Clinical prognostic factors for older people: A systematic review and meta-analysis.

OBJECTIVE: To explore the accuracy and precision of prognostic tools used in older people in predicting mortality, hospitalization, and nursing home admission across different settings and timings. DESIGN: Systematic review and meta-analysis of prospective and retrospective studies. DATA SOURCES: A systematic search from database inception until 01st February 2023 was run in Medline, Embase, Cinhal, Cochrane Library. ELIGIBILITY CRITERIA: Studies were eligible if they reported accuracy (area under the curve [AUC]) and/or precision (C-index) for the prognostic index in relation to any of the following outcomes: mortality, hospitalization, and nursing home admission. DATA EXTRACTION AND SYNTHESIS: Two independent reviewers extracted data. Data were pooled using a random effects model. The risk of bias was assessed with the Quality in Prognosis Studies (QUIPS) tool. If more than three studies for the same setting and time were available, a meta-analysis was performed and evaluated using the GRADE tool; other data were reported descriptively. RESULTS: Among 16,082 studies initially considered, 159 studies with a total of 2398856 older people (mean age: 78 years) were included. The majority of the studies was carried out in hospital or medical wards. In the community setting, only two tools (Health Assessment Tool and the Multidimensional Prognostic Index, MPI) had good precision for long-term mortality. In emergency department setting, Barthel Index had an excellent accuracy in predicting short-term mortality. In medical wards, the MPI had a moderate certainty of the evidence in predicting short-term mortality (13 studies; 11,787 patients; AUC=0.79 and 4 studies; 3915 patients; C-index=0.82). Similar findings were available for MPI when considering longer follow-up periods. When considering nursing home and surgical wards, the literature was limited. The risk of bias was generally acceptable; observed bias was mainly owing to attrition and confounding. CONCLUSIONS: Several tools are used to predict poor prognosis in geriatric patients, but only those derived from a multidimensional evaluation have the characteristics of precision and accuracy.

Effect of COVID-19 quarantine on cognitive, functional and neuropsychiatric symptoms in patients with mild cognitive impairment and dementia.

BACKGROUND: During the last two years, COVID-19 affected older people with dementia or mild cognitive impairment (MCI), but conflicting and sparse results are still present. The objective of this study was to investigate the frequency and type of changes in functional, cognitive and behavioral and psychological symptoms of dementia (BPSD), and caregiver's stress during the period of quarantine in 2020 in patients affected by dementia/MCI living in Palermo, Sicily. METHODS: Outpatients affected by MCI/dementia were evaluated before and after COVID-19 quarantine. Functional status was investigated using basic and instrumental activities of daily living (ADL); cognitive performance with the mini-mental state examination; BPSD through the neuropsychiatric inventory (NPI). All scales were reported as pre/post-COVID-19 quarantine and a logistic regression analysis was performed for investigating the factors associated with worsening in NPI in patients and their caregivers. RESULTS: One hundred patients (mean age 77.1; females = 59%) were evaluated over a median of 10 months. In the sample as whole, a significant decline in functional and cognitive status was observed (p < 0.001 for both comparisons). The NPI significantly increased by 3.56 ± 8.96 points after the COVID-19 quarantine (p < 0.0001), while the caregivers' stress increased by 1.39 ± 3.46 points between the two evaluations (p < 0.0001). The decline was more evident in people with milder dementia. Higher values of instrumental ADL at baseline were associated with a significant lower worsening in NPI and caregiver's stress. CONCLUSIONS: COVID-19 quarantine negatively affected functional, cognitive, and neuropsychiatric symptoms in older people affected by dementia/MCI, highlighting the impact of COVID-19 quarantine for this population.