Resting metabolic rate in relation to incident disability and mobility decline among older adults: the modifying role of frailty.

BACKGROUND: Alterations in resting metabolic rate (RMR), the largest component of daily total energy expenditure, with aging have been shown in various studies. However, little is known about the associations between RMR and health outcomes in later life. AIMS: To analyze whether RMR is associated with incident disability and mobility decline in a 10-year longitudinal study, as well as the moderating role of frailty in these associations. METHODS: Data from 298 older adults aged 70 and over from the Frailty and Dependence in Albacete (FRADEA) study in Spain were used, including a baseline measurement in 2007-2009 and a follow-up measurement 10 years later. RMR was measured by indirect calorimetry. Outcomes were incident disability in basic activities of daily living (BADL, Barthel Index), incident disability in instrumental ADL (IADL, Lawton index), and mobility decline (Functional Ambulation Categories scores). Fried's frailty phenotype was used as an indicator of frailty. Logistic regression analyses were conducted. RESULTS: Fully adjusted and stratified analyses revealed that only in the pre-frail/frail group, a higher RMR was associated with a lower risk of incident BADL disability (OR = 0.47, 95% CI = 0.23-0.96, p = 0.037), incident IADL disability (OR = 0.39, 95% CI = 0.18-0.84, p = 0.017), and mobility decline (OR = 0.30, 95% CI = 0.14-0.64, p = 0.002). CONCLUSIONS: To our knowledge, this is the first study looking at the associations between RMR and functional health using a longitudinal research design. The results suggest that RMR could be used as an early identifier of a specific resilient group within the pre-frail and frail older population, with a lower risk of further health decline.

Psychological and Functional Impact of COVID-19 in Long-Term Care Facilities: The COVID-A Study.

OBJECTIVE: To analyze the psychological and functional sequelae of the COVID-19 pandemic among older adults living in long term care facilities (LTCFs). DESIGN: Cohort longitudinal study SETTING ANT PARTICIPANTS: A total of 215 residents ≥ 65 years without moderate-to-severe cognitive impairment, living in five LTCFs in Albacete (Spain). MEASUREMENTS: Baseline on-site data were collected between March - June 2020 and three-month follow-up between June to September 2020. Symptoms of depression, anxiety, posttraumatic stress disorder (PTSD), and sleep disturbances were measured as psychological variables. Disability in basic activities of daily living (BADL), ambulation and frailty were assessed as functional variables. Differences were analyzed in relation to level of comorbidity and test positivity for COVID-19. RESULTS: At baseline, residents with COVID-19 presented worse functionality, higher frailty levels and malnutrition risk compared to non-COVID-19 residents. At three-month follow-up, higher rates of clinically significant depressive symptoms (57.7%), anxiety symptoms (29.3%), PTSD symptoms (19.1%) and sleep disturbances (93.0%) were found among residents regardless of COVID status. Thus, among 215 residents, 101 (47%) experienced a decline in BADL from baseline to the 3-month follow-up (median functional loss = 5 points in Barthel Index). In multivariate analyses, COVID-19 status did not explain either the functional or the ambulation loss. By contrast, residents with low comorbidity and COVID-19 presented higher PTSD symptoms (effect 2.58; 95% CI 0.93 to 4.23) and anxiety symptoms (effect 2.10; 95% CI 0.48 to 3.73) compared to the low comorbidity/non-COVID19 group. CONCLUSION: COVID-19 pandemic was associated, after three-months, with high psychological impact in older adults in LTCFs., specifically with higher post-traumatic stress and anxiety symptoms. Functional decline did not differ in relation to COVID-19 status but could be related to isolation strategies used for pandemic control.

La pérdida funcional al ingreso, principal variable explicativa de discapacidad y mortalidad al alta y al mes en ancianos hospitalizados / Functional decline on admission: the main independent variable associated with disability and mortality at discharge and 1 month later in the hospitalized elderly

Objetivo: la hospitalización por enfermedad aguda en ancianos provoca frecuentemente deterioro funcional y mortalidad. Es preciso, en nuestro medio, cuantificar la magnitud de esos eventos adversos e identificar cuáles son las variables explicativas de discapacidad y mortalidad asociadas a un ingreso hospitalario. Material y métodos: estudio de cohortes, longitudinal y prospectivo, sobre 376 pacientes consecutivos ingresados en una unidad geriátrica de agudos de un hospital docente terciario durante 6 meses. Variables independientes: edad, sexo, situación funcional previa, pérdida funcional al ingreso (PFi = Barthel previo ­ Barthel ingreso), estado cognitivo, depresión, confusión mental, diagnóstico principal, comorbilidad, número de fármacos y estancia hospitalaria. Variables dependientes: pérdida funcional al alta (PFa = Barthel previo ­ Barthel alta) y al mes (PFm = Barthel previo ­ Barthel mes) y mortalidad al alta y al mes. Resultados: la PFi y la situación funcional previa fueron las variables explicativas de mortalidad o pérdida funcional al alta. La PFi, la edad y la demencia lo fueron de pérdida funcional o mortalidad al mes. La intensidad de la asociación dependió de la cantidad de PFi; la odds ratio varió entre 2,9 y 24,7. Conclusiones: la pérdida de función al ingreso de ancianos hospitalizados es la principal variable explicativa de discapacidad y mortalidad al alta y al mes. La intensidad de asociación depende de la cantidad de función perdida al ingreso

Objective: hospitalization for acute illness in the elderly is frequently associated with functional decline and mortality. In our setting, measurement of these adverse events and identification of the variables associated with disability and mortality following hospitalization due to an acute illness is required. Material and methods: we performed a prospective longitudinal cohort study comprising 376 consecutive elderly patients admitted to an acute geriatric ward of a tertiary teaching hospital over a 6-month period. Independent variables were age, sex, previous functionality, admission functional decline (FDa = previous Barthel score ­ Barthel score on admission), cognitive status, depression, confusional status, main diagnosis, comorbidity, number of drugs, and length of hospital stay. Dependent variables were functional decline at discharge (FDd = previous Barthel score ­ Barthel score at discharge) and at 1 month (FDm = previous Barthel score ­ Barthel score at 1 month), and mortality at discharge and at 1 month. Results: FDa and previous functionality were independently associated with functional decline or mortality at discharge. FDa, age and a diagnosis of dementia were associated with functional decline or mortality at 1 month. The magnitude of the association varied with different FDa, ranging from OR 2.9 to 24.7. Conclusions: functional decline on admission in elderly patients admitted to an acute geriatric ward is a strong independent variable associated with functional decline and mortality at discharge and at 1 month. The magnitude of the association varies with the severity of functional decline on admission

Eficiencia de una unidad de geriatría en la gestión de camas hospitalarias / Efficiency in the management of hospital beds in a geriatric unit

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