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An interconnected system employing Kinect Azure and Fitbit Sense for continuous and non-intrusive data collection was used in the PRO-HOME protected discharge program, aiming at monitoring functional and clinical parameters in hospitalized older patients at different risks of frailty. The present study shows the findings on 30 older patients included in the PRO-HOME project. The Fitbit Sense recorded the mean daily and hourly number of steps, mean daily walked distance, and time spent inactive. Moreover, Kinect infrared camera captured gait speed and daily mean latero-lateral (body sway) and antero-posterior oscillations (lean-in). Patients underwent a standard Comprehensive Geriatric Assessment (CGA) to compute the Multidimensional Prognostic Index (MPI), including basic and instrumental activities of daily living (ADL, IADL), cognition (Short Portable Mental Status Questionnaire, SPMSQ) and nutrition, risk of pressure sores (Exton-Smith Scale, ESS), comorbidity, number of drugs and cohabitation status. Significant correlations between the mean hourly number of steps and MPI ( p  = 0.022), IADL ( p  = 0.013), SPMSQ ( p  = 0.006), ESS ( p  = 0.009), and both mean and maximum automated gait speed ( p  = 0.046 and p  = 0.048) were found. Automated gait speed was also correlated with mean walked distance per day ( p  = 0.007) and lean-in ( p  = 0.047). Domotic technological monitoring through Fitbit Sense and Kinect Azure provides information on multidimensional frailty, including mobility and cognitive and functional status, in older people.

Background Multicomponent interventions based on a comprehensive geriatric assessment (CGA) could promote active aging and improve health status in older people with Noncommunicable Chronic Diseases (NCDs), but conflicting evidences are available. Aim To evaluate the efficacy of a CGA-based multicomponent personalized preventive program (PPP) in reducing unplanned hospitalization rates during 12-month follow-up in community-dwelling older people with NCDs. Materials and methods In this randomized clinical trial (RCT), 1216 older adults recruited by 33 general practitioners (GPs) will be randomly allocated to intervention group (IG) or usual care control group (CG). The IG will receive a multicomponent PPP developed on the findings of the CGA-based Multidimensional Prognostic Index short-form (Brief-MPI), including structured interventions to improve functional, physical, cognitive, and nutritional status, to monitor NCDs and vaccinations, and to prevent social isolation. Participants in the CG will receive usual care. Brief-MPI, resilience, and health-related quality of life will be assessed after 6 and 12 months. Moreover, saliva samples will be collected at baseline in IG to measure biomarkers of oxidative stress, inflammatory cytokines, and oral microbiome. Expected results The CGA-based PPP might reduce unplanned hospitalization rates and potentially institutionalization rates, emergency department (ED) and unplanned GP visits, and mortality. Further outcomes explored in the IG will be the adherence to PPP, resilience, health-related quality of life, and multidimensional frailty as assessed by the Brief-MPI. Conclusions Results will suggest whether the CGA-based multicomponent PPP is able to improve specific outcomes in a primary care setting. Trial registration ClinicalTrials.gov; identifier: NCT06224556 ; Registered January 25, 2024.

Background: The MULTIPLAT_AGE is a network project which developed a digital platform based on the Comprehensive Geriatric Assessment (CGA) for collecting data and identifying personalized healthcare programs for older people at home. In this article, the final recommendations of the MULTIPLAT_AGE Working Group are reported. Methods: The MULTIPLAT_AGE project included five independent studies developed and carried out by five research centers according to two common principles previously shared by the researchers: (i) the multidimensional approach to older people through the CGA-based Multidimensional Prognostic Index (MPI); (ii) the use of a common web-based platform for collecting data to facilitate healthcare interventions of older people at their home according to the aging in place approach. At the end of the studies, a series of recommendations have been proposed by an expert panel including the principal investigators and discussed by all researchers involved in the MULTIPLAT_AGE project in formal meetings. After discussion, the recommendations have been approved with formal vote by all the researchers during the final meeting of the MULTIPLAT_AGE project. Results: The recommendations are addressed to healthcare providers, policy decision-makers, caregivers, and patients. In summary, the CGA-based interventions and technologies adopted in the MULTIPLAT_AGE project reduced length of hospital stay, improved multidimensional frailty, walking safety, physical and cognitive performances, and reduced fear of falling in older people across different clinical settings and suffering from different diseases. Conclusions: The final recommendations of the MULTIPLAT_AGE Working Group could be a useful instrument to facilitate the use of technologies along with CGA-based interventions to improve the management of older people at home.

Background In Europe around 40% of people aged ≥ 65 years are affected by multiple non-communicable chronic diseases (NCDs). The Comprehensive Geriatric Assessment (CGA) showed its usefulness in early identifying healthcare needs of older people with NCDs to develop a care plan to meet these needs. PrimaCare_P3 study aims at assessing healthcare needs of older people referring to their general practitioners (GPs) to plan a personalised prevention programme (PPP) based on the results of the CGA-based short version of the Multidimensional Prognostic Index (BRIEF-MPI). Methods 612 participants with at least one NCDs were included in the intervention group (IG) by twenty GPs from four geographical areas. Functional, cognitive, nutritional, social and co-habitation conditions, co-morbidity, polytherapy, and vaccination status were assessed. Following the CGA-based BRIEF-MPI assessment, participants were provided with a PPP, consisting of targeted indications and interventions including prescribed specialistic examinations, if needed. Results Polytherapy and nutritional status were the most impaired domains with 59% of participants showing severe polypharmacy requiring a deprescribing strategy on GP’s judgement while 25% of participants being malnourished or overweight/obese. Moreover, 22% of participants showed cognitive impairment requiring intervention, 18.5% were at risk of social isolation and/or loneliness, and 16.5% had some form of functional impairments in activities of daily living. Missing vaccinations according to the National Vaccination Prevention Plan (PNPV) were anti-influenza (34%), anti-COVID-19 (45%), anti-pneumococcus (74%), anti-herpes zoster (89%). Conclusions These data suggest that the CGA-based BRIEF-MPI assessment could effectively identify older adults’ healthcare needs to be addressed with a PPP in general practice setting. Trial registration Registered on clinicaltrials.gov, NCT06224556, 05-01-2024.

Background: The Friends and Family Interview (FFI) is assumed to be a valid method to study attachment stability and attachment-related psychopathological processes in adolescence, but no studies have yet tested the test–retest reliability of this interview or the longitudinal association of attachment patterns in response to the FFI from adolescents with symptoms such as psychotic-like experiences (e.g., hallucinations, bizarre behavior, dissociation, self-harm) that are known to have increased during the COVID-19 pandemic. Methods: This study involved 102 community adolescents (M = 14.64, SD = 1.63, 46% males) assessed twice: during a severe COVID-19-related lockdown (in Italy) (T1) and four months later (T2). Measures were the FFI (assessing attachment patterns: secure-autonomous, insecure-dismissing, insecure-preoccupied, and insecure-disorganized) and the thought problems scale of the Youth Self-Report to assess psychotic-like symptoms. Results: revealed high stability of four-way attachment classifications over four months (93.5%), with a modest yet significant link between higher disorganization at T1 and higher scores of thought problems at T2, p = 0.010. Conclusions: The FFI shows high test–retest reliability and can be a valid, age-adapted option to assess adolescents’ attachment. Attachment disorganization should be further investigated as possibly related to psychotic-like experiences in community adolescents.

Background The guideline was promoted by the Italian General Practitioners-Primary Care and Geriatrics Hospital-Community Societies and was carried out involving the National Institute of Health and an Expert Panel including representatives from 25 Scientific and Health-Professional Organizations. The aim of the Guideline was to develop evidence-based recommendations on the efficacy of CGA in older people across different clinical settings and the accuracy and utility of CGA-based tools to assess prognosis. Methods According to the methodological handbook of the Italian National System of Guidelines and NICE criteria (National Institute for Health and Care Excellence in England), the Guideline was produced based on the Grading of Recommendations Assessment, Development and Evaluation. Over 20,000 records gathered through databases searches were initially selected. Sixteen recommendations on CGA efficacy were defined based on 117 studies that met the inclusion criteria and were performed in general practices and primary care (26 studies included), medical and surgical clinics (16 studies), emergency departments (17 studies), hospital medical and surgical wards (53 studies), long-term care facilities and nursing homes (5 studies), hospices and palliative care networks (no studies). Nine recommendations on CGA-based prognostic tools were issues based on 42 included studies carried out in general practices and primary care (5 studies), medical and surgical clinics (4 studies), and hospital wards (33 studies). Results Using CGA can be useful to reduce hospitalization, mortality, institutionalization, the risk of delirium, and improve appropriateness in drug prescription and maintain functional activities in different settings. Further research on the efficacy of CGA in rehabilitative facilities, nursing homes, and hospice and palliative-care settings is recommended. CGA-based tools, particularly the Multidimensional Prognostic Index, should be used to predict some negative outcomes in different settings. Conclusions This Guideline may be useful in clinical practice and as a tool to support research on the use of CGA in older people.

Background The Multidimensional Evaluation of Elderly Person Form (SVaMA) is the official Comprehensive Geriatric Assessment (CGA) tool in most Italian regions for assessing medical, social, and functional needs of community-dwelling older people and developing an integrated care plan to meet them. The Multidimensional Prognostic Index (MPI) is a validated CGA-based tool for predicting mortality, other negative health outcomes and assessing multidimensional frailty. SVaMA’s wide diffusion in clinical practice prompted the development of an MPI version based on its data (MPI-SVaMA). Aims Assessing the usefulness in predicting mortality of a new digital version of the MPI-SVaMA (MPI-SVaMA Digit) through a simpler model. Methods In this retrospective cohort study, 12.020 community-dwelling older people (≥ 65 years) who underwent the SVaMA in Veneto, Italy were included. One-month and one-year mortality rates were retrieved from Registry Offices. The MPI-SVaMA Digit was obtained by assigning a risk category to each domain assessed in the SVaMA. Accuracy and precision were assessed using Area Under the Curve (AUC) and concordance index (C-index). The association between MPI-SVaMA Digit and mortality was evaluated through Cox regression analysis. Results The MPI-SVaMA Digit showed good accuracy and precision in predicting 1-month (AUC = 0.78; 95%CI 0.75–0.81, C-index = 0.78 95%CI 9.75–0.81) and 1-year mortality (AUC = 0.77; 95%CI 0.76–0.78, C-index = 0.72 95%CI 0.71–0.74). People at moderate and severe risk of multidimensional frailty showed, respectively a 4-fold and 12-fold increased mortality risk than the group at mild risk. Conclusion The new MPI-SVaMA Digit is an accurate prognostic tool for short- and long-term mortality useful to address clinical and organizational demands in community-dwelling older people.

Background Longer length of hospital stay (LOS) negatively affects the organizational efficiency of public health systems and both clinical and functional aspects of older patients. Data on the effects of transitional care programs based on multicomponent interventions to reduce LOS of older patients are scarce and controversial. Aims The PRO‐HOME study aimed to assess the efficacy in reducing LOS of a transitional care program involving a multicomponent intervention inside a technologically monitored in‐hospital discharge facility. Methods This is a Randomized Clinical Trial on 60 patients (≥65 years), deemed stable and dischargeable from the Acute Geriatrics Unit, equally assigned to the Control Group (CG) or Intervention Group (IG). The latter underwent a multicomponent intervention including lifestyle educational program, cognitive and physical training. At baseline, multidimensional frailty according to the Multidimensional Prognostic Index (MPI), and Health‐Related Quality of Life (HRQOL) were assessed in both groups, along with physical capacities for the IG. Enrolled subjects were evaluated after 6 months of follow‐up to assess multidimensional frailty, HRQOL, and re‐hospitalization, institutionalization, and death rates. Results The IG showed a significant 2‐day reduction in LOS (median days IG = 2 (2–3) vs. CG = 4 (3–6); p  < 0.001) and an improvement in multidimensional frailty at 6 months compared to CG (median score IG = 0.25(0.25–0.36) vs. CG = 0.38(0.31–0.45); p  = 0.040). No differences were found between the two groups in HRQOL, and re‐hospitalization, institutionalization, and death rates. Discussion Multidimensional frailty is a reversible condition that can be improved by reduced LOS. Conclusions The PRO‐HOME transitional care program reduces LOS and multidimensional frailty in hospitalized older patients. Trial registration : ClinicalTrials.gov n. NCT06227923 (retrospectively registered on 29/01/2024).

Background Resilience is a crucial component of successful aging. However, which interventions might increase resilience in older adults is yet unclear. Aims This study aims to assess the feasibility and the physical and psychological effects of a technology-based multicomponent dance movement intervention that includes physical, cognitive, and sensory activation in older people living in community-dwelling and nursing home. Methods DanzArTe program consists of four sessions on a weekly basis, using a technological platform that integrates visual and auditory contents in real time. 122 participants (mean age = 76.3 ± 8.8 years, 91 females = 74.6%) from seven nursing homes and community-dwelling subjects were assessed, before and after the intervention, with the Resilience Scale-14 items (RES-14), the Multidimensional Prognostic Index (MPI), the Psychological General Well-Being Index (PGWBI-S), and the Client Satisfaction Questionnaire-8 (CSQ-8). Mann–Whitney and Wilcoxon signed-ranks tests were used for statistical analyses. Results At baseline significant differences in MPI and RES-14 between community-dwelling and nursing home residents were observed ( p  < 0.001 for both analyses). After the intervention, resilience significantly increased in total sample (RES-14 mean T1 = 74.6 Vs. T2 = 75.7) and in the nursing home residents (RES-14 mean T1 = 68.1 Vs. T2 = 71.8). All participants showed high overall satisfaction for DanzArTe program (CSQ-8 mean = 23.9 ± 4.4). No differences in MPI and PGWBI-S were observed. Discussion DanzArTe was a feasible intervention and high appreciated by all older adults. Nursing home residents revealed improvements in resilience after DanzArTe program. Conclusion The DanzArTe technology-based multi-component intervention may improve resilience in older people living in nursing homes.

Background: The MULTIPLAT_AGE is a network project which developed a digital platform based on the Comprehensive Geriatric Assessment (CGA) for collecting data and identifying personalized healthcare programs for older people at home. In this article, the final recommendations of the MULTIPLAT_AGE Working Group are reported. Methods: The MULTIPLAT_AGE project included five independent studies developed and carried out by five research centers according to two common principles previously shared by the researchers: (i) the multidimensional approach to older people through the CGA-based Multidimensional Prognostic Index (MPI); (ii) the use of a common web-based platform for collecting data to facilitate healthcare interventions of older people at their home according to the aging in place approach. At the end of the studies, a series of recommendations have been proposed by an expert panel including the principal investigators and discussed by all researchers involved in the MULTIPLAT_AGE project in formal meetings. After discussion, the recommendations have been approved with formal vote by all the researchers during the final meeting of the MULTIPLAT_AGE project. Results: The recommendations are addressed to healthcare providers, policy decision-makers, caregivers, and patients. In summary, the CGA-based interventions and technologies adopted in the MULTIPLAT_AGE project reduced length of hospital stay, improved multidimensional frailty, walking safety, physical and cognitive performances, and reduced fear of falling in older people across different clinical settings and suffering from different diseases. Conclusions: The final recommendations of the MULTIPLAT_AGE Working Group could be a useful instrument to facilitate the use of technologies along with CGA-based interventions to improve the management of older people at home.