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.

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.

[Predisposing factors of delirium in hip fractured patients older than 84 years]. / Factores favorecedores de la aparición de cuadro confusional agudo en pacientes mayores de 84 años con fractura de fémur.

BACKGROUND AND OBJECTIVE: Our objective was to analyze those factors predisposing to delirium in patients older than 84 years who were admitted because of hip fracture. We also compared the prevalence of delirium in this population with a younger group. PATIENTS AND METHOD: One hundred and thirty patients (mean age 91.8 years) and 50 controls aged 65 to 84 years were included. RESULTS: Forty-three patients (33%) developed delirium. A poor previous functional capacity was the best marker identifying those at risk for developing delirium. Although the prevalence of delirium was higher in those older than 84 years, statistically significant differences were not reached. CONCLUSIONS: Disability prior to admission is the main risk factor predisposing to delirium during hospitalization in patients older than 84 years who are admitted because of hip fracture.

Predictors of cognitive decline in 85-year-old patients without cognitive impairment at baseline: 2-year follow-up of the octabaix study.

BACKGROUND/RATIONALE: To determine how many 85-year-old community-dwelling patients with good cognitive performance at baseline maintain this level at 2-year follow-up. METHODS: We realized a longitudinal community-based study including 169 inhabitants. Patients who maintained scores >23 on the Spanish version of the Mini-Mental State Examination (MEC) were compared with the rest. RESULTS: A total of 144 individuals (85.2%) were found maintaining a MEC score >23. Under the combined criteria 110 (65%) presented no new cognitive decline. Multiple logistic regression analysis showed that maintaining a MEC score >23 was significantly associated with having a higher MEC score at baseline (P < .001, odds ratio 1.280, 95% confidence interval 1.104-1.484). CONCLUSION: Most oldest-old patients with good cognitive function at baseline maintain this level at 2-year follow-up.

Predictive items of one-year mortality in nonagenarians. The NonaSantfeliu Study.

BACKGROUND AND AIMS: Few studies have prospectively evaluated predictors of mortality in nonagenarian cohorts. Our objective was to determine a set of predictors of all-cause mortality in a cohort of nonagenarians after one year of follow-up. METHODS: 186 nonagenarians were evaluated prospectively, 137 of whom lived in their own homes (74%) and 49 (26%) were institutionalized. Functional status was determined by the Lawton-Brody (LI) and Barthel Index (BI), and cognition by the Spanish version of the Mini Mental State Examination (MEC). The Charlson score was used to measure global comorbidity. Nutritional status was evaluated by the short version of the Mini Nutritional Assessment questionnaire (short- MNA). RESULTS: The sample was composed of 143 women (76.5%) and 43 men, with a mean age of 93.06 (3.1) years. The rate of mortality was 19.3%. There were no differences in mortality between men and women. Although the BI and LI were both related to 1-year mortality in bivariate, unadjusted analysis, their contribution was minimal in multivariate analyses. Age, heart failure and short-MNA remained associated with mortality in the multivariate analyses. CONCLUSIONS: This study supported the importance of age, heart failure and nutritional status in predicting 1- year mortality in nonagenarians.

Dying in hospital of terminal heart failure or severe dementia: the circumstances associated with death and the opinions of caregivers.

BACKGROUND: Improving the care provided to elderly patients affected by end-stage chronic diseases dying in acute hospitals is a health priority. We evaluated the circumstances related to death in end-stage non-cancer patients dying in two acute care hospitals, and their caregiver's opinions about the death. METHODS: Some 102 patients, over 64 years of age, with end-stage dementia (37%) or congestive heart failure (64%), were included in the study. Caregiver's opinions on the circumstances of death were obtained using a questionnaire. In addition, we collected data regarding written instructions on several items, including do not resuscitate (DNR) orders, decisions about care in terms of the level or intensity of interventions, information provided to relatives about the prognosis, total withdrawal of normal drug therapy, and provision of palliative care. RESULTS: Caregivers stated that the clinical information was accurate in 67.6% of cases, and the control of symptoms was good in 55%. However, the perception of pain persisted in 14% and uncontrolled dyspnoea in 45%. The end-of-life care was assessed as: excellent 30.5%, good 36%, fairly good 25.5%, bad 6%, and very bad 2%. DNR orders were specified in 89% of patients, decisions concerning the intensity of care in 64%, and 80% of relatives were aware of the prognosis. Drug therapy was withdrawn in 64% of cases, and terminal palliative care was initiated in 79.5%. CONCLUSION: Our results suggest that some aspects of the palliative care provided to elderly patients with end-stage chronic diseases, admitted to acute care hospitals, could be improved. Such aspects include the clinical information provided and the successful control of specific symptoms.

Evaluación funcional y cognitiva en una población urbana de mayores de 89 años. Estudio NonaSantFeliu / Functional and cognitive assessment in an urban population older than 89 years: the NonaSantFeliu study

Introducción: el aumento de la expectativa de vida debe ser a expensas de conseguir un aumento en la vida activa o libre de incapacidad. Evaluamos la capacidad funcional y cognitiva de los habitantes > 89 años de una población urbana (estudio Nona-SantFeliu) y comprobamos si existen diferencias según el sexo. Material y métodos: estudio poblacional, longitudinal y observacional. Al comienzo del estudio (primer corte transversal) se presentan los datos de todos los > 89 años de una ciudad: datos sociodemográficos, actividades básicas mediante el índice de Barthel (IB), actividades instrumentales mediante el índice de Lawton (IL), capacidad cognitiva con miniexamen cognoscitivo de Lobo (MEC) y comorbilidad (índice de Charlson). Resultados: de 186 nonagenarios entrevistados, 143 (76,5%) eran mujeres; la edad media ± desviación estándar era de 93,1 ± 3,1 años, y 149 (80,2%) eran viudos/as. El 26% estaba institucionalizado. El valor medio del IB fue de 60,8 ± 30,0: el 56% era independientes o con dependencia leve; IL medio, 2,1 ± 2,8. En el MEC obtuvieron una media de 21,0 ± 11,0 puntos, y en el 56% fue superior a 23. La media del índice Charlson era de 1,4 ± 1,7. No existen diferencias significativas por sexos. Conclusiones: a pesar de su avanzada edad, la mayoría de nonagenarios tienen un leve deterioro funcional y cognitivo, con baja comorbilidad. No se detectaron diferencias significativas según el sexo. Futuros estudios deben ayudarnos en la detección de personas nonagenarias con gran riesgo de deterioro en poco tiempo, para iniciar intervenciones que retrasen la aparición de una mayor discapacidad (AU)

Introduction: the increase in life expectancy should be characterized by an increase in disability-free life. We assessed functional and cognitive capacity in an urban population older than 89 years, as well as possible gender variations. Material and methods: the NonaSantFeliu study is a longitudinal, observational, population-based study. We present the first crosssectional survey of 186 inhabitants older than 89 years in a city. Sociodemographic data were gathered. We assessed basic activities of daily living with the Barthel Index (BI), instrumental activities with the Lawton Index (LI), cognitive status with the Mini-Mental State Examination (MMSE) and comorbidity with the Charlson Index (CI). Results: of 186 examined nonagenarians, 143 (76.5%) were women. The mean age SD was 93.1 ± 3.1 years. One-hundred forty nine (80.2%) were widowed and 26% were institutionalized. The mean BI was 60.8 ± 30; 56% were functionally independent or had slight dependence. The mean LI was 2.1 ± 2.8. The mean MMSE score was 21 ± 11; 56% had an MMSE score higher than 23. The mean CI was 1.4 ± 1.7. No significant differences were found by gender. Conclusions: despite their advanced age, most of the nonagenarians showed mild functional and cognitive impairment with low comorbidity. No significant differences were observed by gender. Future studies should help to detect nonagenarians at high risk of rapid impairment to allow early initiation of interventions to delay the development of further incapacity (AU)

Relación entre la pérdida sensorial y la capacidad funcional en personas mayores de 89 años. Estudio NonaSantfeliu / Relationship between sensory impairment and functional status in nonagenarians. The NonaSantfeliu Study

Objetivo: la alteración de los órganos sensoriales es frecuente en las personas mayores. Se analiza la prevalencia de deterioro de la función visual y auditiva en personas mayores de 89 años, y la relación entre éstas y la capacidad para realizar actividades de la vida diaria. Material y métodos: se obtienen datos del estudio poblacional NonaSantfeliu: sociodemográficos, capacidad para realizar actividades básicas con el índice Barthel (IB) e instrumentales con el índice Lawton y Brody (IL), cognición con el miniexamen cognitivo de Lobo (MEC) y comorbilidad con el índice de Charlson. Se valoró la capacidad de visión de cerca con tablas equivalentes de Snellen y la capacidad auditiva con el test del susurro. Resultados: participaron en el estudio un total de 186 pacientes nonagenarios, con una edad media de 93,06 años (76,5% mujeres), el 74% vivía en su domicilio, el resto estaba institucionalizado. En el 38% la visión de cerca era patológica y en otro 30%, correcta, aunque corregida con gafas. En el 40% había un déficit auditivo no corregido y en otro 8%, corregido con audífono. En el 18% había un déficit doble, y en un 5,3%, una doble corrección ortopédica. Las personas con déficit visual o doble déficit sensorial tenían un menor IB, IL y MEC, y en ambos casos en el análisis multivariante se mantenía asociación con el IL (p < 0,001, odds ratio [OR] = 1,859, intervalo de confianza [IC] del 95%, 1,441-2,398; p < 0,001, OR = 1,995, IC del 95%, 1,320-3,016, respectivamente). Conclusiones: la pérdida en la visión y audición es frecuente en las personas mayores de 89 años. La capacidad para realizar actividades instrumentales está disminuida en las personas con pérdida visual o con doble pérdida sensorial

Objective: alterations in the sense organs are frequent in the elderly. Our aim was to analyze the status of visual function and hearing in nonagenarians in order to evaluate the relationship between sensory impairment and the ability to perform basic or instrumental activities of daily life. Material and methods: data were obtained from the NonaSantfeliu population-based study: sociodemograhic variables were collected. Functional status was determined by the Lawton-Brody Index (LI) and Barthel Index (BI) and cognition by the Spanish version of the Mental State Examination (Miniexamen cognitivo de Lobo [MEC]). Comorbidity was evaluated using the Charlson Index. Near visual acuity was evaluated by the Snellen test, and auditory acuity was assessed with the whisper test. Results: the sample was composed of 186 nonagerians, with a mean age of 93.06 (3.1) years; 76.5% were women. Seventy-four percent lived at home and the remainder lived in nursing homes. Visual impairment was found in 38%, and hearing impairment in 40%. Combined visual and hearing impairment was found in 18% and devices to correct both impairments were required in 5.3%. Nonagenarians with visual or combined impairment had poor LI, BI and MEC values. In multivariate analyses a lower LI was associated with visual impairment (p < 0.001, odds ratio [OR] = 1.859, 95% confidence interval [CI] 1.441-2.398) and combined impairment (p < 0.001, OR = 1.995, 95% CI 1.320-3.016). Conclusions: impairment of vision and hearing ability are common in nonagenarians. The ability to perform instrumental activities of daily life is decreased due to visual and combined sensory impairment in this population