The impact of loneliness and social isolation on the benefits of an exercise program with hospitalised older adults.

OBJECTIVES: This study aimed to assess the prevalence and impact of loneliness (De Jong Gierveld scale) and isolation (Lubben scale) on the effects of a hospital-based exercise programme. DESIGN: Secondary analysis of a randomised clinical trial. SETTING: Acute Geriatric Unit of a tertiary hospital in Spain. PARTICIPANTS: 103 hospitalised older adults. INTERVENTION: Individualised multicomponent exercise program (20-minute sessions twice a day for 3 consecutive days). RESULTS: Among the 103 randomised patients included in the analysis (both arms included), 58.3% were male, and their mean age was 87.3 (4.5) years. According to the Lubben scale, 15.8% of patients were at risk of isolation, while 62.7% were in a situation of severe or moderate loneliness according to the De Jong Gierveld scale. In the non-isolated group, training showed a substantial positive impact on Geriatric Depression Scale (B = -1.25, 95% CI = -0.24 to -0.27). In the isolated group, all outcomes improved, but only the Quality of Life showed significant changes (B = 35, 95% CI = 4.96-35.8). The SPPB test (B = 1.62, 95% CI = 0.19-3.04) and Quality of Life, (B = 17.1, 95% CI = 1.84-32.3) showed a significant improvement in the non-loneliness exercise group while no differences were found in the loneliness group. CONCLUSION: Despite the high prevalence of loneliness and social isolation, individualised exercise programs provide significant benefits to hospitalised patients, especially in quality of life.

Serum biomarkers related to frailty predict negative outcomes in older adults with hip fracture.

PURPOSE: Hip fracture is a public health problem worldwide. Traditional prognostic models do not include blood biomarkers, such as those obtained by proteomics. This study aimed to investigate the relationships between serum inflammatory biomarkers and frailty in older adults with hip fracture as well as adverse outcomes at one and three months after discharge. METHODS: A total of 45 patients aged 75 or older who were admitted for hip fracture were recruited. At admission, a Comprehensive Geriatric Assessment (CGA) was conducted, which included a frailty assessment using the Clinical Frailty Scale (CFS). Blood samples were collected before surgery. Participants were followed up at one and three months after discharge. The levels of 45 cytokines were analyzed using a high-throughput proteomic approach. Binary logistic regression was used to determine independent associations with outcomes, such as functional recovery, polypharmacy, hospital readmission, and mortality. RESULTS: The results showed that IL-7 (OR 0.66 95% CI 0.46-0.94, p = 0.022) and CXCL-12 (OR 0.97 95% CI 0.95-0.99, p = 0.011) were associated with better functional recovery at three months after discharge, while CXCL-8 (OR 1.07 95% CI 1.01-1.14, p = 0.019) was associated with an increased risk of readmission. CONCLUSIONS: These findings suggest that immunology biomarkers may represent useful predictors of clinical outcomes in hip fracture patients.

Tailored Prevention of Functional Decline through a Multicomponent Exercise Program in Hospitalized Oncogeriatric Patients: Study Protocol for a Randomized Clinical Trial.

BACKGROUND: Cancer mostly affects older adults, causing a wide variety of diagnostic and therapeutic dilemmas. One of the most important moments in cancer patients is the hospitalization period, in which older patients usually remain bedridden for many hours and this may lead to the appearance of sarcopenia and disability. METHODS: We present the research protocol for a randomized controlled trial that will analyze whether an intervention applied to older patients (≥ 65 years) who are hospitalized for acute medical conditions in an Oncology Department improves function. A total of 240 hospitalized older patients will be recruited in the Hospital Universitario de Navarra, Pamplona, Spain, and they will be randomized. The intervention consists of a multicomponent exercise training program that will take place for 4 consecutive days (2 sessions/day). The control group will receive usual hospital care, which will include physical rehabilitation when needed. The primary end point will be the change in functional capacity from baseline to hospital discharge, assessed with the Short Physical Performance Battery (SPPB). Secondary end points will be changes in cognitive and mood status, quality of life, fatigue, strength (dynamic and handgrip), pain, nutrition, length of stay, falls, readmission rate and mortality at 3 months after discharge. RESULTS: Basal data of the patients included in the RCT are described. The foreseen recruitment will not be achieved due to the context of the Covid pandemic and the significantly different responses observed during the clinical trial in oncogeriatric patients compared to our previous experience in older adults hospitalized for medical reasons. DISCUSSION: If our hypothesis is correct and shows that a multicomponent, individualized and progressive exercise program is an effective therapy for improving the capacity of acutely hospitalized older patients compared to usual care, a change in the current system of hospitalization may be justified in oncogeriatric patients.

Could a Tailored Exercise Intervention for Hospitalised Older Adults Have a Role in the Resolution of Delirium? Secondary Analysis of a Randomised Clinical Trial.

Delirium is a transient neurocognitive disorder. Nonpharmacological measures can be efficient in reducing the incidence and intensity of delirium, but there is a paucity of evidence when using a physical exercise program exclusively. This was a secondary analysis of a randomised clinical trial that provided evidence on the functional and cognitive benefits of an individualised exercise intervention in hospitalised older adults. Of the 370 patients who participated in the trial, 17.1% in the intervention group had delirium and 12.1% in the control group. After the exercise intervention, 84.6% of the patients in the intervention group showed improvement in delirium compared to 68.4% of patients in the control group. Despite the fluctuating nature of delirium,we show that it is feasible to establish individualised exercise interventions in hospitalised geriatric patients in the periods when patients are able to cooperate. Baseline functional status, measured by the Barthel Index, is a clinical marker that could help to identify those who will benefit most.

Efficacy of Antiresorptive Treatment in Osteoporotic Older Adults: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.

OBJECTIVES: To investigate concerns surrounding the benefits of antiresorptive drugs in older adults, a systematic review was carried out to evaluate the efficacy of these treatments in the prevention of osteoporotic hip fractures in older adults. DESIGN: a systematic review and meta-analysis of randomized clinical trials. SETTING AND PARTICIPANTS: older adults ≥65 years with osteoporosis, with or without a previous fragility fracture. Studies with cancer-related and corticosteroid-induced osteoporosis, participants <65 years and no reported hip fracture were not included. METHODS: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, ISI Web of Science and Scopus databases were searched. The primary outcome was hip fracture, and subgroup analysis (≥75 years, with different drug types and secondary prevention) and sensitivity analysis was carried out using a GRADE evaluation. Secondary outcomes were any type of fractures, vertebral fracture, bone markers and adverse events. The risk of bias was assessment with the Cochrane risk of bias tool. RESULTS: A total of 12 randomised controlled trials (RCTs) qualified for this meta-analysis, with 36,196 participants. Antiresorptive drugs have a statistically significant effect on the prevention of hip fracture (RR=0.70; 95%CI 0.60 to 0.81), but with a moderate GRADE quality of evidence and a high number needed to treat (NNT) of 186. For other outcomes, there is a statistically significant effect, but with a low to moderate quality of evidence. Antiresorptives showed no reduction in the risk of hip fracture in people ≥75 years. The results for different drug types, secondary prevention and sensitivity analysis are similar to the main analyses and have the same concerns. CONCLUSIONS: Antiresorptive drugs have a statistically significant effect on preventing hip fracture but with a moderate quality (unclear/high risk of bias) and high NNT (186). This small benefit disappears in those ≥75 years, but increases in secondary prevention. More RCTs in very old osteoporotic adults are needed.

Multicomponent exercise program in older adults with lung cancer during adjuvant/palliative treatment: A secondary analysis of an intervention study.

BACKGROUND: Lung cancer is the second most prevalent common cancer in the world and predominantly affects older adults. This study aimed to examine the impact of an exercise programme in the use of health resources in older adults and to assess their changes in frailty status. DESIGN: This is a secondary analysis of a quasi-experimental study with a non-randomized control group. SETTING: Oncogeriatrics Unit of the Complejo Hospitalario de Navarra, Spain. PARTICIPANTS: Newly diagnosed patients with NSCLC stage I-IV. INTERVENTION: Multicomponent exercise programme that combined resistance, endurance, balance and flexibility exercises. Each session lasted 45-50 minutes, and the exercise protocol was performed twice a week over 10 weeks. MEASUREMENTS: Mortality, readmissions and Visits to the Emergency Department. Change in frailty status according to Fried, VES-13 and G-8 scales. RESULTS: 26 patients completed the 10-weeks intervention (IG). Mean age in the control group (CG) was 74.5 (3.6 SD) vs 79 (3 SD) in the IG, and 78,9% were male in the IG vs 71,4% in the CG. No major adverse events or health-related issues attributable to the testing or training sessions were noted. Significant between-group differences were obtained on visits to the emergency department during the year post-intervention (4 vs 1; p:0.034). No differences were found in mortality rate and readmissions, where an increasing trend was observed in the CG compared with the IG in the latter (2 vs 0; p 0.092). Fried scale was the unique indicator that seemed to be able to detect changes in frailty status after the intervention. CONCLUSIONS: A multicomponent exercise training programme seems to reduce the number of visits to the emergency department at one-year post-intervention in older adults with NSCLC during adjuvant therapy or palliative treatment, and is able to modify the frailty status when measured with the Fried scale.

Circulating Cytokines and Lower Body Muscle Performance in Older Adults at Hospital Admission.

BACKGROUND: Aging-related traits, including gradual loss of skeletal muscle mass and chronic inflammation, are linked to altered body composition and impaired physical functionality, which are important contributing factors to the disabling process. We sought to explore the potential relationship between lower-body muscle strength decline and inflammatory mediators in older adults. METHODS: We performed a cross-sectional analysis in 38 older adults admitted to an acute care of the elderly unit (57.9% women, mean age=87.9±4.9 years; mean body mass index [BMI]=26.5±4.7 kg/m2). Clinical and functional outcomes including weight, height, BMI, dependence, physical and cognitive performance, and muscle strength measured by one-repetition maximum (1RM) for leg-extension, leg-press, chest-press and handgrip strength, were assessed. Blood serum content of 59 cytokines, chemokines and growth factors was assessed by protein arrays. Multivariate linear regression analyses were used to examine the relationship between cytokine concentrations and muscle strength parameters. RESULTS: After controlling for confounding factors (age, sex, BMI, cumulative illness rating score and physical performance score), 1RM leg-press had a significant negative relationship with GRO (CXCL2) (ß= -18.13, p=0.049), MIG (CXCL9) (ß= -13.94, p=0.004), IGF-1 (ß= -19.63, p=0.003), CK-BETA 8 (CCL23) (ß= -28.31, p=0.018) and GCP-2 (CXCL6) (ß= -25.78, p=0.004). Likewise, 1RM leg-extension had a significant negative relationship with IGFBP-1 (ß= -11.49, p=0.023). CONCLUSIONS: Thus, several serum cytokines/chemokines and growth factors are negatively associated with lower muscle strength in older patients. Further investigation is required to elucidate the mechanism of elevated inflammatory mediators leading to lower muscle strength.

Heterogeneidad en el cribado poblacional de la fragilidad / Heterogeneity amongst different diagnostic tools in frailty screening

Fundamento: La fragilidad supone una situación de vulnerabilidad predisponente a resultados adversos en salud, relacionada con la edad y la pérdida de capacidad funcional. Aunque Atención Primaria (AP) es un nivel asistencial privilegiado para detectarla precozmente e instaurar medidas que frenen su progresión, no existe una herramienta gold standard para su detección. El objetivo es analizar la prevalencia de fragilidad en AP y evidenciar la herramienta diagnóstica más útil para este medio. Materialy métodos: Estudio transversal realizado en una muestra de 225 personas seleccionadas aleatoriamente de una población de 4.252 mayores de 75 años de tres zonas de Navarra. Se realizaron cuatro pruebas diagnósticas de fragilidad: el fenotipo de Fried, el Short Physical Performance Battery (SPPB), el Up-to Go (TUG) y el de la velocidad de la marcha (VM). Los participantes que no consiguieron finalizar alguna de las pruebas no fueron considerados en el análisis posterior. Resultados: El 51% de los participantes eran hombres, con edad media de 80,5 años, el 80% polimedicados, el 8,4% con deterioro cognitivo y el 31,1 y el 41,3% independientes para las actividades básicas e instrumentales, respectivamente, de la vida diaria. La prevalencia de fragilidad fue 8,4% (Fried), 13,7% (SPPB), 46,2% (TUG) y 52,2% (VM). Conclusiones. Se detectó gran heterogeneidad en la prevalencia de fragilidad según la herramienta diagnóstica empleada. Es necesaria una herramienta fiable, rápida y sencilla para la detección precoz de la fragilidad en AP por lo que, según los resultados y las peculiaridades de AP, proponemos el TUG o la VM como buenos predictores precoces de este deterioro

Background: Frailty means a state of vulnerability with a predisposition to adverse health outcomes, closely related to age and a consequent loss of functional capability. Early detection is important for initiating measures to slow its progression. Primary Health Care (PHC) occupies a privileged place in this. However, we do not possess a gold standard tool for its detection. Our aim is to analyse the prevalence of frailty in PHC and define the most useful diagnostic tool for this area. Methods: Cross-sectional study with 225 people were selected from a population of 4,252 people aged over 75 years-old, from three different basic health zones of Navarre. Four different diagnostic tests for frailty were conducted: the Fried phenotype, the Short Physical Performance Battery (SPPB), the Timed Up-to-Go test (TUG) and the Gait Speed test (GS). Patients who were unable to finish any of the tests weren't included in the subsequent analysis. Results: Fifty-one percent of participants were men, with mean age 80.5 years-old, 80% were taking more than five daily drugs, 8.4% had cognitive impairment, and 31.1 and 41.3% were independent for basic and instrumental activities, respectively, of daily living. The frailty prevalence was 8.3% for Fried phenotype, 13.7% for SPPB, 46.2% for TUG and 52.2% for Gait Speed. Conclusion: Great heterogeneity in the prevalence of frailty was shown depending on the tool employed. As a reliable, fast and simple tool for early detection of frailty is needed in PHC, based on our results and the particularities of PHC, we propose TUG or GS as good early predictors of this decline

[Heterogeneity amongst different diagnostic tools in frailty screening]. / Heterogeneidad en el cribado poblacional de la fragilidad.

BACKGROUND: Frailty means a state of vulnerability with a predisposition to adverse health outcomes, closely related to age and a consequent loss of functional capability. Early detection is important for initiating measures to slow its progression. Primary Health Care (PHC) occupies a privileged place in this. However, we do not possess a gold standard tool for its detection. Our aim is to analyse the prevalence of frailty in PHC and define the most useful diagnostic tool for this area. METHODS: Cross-sectional study with 225 people were selected from a population of 4,252 people aged over 75 years-old, from three different basic health zones of Navarre. Four different diagnostic tests for frailty were conducted: the Fried phenotype, the Short Physical Performance Battery (SPPB), the Timed Up-to-Go test (TUG) and the Gait Speed test (GS). Patients who were unable to finish any of the tests weren't included in the subsequent analysis. RESULTS: Fifty-one percent of participants were men, with mean age 80.5 years-old, 80% were taking more than five daily drugs, 8.4% had cognitive impairment, and 31.1 and 41.3% were independent for basic and instrumental activities, respectively, of daily living. The frailty prevalence was 8.3% for Fried phenotype, 13.7% for SPPB, 46.2% for TUG and 52.2% for Gait Speed. CONCLUSION: Great heterogeneity in the prevalence of frailty was shown depending on the tool employed. As a reliable, fast and simple tool for early detection of frailty is needed in PHC, based on our results and the particularities of PHC, we propose TUG or GS as good early predictors of this decline.

Cuantificación de la determinación del antígeno prostático específico en la práctica clínica habitual / Quantification of Prostate-Specific Antigen determination in usual clinical practice

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The relationship between frailty and polypharmacy in older people: A systematic review.

AIMS: Frailty is a complex geriatric syndrome resulting in decreased physiological reserves. Frailty and polypharmacy are common in older adults and the focus of extensive studies, although little is known about the impact they may have on each other. This is the first systematic review analysing the available evidence on the relationship between frailty and polypharmacy in older adults. METHODS: Systematic review of quantitative studies. A comprehensive literature search for publications in English or Spanish was performed on MEDLINE, CINAHL, the Cochrane Database and PsycINFO in September 2017 without applying restrictions on the date of publication. Studies reporting any relationship between frailty and polypharmacy in older adults were considered. RESULTS: A total of 25 publications were included, all of them observational studies. Evaluation of Fried's frailty criteria was the most common approach, followed by the Edmonton Frail Scale and FRAIL scale. Sixteen of 18 cross-sectional analyses and five of seven longitudinal analyses demonstrated a significant association between an increased number of medications and frailty. The causal relationship is unclear and appears to be bidirectional. Our analysis of published data suggests that polypharmacy could be a major contributor to the development of frailty. CONCLUSIONS: A reduction of polypharmacy could be a cautious strategy to prevent and manage frailty. Further research is needed to confirm the possible benefits of reducing polypharmacy in the development, reversion or delay of frailty.

Heterogeneity of Different Tools for Detecting the Prevalence of Frailty in Nursing Homes: Feasibility and Meaning of Different Approaches.

BACKGROUND AND OBJECTIVE: The identification of frail individuals has been recognized as a priority for the effective implementation of healthy aging strategies. Only a limited number of studies have examined frailty in nursing homes, and there is a big heterogeneity in the methods used. The primary objective of this study was to determine the prevalence and feasibility of different frailty screening tools in nursing homes as well as its relationship with multimorbidity and disability. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional analysis from a concurrent cohort study, which included 110 participants aged over 65 years and with different degrees of disability at 2 nursing homes. MEASUREMENTS: The study used 4 different frailty scales: The Fried frailty criteria, the imputed Fried frailty criteria, the Rockwood clinical frailty scale, and the frailty in nursing home scale, and we analyzed their relationship with disability and multimorbidity. RESULTS: The mean age of the study population was 86.3 years (standard deviation 7.3), and 71.8% were female. Most residents had a high percentage of cognitive and functional impairment, multimorbidity, and risk of malnutrition. The following prevalence rates for frailty were determined: 71.8% (62.8, 79.4), 42.7% (33.9, 52.1), and 36.4% (23.8, 51.1) as per according to the Rockwood clinical frailty scale, frailty in nursing home scale, and Fried index (95% confidence interval), respectively. In the case of the Fried index, the prevalence of frailty is based on the percentage of patients meeting the criteria, which is 40% due to the large number of missing values. After the imputation of variables with the multivariate imputation by chained equation software, the prevalence of frailty increased to 66.4% (57.1, 74.5). We observed different statistically significant associations between the frailty scales and the clinical and demographic variables, and also with disability and multimorbidity. CONCLUSIONS: Most residents of nursing homes are likely to be frail, but there is no single operational definition of frailty. Although all measures of frailty had similar associations with the clinical variables of the study, there are important conceptual differences that must be considered in addressing the relationships between frailty, disability, and multimorbidity. Further research is required, and homogeneous frailty criteria must be used so that studies and interventions can be compared.

Physical Activity and Early Rehabilitation in Hospitalized Elderly Medical Patients: Systematic Review of Randomized Clinical Trials.

BACKGROUND: To critically review the effect of interventions incorporating exercise and early rehabilitation (physical therapy, occupational therapy, and physical activity) in the functional outcomes (i.e., active daily living tests, such as Barthel Index Scores, Timed-up-and go, mobility tests), and feasibility in hospitalized elderly medical patients. DESIGN: Systematic review of the literature. METHODS: A literature search was conducted using the following databases and medical resources from 1966 to January 2014: PubMed (Medline), PEDro, the Cochrane Central Register of Controlled Trials and the Cochrane Database of Systematic Reviews, Google Scholar, ClinicalTrials.gov, Clinical Evidence, SportsDiscus, EMBASE and UptoDate. Studies must have mentioned the effects of early rehabilitation on the above mentioned functional outcomes and feasibility. Data on the mortality, economic profile and average stay were also described. RESULTS: From the 6564 manuscripts potentially related to exercise performance in hospitalized elderly patients, the review focused on 1086, and 17 articles were ultimately included. Regarding functional outcomes after discharge, four studies observed significant improvement in functional outcomes following early rehabilitation, even up to twelve months after discharge. Eight studies directly or indirectly assessed the economic impact of exercise intervention. Five of them did not show any increase in costs, while three concluded that the intervention was cost effective. No adverse effect related with the interventions were mentioned. CONCLUSION: The introduction of an exercise program for hospitalized elderly patients may be feasible, and may not increase costs. Importantly, early rehabilitation may also improve the functional and healthcare.

Intervenciones para optimizar el tratamiento farmacológico en ancianos hospitalizados: una revisión sistemática / Interventions to optimize pharmacologic treatment in hospitalized older adults: a systematic review

Objetivo. Resumir la evidencia sobre las intervenciones orientadas a optimizar el tratamiento farmacológico en ancianos hospitalizados. Material y métodos. Se realizó una búsqueda en las principales bases de datos bibliográficas, seleccionando estudios prospectivos en pacientes mayores de 65 años hospitalizados que realizaran intervenciones dirigidas a optimizar el tratamiento farmacológico, disminuir la polifarmacia y mejorar la adecuación terapéutica, los resultados en salud o el aprovechamiento del sistema sanitario. Resultados. Se seleccionaron 18 estudios. Las intervenciones consistieron en revisiones de medicación, detección de medicamentos predefinidos como potencialmente inadecuados en ancianos, asesoramiento de un equipo especializado en geriatría, uso de un sistema informático de apoyo a la prescripción o formación específica al equipo de enfermería. Hasta 14 estudios evaluaron la adecuación terapéutica, demostrando 13 de ellos una mejoría en alguno de los parámetros. Siete estudios midieron el impacto de la intervención sobre la polifarmacia, pero solo uno mejoró los resultados respecto al control. Otros siete estudios analizaron la mortalidad, no demostrándose una disminución de la misma en ninguno. Solo uno de seis estudios mostró una reducción de reingresos hospitalarios y uno de cuatro estudios una disminución de las visitas a urgencias. Conclusiones. Pese a la heterogeneidad de las intervenciones y de las variables analizadas, se obtuvieron mejores resultados en las variables de proceso, especialmente en la adecuación terapéutica, que en aquellas que midieron resultados en salud, donde hubo una mayor variabilidad (AU)

Objective. To summarise the evidence on interventions aimed at optimising the drug treatment of hospitalised elderly patients. Material and methods. We conducted a search in the main medical literature databases, selecting prospective studies of hospitalised patients older than 65 years who underwent interventions aimed at optimising drug treatment, decreasing polypharmacy and improving the medication appropriateness, health outcomes and exploitation of the healthcare system. Results. We selected 18 studies whose interventions consisted of medication reviews, detection of predefined drugs as potentially inappropriate for the elderly, counselling from a specialised geriatric team, the use of a computer support system for prescriptions and specific training for the nursing team. Up to 14 studies assessed the medication appropriateness, 13 of which showed an improvement in one or more of the parameters. Seven studies measured the impact of the intervention on polypharmacy, but only one improved the outcomes compared with the control. Seven other studies analysed mortality, but none of them showed a reduction in that rate. Only 1 of 6 studies showed a reduction in the number of hospital readmissions, and 1 of 4 studies showed a reduction in the number of emergency department visits. Conclusions. Despite the heterogeneity of the analysed interventions and variables, we obtained better results in the process variables (especially in medication appropriateness) than in those that measured health outcomes, which had greater variability (AU)

[Interventions to optimize pharmacologic treatment in hospitalized older adults: a systematic review]. / Intervenciones para optimizar el tratamiento farmacológico en ancianos hospitalizados: una revisión sistemática.

OBJECTIVE: To summarise the evidence on interventions aimed at optimising the drug treatment of hospitalised elderly patients. MATERIAL AND METHODS: We conducted a search in the main medical literature databases, selecting prospective studies of hospitalised patients older than 65 years who underwent interventions aimed at optimising drug treatment, decreasing polypharmacy and improving the medication appropriateness, health outcomes and exploitation of the healthcare system. RESULTS: We selected 18 studies whose interventions consisted of medication reviews, detection of predefined drugs as potentially inappropriate for the elderly, counselling from a specialised geriatric team, the use of a computer support system for prescriptions and specific training for the nursing team. Up to 14 studies assessed the medication appropriateness, 13 of which showed an improvement in one or more of the parameters. Seven studies measured the impact of the intervention on polypharmacy, but only one improved the outcomes compared with the control. Seven other studies analysed mortality, but none of them showed a reduction in that rate. Only 1 of 6 studies showed a reduction in the number of hospital readmissions, and 1 of 4 studies showed a reduction in the number of emergency department visits. CONCLUSIONS: Despite the heterogeneity of the analysed interventions and variables, we obtained better results in the process variables (especially in medication appropriateness) than in those that measured health outcomes, which had greater variability.

Change in Red Blood Cell Distribution width During the Last Years of Life in Geriatric Patients.

OBJECTIVES: Most of the studies that evaluate the association between red blood cell distribution width (RDW) and mortality assess it on a single occasion instead of doing so through serial measurements. Very few studies have investigated repeated measurements of RDW and its prognostic value, and most of them are focused on patients with cardiovascular diseases. RDW is a dynamic value so we aimed at determining the prognostic value of sequential RDW assessment in the last years of life in patients enrolled in a Department of Geriatrics. DESIGN: This work is part of a prospective study derived from a cohort of 122 patients over 75 years hospitalized in 2005 for the purpose of assessing the prognostic significance of several comorbidity and prognostic indices. SETTING: Patients were consecutively recruited for the study at admission in a tertiary hospital and then followed up for at least 5 years. PARTICIPANTS: A total of 55 patients with repeated RDW assessments during all the five years before their death were selected from the total cohort of 122 patients. RESULTS: We found a strong correlation between progressive rise in RDW and mortality risk, especially during the last year of life. There was a gradual significant increase in the RDW values along the last five years of life, with means growing up from 14,8 (95% CI: 13,98-15.62) to 16,37 (15,80-16,94). CONCLUSION: In our cohort of geriatric patients, RDW is a dynamic variable that is modified during the last five years of life, irrespective of their age, and especially during the last year.