MARLON JULIANO ROMERO ALIBERTI
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/66, Hospital das Clínicas, Faculdade de Medicina
LIM/66, Hospital das Clínicas, Faculdade de Medicina
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conferenceObject Physical Frailty and the Risk of Dementia in a Longitudinal Cohort of Older Adults(2019) ALIBERTI, M.; COVINSKY, K.; CENZER, I. S.bookPart Escalas(2019) SARAIVA, Marcos Daniel; ALIBERTI, Márlon Juliano Romero; SERRANO, Priscila Gonçalves; ONODERA, Eduardo Sho; APOLINARIO, Daniel; MAGALDI, Regina Miksian; FORTES FILHO, Sileno de Queiroz; MELO, Juliana de Araújo; ROTTA, Thereza Cristina Ariza; LIN, Sumika Mori; RANGEL, Luis Fernando; SILVA, Marina Maria Biella; APRAHAMIAN, Ivan; MAUER, Sivan; SIQUEIRA, Alaise Silva Santos de; MORILLO, Lilian Schafirovits; ARAúJO, Juliano Silveira de; STORNIOLO, Luana VergianconferenceObject Pre-estimating subsets, a new approach for unavailable predictors in prognostic modeling(2019) ALIBERTI, M.; LEE, S.; SMITH, A. K.; RODRIGUEZ, A.; BOSCARDIN, J.- Home Modifications to Reduce Disability in Older Adults With Functional Disability(2019) ALIBERTI, Marlon J. R.; COVINSKY, Kenneth E.
- 10-Minute Targeted Geriatric Assessment Predicts Disability and Hospitalization in Fast-Paced Acute Care Settings(2019) ALIBERTI, Marlon J. R.; COVINSKY, Kenneth E.; APOLINARIO, Daniel; SMITH, Alexander K.; LEE, Sei J.; FORTES-FILHO, Sileno Q.; MELO, Juliana A.; SOUZA, Natalia P. S.; AVELINO-SILVA, Thiago J.; JACOB-FILHO, WilsonBackground: Limited time and resources hinder the use of comprehensive geriatric assessment in acute contexts. We investigated the predictive value of a 10-minute targeted geriatric assessment (10-TaGA) for adverse outcomes over 6 months among acutely ill older outpatients. Methods: Prospective study comprising 819 acutely ill outpatients (79.2 +/- 8.4 years; 63% women) in need of intensive management (eg, intravenous therapy, laboratory test, radiology) to avoid hospitalization. The 10-TaGA provided a validated measure of cumulative deficits. Previously established 10-TaGA cutoffs defined low (0-0.29), medium (0.30-0.39), and high (0.40-1) risks. To estimate whether 10-TaGA predicts new dependence in activities of daily living and hospitalization over the next 6 months, we used hazard models (considering death as competing risk) adjusted for standard risk factors (sociodemographic factors, Charlson comorbidity index, and physician estimates of risk). Differences among areas under receiver operating characteristic curves (AUROC) examined whether 10-TaGA improves outcome discrimination when added to standard risk factors. Results: Medium- and high-risk patients, according to 10-TaGA, presented a higher incidence of new activities of daily living dependence (21% vs 7%, adjusted subhazard ratio [aHR] = 2.4, 95% CI = 1.3-4.5; 40% vs 7%, aHR = 5.0, 95% CI = 2.8-8.7, respectively) and hospitalization (27% vs 13%, aHR = 2.0, 95% CI = 1.2-3.3; 37% vs 13%, aHR = 2.9, 95% CI = 1.8-4.6, respectively) than low-risk patients. The 10-TaGA remarkably improved the discrimination of models that incorporated standard risk factors to predict new activities of daily living dependence (AUROC = 0.76 vs 0.71, p <.001) and hospitalization (AUROC = 0.71 vs 0.68, p <.001). Conclusions: The 10-TaGA is a practical and efficient comprehensive geriatric assessment tool that improves the prediction of adverse outcomes among acutely ill older outpatients.
- A 10-min Targeted Geriatric Assessment Predicts Mortality in Fast-Paced Acute Care Settings: A Prospective Cohort Study(2019) ALIBERTI, M. J. R.; COVINSKY, K. E.; APOLINARIO, D.; LEE, S. J.; FORTES-FILHO, S. Q.; MELO, J. A.; VIANA, S. S. C.; SUEMOTO, C. K.; JACOB-FILHO, W.ObjectivesTo estimate whether a 10-minute Targeted Geriatric Assessment (10-TaGA) adds utility to sociodemographic characteristics and comorbidities in predicting one-year mortality in busy acute care settings. We have also compared the performance of 10-TaGA with the Identification of Seniors at Risk (ISAR) scale.DesignProspective cohort study.SettingGeriatric day hospital specializing in acute care in BrazilParticipants751 older adults aged 79.4 8.4 years (64% female), presenting non-surgical, medical illness requiring hospital-level care (e.g., intravenous therapy, laboratory test, radiology) for 12 hours.MeasurementsThe 10-TaGA, an easy-to-administer screening tool based on the comprehensive geriatric assessment (CGA), provided a measure of cumulative deficits ranging from 0 (no deficits) to 1 (highest deficit) on admission. Standard risk factors, including sociodemographics (age, gender, ethnicity, income) and the Charlson comorbidity index, were evaluated. The ISAR, a well-validated screening tool, was used for comparison.ResultsDuring one year of follow-up, 130 (17%) participants died. Compared to the ISAR, 10-TaGA offered better accuracy in identifying older patients at risk of death (area under the receiver operating characteristic curve: [AUC] 0.70 vs 0.65; P = 0.03). In a Cox regression model adjusted for sociodemographics and comorbidities, each 0.1 increment in the 10-TaGA score (range 0-1) was associated with increased mortality (hazard ratio = 1.42, 95% confidence interval 1.27-1.59). The addition of 10-TaGA markedly improved the discrimination of the model, which already incorporated standard risk factors (AUC 0.76 vs 0.71; P = 0.005); adding ISAR (AUC 0.73 vs 0.71; P = 0.09) did not have this marked effect.ConclusionThe 10-TaGA is an independent predictor of one-year mortality in acute care patients. This multidimensional screening tool offers better accuracy than ISAR when differentiating between older people at low and high risk of death in healthcare settings where providers have limited time and resources.
bookPart Avaliação global do idoso(2019) ALIBERTI, Márlon Juliano Romero; SARAIVA, Marcos Daniel; RIBEIRO, Octávio Gonçalves- Assessing Risk for Adverse Outcomes in Older Adults: The Need to Include Both Physical Frailty and Cognition(2019) ALIBERTI, Marlon J. R.; CENZER, Irena S.; SMITH, Alexander K.; LEE, Sei J.; YAFFE, Kristine; COVINSKY, Kenneth E.BACKGROUNDPhysical frailty is a powerful tool for identifying nondisabled individuals at high risk of adverse outcomes. The extent to which cognitive impairment in those without dementia adds value to physical frailty in detecting high-risk individuals remains unclear. OBJECTIVESTo estimate the effects of combining physical frailty and cognitive impairment without dementia (CIND) on the risk of basic activities of daily living (ADL) dependence and death over 8 years. DESIGNProspective cohort study. SETTINGThe Health and Retirement Study (HRS). PARTICIPANTSA total of 7338 community-dwelling people, 65 years or older, without dementia and ADL dependence at baseline (2006-2008). Follow-up assessments occurred every 2 years until 2014. MEASUREMENTSThe five components of the Cardiovascular Health Study defined physical frailty. A well-validated HRS method, including verbal recall, series of subtractions, and backward count task, assessed cognition. Primary outcomes were time to ADL dependence and death. Hazard models, considering death as a competing risk, associated physical frailty and CIND with outcomes after adjusting for sociodemographics, comorbidities, depression, and smoking status. RESULTSThe prevalence of physical frailty was 15%; CIND, 19%; and both deficits, 5%. In unadjusted and adjusted analyses, combining these factors identified older adults at an escalating risk for ADL dependence (no deficit = 14% [reference group]; only CIND = 26%, sub-hazard ratio [sHR] = 1.5, 95% confidence interval [CI] = 1.3-1.8; only frail = 33%, sHR = 1.7, 95% CI = 1.4-2.0; both deficits = 46%, sHR = 2.0, 95%CI = 1.6-2.6) and death (no deficit = 21%; only CIND = 41%, HR = 1.6, 95% CI = 1.4-1.9; only frail = 56%, HR = 2.2, 95% CI = 1.7-2.7; both deficits = 66%, HR = 2.6, 95% CI = 2.0-3.3) over 8-year follow-up. Adding the cognitive measure to models that already included physical frailty alone increased accuracy in identifying those at higher risk of ADL dependence (Harrell's concordance [C], 0.74 vs 0.71; P < .001) and death (Harrell's C, 0.70 vs 0.67; P < .001). CONCLUSIONPhysical frailty and CIND are independent predictors of incident disability and death. Because together physical frailty and CIND identify vulnerable older adults better, optimal risk assessment should supplement measures of physical frailty with measures of cognitive function. J Am Geriatr Soc 67:477-483, 2019.