Multidimensional frailty in older people in general practitioners’ clinical practice: the SELFY-MPI SIGOT project

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.

Usefulness of STOPP/START criteria and Beers criteria for prescribing in geriatric patients in a tertiary health care center, Raipur, Central India

“…Some elderly were living alone for more than 15 years, suggesting a potential social frailty. Similar findings had been observed in a study conducted by Pilotto A et al ,[ 16 ] (2022) which was carried out on general practitioners (GPs) in Italy, and suggested developing and diffusing comprehensive geriatric assessment in primary care settings. Polypharmacy and use of OTC herbal medications which were observed in this study warrant watchfulness for suspected adverse drug interactions in these patients.…”

“…observed that older people who were attending on GP’s ambulatories indicated that pre-frailty and frailty are common conditions that should be identified early to allow effective and personalized management based on the multi-dimensional profile of the individual elderly, suggesting the very key role of a primary/family physician in geriatric care. [ 16 ] The quality of primary care becomes important because of an advanced age, disease complexity, and multi-morbidity, resulting in hospitalization which can be improved by interventions targeting primary care[ 17 30 ] and use of screening tools such as STOPP/START and Beers criteria by the primary/family physician.…”

“…Primary or family physicians are catering services to geriatric patients with the health issues and are a key component of primary care. [ 16 ] The quality of primary care becomes important because of an advanced age, disease complexity, and multi-morbidity, resulting in hospitalization which can be improved by interventions targeting primary care and use of screening tools such as STOPP/START and Beers criteria by primary or family physicians. [ 17 ]…”

Multidimensional Frailty and Vaccinations in Older People: A Cross-Sectional Study

“…Moreover, to the best of our knowledge, SELFY-MPI is the only tool for self-reporting frailty available that cannot be considered only as a screening tool. As reported in other works, in older people, frailty, assessed using a multidimensional approach, has a prevalence of about 5%, and more importantly, prefrailty may affect about one person out of two [6,23,41]. In our study, we found a slightly lower prevalence of frailty and prefrailty, according to a multidimensional approach, probably because these older people were able to access the services for receiving vaccination against SARS-CoV-2; therefore, bedridden and more disabled, older participants were not included.…”

“…The sample size was calculated according to a work investigating the prevalence of multidimensional frailty with the SELFY-MPI among general practitioners in Italy [23]. In this regard, hypothesizing a prevalence of multidimensional frailty of 3.99%, a type I error of 5% and a power of 80%, 246 participants should be enrolled.…”