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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

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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.

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Acknowledgements

Members of MPI_AGE Investigators—Sara B. Angleman: Aging Research Center, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet and Stockholm University, Stockholm, Sweden; Marie-Laure Bureau: Geriatrics Department, University Hospital Poitiers and Centre Investigation Clinique 1402, University of Poitiers, CHU Poitiers, INSERM, Poitiers, France; Thomas Brunet: Geriatrics Department, University Hospital Poitiers and Centre Investigation Clinique 1402, University of Poitiers, CHU Poitiers, INSERM, Poitiers, France; Alberto Cella: Department of Geriatric Care, Orthogeriatrics and Rehabilitation, E.O. Galliera Hospital, Genoa, Italy; Carlo Custodero: Department of Interdisciplinary Medicine, University of Bari, Bari, Italy; Romina Custureri: Department of Geriatric Care, Orthogeriatrics and Rehabilitation, E.O. Galliera Hospital, Genoa, Italy; Angelique Egberts: Erasmus University Medical Center, Rotterdam, The Netherlands; Mario Durando: Geriatrics Unit, San Antonio Hospital, Padua, Italy; Alberto Ferri: Department of Geriatric Care, Orthogeriatrics and Rehabilitation, E.O. Galliera Hospital, Genoa, Italy; Pietro Gallina: Geriatrics Unit, San Antonio Hospital, Padua, Italy; Dirk Hoffmann: Ageing Clinical Research, Dpt. II of Internal Medicine and Center of Molecular Medicine, University of Cologne Medical Faculty, Cologne, Germany; Evelyne Liuu: Geriatrics Department, University Hospital Poitiers and Centre Investigation Clinique 1402, University of Poitiers, CHU Poitiers, INSERM, Poitiers, France; Pavla Madlova: First Faculty of Medicine, Charles University in Prague, Czech Republic; Anna Meyer: Ageing Clinical Research, Dpt. II of Internal Medicine and Center of Molecular Medicine, University of Cologne Medical Faculty, Cologne, Germany; Helena Michalkova: First Faculty of Medicine, Charles University in Prague, Czech Republic; Carmen Miret-Corchado: Servicio de Geriatría, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain; Beatriz Montero-Errasquin: Servicio de Geriatría, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain; Clarissa Musacchio: Department of Geriatric Care, Orthogeriatrics and Rehabilitation, E.O. Galliera Hospital, Genoa, Italy; Matteo Puntoni: Department of Geriatric Care, Orthogeriatrics and Rehabilitation, E.O. Galliera Hospital, Genoa, Italy; Kimberley Ruxton: Department of Clinical Pharmacology, College of Medicine and Public Health, Flinders University and Flinders Medical Centre, Adelaide, Australia; Carlo Sabbà: Department of Interdisciplinary Medicine, University of Bari, Bari, Italy; Gioia Santoni: Aging Research Center, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet and Stockholm University, Stockholm, Sweden; Ralf-Joachim Schulz: Ageing Clinical Research, Dpt. II of Internal Medicine and Center of Molecular Medicine, University of Cologne Medical Faculty, Cologne, Germany; Matteo Simonato: Geriatrics Unit, San Antonio Hospital, Padua, Italy; Giacomo Siri: Department of Geriatric Care, Orthogeriatrics and Rehabilitation, E.O. Galliera Hospital, Genoa, Italy; Janet Sultana: Erasmus University Medical Center, Rotterdam, The Netherlands; Lisanne Tap: Erasmus University Medical Center, Rotterdam, The Netherlands; Gianluca Trifirò: Erasmus University Medical Center, Rotterdam, The Netherlands; Anna-Karin Welmer: Aging Research Center, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet and Stockholm University, Stockholm, Sweden.

Funding

This work was supported by the MPI_AGE European project co-funded by the Consumers, Health, Agriculture, and Food Executive Agency (CHAFEA) in the frame of the European Innovation Partnership on Active and Healthy Ageing Second Health Programme 2008–2013. The contents of this article are the sole responsibility of the above mentioned authors and can under no circumstances be regarded as reflecting the position of the European Union. The funding agencies had no role in design or conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.

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Authors and Affiliations

  1. Servicio de Geriatría, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain

    Alfonso J. Cruz-Jentoft

  2. Geriatrics Unit, San Antonio Hospital, Padua, Italy

    Julia Daragjati

  3. Aging Research Center, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet and Stockholm University, Stockholm, Sweden

    Laura Fratiglioni

  4. Aging Section, National Research Council, Padua, Italy

    Stefania Maggi

  5. Department of Clinical Pharmacology, College of Medicine and Public Health, Flinders Medical Centre, Flinders University, Adelaide, Australia

    Arduino A. Mangoni

  6. Erasmus University Medical Center, Rotterdam, The Netherlands

    Francesco Mattace-Raso

  7. Geriatrics Department, University Hospital Poitiers and Centre Investigation Clinique 1402, University of Poitiers, CHU Poitiers, INSERM, Poitiers, France

    Marc Paccalin

  8. Ageing Clinical Research, Dpt. II of Internal Medicine and Center of Molecular Medicine, University of Cologne Medical Faculty, Cologne, Germany

    Maria Cristina Polidori

  9. First Faculty of Medicine, Charles University, Prague, Czech Republic

    Eva Topinkova

  10. National Institute on Aging, Baltimore, MD, USA

    Luigi Ferrucci

  11. Department of Geriatric Care, Orthogeriatrics and Rehabilitation, E.O. Galliera Hospital, Mura delle Cappuccine 14, 16128, Genoa, Italy

    Alberto Pilotto

  12. Department of Interdisciplinary Medicine, University of Bari, Bari, Italy

    Alberto Pilotto

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  1. Alfonso J. Cruz-Jentoft
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  2. Julia Daragjati
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Consortia

on behalf of the MPI_AGE Investigators

  • Sara B. Angleman
  • , Marie-Laure Bureau
  • , Thomas Brunet
  • , Alberto Cella
  • , Carlo Custodero
  • , Romina Custureri
  • , Angelique Egberts
  • , Mario Durando
  • , Alberto Ferri
  • , Pietro Gallina
  • , Dirk Hoffmann
  • , Evelyne Liuu
  • , Pavla Madlova
  • , Anna Meyer
  • , Helena Michalkova
  • , Carmen Miret-Corchado
  • , Beatriz Montero-Errasquin
  • , Clarissa Musacchio
  • , Matteo Puntoni
  • , Kimberley Ruxton
  • , Carlo Sabbà
  • , Gioia Santoni
  • , Ralf-Joachim Schulz
  • , Matteo Simonato
  • , Giacomo Siri
  • , Janet Sultana
  • , Lisanne Tap
  • , Gianluca Trifirò
  •  & Anna-Karin Welmer

Corresponding author

Correspondence to Alberto Pilotto.

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Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical approval

A formal ethical statement was not required, since this is a review of previously published articles.

Statement of human and animal rights

All human and animal studies have been approved by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

The members of the MPI_AGE Investigators are listed in Acknowledgements section.

Appendices

Appendix 1

See Table 2.

Table 2 Recommendations for decision-makers to improve cost-effectiveness of health care for older, complex patients
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Appendix 2

See Table 3.

Table 3 Recommendations for the general public to improve cost-effectiveness of health care for older, complex patients
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Cruz-Jentoft, A.J., Daragjati, J., Fratiglioni, L. et al. 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. Aging Clin Exp Res 32, 861–868 (2020). https://doi.org/10.1007/s40520-020-01516-0

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