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

Se presenta una revisión de los diversos estudios que forman parte de la valoración inicial y del seguimiento durante 5años de una cohorte de personas que cumplieron 85años en el momento de la inclusión: el estudio Octabaix. Se trata de un estudio poblacional con 328 participantes; de ellos el 61,6% eran mujeres, el 53% viudos y un tercio vivían solos. En cuanto a antecedentes, el 75,9% de pacientes presentaban hipertensión arterial, el 51,2% dislipemia y el 17,7% diabetes mellitus. Al inicio del estudio la mediana del índice de Barthel era de 95, la del Mini-Examen Cognitivo de 28, la del índice Charlson de 1, la del Mini-Nutritional Assessment de 25, la de la Escala de riesgo social de Gijón de 10, la de la escala visual analógica del test Euroqol-5D de salud percibida de 60; la media de fármacos era de 6,1. Tener una menor calidad de vida se asoció a género femenino, presentar un fenotipo de fragilidad, insuficiencia cardiaca y un elevado índice de riesgo social. A los 5años de seguimiento la tasa de mortalidad fue elevada (42,1%), lo que representaba una tasa de mortalidad del 8,4% al año. Un denominador común de los estudios incluidos en esta revisión ha sido el de la mayor importancia de la funcionalidad y comorbilidad global, como factores asociados a mortalidad en este grupo de edad muy avanzada frente a otros factores más clásicos presentes en poblaciones más jóvenes. También en este grupo de estudios se han analizado la fragilidad, las caídas, el riesgo nutricional, la diabetes y el envejecimiento satisfactorio, entre otros aspectos importantes para mejor conocer este grupo poblacional (AU)

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 (AU)

[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.

Diabetes mellitus a los 85 años en la comunidad. Estudio Octabaix / Diabetes mellitus at 85 years in the community. Octabaix study

No disponible

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.

Multifactorial assessment and targeted intervention to reduce falls among the oldest-old: a randomized controlled trial.

BACKGROUND: The purpose of this study was to assess the effectiveness of a multifactorial intervention to reduce falls among the oldest-old people, including individuals with cognitive impairment or comorbidities. METHODS: A randomized, single-blind, parallel-group clinical trial was conducted from January 2009 to December 2010 in seven primary health care centers in Baix Llobregat (Barcelona). Of 696 referred people who were born in 1924, 328 were randomized to an intervention group or a control group. The intervention model used an algorithm and was multifaceted for both patients and their primary care providers. Primary outcomes were risk of falling and time until falls. Data analyses were by intention-to-treat. RESULTS: Sixty-five (39.6%) subjects in the intervention group and 48 (29.3%) in the control group fell during follow-up. The difference in the risk of falls was not significant (relative risk 1.28, 95% confidence interval [CI] 0.94-1.75). Cox regression models with time from randomization to the first fall were not significant. Cox models for recurrent falls showed that intervention had a negative effect (hazard ratio [HR] 1.46, 95% CI 1.03-2.09) and that functional impairment (HR 1.42, 95% CI 0.97-2.12), previous falls (HR 1.09, 95% CI 0.74-1.60), and cognitive impairment (HR 1.08, 95% CI 0.72-1.60) had no effect on the assessment. CONCLUSION: This multifactorial intervention among octogenarians, including individuals with cognitive impairment or comorbidities, did not result in a reduction in falls. A history of previous falls, disability, and cognitive impairment had no effect on the program among the community-dwelling subjects in this study.

High rate of anticoagulation therapy in oldest old subjects with atrial fibrillation: the Octabaix study.

OBJECTIVE: To assess the prevalence of permanent atrial fibrillation (AF) in community-dwelling subjects aged 85 and to determine the anticoagulation therapy rate. DESIGN: Community-based survey of inhabitants aged 85 years. PARTICIPANTS: Participants were 328 people born in 1924 and assigned to 7 primary health care teams. MEASUREMENTS: Sociodemographic variables, Barthel Index, the Spanish version of the Mini-Mental State Examination, Mini Nutritional Assessment, Charlson Index, social risk, quality of life, and prevalent chronic diseases were assessed. Permanent AF was determined by patient interview, treatment prescriptions, and clinical records. RESULTS: The sample included 202 women (61.6%) and 126 men. In 41 (12.5%) participants permanent AF was diagnosed; 25 (60.9%) were on anticoagulant oral therapy and 9 (21.9%) were receiving antiplatelet therapy. Using multiple logistic regression analysis, previous diagnosis of heart failure (P < .001, OR 4.170, 95% CI 1.927-9.024) and stroke history (P < .03, OR 2.439, 95% CI 1.101-5.401) were significantly associated with the diagnosis of permanent AF. CONCLUSION: AF is quite prevalent in 85-year-old subjects. A large percentage of patients with AF were receiving chronic anticoagulant therapy. The percentage of patients who were not receiving prophylactic treatment was low.

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

ObjetivoEvaluar diferencias del estado de salud según género de personas de 85 años en la comunidad.DiseñoEstudio descriptivo transversal multicéntrico, en el marco de ensayo clínico aleatorio de caídas y malnutrición.EmplazamientoSiete centros de Atención Primaria.Participantespersonas de 85 años no institucionalizadas.MetodologíaSe recogieron datos sociodemográficos, factores de riesgo cardiovascular, índice Barthel (IB), miniexamen cognitivo Lobo (MEC); caídas, estado nutricional con Mini-Nutritional Assessment (MNA), comorbilidad según índice Charlson, riesgo social según Escala Gijón, calidad de vida mediante Escala Visual Analógica (EQ-EVA) de salud percibida y fármacos.ResultadosDe 328 habitantes, 61,6% eran mujeres, 53% viudos y un tercio vivían solos. Se recogieron antecedentes de hipertensión arterial 76%, dislipemia 51,2% y diabetes mellitus 17,4%. La mediana IB fue 95 (rango: 0-100), del MEC 28 (0-35), índice Charlson 1 (0-7), MNA 25 (10-30), Escala de Gijón 10 (5-21), y del EQ-EVA 60 (0-100); la media fármacos 6,1±3,3. Las mujeres vivían solas más frecuentemente (p<0,001), presentaron más caídas (p<0,006), mayor riesgo nutricional (p<0,016) y riesgo social (p<0,001); existían más hombres casados (p<0,001), con mejor cognición (p<0,003) y funcionalidad (p<0,018), y mayor comorbilidad (p<0,001).ConclusionesSer hombre a los 85 años se asocia a estar casado, tener mejor funcionalidad y cognición, y mayor comorbilidad, mientras que ser mujer se asocia a vivir sola, con mayor índice de caídas, de riesgo nutricional y de riesgo social, lo que debería tenerse en cuenta para contribuir a que estas personas más mayores puedan mantener su espacio en la comunidad(AU)

ObjectiveTo examine gender differences according to health status in the oldest old people of the community.DesignCross-sectional multicentre study, within the framework of a clinical trial on falls and malnutrition.Setting7 primary health centres.ParticipantsNon-institutionalised patients of 85 years or over.MethodsThe 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.ResultsA 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).ConclusionBeing 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(AU)

Low co-morbidity, low levels of malnutrition, and low risk of falls in a community-dwelling sample of 85-year-olds are associated with successful aging: the Octabaix study.

The population is aging throughout the world. Preserving physical and cognitive functions is crucial to successful aging. The aim of this study was to determine the proportion of 85-year-old community-dwelling subjects aging successfully, applying a quantitative approach, and assessing the association of successful aging with sociodemographic data, global geriatric assessment, and co-morbidity. This was a community-based survey of inhabitants aged 85 years, with 328 out of 487 subjects born in 1924 assigned to seven primary health-care teams, representing a participation rate of 67.5%. Sociodemographic variables, Barthel index (BI), the Spanish version of the Mini-Mental State Examination (MEC), Mini Nutritional Assessment (MNA), Charlson Index, Gait Rating Scale, social risk, quality of life (QoL), and prevalent chronic diseases were assessed. Subjects scoring higher than 90 on the BI and higher than 24 on the MEC were compared with the rest. Multiple regression analysis was performed. Using these criteria, successful aging status was defined in 162 (49.3%) subjects. Using multiple logistic regression analysis, successful agers had significantly lower co-morbidity scores (p < 0.02, odds ratio [OR] = 0.791, 95% confidence interval [CI] 0.657-0.952), higher scores on the Gait Rating Scale identifying lower risk of falls (p < 0.0001, OR = 1.753, 95% CI 1.501-2.046), and higher scores on the MNA, indicating lower risk of malnutrition (p < 0.0001, OR = 1.190, 95% CI 1.090-01.299). Regarding QoL, successful agers had significantly higher values than their unsuccessful aging counterparts (p > 0.0001). Almost half of the individuals presented successful aging. Successful agers had less co-morbidity and a lower risk of falls or malnutrition, and they had higher scores on the QoL scale.

[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.

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

IntroducciónEl incremento en la pirámide poblacional conlleva un aumento del grupo de personas mayores de 85 años. En este grupo poblacional es frecuente la presencia de síndromes geriátricos como las caídas y la malnutrición.ObjetivoEvaluar la efectividad de una intervención individualizada multifactorial para conseguir disminuir las caídas y la malnutrición en personas de 85 años de la comunidad.Material y métodosSe trata de un ensayo clínico aleatorizado a 3 años, realizado en el ámbito de Atención Primaria de Costa de Ponent (7 equipos). Se han incluido los residentes en la comunidad nacidos en el año 1924, no institucionalizados y que aceptaron participar en el estudio. Se realizarán 3 entrevistas anuales presenciales por investigadores entrenados, complementadas con 2 estudios analíticos de periodicidad bianual. Recibieron calendarios mensuales donde registraron caídas y peso, además de las hospitalizaciones. De manera aleatoria, se realizó a un grupo una intervención multidisciplinar individualizada específica, según algoritmo diseñado para factores de riesgo de caídas y/o malnutrición. Se realizaron 2 intervenciones presenciales y llamadas telefónicas de adhesión. El grupo control seguirá las recomendaciones habituales en Atención Primaria. La variable principal del estudio fue conseguir disminuir incidencias de caídas y malnutrición.ResultadosEl estudio OCTABAIX espera disminuir los índices de caídas, y de malnutrición en el grupo de 328 pacientes incluidos.ConclusionesEl estudio OCTABAIX nos ayudará a conocer las características de las personas de 85 años, además de la proporción de caídas y de riesgo nutricional y la efectividad de las medidas implementadas para disminuir dichos síndromes geriátricos(AU)

IntroductionPeople aged 85 years old and older constitute a growing population group. Falls and malnutrition are common in the elderly.ObjectiveTo determine the effectiveness of an individualized multifactorial intervention to reduce falls and malnutrition in community-dwelling persons aged 85 years old.Material and methodsThe 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.ResultsThe OCTABAIX study aims to reduce the incidence of falls and the risk of malnutrition in the 328 patients included.ConclusionsThe 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(AU)

[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.

Hypertension in the very old; prevalence, awareness, treatment and control: a cross-sectional population-based study in a Spanish municipality.

BACKGROUND: Information on hypertension in the very elderly is sparse. Until recently evidence of benefits from pharmacological treatment was inconclusive. We estimated the prevalence of hypertension in subjects aged 80 or more, the proportion of awareness, treatment and control. Explanatory variables associated with good control were also studied. METHODS: Cross sectional, population-based study, conducted in Martorell, an urban Spanish municipality, in 2005. By simple random sampling from the census, 323 subjects aged 80 or more were included. Patients were visited at home or in the geriatric institution and after giving informed consent, the study variables were collected. These included: supine and standing blood pressure and information about diagnosis and treatment of hypertension. The estimation and 95% confidence interval were obtained and a logistic regression model was used to study explanatory variables associated with blood pressure below 140/90 mm Hg. RESULTS: The prevalence of hypertension was 72.8% (95%CI: 69.5-76.6%) and 93% of the patients were aware of this condition, of whom 96.3% (95%CI: 93.65-97.9%) had been prescribed pharmacological treatment and 30.7% (95%CI: 25.8 - 36.1%) had blood pressure below 140/90 mm Hg. Some of the patients (43%) had one antihypertensive drug and 39.5% had two in combination. Explanatory variables associated with blood pressure below 140/90 mm Hg included prescription of a diuretic, OR: 0.31 (95%CI: 0.14-0.66), and history of ischemic heart disease, OR: 0.21 (95%CI: 0.1-0.47). CONCLUSION: The prevalence of hypertension in population aged 80 or more was over 70%. Most patients were aware of this condition and they had antihypertensive medication prescribed. Approximately one third of treated patients had blood pressure below 140/90 mm Hg. Patients with heart disease and with diuretics had more frequently blood pressure below this value.