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

Abstract

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.

Frailty trajectories in community‐dwelling older adults during COVID‐19 pandemic: The PRESTIGE study

“…In the multivariable analysis, adjusting for age, gender, BMI, multimorbidity and flu and anti-pneumococcal vaccination, pre-frail/frail older adults both non-infected (aOR: 14.84, 95% CI: 4. 26 risk of further worsening of frailty condition compared to robust and non-infected subjects (Table 3, Table S2). Older adults who were robust at baseline were more likely to experience a worsening in ADL domain, whereas among frail/pre-frail subjects the domains that contributed more to further MPI worsening were loss of IADL, poor mobility, cognitive impairment and malnutrition (Table S3).…”

“…Similarly to the SELFY‐MPI‐SF domains, the TELE‐MPI considered the same eight areas of CGA. 26 The only domains evaluated in different way compared to the SELFY‐MPI‐SF were mobility and cognition. Mobility was evaluated inquiring about: (1) the abilities to transfer from bed to chair or wheelchair, (2) walking at least ten feet without any assistance and (3) going up and down the stairs without assistance.…”

“…We selected this cut‐off to identify significant worsening of frailty, based on previous literature showing that increase of 0.1 points of the MPI score was a clinically relevant change associated with increased risk of negative outcomes. 8 , 22 , 26 A two‐tailed significance level at p = 0.05 was set for each test. All the analyses were performed using SPSS v26.0 software for Windows (SPSS, Chicago, IL, USA).…”

“…These have been developed and validated to extend the spectrum of application of multidimensional approach to frailty, based on the principles of Comprehensive Geriatric Assessment (CGA), in more specific settings as community/general practice (SELFY‐MPI‐SF) 25 and telehealth (TELE‐MPI) 26 . Both tools showed strong agreement with standard MPI 25,26 …”

Remote Healthcare During the COVID-19 Pandemic: Findings for Older Adults in 27 European Countries and Israel

“…Moreover, it can deploy large numbers of providers rapidly, facilitating the triage and supply clinical services when health facilities cannot meet demands (4). Additionally, it can reduce the risk of complications in individuals with chronic conditions (5) or improve medication adherence for people with chronic diseases (6). Furthermore, remote consultations can help control virus transmission and minimize risk exposure for vulnerable populations (7)(8)(9) or improve access to healthcare for patients who fear contagion in health facilities (10,11).…”