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Multidimensional Frailty: The Role of Comprehensive Geriatric Assessment

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Epidemiology & Public Health".

Deadline for manuscript submissions: closed (25 July 2024) | Viewed by 10904

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Special Issue Editors

Dr. Nicola Veronese

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Guest Editor

1. Department of Health Promotion, Mother Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy
2. Chair for Biomarkers of Chronic Diseases, Biochemistry Department, College of Science, King Saud University, Riyadh, Saudi Arabia
Interests: osteoarthritis; frailty; sarcopenia; osteoporosis; comprehensive geriatric assessment; nutritional issues
Special Issues, Collections and Topics in MDPI journals

Prof. Dr. Alberto Pilotto

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Guest Editor

1. Department of Geriatric Care, Orthogeriatrics and Rehabilitation, E.O. Galliera Hospital, Genova, Italy
2. Department of Interdisciplinary Medicine, "Aldo Moro" University of Bari, Bari, Italy
Interests: geriatric care; comprehensive geriatric assessment; multidimensional prognostic index; gerontechnology; gastroenterology

Special Issue Information

Dear Colleagues,

Recently there has been extensive literature that suggested that frailty should be identified using a multidimensional approach, a novel approach that permits to better understand the needs of older people. For example, the prevalence of frailty and pre-frailty in older populations, using the multidimensional prognostic index (MPI), a product of the comprehensive geriatric assessment (CGA) are extremely high, particularly in some settings, such as nursing homes and hospitals. Moreover, a multidimensional approach could be useful in identifying the pathophysiological mechanisms of clinical frailty useful to understand the trajectory from healthy aging to frailty, including the role of the individual response to chronic diseases that seems to be associated with clinical frailty.

In this Special Issue, we invite authors to submit works regarding the importance and use of CGA in older people for a better understanding of frailty from a multidimensional point of view, including the functional and psychosocial, as well as the biological and genetic factors related to clinical frailty. Both reviews (narrative or systematic) and original works (also in terms of intervention studies) are welcome for this Special Issue.

Dr. Nicola Veronese
Prof. Dr. Alberto Pilotto
Guest Editors

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Keywords

frailty
multidimensional
comprehensive geriatric assessment
multidimensional prognostic index
prognosis
older people

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Published Papers (6 papers)

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Research

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14 pages, 1028 KiB

Open AccessArticle

Profiles of Geriatric Syndromes and Resources in Older Patients with Atrial Fibrillation

by Joshua Verleysdonk, Nicolas Noetzel, Ingrid Becker, Lena Pickert, Thomas Benzing, Roman Pfister, Maria Cristina Polidori and Anna Maria Affeldt

J. Clin. Med. 2024, 13(14), 4009; https://doi.org/10.3390/jcm13144009 - 9 Jul 2024

Viewed by 1062

Abstract

Objective: Older patients with nonvalvular atrial fibrillation (AF) are at high risk for frailty and geriatric syndromes (GSs), which modulate their individual prognosis and are therefore relevant for further management. Because few studies have evaluated the geriatric profile of older AF patients, this secondary analysis aims to further characterize the patterns of GSs and geriatric resources (GRs) in AF patients and their association with anticoagulation use. Methods: Data from 362 hospitalized patients aged 65 years and older with AF (n = 181, 77.8 ± 5.8 years, 38% female) and without AF (non-AF [NAF]; n = 181, 77.5 ± 5.9 years, 40% female) admitted to an internal medicine and nephrology ward of a large university hospital in Germany were included. All patients underwent usual care plus a comprehensive geriatric assessment (CGA) including calculation of the Multidimensional Prognostic Index (MPI) and collection of 17 GSs and 10 GRs. Patients were followed up by telephone 6 and 12 months after discharge to collect data on their health status. Results: The mean MPI score of 0.47 indicated an average risk of poor outcome, and patients with AF had a significantly higher MPI than those without AF (p = 0.040). After adjustment for chronological age, biological sex, Cumulative Illness Rating Scale (CIRS) for relevant chronic diagnoses and MPI as a proxy for biological age, AF patients had significantly more mnestic resources (63.5% vs. 33.1%, p < 0.001), a tendency for less age-appropriate living conditions (56.4% vs. 72.9%, p = 0.051) and more sensory impairment (78.5% vs. 52.5%, p < 0.001) than NAF patients. They also had a higher number of GSs (p = 0.046). AF patients on oral anticoagulants (OACs, n = 91) had less age-appropriate living conditions (48.4% vs. 64.4%, p < 0.05) and mnestic resources (36.3% vs. 54.4%, p < 0.01), but more emotional resources (80.2% vs. 65.6%, p < 0.05) and chronic pain (56% vs. 40%, p < 0.05) than patients without OACs (n = 90). Overall, mortality at 1 year was increased in patients with a higher MPI (p < 0.009, adjusted for age, sex and CIRS), with a diagnosis of AF (p = 0.007, adjusted for age, sex, CIRS and MPI), with of male sex (p = 0.008, adjusted for age, CIRS and MPI) and those with AF and treated with hemodialysis (p = 0.022, compared to AF patients without dialysis treatment). Conclusions: Patients with AF and patients with AF and OACs show differences in their multidimensional frailty degree as well as GR and GS profiles compared to patients without AF or with AF not treated with OACs. Mortality after 1 year is increased in AF patients with a higher MPI and dialysis, independently from OAC use and overall burden of chronic disease as assessed per CIRS. GRs and GSs, especially age-appropriate living conditions, emotional resources, sensory impairment and chronic pain, can be considered as factors that may modify the individual impact of frailty, underscoring the relevance of these parameters in the management of older patients. Full article

(This article belongs to the Special Issue Multidimensional Frailty: The Role of Comprehensive Geriatric Assessment)

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14 pages, 1231 KiB

Open AccessArticle

Prognostic Features of Sarcopenia in Older Hospitalized Patients: A 6-Month Follow-Up Study

by Anne Ferring, Luisa Mück, Jill Stegemann, Laura Wiebe, Ingrid Becker, Thomas Benzing, Anna Maria Meyer and Maria Cristina Polidori

J. Clin. Med. 2024, 13(11), 3116; https://doi.org/10.3390/jcm13113116 - 26 May 2024

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Abstract

Background: Sarcopenia is associated with adverse health outcomes. Understanding the association between sarcopenia, multidimensional frailty, and prognosis is essential for improving patient care. The aim of this study was to assess the prevalence and prognostic signature of sarcopenia in an acute hospital setting co-led by internists and geriatricians. Methods: Sarcopenia was assessed by applying the European Working Group on Sarcopenia in Older People (EWGSOP2) algorithm, including the SARC-F score, handgrip strength, bioelectrical impedance analysis (BIA), and Timed Up and Go (TUG) test, to 97 older multimorbid inpatients (76.5 ± 6.8 years, 55% women). The patients underwent a Comprehensive Geriatric Assessment (CGA) including an evaluation of Geriatric Syndromes (GSs) and Resources (GR) and prognosis calculation using the CGA-based Multidimensional Prognostic Index (MPI), European Quality of life—5 Dimensions (EQ-5D-5L) scale, Rosenberg Self-Esteem Scale (RSES), and Geriatric Depression Scale (GDS). Information on survival and rehospitalizations was collected 1, 3, and 6 months after discharge. Results: Sarcopenia was present in 63% (95% CI: 54–72%) of patients and categorized as probable (31%), confirmed (13%), and severe sarcopenia (18%). Sarcopenic patients showed significantly higher median MPI-values (p < 0.001), more GSs (p = 0.033), fewer GR (p = 0.003), lower EQ-5D-5L scores (p < 0.001), and lower RSES scores (p = 0.025) than non-sarcopenic patients. Six months after discharge, being sarcopenic at baseline was predictive of falls (p = 0.027) and quality of life (p = 0.043), independent of age, gender, and MPI. Conclusions: Sarcopenia is highly prevalent in older hospitalized multimorbid patients and is associated with poorer prognosis, mood, and quality of life up to 6 months after discharge, independent of age, sex, and MPI as surrogate markers of biological age. Full article

(This article belongs to the Special Issue Multidimensional Frailty: The Role of Comprehensive Geriatric Assessment)

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13 pages, 1225 KiB

Open AccessArticle

A Prospective Observational Study of Frailty in Geriatric Revitalization Aimed at Community-Dwelling Elderly

by Almudena Morales-Sánchez, José Ignacio Calvo Arenillas, María José Gutiérrez Palmero, José L. Martín-Conty, Begoña Polonio-López, Luís Alonso Dzul López, Laura Mordillo-Mateos, Juan José Bernal-Jiménez, Rosa Conty-Serrano, Francisca Torres-Falguera, Alfonso Martínez Cano and Carlos Durantez-Fernández

J. Clin. Med. 2024, 13(9), 2514; https://doi.org/10.3390/jcm13092514 - 25 Apr 2024

Cited by 1 | Viewed by 1226

Abstract

(1) Background: The increasing life expectancy brings an increase in geriatric syndromes, specifically frailty. The literature shows that exercise is a key to preventing, or even reversing, frailty in community-dwelling populations. The main objective is to demonstrate how an intervention based on multicomponent exercise produces an improvement in frailty and pre-frailty in a community-dwelling population. (2) Methods: a prospective observational study of a multicomponent exercise program for geriatric revitalization with people aged over 65 holding Barthel Index scores equal to, or beyond, 90. The program was developed over 30 weeks, three times a week, in sessions lasting 45–50 min each. Frailty levels were registered by the Short Physical Performance Battery, FRAIL Questionnaire Screening Tool, and Timed “Up & Go” at the beginning of the program, 30 weeks later (at the end of the program), and following 13 weeks without training; (3) Results: 360 participants completed the program; a greater risk of frailty was found before the program started among older women living in urban areas, with a more elevated fat percentage, more baseline pathologies, and wider baseline medication use. Furthermore, heterogeneous results were observed both in training periods and in periods without physical activity. However, they are consistent over time and show improvement after training. They show a good correlation between TUG and SPPB; (4) Conclusions: A thirty-week multicomponent exercise program improves frailty and pre-frailty status in a community-dwelling population with no functional decline. Nevertheless, a lack of homogeneity is evident among the various tools used for measuring frailty over training periods and inactivity periods. Full article

(This article belongs to the Special Issue Multidimensional Frailty: The Role of Comprehensive Geriatric Assessment)

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11 pages, 1321 KiB

Open AccessFeature PaperArticle

Validation of a Brief Form of the Self-Administered Multidimensional Prognostic Index: The SELFY-BRIEF-MPI Project

by Wanda Morganti, Nicola Veronese, Marina Barbagelata, Alberto Castagna, Carlo Custodero, Luisa Solimando, Marianna Ilarj Burgio, Sofia Elena Montana Lampo, Emanuele Seminerio, Gianluca Puleo, Barbara Senesi, Lisa Cammalleri, Giovanni Ruotolo, Carlo Sabbà, Mario Barbagallo and Alberto Pilotto

J. Clin. Med. 2023, 12(18), 6026; https://doi.org/10.3390/jcm12186026 - 18 Sep 2023

Cited by 1 | Viewed by 3376

Abstract

In clinical practice, self-administered and brief tools to promptly identify older people at risk of frailty are required. The Multidimensional Prognostic Index (MPI), derived from the Comprehensive Geriatric Assessment (CGA) seems reliable enough to serve this purpose, but despite the several versions developed over the past 15 years, it lacks a self-administered and brief version. In this study, we aimed to evaluate the agreement between an abbreviated form of the SELFY-MPI (i.e., SELFY-BRIEF-MPI) and the standard version of the MPI. Four Italian hospitals consecutively enrolled outpatients and inpatients >65 years. The sample included 105 participants (mean age = 78.8 years, 53.3% females). Overall, the two versions showed non-statistically significant differences (Standard-MPI 0.42 ± 0.19 vs.. SELFY-BRIEF-MPI 0.41 ± 0.18; p = 0.104) and a very strong correlation (R = 0.86, p < 0.001). The Bland–Altman Plot revealed that only 5/105 measurements (4.76%) were outside the limits of agreement. The accuracy of the SELFY-BRIEF-MPI in identifying frail people (defined as a Standard-MPI > 0.66) was optimal (area under the curve, AUC = 0.90, p < 0.001). To predict multidimensional frailty, a SELFY-BRIEF-MPI score of 0.60 exhibited the greatest sensitivity/specificity ratio. In conclusion, the SELFY-BRIEF-MPI reported a good agreement with the standard version of the MPI, indicating its application in the screening of multidimensional frailty among older people. Full article

(This article belongs to the Special Issue Multidimensional Frailty: The Role of Comprehensive Geriatric Assessment)

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20 pages, 1950 KiB

Open AccessArticle

Comprehensive Geriatric Assessment and Quality of Life Aspects in Patients with Recurrent/Metastatic Head and Neck Squamous Cell Carcinoma (HNSCC)

by Anna Winter, Stefan M. Schulz, Marc Schmitter, Urs Müller-Richter, Alexander Kübler, Sylvia Kasper and Stefan Hartmann

J. Clin. Med. 2023, 12(17), 5738; https://doi.org/10.3390/jcm12175738 - 3 Sep 2023

Cited by 3 | Viewed by 1596

Abstract

To define frailty in older cancer patients, the aim of this study was to assess the geriatric status and quality of life (QoL) aspects in patients suffering from recurrent/metastatic head and neck squamous cell carcinoma (r/m HNSCC) under palliative treatment. A comprehensive geriatric assessment (CGA) was performed on 21 r/m HNSCC patients at two defined assessments, and the QoL aspects and the impact of descriptive data were evaluated. The Kolmogorov–Smirnov test, Spearman’s rho correlation, and two-way mixed ANOVA were used for statistical analysis. All patients were found to be “frail”. Pain, fatigue, and the burden of illness were the highest-rated symptoms. Oral function and orofacial appearance were highly impaired. A significant impact of descriptive data on the CGA and QoL results was found (all p ≤ 0.05). Thus, the CGA results revealed high frailty, severe comorbidities, and high impairments in QoL aspects. The CGA and QoL results were negatively affected by the primary HNSCC treatment approach, the need for prosthetic treatment, and worse oral functional capacity. Therefore, frailty in r/m HNSCC patients seems to be multidimensional. The evaluation of the CGA and QoL aspects in r/m HNSCC patients can be recommended to detect special needs, organize aftercare, and improve the support for frail and vulnerable cancer patients to create a multidisciplinary treatment approach. Full article

(This article belongs to the Special Issue Multidimensional Frailty: The Role of Comprehensive Geriatric Assessment)

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Review

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11 pages, 271 KiB

Open AccessReview

Pre-Therapeutic Assessment of Older People in Sub-Saharan Africa: Introduction to the Comprehensive Geriatric Assessment

by Marie-Josiane Ntsama Essomba, Berthe Sabine Esson Mapoko, Junette Arlette Metogo Mbengono, Nadine Simo-Tabue, Andre Pascal Kengne, Simeon Pierre Choukem, Eugène Sobngwi, Jacqueline Ze Minkande and Maturin Tabue Teguo

J. Clin. Med. 2024, 13(6), 1801; https://doi.org/10.3390/jcm13061801 - 21 Mar 2024

Cited by 1 | Viewed by 1733

Abstract

Objectives: With the ongoing epidemiological transition in sub-Saharan Africa (SSA), conditions that require invasive treatment (surgery, cancer, and anaesthesia, etc.) will become increasingly common. Comprehensive geriatric assessment (CGA) is a multidisciplinary diagnostic process aimed at identifying older people at risk of negative outcomes. It is important to know whether this approach integrates care management strategies for older people in a context where health services for older people are scarce, and staff members have little training in geriatrics. The current work is a situational analysis on the use of CGA on invasive care (cancer, surgery, etc.) among older people in SSA. Methods: We searched PubMed-MEDLINE and other sources for studies reporting on CGA and conditions requiring invasive treatment in older patients in SSA. Results/Conclusions: We found no study that had comprehensively examined CGA and invasive care in SSA. There is, however, evidence that the offer of invasive care to older people has improved in SSA. Further research is needed to explore the applicability of CGA in SSA. Similarly, more investigations are needed on the role of CGA in the care trajectories of older people in SSA, in terms of outcomes and affordability. Full article

(This article belongs to the Special Issue Multidimensional Frailty: The Role of Comprehensive Geriatric Assessment)

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