The early identification of individuals at high risk for adverse outcomes by a Comprehensive Geriatric Assessment (CGA) in resource-limited primary care settings enables tailored treatments, however, the evidence concerning its benefits are still controversial. The main objective of this study was to examine the validity and reliability of the “Multidimensional Assessment of Older People in Primary Care (AMPI-AB)”, a CGA for primary care in resource-limited settings. Longitudinal study, with median follow-up time of 16 months. Older adults from a public primary care unit in São Paulo, Brazil, were consecutively admitted. Reliability was tested in a sample from a public geriatric outpatient clinic. Participants were classified by the AMPI-AB score as requiring a low, intermediate or high complexity of care. The Physical Frailty Phenotype was used to explore the AMPI-AB’s concurrent validity. Predictive validity was assessed with mortality, worsening of the functional status, hospitalizations, emergency room (ER) visits and falls. The area under the ROC curve and logistic regression were calculated for binary outcomes, and a Cox proportional hazards model was used for survival analysis. Older adults (n = 317) with a median age of 80 (74–86) years, 67% female, were consecutively admitted. At the follow-up, 7.1% of participants had died, and increased dependency on basic and instrumental activities of daily living was detected in 8.9 and 41.1% of the participants, respectively. The AMPI-AB score was accurate in detecting frailty (area under the ROC curve = 0.851), predicted mortality (HR = 1.25, 95%CI = 1.13–1.39) and increased dependency on basic (OR = 1.26, 95%CI = 1.10–1.46) and instrumental (OR = 1.22, 95%CI = 1.12–1.34) activities of daily living, hospitalizations (OR = 2.05, 95%CI = 1.04–1.26), ER visits (OR = 1.20, 95%CI = 1.10–1.31) and falls (OR = 1.10, 95%CI = 1.01–1.20), all models adjusted for sex and years of schooling. Reliability was tested in a sample of 52 older adults with a median age of 72 (85–64) years, 63.5% female. The AMPI-AB also had good interrater (ICC = 0.87, 95%CI = 0.78–0.92), test-retest (ICC = 0.86, 95%CI = 0.76–0.93) and proxy reliability (ICC = 0.84, 95%CI = 0.67–0.93). The Cronbach’s alpha was 0.69, and the mean AMPI-AB administration time was 05:44 ± 02:42 min. The AMPI-AB is a valid and reliable tool for managing older adults in resource-limited primary care settings.

中文翻译：

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AMPI-AB有效性和可靠性：在资源有限的初级保健环境中的多维工具

在资源有限的初级保健环境中，通过全面的老年医学评估（CGA）来早期识别处于不良后果高风险的个体，可以进行量身定制的治疗，但是，有关其益处的证据仍存在争议。这项研究的主要目的是检验“初级保健中老年人的多维评估（AMPI-AB）”的有效性和可靠性，这是一种在资源有限的环境中进行初级保健的CGA。纵向研究，中位随访时间为16个月。来自巴西圣保罗的公共初级保健部门的老年人被连续接纳。在一家公共老年门诊诊所的样本中对可靠性进行了测试。根据AMPI-AB评分将参与者分类为需要低，中或高复杂性的护理。身体虚弱表型用于探讨AMPI-AB的并发有效性。通过死亡率，功能状态恶化，住院，急诊就诊和摔倒来评估预测有效性。计算ROC曲线下的面积和logistic回归以得出二元结果，并使用Cox比例风险模型进行生存分析。年龄在80岁（74-86）之间的老年人（n = 317），女性占67％，是连续入院的。在随访中，有7.1％的参与者死亡，分别有8.9％和41.1％的参与者发现对日常生活基本和工具活动的依赖性增加。AMPI-AB评分可准确检测出身体虚弱（ROC曲线下的面积= 0.851），预测的死亡率（HR = 1.25、95％CI = 1.13–1）。39）和对日常生活，住院的基本活动（OR = 1.26，95％CI = 1.10-1.46）和工具性活动（OR = 1.22，95％CI = 1.12-1.34）的依赖性增加（OR = 2.05，95％CI = 1.04-1.26），急诊就诊（OR = 1.20，95％CI = 1.10-1.31）和跌倒（OR = 1.10，95％CI = 1.01-1.20），所有模型均针对性别和受教育年限进行了调整。在52位中位年龄为72（85-64）岁的成年人中，女性为63.5％，对可靠性进行了测试。AMPI-AB还具有良好的跨度（ICC = 0.87，95％CI = 0.78-0.92），重测（ICC = 0.86，95％CI = 0.76-0.93）和代理可靠性（ICC = 0.84，95％CI = 0.67–0.93）。Cronbach的α为0.69，平均AMPI-AB施用时间为05:44±02:42分钟。AMPI-AB是用于在资源有限的初级保健机构中管理老年人的有效且可靠的工具。22、95％CI = 1.12–1.34）的日常活动，住院（OR = 2.05，95％CI = 1.04–1.26），急诊就诊（OR = 1.20，95％CI = 1.10–1.31）和跌倒（OR = 1.10，95％CI = 1.01-1.20），所有模型均针对性别和受教育年限进行了调整。在52位中位年龄为72（85-64）岁的成年人中，女性为63.5％，对可靠性进行了测试。AMPI-AB还具有良好的跨度（ICC = 0.87，95％CI = 0.78-0.92），重测（ICC = 0.86，95％CI = 0.76-0.93）和代理可靠性（ICC = 0.84，95％CI = 0.67–0.93）。Cronbach的α为0.69，平均AMPI-AB施用时间为05:44±02:42分钟。AMPI-AB是用于在资源有限的初级保健机构中管理老年人的有效且可靠的工具。22、95％CI = 1.12–1.34）的日常活动，住院（OR = 2.05，95％CI = 1.04–1.26），急诊就诊（OR = 1.20，95％CI = 1.10–1.31）和跌倒（OR = 1.10，95％CI = 1.01-1.20），所有模型均针对性别和受教育年限进行了调整。在52位中位年龄为72（85-64）岁的成年人中，女性为63.5％，对可靠性进行了测试。AMPI-AB还具有良好的跨度（ICC = 0.87，95％CI = 0.78-0.92），重测（ICC = 0.86，95％CI = 0.76-0.93）和代理可靠性（ICC = 0.84，95％CI = 0.67–0.93）。Cronbach的α为0.69，平均AMPI-AB施用时间为05:44±02:42分钟。AMPI-AB是用于在资源有限的初级保健机构中管理老年人的有效且可靠的工具。31）和跌倒（OR = 1.10，95％CI = 1.01-1.20），所有模型都针对性别和受教育年限进行了调整。在52位中位年龄为72（85-64）岁的成年人中，女性为63.5％，对可靠性进行了测试。AMPI-AB还具有良好的跨度（ICC = 0.87，95％CI = 0.78-0.92），重测（ICC = 0.86，95％CI = 0.76-0.93）和代理可靠性（ICC = 0.84，95％CI = 0.67–0.93）。Cronbach的α为0.69，平均AMPI-AB施用时间为05:44±02:42分钟。AMPI-AB是用于在资源有限的初级保健机构中管理老年人的有效且可靠的工具。31）和跌倒（OR = 1.10，95％CI = 1.01-1.20），所有模型都针对性别和受教育年限进行了调整。在52位中位年龄为72（85-64）岁的成年人中，女性为63.5％，对可靠性进行了测试。AMPI-AB还具有良好的跨度（ICC = 0.87，95％CI = 0.78-0.92），重测（ICC = 0.86，95％CI = 0.76-0.93）和代理可靠性（ICC = 0.84，95％CI = 0.67–0.93）。Cronbach的α为0.69，平均AMPI-AB施用时间为05:44±02:42分钟。AMPI-AB是用于在资源有限的初级保健机构中管理老年人的有效且可靠的工具。重测（ICC = 0.86，95％CI = 0.76-0.93）和代理可靠性（ICC = 0.84，95％CI = 0.67-0.93）。Cronbach的α为0.69，平均AMPI-AB施用时间为05:44±02:42分钟。AMPI-AB是用于在资源有限的初级保健机构中管理老年人的有效且可靠的工具。重测（ICC = 0.86，95％CI = 0.76-0.93）和代理可靠性（ICC = 0.84，95％CI = 0.67-0.93）。Cronbach的α为0.69，平均AMPI-AB施用时间为05:44±02:42分钟。AMPI-AB是用于在资源有限的初级保健机构中管理老年人的有效且可靠的工具。