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1. Comparing the prognostic accuracy for all-cause mortality of frailty instruments: a multicentre 1-year follow-up in hospitalized older patients

Author

Pilotto A, Rengo F, Marchionni N, Sancarlo D, Fontana A, Panza F, Ferrucci L, Branca S, Gregorio TD, Manmano M, Spallina G, Laguzzi E, Estienne G, Massone A, Moscato M, Ravera C, Ferrara L, Tommaso GD, Serenella D, Rozzini R, Barbisoni P, Sleiman I, Carrieri V, Devicienti C, Cristofalo R, Argentieri G, Salsi A, Bellotti L, Bernardi R, Nicolino F, Putzu PF, Caddeo G, Coghe F, Riccio D, Mazzei B, Corsonello A, Bari MD, Caldi F, Lopilato E, Tassinari I, Tardi S, Mascolo EP, Abete P, Simione I, Centomo R, Cester A, Scevola M, Lunardelli P, Giordano A, Martini E, Nardelli A, Visioli S, Cherubini A, Dell'Aquila G, Gasperini B, Senin U, Costanza AM, Bavazzano A, Gambardella L, Malin N, Bernabei R, D'Arco C, Gambassi G, Mammarella F, Cascavilla L, Paris F, Scarcelli C, Grasselli C, Brunello P, Cortiana C, Pavin D, Cabodi S, Carlucci R, Grassone D, Colle PD, Lattuada L, Tulliani A., TOIGO, GABRIELE, Pilotto, A, Rengo, F, Marchionni, N, Sancarlo, D, Fontana, A, Panza, F, Ferrucci, L, Branca, S, Gregorio, Td, Manmano, M, Spallina, G, Laguzzi, E, Estienne, G, Massone, A, Moscato, M, Ravera, C, Ferrara, L, Tommaso, Gd, Serenella, D, Rozzini, R, Barbisoni, P, Sleiman, I, Carrieri, V, Devicienti, C, Cristofalo, R, Argentieri, G, Salsi, A, Bellotti, L, Bernardi, R, Nicolino, F, Putzu, Pf, Caddeo, G, Coghe, F, Riccio, D, Mazzei, B, Corsonello, A, Bari, Md, Caldi, F, Lopilato, E, Tassinari, I, Tardi, S, Mascolo, Ep, Abete, P, Simione, I, Centomo, R, Cester, A, Scevola, M, Lunardelli, P, Giordano, A, Martini, E, Nardelli, A, Visioli, S, Cherubini, A, Dell'Aquila, G, Gasperini, B, Senin, U, Costanza, Am, Bavazzano, A, Gambardella, L, Malin, N, Bernabei, R, D'Arco, C, Gambassi, G, Mammarella, F, Cascavilla, L, Paris, F, Scarcelli, C, Grasselli, C, Brunello, P, Cortiana, C, Pavin, D, Cabodi, S, Carlucci, R, Grassone, D, Toigo, Gabriele, Colle, Pd, Lattuada, L, and Tulliani, A.

Subjects
prognostic accuracy, multicentric study, frailty, MPI
Abstract

Background: Frailty is a dynamic age-related condition of increased vulnerability characterized by declines across multiple physiologic systems and associated with an increased risk of death. We compared the predictive accuracy for one-month and one-year all-cause mortality of four frailty instruments in a large population of hospitalized older patients in a prospective multicentre cohort study. Methods and Findings: On 2033 hospitalized patients aged $65 years from twenty Italian geriatric units, we calculated the frailty indexes derived from the Study of Osteoporotic Fractures (FI-SOF), based on the cumulative deficits model (FI-CD), based on a comprehensive geriatric assessment (FI-CGA), and the Multidimensional Prognostic Index (MPI). The overall mortality rates were 8.6% after one-month and 24.9% after one-year follow-up. All frailty instruments were significantly associated with one-month and one-year all-cause mortality. The areas under the receiver operating characteristic (ROC) curves estimated from age- and sex-adjusted logistic regression models, accounting for clustering due to centre effect, showed that the MPI had a significant higher discriminatory accuracy than FI-SOF, FI-CD, and FI-CGA after one month (areas under the ROC curves: FI-SOF = 0.685 vs. FI-CD = 0.738 vs. FI-CGA = 0.724 vs. MPI = 0.765, p,0.0001) and one year of followup (areas under the ROC curves: FI-SOF = 0.694 vs. FI-CD = 0.729 vs. FI-CGA = 0.727 vs. MPI = 0.750, p,0.0001). The MPI showed a significant higher discriminatory power for predicting one-year mortality also in hospitalized older patients without functional limitations, without cognitive impairment, malnourished, with increased comorbidity, and with a high number of drugs. Conclusions: All frailty instruments were significantly associated with short- and long-term all-cause mortality, but MPI demonstrated a significant higher predictive power than other frailty instruments in hospitalized older patients.

Published
2012

2. Improving the diagnostic accuracy of depression in older persons: the Depression in the Aged Female National Evaluation cluster randomized trial

Author

Lattanzio F, Di Bari M, Sgadari A, Baccini M, Ercolani S, Rengo F, Senin U, Bernabei R, Marchionni N, Cherubini A, Depression in the Aged Female National Evaluation Study Group: Rozzini R, Cassinadri A, Ricci A, Valenti G, Falzoi C, Grimaldi W, Putzu PF, Porceddu C, Coghe F, Matta M, Manca E, Mereu MR, Viale D, Antonelli Incalzi R, Ciaburri M, Di Palma R, Pagano F, Zamboni V, Borghesi T, Crovetti B, Inzitari M, Masotti G, Mossello E, Sarcone E, Sforza G, Cerqua R, Califano M, Pilotto A, Cascavilla L, Paris F, Salvioli G, Badini I, Foroni M, Sabbatici F, Salsi F, Abate G, Abate M, D'Attilio A, Di Iorio A, Fogliatta M, Zanatta A, Gasparini R, Gasparini G, Pedrazzoli R, Tobaldini C, Biagini C, Bencini F, Caleri V, Cantini C, Cipriani C, Luzzi C, Tonon E, Benedetti C, Ferretti R, Macchiarulo C, ABETE, PASQUALE, Mazzella F, Pollice S, Vassallo V, Di Stefano F, Gulizia G, Mazzarella R., Lattanzio, F, Di Bari, M, Sgadari, A, Baccini, M, Ercolani, S, Rengo, F, Senin, U, Bernabei, R, Marchionni, N, Cherubini, A, Depression in the Aged Female National Evaluation Study Group: Rozzini, R, Cassinadri, A, Ricci, A, Valenti, G, Falzoi, C, Grimaldi, W, Putzu, Pf, Porceddu, C, Coghe, F, Matta, M, Manca, E, Mereu, Mr, Viale, D, Antonelli Incalzi, R, Ciaburri, M, Di Palma, R, Pagano, F, Zamboni, V, Borghesi, T, Crovetti, B, Inzitari, M, Masotti, G, Mossello, E, Sarcone, E, Sforza, G, Cerqua, R, Califano, M, Pilotto, A, Cascavilla, L, Paris, F, Salvioli, G, Badini, I, Foroni, M, Sabbatici, F, Salsi, F, Abate, G, Abate, M, D'Attilio, A, Di Iorio, A, Fogliatta, M, Zanatta, A, Gasparini, R, Gasparini, G, Pedrazzoli, R, Tobaldini, C, Biagini, C, Bencini, F, Caleri, V, Cantini, C, Cipriani, C, Luzzi, C, Tonon, E, Benedetti, C, Ferretti, R, Macchiarulo, C, Abete, Pasquale, Mazzella, F, Pollice, S, Vassallo, V, Di Stefano, F, Gulizia, G, and Mazzarella, R.

Abstract

Objectives: To evaluate whether a training intervention can improve the ability of geriatricians to recognize depression in older persons. Design: Multicenter, cluster randomized clinical trial. Setting: Fourteen geriatric outpatient clinics in Italy, each representing the unit of randomization. Participants: After training, a total of 1,914 outpatients aged 65 years and older in both arms, not on antidepressant at entry, were blindly evaluated by the clinic geriatrician, in charge of routine clinical management, and by a field researcher, who formally diagnosed depression by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), taken as the criterion standard. Intervention: After randomization, geriatricians belonging to the intervention arm were assigned to receive a residential 3-day educational program on depression. Those in the control arm received a generic course on disease management in elderly people. Measurements: Sensitivity and specificity of the diagnosis of depression made by geriatricians, compared with the DSM-IV diagnosis. Results: Sensitivity and specificity were significantly higher in trained than in untrained geriatricians (49 vs 35% and 91 vs 88%, respectively; P=.002 in marginal regression models). Effectiveness of training was confirmed, adjusting for age, sex, and cognitive performance (P=.02). Conclusion: The ability of geriatricians to diagnose depression in older outpatients can be improved with a specific training intervention. Improvement of diagnostic performance might translate into more-appropriate clinical management.

Published
2009

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