Using the Multidimensional Prognostic Index (MPI) to improve cost-effectiveness of interventions in multimorbid frail older persons: results and final recommendations from the MPI_AGE European Project

Cruz-Jentoft, Alfonso J.; Daragjati, Julia; Fratiglioni, Laura; Maggi, Stefania; Mangoni, Arduino A.; Mattace-Raso, Francesco; Pocard, Marc; Polidori, Maria Cristina; Topinková, Eva; Ferrucci, Luigi

doi:10.1007/s40520-020-01516-0

Cited by 35 publications

(22 citation statements)

References 40 publications

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“…4 There is a strong rationale for this as well as for the rapid development of prospective protocols with prognostic tools based operationally on a multidimensional approach to frailty 5 like the Multidimensional Prognostic Index (MPI). 6 Although patients with COVID-19 are at risk of poor prognosis if affected by multimorbidity, this information is not enough, as type of comorbidity clusters is far more predictive than number of comorbidities itself. 7 Indeed, crucial for prognosis in older patients are, besides disease-specific determinants and polypharmacy, also functional, physical, and psychosocial factors, that can be best addressed by multidimensional tools.…”

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The unavoidable costs of frailty: a geriatric perspective in the time of COVID-19

2020

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The world is facing speechless one of the most feared, greatest catastrophes for human beings. Despite better healthcare systems, despite warnings through similar situations and even documented threats, as the COVID-19 pandemic hit, it found us largely unprepared. It offered to us on a silver tray the fragility of mankind. And once again, but this time in a particularly overwhelming way, the most vulnerable part of the world population is mowed down: older persons. Indeed, recent data from the Italian Istituto Superiore di Sanità showed that COVID-19 is more lethal in older subjects: in Italy, at the date of March 17, 2020, the overall case-fatality rate was 7.2% and 96.4% of died patients had more than 60 years. When data were stratified by age groups, individuals aged 70 years or older represent 35.5% of cases, while subjects aged ≥80 years were 52.3%. These data confirm once again that the older generation payed the highest price in time of crisis...

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The unavoidable costs of frailty: a geriatric perspective in the time of COVID-19

2020

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“…Although guidance exists for inclusion of older patients in clinical trials [ 11 ], these are still underrepresented in randomized clinical trials (RCTs), whereas the most robust, independent and cognitively intact older patients fit are usually enrolled [ 12 ]. Although the Comprehensive Geriatric Assessment (CGA) and frailty measurement tools have been recommended to help guide decisions about AF anticoagulation in older patients [ 13 , 14 ], this is not generalized in clinical trials nor current practice yet.…”

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Atrial fibrillation: a geriatric perspective on the 2020 ESC guidelines

et al. 2021

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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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“…The Multidimensional Prognostic Index derived from Comprehensive Geriatric Assessment (CGA) has been demonstrated as a feasible and reliable tool predicting morbidity, mortality, hospitalization, institutionalization in community-dwelling older adults [ 12 ]. Moreover, it offers the opportunity to guide the healthcare providers in clinical decision making and allocation of resources [ 13 ].…”

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Validation and implementation of telephone-administered version of the Multidimensional Prognostic Index (TELE-MPI) for remote monitoring of community-dwelling older adults

et al. 2021

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Background During the recent lockdown measures adopted by national authorities to contain the COVID-19 pandemic, many vulnerable older patients with chronic conditions, normally followed in ambulatory setting, needed to be monitored and managed in alternative ways, including telemedicine. Aims In the framework of a telemedicine program, we aimed to validate and implement a telephone-administered version of the Multidimensional Prognostic Index (TELE-MPI) among community-dwelling older outpatients. Method From March 9 to May 11, 2020, 131 older patients (82.1 years; 74% females) were interviewed using a telephonebased survey to calculate the TELE-MPI. The standard MPI was performed face-to-face three months apart. The Bland-Altman methodology measured the agreement between the two tools. Multivariate logistic regression models were built to ascertain the prognostic value of TELE-MPI and TELE-MPI classes (low, moderate, or severe risk) on negative outcomes occurring during the lockdown period. Results Mean MPI and TELE-MPI values were 0.523 and 0.522, respectively. Lower and upper 95% limits of agreement were − 0.122 and + 0.124, respectively, with only 4.6% of observations outside the limits. Each 0.1 increase of TELE-MPI score was significantly correlated with higher incidence of psychiatric disorders [odd ratio (OR): 1.57; 95% confidence interval (CI) 1.27, 1.95] and falls (OR: 1.41; 95% CI 1.08, 1.82) in community-dwelling-older adults. Discussion TELE-MPI showed a strong agreement with the standard MPI and was able to predict psychiatric disorders and falls during lockdown period. Conclusion TELE-MPI may represent a useful way to follow by remote the health status of older adults.

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Using the Multidimensional Prognostic Index (MPI) to improve cost-effectiveness of interventions in multimorbid frail older persons: results and final recommendations from the MPI_AGE European Project

Cited by 35 publications

References 40 publications

The unavoidable costs of frailty: a geriatric perspective in the time of COVID-19

The unavoidable costs of frailty: a geriatric perspective in the time of COVID-19

Atrial fibrillation: a geriatric perspective on the 2020 ESC guidelines

Validation and implementation of telephone-administered version of the Multidimensional Prognostic Index (TELE-MPI) for remote monitoring of community-dwelling older adults

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