The burden of frailty in older people visiting GPs in Veneto and Sicily, Italy

Abstract

Context: In Italy, little is known about the territorial distribution of the frailty status.

Aims: To compare frailty- and multimorbidity-prevalence in the elderly population of two Italian regions.

Methods: This study examined randomized samples of elderly (both community dwelling and institutionalized) assisted by general practitioners. Frailty was evaluated through the CSHA-Scale, multimorbidity through the Charlson-Score. The relation between frailty and multimorbidity was studied through a logistic model. Both crude and standardized prevalences were calculated.

Results: One hundred and sixteen physicians assisted 176,503 patients highly representative of Italian people. In a randomized sample of 4,531 older people, the sex–age-standardized prevalence of Frailty (standard population: Italy) was 25.74% (24.63–26.85%). Age-standardized prevalence for males was 20.08% (18.46–21.71%) and 30.00% (28.54–31.57%) for females. Using the sex–age-standardization pooled sample, the prevalence of frailty was significantly higher in Sicily than Veneto (28.74% [27.03–30.46%] vs 22.30% [20.94–23.67%]. This study did not find differences in the prevalence of multimorbidity: Veneto 20.76% (19.21–22.31%); Sicily 22.05% (20.33–23.77%). Both “to be female” and “to live in Sicily” were shown to be predictors of frailty OR for being female = 1.64 (1.42–1.88); OR for living in Sicily = 1.27 (1.11–1.46). Multimorbidity was an independent frailty-predictor only for those aged < 85: OR of Charlson Index ≥ 4 for ages < 85 = 3.44 (2.88–4.11), OR for ages ≥ 85 = 1.44 (0.97–2.12).

Limitations: (1) This study considered patients assisted by doctors, not a random sample of the general population. (2) The cross-sectional nature of the study limits the interpretation of the relationships between frailty and multi-morbidity. (3) Few covariates were available for our multivariate models.

Conclusions: More than 1/4 of elderly persons are shown to be frail (1/5 of males and 1/3 of females). Frailty is more frequent in Sicily, while multimorbidity does not differ between the two regions. This could be due to regional differences in the organization of care networks dedicated to elderly patients.

Keywords:

• Elderly
• Rockwood Clinical Frailty scale
• frailty
• Charlson score
• multimorbidity
• cross-sectional design
• prevalence

Transparency

Declaration of funding

There is no funding to declare.

Declaration of financial/other relationships

The authors and JDA peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgements

We are grateful for the important contribution in the recruitment of researchers to: Musto Martina^1,2, Carraro Alessandro², Pirolo Giulio^1–3, Ioverno Enrico^1,2,4, Franchini C. Andrea^1,2,5, De Conto Umberto^1,2,6, Galvano Luigi^1,9, and Li Puma Giusy⁹. We thank for participating actively as researchers of “Italian Study Group on the Elderly”:

For Veneto

Pirolo Giulio³, Balzan Corrado³, Barilla Giuseppe³, Buzzatti Agostino³, Cassol Maria Antonia³, Mazzorana Michela³, Scarrocchia Luisa³, Zollino Maria Luciana³, Cabri Giovanni⁴, Dolci Alberto⁴, Tonello Paolo⁴, Franchini Carlo Andrea⁵, Fracasso Isabella⁵, Casalena Michele⁵, Dima Catia⁵, Givanni Silvana⁵, Marrocchella Raffaella⁵, Menini Ernesto⁵, Micchi Alessio⁵, Pastori Caterina⁵, Sciortino Maurizio⁵, Cancian Maurizio⁶, De Conto Umberto⁶, Antiga Gianluigi⁶, Camarotto Antonio⁶, Camerotto Antonio⁶, Dalla Zentil Giovanni⁶, Mulato Giuseppe⁶, Pantaleoni Nicola⁶, Peccolo Franco⁶, Penco Claudio⁶, Pieropan Franco⁶, Pregnolato Umberto⁶, Redetti Marina⁷, Zorgno Nadia⁶, Musto Martina⁷, Michieli Raffaella⁷, Bergamasco Giulio⁷, Blundetto Emanuela⁷, De Zan Antonio⁷, Moressa Maria Pia⁷, Ongaro Andrea⁷, Severi Sandro⁷, Spinardi Francesco⁷, Franco Novelletto Bruno⁸, Bordin Anna⁸, De Gobbi Riccardo⁸, Fanton Livio⁸, Fraccaro Bianca Maria⁸, Franzoso Federico⁸, Merola Gennaro⁸, Bordin Anna⁸, and Simioni Giuliana⁸.

For Sicily

Amodeo Angela¹⁰, Amodeo Vincenzo¹⁰, Arezio Palma Carmela¹¹, Aulicino Maria Caterina¹², Blunda Gaetano¹³, Bongiorno Mario¹⁰, Calderone Rosa Maria¹⁰, Calì Claudia¹⁰, Campo Francesco¹³, Carlino Vincenzo¹⁰, Caudo Giacomo¹¹, Cincotta Gaetano¹¹, Cirrito Francesco¹⁰, Consiglio Girolamo¹⁰, D’Alessandro Rosario¹⁰, D’Aratro Vincenzo¹⁰, Di Carlo Vittorio¹⁰, Di Gregorio Carmelo¹⁴, Disclafani Giuseppe¹⁰, Di Silvestre Baldassare¹⁰, Dolce Antonino Felice¹⁰, Fasulo Serenella¹⁰, Galvano Luigi¹⁰, Gattuso Salvatore¹⁰, Giammalva Maria Giuseppa¹⁰, Giardina Giovanni¹⁵, Giarrusso Paolo¹⁰, Giusa Paolo¹⁴, Greco Andrea¹⁰, Greco Rosa Vincenza¹⁰, Gurgone Francesco¹⁷, Iraci Tindaro¹⁰, La Spia Emanuele¹⁰, La Verde Francesco¹⁶, Liberti Grace¹⁰, Litrico Angelo¹⁴, Lo Bue Giuseppe¹⁰, Lo Giudice Domenico¹³, Lombardo Francesco Paolo¹⁰, Longo Santi¹⁰, Magliozzo Francesco¹⁰, Mannina Giuseppe¹³, Manno Maria Vincenza¹⁰, Merlino Giovanni¹⁰, Milazzo Vito¹³, Paradisi Vincenza¹⁴, Parlapiano Calogero¹⁰, Polizzi Rosaria¹⁰, Progno Mariassunta¹⁰, Quartetti Giovanni¹⁰, Rodolico Pasquale¹⁰, Salamone Francesco¹⁰, Salvo Anna¹⁴, Salvo Nicolò¹⁰, Santoro Giuseppe¹⁷, Sferlazza Concetta¹⁰, Simonetti Maria Teresa¹⁰, Spallina Antonio¹⁰, Spicola Luigi¹⁰, Terzo Maurizio¹³, Vicari Maria Grazia¹⁰, Violini Emanuela¹⁶, and Zafonte Rita¹⁰.

¹ SIMG (Societa’ Italiana di Medicina Generale e delle Cure Primarie); ² SVEMG (Scuola Veneta di Medicina Generale); ³ General practitioner, Belluno; ⁴ General practitioner, Vicenza; ⁵ General practitioner, Verona; ⁶General practitioner, Treviso; ⁷ General practitioner, Venezia; ⁸ General practitioner, Padova; ⁹ FIMMG (Federazione Italiana Medici di Medicina Generale), Palermo; ¹⁰ General practitioner, Palermo; ¹¹ General practitioner, Messina; ¹² General practitioner, Siracusa; ¹³ General practitioner, Trapani; ¹⁴ General practitioner, Catania; ¹⁵ General practitioner, Agrigento; ¹⁶ General practitioner, Caltanissetta; ¹⁷ General practitioner, Enna.

Previous presentation

This work was presented at this meeting in a oral communication: Societa’ Italiana di Medicina Generale e delle Cure Primarie, Centro Congressi (Florence, Italy), November 30, 2018.