CGA and Clinical Decision-Making: The Multidimensional Prognostic Index

Abstract

Clinical decision-making is usually difficult in older people due to the presence of a greater number of comorbidities and functional and cognitive or social problems that could worsen prognosis. All these factors could create relevant problems in terms of the correct diagnostic or therapeutic approach to these individuals. Frail individuals are particularly susceptible to adverse drug reactions, and frailty may result in reduced treatment efficacy by physicians. Thus, life expectancy should be included in clinical decisions to better assess the pros and the cons of different treatment approaches in advanced age. Mortality prognostic tools might help clinical decision-making in diagnostics and therapeutics, suggesting appropriate intervention for older patients since it is likely that the effectiveness of drug treatments may be significantly different in older patients with different risk of mortality. In this chapter, we will discuss the importance of prognosis in clinical decision-making and the use of the multidimensional prognostic index (MPI) in defining the most appropriate intervention for older frail subjects.