Comprehensive Geriatric Assessment in Infectious Diseases

  • Alberto PilottoEmail author
Part of the Practical Issues in Geriatrics book series (PIG)


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.


Comprehensive geriatric assessment (CGA) Multidimensional prognostic index (MPI) Community-acquired pneumonia (CAP) Older Mortality risk Multidimensional assessment Infectious disease Elderly Functional decline Ageing Frailty Prognosis Risk factors Decision-making 


  1. 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.CrossRefGoogle Scholar
  2. 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.CrossRefGoogle Scholar
  3. 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.CrossRefGoogle Scholar
  4. 4.
    Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people. Lancet. 2013;381(9868):752–62.CrossRefGoogle Scholar
  5. 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.CrossRefGoogle Scholar
  6. 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.CrossRefGoogle Scholar
  7. 7.
    Mody L, Juthani-Mehta M. Urinary tract infections in older women: a clinical review. JAMA. 2014;311(8):844–54.CrossRefGoogle Scholar
  8. 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.CrossRefGoogle Scholar
  9. 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. 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.CrossRefGoogle Scholar
  11. 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.CrossRefGoogle Scholar
  12. 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.CrossRefGoogle Scholar
  13. 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.CrossRefGoogle Scholar
  14. 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.CrossRefGoogle Scholar
  15. 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.PubMedGoogle Scholar
  16. 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.CrossRefGoogle Scholar
  17. 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.CrossRefGoogle Scholar
  18. 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.CrossRefGoogle Scholar
  19. 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.CrossRefGoogle Scholar
  20. 20.
    Dent E, Kowal P, Hoogendijk EO. Frailty measurement in research and clinical practice: a review. Eur J Intern Med. 2016;31:3–10.CrossRefGoogle Scholar
  21. 21.
    Mitnitski AB, Mogilner AJ, Rockwood K. Accumulation of deficits as a proxy measure of aging. ScientificWorldJournal. 2001;1:323–36.CrossRefGoogle Scholar
  22. 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.CrossRefGoogle Scholar
  23. 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.CrossRefGoogle Scholar
  24. 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.CrossRefGoogle Scholar
  25. 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.CrossRefGoogle Scholar
  26. 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.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Geriatric Care, OrthoGeriatrics and RehabilitationE.O. Galliera HospitalGenoaItaly

Personalised recommendations