A Personalized Prevention Program (PPP) based on the Comprehensive Geriatric Assessment (CGA) for the prevention of multidimensional frailty related to non-communicable chronic diseases (NCDs) in older people: a practical approach in primary care setting (PrimaCare_P3)

The topic of prevention of the global impairment related to non-communicable diseases (NCD) in the older people is actual. The comprehensive geriatric assessment (CGA) is one of the pillars of modern medicine being able, by using validated instruments, to improve diagnosis, prognosis and management of older people. Recently the group presenting this proposal promoted the first National Guideline on the CGA for older people in different settings. CGA is able to identify high-risk older subjects who may benefit from a CGA-based personalized prevention program (PPP). However, no study has explored the usefulness of a CGA-based PPP in primary care setting for early individualizing and treating people needing preventive interventions.
Four national partners representative of the national health care system, i.e. E.O. Ospedali Galliera (Genova), University of Bari Aldo Moro (Bari), Azienda Ospedaliera Universitaria Policlinico ¿Paolo Giaccone Palermo (Palermo) and Istituto Superiore di Sanità (Roma) will be involved in the project.
This project will have three relevant aims: AIM 1. to evaluate the efficacy of the CGA methodology in the primary care setting by using a well-validated product of the CGA, i.e. the brief version of the multidimensional prognostic index (BRIEF-MPI), that allows to stratify older people with different needs, also in terms of prevention, considering strong clinical endpoints as outcomes. For reaching this objective, we plan to involve a group of General Practitioners (GPS) representative of different geographical areas, north-central-south Italy. GPs will enroll subjects aged 65 years and older from the list of their in-charge subjects in an interventional clinical trial aiming to assess the efficacy of the CGA-based PPP in primary care setting. AIM 2. to develop a digital PPP platform (DIGIPLAT_P3), that will include data from the GPs electronic health record and multidimensional information derived from the BRIEF-MPI; these information will be the base of tailored interventions addressing the specific domain impairments. In detail, the PPP will include a set of interventions focusing on specific impairments as follows: a) low mobility; b) cognitive impairment; c) malnutrition; d) low functions in basal and instrumental activities of daily living; e) polypharmacy; f) multimorbidity; g) prevention of infectious diseases; h) loneliness and/or isolation. AIM 3. to explore the biological pathways underlying the progression of NCDs towards to multidimensional impairments in old age by measuring in saliva samples, in a practical and non-invasive way, the levels of redox status, inflammatory cytokines and oral microbiota composition as potential predictive biomarkers of multidimensional frailty related to NCDs in older adults.
We believe that our project by exploring a CGA-based PPP in primary care setting may effectively translate into clinical practice the principle of the ¿4P medicine (predictive, preventive, personalized and participatory) in which the target of the interventions must no longer be the single pathology but the subject, even healthy, in its entirety promoting a better health span and potentially reducing frailty progression and incidence of other dismal outcomes of the NCDs. Moreover, our project will give space to young collaborators that will work in a constructive and synergistic way with an outstanding research group.