Analysis of survival in a sample of elderly patients from Ragusa, Italy on the basis of a primary care level multidimensional evaluation.

The detection of frail elderly people is a crucial point in planning health care services. The aim of this study is to assess the effectiveness of a multidimensional evaluation instrument in order to identify frail elderly people, in a primary care setting. In 1994, a 15-20-min multidimensional questionnaire, called Geriatric Functional Evaluation (GFE), was administered to 3060 over 65-year-old citizens of Ragusa (Italy), who live in their own home. The sample was subdivided in three groups (independent, moderately impaired, and severely impaired) on the basis of the Final Synthetic Score (FSS) originated by the answers to the questionnaire. A follow up was carried out in 1999 with survival and institutionalization as the end-point. The lost to follow-up rate was 1.2%. After 5 years, the Kaplan-Meyer survival analysis showed that the survival rate of the three groups was 42%, 68%, and 88%, respectively. The Cox Proportional Survival analysis showed that the risk of death was doubled in the moderately impaired group and tripled in the severely impaired group compared with higher FSS group. The multivariate analysis showed that the use of services was increased by 40% and therefore indirectly their need, shifting from the lowest to the highest score. The FGE questionnaire had a strong predictivity of both mortality and need of services. The use of FGE in a primary care setting could make it possible to detect the frail population in order to address the community based services.