Skip to main content
SpringerLink
Log in

Comprehensive Geriatric Assessment in Infectious Diseases

  • Chapter
  • First Online:
Book cover Adult Vaccinations

Part of the book series: Practical Issues in Geriatrics ((PIG))

  • 733 Accesses

Abstract

Comprehensive geriatric assessment (CGA) is a multidimensional, interdisciplinary diagnostic process to determine the medical, psychological and functional capabilities of a frail elderly person in order to develop a coordinated and integrated plan for treatment and long-term follow-up. CGA was significantly useful in reducing negative health outcomes such as mortality, functional decline, institutionalization or hospital readmission in different clinical settings and conditions. CGA has become the internationally established method to assess elderly people in clinical practice, because it is sensitive to the reliable detection of degrees of frailty. In several infectious diseases, there are risk factors related to functional disability, mobility limitation, cognitive impairment and concomitant geriatric syndromes. Therefore, there is a compelling need to incorporate CGA into the management approaches in older adults with infectious diseases and adopt CGA-based prognostic tools to facilitate clinical decision-making in older frail patients with infectious diseases. In this contest, the CGA-based multidimensional prognostic index (MPI), combining eight different domains of standard CGA (ADL, IADL, cognitive, nutrition, motility, comorbidity, polypharmacy, cohabitation status), showed very good accuracy in identifying older patients with community-acquired pneumonia (CAP) at different risk of mortality who need a different intensity of clinical interventions. Moreover, the addition of procalcitonin levels significantly improved the accuracy of MPI in predicting short-term mortality in older patients with CAP. These data suggest that the MPI may be poised to become a key parameter in infectious diseases and vaccination discussions.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 39.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 54.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Rubenstein LZ, Josephson KR, Wieland GD, English PA, Sayre JA, Kane RL. Effectiveness of a geriatric evaluation unit. A randomized clinical trial. N Engl J Med. 1984;311(26):1664–70.

    Article  CAS  Google Scholar 

  2. Rubenstein LZ, Rubenstein LV. Multidimensional geriatric assessment. In: Fillit H, Rockwood K, Woodhouse K, editors. Brocklehurst’s textbook of geriatric medicine and gerontology. 7th ed. Philadelphia, PA: Saunders Elsevier; 2010. p. 211.

    Chapter  Google Scholar 

  3. Pilotto A, Cella A, Pilotto A, Daragjati J, Veronese N, Musacchio C, et al. Three decades of comprehensive geriatric assessment: evidence coming from different healthcare settings and specific clinical conditions. J Am Med Dir Assoc. 2017;18(2):192 e1–e11.

    Article  Google Scholar 

  4. Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people. Lancet. 2013;381(9868):752–62.

    Article  Google Scholar 

  5. Juthani-Mehta M, De Rekeneire N, Allore H, Chen S, O’Leary JR, Bauer DC, et al. Modifiable risk factors for pneumonia requiring hospitalization of community-dwelling older adults: the health, aging, and body composition study. J Am Geriatr Soc. 2013;61(7):1111–8.

    Article  Google Scholar 

  6. Rao K, Micic D, Chenoweth E, Deng L, Galecki AT, Ring C, et al. Poor functional status as a risk factor for severe Clostridium difficile infection in hospitalized older adults. J Am Geriatr Soc. 2013;61(10):1738–42.

    Article  Google Scholar 

  7. Mody L, Juthani-Mehta M. Urinary tract infections in older women: a clinical review. JAMA. 2014;311(8):844–54.

    Article  CAS  Google Scholar 

  8. Greene M, Covinsky KE, Valcour V, Miao Y, Madamba J, Lampiris H, et al. Geriatric syndromes in older HIV-infected adults. J Acquir Immune Defic Syndr. 2015;69(2):161–7.

    Article  Google Scholar 

  9. Pilotto A, Sancarlo D, Daragjati J, Panza F. Perspective: the challenge of clinical decision-making for drug treatment in older people. The role of multidimensional assessment and prognosis. Front Med (Lausanne). 2014;1:61.

    Google Scholar 

  10. Pilotto A, Ferrucci L, Franceschi M, D’Ambrosio LP, Scarcelli C, Cascavilla L, et al. Development and validation of a multidimensional prognostic index for one-year mortality from comprehensive geriatric assessment in hospitalized older patients. Rejuvenation Res. 2008;11(1):151–61.

    Article  Google Scholar 

  11. Pilotto A, Addante F, Ferrucci L, Leandro G, D’Onofrio G, Corritore M, et al. The multidimensional prognostic index predicts short- and long-term mortality in hospitalized geriatric patients with pneumonia. J Gerontol A Biol Sci Med Sci. 2009;64(8):880–7.

    Article  Google Scholar 

  12. Pilotto A, Dini S, Daragjati J, Miolo M, Mion MM, Fontana A, et al. Combined use of the multidimensional prognostic index (MPI) and procalcitonin serum levels in predicting 1-month mortality risk in older patients hospitalized with community-acquired pneumonia (CAP): a prospective study. Aging Clin Exp Res. 2018;30(2):193–7.

    Article  Google Scholar 

  13. Pilotto A, Ferrucci L, Scarcelli C, Niro V, Di Mario F, Seripa D, et al. Usefulness of the comprehensive geriatric assessment in older patients with upper gastrointestinal bleeding: a two-year follow-up study. Dig Dis. 2007;25(2):124–8.

    Article  Google Scholar 

  14. Sancarlo D, Pilotto A, Panza F, Copetti M, Longo MG, D’Ambrosio P, et al. A Multidimensional Prognostic index (MPI) based on a comprehensive geriatric assessment predicts short- and long-term all-cause mortality in older hospitalized patients with transient ischemic attack. J Neurol. 2012;259(4):670–8.

    Article  Google Scholar 

  15. Pilotto A, Sancarlo D, Franceschi M, Aucella F, D’Ambrosio P, Scarcelli C, et al. A multidimensional approach to the geriatric patient with chronic kidney disease. J Nephrol. 2010;23(Suppl 15):S5–10.

    PubMed  Google Scholar 

  16. Giantin V, Valentini E, Iasevoli M, Falci C, Siviero P, De Luca E, et al. Does the multidimensional prognostic index (MPI), based on a comprehensive geriatric assessment (CGA), predict mortality in cancer patients? Results of a prospective observational trial. J Geriatr Oncol. 2013;4(3):208–17.

    Article  Google Scholar 

  17. Pilotto A, Addante F, Franceschi M, Leandro G, Rengo G, D’Ambrosio P, et al. Multidimensional prognostic index based on a comprehensive geriatric assessment predicts short-term mortality in older patients with heart failure. Circ Heart Fail. 2010;3(1):14–20.

    Article  Google Scholar 

  18. Pilotto A, Sancarlo D, Panza F, Paris F, D’Onofrio G, Cascavilla L, et al. The multidimensional prognostic index (MPI), based on a comprehensive geriatric assessment predicts short- and long-term mortality in hospitalized older patients with dementia. J Alzheimers Dis. 2009;18(1):191–9.

    Article  Google Scholar 

  19. Warnier RM, van Rossum E, van Velthuijsen E, Mulder WJ, Schols JM, Kempen GI. Validity, reliability and feasibility of tools to identify frail older patients in inpatient hospital care: a systematic review. J Nutr Health Aging. 2016;20(2):218–30.

    Article  CAS  Google Scholar 

  20. Dent E, Kowal P, Hoogendijk EO. Frailty measurement in research and clinical practice: a review. Eur J Intern Med. 2016;31:3–10.

    Article  Google Scholar 

  21. Mitnitski AB, Mogilner AJ, Rockwood K. Accumulation of deficits as a proxy measure of aging. ScientificWorldJournal. 2001;1:323–36.

    Article  CAS  Google Scholar 

  22. Morley JE, Malmstrom TK, Miller DK. A simple frailty questionnaire (FRAIL) predicts outcomes in middle aged African Americans. J Nutr Health Aging. 2012;16(7):601–8.

    Article  CAS  Google Scholar 

  23. Pilotto A, Panza F, Copetti M, Simonato M, Sancarlo D, Gallina P, et al. Statin treatment and mortality in community-dwelling frail older patients with diabetes mellitus: a retrospective observational study. PLoS One. 2015;10(6):e0130946.

    Article  Google Scholar 

  24. Pilotto A, Gallina P, Panza F, Copetti M, Cella A, Cruz-Jentoft A, et al. Relation of statin use and mortality in community-dwelling frail older patients with coronary artery disease. Am J Cardiol. 2016;118(11):1624–30.

    Article  CAS  Google Scholar 

  25. Pilotto A, Polidori MC, Veronese N, Panza F, Arboretti Giancristofaro R, Pilotto A, et al. Association of antidementia drugs and mortality in community-dwelling frail older patients with dementia: the role of mortality risk assessment. J Am Med Dir Assoc. 2018;19(2):162–8.

    Article  Google Scholar 

  26. Fontana L, Addante F, Copetti M, Paroni G, Fontana A, Sancarlo D, et al. Identification of a metabolic signature for multidimensional impairment and mortality risk in hospitalized older patients. Aging Cell. 2013;12(3):459–66.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Geriatric Care, OrthoGeriatrics and Rehabilitation, E.O. Galliera Hospital, Genoa, Italy

    Alberto Pilotto

Authors
  1. Alberto Pilotto
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alberto Pilotto .

Editor information

Editors and Affiliations

  1. Geneva Medical School, University of Geneva, Geneva, Switzerland

    Jean-Pierre Michel

  2. Aging Branch, CNR-Neuroscience Institute, Padua, Italy

    Stefania Maggi

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Pilotto, A. (2019). Comprehensive Geriatric Assessment in Infectious Diseases. In: Michel, JP., Maggi, S. (eds) Adult Vaccinations. Practical Issues in Geriatrics. Springer, Cham. https://doi.org/10.1007/978-3-030-05159-4_8

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-05159-4_8

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-05158-7

  • Online ISBN: 978-3-030-05159-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation