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Objective: Data on prognostic tools for indicating mechanical ventilation in older people with COVID-19 are still limited. The aim of this research was to evaluate if the Multidimensional Prognostic Index (MPI), based on the Comprehensive Geriatric Assessment (CGA), may help physicians in identifying older hospitalized patients affected by COVID-19 who might benefit from mechanical ventilation. Design: Longitudinal, multicenter study. Settings and Participants: 502 older people hospitalized for COVID-19 in 10 European hospitals. Methods: MPI was calculated using 8 different domains typical of the CGA. A propensity score, Cox's regression analysis was used for assessing the impact of mechanical ventilation on rehospitalization/mortality for 90 days' follow-up, stratified by MPI = 0.50. The accuracy of MPI in predicting negative outcomes (ie, rehospitalization/mortality) was assessed using the area under the curve (AUC), and the discrimination with several indexes like the Net Reclassification Improvement (NRI) and the Integrated Discrimination Improvement (IDI). Results: Among 502 older people hospitalized for COVID-19 (mean age: 80 years), 152 were treated with mechanical ventilation. In the propensity score analysis, during the 90-day follow-up period, there were 44 rehospitalizations and 95 deaths. Mechanical ventilation in patients with MPI values >= 0.50, indicating frailer participants, was associated with a higher risk of rehospitalization/mortality (hazard ratio 1.56, 95% CI 1.09-2.23), whereas in participants with MPI values < 0.50 this association was not significant. The accuracy of the model including age, sex, respiratory parameters, and MPI was good (AUC = 0.783) as confirmed by an NRI of 0.2756 (P < .001) and an IDI of 0.1858 (P < .001), suggesting a good discrimination of the model in predicting negative outcomes. Conclusions and Implications: MPI could be useful for better individualizing older people hospitalized by COVID-19 who could benefit from m

Alberto Cella,1 Nicola Veronese,2 Carlo Custodero,3 Alberto Castagna,4 Lisa A Cammalleri,1 Walter M Capitano,2 Luisa Solimando,2 Luca Carruba,2 Carlo Sabbà ,3 Giovanni Ruotolo,4 Mario Barbagallo,2 Alberto Pilotto1,3 1Department of Geriatric Care, Orthogeriatrics and Rehabilitation, E.O. Ospedali Galliera, Genova, Italy; 2Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Palermo, Italy; 3Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, Bari, Italy; 4Geriatrics Unit, “Pugliese Ciaccio” Hospital, Catanzaro, ItalyCorrespondence: Alberto Pilotto, Via delle Mura Capuccine, 14, Genova, 16128, Italy, Tel +39 010 5634400, Fax +39 010 5634400, Email alberto.pilotto@galliera.itPurpose: To screen multidimensional frailty in older people, using a comprehensive geriatric assessment (CGA) tool such as the multidimensional prognostic index (MPI), is a public health priority. Unfortunately, the screening tools available are not able to capture multidimensional frailty. In this work, we aimed to evaluate in a population of hospitalized and ambulatory older patients, the agreement between an abbreviated form of the MPI (ie, BRIEF-MPI) and the standard/full version.Participants and Methods: All participants included in the study completed both versions of the MPI, brief and full, which share the following domains: 1) basic and 2) instrumental activities of daily living, 3) mobility/risk of pressure sores, 4) cognition, 5) nutrition, 6) comorbidity, 7) social and 8) number of medications. The agreement between the two instruments was reported using either the mean comparisons with a t-test matched sample, a simple correlation analysis and the Bland–Altman methodology.Results: The study sample included 110 participants (mean age=83.2 years, 51.8% women). The mean difference was statistically and clinically irrelevant (mean difference=0.01± 0.10; p=0.27). The correlation between brief and full MPI versions was optima

Background & aims: The literature regarding enteral nutrition and mortality in older frail people is limited and still conflicting. Moreover, the potential role of comprehensive geriatric assessment is poorly explored. We therefore aimed to investigate whether the Multidimensional Prognostic Index (MPI), an established tool that assesses measures of frailty and predicts mortality, may help physicians in identifying patients in whom ETF (enteral tube feeding) is effective in terms of reduced mortality. Methods: Observational, longitudinal, multicenter study with one year of follow-up. Data regarding ETF were recorded through medical records. A standardized comprehensive geriatric assessment was used to calculate the MPI. Participants were divided in low (MPI-1), moderate (MPI-2) or severe (MPI-3) risk of mortality. Data regarding mortality were recorded through administrative information. Results: 1064 patients were included, with 79 (13 in MPI 1-2 and 66 in MPI-3 class) receiving ETF. In multivariable analysis, patients receiving ETF experienced a higher risk of death (odds ratio, OR = 2.00; 95% confidence intervals, CI: 1.19-3.38). However, after stratifying for their MPI at admission, mortality was higher in MPI-3 class patients (OR = 2.03; 95%CI: 1.09-3.76), but not in MPI 1-2 class patients (OR = 1.51; 95%CI: 0.44-5.25). The use of propensity score confirmed these findings. Conclusions: ETF is associated with a higher risk of death. However, this is limited to more frail patients, suggesting the importance of the MPI in the prognostic evaluation of ETF. (C) 2019 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

Alberto Cella,1 Alberto Ferrari,2 Giuseppe Rengo,3 Vincenzo Solfrizzi,4 Nicola Veronese,5 Matteo Puntoni,6 Sabrina Zora,1 Alberto Pilotto,1,4 Filippo Fimognari7 On behalf of the SELFY-MPI SIGOT Investigators1Geriatric Unit, Department of Geriatric Care, Orthogeriatrics and Rehabilitation, EO Galliera Hospital, Genova, Italy; 2Geriatric Unit, Arcispedale S. Maria Nuova, AUSL Reggio Emilia, Reggio Emilia, Italy; 3Department of Translational Medical Sciences, Division of Geriatrics, Federico II University, Napoli, Italy; 4Department of Interdisciplinary Medicine, University of Bari, Bari, Italy; 5Primary Care Department, Azienda ULSS 3 Serenissima, Venice, Italy; 6Scientific Coordination Unit, EO Galliera Hospital, Genova, Italy; 7Geriatric Unit, Department of Internal Medicine, Azienda Ospedaliera di Cosenza, Cosenza, ItalyCorrespondence: Sabrina ZoraGeriatric Unit, Department of Geriatric Care, Orthogeriatrics and Rehabilitation, EO Galliera Hospital, Genova, ItalyEmail sabrina.zora@galliera.itBackground: The Multidimensional Prognostic Index (MPI) is a comprehensive geriatric assessment (CGA)-based tool that has shown excellent accuracy in predicting negative health outcomes in older people. Recently, the self-administered version of MPI (SELFY-MPI) has been validated in a community-dwelling sample, revealing excellent agreement with the original MPI. In the SELFY-MPI, Gijon’s social-familial evaluation scale (SFES) was used to assess socio-relational and economic aspects. Completion of the SELFY-MPI, however, requires a significant amount of time in people aged over 60 years, particularly to fill in the SFES scale. The aim of this study was to validate, in a sample of community-dwelling older people, a short-form version of the SELFY-MPI (SELFY-MPI-SF), in which the SFES scale was replaced by the “co-habitation status” domain, as in the original version of the MPI.Methods: All participants included in the study completed both versions