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1. Frailty and anticoagulants in older subjects with atrial fibrillation: the EUROSAF study.

Author

Pilotto A, Veronese N, Polidori MC, Strandberg T, Topinkova E, Cruz-Jentoft AJ, Custodero C, Barbagallo M, and Maggi S

Subjects
Humans, Female, Male, Aged, 80 and over, Aged, Prospective Studies, Risk Assessment, Risk Factors, Europe epidemiology, Atrial Fibrillation drug therapy, Atrial Fibrillation mortality, Atrial Fibrillation complications, Atrial Fibrillation diagnosis, Anticoagulants therapeutic use, Anticoagulants adverse effects, Frail Elderly statistics & numerical data, Geriatric Assessment, Frailty mortality, Frailty diagnosis
Abstract

Aims: Literature regarding anticoagulants in older people affected by atrial fibrillation (AF) is limited to retrospective studies, poorly considering the importance of multidimensional frailty. The main objective of this study is to evaluate in hospitalised older persons with AF the benefit/risk ratio of the anticoagulant treatments, considering the severity of frailty, determined by the multidimensional prognostic index (MPI)., Methods: In this European, multicentre, prospective study, older hospitalised patients (≥65 years) with non-valvular AF were followed-up for 12 months. Anticoagulants' use at discharge ascertained using medical records. MPI was calculated using tools derived from comprehensive geriatric assessment, classifying participants in robust, pre-frail or frail. Mortality (primary outcome); vascular events, including ischemic heart disease or ischemic stroke, hemorrhagic stroke or gastrointestinal bleedings (secondary outcomes)., Results: 2,022 participants (mean age 82.9 years; females 56.6%) were included. Compared with people not taking anticoagulants (n = 823), people using vitamin K antagonists (n = 450) showed a decreased risk of mortality (hazard ratio, HR = 0.74; 95% CI: 0.59-0.93), more pronounced in patients using direct oral anticoagulants (DOACs) (n = 749) (HR = 0.46; 95% CI: 0.37-0.57). Only people taking DOACs reported a significantly lower risk of vascular events (HR = 0.55; 95% CI: 0.31-0.97). The efficacy of DOACs was present independently from frailty status. The risk of gastrointestinal bleedings and hemorrhagic stroke did not differ based on the anticoagulant treatments and by MPI values., Conclusions: Anticoagulant treatment, particularly with DOACs, was associated with reduced mortality in older people, without increasing the risk of hemorrhagic events, overall suggesting the importance of treating with anticoagulants older people with AF., (© The Author(s) 2023. Published by Oxford University Press on behalf of the British Geriatrics Society.)

Published
2023
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2. 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.

Author

Custodero C, Veronese N, Topinkova E, Michalkova H, Polidori MC, Cella A, Cruz-Jentoft AJ, von Arnim CAF, Azzini M, Gruner H, Castagna A, Cenderello G, Custureri R, Zieschang T, Padovani A, Sanchez-Garcia E, and Pilotto A

Subjects
Humans, Female, Aged, Aged, 80 and over, Prospective Studies, Prognosis, COVID-19 Drug Treatment, Geriatric Assessment methods, Frailty drug therapy, COVID-19
Abstract

Background: Data 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., Objective: The 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., Methods: This 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., Results: Among 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., Conclusions: MPI 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., (© 2023. The Author(s).)

Published
2023
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3. Preserving Mobility in Older Adults with Physical Frailty and Sarcopenia: Opportunities, Challenges, and Recommendations for Physical Activity Interventions.

Author

Billot M, Calvani R, Urtamo A, Sánchez-Sánchez JL, Ciccolari-Micaldi C, Chang M, Roller-Wirnsberger R, Wirnsberger G, Sinclair A, Vaquero-Pinto N, Jyväkorpi S, Öhman H, Strandberg T, Schols JMGA, Schols AMWJ, Smeets N, Topinkova E, Michalkova H, Bonfigli AR, Lattanzio F, Rodríguez-Mañas L, Coelho-Júnior H, Broccatelli M, D'Elia ME, Biscotti D, Marzetti E, and Freiberger E

Subjects
Accidental Falls prevention & control, Aged, Aging physiology, Frailty physiopathology, Humans, Postural Balance physiology, Quality of Life, Sarcopenia physiopathology, Exercise physiology, Frail Elderly statistics & numerical data, Frailty rehabilitation, Sarcopenia rehabilitation
Abstract

One of the most widely conserved hallmarks of aging is a decline in functional capabilities. Mobility loss is particularly burdensome due to its association with negative health outcomes, loss of independence and disability, and the heavy impact on quality of life. Recently, a new condition, physical frailty and sarcopenia, has been proposed to define a critical stage in the disabling cascade. Physical frailty and sarcopenia are characterized by weakness, slowness, and reduced muscle mass, yet with preserved ability to move independently. One of the strategies that have shown some benefits in combatting mobility loss and its consequences for older adults is physical activity. Here, we describe the opportunities and challenges for the development of physical activity interventions in people with physical frailty and sarcopenia. The aim of this article is to review age-related physio(patho)logical changes that impact mobility in old age and to provide recommendations and procedures in accordance with the available literature., Competing Interests: All of the authors of the present work are partners of the SPRINTT consortium, which is partially funded by the European Federation of Pharmaceutical Industries and Associations (EFPIA). The authors report no potential conflicts of interest in this work., (© 2020 Billot et al.)

Published
2020
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4. Older women are frailer, but less often die then men: a prospective study of older hospitalized people.

Author

Veronese N, Siri G, Cella A, Daragjati J, Cruz-Jentoft AJ, Polidori MC, Mattace-Raso F, Paccalin M, Topinkova E, Greco A, Mangoni AA, Maggi S, Ferrucci L, and Pilotto A

Subjects
Aged, Aged, 80 and over, Australia, Europe, Female, Geriatric Assessment, Hospitals, Humans, Longitudinal Studies, Male, Patient Discharge, Prognosis, Prospective Studies, Sex Characteristics, Survival Rate, Frailty mortality, Hospitalization
Abstract

Objectives: The association between frailty, mortality and sex is complex, but a limited literature is available on this topic, particularly for older hospitalized patients. Therefore, the objective of our study was to prospectively evaluate sex differences in frailty, assessed by the Multidimensional Prognostic Index (MPI) and mortality, institutionalization, and re-hospitalization in an international cohort of older people admitted to hospital., Study Design: We used data from nine public hospitals in Europe and Australia, to evaluate sex differences in mortality, frailty and the risk of institutionalization and re-hospitalization, during one year of follow-up., Main Outcome Measures: People aged 65 years or more admitted to hospital for an acute medical condition or for a relapse of a chronic disease were included. A standardized comprehensive geriatric assessment, which evaluated functional, nutritional, and cognitive status, risk of pressure sores, comorbidities, medications and co-habitation status, was used to calculate the MPI to measure frailty in all hospitalized older people. Data regarding mortality, institutionalization and re-hospitalization were also recorded for one year., Results: Altogether, 1140 hospitalized patients (mean age = 84.2 years; 694 women = 60.9%) were included. The one-year mortality rate was 33.2%. In multivariate analysis, adjusted for age, MPI score, centre and diagnosis at baseline, although women had higher MPI scores than men, the latter had higher in-hospital (odds ratio, OR = 2.26; 95% confidence intervals, CI = 1.27-4.01) and one-year post-discharge mortality (OR = 2.04; 95%CI = 1.50-2.79). Furthermore, men were less frequently institutionalized in a care home than female patients (OR = 0.55; 95%CI: 0.34-0.91), but they were also more frequently re-hospitalized (OR = 1.42; 95%CI: 1.06-1.91) during the year after hospital discharge., Conclusion: Older hospitalized men were less frail, but experienced higher in-hospital and one-year mortality than women. Women were admitted more frequently to nursing homes and experienced a lower risk of re-hospitalization. These findings suggest important differences between the sexes and extends the 'male-female health-survival paradox' to acutely ill patient groups., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Published
2019
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5. The sarcopenia and physical frailty in older people: multi-component treatment strategies (SPRINTT) project: description and feasibility of a nutrition intervention in community-dwelling older Europeans

Author

Jyvakorpi S. K., Ramel A., Strandberg T. E., Piotrowicz K., Blaszczyk-Bebenek E., Urtamo A., Rempe H. M., Geirsdottir O., Vagnerova T., Billot M., Larreur A., Savera G., Soriano G., Picauron C., Tagliaferri S., Sanchez-Puelles C., Cadenas V. S., Perl A., Tirrel L., Ohman H., Weling-Scheepers C., Ambrosi S., Costantini A., Pavelkova K., Klimkova M., Freiberger E., Jonsson P. V., Marzetti E., Pitkala K. H., Landi F., Calvani R., Bernabei R., Boni C., Brandi V., Broccatelli M., Celesti C., Cicchetti A., Collamati A., Coretti S., D'Angelo E., D'Elia M., Landi G., Lorenzi M., Mariotti L., Martone A. M., Ortolani E., Pafundi T., Picca A., Ruggeri M., Salini S., Tosato M., Vetrano D. L., Lattanzio F., Baldoni R., Bernabei S., Bonfigli A. R., Bustacchini S., Carrieri B., Cassetta L., Cherubini A., Cucchi M., Cucchieri G., Costantini A. R., Dell'Aquila G., Espinosa E., Fedecostante M., Fraternali R., Galeazzi R., Mengarelli A., Piomboni S., Posacki E., Severini E., Tregambe T., Trotta F., Maggio M., Lauretani F., Butto V., Fisichella A., Guareschi C., Longobucco Y., Di Bari M., Rodriguez-Manas L., Alamo S., Bouzon C. A., Gonzales Turin J., Zafra O. L. L., Picazo A. L., Sepulveda L. P., SanchezSanchez J. L., Puelles C. S., Aragones M. V., CruzJentoft A. J., Santos J. A., Alvarez-Nebreda L., JimenezJimenez N. F., Nozal J. M. -D., Montero-Errasquin B., Moreno B. P. B. P., Roldan-Plaza C., Vicente A. R. -D., Sanchez-Cadenas V., Sanchez-Castellano C., Sanchez-Garcia E., Vaquero-Pinto M. N., Topinkova E., Bautzka L., Blechova K., Gueye T., Juklickova I., Klbikova T., Krenkova J. J., Madlova P., Mejstrikova H., Melcova R., Michalkova H., Ryznarova I., Drastichova I., Hasalikova E., Hucko R., Jakub S., Janacova M., Kilmkova M., Parizkova M., Redrova M., Ruskova P. P., Sieber C. C., Auerswald T., Engel C., Franke A., Freibergen E., Freiheit U., Gotthardt S., Kampe K., Kob R., Kokott C., Kraska C., Meyer C., Reith V., Rempe H., Schoene D., Sieber G., Zielinski K., Anker S. D., Ebner N., Grutz R., von Haehling S., Schols A. M. W. J., Gosker H., Huysmans S., Quaaden S., Schols J. M., Smeets N., Stevens P., van de Bool C., Weling C., Strandberg T., Jyvakorpi S., Hallikas K., Herranen M., Huusko T., Hytonen L., Ikonen K., Karppi-Sjoblom A., Karvinen K., Kayhty M., Kindsted T., Landstrom E., Leirimaa S., Pitkala K., Punkka A., Saavalainen A. -M., Salo T., Sepa M., Sohlberg K., Vaatamoinen E., Venalainen S., Vanhanen H., Vellas B., Van Kan G. A., Biville V., Brigitte L., Cervera C., Cesari M., Champarnaud M., Cluzan C., Croizet M., Dardenne S., Dorard M., Dupuy C., Durand E., Faisant C., Fougere B., Girard P., Guyonnet S., Hoogendijk E., Mauroux R., Milhet A., Montel S., Ousset P. -J., Teguo M. T., Teysseyre B., Andrieu S., Blasimme A., Dray C., Rial-Sebbag E., Valet P., Dantoine T., Cardinaud N., Castelli M., Charenton-Blavignac M., Ciccolari-Micaldi C., Gayot C., Laubarie-Mouriet C., Marchesseau D., Mergans T., Nguyen T. B., Papon A., Ribet J., Saulinier I., Tchalla A., Rapp T., Sirven N., Skalska A., Blaszcyk E., Cwynar M., Czesak J., Fatyga P., Fedyk-Lukasik M., Grodzicki T., Jamrozik P., Janusz Z., Klimek E., Komoniewska S., Kret M., Ozog M., Parnicka A., Petitjean K., Pietrzyk A., Skalska-Dulinska B., Starzyk D., Szczerbinska K., Witkiewicz B., Wlodarczyk A., Sinclair A., Harris S., Ogborne A., Ritchie S., Sinclair C., Sinclair H., Bellary S., Worthington H., Derejczyk J., Roller-Wirnsberger R., Jonsson P., Bordes P., Arnaud S., Asbrand C., Bejuit R., Durand S., Flechsenhar K., Joly F., Lain R. L., Moncharmont M., Msihid J., Ndja A., Riche B., Weber A. C., Yuan J., Roubenoff R., Kortebein P., Miller R. R., Gorostiaga C., Belissa-Mathiot P., Hu H., Laigle L., Melchor I. M., Russel A., Bennecky M., Haws T., Joshi A., Philpott K., Walker A., Zia G., Giorgi S. D., Feletti L., Marchioro E., Mocci F., Varesio M. G., Cesario A., Cabin B., de Boer W. P., Ignaszewski C., Klingmann I., Vollenbroek-Hutten M., Hermens T., Jansen-Kosterink S., Tabak M., Blandin P., Coutard L., Lenzotti A. -M., Mokhtari H., Rodon N., RS: MHeNs - R1 - Cognitive Neuropsychiatry and Clinical Neuroscience, RS: CAPHRI - R1 - Ageing and Long-Term Care, Health Services Research, Handicap, Activité, Vieillissement, Autonomie, Environnement (HAVAE), Institut Génomique, Environnement, Immunité, Santé, Thérapeutique (GEIST), Université de Limoges (UNILIM)-Université de Limoges (UNILIM), Clinicum, Department of General Practice and Primary Health Care, University of Helsinki, HUS Internal Medicine and Rehabilitation, Timo Strandberg / Principal Investigator, Department of Medicine, Helsinki University Hospital Area, Teachers' Academy, Jyvakorpi S.K., Ramel A., Strandberg T.E., Piotrowicz K., Blaszczyk-Bebenek E., Urtamo A., Rempe H.M., Geirsdottir O., Vagnerova T., Billot M., Larreur A., Savera G., Soriano G., Picauron C., Tagliaferri S., Sanchez-Puelles C., Cadenas V.S., Perl A., Tirrel L., Ohman H., Weling-Scheepers C., Ambrosi S., Costantini A., Pavelkova K., Klimkova M., Freiberger E., Jonsson P.V., Marzetti E., Pitkala K.H., Landi F., Calvani R., Bernabei R., Boni C., Brandi V., Broccatelli M., Celesti C., Cicchetti A., Collamati A., Coretti S., D'Angelo E., D'Elia M., Landi G., Lorenzi M., Mariotti L., Martone A.M., Ortolani E., Pafundi T., Picca A., Ruggeri M., Salini S., Tosato M., Vetrano D.L., Lattanzio F., Baldoni R., Bernabei S., Bonfigli A.R., Bustacchini S., Carrieri B., Cassetta L., Cherubini A., Cucchi M., Cucchieri G., Costantini A.R., Dell'Aquila G., Espinosa E., Fedecostante M., Fraternali R., Galeazzi R., Mengarelli A., Piomboni S., Posacki E., Severini E., Tregambe T., Trotta F., Maggio M., Lauretani F., Butto V., Fisichella A., Guareschi C., Longobucco Y., Di Bari M., Rodriguez-Manas L., Alamo S., Bouzon C.A., Gonzales Turin J., Zafra O.L.L., Picazo A.L., Sepulveda L.P., SanchezSanchez J.L., Puelles C.S., Aragones M.V., CruzJentoft A.J., Santos J.A., Alvarez-Nebreda L., JimenezJimenez N.F., Nozal J.M.-D., Montero-Errasquin B., Moreno B.P.B.P., Roldan-Plaza C., Vicente A.R.-D., Sanchez-Cadenas V., Sanchez-Castellano C., Sanchez-Garcia E., Vaquero-Pinto M.N., Topinkova E., Bautzka L., Blechova K., Gueye T., Juklickova I., Klbikova T., Krenkova J.J., Madlova P., Mejstrikova H., Melcova R., Michalkova H., Ryznarova I., Drastichova I., Hasalikova E., Hucko R., Jakub S., Janacova M., Kilmkova M., Parizkova M., Redrova M., Ruskova P.P., Sieber C.C., Auerswald T., Engel C., Franke A., Freibergen E., Freiheit U., Gotthardt S., Kampe K., Kob R., Kokott C., Kraska C., Meyer C., Reith V., Rempe H., Schoene D., Sieber G., Zielinski K., Anker S.D., Ebner N., Grutz R., von Haehling S., Schols A.M.W.J., Gosker H., Huysmans S., Quaaden S., Schols J.M., Smeets N., Stevens P., van de Bool C., Weling C., Strandberg T., Jyvakorpi S., Hallikas K., Herranen M., Huusko T., Hytonen L., Ikonen K., Karppi-Sjoblom A., Karvinen K., Kayhty M., Kindsted T., Landstrom E., Leirimaa S., Pitkala K., Punkka A., Saavalainen A.-M., Salo T., Sepa M., Sohlberg K., Vaatamoinen E., Venalainen S., Vanhanen H., Vellas B., Van Kan G.A., Biville V., Brigitte L., Cervera C., Cesari M., Champarnaud M., Cluzan C., Croizet M., Dardenne S., Dorard M., Dupuy C., Durand E., Faisant C., Fougere B., Girard P., Guyonnet S., Hoogendijk E., Mauroux R., Milhet A., Montel S., Ousset P.-J., Teguo M.T., Teysseyre B., Andrieu S., Blasimme A., Dray C., Rial-Sebbag E., Valet P., Dantoine T., Cardinaud N., Castelli M., Charenton-Blavignac M., Ciccolari-Micaldi C., Gayot C., Laubarie-Mouriet C., Marchesseau D., Mergans T., Nguyen T.B., Papon A., Ribet J., Saulinier I., Tchalla A., Rapp T., Sirven N., Skalska A., Blaszcyk E., Cwynar M., Czesak J., Fatyga P., Fedyk-Lukasik M., Grodzicki T., Jamrozik P., Janusz Z., Klimek E., Komoniewska S., Kret M., Ozog M., Parnicka A., Petitjean K., Pietrzyk A., Skalska-Dulinska B., Starzyk D., Szczerbinska K., Witkiewicz B., Wlodarczyk A., Sinclair A., Harris S., Ogborne A., Ritchie S., Sinclair C., Sinclair H., Bellary S., Worthington H., Derejczyk J., Roller-Wirnsberger R., Jonsson P., Bordes P., Arnaud S., Asbrand C., Bejuit R., Durand S., Flechsenhar K., Joly F., Lain R.L., Moncharmont M., Msihid J., Ndja A., Riche B., Weber A.C., Yuan J., Roubenoff R., Kortebein P., Miller R.R., Gorostiaga C., Belissa-Mathiot P., Hu H., Laigle L., Melchor I.M., Russel A., Bennecky M., Haws T., Joshi A., Philpott K., Walker A., Zia G., Giorgi S.D., Feletti L., Marchioro E., Mocci F., Varesio M.G., Cesario A., Cabin B., de Boer W.P., Ignaszewski C., Klingmann I., Vollenbroek-Hutten M., Hermens T., Jansen-Kosterink S., Tabak M., Blandin P., Coutard L., Lenzotti A.-M., Mokhtari H., Rodon N., Epidemiology and Data Science, APH - Aging & Later Life, and APH - Quality of Care

Subjects
0301 basic medicine, Gerontology, Sarcopenia, [SDV]Life Sciences [q-bio], Population, PROTEIN, RECOMMENDATIONS, law.invention, SUPPLEMENTATION, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, Intervention (counseling), Cultural diversity, medicine, Nutrition counselling, Nutrition intervention, Humans, 030212 general & internal medicine, Medical prescription, education, Exercise, Aged, 2. Zero hunger, education.field_of_study, 030109 nutrition & dietetics, Frailty, business.industry, Settore MED/09 - MEDICINA INTERNA, ADULTS, medicine.disease, mobility, 3. Good health, Feasibility Studie, Malnutrition, SPRINTT, resistance exercise, muscle mass, Protein intake, 3121 General medicine, internal medicine and other clinical medicine, Feasibility Studies, Energy intake, Independent Living, business, Nutrition counseling, Research Paper, Human
Abstract

Aim To describe the methods and feasibility of the nutritional intervention carried out within the SPRINTT Randomized cotrolled trial. We also illustrate how nutrition interventionists identified participants at risk of malnutrition and the lessons learnt from the nutrition intervention. Findings SPRINTT nutrition intervention was well-received by the majority of the participants. It was mainly carried out using tailored nutrition counselling, but also other means of delivering the intervention were successfully used. Compared with a standard nutrition prescription, an individualized protocol to diagnose malnutrition and follow-up by tailored nutrition counselling helped achieve nutritional targets more effectively in spite of diversity of population in nutritional habits and in some cases reluctance to accept changes. Message The SPRINTT nutrition intervention was feasible and allowed flexibility to the varying needs and cultural differences of this heterogeneous population of frail, older Europeans. It may serve as a model to educate and improve nutrition among community-dwelling older people at risk of mobility limitations. Supplementary Information The online version contains supplementary material available at 10.1007/s41999-020-00438-4., Background The “Sarcopenia and Physical Frailty in Older People: Multicomponent Treatment Strategies” (SPRINTT) project sponsored a multi-center randomized controlled trial (RCT) with the objective to determine the effect of physical activity and nutrition intervention for prevention of mobility disability in community-dwelling frail older Europeans. We describe here the design and feasibility of the SPRINTT nutrition intervention, including techniques used by nutrition interventionists to identify those at risk of malnutrition and to carry out the nutrition intervention. Methods SPRINTT RCT recruited older adults (≥ 70 years) from 11 European countries. Eligible participants (n = 1517) had functional limitations measured with Short Physical Performance Battery (SPPB score 3–9) and low muscle mass as determined by DXA scans, but were able to walk 400 m without assistance within 15 min. Participants were followed up for up to 3 years. The nutrition intervention was carried out mainly by individual nutrition counseling. Nutrition goals included achieving a daily protein intake of 1.0–1.2 g/kg body weight, energy intake of 25–30 kcal/kg of body weight/day, and serum vitamin D concentration ≥ 75 mmol/L. Survey on the method strategies and feasibility of the nutrition intervention was sent to all nutrition interventionists of the 16 SPRINTT study sites. Results Nutrition interventionists from all study sites responded to the survey. All responders found that the SPRINTT nutrition intervention was feasible for the target population, and it was well received by the majority. The identification of participants at nutritional risk was accomplished by combining information from interviews, questionnaires, clinical and laboratory data. Although the nutrition intervention was mainly carried out using individual nutritional counselling, other assisting methods were used as appropriate. Conclusion The SPRINTT nutrition intervention was feasible and able to adapt flexibly to varying needs of this heterogeneous population. The procedures adopted to identify older adults at risk of malnutrition and to design the appropriate intervention may serve as a model to deliver nutrition intervention for community-dwelling older people with mobility limitations. Supplementary Information The online version contains supplementary material available at 10.1007/s41999-020-00438-4.

Published
2021
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6. Promoting access to innovation for frail old persons: IAGG (International Association of Gerontology and Geriatrics), WHO (World Health Organization) and SFGG (Societe Francaise de Geriatrie et de Gerontologie) workshop — Athens January 20–21, 2012

Author

Berrut, G., Andrieu, S., Araujo De Carvalho, I., Baeyens, J. P., Bergman, H., Cassim, B., Cerreta, F., Cesari, M., Cha, H. B., Chen, L. K., Cherubini, A., Chou, M. Y., Cruz-Jentoft, A. J., De Decker, L., Du, P., Forette, B., Forette, F., Franco, A., Guimaraes, R., Gutierrez-Robledo, L. M., Jauregui, J., Khavinson, V., Lee, W. J., Peng, L. N., Perret-Guillaume, C., Petrovic, M., Retornaz, F., Rockwood, K., Rodriguez-Manas, L., Sieber, C., Spatharakis, G., Theou, O., Topinkova, E., Vellas, B., and Benetos, Athanase

Published
2013
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7. Nutrition in the age-related disablement process

Author

Inzitari, Marco, Doets, E., Bartali, B., Benetou, V., Di Bari, M., Visser, M., Volpato, S., Gambassi, G., Topinkova, E., De Groot, L., Salva, A., and For the International Association of Gerontology and Geriatrics (IAGG) Task Force for Nutrition in the Elderly

Published
2011
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8. 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

Author

Cruz-Jentoft, A. J., Daragjati, J., Fratiglioni, L., Maggi, S., Mangoni, A. A., Mattace-Raso, F., Paccalin, M., Polidori, M. C., Topinkova, E., Ferrucci, L., Pilotto, A., Angleman, S. B., Bureau, M. -L., Brunet, T., Cella, A., Custodero, C., Custureri, R., Egberts, A., Durando, M., Ferri, A., Gallina, P., Hoffmann, D., Liuu, E., Madlova, P., Meyer, A., Michalkova, H., Miret-Corchado, C., Montero-Errasquin, B., Musacchio, C., Puntoni, M., Ruxton, K., Sabba, C., Santoni, G., Schulz, R. -J., Simonato, M., Siri, G., Sultana, J., Tap, L., Trifiro, G., Welmer, A. -K., and Internal Medicine

Subjects
Male, Aging, medicine.medical_specialty, Cost effectiveness, Cost-Benefit Analysis, Frail Elderly, Population, Psychological intervention, Coronary artery disease, 03 medical and health sciences, 0302 clinical medicine, Multidimensional Prognostic Index, Risk Factors, Health care, Medicine, media_common.cataloged_instance, Humans, 030212 general & internal medicine, Prospective Studies, European union, Cognitive decline, Intensive care medicine, education, Comprehensive Geriatric Assessment, Frailty, MPI_AGE, Multimorbidity, Geriatric Assessment, media_common, Aged, Geriatrics, Aged, 80 and over, education.field_of_study, business.industry, medicine.disease, Prognosis, Hospitalization, Female, Independent Living, Geriatrics and Gerontology, business, 030217 neurology & neurosurgery
Abstract

MPI_AGE is a European Union co-funded research project aimed to use the Multidimensional Prognostic Index (MPI), a validated Comprehensive Geriatric Assessment (CGA)-based prognostic tool, to develop predictive rules that guide clinical and management decisions in older people in different European countries. A series of international studies performed in different settings have shown that the MPI is useful to predict mortality and risk of hospitalization in community-dwelling older subjects at population level. Furthermore, studies performed in older people who underwent a CGA before admission to a nursing home or receiving homecare services showed that the MPI successfully identified groups of persons who could benefit, in terms of reduced mortality, of specific therapies such as statins in diabetes mellitus and coronary artery disease, anticoagulants in atrial fibrillation and antidementia drugs in cognitive decline. A prospective trial carried out in nine hospitals in Europe and Australia demonstrated that the MPI was able to predict not only in-hospital and long-term mortality, but also institutionalization, re-hospitalization and receiving homecare services during the one-year follow-up after hospital discharge. The project also explored the association between MPI and mortality in hospitalized older patients in need of complex procedures such as transcatheter aortic valve implantation or enteral tube feeding. Evidence from these studies has prompted the MPI_AGE Investigators to formulate recommendations for healthcare providers, policy makers and the general population which may help to improve the cost-effectiveness of appropriate health care interventions for older patients.

Published
2020

9. Association of Antidementia Drugs and Mortality in Community-Dwelling Frail Older Patients With Dementia: The Role of Mortality Risk Assessment

Author

Pilotto, A., Polidori, M. C., Veronese, N., Panza, F., Arboretti Giancristofaro, R., Daragjati, J., Carrozzo, E., Prete, C., Gallina, P., Padovani, A., Maggi, S., Cruz-Jentoft, A., Durando, M., Ferrucci, L., Fratiglioni, L., Mattace-Raso, F., Paccalin, M., Ruppe, G., Schulz, R. -J., Topinkova, E., Trifirò, G., Welmer, A. -K., Multidimensional Prognostic Index (MPI)_Age Project Investigators, Internal Medicine, Medical Informatics, Pilotto, A., Polidori, M.C., Veronese, N., Panza, F., Arboretti Giancristofaro, R., Daragjati, J., Carrozzo, E., Prete, C., Gallina, P., Padovani, A., Maggi, S., Cruz-Jentoft, A., Durando, M., Ferrucci, L., Fratiglioni, L., Mattace-Raso, F., Paccalin, M., Ruppe, G., Schulz, R.-J., Topinkova, E., Trifirò, G., Welmer, A.-K., and Multidimensional Prognostic Index (MPI)_Age Project Investigators

Subjects
Male, Gerontology, medicine.medical_specialty, Frail Elderly, Multidimensional assessment, antidementia drug, Lower risk, Comprehensive geriatric assessment, Risk Assessment, Article, 03 medical and health sciences, 0302 clinical medicine, Older patients, SDG 3 - Good Health and Well-being, Risk Factors, antidementia drugs, comprehensive geriatric assessment, Dementia, frailty, mortality, multidimensional prognostic index (MPI), Nursing (all)2901 Nursing (miscellaneous), Health Policy, Geriatrics and Gerontology, Internal medicine, medicine, Humans, 030212 general & internal medicine, Multidimensional prognostic index (MPI), Mortality, Geriatric Assessment, General Nursing, Aged, Retrospective Studies, Aged, 80 and over, Frailty, business.industry, Hazard ratio, General Medicine, medicine.disease, Survival Analysis, Confidence interval, Antidementia drugs, Female, Independent Living, Nursing homes, business, Risk assessment, 030217 neurology & neurosurgery
Abstract

Objective: To evaluate whether treatment with antidementia drugs is associated with reduced mortality in older patients with different mortality risk at baseline. Design: Retrospective. Setting: Community-dwelling. Participants: A total of 6818 older people who underwent a Standardized Multidimensional Assessment Schedule for Adults and Aged Persons (SVaMA) evaluation to determine accessibility to homecare services or nursing home admission from 2005 to 2013 in the Padova Health District, Italy were included. Measurements: Mortality risk at baseline was calculated by the Multidimensional Prognostic Index (MPI), based on information collected with the SVaMA. Participants were categorized to have mild (MPI-SVaMA-1), moderate (MPI-SVaMA-2), and high (MPI-SVaMA-3) mortality risk. Propensity score-adjusted hazard ratios (HR) of 2-year mortality were calculated according to antidementia drug treatment. Results: Patients treated with antidementia drugs had a significant lower risk of death than untreated patients (HR 0.82; 95% confidence interval [CI] 0.73–0.92 and 0.56; 95% CI 0.49–0.65 for patients treated less than 2 years and more than 2 years treatment, respectively). After dividing patients according to their MPI-SVaMA grade, antidementia treatment was significantly associated with reduced mortality in the MPI-SVaMA-1 mild (HR 0.71; 95% CI 0.54–0.92) and MPI-SVaMA-2 moderate risk (HR 0.61; 95% CI 0.40–0.91, matched sample), but not in the MPI-SVaMA-3 high risk of death. Conclusions: This large community-dwelling patient study suggests that antidementia drugs might contribute to increased survival in older adults with dementia with lower mortality risk. © 2017 AMDA – The Society for Post-Acute and Long-Term Care Medicine

Published
2018

10. Relationship between the Gérontopôle Frailty Screening Tool and the frailty phenotype in primary care.

Author

Cherubini, A., Demougeot, L., Cruz Jentoft, A., Curgunlu, A., Michel, J.-P., Roberts, H., Aihie Sayer, A., Strandberg, T., Topinkova, E., Trotta, F.M., van Asselt, D.Z.B., Vellas, B., Zekry, D., and Cesari, M.

Abstract

Introduction Frailty is characterized by increased vulnerability to stressors that poses the older subject at risk of adverse health-related outcomes, including hospitalization, disability and mortality. Early identification of community-dwelling frail older subjects is important in order to implement preventive strategies against negative health-related outcomes, in particular disability. Validated brief screening tools are needed to detect frail community-dwelling elders. Materials and methods The aim of the present study, promoted by the European Union Geriatric Medicine Society (EUGMS) working group on “Frailty in older persons”, is to determine the agreement between the Gérontopôle Frailty Screening Tool (GFST) (administered by the general practitioner) and the Fried’ criteria for frailty phenotype as reference measure (administered by a blinded assessor). The study is performed in older primary care patients in nine European countries after translation of the GFST into eight languages. Results The sample ( n = 109 older patients,) included 37.6%, 56.9%, and 5.5% robust, pre-frail or frail, and disabled individuals, respectively. The GFST showed a sensitivity of 71.0%, a specificity of 70.2%, a positive predictive value of 75.9% and a negative predictive value of 64.7% at the identification of non-disabled frail elders. The positive and negative likelihood ratios were 2.38 and 0.41, respectively. In logistic regression models only slow gait speed (odds ratio [OR]: 19.65, 95% confidence interval [95% CI]: 4.69–82.35) and mobility issues (OR: 18.04, 95% CI: 3.11–104.78) were significantly associated with the condition of frailty in the absence of disability. Conclusions Our findings demonstrate an overall moderate agreement between the GFST and the frailty phenotype. [ABSTRACT FROM AUTHOR]

Published
2015
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11. The MPI_AGE European Project: Using Multidimensional Prognostic Indices (MPI) to improve cost-effectiveness of interventions in multimorbid frail older persons. Background, aim and design.

Author

Pilotto, A., Sancarlo, D., Polidori, M.C., Cruz-Jentoft, A.J., Mattace-Raso, F., Paccalin, M., Topinkova, E., Welmer, A.-K., and Maggi, S.

Abstract

Purpose The MPI_AGE project is a multicenter project co-funded by the Executive Agency for Health and Consumers in the frame of Active and Healthy Ageing 2nd-Health Programme 2008–2013. Aim of the project is to implement Multidimensional Prognostic Indices (MPI) that predict survival, based on the Comprehensive Geriatric Assessment, in order to improve the cost-effectiveness of health interventions in frail older individuals with multimorbidity and polypharmacy. Materials and methods The project is divided in seven Work Packages (WP). WP1, WP2 and WP3 include the activities of coordination, evaluation and dissemination, respectively. WP4 is a retrospective analysis of clinical, functional and administrative data carried out in order to develop and validate MPI in community-dwelling older subjects. In WP5, the best cost-effective profile of different therapeutic interventions in older individuals with different MPI-based mortality risk profile will be identified. WP6 is a multicenter prospective study with a follow-up of 12 months carried out in 11 geriatric clinical centres with the aim of evaluating the usefulness of the MPI in the clinical decision making in patients with different mortality risk. In WP7, a systematic process of recommendations will be carried out through the wide involvement of partners, external experts and stakeholders in meetings and web diffusion. Conclusions Mortality risk may influence the effectiveness of specific treatments and interventions in frail older subjects with multimorbidity and polypharmacy. Clinicians and health policy makers need to consider the prognostic information obtained through the MPI to identify those setting-specific profiles of older subjects who may better benefit from interventions. [ABSTRACT FROM AUTHOR]

Published
2015
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12. Older women are frailer, but less often die then men: a prospective study of older hospitalized people

Author

Alfonso J. Cruz-Jentoft, Nicola Veronese, Stefania Maggi, Antonio Greco, Maria Cristina Polidori, Marc Paccalin, Luigi Ferrucci, Eva Topinkova, Alberto Cella, Julia Daragjati, Alberto Pilotto, Francesco U.S. Mattace-Raso, Giacomo Siri, Arduino A. Mangoni, Internal Medicine, Veronese, N., Siri, G., Cella, A., Daragjati, J., Cruz-Jentoft, A.J., Polidori, M.C., Mattace-Raso, F., Paccalin, M., Topinkova, E., Greco, A., Mangoni, A.A., Maggi, S., Ferrucci, L., and Pilotto, A.

Subjects
Male, Gerontology, Multivariate analysis, Prognosi, Lower risk, Article, General Biochemistry, Genetics and Molecular Biology, Hospital, 03 medical and health sciences, 0302 clinical medicine, Multidimensional Prognostic Index, Humans, Medicine, Longitudinal Studies, Prospective Studies, 030212 general & internal medicine, Prospective cohort study, Geriatric Assessment, Aged, Aged, 80 and over, Sex Characteristics, 030219 obstetrics & reproductive medicine, Frailty, business.industry, Mortality rate, Australia, Obstetrics and Gynecology, Odds ratio, Prognosis, Hospitals, Patient Discharge, Confidence interval, Europe, Hospitalization, Survival Rate, Cohort, Sex, Female, Cohort study, business
Abstract

Objectives The association between frailty, mortality and sex is complex, but a limited literature is available on this topic, particularly for older hospitalized patients. Therefore, the objective of our study was to prospectively evaluate sex differences in frailty, assessed by the Multidimensional Prognostic Index (MPI) and mortality, institutionalization, and re-hospitalization in an international cohort of older people admitted to hospital. Study design We used data from nine public hospitals in Europe and Australia, to evaluate sex differences in mortality, frailty and the risk of institutionalization and re-hospitalization, during one year of follow-up. Main outcome measures People aged 65 years or more admitted to hospital for an acute medical condition or for a relapse of a chronic disease were included. A standardized comprehensive geriatric assessment, which evaluated functional, nutritional, and cognitive status, risk of pressure sores, comorbidities, medications and co-habitation status, was used to calculate the MPI to measure frailty in all hospitalized older people. Data regarding mortality, institutionalization and re-hospitalization were also recorded for one year. Results Altogether, 1140 hospitalized patients (mean age = 84.2 years; 694 women = 60.9%) were included. The one-year mortality rate was 33.2%. In multivariate analysis, adjusted for age, MPI score, centre and diagnosis at baseline, although women had higher MPI scores than men, the latter had higher in-hospital (odds ratio, OR = 2.26; 95% confidence intervals, CI = 1.27–4.01) and one-year post-discharge mortality (OR = 2.04; 95%CI = 1.50–2.79). Furthermore, men were less frequently institutionalized in a care home than female patients (OR = 0.55; 95%CI: 0.34–0.91), but they were also more frequently re-hospitalized (OR = 1.42; 95%CI: 1.06–1.91) during the year after hospital discharge. Conclusion Older hospitalized men were less frail, but experienced higher in-hospital and one-year mortality than women. Women were admitted more frequently to nursing homes and experienced a lower risk of re-hospitalization. These findings suggest important differences between the sexes and extends the ‘male-female health-survival paradox’ to acutely ill patient groups.

Published
2019
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