The potential impact of multidimesional geriatric assessment in the social security system

  • Graziamaria Corbi
  • Immacolata Ambrosino
  • Marco Massari
  • Onofrio De Lucia
  • Sirio Simplicio
  • Michele Dragone
  • Giuseppe Paolisso
  • Massimo Piccioni
  • Nicola Ferrara
  • Carlo Pietro Campobasso
Original Article
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Abstract

Aim

To evaluate the efficacy of multidimensional geriatric assessment (MGA/CGA) in patients over 65 years old in predicting the release of the accompaniment allowance (AA) indemnity by a Local Medico-Legal Committee (MLC-NHS) and by the National Institute of Social Security Committee (MLC-INPS).

Methods

In a longitudinal observational study, 200 Italian elder citizens requesting AA were first evaluated by MLC-NHS and later by MLC-INPS. Only MLC-INPS performed a MGA/CGA (including SPMSQ, Barthel Index, GDS-SF, and CIRS). This report was written according to the STROBE guidelines.

Results

The data analysis was performed on January 2016. The evaluation by the MLC-NHS and by the MLC-INPS was in agreement in 66% of cases. In the 28%, the AA benefit was recognized by the MLC-NHS, but not by the MLC-INPS. By the multivariate analysis, the best predictors of the AA release, by the MLC-NHS, were represented by gender and the Barthel Index score. The presence of carcinoma, the Barthel Index score, and the SPMQ score were the best predictors for the AA release by MLC-INPS.

Conclusions

MGA/CGA could be useful in saving financial resources reducing the risk of incorrect indemnity release. It can improve the accuracy of the impairment assessment in social security system.

Keywords

Disability Medico-legal assessment Public health Saving resource 

Notes

Compliance with ethical standards

Conflict of interest

The author declares that there are no competing interests.

Ethical approval

The study was in accordance with the ethical standards of the responsible committee on human experimentation and the Helsinki Declaration of 1975, as revised in 2013. The Ethics Committee of Molise University approved the protocol.

Informed consent

Informed consent was obtained from all patients included.

References

  1. 1.
    Beard JR, Officer A, de Carvalho IA et al (2016) The World report on ageing and health: a policy framework for healthy ageing. Lancet 387:2145–2154.  https://doi.org/10.1016/S0140-6736(15)00516-4CrossRefPubMedGoogle Scholar
  2. 2.
    Pammolli F, Riccaboni M, Magazzini L (2012) The sustainability of European health care systems: beyond income and aging. Eur J Health Econ 13:623–634.  https://doi.org/10.1007/s10198-011-0337-8CrossRefGoogle Scholar
  3. 3.
    Christensen K, Doblhammer G, Rau R et al (2009) Ageing populations: the challenges ahead. Lancet 374:1196–1208.  https://doi.org/10.1016/S0140-6736(09)61460-4CrossRefGoogle Scholar
  4. 4.
    Olshansky SJ, Antonucci T, Berkman L et al (2012) Differences in life expectancy due to race and educational differences are widening, and many may not catch up. Health Aff 31:1803–1813. https://doi.org/10.1377/hlthaff.2011.0746CrossRefGoogle Scholar
  5. 5.
    Eurostat (2015) The Ageing Report 2015. Underlying Assumptions and Projection Methodologies. European Economy 8|2014. http://europa.eu/epc/pdf/ageing_report_2015_en.pdf. Accessed 07 July 2017
  6. 6.
    ISTAT (2015) Popolazione e famiglie. Annuario Statistico Italiano, pp 71–108. http://www.istat.it/it/files/2015/12/Asi-2015.pdf. Accessed 09 Aug 2017
  7. 7.
    World Health Organization (2015) Health in older age. World report on ageing and health. WHO, Luxembourg pp 43–88Google Scholar
  8. 8.
    Legislative Decree of 23 November 1988, n. 509, on Amendments of the Decree-Law Art. 2 n. 118 of 30 March 1971 on “Standards for the review of the categories of disabilities and disabling diseases, as well as the benefits provided by the legislation in force for the same categories”Google Scholar
  9. 9.
    Law no. 18, Article 1, of 11 February 1980, on “Accompaniment Allowance to totally disabled invalids”Google Scholar
  10. 10.
    Law no. 508 Article 1, comma. 2, letter b of 21 November 1988, on “Supplementary rules on economic assistance to disabled civilians, the civilian blind and deaf”Google Scholar
  11. 11.
    Law no. 102, art. 20, of 3 August 2009 on “Fight against fraud in the field of disability support”Google Scholar
  12. 12.
    Pfeiffer E (1975) A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients. J Am Geriatr Soc 23:433–441.  https://doi.org/10.1111/j.1532-5415.1975.tb00927.xCrossRefGoogle Scholar
  13. 13.
    Malhotra C, Chan A, Matchar D et al (2013) Diagnostic performance of Short Portable Mental Status Questionnaire for screening dementia among patients attending cognitive assessment clinics in Singapore. Ann Acad Med Singapore 42:315–319PubMedGoogle Scholar
  14. 14.
    Granger CV, Dewis LS, Peters NC et al (1979) Stroke rehabilitation: analysis of repeated Barthel index measures. Arch Phys Med Rehabil 60:14–17Google Scholar
  15. 15.
    Alden D, Austin C, Sturgeon R (1989) A correlation between the geriatric depression scale long and short forms. J Gerontol 44:124–125CrossRefGoogle Scholar
  16. 16.
    Parmelee PA, Thuras PD, Katz IR et al (1995) Validation of the cumulative illness rating scale in a geriatric residential population. J Am Geriatr Soc 43:130–137CrossRefPubMedGoogle Scholar
  17. 17.
    Gallo V, Egger M, McCormack V et al (2012) STrengthening the reporting of observational studies in epidemiology—molecular epidemiology (STROBE-ME): an extension of the STROBE statement. Eur J Clin Invest 2:1–16.  https://doi.org/10.1111/j.1365-2362.2011.02561.xCrossRefGoogle Scholar
  18. 18.
    Erkinjuntti T, Sulkava R, Wikstrom J et al (1987) Short portable mental status questionnaire as a screening test for dementia and delirium among the elderly. J Am Geriatr Soc 35:412–416CrossRefPubMedGoogle Scholar
  19. 19.
    Albert M, Smith LA, Scherr PA et al (1991) Use of brief cognitive tests to identify individuals in the community with clinically diagnosed Alzheimer’s disease. Int J Neurosci. 57:167–178CrossRefGoogle Scholar
  20. 20.
    Shah S, Vanclay F, Cooper B (1989) Improving the sensitivity of the Barthel Index for stroke rehabilitation. J Clin Epidemiol 42:703–709CrossRefPubMedGoogle Scholar
  21. 21.
    Hsueh IP, Lee MM, Hsieh CL (2001) Psychometric characteristics of the Barthel activities of daily living index in stroke patients. J Formos Med Assoc 100:526–532Google Scholar
  22. 22.
    Leung SO, Chan CC, Shah S (2007) Development of a Chinese version of the modified Barthel Index. Clin Rehabil 21:912–922CrossRefPubMedGoogle Scholar
  23. 23.
    Sainsbury A, Seebass G, Bansal A et al (2005) Reliability of the Barthel when used with older people. Age Ageing 34:228–232CrossRefPubMedGoogle Scholar
  24. 24.
    [No authors listed] (1988) National Institutes of Health Consensus Development Conference Statement: geriatric assessment methods for clinical decision-making. J Am Geriatr Soc 36:342–347CrossRefGoogle Scholar
  25. 25.
    Rubenstein LZ (2004) Joseph T. Freeman award lecture: comprehensive geriatric assessment: from miracle to reality. J Gerontol A Biol Sci Med Sci. 59(5):473–477CrossRefGoogle Scholar
  26. 26.
    Ekdahl AW, Sjöstrand F, Ehrenberg A et al (2015) Frailty and comprehensive geriatric assessment organized as CGA-ward or CGA-consult for older adult patients in the acute care setting: a systematic review and meta-analysis. Eur Geriatr Med 6:523–540.  https://doi.org/10.1016/j.eurger.2015.10.007CrossRefGoogle Scholar
  27. 27.
    Ellis G, Whitehead MA, Robinson D et al (2011) Comprehensive geriatric assessment for older adults admitted to hospital: meta-analysis of randomised controlled trials. BMJ 343:d6553.  https://doi.org/10.1136/bmj.d6553CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Baztán JJ, Suárez-García FM, López-Arrieta J et al (2009) Effectiveness of acute geriatric units on functional decline, living at home, and case fatality among older patients admitted to hospital for acute medical disorders: meta-analysis. BMJ 338:b50.  https://doi.org/10.1136/bmj.b50CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Ekdahl AW, Wirehn AB, Alwin J et al (2015) Costs and effects of an ambulatory geriatric unit (the AGe-FIT Study): a randomized controlled trial. J Am Med Dir Assoc 16:497–503.  https://doi.org/10.1016/j.jamda.2015.01.074CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Graziamaria Corbi
    • 1
  • Immacolata Ambrosino
    • 2
  • Marco Massari
    • 3
  • Onofrio De Lucia
    • 4
  • Sirio Simplicio
    • 2
  • Michele Dragone
    • 3
  • Giuseppe Paolisso
    • 5
  • Massimo Piccioni
    • 4
  • Nicola Ferrara
    • 6
  • Carlo Pietro Campobasso
    • 7
  1. 1.Department of Medicine and Health Sciences “V. Tiberio”University of MoliseCampobassoItaly
  2. 2.Operative Unit INPS of Bari 2BariItaly
  3. 3.Regional Coordination Office INPS of PugliaBariItaly
  4. 4.National General Coordination Office INPSRomeItaly
  5. 5.Department of Medical, Surgical, Neurological, Aging and Metabolic SciencesUniversity of Campania “L. Vanvitelli”NaplesItaly
  6. 6.Department of Translational Medical SciencesFederico II University of NaplesNaplesItaly
  7. 7.Department of Experimental MedicineUniversity of Campania “L. Vanvitelli”NaplesItaly

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