Comprehensive Geriatric Assessment in Infectious Diseases

Abstract

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.