the hospital for an acute event, deemed stable and dischargeable. MATERIALS AND METHODS This is a pilot randomized controlled study, comparing 30 hospitalized participants included in a multidimensional, transitional care programme based on information and communication technologies to 30 patients in standard usual care until hospital discharge. RESULTS We presented the study design of the PRO-HOME programme, including architectural and technological components, the enrolment procedures, the components of the intervention that is physical activity, cognitive training and life-style education and the evaluation method of the intervention based on the Comprehensive Geriatric Assessment to explore the changes in the individual domains that are target of the multicomponent intervention. CONCLUSIONS The final results will suggest whether the PRO-HOME programme represents a useful and feasible intervention to reduce the length of hospital stay of multimorbid and polytreated hospitalized older patients and improve their physical and cognitive performances and overall quality of life. PATIENT OR PUBLIC CONTRIBUTION Due to the characteristics of the population of interest of the PRO-HOME study, we involved in the study design and programme of the activities the participants enrolled in a previous smart home-based project named MoDiPro carried-out during a 3-year period. The elderly participants from the local population involved were asked, by means of focus groups, for feedback on their experience in MoDiPro, and their suggestions were integrated into the design phase of the current PRO-HOME project. The focus groups included open group interviews with a qualitative collection of the patients' feedback so that the participants could interact with each other.
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Affiliation(s)
- Alberto Pilotto
- Department Geriatric Care, Orthogeriatrics and RehabilitationE.O. Galliera HospitalGenovaItaly
- Department of Interdisciplinary Medicine“Aldo Moro”, University of BariBariItaly
| | - Erica Volta
- Department Geriatric Care, Orthogeriatrics and RehabilitationE.O. Galliera HospitalGenovaItaly
- Department of Informatics, Bioengineering, Robotics and Systems' Engineering (DIBRIS)University of GenovaGenovaItaly
| | - Marina Barbagelata
- Department Geriatric Care, Orthogeriatrics and RehabilitationE.O. Galliera HospitalGenovaItaly
| | | | - Antonio Camurri
- Department of Informatics, Bioengineering, Robotics and Systems' Engineering (DIBRIS)University of GenovaGenovaItaly
| | - Niccolò Casiddu
- Department of Architecture and Design (DAD)University of GenovaGenovaItaly
| | | | - Carlo Custodero
- Department of Interdisciplinary Medicine“Aldo Moro”, University of BariBariItaly
| | - Alberto Cella
- Department Geriatric Care, Orthogeriatrics and RehabilitationE.O. Galliera HospitalGenovaItaly
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Morganti W, Veronese N, Barbagelata M, Castagna A, Custodero C, Solimando L, Burgio MI, Montana Lampo SE, Seminerio E, Puleo G, Senesi B, Cammalleri L, Ruotolo G, Sabbà C, Barbagallo M, Pilotto A. Validation of a Brief Form of the Self-Administered Multidimensional Prognostic Index: The SELFY-BRIEF-MPI Project. J Clin Med 2023; 12:6026. [PMID: 37762966 PMCID: PMC10531940 DOI: 10.3390/jcm12186026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 08/31/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023] Open
Abstract
In clinical practice, self-administered and brief tools to promptly identify older people at risk of frailty are required. The Multidimensional Prognostic Index (MPI), derived from the Comprehensive Geriatric Assessment (CGA) seems reliable enough to serve this purpose, but despite the several versions developed over the past 15 years, it lacks a self-administered and brief version. In this study, we aimed to evaluate the agreement between an abbreviated form of the SELFY-MPI (i.e., SELFY-BRIEF-MPI) and the standard version of the MPI. Four Italian hospitals consecutively enrolled outpatients and inpatients >65 years. The sample included 105 participants (mean age = 78.8 years, 53.3% females). Overall, the two versions showed non-statistically significant differences (Standard-MPI 0.42 ± 0.19 vs.. SELFY-BRIEF-MPI 0.41 ± 0.18; p = 0.104) and a very strong correlation (R = 0.86, p < 0.001). The Bland-Altman Plot revealed that only 5/105 measurements (4.76%) were outside the limits of agreement. The accuracy of the SELFY-BRIEF-MPI in identifying frail people (defined as a Standard-MPI > 0.66) was optimal (area under the curve, AUC = 0.90, p < 0.001). To predict multidimensional frailty, a SELFY-BRIEF-MPI score of 0.60 exhibited the greatest sensitivity/specificity ratio. In conclusion, the SELFY-BRIEF-MPI reported a good agreement with the standard version of the MPI, indicating its application in the screening of multidimensional frailty among older people.
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Affiliation(s)
- Wanda Morganti
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Ente Ospedaliero Galliera Hospital, 16128 Genoa, Italy; (W.M.); (M.B.); (E.S.); (G.P.); (L.C.)
| | - Nicola Veronese
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, 90127 Palermo, Italy; (L.S.); (M.I.B.); (S.E.M.L.); (M.B.)
| | - Marina Barbagelata
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Ente Ospedaliero Galliera Hospital, 16128 Genoa, Italy; (W.M.); (M.B.); (E.S.); (G.P.); (L.C.)
| | - Alberto Castagna
- Primary Care Department, Health District of Soverato, Catanzaro Provincial Health Unit, 88068 Soverato, Italy;
| | - Carlo Custodero
- Department of Interdisciplinary Medicine, “Aldo Moro” University of Bari, 70124 Bari, Italy;
| | - Luisa Solimando
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, 90127 Palermo, Italy; (L.S.); (M.I.B.); (S.E.M.L.); (M.B.)
| | - Marianna Ilarj Burgio
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, 90127 Palermo, Italy; (L.S.); (M.I.B.); (S.E.M.L.); (M.B.)
| | - Sofia Elena Montana Lampo
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, 90127 Palermo, Italy; (L.S.); (M.I.B.); (S.E.M.L.); (M.B.)
| | - Emanuele Seminerio
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Ente Ospedaliero Galliera Hospital, 16128 Genoa, Italy; (W.M.); (M.B.); (E.S.); (G.P.); (L.C.)
| | - Gianluca Puleo
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Ente Ospedaliero Galliera Hospital, 16128 Genoa, Italy; (W.M.); (M.B.); (E.S.); (G.P.); (L.C.)
| | - Barbara Senesi
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Ente Ospedaliero Galliera Hospital, 16128 Genoa, Italy; (W.M.); (M.B.); (E.S.); (G.P.); (L.C.)
| | - Lisa Cammalleri
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Ente Ospedaliero Galliera Hospital, 16128 Genoa, Italy; (W.M.); (M.B.); (E.S.); (G.P.); (L.C.)
| | - Giovanni Ruotolo
- Geriatric Medicine Department, Azienda Sanitario Ospedaliero “Renato Dulbecco”, 88100 Catanzaro, Italy;
| | - Carlo Sabbà
- Department of Internal Medicine, and Rare Diseases Centre “C. Frugoni”, University Hospital of Bari, 70120 Bari, Italy
| | - Mario Barbagallo
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, 90127 Palermo, Italy; (L.S.); (M.I.B.); (S.E.M.L.); (M.B.)
| | - Alberto Pilotto
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Ente Ospedaliero Galliera Hospital, 16128 Genoa, Italy; (W.M.); (M.B.); (E.S.); (G.P.); (L.C.)
- Department of Interdisciplinary Medicine, “Aldo Moro” University of Bari, 70124 Bari, Italy;
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Dibello V, Lobbezoo F, Sardone R, Lozupone M, Castellana F, Zupo R, Pilotto A, Daniele A, Solfrizzi V, Manfredini D, Panza F. The Relationship between Oral Health-Related Quality of Life and Body Mass Index in an Older Population from Southern Italy: The Salus in Apulia Study. J Pers Med 2023; 13:1300. [PMID: 37763068 PMCID: PMC10533155 DOI: 10.3390/jpm13091300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 08/23/2023] [Accepted: 08/24/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND The assessment of oral health-related quality of life (OHRQoL) evaluated the impact of an individual's oral health on the patient's physical and psychosocial status. We evaluated the association between subjective OHRQoL, measured with the Oral Health Impact Profile-14 (OHIP-14) questionnaire, and unfavorable body mass index (BMI) (i.e., too high or too low) in a large population-based study on older adults from Southern Italy. Moreover, we assessed which of the seven OHIP-14 domains was the most strongly associated with an unfavorable BMI. METHODS We used data on a subpopulation of the Salus in Apulia Study, including 216 older adults. BMI < 18.4 kg/m2 and >30 kg/m2 were classified as unfavorable, while values between 18.5 and 30 kg/m2 were classified as ideal. RESULTS A higher OHIP-14 total score increased the risk of an unfavorable BMI (odds ratio (OR): 1.08, 95% confidence interval (CI): 1.01-1.15). In the model adjusted for age, sex, education, hypertension, carbohydrate consumption, and alcohol consumption, this finding was confirmed with a higher OHIP-14 total score increasing the risk of an unfavorable BMI (OR: 1.10, 95% CI: 1.01-1.22), and higher age linked to a decreased risk of an unfavorable BMI (OR: 0.89, 95% CI: 0.82-0.97). In a random forest regression model, the most important predictive domains/sub-scales of OHIP-14 in the mean decrease in the Gini coefficient for unfavorable BMI were, in order of decreasing importance, physical pain, functional limitation, psychological discomfort, physical disability, social disability, psychological disability, and handicap. CONCLUSIONS In older age, negative OHRQoL, particularly linked to the physical pain domain, increased the risk of being underweight or overweight and obesity.
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Affiliation(s)
- Vittorio Dibello
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Frank Lobbezoo
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
| | | | - Madia Lozupone
- Department of Translational Biomedicine and Neuroscience “DiBraiN”, University of Bari Aldo Moro, 70124 Bari, Italy
| | - Fabio Castellana
- Department of Interdisciplinary Medicine, Clinica Medica e Geriatria “Cesare Frugoni”, University of Bari Aldo Moro, 70124 Bari, Italy
| | - Roberta Zupo
- Department of Interdisciplinary Medicine, Clinica Medica e Geriatria “Cesare Frugoni”, University of Bari Aldo Moro, 70124 Bari, Italy
| | - Alberto Pilotto
- Department of Interdisciplinary Medicine, Clinica Medica e Geriatria “Cesare Frugoni”, University of Bari Aldo Moro, 70124 Bari, Italy
- Geriatrics Unit, Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Galliera Hospital, 16128 Genoa, Italy
| | - Antonio Daniele
- Department of Neuroscience, Catholic University of Sacred Heart, 00168 Rome, Italy
- Neurology Unit, IRCCS Fondazione Policlinico Universitario A. Gemelli, 00168 Rome, Italy
| | - Vincenzo Solfrizzi
- Department of Interdisciplinary Medicine, Clinica Medica e Geriatria “Cesare Frugoni”, University of Bari Aldo Moro, 70124 Bari, Italy
| | - Daniele Manfredini
- Department of Prosthodontics and Dental Materials, University of Siena, 53100 Siena, Italy
| | - Francesco Panza
- Department of Interdisciplinary Medicine, Clinica Medica e Geriatria “Cesare Frugoni”, University of Bari Aldo Moro, 70124 Bari, Italy
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Korenhof SA, Rouwet EV, Elstgeest LEM, Fierloos IN, Tan SS, Pisano-Gonzalez MM, Boone ALD, Pers YM, Pilotto A, López-Ventoso M, Diez Valcarce I, Zhang X, Raat H. The effect of a community-based group intervention on chronic disease self-management in a vulnerable population. Front Public Health 2023; 11:1221675. [PMID: 37670825 PMCID: PMC10475542 DOI: 10.3389/fpubh.2023.1221675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 07/24/2023] [Indexed: 09/07/2023] Open
Abstract
Introduction Chronic non-communicable diseases (NCDs) are predominantly related to modifiable health behaviors and account for 74% of global deaths at present. Behavior modification through self-management is a strategy to prevent NCDs. Chronic Disease Self-Management Programs (CDSMPs) have demonstrated improvements in health behaviors, health status, and use of healthcare. Objective We evaluated the effects of a 6-week CDSMP on self-efficacy, health behaviors, mental health, health-related quality of life (HR-QoL), and health responsibilities among vulnerable populations with chronic disease in Europe. Methods A prospective cohort study with a 6-month pre-post single-group design was conducted in five European countries. The intervention targeted adults with chronic conditions and low socioeconomic status, as well as their caregivers. The intervention was a 6-week community-based CDSMP in a group setting. Outcomes were measured per self-report questionnaire at baseline and 6-month follow-up: self-efficacy, health behaviors, mental health, HR-QoL, and health responsibilities. Results Of 1,844 participants, 1,248 (67.7%) completed follow-up and attended ≥4 sessions. For the chronic condition group, the following outcome measures at follow-up significantly improved compared with baseline (all P < 0.002): self-efficacy (SEMCD-6 6.7 vs. 6.4), mental health (PHQ-8 6.3 vs. 7.0), HR-QoL (SF-12 PCS 42.3 vs. 40.2, SF-12 MCS 42.8 vs. 41.4), health utility (EQ-5D-5L 0.88 vs. 0.86), self-rated health (EQ-5D-5L 67.2 vs. 63.9), communication with healthcare providers (2.28 vs. 2.11), understanding information (3.10 vs. 3.02), number of doctor visits (3.61 vs. 4.97), accident and emergency department visits (0.25 vs. 0.48), total nights in a hospital (0.65 vs. 1.13), and perceived medical errors (19.6 vs. 28.7%). No significant changes were detected in dietary habits, physical activity, substance use, and sleep and fatigue. For caregivers without a chronic condition, only doctor visits significantly decreased (1.54 vs. 2.25, P < 0.001). Discussion This CDSMP was associated with improvement in self-efficacy, depression, HR-QoL, and health responsibilities over 6 months in a diverse European population with a chronic condition. However, additional interventions targeting lifestyle risk factors are needed to improve health outcomes.
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Affiliation(s)
- Sophie A. Korenhof
- Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Ellen V. Rouwet
- Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Liset E. M. Elstgeest
- Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands
- Reinier Academy, Reinier de Graaf Hospital, Delft, Netherlands
| | - Irene N. Fierloos
- Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Siok Swan Tan
- Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands
- Research Group City Dynamics, InHolland University of Applied Sciences, Rotterdam, Netherlands
| | - Marta M. Pisano-Gonzalez
- Research Group “Community Health and Active Aging” of the Research Institute of Asturias (IPSA), General Directorate of Care, Ministry of Health, Oviedo, Spain
| | - An L. D. Boone
- Public Health General Directorate, Ministry of Health of the Principality of Asturias, Oviedo, Spain
| | - Yves-Marie Pers
- IRMB, University of Montpellier, INSERM, CHU Montpellier, Montpellier, France
- Clinical Immunology and Osteoarticular Diseases Therapeutic Unit, Department of Rheumatology, Lapeyronie University Hospital, Montpellier, France
| | - Alberto Pilotto
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Galliera Hospital, Genoa, Italy
- Department of Interdisciplinary Medicine, University of Bari, Bari, Italy
| | - Mónica López-Ventoso
- Research Group “Community Health and Active Aging” of the Research Institute of Asturias (IPSA), General Directorate of Care, Ministry of Health, Oviedo, Spain
| | - Isabel Diez Valcarce
- Research Group “Community Health and Active Aging” of the Research Institute of Asturias (IPSA), General Directorate of Care, Ministry of Health, Oviedo, Spain
| | - Xuxi Zhang
- Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands
- Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, China
| | | | - Hein Raat
- Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands
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10
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Custodero C, Veronese N, Topinkova E, Michalkova H, Polidori MC, Cella A, Cruz-Jentoft AJ, von Arnim CAF, Azzini M, Gruner H, Castagna A, Cenderello G, Custureri R, Zieschang T, Padovani A, Sanchez-Garcia E, Pilotto A. The Role of Multidimensional Prognostic Index to Identify Hospitalized Older Adults with COVID-19 Who Can Benefit from Remdesivir Treatment: An Observational, Prospective, Multicenter Study. Drugs Aging 2023:10.1007/s40266-023-01036-2. [PMID: 37310575 DOI: 10.1007/s40266-023-01036-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND Data regarding the importance of multidimensional frailty to guide clinical decision making for remdesivir use in older patients with coronavirus disease 2019 (COVID-19) are largely unexplored. OBJECTIVE The aim of this research was to evaluate if the Multidimensional Prognostic Index (MPI), a multidimensional frailty tool based on the Comprehensive Geriatric Assessment (CGA), may help physicians in identifying older hospitalized patients affected by COVID-19 who might benefit from the use of remdesivir. METHODS This was a multicenter, prospective study of older adults hospitalized for COVID-19 in 10 European hospitals, followed-up for 90 days after hospital discharge. A standardized CGA was performed at hospital admission and the MPI was calculated, with a final score ranging between 0 (lowest mortality risk) and 1 (highest mortality risk). We assessed survival with Cox regression, and the impact of remdesivir on mortality (overall and in hospital) with propensity score analysis, stratified by MPI = 0.50. RESULTS Among 496 older adults hospitalized for COVID-19 (mean age 80 years, female 59.9%), 140 (28.2% of patients) were treated with remdesivir. During the 90 days of follow-up, 175 deaths were reported, 115 in hospital. Remdesivir treatment significantly reduced the risk of overall mortality (hazard ratio [HR] 0.54, 95% confidence interval CI 0.35-0.83 in the propensity score analysis) in the sample as whole. Stratifying the population, based on MPI score, the effect was observed only in less frail participants (HR 0.47, 95% CI 0.22-0.96 in propensity score analysis), but not in frailer subjects. In-hospital mortality was not influenced by remdesivir use. CONCLUSIONS MPI could help to identify less frail older adults hospitalized for COVID-19 who could benefit more from remdesivir treatment in terms of long-term survival.
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Affiliation(s)
- Carlo Custodero
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", Bari, Italy
| | - Nicola Veronese
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, via del Vespro, 141, 90127, Palermo, Italy.
| | - Eva Topinkova
- Department of Geriatrics, First Faculty of Medicine, Charles University, Prague, Czech Republic
- Faculty of Health and Social Sciences, University of South Bohemia, Ceske Budejovice, Czech Republic
| | - Helena Michalkova
- Department of Geriatrics, First Faculty of Medicine, Charles University, Prague, Czech Republic
- Faculty of Health and Social Sciences, University of South Bohemia, Ceske Budejovice, Czech Republic
| | - Maria Cristina Polidori
- Ageing Clinical Research, Department II of Internal Medicine and Center for Molecular Medicine, University of Cologne, Cologne, Germany
| | - Alberto Cella
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Galliera Hospital, Genoa, Italy
| | | | | | - Margherita Azzini
- Geriatrics Unit, "Mater Salutis" Hospital, Legnago ULSS 9 Scaligera, Verona, Italy
| | - Heidi Gruner
- Serviço de Medicina Interna, Hospital Curry Cabral, Centro Hospitalar Universitário Lisboa Central/Universidade Nova de Lisboa, Lisbon, Portugal
| | | | | | - Romina Custureri
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Galliera Hospital, Genoa, Italy
| | - Tania Zieschang
- Klinikum Oldenburg AöR, Oldenburg University, Oldenburg, Germany
| | - Alessandro Padovani
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | | | - Alberto Pilotto
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", Bari, Italy
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Galliera Hospital, Genoa, Italy
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11
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Falcone M, Bauer M, Ferrer R, Gavazzi G, Gonzalez Del Castillo J, Pilotto A, Schuetz P. Biomarkers for risk stratification and antibiotic stewardship in elderly patients. Aging Clin Exp Res 2023; 35:925-935. [PMID: 36995460 PMCID: PMC10060920 DOI: 10.1007/s40520-023-02388-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2023] [Indexed: 03/31/2023]
Abstract
PURPOSE Optimal treatment of infections in the elderly patients population is challenging because clinical symptoms and signs may be less specific potentially resulting in both, over- and undertreatment. Elderly patients also have a less pronounced immune response to infection, which may influence kinetics of biomarkers of infection. METHODS Within a group of experts, we critically reviewed the current literature regarding biomarkers for risk stratification and antibiotic stewardship in elderly patients with emphasis on procalcitonin (PCT). RESULTS The expert group agreed that there is strong evidence that the elderly patient population is particularly vulnerable for infections and due to ambiguity of clinical signs and parameters in the elderly, there is considerable risk for undertreatment. At the same time, however, this group of patients is particularly vulnerable for off-target effects from antibiotic treatment and limiting the use of antibiotics is therefore important. The use of infection markers including PCT to guide individual treatment decisions has thus particular appeal in geriatric patients. For the elderly, there is evidence that PCT is a valuable biomarker for assessing the risk of septic complications and adverse outcomes, and helpful for guiding individual decisions for or against antibiotic treatment. There is need for additional educational efforts regarding the concept of "biomarker-guided antibiotic stewardship" for health care providers caring for elderly patients. CONCLUSION Use of biomarkers, most notably PCT, has high potential to improve the antibiotic management of elderly patients with possible infection for improving both, undertreatment and overtreatment. Within this narrative review, we aim to provide evidence-based concepts for the safe and efficient use of PCT in elderly patients.
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Affiliation(s)
- Marco Falcone
- Department of Infectious Diseases, Pisa University Hospital, Pisa, Italy
| | - Michael Bauer
- Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany
| | - Ricard Ferrer
- Intensive Care Department, Hospital Universitari Vall d'Hebron, SODIR Research Group, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Gaëtan Gavazzi
- Clinical Geriatrics Unit, Grenoble University Hospital, Grenoble, France
| | - Juan Gonzalez Del Castillo
- Department of Emergency Medicine, Clínico San Carlos Hospital, IdISSC, Complutense University, Madrid, Spain
| | - Alberto Pilotto
- Department of Interdisciplinary Medicine, University of Bari, Bari, Italy
- Department of Geriatric Care, OrthoGeriatrics and Rehabilitation, Galliera Hospital, Genoa, Italy
| | - Philipp Schuetz
- Internal Medicine and Emergency Medicine, Aarau Hospital, Aarau, Switzerland.
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12
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Pilotto A, Custodero C, Palmer K, Sanchez-Garcia EM, Topinkova E, Polidori MC. A multidimensional approach to older patients during COVID-19 pandemic: a position paper of the Special Interest Group on Comprehensive Geriatric Assessment of the European Geriatric Medicine Society (EuGMS). Eur Geriatr Med 2023; 14:33-41. [PMID: 36656486 PMCID: PMC9851592 DOI: 10.1007/s41999-022-00740-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 12/24/2022] [Indexed: 01/20/2023]
Abstract
PURPOSE The COVID-19 pandemic has been a dramatic trigger that has challenged the intrinsic capacity of older adults and of society. Due to the consequences for the older population worldwide, the Special Interest Group on Comprehensive Geriatric Assessment (CGA) of the European Geriatric Medicine Society (EuGMS) took the initiative of collecting evidence on the usefulness of the CGA-based multidimensional approach to older people during the COVID-19 pandemic. METHODS A narrative review of the most relevant articles published between January 2020 and November 2022 that focused on the multidimensional assessment of older adults during the COVID-19 pandemic. RESULTS Current evidence supports the critical role of the multidimensional approach to identify older adults hospitalized with COVID-19 at higher risk of longer hospitalization, functional decline, and short-term mortality. This approach appears to also be pivotal for the adequate stratification and management of the post-COVID condition as well as for the adoption of preventive measures (e.g., vaccinations, healthy lifestyle) among non-infected individuals. CONCLUSION Collecting information on multiple health domains (e.g., functional, cognitive, nutritional, social status, mobility, comorbidities, and polypharmacy) provides a better understanding of the intrinsic capacities and resilience of older adults affected by SARS-CoV-2 infection. The EuGMS SIG on CGA endorses the adoption of the multidimensional approach to guide the clinical management of older adults during the COVID-19 pandemic.
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Affiliation(s)
- Alberto Pilotto
- Geriatrics Unit, Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Galliera Hospital, Genoa, Italy.,Department of Interdisciplinary Medicine, Clinica Medica e Geriatria "Cesare Frugoni", University of Bari Aldo Moro, P.zza Giulio Cesare, 11, 70124, Bari, Italy
| | - Carlo Custodero
- Department of Interdisciplinary Medicine, Clinica Medica e Geriatria "Cesare Frugoni", University of Bari Aldo Moro, P.zza Giulio Cesare, 11, 70124, Bari, Italy.
| | - Katie Palmer
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | | | - Eva Topinkova
- Department of Geriatrics, First Faculty of Medicine, Charles University, Prague, Czech Republic.,Faculty of Health and Social Sciences, University of South Bohemia, Ceske Budejovice, Czech Republic
| | - Maria Cristina Polidori
- Ageing Clinical Research, Department II of Internal Medicine and Center for Molecular Medicine, University of Cologne, Cologne, Germany.,Cologne Excellence Cluster on Cellular Stress-Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
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13
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Veronese N, Fazzari A, Caudal M, Polidori MC, Topinkova E, Mattace Raso F, Barbagelata M, Barbagallo M, Pilotto A. The role of comprehensive geriatric assessment in older patients affected by knee osteoarthritis: a systematic review. Geriatr Care 2022. [DOI: 10.4081/gc.2022.11049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
Osteoarthritis (OA) is one of the most common musculoskeletal diseases and highly prevalent in older people. Whilst the management of knee OA is usually multidisciplinary, the use of comprehensive geriatric assessment (CGA) for this condition is still limited. Given this background, with this systematic review, we summarized the current literature regarding the importance of CGA in people affected by knee OA. A systematic search across several databases was run until 10th April 2022 and updated on 21st November 2022 for any study investigating the use of CGA in patients with knee OA. The data were summarized descriptively. Among 295 articles initially included, three studies made in the context of the osteoarthritis initiative (OAI) were included. All the three studies used the OAI multidimensional prognostic index (MPI), a composite score derived from the CGA. Higher MPI values were associated with a higher risk of falls, cardiovascular conditions, and fractures across a follow-up period of 8 years and after adjusting for potential confounders. In conclusion, in this systematic review we summarized the current evidence of CGA in knee OA, finding that the MPI, a CGA derived tool, could be useful to early find people at higher risk of conditions that are associated with knee OA and therefore that can be the target of personalized interventions for preventing these conditions.
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Pilotto A, Veronese N, Polidori MC, Strandberg T, Topinkova E, Cruz-Jentoft AJ, Custodero C, Maggi S. The role of prognostic stratification on prescription of anticoagulants in older patients with atrial fibrillation: a multicenter, observational, prospective European study (EUROSAF). Ann Med 2022; 54:2411-2419. [PMID: 36062815 PMCID: PMC9448408 DOI: 10.1080/07853890.2022.2117407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Literature suggests that different risks of mortality could influence physicians in prescribing or not anticoagulants in older patients with atrial fibrillation (AF). The Multidimensional Prognostic Index (MPI) can be considered a tool for the detection of multidimensional frailty. The aim of this cross-sectional study was to evaluate whether prescription patterns of oral anticoagulants exist, based on MPI values. METHODS Older hospitalised patients (age ≥ 65 years) with non-valvular AF were included across 24 European centres. MPI was calculated using validated and standardised tools derived from a comprehensive geriatric assessment. Other functional and clinical information were collected to calculate indexes specific for haemorrhagic and thromboembolic risk in AF. RESULTS Altogether, 2,012 participants affected by AF (mean age was 83.2 ± 7.5, range: 65-104 years), with a higher presence of women (57.0%), were included. Overall, 440 took vitamin K antagonists VKAs (22.0%), 667 (33.4%) direct oral anticoagulants (DOACs), whilst 44.6% did not take any anticoagulant treatment. Prescription of anticoagulants was associated with MPI values, with people taking anticoagulants having lower mean MPI values. Anticoagulant therapy was not used in 53.1% of the group with the highest risk of mortality, compared with 32.3% of those in the group with the lowest mortality risk. People with higher scores in MPI were less frequently treated with anticoagulant therapy, after adjusting for several potential confounders. CONCLUSIONS The EURopean study of Older Subjects with Atrial Fibrillation (EUROSAF) suggested that almost half of the older persons with AF do not receive anticoagulants and that MPI is an important determinant in prescribing or not anticoagulants. Trial Registration: https://clinicaltrials.gov/ct2/show/NCT02973984KEY POINTSAtrial fibrillation is a common condition in older people. The data regarding the use of anticoagulants is mainly derived from randomised controlled trials that do not include a sufficient number of older frail people.Our study suggests that a consistent part of older people affected by atrial fibrillation was not treated with anticoagulants, in particular, older frail patients; however, it is unclear if this choice is supported or not by evidence.The prognostic evaluation through the multidimensional prognostic index could be useful information for the choice in the prescription of anticoagulants in older people affected by atrial fibrillation.
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Affiliation(s)
- Alberto Pilotto
- Geriatrics Unit, Department of Geriatric Care, OrthoGeriatrics and Rehabilitation, E.O. Galliera Hospital, Genova, Italy.,Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", Bari, Italy
| | - Nicola Veronese
- Geriatrics Unit, Department of Internal Medicine, University of Palermo, Palermo, Italy
| | - Maria Cristina Polidori
- Ageing Clinical Research, Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Timo Strandberg
- University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Eva Topinkova
- First Faculty of Medicine, Charles University in Prague, Czech Republic
| | | | - Carlo Custodero
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", Bari, Italy
| | - Stefania Maggi
- National Research Council, Neuroscience Section, Padova, Italy
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Pilotto A, Custodero C, Zora S, Poli S, Senesi B, Prete C, Tavella E, Veronese N, Zini E, Torrigiani C, Sabbà C, Cella A. Frailty trajectories in community-dwelling older adults during COVID-19 pandemic: The PRESTIGE study. Eur J Clin Invest 2022; 52:e13838. [PMID: 35842830 PMCID: PMC9350279 DOI: 10.1111/eci.13838] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 07/03/2022] [Accepted: 07/14/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Frailty has been recognized as potential surrogate of biological age and relevant risk factor for COVID-19 severity. Thus, it is important to explore the frailty trajectories during COVID-19 pandemic and understand how COVID-19 directly and indirectly impacts on frailty condition. METHODS We enrolled 217 community-dwelling older adults with available information on frailty condition as assessed by multidimensional frailty model both at baseline and at one-year follow-up using Multidimensional Prognostic Index (MPI) tools. Pre-frail/frail subjects were identified at baseline as those with MPI score >0.33 (MPI grades 2-3). Frailty worsening was defined by MPI difference between 12 months follow-up and baseline ≥0.1. Multivariable logistic regression was modelled to identify predictors of worsening of frailty condition. RESULTS Frailer subjects at baseline (MPI grades 2-3 = 48.4%) were older, more frequently female and had higher rates of hospitalization and Sars-CoV-2 infection compared to robust ones (MPI grade 1). Having MPI grades 2-3 at baseline was associated with higher risk of further worsening of frailty condition (adjusted odd ratio (aOR): 13.60, 95% confidence interval (CI): 4.01-46.09), independently by age, gender and Sars-CoV-2 infection. Specifically, frail subjects without COVID-19 (aOR: 14.84, 95% CI: 4.26-51.74) as well as those with COVID-19 (aOR: 12.77, 95% CI: 2.66-61.40, p = 0.001) had significantly higher risk of worsening of frailty condition. CONCLUSIONS Effects of COVID-19 pandemic among community-dwelling frailer individuals are far beyond the mere infection and disease, determining a significant deterioration of frailty status both in infected and non-infected subjects.
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Affiliation(s)
- Alberto Pilotto
- Geriatrics Unit, Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Genoa, Italy.,Department of Interdisciplinary Medicine, Clinica Medica e Geriatria "Cesare Frugoni", University of Bari "Aldo Moro", Bari, Italy
| | - Carlo Custodero
- Department of Interdisciplinary Medicine, Clinica Medica e Geriatria "Cesare Frugoni", University of Bari "Aldo Moro", Bari, Italy
| | - Sabrina Zora
- Geriatrics Unit, Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Genoa, Italy
| | - Stefano Poli
- Department of Education, University of Genoa, Genoa, Italy
| | - Barbara Senesi
- Geriatrics Unit, Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Genoa, Italy
| | - Camilla Prete
- Geriatrics Unit, Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Genoa, Italy
| | - Erica Tavella
- Geriatrics Unit, Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Genoa, Italy
| | - Nicola Veronese
- Department of Geriatrics, University of Palermo, Palermo, Italy
| | - Elena Zini
- Department of Education, University of Genoa, Genoa, Italy
| | | | - Carlo Sabbà
- Department of Interdisciplinary Medicine, Clinica Medica e Geriatria "Cesare Frugoni", University of Bari "Aldo Moro", Bari, Italy
| | - Alberto Cella
- Geriatrics Unit, Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Genoa, Italy
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Pilotto A. Abstract Book of the 36° Congresso Nazionale SIGOT - Bari, 5-7 ottobre 2022. Geriatr Care 2022. [DOI: 10.4081/gc.2022.10916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Abstract Book of the 36° Congresso Nazionale SIGOT - Bari, 5-7 ottobre 2022
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Zampino M, Polidori MC, Ferrucci L, O’Neill D, Pilotto A, Gogol M, Rubenstein L. Biomarkers of aging in real life: three questions on aging and the comprehensive geriatric assessment. GeroScience 2022; 44:2611-2622. [PMID: 35796977 PMCID: PMC9261220 DOI: 10.1007/s11357-022-00613-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 06/19/2022] [Indexed: 01/07/2023] Open
Abstract
Measuring intrinsic, biological age is a central question in medicine, which scientists have been trying to answer for decades. Age manifests itself differently in different individuals, and chronological age often does not reflect such heterogeneity of health and function. We discuss here the value of measuring age and aging using the comprehensive geriatric assessment (CGA), cornerstone of geriatric medicine, and operationalized assessment tools for prognosis. Specifically, we review the benefits of employing the multidimensional prognostic index (MPI), which collects information about eight domains relevant for the global assessment of the older person (functional and cognitive status, nutrition, mobility and risk of pressure sores, multi-morbidity, polypharmacy, and co-habitation), in the evaluation of the functional status, and in the prediction of health outcomes for older adults. Further integration of biological markers of aging into multidimensional prognostic tools is warranted, as well as actions which could facilitate prognostic assessments for older persons in all healthcare settings.
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Affiliation(s)
- Marta Zampino
- grid.94365.3d0000 0001 2297 5165Longitudinal Studies Section, Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, Baltimore, MD USA
| | - M. Cristina Polidori
- grid.6190.e0000 0000 8580 3777Aging Clinical Research, Department II of Internal Medicine and Center for Molecular Medicine Cologne, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany ,grid.6190.e0000 0000 8580 3777Cologne Excellence Cluster On Cellular Stress- Responses in Aging-Associated Diseases (CECAD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Luigi Ferrucci
- grid.94365.3d0000 0001 2297 5165Longitudinal Studies Section, Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, Baltimore, MD USA
| | - Desmond O’Neill
- grid.413305.00000 0004 0617 5936Tallaght University Hospital and Trinity College Dublin, Tallaght University Hospital, Trinity Centre for Health Sciences, Dublin, Ireland
| | - Alberto Pilotto
- grid.450697.90000 0004 1757 8650Geriatrics Unit, Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Galliera Hospital, Genoa, Italy ,grid.7644.10000 0001 0120 3326Department of Interdisciplinary Medicine, University of Bari, Bari, Italy
| | - Manfred Gogol
- grid.10423.340000 0000 9529 9877Trauma Department, Orthogeriatric Unit, Hannover Medical School, Hannover, Germany ,grid.7700.00000 0001 2190 4373Institute of Gerontology, University of Heidelberg, Heidelberg, Germany
| | - Laurence Rubenstein
- grid.266900.b0000 0004 0447 0018Department of Geriatric Medicine, University of Oklahoma, Oklahoma City, OK USA
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Pilotto A, Topinkova E, Michalkova H, Polidori MC, Cella A, Cruz-Jentoft A, von Arnim CAF, Azzini M, Gruner H, Castagna A, Cenderello G, Custureri R, Custodero C, Zieschang T, Padovani A, Sanchez-Garcia E, Veronese N. Can the Multidimensional Prognostic Index Improve the Identification of Older Hospitalized Patients with COVID-19 Likely to Benefit from Mechanical Ventilation? An observational, prospective, multicenter study. J Am Med Dir Assoc 2022; 23:1608.e1-1608.e8. [PMID: 35934019 PMCID: PMC9247233 DOI: 10.1016/j.jamda.2022.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 06/13/2022] [Accepted: 06/25/2022] [Indexed: 11/18/2022]
Abstract
Objective Data on prognostic tools for indicating mechanical ventilation in older people with COVID-19 are still limited. The aim of this research was to evaluate if the Multidimensional Prognostic Index (MPI), based on the Comprehensive Geriatric Assessment (CGA), may help physicians in identifying older hospitalized patients affected by COVID-19 who might benefit from mechanical ventilation. Design Longitudinal, multicenter study. Settings and Participants 502 older people hospitalized for COVID-19 in 10 European hospitals. Methods MPI was calculated using 8 different domains typical of the CGA. A propensity score, Cox's regression analysis was used for assessing the impact of mechanical ventilation on rehospitalization/mortality for 90 days' follow-up, stratified by MPI = 0.50. The accuracy of MPI in predicting negative outcomes (ie, rehospitalization/mortality) was assessed using the area under the curve (AUC), and the discrimination with several indexes like the Net Reclassification Improvement (NRI) and the Integrated Discrimination Improvement (IDI). Results Among 502 older people hospitalized for COVID-19 (mean age: 80 years), 152 were treated with mechanical ventilation. In the propensity score analysis, during the 90-day follow-up period, there were 44 rehospitalizations and 95 deaths. Mechanical ventilation in patients with MPI values ≥ 0.50, indicating frailer participants, was associated with a higher risk of rehospitalization/mortality (hazard ratio 1.56, 95% CI 1.09-2.23), whereas in participants with MPI values < 0.50 this association was not significant. The accuracy of the model including age, sex, respiratory parameters, and MPI was good (AUC = 0.783) as confirmed by an NRI of 0.2756 (P < .001) and an IDI of 0.1858 (P < .001), suggesting a good discrimination of the model in predicting negative outcomes. Conclusions and Implications MPI could be useful for better individualizing older people hospitalized by COVID-19 who could benefit from mechanical ventilation.
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Affiliation(s)
- Alberto Pilotto
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Galliera Hospital, Genoa, Italy; Department of Interdisciplinary Medicine, "Aldo Moro" University of Bari, Bari, Italy
| | - Eva Topinkova
- Department of Geriatrics, First Faculty of Medicine, Charles University, Prague, Czech Republic; Faculty of Health and Social Sciences, University of South Bohemia, Ceske Budejovice, Czech Republic
| | - Helena Michalkova
- Department of Geriatrics, First Faculty of Medicine, Charles University, Prague, Czech Republic; Faculty of Health and Social Sciences, University of South Bohemia, Ceske Budejovice, Czech Republic
| | - Maria Cristina Polidori
- Ageing Clinical Research, Department II of Internal Medicine and Center for Molecular Medicine, University of Cologne, Cologne, Germany
| | - Alberto Cella
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Galliera Hospital, Genoa, Italy
| | - Alfonso Cruz-Jentoft
- Servicio de Geriatría, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain
| | | | - Margherita Azzini
- Geriatrics Unit, "Mater Salutis" Hospital, Legnago ULSS 9 Scaligera, Verona, Italy
| | - Heidi Gruner
- Serviço de Medicina Interna, Hospital Curry Cabral, Centro Hospitalar Universitário Lisboa Central / Universidade Nova de Lisboa Lisbon, Portugal
| | | | | | - Romina Custureri
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Galliera Hospital, Genoa, Italy
| | - Carlo Custodero
- Department of Interdisciplinary Medicine, "Aldo Moro" University of Bari, Bari, Italy
| | - Tania Zieschang
- Klinikum Oldenburg AöR, Oldenburg University, Oldenburg, Germany
| | - Alessandro Padovani
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Italy
| | | | - Nicola Veronese
- Department of Internal Medicine and Geriatrics, University of Palermo, Italy.
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Veronese N, Noale M, Cella A, Custodero C, Smith L, Barbagelata M, Maggi S, Barbagallo M, Sabbà C, Ferrucci L, Pilotto A. Multidimensional frailty and quality of life: data from the English Longitudinal Study of Ageing. Qual Life Res 2022; 31:2985-2993. [PMID: 35579730 PMCID: PMC9470717 DOI: 10.1007/s11136-022-03152-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2022] [Indexed: 11/26/2022]
Abstract
Purpose Frailty has been found to be associated with poor quality of life (QoL) in older people, but data available are limited to cross-sectional studies. We therefore aimed to assess the association between multidimensional frailty, determined by Multidimensional Prognostic Index (MPI), with mortality and good QoL expectancy (GQoLE) in a large representative sample of older adults, over 10 years of follow-up. Methods In the English Longitudinal Study of Ageing, using the data from 2004–2005 and 2014–2015, MPI was calculated using a weighted score of domains of comprehensive geriatric assessment, i.e., number of difficulties in activities of daily living (ADL) and instrumental ADL, depressive symptoms, number of medical conditions, body mass index, physical activity level, and social aspects. Mortality was assessed using administrative data, GQoLE indicators were used for longitudinal changes in QoL. Results 6244 Participants (mean age 71.8 years, 44.5% males) were followed up for 10 years. After adjusting for potential confounders, compared to people in the MPI low-risk group, people in the moderate (hazard ratio, HR = 4.27; 95% confidence interval, CI 3.55–5.14) and severe-risk group (HR = 10.3; 95% CI 7.88–13.5) experienced a significantly higher mortality rate. During the follow-up period, people in the moderate and severe-risk groups reported lower GQoLE values than their counterparts, independently from age and gender. Conclusions Multidimensional frailty was associated with a higher risk of mortality and significantly lower GQoLE, suggesting that the multifactorial nature of frailty is associated not only with mortality, but also poor QoL. Supplementary Information The online version contains supplementary material available at 10.1007/s11136-022-03152-9.
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Affiliation(s)
- Nicola Veronese
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Via del Vespro, 141, 90127, Palermo, Italy.
| | - Marianna Noale
- Neuroscience Institute, National Research Council, Padua, Italy
| | - Alberto Cella
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, E.O. Ospedali Galliera, Genoa, Italy
| | - Carlo Custodero
- Department of Interdisciplinary Medicine, Clinica Medica e Geriatria "Cesare Frugoni", University of Bari "Aldo Moro", Bari, Italy
| | - Lee Smith
- Centre for Health, Performance, and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Marina Barbagelata
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, E.O. Ospedali Galliera, Genoa, Italy
| | - Stefania Maggi
- Neuroscience Institute, National Research Council, Padua, Italy
| | - Mario Barbagallo
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Via del Vespro, 141, 90127, Palermo, Italy
| | - Carlo Sabbà
- Department of Interdisciplinary Medicine, Clinica Medica e Geriatria "Cesare Frugoni", University of Bari "Aldo Moro", Bari, Italy
| | - Luigi Ferrucci
- National Institute on Aging, National Institute of Health, Bethesda, MD, USA
| | - Alberto Pilotto
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, E.O. Ospedali Galliera, Genoa, Italy
- Department of Interdisciplinary Medicine, Clinica Medica e Geriatria "Cesare Frugoni", University of Bari "Aldo Moro", Bari, Italy
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Veronese N, Custodero C, Demurtas J, Smith L, Barbagallo M, Maggi S, Cella A, Vanacore N, Aprile PL, Ferrucci L, Pilotto A, Alberto P, Maria Cristina P, Alves M, Benzinger P, Berg N, Brach J, Cardoso I, Cella A, Chefi B, Ciurea A, Cornejo Lingan Ana M, Cotobal Rodeles S, Cruz-Jentoft A, Curiale V, Custodero C, Danielova L, Davies F, De Groot A, De Groot C, De Lepeleire J, De Vries B, Decock AM, Denkinger M, Dikmeer A, Dini S, Durand A, Fatin A, Fernandes M, Ferrara N, Francis B, Fratiglioni L, Freiberger E, Galvin R, Garmendia B, Gillain S, Gomez Pavon J, Goudzwaard J, Greco A, Gruner H, Gunther B, Happe L, Hermush V, Huibregtse Bimmel JK, Indiano I, Isaak J, Jaramillo J, Kerminen H, Laocha Aoife N, Lau S, Lozano I, Madeira Sarmento Ana T, Mangoni A, Marques da Silva P, Mars P, Matejovska-Kubesova H, Mattace Raso F, Moeskops S, Molnar A, Musacchio C, Nagaratnam K, Nieminen U, O’Connor M, Özge Kayhan Koçak F, Paccalin M, Palikhe A, Pavic T, Per Nordnes R, Platon I, Polinder H, Prada G, Ragnheim R, Ramsawak L, Rewiuk K, Rodrigues C, Roller-Wirnsberger R, Rossinen J, Ruotolo G, Ruppe G, Ryan D, Sabba C, Sanchez E, Savas S, Schmid V, Schroderus K, Siegrist M, Smedberg D, Smit O, Soulis G, Tampaki M, Tenkattelaar N, Thiem U, Topinkova E, Tromp J, Van Beek M, Van Heijningen L, Vandeelen B, Vanderhulst H, Vankova H, Verissimo R, Vonk M, Vrabie C, Wearing P, Weiss M, Welmer AK, Werle B, Ylmaz O, Shoaib Muhammad Z, Zamfir M, Zanom I, Zuidhof J, Nicola V, Lee S, Alves M, Avcy S, Bahat-Ozturk G, Balci C, Beaudart C, Bruyère O, Cherubini A, Da Cruz Alves M, Firth J, Goisser S, Hursitoglu M, Hurst C, Kemmler W, Kiesswetter E, Kotsani M, Koyanagi A, Locquet M, Marengoni A, Nida M, Obretin Florian A, O’Hanlon S, Okpe A, Pedone C, Petrovic M, Pizzol D, Prokopidis K, Rempe H, Sanchez Rodrigues D, Schoene D, Schwingshackl L, Shenkin S, Solmi M, Soysal P, Stubbs B, Thompson T, Torbahn G, Unim B. Comprehensive geriatric assessment in older people: an umbrella review of health outcomes. Age Ageing 2022; 51:6581610. [PMID: 35524746 DOI: 10.1093/ageing/afac104] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Comprehensive geriatric assessment (CGA) has been in use for the last three decades. However, some doubts remain regarding its clinical use. Therefore, we aimed to capture the breadth of outcomes reported and assess the strength of evidence of the use of comprehensive geriatric assessment (CGA) for health outcomes in older persons. METHODS Umbrella review of systematic reviews of the use of CGA in older adults searching in Pubmed, Embase, Scopus, Cochrane library and CINHAL until 05 November 2021. All possible health outcomes were eligible. Two independent reviewers extracted key data. The grading of evidence was carried out using the GRADE for intervention studies, whilst data regarding systematic reviews were reported as narrative findings. RESULTS Among 1,683 papers, 31 systematic reviews (19 with meta-analysis) were considered, including 279,744 subjects. Overall, 13/53 outcomes were statistically significant (P < 0.05). There was high certainty of evidence that CGA reduces nursing home admission (risk ratio [RR] = 0.86; 95% confidence interval [CI]: 0.75-0.89), risk of falls (RR = 0.51; 95%CI: 0.29-0.89), and pressure sores (RR = 0.46; 95%CI: 0.24-0.89) in hospital medical setting; decreases the risk of delirium (OR = 0.71; 95%CI: 0.54-0.92) in hip fracture; decreases the risk of physical frailty in community-dwelling older adults (RR = 0.77; 95%CI: 0.64-0.93). Systematic reviews without meta-analysis indicate that CGA improves clinical outcomes in oncology, haematology, and in emergency department. CONCLUSIONS CGA seems to be beneficial in the hospital medical setting for multiple health outcomes, with a high certainty of evidence. The evidence of benefits is less strong for the use of CGA in other settings.
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Affiliation(s)
- Nicola Veronese
- Geriatrics Section, Department of Internal Medicine, University of Palermo, Palermo, Italy
| | - Carlo Custodero
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, Bari, Italy
| | - Jacopo Demurtas
- Clinical and Experimental Medicine PhD Program, Università di Modena e Reggio Emilia, Modena, Italy
| | - Lee Smith
- The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK
| | - Mario Barbagallo
- Geriatrics Section, Department of Internal Medicine, University of Palermo, Palermo, Italy
| | - Stefania Maggi
- Institute of Neuroscience, Aging Branch, CNR, Padua, Italy
| | - Alberto Cella
- Department Geriatric Care, Orthogeriatrics and Rehabilitation, E.O. Ospedali Galliera, Genova, Italy
| | - Nicola Vanacore
- National Center for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome, Italy
| | | | - Luigi Ferrucci
- Intramural Research Program, National Institute on Aging, National Institute of Health, MD, USA
| | - Alberto Pilotto
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, Bari, Italy
- Department Geriatric Care, Orthogeriatrics and Rehabilitation, E.O. Ospedali Galliera, Genova, Italy
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Cella A, Veronese N, Custodero C, Castagna A, Cammalleri LA, Capitano WM, Solimando L, Carruba L, Sabbà C, Ruotolo G, Barbagallo M, Pilotto A. Validation of Abbreviated Form of the Multidimensional Prognostic Index (MPI): The BRIEF-MPI Project. Clin Interv Aging 2022; 17:789-796. [PMID: 35592643 PMCID: PMC9112183 DOI: 10.2147/cia.s355801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 03/10/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Participants and Methods Results Conclusion
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Affiliation(s)
- Alberto Cella
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, E.O. Ospedali Galliera, Genova, Italy
| | - Nicola Veronese
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Palermo, Italy
| | - Carlo Custodero
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, Bari, Italy
| | | | - Lisa A Cammalleri
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, E.O. Ospedali Galliera, Genova, Italy
| | - Walter M Capitano
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Palermo, Italy
| | - Luisa Solimando
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Palermo, Italy
| | - Luca Carruba
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Palermo, Italy
| | - Carlo Sabbà
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, Bari, Italy
| | | | - Mario Barbagallo
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Palermo, Italy
| | - Alberto Pilotto
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, E.O. Ospedali Galliera, Genova, Italy
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, Bari, Italy
- Correspondence: Alberto Pilotto, Via delle Mura Capuccine, 14, Genova, 16128, Italy, Tel +39 010 5634400, Fax +39 010 5634400, Email
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Fabbo A, Veronese N, Genovese E, Mecocci P, Cella A, Custodero C, Ferrero V, Ragusa FS, Pilotto A. Interest in hearing loss in geriatric medicine: a survey of members of the <em>Societa' Italiana Geriatria Ospedale e Territorio</em> (SIGOT). Geriatr Care 2022. [DOI: 10.4081/gc.2022.10455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Hearing loss is a common condition in older people. Increasing research has shown that this condition is associated with a higher risk of several health problems. The aim of this survey made among the members of the Societa' Italiana Geriatria Ospedale e Territorio (SIGOT) is to explore how far hearing loss is known in the Italian geriatric community and how to develop a collaboration with other services. A short survey (taking approximately 5 min to complete) was freely available on the SIGOT website and disseminated using social channels. The questionnaire was available during the whole year of 2021. The questionnaire specifically addressed general characteristics/ demographics, general attention to hearing loss problem in older people and relationships with the National Health System, and personal opinions regarding hearing loss. A total of 122 participants (mainly females and aging between 61-70 years) from all Italian Regions were included. The SIGOT members answered that they consider hearing loss as clinically relevant is always important (55.7%). Unfortunately, many members had not audiological centers or specialists available. Moreover, 38.5% of SIGOT members reported that the possibility of correction of hearing loss with prostheses or cochlear implants in older people is very good for older patients and that in 87.7% a significant improvement in quality of life was observed. The interest in hearing loss problems in older people perceived by the SIGOT members is elevated, but some barriers, particularly in the availability of other specialists and in the services given by National Health System are still very limited.
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Pilotto A, Maggi S, Ferrari A, Rengo G, Solfrizzi V, Zora S, Brignoli O, Lora Aprile P, Fascella G, Dominguez LJ, Veronese N, Cella A, The SELFY-MPI SIGOT Project OBO. Multidimensional frailty in older people in general practitioners’ clinical practice: the SELFY-MPI SIGOT project. Geriatr Care 2022. [DOI: 10.4081/gc.2022.10388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The multidimensional prognostic index (MPI) is a comprehensive geriatric assessment (CGA) tool exploring the multiple domains of older subject. The knowledge and the diffusion of self-assessment tools for identifying frailty in general medicine is still limited. The aim of our study is to determine the prevalence of frailty using a multidimensional frailty screening tool (SELFY-MPI) in a cohort of older adults, belonging to the general practitioner’s (GPs) experience. In the frame of a national educational program organized by the Italian Geriatric Hospital and Community Society (SIGOT), expert geriatricians carried-out local courses addressed to GPs, focused on multidimensional approach in primary care. A cross-sectional study of the SELFY-MPI, based on eight different domains, in the general practitioners’ outpatient clinic was performed among 50 GPs. SELFY-MPI risk score was used for dividing the participants in robust, pre-frail, or frail. A total of 526 participants (mean age: 77.7 years; females=55.3%) fulfilled the SELFY-MPI. The participants were, on average, independent in the activities of daily living, had a good mobility, but they reported some cognitive difficulties, and they can be considered at risk of malnutrition. A high prevalence of comorbidities and polypharmacotherapy was also present. The 20.2% of the sample lived alone, suggesting a potential social frailty. The mean SELFY-MPI score was 0.26 0.17: therefore, 21.67% of the participants were categorized as pre-frail, and 3.99% as frail. Pre-frailty and frailty are common in GPs experience. SELFY-MPI is a feasible screening tool for multidimensional frailty in the GPs clinical practice.
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Marchesi G, De Luca A, Squeri V, De Michieli L, Vallone F, Pilotto A, Leo A, Casadio M, Canessa A. A Lifespan Approach to Balance in Static and Dynamic Conditions: The Effect of Age on Balance Abilities. Front Neurol 2022; 13:801142. [PMID: 35265025 PMCID: PMC8899125 DOI: 10.3389/fneur.2022.801142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 01/05/2022] [Indexed: 11/23/2022] Open
Abstract
Postural control is a complex sensorimotor skill that is fundamental to our daily life. The abilities to maintain and recover balance degrade with age. However, the time decay of balance performance with age is not well understood. In this study, we aim at quantifying the age-dependent changes in standing balance under static and dynamic conditions. We tested 272 healthy subjects with ages ranging from 20 to 90. Subjects maintained the upright posture while standing on the robotic platform hunova®. In the evaluation of static balance, subjects stood on the fixed platform both with eyes open (EO) and eyes closed (EC). In the dynamic condition, subjects stood with eyes open on the moving foot platform that provided three different perturbations: (i) an inclination proportional to the center of pressure displacements, (ii) a pre-defined predictable motion, and (iii) an unpredictable and unexpected tilt. During all these tests, hunova® measured the inclination of the platform and the displacement of the center of pressure, while the trunk movements were recorded with an accelerometer placed on the sternum. To quantify balance performance, we computed spatio-temporal parameters typically used in clinical environments from the acceleration measures: mean velocity, variability of trunk motion, and trunk sway area. All subjects successfully completed all the proposed exercises. Their motor performance in the dynamic balance tasks quadratically changed with age. Also, we found that the reliance on visual feedback is not age-dependent in static conditions. All subjects well-tolerated the proposed protocol independently of their age without experiencing fatigue as we chose the timing of the evaluations based on clinical needs and routines. Thus, this study is a starting point for the definition of robot-based assessment protocols aiming at detecting the onset of age-related standing balance deficits and allowing the planning of tailored rehabilitation protocols to prevent falls in older adults.
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Affiliation(s)
- Giorgia Marchesi
- Spinal Cord Italian Lab (SCIL), Unità Spinale Unipolare, Santa Corona Hospital, Pietra Ligure, Italy.,Department of Informatics, Bioengineering, Robotics, and Systems Engineering (DIBRIS), University of Genoa, Genoa, Italy
| | | | | | | | - Francesco Vallone
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Galliera Hospital, Genoa, Italy
| | - Alberto Pilotto
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Galliera Hospital, Genoa, Italy
| | - Alessandra Leo
- Unità Spinale Unipolare, Ospedale Metropolitano Niguarda, Milan, Italy
| | - Maura Casadio
- Spinal Cord Italian Lab (SCIL), Unità Spinale Unipolare, Santa Corona Hospital, Pietra Ligure, Italy.,Department of Informatics, Bioengineering, Robotics, and Systems Engineering (DIBRIS), University of Genoa, Genoa, Italy
| | - Andrea Canessa
- Spinal Cord Italian Lab (SCIL), Unità Spinale Unipolare, Santa Corona Hospital, Pietra Ligure, Italy.,Department of Informatics, Bioengineering, Robotics, and Systems Engineering (DIBRIS), University of Genoa, Genoa, Italy
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Zora S, Cella A, Poli S, Veronese N, Zini E, Giannoni P, Pandolfini V, Torrigiani C, Pilotto A. “Ageism” Is Associated With Self-Reported Multidimensional Frailty in Community-Dwelling Older Subjects: A Population-Based Study. Front Med (Lausanne) 2022; 8:734636. [PMID: 35252221 PMCID: PMC8894609 DOI: 10.3389/fmed.2021.734636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 12/22/2021] [Indexed: 01/08/2023] Open
Abstract
Ageism is a stereotyping, prejudice and discrimination against people, based on age. Ageism may impact the quality of life and the care of older people, a problem that can be greater when the older person is “frail.” However, few studies explored the role of frailty as a factor related to ageism. The aim of this study was to assess the association between perceived age discrimination (PAD), i.e., ageism, and multidimensional frailty in a cohort of community-dwelling older adults. We enrolled 1,337 community-dwelling subjects over-65 years that filled out a structured questionnaire to collect psycho-socio-economic and behavioral information. Multidimensional frailty was assessed by the SELFY-Multidimensional Prognostic Index Short-Form (SELFY-MPI-SF). PAD, over the past 5 years, was assessed based on explicit criteria. Overall, 83 out of 1,337 participants (6.2%) reported PAD. These subjects were older, more frequently women, with greater economic difficulties, lower level of cultural fruition, social network and psychological well-being, and a greater degree of frailty compared to their counterparts. After adjustment for age and gender, multidimensional frailty (SELFY-MPI-SF score) and negative affectivity were the two only “predictors” significantly associated with PAD (SELFY -MPI-SF, Odds Ratio: 1.19, 95%CI: 1.029–1.370; PANAS negative: Odds Ratio: 1.06, 95%CI: 1.033–1.099). In conclusion, self-reported frailty and negative affectivity are independently associated with PAD in community-dwelling older people. Interventions to prevent and treat frailty could be useful to reduce ageism and improve the well-being of the older people.
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Affiliation(s)
- Sabrina Zora
- Geriatrics Unit, Department of Geriatric Care, Orthogeriatrics and Rehabilitation, E.O. Ospedali Galliera, Genova, Italy
| | - Alberto Cella
- Geriatrics Unit, Department of Geriatric Care, Orthogeriatrics and Rehabilitation, E.O. Ospedali Galliera, Genova, Italy
| | - Stefano Poli
- Department of Education, University of Genoa, Genova, Italy
| | - Nicola Veronese
- Department of Geriatrics, University of Palermo, Palermo, Italy
| | - Elena Zini
- Department of Education, University of Genoa, Genova, Italy
| | - Paola Giannoni
- Department of Education, University of Genoa, Genova, Italy
| | | | | | - Alberto Pilotto
- Geriatrics Unit, Department of Geriatric Care, Orthogeriatrics and Rehabilitation, E.O. Ospedali Galliera, Genova, Italy
- Department of Interdisciplinary Medicine, University of Bari Aldo Moro, Bari, Italy
- *Correspondence: Alberto Pilotto
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26
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Fracso D, Bourrel G, Jorgensen C, Fanton H, Raat H, Pilotto A, Baker G, Pisano MM, Ferreira R, Valsecchi V, Pers YM, Engberink AO. The chronic disease Self-Management Programme: A phenomenological study for empowering vulnerable patients with chronic diseases included in the EFFICHRONIC project. Health Expect 2022; 25:947-958. [PMID: 35014112 PMCID: PMC9122418 DOI: 10.1111/hex.13430] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 12/14/2021] [Accepted: 12/24/2021] [Indexed: 11/27/2022] Open
Abstract
Introduction The Chronic Disease Self‐Management Programme (CDSMP) has resulted in improved health outcomes for patients. However, research has focused mainly on those with chronic conditions and has not extensively explored prevention programmes targeting individuals with specific vulnerability profiles. Aim This study aimed to understand the effects of the CDSMP on the lived experience of vulnerable patients included in the EFFICHRONIC project in France, based on their needs and expectations before and after participation. Methods We conducted a qualitative phenomenological semio‐pragmatic study based on 37 in‐depth interviews with 20 patients (20 before/17 after CDSMP). Results By transforming existential dimensions (identity, relationship with others and bodily experience), chronic illness generates new needs in the vulnerable person. By resonating with the expectations and needs of participants, the CDSMP induces motivation and a sense of belonging to a community of peers. It has enabled the participants to become actors of their own health until empowerment. Although some limitations are reported, the programme has awakened a desire in the participants to take better care of their health and to develop personal skills with, for some, a desire to become involved in health education. Conclusion Our phenomenological approach highlighted the resonance between the programme (its design and implementation) and the lived experience of patients, as an effective element of empowerment. This necessitates training the facilitators to elicit the lived experience of patients. Furthermore, as a patient‐centred approach is required, the facilitators need to learn how to adapt the design of the programme to the singularity of the patient. Patient or Public Contribution Patients provided the data that were collected through in‐depth interviews, and their experiences before and after the programme were analysed.
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Affiliation(s)
- Dallal Fracso
- IRMB, INSERM, CHU Montpellier, University of Montpellier, Montpellier, France.,Department of Primary Care, School of Medicine, University of Montpellier, Montpellier, France
| | - Gérard Bourrel
- Department of Primary Care, School of Medicine, University of Montpellier, Montpellier, France.,Institut Desbrest d'Epidémiologie et de Santé Public, UMR UA11 INSERM, Université de Montpellier, Montpellier, France
| | - Christian Jorgensen
- IRMB, INSERM, CHU Montpellier, University of Montpellier, Montpellier, France
| | - Hélène Fanton
- Department of Primary Care, School of Medicine, University of Montpellier, Montpellier, France
| | - Hein Raat
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Alberto Pilotto
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, E.O. Galliera Hospital, Genoa, Italy
| | - Graham Baker
- Quality Institute for Self Management Education and Training, Portsmouth, UK
| | - Marta M Pisano
- General Direction of Care, Humanization and Social and Health Care, Ministry of Health, Biosanitary Research Institute of the Principality of Asturias, Asturias, Spain
| | - Rosanna Ferreira
- IRMB, INSERM, CHU Montpellier, University of Montpellier, Montpellier, France
| | - Verushka Valsecchi
- IRMB, INSERM, CHU Montpellier, University of Montpellier, Montpellier, France
| | - Yves-Marie Pers
- IRMB, INSERM, CHU Montpellier, University of Montpellier, Montpellier, France
| | - Agnes Oude Engberink
- Department of Primary Care, School of Medicine, University of Montpellier, Montpellier, France.,Institut Desbrest d'Epidémiologie et de Santé Public, UMR UA11 INSERM, Université de Montpellier, Montpellier, France
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Cella A, Volta E, Demurtas J, Zaccaria R, Ceci M, Pilotto A, Boccardi V, Castagna A, Custodero C, Vetta F, Barbagelata M, Veronese N, Pilotto A. The use of eHealth and digital technologies in the Italian geriatric practice: a survey of the Italian Geriatric Society (SIGOT). Geriatr Care 2021. [DOI: 10.4081/gc.2021.10301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
e-Health technologies may potentially improve healthcare assistance for frail elderly subjects. However, despite the interest and potential benefits of the field, research highlighted that several challenges remain, such as scarce wide spreading of information and communication technology technologies among the elderly and infrastructural difficulties. The aim of this survey was to assess to what extent digital technologies are widespread and used among Italian geriatricians. We conducted an online survey addressed to geriatricians, from the SIGOT (The Italian Geriatric Society) website, collecting the 78 completed questionnaires. We then analyzed with descriptive statistics the data. Results showed a still scarce use of digital technologies in geriatric practice in Italy. However, more than 60% of the SIGOT geriatricians who participated in the survey responded that the use of digital technology had increased significantly due to COVID-19 pandemic and for 80% of the members, the priority areas for the use of technologies for the care and treatment of the elderly are the management of chronic diseases and the prevention of hospitalization.
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Veronese N, Smith L, Zigoura E, Barbagallo M, Dominguez LJ, Barone A, Cella A, Cooper C, Rizzoli R, Reginster JY, Maggi S, Pilotto A. Multidimensional prognostic index and the risk of fractures: an 8-year longitudinal cohort study in the Osteoarthritis Initiative. Arch Osteoporos 2021; 17:5. [PMID: 34905117 PMCID: PMC8669664 DOI: 10.1007/s11657-021-01015-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 09/27/2021] [Indexed: 02/03/2023]
Abstract
In this longitudinal study, with a follow-up of 8 years, multidimensional prognostic index (MPI), a product of the comprehensive geriatric assessment, significantly predicted the onset of fractures in older people affected by knee osteoarthritis. PURPOSE Frailty may be associated with higher fracture risk, but limited research has been carried out using a multidimensional approach to frailty assessment and diagnosis. The present research aimed to investigate whether the MPI, based on comprehensive geriatric assessment (CGA), is associated with the risk of fractures in the Osteoarthritis Initiative (OAI) study. METHODS Community-dwellers affected by knee OA or at high risk for this condition were followed-up for 8 years. A standardized CGA including information on functional, nutritional, mood, comorbidity, medication, quality of life, and co-habitation status was used to calculate the MPI. Fractures were diagnosed using self-reported information. Cox's regression analysis was carried out and results are reported as hazard ratios (HRs), with their 95% confidence intervals (CIs), adjusted for potential confounders. RESULTS The sample consisted of 4024 individuals (mean age 61.0 years, females = 59.0%). People with incident fractures had a significant higher MPI baseline value than those without (0.42 ± 0.18 vs. 0.40 ± 0.17). After adjusting for several potential confounders, people with an MPI over 0.66 (HR = 1.49; 95%CI: 1.11-2.00) experienced a higher risk of fractures. An increase in 0.10 point in MPI score corresponded to an increase in fracture risk of 4% (HR = 1.04; 95%CI: 1.008-1.07). Higher MPI values were also associated with a higher risk of non-vertebral clinical fractures. CONCLUSION Higher MPI values at baseline were associated with an increased risk of fractures, reinforcing the importance of CGA in predicting fractures in older people affected by knee OA.
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Affiliation(s)
- Nicola Veronese
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Via del Vespro, 141 90127, Palermo, Italy.
- Biochemistry Department, College of Science, King Saud University, Riyadh, Saudi Arabia.
| | - Lee Smith
- The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK
| | - Ekaterini Zigoura
- Department Geriatric Care, Orthogeriatrics and Rehabilitation, Frailty Area, E.O. Galliera Hospital, Genova, Italy
| | - Mario Barbagallo
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Via del Vespro, 141 90127, Palermo, Italy
| | - Ligia J Dominguez
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Via del Vespro, 141 90127, Palermo, Italy
| | - Antonella Barone
- Department Geriatric Care, Orthogeriatrics and Rehabilitation, Frailty Area, E.O. Galliera Hospital, Genova, Italy
| | - Alberto Cella
- Department Geriatric Care, Orthogeriatrics and Rehabilitation, Frailty Area, E.O. Galliera Hospital, Genova, Italy
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, UK
- NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK
| | - Renè Rizzoli
- Division of Bone Diseases, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Jean-Yves Reginster
- WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Liège, Belgium
- Department of Public Health, Epidemiology and Health Economics, University of Liège, CHU Sart Tilman B23, 4000, Liège, Belgium
- Biochemistry Department, College of Science, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Stefania Maggi
- Aging Branch, Neuroscience Institute, National Research Council, Padua, Italy
| | - Alberto Pilotto
- Department Geriatric Care, Orthogeriatrics and Rehabilitation, Frailty Area, E.O. Galliera Hospital, Genova, Italy
- Department of Interdisciplinary Medicine, University of Bari, Bari, Italy
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Zora S, Custodero C, Pers YM, Valsecchi V, Cella A, Ferri A, Pisano-González MM, Peñacoba Maestre D, Vazquez Alvarez R, Raat H, Baker G, Pilotto A. Impact of the chronic disease self-management program (CDSMP) on self-perceived frailty condition: the EU-EFFICHRONIC project. Ther Adv Chronic Dis 2021; 12:20406223211056722. [PMID: 34820081 PMCID: PMC8606718 DOI: 10.1177/20406223211056722] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 10/12/2021] [Indexed: 11/15/2022] Open
Abstract
Introduction: The Chronic Disease Self-Management Program (CDSMP) improves self-efficacy and health outcomes in people with chronic diseases. In the context of the EFFICHRONIC project, we evaluated the efficacy of CDSMP in relieving frailty, as assessed by the self-administered version of Multidimensional Prognostic Index (SELFY-MPI), identifying also potential predictors of better response over 6-month follow-up. Methods: The SELFY-MPI explores mobility, basal and instrumental activities of daily living (Barthel mobility, ADL, IADL), cognition (Test Your Memory-TYM Test), nutrition (Mini Nutritional Assessment-Short Form-MNA-SF), comorbidities, medications, and socio-economic conditions (social-familiar evaluation scale-SFES). Participants were stratified in three groups according to the 6-month change of SELFY-MPI: those who improved after CDSMP (Δ SELFY-MPI < 0), those who remained unchanged (Δ SELFY-MPI = 0), and those who worsened (Δ SELFY-MPI > 0). Multivariable logistic regression was modeled to identify predictors of SELFY-MPI improvement. Results: Among 270 participants (mean age = 61.45 years, range = 26–93 years; females = 78.1%) a benefit from CDSMP intervention, in terms of decrease in the SELFY-MPI score, was observed in 32.6% of subjects. SELFY-MPI improvement was found in participants with higher number of comorbidities (1–2 chronic diseases: adjusted odd ratio (aOR)=2.38, 95% confidence interval (CI) =1.01, 5.58; ⩾ 3 chronic diseases: aOR = 3.34, 95% CI = 1.25, 8.90 vs no chronic disease), poorer cognitive performance (TYM ⩽ 42: aOR = 2.41, 95% CI = 1.12, 5.19 vs TYM > 42) or higher risk of malnutrition (MNA-SF ⩽ 11: aOR = 6.11, 95% CI = 3.15, 11.83 vs MNA-SF > 11). Conclusion: These findings suggest that the CDSMP intervention contributes to decreasing the self-perceived severity of frailty (SELFY-MPI score) in more vulnerable participants with several chronic diseases and lower cognitive performance and nutritional status.
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Affiliation(s)
- Sabrina Zora
- Geriatrics Unit, Department of Geriatric Care, Orthogeriatrics and Rehabilitation, EO Galliera Hospital, Genova, Italy
| | - Carlo Custodero
- Department of Interdisciplinary Medicine, Clinica Medica e Geriatria “Cesare Frugoni,” University of Bari Aldo Moro, Bari, Italy
| | - Yves-Marie Pers
- IRMB, University of Montpellier, INSERM, CHU Montpellier, Montpellier, France
| | - Verushka Valsecchi
- IRMB, University of Montpellier, INSERM, CHU Montpellier, Montpellier, France
| | - Alberto Cella
- Geriatrics Unit, Department of Geriatric Care, Orthogeriatrics and Rehabilitation, EO Galliera Hospital, Genova, Italy
| | - Alberto Ferri
- Geriatrics Unit, Department of Geriatric Care, Orthogeriatrics and Rehabilitation, EO Galliera Hospital, Genova, Italy
| | - Marta M. Pisano-González
- SESPA, Health Service of the Principality of Asturias, Research Group “Community Health and Active Aging” of the Research Institute of Asturias (IPSA), Oviedo, Spain
| | - Delia Peñacoba Maestre
- SESPA, Health Service of the Principality of Asturias, Research Group “Community Health and Active Aging” of the Research Institute of Asturias (IPSA), Oviedo, Spain
| | - Raquel Vazquez Alvarez
- SESPA, Health Service of the Principality of Asturias, Research Group “Community Health and Active Aging” of the Research Institute of Asturias (IPSA), Oviedo, Spain
| | - Hein Raat
- Erasmus University Medical Center, Rotterdam, The Netherlands
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Polidori MC, Alves M, Bahat G, Boureau AS, Ozkok S, Pfister R, Pilotto A, Veronese N, Bo M. Atrial fibrillation: a geriatric perspective on the 2020 ESC guidelines. Eur Geriatr Med 2021; 13:5-18. [PMID: 34727362 PMCID: PMC8562074 DOI: 10.1007/s41999-021-00537-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 07/03/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND The Task Force for the diagnosis and management of atrial fibrillation (AF) of the European Society of Cardiology (ESC) published in 2020 the updated Guidelines for the Diagnosis and Management of Atrial Fibrillation with the contribution of the European Heart Rhythm Association (EHRA) of the ESC and the European Association for Cardiothoracic Surgery (EACTS). METHODS AND RESULTS In this narrative viewpoint, we approach AF from the perspective of aging medicine and try to provide the readers with information usually neglected in clinical routine, mainly due to the fact that while the large majority of AF patients in real life are older, frail and cognitively impaired, these are mostly excluded from clinical trials, and physicians' attitudes often prevail over standardized algorithms. CONCLUSIONS On the basis of existing evidence, (1) opportunistic AF screening by pulse palpation or ECG rhythm strip is cost-effective, and (2) whereas advanced chronological age by itself is not a contraindication to AF treatment, a Comprehensive Geriatric Assessment (CGA) including frailty, cognitive impairment, falls and bleeding risk may assist in clinical decision making to provide the best individualized treatment.
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Affiliation(s)
- M Cristina Polidori
- Ageing Clinical Research, Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Str. 62, 50937, 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.
| | - Mariana Alves
- Serviço de Medicina III, Hospital Pulido Valente, CHULN, Lisbon, Portugal.,Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Gulistan Bahat
- Department of Internal Medicine, Division of Geriatrics, Istanbul Medical School, Istanbul University, Capa, 34390, Istanbul, Turkey
| | - Anne Sophie Boureau
- Department of Geriatrics, CHU Nantes and Université de Nantes, CNRS, INSERM, l'Institut du Thorax, 44000, Nantes, France
| | - Serdar Ozkok
- Department of Internal Medicine, Division of Geriatrics, Istanbul Medical School, Istanbul University, Capa, 34390, Istanbul, Turkey
| | - Roman Pfister
- Department of Cardiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Alberto Pilotto
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Galliera Hospital, Genoa, Italy.,Department of Interdisciplinary Medicine, University of Bari, Bari, Italy
| | - Nicola Veronese
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Palermo, Italy
| | - Mario Bo
- Section of Geriatrics, Department of Medical Sciences, University of Turin, A.O.U. Città della Salute e della Scienza, Molinette, Corso Bramante 88, 10126, Turin, Italy
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Pazan F, Petrovic M, Cherubini A, Onder G, Cruz-Jentoft AJ, Denkinger M, van der Cammen TJM, Stevenson JM, Ibrahim K, Rajkumar C, Bakken MS, Baeyens JP, Crome P, Frühwald T, Gallaghar P, Guðmundsson A, Knol W, O'Mahony D, Pilotto A, Rönnemaa E, Serra-Rexach JA, Soulis G, van Marum RJ, Ziere G, Mair A, Burkhardt H, Neumann-Podczaska A, Wieczorowska-Tobis K, Fernandes MA, Gruner H, Dallmeier D, Beuscart JB, van der Velde N, Wehling M. Correction to: Current evidence on the impact of medication optimization or pharmacological interventions on frailty or aspects of frailty: a systematic review of randomized controlled trials. Eur J Clin Pharmacol 2021; 77:1593-1594. [PMID: 34363520 PMCID: PMC8440242 DOI: 10.1007/s00228-021-03166-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Farhad Pazan
- Clinical Pharmacology Mannheim, Faculty of Medicine Mannheim, Ruprecht-Karls-UniversityofHeidelberg, Theodor-Kutzer-Ufer1-3, 68167, Mannheim, Germany
| | - Mirko Petrovic
- Section of Geriatrics, Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium
| | - Antonio Cherubini
- Department of Geriatric Medicine, INRCA Istituto Nazionale Di Ricovero E Cura Per Anziani, Ancona, Italy
| | - Graziano Onder
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore Di Sanità, Rome, Italy
| | | | - Michael Denkinger
- Department of Geriatrics, Alb-Donau, University of Ulm and Geriatric Center Ulm/Alb-DonauAgaplesion Bethesda Hospital, Ulm, Germany
| | | | | | - Kinda Ibrahim
- Faculty of Medicine, Academic Geriatric Medicine, Southampton University, Southampton, UK
| | | | | | - Jean-Pierre Baeyens
- AZ Alma, Eeklo, Belgium
- University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | | | - Thomas Frühwald
- Department of Acute Geriatrics, Social Medical Center East, Vienna, Austria
| | - Paul Gallaghar
- School of Medicine, University College Cork, Cambridge, UK
| | | | - Wilma Knol
- Geriatrics, Department of Geriatric Medicine and Expertise Centre Pharmacotherapy in Old Persons, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Denis O'Mahony
- DepartmentofMedicine, University College Cork, Cork University Hospital, Cork, Ireland
| | - Alberto Pilotto
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Galliera Hospital, Genoa, Italy
- Department of Interdisciplinary Medicine, University of Bari, Bari, Italy
| | - Elina Rönnemaa
- Department of Public Health and Caring Sciences/Geriatrics, Uppsala, Sweden
| | - José Antonio Serra-Rexach
- Geriatric Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Consorcio de Investigación Biomédica en Red: Fragilidad y Envejecimiento Saludable, CIBERFES, Madrid, Spain
- Medicine Department, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - George Soulis
- Outpatient Geriatric Assessment Unit, Henry Dunant Hospital Center, Athens, Greece
| | - Rob J van Marum
- Department of General Medicine and Geriatric Medicine, Free University, Amsterdam, The Netherlands
| | - Gijsbertus Ziere
- Section of Geriatric Medicine, Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Geriatric Medicine, Maasstad Hospital, Rotterdam, The Netherlands
| | - Alpana Mair
- Effective Prescribing and Therapeutics, Scottish Government, Edinburgh, EH1 3DG, UK
| | - Heinrich Burkhardt
- IV. Medical Department, University Hospital Mannheim, Heidelberg University, GeriatricsMannheim, Germany
| | | | - Katarzyna Wieczorowska-Tobis
- Department of Palliative Medicine, Poznan University of Medical Sciences, Poznan, Poland
- Palliative Medicine Unit, University Hospital of Lord's Transfiguration, Poznan, Poland
| | - Marilia Andreia Fernandes
- Department of Internal Medicine, Hospital Curry Cabral, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Heidi Gruner
- Internal Medicine Department 7.2, Hospital Curry Cabral - Centro Hospitalar Universitário Lisboa Central, EPE, Lisbon, Portugal
| | - Dhayana Dallmeier
- AGAPLESION Bethesda Clinic Ulm, Ulm, Germany
- Dept.ofEpidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Jean-Baptiste Beuscart
- Évaluation Des Technologies de Santé Et Des Pratiques Médicales, CHULille, ULR2694-METRICS, Univ. Lille, 59000, Lille, France
| | | | - Martin Wehling
- Clinical Pharmacology Mannheim, Faculty of Medicine Mannheim, Ruprecht-Karls-UniversityofHeidelberg, Theodor-Kutzer-Ufer1-3, 68167, Mannheim, Germany.
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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: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Woodman RJ, Bryant K, Sorich MJ, Pilotto A, Mangoni AA. Use of Multiprognostic Index Domain Scores, Clinical Data, and Machine Learning to Improve 12-Month Mortality Risk Prediction in Older Hospitalized Patients: Prospective Cohort Study. J Med Internet Res 2021; 23:e26139. [PMID: 34152274 PMCID: PMC8277374 DOI: 10.2196/26139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/16/2021] [Accepted: 05/13/2021] [Indexed: 12/23/2022] Open
Abstract
Background The Multidimensional Prognostic Index (MPI) is an aggregate, comprehensive, geriatric assessment scoring system derived from eight domains that predict adverse outcomes, including 12-month mortality. However, the prediction accuracy of using the three MPI categories (mild, moderate, and severe risk) was relatively poor in a study of older hospitalized Australian patients. Prediction modeling using the component domains of the MPI together with additional clinical features and machine learning (ML) algorithms might improve prediction accuracy. Objective This study aims to assess whether the accuracy of prediction for 12-month mortality using logistic regression with maximum likelihood estimation (LR-MLE) with the 3-category MPI together with age and gender (feature set 1) can be improved with the addition of 10 clinical features (sodium, hemoglobin, albumin, creatinine, urea, urea-to-creatinine ratio, estimated glomerular filtration rate, C-reactive protein, BMI, and anticholinergic risk score; feature set 2) and the replacement of the 3-category MPI in feature sets 1 and 2 with the eight separate MPI domains (feature sets 3 and 4, respectively), and to assess the prediction accuracy of the ML algorithms using the same feature sets. Methods MPI and clinical features were collected from patients aged 65 years and above who were admitted to either the general medical or acute care of the elderly wards of a South Australian hospital between September 2015 and February 2017. The diagnostic accuracy of LR-MLE was assessed together with nine ML algorithms: decision trees, random forests, extreme gradient boosting (XGBoost), support-vector machines, naïve Bayes, K-nearest neighbors, ridge regression, logistic regression without regularization, and neural networks. A 70:30 training set:test set split of the data and a grid search of hyper-parameters with 10-fold cross-validation—was used during model training. The area under the curve was used as the primary measure of accuracy. Results A total of 737 patients (female: 370/737, 50.2%; male: 367/737, 49.8%) with a median age of 80 (IQR 72-86) years had complete MPI data recorded on admission and had completed the 12-month follow-up. The area under the receiver operating curve for LR-MLE was 0.632, 0.688, 0.738, and 0.757 for feature sets 1 to 4, respectively. The best overall accuracy for the nine ML algorithms was obtained using the XGBoost algorithm (0.635, 0.706, 0.756, and 0.757 for feature sets 1 to 4, respectively). Conclusions The use of MPI domains with LR-MLE considerably improved the prediction accuracy compared with that obtained using the traditional 3-category MPI. The XGBoost ML algorithm slightly improved accuracy compared with LR-MLE, and adding clinical data improved accuracy. These results build on previous work on the MPI and suggest that implementing risk scores based on MPI domains and clinical data by using ML prediction models can support clinical decision-making with respect to risk stratification for the follow-up care of older hospitalized patients.
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Affiliation(s)
| | - Kimberley Bryant
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Michael J Sorich
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Alberto Pilotto
- Department of Geriatric Care, OrthoGeriatrics and Rehabilitation, Galliera Hospital, Genoa, Italy.,Department of Interdisciplinary Medicine, University of Bari, Bari, Italy
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Veronese N, Vianello S, Danesin C, Tudor F, Pozzobon G, Pilotto A. Multidimensional Prognostic Index and Mortality in Intermediate Care Facilities: A Retrospective Study. J Clin Med 2021; 10:2632. [PMID: 34203781 PMCID: PMC8232637 DOI: 10.3390/jcm10122632] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/04/2021] [Accepted: 06/09/2021] [Indexed: 11/17/2022] Open
Abstract
Multidimensional prognostic index (MPI) is a frailty assessment tool used for stratifying prognosis in older hospitalized people, but data regarding older people admitted to intermediate care facilities (ICFs) are missing. The aim of this study is to evaluate whether MPI can predict mortality in older patients admitted to the ICFs. MPI was calculated using different domains explored by a standard comprehensive geriatric assessment and categorized into tertiles (MPI-1 ≤ 0.20, MPI-2 0.20-0.34, MPI-3 > 0.34). A Cox's regression analysis, taking mortality as the outcome, was used, reporting the results as hazard ratios (HRs) with 95% confidence intervals (CIs). In total, 653 older patients were enrolled (mean age: 82 years, 59.1% females). Patients in MPI-2 (HR = 3.66; 95%CI: 2.45-5.47) and MPI-3 (HR = 6.22; 95%CI: 4.22-9.16) experienced a higher risk of mortality, compared to MPI-1. The accuracy of MPI in predicting mortality was good (area under the curve (AUC) = 0.74, 95%CI: 0.70-0.78). In conclusion, our study showed that prognostic stratification, as assessed by the MPI, was associated with a significantly different risk of mortality in older patients admitted to the ICFs, indicating the necessity of using a CGA-based tool for better managing older people in this setting as well.
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Affiliation(s)
- Nicola Veronese
- Azienda ULSS (Unità Locale Socio Sanitaria) 3 “Serenissima”, 30174 Venice, Italy; (S.V.); (C.D.); (F.T.); (G.P.)
- Geriatrics Section, Department of Medicine, University of Palermo, 90127 Palermo, Italy
| | - Stefano Vianello
- Azienda ULSS (Unità Locale Socio Sanitaria) 3 “Serenissima”, 30174 Venice, Italy; (S.V.); (C.D.); (F.T.); (G.P.)
| | - Claudia Danesin
- Azienda ULSS (Unità Locale Socio Sanitaria) 3 “Serenissima”, 30174 Venice, Italy; (S.V.); (C.D.); (F.T.); (G.P.)
| | - Florina Tudor
- Azienda ULSS (Unità Locale Socio Sanitaria) 3 “Serenissima”, 30174 Venice, Italy; (S.V.); (C.D.); (F.T.); (G.P.)
| | - Gianfranco Pozzobon
- Azienda ULSS (Unità Locale Socio Sanitaria) 3 “Serenissima”, 30174 Venice, Italy; (S.V.); (C.D.); (F.T.); (G.P.)
| | - Alberto Pilotto
- Department Geriatric Care, Orthogeriatrics and Rehabilitation, Frailty Area, E.O. Galliera Hospital, 16128 Genova, Italy;
- Department of Interdisciplinary Medicine, Aldo Moro University of Bari, 70121 Bari, Italy
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Pilotto A. Abstract Book of the 35º Congresso Nazionale SIGOT - Live streaming, 16-18 giugno 2021. Geriatr Care 2021. [DOI: 10.4081/gc.2021.9915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Book of the 35º Congresso Nazionale SIGOT - Live streaming, 16-18 giugno 2021.
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Veronese N, Koyanagi A, Stangherlin V, Mantoan P, Chiavalin M, Tudor F, Pozzobon G, Tessarin M, Pilotto A. Mortality attributable to COVID-19 in nursing home residents: a retrospective study. Aging Clin Exp Res 2021; 33:1745-1751. [PMID: 33893989 PMCID: PMC8067779 DOI: 10.1007/s40520-021-01855-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 04/02/2021] [Indexed: 12/25/2022]
Abstract
AIM Coronavirus-19 disease (COVID-19) is a widespread condition in nursing home (NH). It is not known whether COVID-19 is associated with a higher risk of death than residents without COVID-19. Therefore, the aim of this study was to assess whether COVID-19 is associated with a higher mortality rate in NH residents, considering frailty status assessed with the Multidimensional Prognostic Index (MPI). METHODS In this retrospective study, made in 31 NHs in Venice, Italy, the presence of COVID-19 was ascertained with a nasopharyngeal swab. Frailty was evaluated using the MPI, modified according to the tools commonly used in our NHs. A Cox's regression analysis was used reporting the results as hazard ratios (HRs) with 95% confidence intervals (CIs), using COVID-19 as exposure and mortality as outcome and stratified by MPI tertiles. Similar analyses were run using MPI tertiles as exposure. RESULTS Overall, 3946 NH residents (median age = 87 years, females: 73.9%) were eligible, with 1136 COVID-19 + . During a median follow-up of 275 days, higher values of MPI, indicating frailer people, were associated with an increased risk of mortality. The incidence of mortality in COVID-19 + was more than doubled than COVID-19- either in MPI-1, MPI-2 and MPI-3 groups. The presence of COVID-19 increased the risk of death (HR = 1.85; 95% CI 1.59-2.15), also in the propensity score model using MPI as confounder (HR = 2.48; 95% CI 2.10-2.93). CONCLUSION In this retrospective study of NH residents, COVID-19 was associated with a higher risk of all-cause mortality than those not affected by COVID-19 also considering the different grades of frailty.
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Affiliation(s)
- Nicola Veronese
- Primary Care Department, Azienda ULSS 3 (Unità Locale Socio Sanitaria) "Serenissima" Veneto Region, Dolo-Mirano District, Venice, Italy.
- Geriatrics Section, Department of Medicine, University of Palermo, Palermo, Italy.
| | - Ai Koyanagi
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Dr Antoni Pujadas, 42, 08830, Sant Boi de Llobregat, Barcelona, Spain
- ICREA, Pg. Lluis Companys 23, Barcelona, Spain
| | - Vanni Stangherlin
- Social Unit, Azienda ULSS 3 (Unità Locale Socio Sanitaria) "Serenissima" Veneto Region, Venice, Italy
| | - Paola Mantoan
- Social Unit, Azienda ULSS 3 (Unità Locale Socio Sanitaria) "Serenissima" Veneto Region, Venice, Italy
| | | | - Florina Tudor
- Primary Care Department, Azienda ULSS 3 (Unità Locale Socio Sanitaria) "Serenissima" Veneto Region, Dolo-Mirano District, Venice, Italy
| | - Gianfranco Pozzobon
- Social Direction, Azienda ULSS 3 (Unità Locale Socio Sanitaria) "Serenissima" Veneto Region, Venice, Italy
| | - Michele Tessarin
- Sanitary Direction, Azienda ULSS 3 (Unità Locale Socio Sanitaria) "Serenissima" Veneto Region, Venice, Italy
| | - Alberto Pilotto
- Department Geriatric Care, Orthogeriatrics and Rehabilitation, Frailty Area, E.O. Galliera Hospital, Genoa, Italy
- Department of Interdisciplinary Medicine, Aldo Moro University of Bari, Bari, Italy
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Pickert L, Meyer AM, Becker I, Heeß A, Noetzel N, Brinkkötter P, Pilotto A, Benzing T, Polidori MC. Role of a multidimensional prognosis in-hospital monitoring for older patients with prolonged stay. Int J Clin Pract 2021; 75:e13989. [PMID: 33406298 DOI: 10.1111/ijcp.13989] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 01/03/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES The Multidimensional Prognostic Index (MPI) is a prognostic tool-amongst others-validated for mortality, length of hospital stay (LHS) and rehospitalisation risk assessment. Like the Comprehensive Geriatric Assessment (CGA), the MPI is usually obtained at hospital admission and discharge, not during the hospital stay. The aim of the present study was to address the role of an additional CGA-based MPI measurement during hospitalisation as an indicator of "real-time" in-hospital changes. STUDY DESIGN AND MAIN OUTCOME MEASURES Two-hundred consecutive multimorbid patients (128 M, 72 F, median age 75 (78-82)) admitted to an internal medicine ward of a German metropolitan university hospital prospectively underwent a CGA and a prognosis calculation using the MPI on admission and discharge. Seven to 10 days later, an intermediate assessment (IA) was performed for patients needing a longer stay. RESULTS The median LHS was 10 (6-19) days. As expected, patients who received an IA had poorer prognosis as measured by higher MPI values (P = .037) and a worse functional status at admission than patients who had a shorter stay (P = .025). In case of prolonged hospitalisation, significant changes in the MPI were detected between admission and IA, both in terms of improvement and deterioration (P < .001). Different overtime courses were observed during prolonged hospitalisation according to the severity of prognosis (P < .001). CONCLUSION A CGA-based MPI evaluation during hospitalisation can be used as an objective instrument to detect changes in multidimensional health course. Prompt identification of the latter may enable quick tailored interventions to ensure overall better outcomes at and after discharge.
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Affiliation(s)
- Lena Pickert
- Ageing Clinical Research, Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Anna M Meyer
- Ageing Clinical Research, Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Ingrid Becker
- Institute of Medical Statistics and Computational Biology, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Annika Heeß
- Ageing Clinical Research, Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Nicolas Noetzel
- Ageing Clinical Research, Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Paul Brinkkötter
- Ageing Clinical Research, Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Alberto Pilotto
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Frailty Area, E.O. Galliera Hospital, Genova, Italy
- Department of Medicine, University of Bari, Bari, Italy
| | - Thomas Benzing
- Ageing Clinical Research, Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty 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 C Polidori
- Ageing Clinical Research, Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty 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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Lenti MV, Aronico N, Giuffrida P, Costa S, Costetti M, Musacchio C, Pastorelli L, Mengoli C, Borrelli de Andreis F, Cococcia S, Tinelli C, Klersy C, Vecchi M, Pilotto A, Di Sabatino A. Multidimensional Prognostic Index Predicts Clinical Outcome and Mortality in Hospitalised Older Patients with Diverticular Disease. Gerontology 2021; 68:44-52. [PMID: 33849017 DOI: 10.1159/000515161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 02/11/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The Multidimensional Prognostic Index (MPI) is a validated tool for assessing mortality risk in hospitalised patients. We aimed to evaluate whether the MPI predicted mortality and the risk of developing diverticular disease (DD) complications in older patients. METHODS This is a multicentre study conducted in January 2016-March 2018. All patients with DD aged 65 years and older were included. Patients were stratified into three groups according to MPI groups (1, low risk; 2, moderate risk; 3, high risk). Risk of developing DD complications and mortality rate were assessed. Bivariate models were fitted. RESULTS One hundred hospitalised patients with DD (mean age 77.9 ± 10.6 years, 53 female patients) were included. Patients with higher MPI groups were more likely to develop DD complications. In particular, 12 (46.2%), 21 (52.5%), and 28 (82.4%) patients with complicated DD were distributed to the MPI 1, MPI 2, and MPI 3 groups (p = 0.0063), respectively. Two patients died in the MPI 1, 4 in the MPI 2, and 29 in the MPI 3 group, with mortality rates of 4.0 per 100 person-year (95% confidence interval [CI] 1.0-15.9), 5.6 (95% CI 2.1-15.0), and 89.2 (95% CI 62-130), respectively (log-rank test p < 0.001). In bivariate analysis, after adjustment for age >80 years, Charlson Comorbidity Index >4, DD complications, and the presence of thromboembolism, higher MPI group was independently associated with higher mortality. Those in the MPI 3 group experienced a greater risk of 1-year hospital readmission (p < 0.001). CONCLUSION MPI predicted mortality in patients with DD and also correlated with the risk of developing DD complications. Studies focussing on possible pathophysiological mechanisms between DD complications and MPI are needed.
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Affiliation(s)
- Marco Vincenzo Lenti
- Department of Internal Medicine, IRCCS San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Nicola Aronico
- Department of Internal Medicine, IRCCS San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Paolo Giuffrida
- Department of Internal Medicine, IRCCS San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Stefania Costa
- Department of Internal Medicine, IRCCS San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Martina Costetti
- Department of Internal Medicine, IRCCS San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Clarissa Musacchio
- Geriatrics Unit, Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Genova, Italy
| | - Luca Pastorelli
- Department of Gastroenterology and Digestive Endoscopy Unit, IRCCS San Donato Hospital Foundation, University of Milan, San Donato Milanese, Milan, Italy
| | - Caterina Mengoli
- Department of Internal Medicine, IRCCS San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | | | - Sara Cococcia
- Department of Internal Medicine, IRCCS San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Carmine Tinelli
- Service of Biometry and Statistics, IRCCS San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Catherine Klersy
- Service of Biometry and Statistics, IRCCS San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Maurizio Vecchi
- Gastroenterology and Endoscopy Unit, IRCCS Ca' Granda Hospital Foundation, University of Milan, Milan, Italy
| | - Alberto Pilotto
- Geriatrics Unit, Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Genova, Italy.,Department of Interdisciplinary Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Antonio Di Sabatino
- Department of Internal Medicine, IRCCS San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
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Pilotto A, Azzini M, Cella A, Cenderello G, Castagna A, Pilotto A, Custureri R, Dini S, Farinella ST, Ruotolo G, Padovani A, Custodero C, Veronese N. The multidimensional prognostic index (MPI) for the prognostic stratification of older inpatients with COVID-19: A multicenter prospective observational cohort study. Arch Gerontol Geriatr 2021; 95:104415. [PMID: 33882420 PMCID: PMC8020604 DOI: 10.1016/j.archger.2021.104415] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 03/28/2021] [Accepted: 04/02/2021] [Indexed: 01/09/2023]
Abstract
Background The topic of prognosis in COVID-19 research may be important in adopting appropriate clinical decisions. Multidimensional prognostic index (MPI) is a frailty assessment tool widely used for stratifying prognosis in older people, but data regarding inpatients, affected by COVID-19, are not available. Objectives To evaluate whether MPI can predict in-hospital mortality and the admission to intensive care unit (ICU) in older inpatients hospitalized for COVID-19 infection. Methods In this longitudinal, Italian, multi-center study, older patients with COVID-19 were included. MPI was calculated using eight different domains typical of comprehensive geriatric assessment and categorized in three groups (MPI 1 ≤ 0.33, MPI 2 0.34–0.66, MPI 3 > 0.66). A multivariable Cox's regression analysis was used reporting the results as hazard ratios (HRs) with 95% confidence intervals (CIs). Results 227 older patients hospitalized for SARS-CoV-2 infection were enrolled (mean age: 80.5 years, 59% females). Inpatients in the MPI 3 were subjected less frequently than those in the MPI 1 to non-invasive ventilation (NIV). In the multivariable analysis, people in MPI 3 experienced a higher risk of in hospital mortality (HR = 6.30, 95%CI: 1.44–27.61), compared to MPI 1. The accuracy of MPI in predicting in hospital mortality was good (Area Under the Curve (AUC) = 0.76, 95%CI: 0.68–0.83). People in MPI 3 experienced a significant longer length of stay (LOS) in hospital compared to other participants. No association between MPI and ICU admission was found. Conclusions Frailty- as assessed by high MPI score - was associated with a significant higher risk of in-hospital mortality, longer LOS, and lower use NIV, whilst the association with ICU admission was not significant. These findings suggest that prognostic stratification by using the MPI could be useful in clinical decision making in older inpatients affected by COVID-19.
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Affiliation(s)
- Alberto Pilotto
- Department Geriatric Care, Orthogeriatrics and Rehabilitation, Galliera Hospital, Genova, Italy,; Department of Interdisciplinary Medicine, University of Bari, Italy,.
| | - Margherita Azzini
- Geriatrics Unit, "Mater Salutis " Hospital, Legnago ULSS 9 Scaligera, Verona, Italy
| | - Alberto Cella
- Department Geriatric Care, Orthogeriatrics and Rehabilitation, Galliera Hospital, Genova, Italy
| | | | | | - Andrea Pilotto
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Italy
| | - Romina Custureri
- Department Geriatric Care, Orthogeriatrics and Rehabilitation, Galliera Hospital, Genova, Italy
| | - Simone Dini
- Department Geriatric Care, Orthogeriatrics and Rehabilitation, Galliera Hospital, Genova, Italy
| | | | | | - Alessandro Padovani
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Italy
| | - Carlo Custodero
- Department of Interdisciplinary Medicine, University of Bari, Italy
| | - Nicola Veronese
- Department of Primary Care, District 3, ULSS 3, Venice, Italy,; Department of Internal Medicine and Geriatrics, University of Palermo, Italy.
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De Vincentis A, Vespasiani-Gentilucci U, Costanzo L, Novella A, Cortesi L, Nobili A, Mannucci PM, Incalzi RA, Mannucci PM, Nobili A, Pietrangelo A, Perticone F, Licata G, Violi F, Corazza GR, Corrao S, Marengoni A, Salerno F, Cesari M, Tettamanti M, Pasina L, Franchi C, Franchi C, Cortesi L, Tettamanti M, Miglio G, Tettamanti M, Cortesi L, Ardoino I, Novella A, Prisco D, Silvestri E, Emmi G, Bettiol A, Mattioli I, Biolo G, Zanetti M, Bartelloni G, Vanoli M, Grignani G, Pulixi EA, Lupattelli G, Bianconi V, Alcidi R, Girelli D, Busti F, Marchi G, Barbagallo M, Dominguez L, Beneduce V, Cacioppo F, Corrao S, Natoli G, Mularo S, Raspanti M, Zoli M, Matacena ML, Orio G, Magnolfi E, Serafini G, Simili A, Palasciano G, Modeo ME, Gennaro CD, Cappellini MD, Fabio G, De Amicis MM, De Luca G, Scaramellini N, Cesari M, Rossi PD, Damanti S, Clerici M, Leoni S, Di Mauro AD, Di Sabatino A, Miceli E, Lenti MV, Pisati M, Dominioni CC, Pontremoli R, Beccati V, Nobili G, Leoncini G, Anastasio L, Carbone M, Cipollone F, Guagnano MT, Rossi I, Mancuso G, Calipari D, Bartone M, Delitala G, Berria M, Delitala A, Muscaritoli M, Molfino A, Petrillo E, Giorgi A, Gracin C, Zuccalà G, D'Aurizio G, Romanelli G, Marengoni A, Volpini A, Lucente D, Picardi A, Gentilucci UV, Bellelli G, Corsi M, Antonucci C, Sidoli C, Principato G, Arturi F, Succurro E, Tassone B, Giofrè F, Serra MG, Bleve MA, Brucato A, De Falco T, Fabris F, Bertozzi I, Bogoni G, Rabuini MV, Prandini T, Manfredini R, Fabbian F, Boari B, De Giorgi A, Tiseo R, Paolisso G, Rizzo MR, Catalano C, Borghi C, Strocchi E, Ianniello E, Soldati M, Schiavone S, Bragagni A, Sabbà C, Vella FS, Suppressa P, De Vincenzo GM, Comitangelo A, Amoruso E, Custodero C, Fenoglio L, Falcetta A, Fracanzani AL, Tiraboschi S, Cespiati A, Oberti G, Sigon G, Peyvandi F, Rossio R, Colombo G, Agosti P, Monzani V, Savojardo V, Ceriani G, Salerno F, Pallini G, Montecucco F, Ottonello L, Caserza L, Vischi G, Liberato NL, Tognin T, Purrello F, Di Pino A, Piro S, Rozzini R, Falanga L, Pisciotta MS, Bellucci FB, Buffelli S, Montrucchio G, Peasso P, Favale E, Poletto C, Margaria C, Sanino M, Violi F, Perri L, Guasti L, Castiglioni L, Maresca A, Squizzato A, Campiotti L, Grossi A, Diprizio RD, Bertolotti M, Mussi C, Lancellotti G, Libbra MV, Galassi M, Grassi Y, Greco A, Sciacqua A, Perticone M, Battaglia R, Maio R, Stanghellini V, Ruggeri E, del Vecchio S, Salvi A, Leonardi R, Damiani G, Capeci W, Mattioli M, Martino GP, Biondi L, Pettinari P, Ghio R, Col AD, Minisola S, Colangelo L, Cilli M, Labbadia G, Afeltra A, Pipita ME, Castellino P, Zanoli L, Gennaro A, Gaudio A, Saracco V, Fogliati M, Bussolino C, Mete F, Gino M, Vigorito C, Cittadini A, Moreo G, Prolo S, Pina G, Ballestrero A, Ferrando F, Gonella R, Cerminara D, Berra S, Dassi S, Nava MC, Graziella B, Baldassarre S, Fragapani S, Gruden G, Galanti G, Mascherini G, Petri C, Stefani L, Girino M, Piccinelli V, Nasso F, Gioffrè V, Pasquale M, Sechi L, Catena C, Colussi G, Cavarape A, Da Porto A, Passariello N, Rinaldi L, Berti F, Famularo G, Tarsitani P, Castello R, Pasino M, Ceda GP, Maggio MG, Morganti S, Artoni A, Grossi M, Del Giacco S, Firinu D, Costanzo G, Argiolas G, Montalto G, Licata A, Montalto FA, Corica F, Basile G, Catalano A, Bellone F, Principato C, Malatino L, Stancanelli B, Terranova V, Di Marca S, Di Quattro R, Malfa LL, Caruso R, Mecocci P, Ruggiero C, Boccardi V, Meschi T, Ticinesi A, Nouvenne A, Minuz P, Fondrieschi L, Imperiale GN, Pirisi M, Fra GP, Sola D, Bellan M, Porta M, Riva P, Quadri R, Larovere E, Novelli M, Scanzi G, Mengoli C, Provini S, Ricevuti L, Simeone E, Scurti R, Tolloso F, Tarquini R, Valoriani A, Dolenti S, Vannini G, Volpi R, Bocchi P, Vignali A, Harari S, Lonati C, Napoli F, Aiello I, Landolfi R, Montalto M, Mirijello A, Purrello F, Di Pino A, del Primario NEC, Ghidoni S, Salvatore T, Monaco L, Ricozzi C, Pilotto A, Indiano I, Gandolfo F. The multifaceted spectrum of liver cirrhosis in older hospitalised patients: analysis of the REPOSI registry. Age Ageing 2021; 50:498-504. [PMID: 32926127 DOI: 10.1093/ageing/afaa150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Knowledge on the main clinical and prognostic characteristics of older multimorbid subjects with liver cirrhosis (LC) admitted to acute medical wards is scarce. OBJECTIVES To estimate the prevalence of LC among older patients admitted to acute medical wards and to assess the main clinical characteristics of LC along with its association with major clinical outcomes and to explore the possibility that well-distinguished phenotypic profiles of LC have classificatory and prognostic properties. METHODS A cohort of 6,193 older subjects hospitalised between 2010 and 2018 and included in the REPOSI registry was analysed. RESULTS LC was diagnosed in 315 patients (5%). LC was associated with rehospitalisation (age-sex adjusted hazard ratio, [aHR] 1.44; 95% CI, 1.10-1.88) and with mortality after discharge, independently of all confounders (multiple aHR, 2.1; 95% CI, 1.37-3.22), but not with in-hospital mortality and incident disability. Three main clinical phenotypes of LC patients were recognised: relatively fit subjects (FIT, N = 150), subjects characterised by poor social support (PSS, N = 89) and, finally, subjects with disability and multimorbidity (D&M, N = 76). PSS subjects had an increased incident disability (35% vs 13%, P < 0.05) compared to FIT. D&M patients had a higher mortality (in-hospital: 12% vs 3%/1%, P < 0.01; post-discharge: 41% vs 12%/15%, P < 0.01) and less rehospitalisation (10% vs 32%/34%, P < 0.01) compared to PSS and FIT. CONCLUSIONS LC has a relatively low prevalence in older hospitalised subjects but, when present, accounts for worse post-discharge outcomes. Phenotypic analysis unravelled the heterogeneity of LC older population and the association of selected phenotypes with different clinical and prognostic features.
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Affiliation(s)
| | | | - Luisa Costanzo
- Unit of Geriatrics, University Campus Bio-Medico, Rome, Italy
| | - Alessio Novella
- Laboratorio di Valutazione della Qualità delle Cure e dei Servizi per l'Anziano, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Laura Cortesi
- Laboratorio di Valutazione della Qualità delle Cure e dei Servizi per l'Anziano, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Alessandro Nobili
- Laboratorio di Valutazione della Qualità delle Cure e dei Servizi per l'Anziano, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
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Affiliation(s)
- Francesco Mattace-Raso
- Division of Geriatric Medicine, Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Alberto Pilotto
- Geriatric Unit, Department of Geriatric Care, Orthogeriatrics and Rehabilitation, EO Galliera Hospital, Genova, Italy. .,Department of Interdisciplinary Medicine, University of Bari, Bari, Italy.
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Veronese N, Koyanagi A, Smith L, Musacchio C, Cammalleri L, Barbagallo M, Pilotto A. Multidimensional frailty increases cardiovascular risk in older people: An 8-year longitudinal cohort study in the Osteoarthritis Initiative. Exp Gerontol 2021; 147:111265. [PMID: 33539985 DOI: 10.1016/j.exger.2021.111265] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 01/27/2021] [Accepted: 01/28/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Cardiovascular diseases (CVDs) are the most important cause of mortality and an important cause of disability. Frailty seems to be associated with higher cardiovascular risk, but limited research has been done using a multidimensional approach to frailty. Thus, the present study aimed to investigate whether the multidimensional prognostic index (MPI), based on comprehensive geriatric assessment (CGA), is associated with CVD risk in the Osteoarthritis Initiative (OAI) study. METHODS Community-dwellers affected by knee OA or at high risk for this condition were followed for 8 years. A standardized CGA including information on functional, nutritional, mood, comorbidities, medications, quality of life and co-habitation status was used to calculate a modified version of the MPI (range 0-1), with higher scores representing greater risk of mortality. CVDs were recorded using self-reported information. Logistic regression analyses, adjusting for potential confounders, were conducted. RESULTS The final sample consisted of 4211 individuals (mean age 60.8 years, females = 58.6%). People with incident CVD had a significant higher baseline MPI value than those without CVD (0.44 ± 0.17 vs. 0.39 ± 0.17). People with an MPI between 0.34 and 0.66 (OR = 1.31; 95%CI: 1.03-1.67) and over 0.66 (OR = 1.91; 95%CI: 1.26-2.89) experienced a higher risk of CVD (vs. MPI score < 0.34). A 0.10 points increase in the MPI score at baseline was associated with a 1.16 (95%CI: 1.09-1.24) times higher odds for incident CVD. CONCLUSIONS AND IMPLICATIONS Higher MPI values at baseline were associated with an increased risk of CVD, reinforcing the importance of CGA in predicting CVD risk in older people.
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Affiliation(s)
- Nicola Veronese
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Palermo, Italy; Department Geriatric Care, Orthogeriatrics and Rehabilitation, Frailty Area, E.O. Galliera Hospital, Genova, Italy.
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, 08830 Barcelona, Spain; ICREA, Pg. Lluis Companys 23, 08010 Barcelona, Spain
| | - Lee Smith
- The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK
| | - Clarissa Musacchio
- Department Geriatric Care, Orthogeriatrics and Rehabilitation, Frailty Area, E.O. Galliera Hospital, Genova, Italy
| | - Lisa Cammalleri
- Department Geriatric Care, Orthogeriatrics and Rehabilitation, Frailty Area, E.O. Galliera Hospital, Genova, Italy
| | - Mario Barbagallo
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Palermo, Italy
| | - Alberto Pilotto
- Department Geriatric Care, Orthogeriatrics and Rehabilitation, Frailty Area, E.O. Galliera Hospital, Genova, Italy; Department of Interdisciplinary Medicine, University of Bari, Bari, Italy
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Custodero C, Gandolfo F, Cella A, Cammalleri LA, Custureri R, Dini S, Femia R, Garaboldi S, Indiano I, Musacchio C, Podestà S, Tricerri F, Pasa A, Sabbà C, Pilotto A. Multidimensional prognostic index (MPI) predicts non-invasive ventilation failure in older adults with acute respiratory failure. Arch Gerontol Geriatr 2020; 94:104327. [PMID: 33485005 DOI: 10.1016/j.archger.2020.104327] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 12/15/2020] [Accepted: 12/19/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Acute respiratory failure (ARF) is a very common complication among hospitalized older adults. Non-invasive ventilation (NIV) may avoid admission to intensive care units, intubation and their related complication, but still lacks specific indications in older adults. Multidimensional Prognostic Index (MPI) based on comprehensive geriatric assessment (CGA) could have a role in defining the short-term prognosis and the best candidates for NIV among older adults with ARF. METHODS This is a retrospective observational study which enrolled patients older than 70 years, consecutively admitted to an acute geriatric unit with ARF. A standardized CGA was used to calculate the MPI at admission. Multivariate Cox regression models were used to test if MPI score could predict in-hospital mortality and NIV failure. Receiver operator curve (ROC) analysis was used to identify the discriminatory power of MPI for NIV failure. RESULTS We enrolled 231 patients (88.2 ± 5.9 years, 47% females). Mean MPI at admission was 0.76±0.16. In-hospital mortality rate was 33.8%, with similar incidence in patients treated with and without NIV. Among NIV users (26.4%), NIV failure occurred in 39.3%. Higher MPI scores at admission significantly predicted in-hospital mortality (β=4.46, p<0.0001) among patients with ARF and NIV failure (β=7.82, p = 0.001) among NIV users. MPI showed good discriminatory power for NIV failure (area under the curve: 0.72, 95% CI: 0.58-0.85, p<0.001) with optimal cut-off at MPI value of 0.84. CONCLUSIONS MPI at admission might be a useful tool to early detect patients more at risk of in-hospital death and NIV failure among older adults with ARF.
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Affiliation(s)
- Carlo Custodero
- Department of Interdisciplinary Medicine, University of Bari, Italy
| | - Federica Gandolfo
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, E.O. Galliera Hospital, Genova, Italy
| | - Alberto Cella
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, E.O. Galliera Hospital, Genova, Italy
| | - Lisa A Cammalleri
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, E.O. Galliera Hospital, Genova, Italy
| | - Romina Custureri
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, E.O. Galliera Hospital, Genova, Italy
| | - Simone Dini
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, E.O. Galliera Hospital, Genova, Italy
| | - Rosetta Femia
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, E.O. Galliera Hospital, Genova, Italy
| | - Sara Garaboldi
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, E.O. Galliera Hospital, Genova, Italy
| | - Ilaria Indiano
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, E.O. Galliera Hospital, Genova, Italy
| | - Clarissa Musacchio
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, E.O. Galliera Hospital, Genova, Italy
| | - Silvia Podestà
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, E.O. Galliera Hospital, Genova, Italy
| | - Francesca Tricerri
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, E.O. Galliera Hospital, Genova, Italy
| | - Ambra Pasa
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, E.O. Galliera Hospital, Genova, Italy
| | - Carlo Sabbà
- Department of Interdisciplinary Medicine, University of Bari, Italy
| | - Alberto Pilotto
- Department of Interdisciplinary Medicine, University of Bari, Italy; Department of Geriatric Care, Orthogeriatrics and Rehabilitation, E.O. Galliera Hospital, Genova, Italy.
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Noetzel N, Meyer AM, Siri G, Pickert L, Heeß A, Verleysdonk J, Benzing T, Pilotto A, Barbe AG, Polidori MC. The impact of oral health on prognosis of older multimorbid inpatients: the 6-month follow up MPI oral health study (MPIOH). Eur Geriatr Med 2020; 12:263-273. [PMID: 33206351 DOI: 10.1007/s41999-020-00427-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 10/30/2020] [Indexed: 01/11/2023]
Abstract
PURPOSE There is clear evidence for an association between oral health and systemic illnesses, geriatric syndromes, and mortality. Frail and multimorbid older people often suffer from insufficient oral health care, but standardized dental examinations are not routinely performed in clinical settings. The aim of this study was to verify the practicability of in-hospital oral health examinations and to identify their association with patients' prognosis as assessed by means of the Comprehensive Geriatric Assessment (CGA)-based Multidimensional Prognostic Index (MPI). METHODS One hundred hospitalized patients aged 65 years and older (mean age 76.9 years (SD 6.4); 58.2% male, 41.8% female) underwent a CGA-based MPI calculation at discharge with subdivision into three mortality risk groups (MPI-1, low risk, score 0-0.33; MPI-2, moderate risk, score 0.34-0.66; MPI-3, high risk, score 0.67-1). To identify the current oral health status and the Oral Health-related Quality of Life (OHRQoL), three oral health examinations were performed. Information on survival, the incidence of oral diseases, dental appointments, and treatments up to 6 months after discharge were collected. RESULTS All oral health examinations were feasible during hospitalization and were associated with MPI prognosis, even though they were not associated with 6-month mortality. The MPI could not predict the use of dental health care or treatment, as, irrespective of MPI and oral health examinations, dental services were underutilized during follow up. CONCLUSION Besides MPI evaluation, oral health examinations should be implemented into an inhospital course to improve clinical decision-making as well as secondary and tertiary prevention of oral health- and related systemic diseases. TRIAL REGISTRATION NUMBER German Clinical Trials Register: DRKS00013607 (07.02.2019, retrospectively registered).
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Affiliation(s)
- Nicolas Noetzel
- Ageing Clinical Research, Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.
| | - Anna Maria Meyer
- Ageing Clinical Research, Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Giacomo Siri
- Scientific Directorate-Biostatistics, E.O. Galliera Hospital, Genova, Italy
| | - Lena Pickert
- Ageing Clinical Research, Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Annika Heeß
- Ageing Clinical Research, Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Joshua Verleysdonk
- Ageing Clinical Research, Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Thomas Benzing
- Ageing Clinical Research, Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty 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
| | - Alberto Pilotto
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Frailty Area, E.O. Galliera Hospital, Genova, Italy.,Department of Interdisciplinary Medicine, University of Bari, Bari, Italy
| | - Anna Greta Barbe
- Department of Operative Dentistry and Periodontology, Centre of Dental Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Maria Cristina Polidori
- Ageing Clinical Research, Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty 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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Veronese N, Demurtas J, Maggi S, Cherubini A, Solfrizzi V, Cella A, Fimognari FL, Ferrari A, Pilotto A. Meta-research in geriatric medicine: a survey of the Italian Society of Hospital and Community Geriatrics (SIGOT). Geriatr Care 2020. [DOI: 10.4081/gc.2020.9339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The need for major information in meta-research (i.e. the part of medicine interested in systematic reviews [SRs] and meta-analyses [MAs]) is increasing. In the last years we are observing an exponential rate of publications as SRs/MAs in geriatric medicine. In order to better assess the interest in meta-research, we proposed a survey to know the knowledge and the needs in meta-research in geriatrics. A short survey (about 5 minutes) was freely available in the Italian Society of Hospital and Community Geriatrics (SIGOT) website and diffused in social networks. The survey was available during the entire 2019. The survey regards demographic information, previous research activities and the knowledge of the participant on meta-research. Altogether, 148 participants mainly men (=65.5%) and mainly aged 36 to 44 years and working in hospital from all Italian regions completed the survey. Responders read more than 20 articles in the previous year (=58.1%), including 10-20 SRs/MAs (25%). Many respondents (41.9%) had published >20 articles during their life. At the same time, a consistent part of the respondents recognized the importance of metaresearch for clinical practice and almost all the participants recognized that metaresearch has changed their daily clinical approach to the patient. Almost all the participants would like to have more training in meta-research suggesting that SIGOT should organize training courses for metaresearch in geriatric medicine. In conclusion, our survey showed that the interest in SRs/MAs is high, whilst the knowledge is still limited suggesting that education is needed to fill the gap in this field.
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Benussi A, Premi E, Pilotto A, Libri I, Pezzini A, Paolillo C, Borroni B, Magoni M, Padovani A. Effects of COVID-19 outbreak on stroke admissions in Brescia, Lombardy, Italy. Eur J Neurol 2020; 28:e4-e5. [PMID: 32892411 DOI: 10.1111/ene.14505] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 08/31/2020] [Indexed: 12/21/2022]
Affiliation(s)
- A Benussi
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.,Neurology Unit, Department of Neurological and Vision Sciences, ASST Spedali Civili, Brescia, Italy
| | - E Premi
- Vascular Neurology Unit, Department of Neurological and Vision Sciences, ASST Spedali Civili, Brescia, Italy
| | - A Pilotto
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.,Neurology Unit, Department of Neurological and Vision Sciences, ASST Spedali Civili, Brescia, Italy
| | - I Libri
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - A Pezzini
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.,Neurology Unit, Department of Neurological and Vision Sciences, ASST Spedali Civili, Brescia, Italy
| | - C Paolillo
- Emergency Department, ASST Spedali Civili, Brescia, Italy
| | - B Borroni
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.,Neurology Unit, Department of Neurological and Vision Sciences, ASST Spedali Civili, Brescia, Italy
| | - M Magoni
- Vascular Neurology Unit, Department of Neurological and Vision Sciences, ASST Spedali Civili, Brescia, Italy
| | - A Padovani
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.,Neurology Unit, Department of Neurological and Vision Sciences, ASST Spedali Civili, Brescia, Italy
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Veronese N, Koyanagi A, Smith L, Solmi M, Senesi B, Cella A, Pilotto A. Relationship between multidimensional prognostic index and incident depressive symptoms in older people: Findings from the Irish Longitudinal Study on Ageing. Int J Geriatr Psychiatry 2020; 35:1097-1104. [PMID: 32383779 DOI: 10.1002/gps.5331] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 04/13/2020] [Accepted: 05/04/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVES The multidimensional prognostic index (MPI) is a useful prognostic tool for evaluating adverse health outcomes in older individuals. However, the association between MPI and depressive symptoms has never been explored, despite depression being a common condition in older people. We therefore aimed to evaluate whether MPI may predict incident depressive symptoms. METHODS Longitudinal, cohort study, with 2 years of follow-up (W1: October 2009-February 2011; W2: April 2012-January 2013), including people aged ≥65 years without depressive symptoms at baseline. A comprehensive geriatric assessment including information on functional, nutritional, cognitive status, mobility, comorbidities, medications, and cohabitation status was used to calculate the MPI dividing the participants into low, moderate, or severe risk. Those who scored ≥16/60 with the Center of Epidemiology Studies Depression (CES-D) tool were considered to have depressive symptoms. Multivariable logistic regression models were built to explore the association between MPI and incident depressive symptoms. RESULTS The sample consisted of 1854 participants (mean age: 72.8 ± SD 5.1 years; females: 52.1%). The prevalence of incident depressive symptoms by MPI tertiles at baseline were: low 2.5%, moderate 3.9%, and severe 6.7%. In multivariable analyses, baseline MPI values were significantly associated with incident depressive symptoms (increase in 0.1 points in MPI: odds ratio, OR = 1.47; 95% confidence intervals, CI: 1.17-1.85; MPI tertile severe vs low: OR = 2.96; 95%CI: 1.50-5.85). CONCLUSION Baseline MPI values were associated with incident depressive symptoms indicating that multidimensional assessment of older people may lead to early identification of individuals at increased risk of depression onset.
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Affiliation(s)
- Nicola Veronese
- Primary Care Department, District 3, Azienda ULSS 3 Serenissima, Venice, Italy.,Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Palermo, Italy
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, Barcelona, Spain.,ICREA, Pg. Lluis Companys 23, Barcelona, Spain
| | - Lee Smith
- The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK
| | - Marco Solmi
- Department of Neurosciences, University of Padova, Padova, Italy.,Padova Neuroscience Center, University of Padova, Padova, Italy
| | - Barbara Senesi
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, E.O. Galliera Hospital, National Relevance & High Specialization Hospital, Genoa, Italy
| | - Alberto Cella
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, E.O. Galliera Hospital, National Relevance & High Specialization Hospital, Genoa, Italy
| | - Alberto Pilotto
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, E.O. Galliera Hospital, National Relevance & High Specialization Hospital, Genoa, Italy.,Department of Interdisciplinary Medicine, University of Bari, Bari, Italy
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Pilotto A. Abstract Book of the 34° Congresso Nazionale SIGOT - Live streaming, 22-23 settembre 2020. Geriatr Care 2020. [DOI: 10.4081/gc.2020.9363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Book of the 34° Congresso Nazionale SIGOT - Live streaming, 22-23 settembre 2020.
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Pilotto A, Veronese N, Siri G, Bandinelli S, Tanaka T, Cella A, Ferrucci L. Association Between the Multidimensional Prognostic Index and Mortality During 15 Years of Follow-up in the InCHIANTI Study. J Gerontol A Biol Sci Med Sci 2020; 76:1678-1685. [PMID: 32941606 DOI: 10.1093/gerona/glaa237] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Multidimensional Prognostic Index (MPI) is recognized as a prognostic tool in hospitalized patients, but data on the value of MPI in community-dwelling older persons are limited. Using data from a representative cohort of community-dwelling persons, we tested the hypothesis that MPI explains mortality during 15 years of follow-up. METHODS A standardized comprehensive geriatric assessment was used to calculate the MPI and to categorize participants in low-, moderate-, and high-risk classes. The results were reported as hazard ratios (HRs) and the accuracy was evaluated with the area under the curve (AUC), with 95% confidence intervals (CIs) and the C-index. We also reported the median survival time by standard age groups. RESULTS All 1453 participants (mean age 68.9 years, women = 55.8%) enrolled in the InCHIANTI study at baseline were included. Compared to low-risk group, participants in moderate (HR = 2.10; 95% CI: 1.73-2.55) and high-risk MPI group (HR = 4.94; 95% CI: 3.91-6.24) had significantly higher mortality risk. The C-index of the model containing age, sex, and MPI was 82.1, indicating a very good accuracy of this model in explaining mortality. Additionally, the time-dependent AUC indicated that the accuracy of the model incorporating MPI to age and sex was excellent (>85.0) during the whole follow-up period. Compared to participants in the low-risk MPI group across different age groups, those in moderate- and high-risk groups survived 2.9-7.0 years less and 4.3-8.9 years less, respectively. CONCLUSIONS In community-dwelling individuals, higher MPI values are associated with higher risk of all-cause mortality with a dose-response effect.
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Affiliation(s)
- Alberto Pilotto
- Geriatrics Unit, Department of Geriatric Care, Orthogeriatrics and Rehabilitation, E.O. Ospedali Galliera, Genova, Italy.,Department of Interdisciplinary Medicine, University of Bari Aldo Moro, Italy
| | - Nicola Veronese
- Geriatrics Unit, Department of Geriatric Care, Orthogeriatrics and Rehabilitation, E.O. Ospedali Galliera, Genova, Italy.,Department of Geriatrics, University of Palermo, Italy
| | - Giacomo Siri
- Geriatrics Unit, Department of Geriatric Care, Orthogeriatrics and Rehabilitation, E.O. Ospedali Galliera, Genova, Italy
| | - Stefania Bandinelli
- Geriatric Unit, Local Health Unit Tuscany Centre, InCHIANTI Study, Florence, Italy
| | - Toshiko Tanaka
- Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, Baltimore, Maryland
| | - Alberto Cella
- Geriatrics Unit, Department of Geriatric Care, Orthogeriatrics and Rehabilitation, E.O. Ospedali Galliera, Genova, Italy
| | - Luigi Ferrucci
- Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, Baltimore, Maryland
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Solfrizzi V, Scafato E, Custodero C, Loparco F, Ciavarella A, Panza F, Seripa D, Imbimbo BP, Lozupone M, Napoli N, Piazzolla G, Galluzzo L, Gandin C, Baldereschi M, Di Carlo A, Inzitari D, Pilotto A, Sabbà C. Liver fibrosis score, physical frailty, and the risk of dementia in older adults: The Italian Longitudinal Study on Aging. Alzheimers Dement (N Y) 2020; 6:e12065. [PMID: 32864415 PMCID: PMC7443742 DOI: 10.1002/trc2.12065] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 06/14/2020] [Accepted: 07/09/2020] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Liver fibrosis increases progressively with aging and has been associated with poorer cognitive performance in middle-aged and older adults. We investigated the relationships between a non-invasive score for advanced liver fibrosis (non-alcoholic fatty liver disease [NAFLD] fibrosis score [NFS]) and dementia risk. We also assessed physical frailty, a common geriatric condition which is associated to dementia. We tested the joint effects of physical frailty and fibrosis on dementia incidence. METHODS A total of 1061 older adults (65 to 84 years), from the Italian Longitudinal Study on Aging, were prospectively evaluated for the risk of dementia in a period between 1992 and 2001. Liver fibrosis was defined according to the NFS. Physical frailty was assessed according to the Fried's criteria. Cox proportional hazards models were used to estimate the short- and long-term risk of overall dementia, associated to the NFS, testing the effect modifier of physical frailty status. RESULTS Older adults with only high NFS (F3-F4) did not exhibit a significant increased risk of overall dementia. Over 8 years of follow-up, frail older adults with high NFS had an increased risk of overall dementia (hazard ratio [HR]: 4.23; 95% confidence interval [CI]: 1.22 to 14.70, P = .023). Finally, physically frail older adults with low albumin serum levels (albumin < 4.3 g/dL) and with advanced liver fibrosis (F3-F4 NFS) compared to those with lower liver fibrosis score (F0-F2 NFS) were more likely to have a higher risk of overall dementia in a long term-period (HR: 16.42; 95% CI: 1.44 to 187.67, P = .024). DISCUSSION Advanced liver fibrosis (F3-F4 NFS) could be a long-term predictor for overall dementia in people with physical frailty. These findings should encourage a typical geriatric, multidisciplinary assessment which accounts also for the possible co-presence of frail condition in older adults with chronic liver disease and liver fibrosis.
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Affiliation(s)
- Vincenzo Solfrizzi
- Clinica Medica “Frugoni” and Geriatric Medicine‐Memory UnitUniversity of Bari Aldo MoroBariItaly
| | - Emanuele Scafato
- Population Health and Health Determinants Unit, National Centre for Epidemiology, Surveillance and Health Promotion (CNESPS)Istituto Superiore di Sanità (ISS)RomaItaly
- Department of Cardiovascular, Dysmetabolic and Ageing‐Associated DiseasesIstituto Superiore di Sanità (ISS)RomaItaly
| | - Carlo Custodero
- Clinica Medica “Frugoni” and Geriatric Medicine‐Memory UnitUniversity of Bari Aldo MoroBariItaly
| | - Francesca Loparco
- Clinica Medica “Frugoni” and Geriatric Medicine‐Memory UnitUniversity of Bari Aldo MoroBariItaly
| | - Alessandro Ciavarella
- Clinica Medica “Frugoni” and Geriatric Medicine‐Memory UnitUniversity of Bari Aldo MoroBariItaly
| | - Francesco Panza
- Geriatric UnitFondazione IRCCS “Casa Sollievo della Sofferenza”FoggiaItaly
- National Institute of Gastroenterology “Saverio de Bellis”Research HospitalBariItaly
| | - Davide Seripa
- Geriatric UnitFondazione IRCCS “Casa Sollievo della Sofferenza”FoggiaItaly
- Hematology and Stem Cell Transplant UnitVito Fazzi HospitalLecceItaly
| | | | - Madia Lozupone
- Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense OrgansUniversity of Bari Aldo MoroBariItaly
| | - Nicola Napoli
- Clinica Medica “Frugoni” and Geriatric Medicine‐Memory UnitUniversity of Bari Aldo MoroBariItaly
| | - Giuseppina Piazzolla
- Clinica Medica “Frugoni” and Geriatric Medicine‐Memory UnitUniversity of Bari Aldo MoroBariItaly
| | - Lucia Galluzzo
- Department of Cardiovascular, Dysmetabolic and Ageing‐Associated DiseasesIstituto Superiore di Sanità (ISS)RomaItaly
| | - Claudia Gandin
- Population Health and Health Determinants Unit, National Centre for Epidemiology, Surveillance and Health Promotion (CNESPS)Istituto Superiore di Sanità (ISS)RomaItaly
| | - Marzia Baldereschi
- Institute of NeuroscienceItalian National Research Council (CNR)FirenzeItaly
| | - Antonio Di Carlo
- Institute of NeuroscienceItalian National Research Council (CNR)FirenzeItaly
| | - Domenico Inzitari
- Institute of NeuroscienceItalian National Research Council (CNR)FirenzeItaly
- Department of NEUROFARBA, Neuroscience SectionUniversity of FlorenceFirenzeItaly
| | - Alberto Pilotto
- Clinica Medica “Frugoni” and Geriatric Medicine‐Memory UnitUniversity of Bari Aldo MoroBariItaly
- Geriatrics Unit, Department of Geriatric CareOrthogeriatrics and RehabilitationGenovaItaly
| | - Carlo Sabbà
- Clinica Medica “Frugoni” and Geriatric Medicine‐Memory UnitUniversity of Bari Aldo MoroBariItaly
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