Predicting factors of health-related quality of life in octogenarians: a 3-year follow-up longitudinal study.

PURPOSE: The proportion of very old people is rising, and so, describing their health-related quality of life (HRQoL) is an important point of interest. The aim of this study was to analyse the predictive factors on HRQoL throughout a 3-year follow-up period, in a community-based cohort of octogenarian people. METHODS: From 290 subjects aged 85 and over, sociodemographic and geriatric data, including levels of frailty phenotype assessment, and HRQoL using the EuroQol 5D3L (EQ-5D) instrument were collected. A longitudinal analysis was performed by generalized estimating equations (jointly testing the bivariate effect of variables and its time dependence) and regression mixed models to evaluate the adjusted effect of variables on HRQoL after a 3-year follow-up. RESULTS: In the EQ-5D baseline assessment, the average visual analogue self-rating scale value was 63.82 (SD ± 19.45), the EQ-5D index was 0.67 (0.34) and the most significant issues were pain/discomfort (61.2 %), depression (45.3 %) and mobility (44.6 %). The third year index was 0.55 (0.38). Independent predictive factors of a lower HRQoL identified by the regression mixed models were female gender (marginal effect ME = -0.101; p = 0.003), being pre-frail (ME = -0.142; p = 0.011) or frail (ME = -0.071; p = 0.030), having heart failure (ME = -0.081; p = 0.037) and having a high social risk score (ME = -0.020; p = 0.015). In contrast, higher functional status (ME = 0.050; p < 0.001) and nutritional score (ME = 0.013; p = 0.011) appeared to be predictive factors of an enhanced HRQoL. The adjusted effect of "time of follow-up" had no statistical significance. CONCLUSION: Frail individuals at baseline have a significant lower HRQoL, whereas a higher functional status and nutritional status are independent predicting factors of an enhanced HRQoL after 3 years of follow-up. These findings may encourage clinicians in order to asses HRQoL.

Multifactorial assessment and targeted intervention in nutritional status among the older adults: a randomized controlled trial: the Octabaix study.

BACKGROUND: Malnutrition is frequent among older people and is associated with morbi-mortality. The aim of the study is to assess the effectiveness of a multifactorial and multidisciplinary intervention in the nutritional status among the elderly. METHODS: Randomized, single-blind, parallel-group, clinical trial conducted from January 2009 to December 2010 in seven primary health care centers in Baix Llobregat (Barcelona). Of 696 referred people, born in 1924, 328 subjects were randomized to an intervention group or a control group. The intervention model used an algorithm and was multifaceted for both the patients and their primary care providers. The main outcome was improvement in nutritional status assessed by Mini Nutritional Assessment (MNA). Data analyses were done by intention-to-treat. RESULTS: Two-year assessment was completed for 127 patients (77.4%) in the intervention group and 98 patients (59.7%) in the control group. In the adjusted linear mixed models for MNA, intervention showed no significant effect during all follow-up period with -0.21 (CI: - 0.96; 0.26). In subjects with nutritional risk (MNA ≤ 23.5/30) existed a tendency towards improvement in MNA score 1.13 (95% CI -0.48; 2.74) after 2 years. CONCLUSION: A universal multifactorial assessment and target intervention over a two year period in subjects at nutritional risk showed a tendency to improve nutrition but not in the rest of community-dwelling studied subjects. Cognitive impairment was an independent factor strongly associated with a decline in nutritional status. TRIAL REGISTRATION: The clinical trial is registered as part of a US National Institutes of Health Clinical Trial: NCT01141166.

Low serum vitamin D is not associated with an increase in mortality in oldest old subjects: the Octabaix three-year follow-up study.

BACKGROUND: Poor vitamin D status, i.e. low serum levels of 25-hydroxyvitamin D [25(OH)D], is common in the general population. Prospective epidemiologic data on the association between vitamin D and mortality in oldest old subjects are limited. OBJECTIVE: This study aimed to determine whether 25(OH)D concentrations were prospectively and independently associated with cardiovascular disease (CVD) mortality and all-cause mortality in oldest old subjects. METHODS: A total of 312 subjects aged 85 years old at baseline (Octabaix study) were followed for 3 years. Sociodemographic and overall geriatric assessment data were collected. Serum 25(OH)D concentrations were used to assess vitamin D status. Data on overall and cardiovascular mortality were collected. RESULTS: The mean serum 25(OH)D levels were 28 ± 30 ng/ml. During the follow-up period, 58 subjects (18.5%) died. Twenty-five of the deaths (8%) were related to CVD. There were no differences in mortality rates according to the different quartiles of vitamin D (p = 0.41 for total mortality and p = 0.86 for CVD mortality). CONCLUSION: In community-dwelling oldest old subjects, serum 25(OH)D levels were not associated with overall or CVD mortality after a 3-year follow-up.

[Successful aging and indicators of frailty in the elderly. Octabaix Study]. / Envejecimiento satisfactorio e indicadores de fragilidad en los mayores de la comunidad. Estudio Octabaix.

UNLABELLED: Successful aging as a process of adaptation to the optimal state is little known in older people. OBJECTIVE: To describe successful aging and to analyze the factors associated with frailty in people aged 86 years. DESIGN: A cross-sectional study of a clinical trial at the second year of follow-up (Octabaix Study). SETTING: Seven Primary Care Centers. PARTICIPANTS: Non-institutionalized subjects born in 1924. MAIN MEASUREMENTS: Data on sociodemographic, comorbidity and geriatric assessment scales were collected. Frailty was defined by the presence of 3 or more of the following criteria: muscle weakness, slow walking, weight loss, exhaustion, low physical activity. Successful aging was defined as: Barthel index >90/100 and Lobo test ≥ 24/35. Multiple regression analysis was performed. RESULTS: A total of 273 patients were evaluated, 39.2% men. The prevalence of successful aging was 47.2% (129). In the unsuccessful aging, the frailty prevalence was 34.7% (50). The frailty factors associated with unsuccessful aging were low activity (OR: 7.56; 95%CI: 3.8 -14.9), weakness (OR: 6.08; 95%CI: 2.5-14.7), slowness (OR: 5.1; 95%CI: 2.8-9.5), and exhaustion (OR: 3.6; 95%CI: 1.6-8.3). The prevalence of successful aging is high in 86-year-old community-dwelling subjects. The low physical activity multiplied by seven, and muscle weakness by 6, were the factors most associated with unsuccessful aging. Therefore, incorporating screening designed to detect these two factors could improve future interventions towards more optimal aging in the community, if these results are confirmed in future studies.

Grandchildren of grandparents with Alzheimer's disease: Exploratory study of the impact of the disease on their relationships.

The aim of this study was to describe the perception of changes that Alzheimer's disease in grandparents has made to the relationship with their grandchildren of between 6 and 13. Qualitative methodology was used. Semi-structured interviews were carried out with 25 grandchildren living in Catalonia, Spain. Participants reported a change in roles from being the care receiver to being the caregiver, changes in the activities that they did together and a positive impact on the grandparent's emotional wellbeing. In the physical sphere, sleeping problems were reported in grandchildren that cohabited with their grandparents. The feelings they described include fear of not being recognized by their grandparents and sadness, as well as satisfaction resulting from their affection and participating in caring. These findings suggest the need to provide information and resources for grandchildren and their families to enable them to deal with the disease.

Predictors of long-term survival in nonagenarians: the NonaSantfeliu study.

BACKGROUND: few studies have prospectively evaluated long-term predictors of mortality in nonagenarians. OBJECTIVE: to determine predictors of death in a nonagenarian cohort after 5 years of follow-up. DESIGN: a prospective community-based study. SETTING: a community-based study. SUBJECTS: one hundred and eighty-six nonagenarians both living in the community and institutionalised. METHODS: functional status was determined by the Lawton-Brody and Barthel Indexes (BI) and cognition by the Spanish version of the mental state examination (MEC). The Charlson Index was used to measure comorbidity. Nutritional status was evaluated by the short version of the Mini-Nutritional Assessment questionnaire. RESULTS: mortality after 5 years was 75.53%. Patients who did not survive were significantly older, with lower cognitive and functional performance, with diminished visual acuity, higher comorbidity, high risk of malnutrition, higher number of drugs taken and a higher percentage of patients with the diagnosis of dyslipidaemia, heart failure or previous stroke. Cox regression analysis, identified the Charlson Index (hazard ratio 1.23, 95% CI 1.09-1.37) and MEC (hazard ratio 0.98, 95% CI 0.97-0.99) as independent predictors of mortality after 5 years. CONCLUSIONS: better cognitive status and lesser comorbidity at baseline are the best predictors to identify which nonagenarians survived after a 5-year follow-up period.

[Gender differences in health status in a population of over 85 year-olds: the Octabaix study]. / Diferencias de género en el perfil de salud de una cohorte de 85 años. Estudio Octabaix.

OBJECTIVE: To examine gender differences according to health status in the oldest old people of the community. DESIGN: Cross-sectional multicentre study, within the framework of a clinical trial on falls and malnutrition. SETTING: 7 primary health centres. PARTICIPANTS: Non-institutionalised patients of 85 years or over. METHODS: The data collected included, socioeconomic data, cardiovascular risk factors, Barthel Index (BI), cognitive status with the Mini-Mental State Examination (MMSE), Charlson Index to measure comorbidity, nutritional risk evaluated by Nutritional Assessment questionnaire (MNA), mean visual analogue self-rating scale in Euroqol- 5D (EQ-VAS) to assess health related quality life and, Gijón social risk test, and prescribed drugs. RESULTS: A total of 312 subjects were included, of which 61.6% were women, 53% widows and a third of them lived alone. High blood pressure was observed in 76%, dyslipidemia in 51.2%, diabetes in 17.4%, median BI 95 (rank 0-100), MMSE 28 (0-35), Charlson index 1 (0-7), MNA 25 (10-30), Gijón test 10 (5-21), EQ-VAS 60 (0-100) and the mean prescription drugs 6.1±3.3. Women most frequently lived alone (P<.001), fell more (P<.006), had a greater nutritional (P<.016) and social risk (P<.001). Men were more likely to be married (P<.001), had better cognition (P<.003), better functional status (P<.018), and higher comorbidity (P<.001). CONCLUSION: Being a 85 years old man is associated with being married, having better functionality and cognition, and a higher comorbidity. While being a woman is associated with living alone, a higher rate of falls, and nutritional and social risk. These results are important to help this group of elderly to maintain their position in the community.

Functional and Cognitive Decline Is Associated With Increased Endothelial Cell Inflammation and Platelet Activation: Liquid Biopsy of Microvesicles in Community- Dwelling Octogenarians.

Increased life expectancy is usually associated with comorbidities, such as cardio and cerebrovascular disease causing impaired functionality. A common underlying cause of these comorbidities is vascular inflammation and injury. Elevated levels of circulating microvesicles (cMV), as a product of a hemostatic and inflammatory cell activation, could be direct mapping of an imbalanced hemostasis. In this manuscript, we aimed to investigate by liquid biopsy whether successful aging can be discriminated by cMV levels and phenotype. To this purpose, we included 135 community-dwelling octogenarians in a cross-sectional study. Successful aging was defined as good functional (Barthel Index > 90 points, and Lawton index score > 7/4 points for women and men, respectively) and cognitive status (Spanish version of the Mini-Mental State Examination -MEC- > 24 points) and no need for institutionalization. Total, annexin V positive (AV+), and AV- cMV from different cell origins from the vascular compartment were phenotypically characterized and quantified from fasting plasma samples by flow cytometry. Successful aging was associated with lower plasma concentrations of total and AV+ CD141+/CD41+-CD61+, and PAC1+/AV+, CD141+/AV+, and CD36+/AV- cMV. From these phenotypes, ROC curve analyses revealed that CD141+/AV+ and CD141+/CD41+-CD61+/AV+ endothelial- and platelet-derived cMV discriminate successful and non-successful aging with an AUC (95%CI) of 0.655 (0.551, 0.758), P = 0.005, and 0.638 (0.535, 0.741), P = 0.013, respectively. In conclusion, successful aging is associated with low levels of cMV released by endothelial cells and platelets, indicating lower endothelial cell inflammation and platelet activation. Our results contribute to the understanding of the link between unsuccessful aging, cognitive decline and vascular cell inflammatory disturbances.

[Health-related quality of life in nonagenarians: gender, functional status and nutritional risk as associated factors]. / Calidad de vida en nonagenarios: género, funcionalidad y riesgo nutricional como factores asociados.

BACKGROUND AND OBJECTIVES: The group of age showing a faster growth is the most elderly people. The objective of this study is to describe the health related quality of life in elderly subjects older than 89 year and to identify related factors. PATIENTS AND METHODS: A cross-sectional study was done at the third year of a longitudinal study (NonaSantfeliu). We evaluated all survived patients who scored >19 in the Spanish version of the Mental State Examination (MEC). Sociodemographic data were collected, functional status was determined by Lawton-Brody and Barthel Index (BI) and cognition with MEC. Charlson score was used to measure comorbidity and the nutritional risk was evaluated by the short version of Mini Nutritional Assessment questionnaire (short-MNA). Euroqol-5D (EQ-5D) was used to assess health related quality of life. RESULTS: The final sample was composed by 37 subjects, 25 women (68%) and 12 men, with a mean age of 94.32 (2.9) years. The mean score in EQ-5D was 0,51 (0,2) and the mean visual analogue self-rating scale (EQ-VAS) was 63 (2,9). Three variables: female gender (p=0,011; regression Beta coefficient : 18,99; IC 95%: 4,66-33,33 , poor BI score (p=0.010; regression Beta coefficient 0.38; IC 95%: 0.09-0.67) and high nutritional risk in short-MNA (p=0.001; regression Beta coefficient: 3.95; IC 95%: 2.50-5.41) were associated with quality of life in the multivariate analyses. CONCLUSION: A good health quality of life in the oldest old people was observed in this study. Gender, functional status and nutritional risk were associated with quality of life in nonagenarians.

[A randomized clinical trial of falls and malnutrition prevention in community-dwelling elders aged 85 years old. The OCTABAIX study]. / Ensayo clínico aleatorizado de prevención de caídas y malnutrición en personas de 85 años en la comunidad. Estudio OCTABAIX.

INTRODUCTION: People aged 85 years old and older constitute a growing population group. Falls and malnutrition are common in the elderly. OBJECTIVE: To determine the effectiveness of an individualized multifactorial intervention to reduce falls and malnutrition in community-dwelling persons aged 85 years old. MATERIAL AND METHODS: The OCTABAIX study is a randomized controlled clinical trial lasting 3 years in primary care in Costa de Ponent (seven primary care teams). Community-dwelling elders born in 1924 who agreed to participate in the study have been included. Three in-home visits will be made annually by a trained nurse or physician and will be complemented by two biannual analytical studies. Participants will be followed-up for hospitalizations, falls and weight using a monthly calendar. The specifically-designed algorithm to detect risk factors for falls and malnutrition will be used to provide recommendations and specific, standardized interventions for risk reduction in a randomly selected intervention group. Two face-to-face interventions will be carried out and telephone calls will be made to reinforce adherence. The control group will follow routine primary care recommendations. The primary outcome is a decline in the rate of falls and malnutrition. RESULTS: The OCTABAIX study aims to reduce the incidence of falls and the risk of malnutrition in the 328 patients included. CONCLUSIONS: The OCTABAIX study will help to determine the characteristics of persons aged 85 years old as well as the rate of falls and nutritional risk. The effectiveness of the measures adopted to reduce these geriatric syndromes will also be assessed.

Predictive items of functional decline and 2-year mortality in nonagenarians--the NonaSantfeliu study.

BACKGROUND: Few studies have prospectively evaluated predictors of mortality or decline in functional capacity in nonagenarians. The aim of this study is to determine predictors of death or functional decline in basic activities of daily living in nonagenarians after 2 years of follow-up. METHODS: One hundred and seventy-six nonagenarians were prospectively evaluated. Functional status was determined by the Lawton-Brody index (LI) and the Barthel Index (BI), and cognition by the Spanish version of the Mental State Examination. The Charlson score was used to measure co-morbidity. Nutritional status was evaluated by the short version of the Mini Nutritional Assessment questionnaire. RESULTS: The sample comprised 135 women (76.3%) and 41 men. Mean age was 93 +/- 3.2 years. Mortality after 2 years was 36.3%. Forty-six (41%) of the 112 survivors presented BI losses >19%. One hundred and ten subjects (63%) presented the combined negative outcome item (death or functional decline). A multiple stepwise logistic regression analysis identified two variables associated with a fall of >19% on the BI or death: a low LI (odds ratio 0.785, 95% CI 0.656-0.940) and a low score at baseline on the Spanish version of the Mental State Examination (odds ratio 0.950, 95% CI 0.914-0.987). CONCLUSION: Better cognitive status and higher capacity to perform instrumental activities of daily living (ADL) at baseline are the best predictors to identify which nonagenarians survived without major functional decline after a 2-year follow-up period.

Falls in nonagenarians after 1-year of follow-up: the NonaSantfeliu study.

An increase in the rate of falls may be an indicator of frailty. This study included a 12-month follow-up investigation into the rate of falls, in people over 89 years, living in an urban community and analyzed the differences between inhabitants with falls and those without falls. The study was conducted within the framework of the NonaSantfeliu study and 140 nonagenarians participated. Sociodemograhic data, Barthel index (BI), activities of daily living (ADL), Spanish version (MEC) of the mini mental state examination (MMSE), the mini nutritional assessment (MNA) questionnaire, near visual acuity by Snellen test and auditory acuity with the Whisper test were evaluated. The fall rate was 47.1%. The 1-year incidence of falls was 26.4%. The incidence of recurrent falls (two or more falls per year) was 10% (n=14). The prevalence of previous falls within the year preceding the study was 45.7%, 64 of 140 nonagenarians fell and 17 (26.5%) of them fell again during the follow-up. Seventy-six out of 140 (54.3%) nonagenarians had not fallen during the year prior to the study and during the year of follow-up, 20 (26.3%) of them had a new fall. In conclusion, the rate of falls among nonagenarians is high. These results emphasize the need to increase the awareness, to provide recommendations and to incorporate strategies to prevent falls.

Prevalence and clinical significance of interatrial block in very older persons.

PURPOSE: The presence in older patients of an interatrial block (IAB) may be a predictor of atrial fibrillation (AF). The objective of the study was to assess in a group of very older participants: the prevalence of IAB, its association with the presence of functional and cognitive status, of new AF diagnosis and mortality after 2-year of follow-up. METHODS: A prospective subcohort of the OCTABAIX population-based study with 75 inhabitants, all 85-year-olds, at baseline in sinus rhythm were assessed. Functional and cognitive status, nutritional risk, and previous falls were recorded. Participants were classified according to the presence or absence of IAB. RESULTS: 23 patients had IAB (30.7%). We did not observe significant differences regarding gender, comorbidity, functional status, nutritional risk and global geriatric assessment according to interatrial conduction. The patients with IAB had statistically significant better cognitive performance (p = 0.029) and a lower number of previous falls (p = 0.008). During the 2 years follow-up 3 participants (4%) died; without statistical differences between both groups. A non-significant trend to a higher incidence of new-onset AF was observed in patients with IAB (8.7 vs. 6.1%; p = 0.652). CONCLUSIONS: Nearly one-third of very older patients with sinus rhythm have IAB. They had a tendency to higher incidence of AF and no association with mortality after 2 years of follow-up.

Risk factors for functional decline in nonagenarians: a one-year follow-up. The NonaSantfeliu study.

BACKGROUND: Disability and a decline in functional capacity are common in old age. OBJECTIVE: To determine predictors of functional decline in nonagenarians' basic activities of daily living (ADL) after 1 year of follow-up. METHODS: A sample of 97 nonagenarians subjects not previously severely dependent (Barthel Index >59) was evaluated. This sample included 72 women (74.2%) and the mean (SD) age was 93.4 +/- 2.7 years. The following data were collected: sociodemographic data, Barthel Index (BI), Lawton-Brody Index (LI), Mental State Examination (MEC), a short version of the Mini-Nutritional Assessment, comorbidity (Charlson Index), lower-extremity function, Gait Rating Scale from the Tinetti Performance-Oriented Mobility Scale and prevalent chronic diseases. Subjects who had a 10-point or higher decline in the BI in 1 year were compared to subjects who had no decline or a maximum decline of 9 points. In addition, subjects whose total BI score fell below 60 were compared to the group of subjects who maintained scores between 60 and 100. The Student's t test, the chi(2) or the Fisher's exact test, and a multiple logistic regression analysis (with the identified risk factors of age and gender) were performed. RESULTS: 39 nonagenarians experienced a 10-point or higher decline in the BI in 1 year. A lower LI score (p = 0.003) and visual impairment (p = 0.01) were associated with functional decline. The multiple regression analysis showed that there was a significant association with LI (odds ratio (OR) 0.74, confidence interval 95% 0.60-0.91, p < 0.005). The 18 nonagenarians who had a BI <60 had a BI >60 at baseline. Lower scores on the LI (p = 0.004) and on the MEC (p = 0.01), a history of a previous stroke (p = 0.009) and higher Charlson Index scores (p = 0.03) were associated with recently acquired, severe dependency. A multiple regression analysis showed a significant association between LI (OR 0.65, 0.47-0.89, p < 0.008) and a history of previous strokes (OR 3.39, 1.01-11.34, p < 0.04). CONCLUSIONS: According to the definition used to describe functional basic ADL decline, poor performance in instrumental ADL at baseline and a history of a stroke appear to be independent risk factors. Prevention strategies could be intensified in this subgroup of nonagenarians.

Multimorbidity as specific disease combinations, an important predictor factor for mortality in octogenarians: the Octabaix study.

BACKGROUND: The population is aging and multimorbidity is becoming a common problem in the elderly. OBJECTIVE: To explore the effect of multimorbidity patterns on mortality for all causes at 3- and 5-year follow-up periods. MATERIALS AND METHODS: A prospective community-based cohort (2009-2014) embedded within a randomized clinical trial was conducted in seven primary health care centers, including 328 subjects aged 85 years at baseline. Sociodemographic variables, sensory status, cardiovascular risk factors, comorbidity, and geriatric tests were analyzed. Multimorbidity patterns were defined as combinations of two or three of 16 specific chronic conditions in the same individual. RESULTS: Of the total sample, the median and interquartile range value of conditions was 4 (3-5). The individual morbidities significantly associated with death were chronic obstructive pulmonary disease (COPD; hazard ratio [HR]: 2.47; 95% confidence interval [CI]: 1.3; 4.7), atrial fibrillation (AF; HR: 2.41; 95% CI: 1.3; 4.3), and malignancy (HR: 1.9; 95% CI: 1.0; 3.6) at 3-year follow-up; whereas dementia (HR: 2.04; 95% CI: 1.3; 3.2), malignancy (HR: 1.84; 95% CI: 1.2; 2.8), and COPD (HR: 1.77; 95% CI: 1.1; 2.8) were the most associated with mortality at 5-year follow-up, after adjusting using Barthel functional index (BI). The two multimorbidity patterns most associated with death were AF, chronic kidney disease (CKD), and visual impairment (HR: 4.19; 95% CI: 2.2; 8.2) at 3-year follow-up as well as hypertension, CKD, and malignancy (HR: 3.24; 95% CI: 1.8; 5.8) at 5 years, after adjusting using BI. CONCLUSION: Multimorbidity as specific combinations of chronic conditions showed an effect on mortality, which would be higher than the risk attributable to individual morbidities. The most important predicting pattern for mortality was the combination of AF, CKD, and visual impairment after 3 years. These findings suggest that a new approach is required to target multimorbidity in octogenarians.

Inflammation and hemostasis in older octogenarians: implication in 5-year survival.

Social changes and medical advances have increased longevity, but the conditions governing healthy vs unhealthy cardiovascular (CV) aging are not fully known. Factors beyond classical CV risk factors may have an important unrecognized value. We sought to identify proteins differentially expressed in healthy octogenarians (HOs) without a history of cardiovascular disease (CVD) and preserved functional and cognitive state compared with octogenarians with a history of CVD and cognitive decline (UHOs) using a systems biology approach, and investigated how these proteins relate to CV mortality at 5-year follow-up. Plasmas obtained from older octogenarians (87 ± 0 years) were analyzed by 2-DE + MS and bioinformatic pathway analysis in HOs (N = 38) and UHOs with cognitive (MEC<25) and functional (Barthel<90) decline and a previous ischemic event (acute myocardial infarction and/or stroke; N = 27). Results were validated by ELISA in HOs and UHOs and in an additional group of older octogenarians without cognitive impairment but with a previous CVD manifestation (HO-CVD; N = 35). UHOs showed a coordinated change in several inflammation-related proteins (AMBP, RBP4, and ITIH4; P < 0.05), together with a significant increase in the major inducer of the acute-phase reaction, interleukin-6 (P = 0.03). UHOs also showed a coordinated increase in hemostatic proteins that was associated with an impairment of fibrinolysis and an increased 5-year CV mortality (P = 0.003). The combination of inflammation (ITIH4 and interleukin-6) and hemostatic markers (D-dimer, A2AP, and coagulation factor XIII) was able to discriminate the presence of an unhealthy phenotype in the elderly (AUC = 0.750; P = 0.001). Unhealthy older octogenarians show increased levels of several plasma proteins of inflammation and coagulation. In older octogenarians, the increase in hemostatic markers indicated an increase in 5-year CV mortality at follow-up.

[The Octabaix study. Baseline assessment and 5 years of follow-up]. / Estudio Octabaix. Sumario de la valoración inicial y 5 años de seguimiento.

This is a review of a prospective, community-based study with a follow-up period of 5years. It is a study of 328 participants aged 85 at baseline, of which 62% were female, 53% widows, and a third of them living alone. High blood pressure was observed in 75.9%, dyslipidaemia in 51.2%, and diabetes in 17.7%. At baseline the median Barthel Index was 95, the Spanish version of the Mini-Mental State Examination was 28, the Charlson index 1, the Mini Nutritional Assessment 25, the Gijón test 10, the visual analogue scale of the Quality of Life Test was 60, and with a mean of 6.1 prescription drugs. A lower quality of life was also associated with female gender, a phenotype of frailty, heart failure, and a high level of social risk. At 5years of follow-up, the mortality rate was high, with 138 (42.1%) of the population sample dying at the end of the period. It represents an annual mortality rate of 8.4%. Thus, a common denominator of this review has been the high importance of functionality and overall comorbidity factors associated with mortality in this very old age group, compared to other more traditional factors in younger populations. Several studies of frailty have also been assessed in this group, as well as falls, nutritional risk, diabetes and successful aging, including important aspects to better understand this population group.

High rate of mortality in Spanish community-dwelling population aged 85 with atrial fibrillation after three years of follow-up: The Octabaix study.

AIM: To assess the possible association between three-year global mortality and atrial fibrillation (AF) in 328 community-dwelling participants aged 85 at baseline. METHODS: Sociodemographic data, comorbidity and geriatric assessment tools, thromboembolic risk, and AF therapy were assessed. We compared the patients who survived with those who died. RESULTS: At baseline, 41 (12.5%) of participants had permanent AF, and 13 of them died (31.7%) after the three-year follow-up period compared with 44 (15.3%) of the rest of cohort (P = 0.01). Cox regression analysis identified two significant clinical variables as independent predictors of three-year risk of global mortality: Lawton Index (hazard ratio 0.82, 95% confidence interval 0.75-0.91) and AF (hazard ratio 1.90, 95% confidence interval 1.01-3.56). None of the other of variables evaluated showed predictive value of global mortality in the AF patients. CONCLUSION: In oldest old community-dwelling participants, AF is an independent risk factor for global mortality after a three-year follow-up period.

Evidence of functional declining and global comorbidity measured at baseline proved to be the strongest predictors for long-term death in elderly community residents aged 85 years: a 5-year follow-up evaluation, the OCTABAIX study.

OBJECTIVE: To investigate the predictive value of functional impairment, chronic conditions, and laboratory biomarkers of aging for predicting 5-year mortality in the elderly aged 85 years. METHODS: Predictive value for mortality of different geriatric assessments carried out during the OCTABAIX study was evaluated after 5 years of follow-up in 328 subjects aged 85 years. Measurements included assessment of functional status comorbidity, along with laboratory tests on vitamin D, cholesterol, CD4/CD8 ratio, hemoglobin, and serum thyrotropin. RESULTS: Overall, the mortality rate after 5 years of follow-up was 42.07%. Bivariate analysis showed that patients who survived were predominantly female (P=0.02), and they showed a significantly better baseline functional status for both basic (P<0.001) and instrumental (P<0.001) activities of daily living (Barthel and Lawton index), better cognitive performance (Spanish version of the Mini-Mental State Examination) (P<0.001), lower comorbidity conditions (Charlson) (P<0.001), lower nutritional risk (Mini Nutritional Assessment) (P<0.001), lower risk of falls (Tinetti gait scale) (P<0.001), less percentage of heart failure (P=0.03) and chronic obstructive pulmonary disease (P=0.03), and took less chronic prescription drugs (P=0.002) than nonsurvivors. Multivariate Cox regression analysis identified a decreased score in the Lawton index (hazard ratio 0.86, 95% confidence interval: 0.78-0.91) and higher comorbidity conditions (hazard ratio 1.20, 95% confidence interval: 1.08-1.33) as independent predictors of mortality at 5 years in the studied population. CONCLUSION: The ability to perform instrumental activities of daily living and the global comorbidity assessed at baseline were the predictors of death, identified in our 85-year-old community-dwelling subjects after 5 years of follow-up.