Multidimensional frailty increases cardiovascular risk in older people: an 8-year longitudinal cohort study in the Osteoarthritis Initiative

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

Association between multidimensional prognostic index (MPI) and pre-operative delirium in older patients with hip fracture

Pre-operative delirium may cause delay in surgical intervention in older patients hospitalized for hip fracture. Also it has been associated with higher risk of post-surgical complications and worst functional outcomes. Aim of this retrospective cohort study was to evaluate whether the multidimensional prognostic index (MPI) at hospital admission was associated with pre-operative delirium in older individuals with hip fracture who are deemed to require surgical intervention. Consecutive older patients (&gt;= 65 years) with hip fracture underwent a comprehensive geriatric assessment to calculate the MPI at hospital admission. According to previously established cut-offs, MPI was expressed in three grades, i.e. MPI-1 (low-risk), MPI-2 (moderate-risk) and MPI-3 (high risk of mortality). Pre-operative delirium was assessed using the four 'A's Test. Out of 244 older patients who underwent surgery for hip fracture, 104 subjects (43%) received a diagnosis of delirium. Overall, the incidence of delirium before surgery was significantly higher in patients with more severe MPI score at admission. Higher MPI grade (MPI-3) was independently associated with higher risk of pre-operative delirium (OR 2.45, CI 1.21-4.96). Therefore, the MPI at hospital admission might help in early identification of older patients with hip fracture at risk for pre-operative delirium

Frailty is associated with socioeconomic and lifestyle factors in community-dwelling older subjects

Background and Aims: This study assessed the association between frailty and sociodemographic, socioeconomic and lifestyle factors in community-dwelling older people. Methods: This was a cross-sectional survey in a population-based sample of 542 community-dwelling aged 65 years and older subjects living in a metropolitan area in Italy. Frailty was evaluated by means of the FRAIL scale proposed by the International Association of Nutrition and Aging. Basal and instrumental activities of daily living (ADL, IADL), physical activity, sociodemographic (age, gender, marital status and co-habitation), socioeconomic (education, economic conditions and occupational status) and lifestyle domains (cultural and technological fruition and social activation) were assessed through specific validated tools. Statistical analysis was performed through multinomial logistic regression. Results: Impairments in ADL and IADL were significantly associated with frailty while moderate and high physical activity were inversely associated with frailty. Moreover, regarding both socioeconomic variables and lifestyle factors, more disadvantaged socioeconomic conditions and low levels of cultural fruition were significantly associated with frailty. Conclusions: Socioeconomic and lifestyle factors, particularly cultural fruition, are associated with frailty independently from functional impairment and low physical activity. Cultural habits may therefore represent a new target of multimodal interventions against geriatric frailty

Higher Animal-Derived Dietary Protein Intake is Associated with Lower Prevalence of Frailty

Background: It is accepted that malnutrition is involved in the pathophysiology of frailty. However, the relationship between dietary animal-derived protein (DAP) intake and the prevalence of frailty is still unclear. Using data from the FRAIL Project, we aimed to determine whether DAP consumption is associated with frailty in community-dwellers aged 65 years and older. Methods: In this cross-sectional study involving only participants older than 65 years, DAP intake was evaluated through specific items of the Mini-Nutritional Assessment (MNA). Frailty statuswas assessed according to the Cardiovascular Health Study (CHS) model, which consists of five items (unintentional weight loss, weakness, slow gait speed, exhaustion, low physical activity). Frailty was defined as the presence of at least 3 criteria, and pre-frailty as the presence of 1 or 2. Results: Among the 407 participants enrolled (mean age 77.9 4.5 years; 51.6%women) the prevalence of frailty was 9.3%, and of pre-frailty 26.5%. Daily DAP consumption was reported by 206. Multinomial logistic regression analysis, adjusted for potential confounders, showed that higher DAP intake was associated with a significant reduction in frailty (odds ratio, OR = 0.41; 95% confidence intervals, CIs: 0.160.98) and pre-frailty (OR = 0.46; 95%CI: 0.270.79). Conclusion: Daily animal protein intake is associated with a lower prevalence of frailty in communitydwelling older subjects, suggesting that a diet rich in animal proteins could be useful in preventing frailty. Simple specific questions drawn fromtheMNAmay be an effective tool to gather useful information on protein consumption in elderly people and on their nutritional risk of being frail

Three Decades of Comprehensive Geriatric Assessment: Evidence Coming From Different Healthcare Settings and Specific Clinical Conditions

Comprehensive geriatric assessment (CGA) is a multidisciplinary diagnostic and treatment process that identifies medical, psychosocial, and functional capabilities of older adults to develop a coordinated plan to maximize overall health with aging. Specific criteria used by CGA programs to evaluate patients include age, medical comorbidities, psychosocial problems, previous or predicted high healthcare utilization, change in living situation, and specific geriatric conditions. However, no universal criteria have been agreed upon to readily identify patients who are likely to benefit from CGA. Evidence from randomized controlled trials and large systematic reviews and meta-analyses suggested that the healthcare setting may modify the effectiveness of CGA programs. Home CGA programs and CGA performed in the hospital were shown to be consistently beneficial for several health outcomes. In contrast, the data are conflicting for posthospital discharge CGA programs, outpatient CGA consultation, and CGA-based inpatient geriatric consultation services. The effectiveness of CGA programs may be modified also by particular settings or specific clinical conditions, with tailored CGA programs in older frail patients evaluated for preoperative assessment, admitted or discharged from emergency departments and orthogeriatric units or with cancer and cognitive impairment. CGA is capable of effectively exploring multiple domains in older age, being the multidimensional and multidisciplinary tool of choice to determine the clinical profile, the pathologic risk and the residual skills as well as the short- and long-term prognosis to facilitate the clinical decision making on the personalized care plan of older persons

The multidimensional prognostic index predicts falls in older people: an 8-year longitudinal cohort study in the Osteoarthritis Initiative

Objectives: Falls are associated with several negative outcomes. Early identification of those who are at risk of falling is of importance in geriatrics and comprehensive geriatric assessment (CGA) seems to be promising in this regard. Therefore, the present study investigated whether the multidimensional prognostic index (MPI), based on a standard CGA, is associated with falls in the Osteoarthritis Initiative (OAI). Design: Longitudinal, 8 years of follow-up. Setting and participants: Community-dwelling older people (> 65 years) with knee OA or at high risk for this condition. Methods: 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, categorized as MPI-1 (low), MPI-2 (moderate) and MPI-3 (high risk). Falls were self-reported and recurrent fallers were defined as >2 in the previous year. Logistic regression was carried out and results are reported as odds ratio (ORs), with their 95% confidence intervals (CIs). Results: The final sample consisted of 885 older adults (mean age 71.3 years, females=54.6%). Recurrent fallers showed a significant higher MPI than their counterparts (46.1±17.2 vs. 38.2±15.8; p<0.001). Compared to those in MPI-1 category, participants in MPI-2 (OR=2.13; 95%CI: 1.53-2.94; p<0.001) and in MPI-3 (OR=5.98; 95%CI: 3.29-10.86; p<0.001) reported a significant higher risk of recurrent falls over the 8-years of follow-up. Similar results were evident when using an increase in 0.1 points in the MPI or risk of falls after one year. Conclusions and implications: Higher MPI values at baseline were associated with an increased risk of recurrent falls suggesting the importance of CGA in predicting falls in older people

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

BackgroundData 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.ObjectiveThe 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.MethodsThis 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.ResultsAmong 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.ConclusionsMPI 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