Battaggia Alessandro, Scalisi Andrea, Franco Novelletto Bruno, Fusello Massimo, Michieli Raffaella, Cancian Maurizio
Italian Society of General Medicine and Primary Care (SIMG) Via del Sansovino 179 - 50142Firenze, Italia.
Veneto's School of General Medicine (SVEMG) Via Pelosa, 78 -35030 Selvazzano dentro Padova, Italia.
J Drug Assess. 2019 Jan 3;8(1):1-12. doi: 10.1080/21556660.2018.1563549. eCollection 2019.
Both frailty and multimorbidity are strong predictors of clinical endpoints for older people. In Italy, the interventions targeting chronicity are mainly based on the treatment of diseases: sufficient epidemiological literature is available about these strategies. Less is known about the territorial distribution of the frailty status. To estimate the prevalence of frailty in older people (65+) and to evaluate the relationship between frailty and multimorbidity. A group of general practitioners working in Veneto (Italy) was enrolled on a voluntary basis. Older individuals were both community dwelling and institutionalized patients, that is, the older people normally followed by Italian general practitioners. A centrally randomized sample was extracted from the pool of physician-assisted elderly. Each doctor evaluated the frailty status through the CSHA Clinical Frailty Scale and the multimorbidity status through the Charlson score (Frailty = CSHA Clinical Frailty Scale's score >4; serious multimorbidity = Charlson score ≥4). Prevalence and its confidence interval (CI) 95% were evaluated through the Agresti's method for proportions. The relation between frailty and multimorbidity was studied through a logistic regression model adjusted for age and sex. Fifty-three physicians were enrolled, whose population of elderly individuals ( = 82919) was highly representative of the population of Veneto. The prevalence of frailty in the randomized sample of 2407 older people was 23.18% (CI 95%: 21.53%-24.91%). Sex was shown to be a strong predictor of frailty (female status OR = 1.58 < .0001) and multimorbidity was shown to be an independent predictor only for individuals <85 years of age. In Veneto, more than 20% of elderly people are frail. Physicians should pay close attention to frailty and multimorbidity because both are important prognostic factors toward clinical endpoints relevant to territorial care. The CSHA Clinical Frailty Scale (easy and quick) should become part of their professional routine.
衰弱和多病共存都是老年人临床终点的有力预测因素。在意大利,针对慢性病的干预措施主要基于疾病治疗:关于这些策略有足够的流行病学文献。而对于衰弱状态的地域分布了解较少。为了估计老年人(65岁及以上)中衰弱的患病率,并评估衰弱与多病共存之间的关系。一组在意大利威尼托地区工作的全科医生自愿参与。老年个体包括社区居民和机构化患者,即通常由意大利全科医生随访的老年人。从医生协助的老年人样本库中抽取中心随机样本。每位医生通过CSHA临床衰弱量表评估衰弱状态,并通过查尔森评分评估多病共存状态(衰弱=CSHA临床衰弱量表得分>4;严重多病共存=查尔森评分≥4)。通过阿格雷斯蒂比例法评估患病率及其95%置信区间(CI)。通过调整年龄和性别的逻辑回归模型研究衰弱与多病共存之间的关系。招募了53名医生,其老年个体群体(n=82919)具有威尼托地区人口的高度代表性。在2407名老年人的随机样本中,衰弱的患病率为23.18%(95%CI:21.53%-24.91%)。性别被证明是衰弱的有力预测因素(女性状态OR=1.58,P<0.0001),而多病共存仅对85岁以下个体是独立预测因素。在威尼托,超过20%的老年人衰弱。医生应密切关注衰弱和多病共存,因为两者都是与地域护理相关的临床终点的重要预后因素。CSHA临床衰弱量表(简单快捷)应成为他们专业日常工作的一部分。