Development and Validation of a Multidimensional Prognostic Index for Mortality Based on a Standardized Multidimensional Assessment Schedule (MPI-SVaMA) in Community-Dwelling Older Subjects

Abstract

Objectives: To develop and validate a Multidimensional Prognostic Index (MPI) for mortality based on information collected by the Multidimensional Assessment Schedule (SVaMA), the recommended standard tool for multidimensional assessment of community-dwelling older subjects in seven Italian regions. Design: Prospective cohort study. Participants: Community-dwelling subjects older than 65 years who underwent an SVaMA evaluation from 2004 to 2010 in Padova Health District, Veneto, Italy. Measurements: The MPI-SVaMA was calculated as a weighted (weights were derived from multivariate Cox regressions) linear combination of the following nine domains: age, sex, main diagnosis, and six scores, ie, the Short Portable Mental Status Questionnaire, the Barthel index (contains two domains: activities of daily living and mobility), the Exton-Smith scale, the Nursing Care Needs, and the Social Network Support by a structured interview. Subjects were followed for a median of 2 years; those who had not died were followed for at least 1 year. The MPI-SVaMA score ranged from 0 to 1 and 3 grades of severity of the MPI-SVaMA were calculated on the basis of estimated cutoffs. Discriminatory power and calibration were further assessed. Results: A total of 12,020 subjects (mean age 81.84 ± 7.97 years) were included. Two random cohorts were selected: (1) a development cohort, ie, 7876 subjects (mean age 81.79 ± 8.05, %females: 63.1) and (2) a validation cohort, ie, 4144 subjects (mean age: 81.95 ± 7.83, %females: 63.7). The discriminatory power for mortality of MPI-SVaMA was 0.828 (95% CI 0.817–0.838) and 0.832 (95% CI 0.818–0.845) at 1 month and 0.791 (95% CI 0.784–0.798) and 0.792 (95% CI 0.783–0.802) at 1 year in development and validation cohorts, respectively. MPI-SVaMA results were well calibrated showing lower than 10% differences between predicted and observed mortality, both in development and validation cohorts. Conclusions: The MPI-SVaMA is an accurate and well-calibrated prognostic tool for mortality in community-dwelling older subjects, and can be used in clinical decision making.

<b> Incapacidade funcional para atividades básicas de vida diária de idosos: estudo populacional/Functional disability for basic activities of daily lives of the elderly: a population study <b>

“…A capacidade funcional para realizar ABVD tem sido considerada um indicador de situação de saúde da população idosa (2,10) e sua avaliação está incluída no Multidimensional Assessment Schedule (SVaMA), pelo qual se determina o Multidimensional Prognostic Index (MPI) para mortalidade (12) . A prevalência de incapacidade funcional varia conforme o país e suas regiões, sendo a faixa etária fator considerado para definir o idoso.…”

“…Na região Centro-Oeste, estudo realizado em áreas de abrangência da estratégia saúde da família apontaram prevalências de incapacidade funcional para ABVD de 34,8% (4) e 42,1% (16) . Os principais fatores associados à incapacidade funcional incluem a baixa escolaridade, aumento da idade, hospitalização, acidente vascular encefálico, autopercepção de saúde ruim, presença de multimorbidade, déficit visual e sintomas depressivos ou problemas mentais, polifarmácia e peso abaixo ou acima do normal (6,10,12,17) . Em função do aumento da expectativa de vida da população e do perfil epidemiológico entre os idosos, a avaliação das limitações funcionais é fundamental na prática dos serviços de saúde, uma vez que a incapacidade gera ônus para a comunidade de forma geral, incluindo aumento na procura por serviços de saúde, redução da qualidade de vida, aumento nos custos dos cuidados, além de maior mortalidade (7,14) .…”

31. Eligibility regulations and formal home-care utilisation among the vulnerable older people in SHARE Wave 5

“…Recent clinical research has produced tools which focus on the implementation of the theory, as reviewed by Clegg, Young, Iliffe, Rikkert, and Rockwood (2013), Pel-Littel et al (2009), De Vries et al (2011) and Pialoux, Goyard, and Lesourd (2012. The frailty index in Mitnitski, Mogilner, and Rockwood (2001) and Rockwood and Mitnitski (2007) links the condition of frailty to the accumulation of deficits, while Pilotto et al (2013) develop and validate a multidimensional index of vulnerability and mortality based on a multidimensional assessment schedule (SVaMA) adopted in several Italian regions. Finally, the World Health Organization (WHO) developed an instrument-the International Classification of Functioning (ICF)-to provide public institutions with a "consistent and internationally comparable" tool to collect data on vulnerability, adopting a bio-psychosocial perspective on the phenomenon (WHO, 2002).…”

“…It is worth noting that the Barthel scale does not comprise iADL tasks. However, it also includes the economic conditions and the housing arrangements of the household (Pilotto et al, 2013 …”

“…(2011) A few observations on the Czech assessment criteria are in order. The 2006 version of the assessment-of-need scale was perhaps the most detailed (36 tasks) among those adopted in the major LTC programmes in Europe with the potential exception of the SVaMA [adopted in Italy, see Pilotto et al (2013)] which nevertheless is built for clinical usage and, in its full version, has no clear threshold to determine dependency. The 2012 version of the scale is simpler, as it consists of ten basic activities which somehow summarise the 36 points of the previous legislation.…”