David Chivite

Factors associated with hip fracture-related falls among patients with a history of recurrent falling

BACKGROUND People who have suffered falls are at greater risk of falling again. We study the characteristics of falls leading to hip fracture in people with a history of recurrent falls, comparing them with those of people with a history of sporadic falling. MATERIALS AND METHODS Analysis of the characteristics of a sample of 1225 patients consecutively admitted to six hospitals because of a hip fracture secondary to a fall (index fall) - index fall characteristics (location, time and the possible cause of the fall: intrinsic, extrinsic or combined risk factors) were also determined. Patients with a history of three or more falls (recurrent fallers) in the year prior to the index fall were identified as high-risk fallers; those with less than three falls were considered to be sporadic fallers. RESULTS The mean number of falls in the year prior to the index fall was 1.7+/-6.5; 227 patients (22%) had experienced three or more falls within that period. Most index falls (880, 71.8%) took place at the patients home, 232 (18.95%) in the street and 113 (9.2%) elsewhere; most (892, 72.9%) took place during daytime. Multiple stepwise logistic regression analysis showed that recurrent fallers were characterized by poorer baseline independence for activities of the daily living, a prior diagnosis of dementia, greater use of prescription drugs and a greater use of neuroleptics. For frequent fallers, the index fall was more often associated with an intrinsic factor than for sporadic fallers. CONCLUSIONS A significant percentage of patients experiencing a fall followed by hip fracture have a history of recurrent falling in the year prior to a fall-related hip fracture. Poorer functional and cognitive status, polypharmacy and the use of neuroleptics are more prevalent in this subgroup of patients, and intrinsic factors as a cause of the fall are more common in this group. Whether these circumstances associated with recurrent falling are responsible for this higher prevalence of intrinsic, non-accidental falls should be addressed prospectively in order to implement preventive strategies.

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.

Valoración funcional en pacientes ancianos ingresados por insuficiencia cardiaca

Evaluamos la utilidad de la valoracion funcional de las actividades basicas e instrumentales de la vida diaria en pacientes muy ancianos ingresados por insuficiencia cardiaca (IC). Se incluyo a 188 pacientes > 79 anos, un 67% mujeres, con una edad media de 84,6 ± 3,5 anos. Durante el ingreso fallecieron 25 (13%) pacientes y hubo una mayor mortalidad en los que previamente eran mas dependientes para las actividades basicas e instrumentales, con una mayor comorbilidad (indice de Charlson), asi como con cifras mas bajas de hematocrito y mas altas de creatinina. En el analisis multivariable mantuvieron su significacion el indice de Barthel, el indice de Charlson y la creatinina serica. En los ingresos hospitalarios por IC en el paciente muy anciano, una valoracion funcional previa ayuda a identificar a los pacientes de riesgo.

Admission characteristics predicting longer length of stay among elderly patients hospitalized for decompensated heart failure

BACKGROUND Acutely decompensated heart failure (HF) has become the leading cause of hospitalization for people aged 65 or older. Hospital length of stay (LOS) is a key determinant of higher hospitals costs. The aim of our study is to identify the admission characteristics that predict a longer LOS for elderly patients admitted for an acute exacerbation of HF. METHODS We prospectively evaluated 324 patients (65 years of age or older), who were consecutively admitted for decompensated HF to a tertiary teaching hospital. Variables present at the time of emergency room evaluation that could predict a longer hospital LOS were determined by comparing the characteristics of patients hospitalized for less than 4 days with those of patients needing a longer stay. RESULTS There were 191 women (59%) and 133 men in the study, with an average age of 78.6 years and a mean LOS of 7.1 days. Multivariate regression models identified two independent predictors of a hospital stay longer than four days: female gender (p=0.03, OR 1.645, 95% CI 1.047-2.584) and poorer NYHA functional class (p<0.01, OR 1.699, 95% CI 1.135-2.542). CONCLUSION In elderly patients admitted for decompensated HF, the female gender and a worse functional class at the time of admission were associated with a longer subsequent LOS.

Predictors of In-Hospital Mortality Present at Admission among Patients Hospitalised because of Decompensated Heart Failure

Chronic heart failure (HF) is associated with a poor prognosis and causes considerable mortality. The aim of this study was to identify the admission characteristics useful to predict in-hospital mortality in patients admitted because of decompensation of HF. We evaluated 414 patients (age 76.2 years, 57% women). The hospital mortality rate was 11.1%. We identified 4 independent predictors of mortality: low Barthel index (odds ratio 1.03; 95% confidence interval 1.01–1.04), creatinine level >200 µmol/l (odds ratio 3.40; 95% confidence interval 1.51–7.66), peripheral oedema (odds ratio 3.12; 95% confidence interval 1.28–7.58) and the protective effect of the new onset of the disease (odds ratio 0.2; 95% confidence interval 0.08–0.77). In conclusion, the mortality of patients admitted to the hospital with an exacerbation of HF can be predicted if either poor functional capacity, renal insufficiency, peripheral oedema or previous diagnoses of HF are present. This clinical finding may help clinicians in their decision making in HF in the emergency room.

No correlation between Mini-Nutritional Assessment (short form) scale and clinical outcomes in 73 elderly patients admitted for hip fracture

Background and aims: Malnutrition in general and protein deficiency in particular, both upon admission and during the recovery period, may adversely influence the clinical outcome after hip fracture. This study investigates the relationship between nutritional status measured by the Mini-Nutritional Assessment short form (MNA-SF) and biological markers in elderly hip-fractured patients. Methods: A prospective study in a university hospital. The MNA-SF nutritional scale and laboratory values (serum albumin, cholesterol, total lymphocyte count) were assessed within three days after hip fracture surgery. Results: Seventy-three patients were included: 61 (84%) were women and 12 men. Mean age was 81.5±7.1 years. Inhospital mortality was 10%. The mean MNA-SF score was 11±0.5 (range 3–14); according to these values, 39 patients (53%) were at risk of malnutrition. MNA-SF scores were not significantly correlated to patients’ laboratory values. Fourteen episodes of nosocomial infection were diagnosed in 11 patients, and 6 patients developed pressure ulcers during hospitalization. Conclusions: MNA-SF test scale values reflect a clinical process in post-operative hip-fractured patients which is different from serum albumin, cholesterol or lymphocyte count.

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.

Utility of Geriatric Assessment to Predict Mortality in the Oldest Old: The Octabaix Study 3-Year Follow-Up

OBJECTIVE Few studies have prospectively evaluated the utility of geriatric assessment tools as predictors of mortality in the oldest population. We investigated predictors of death in an oldest-old cohort after 3 years of follow-up. METHODS The Octabaix study is a prospective, community-based study with a follow-up period of 3 years involving 328 subjects aged 85 at baseline. Data were collected on functional and cognitive status, co-morbidity, nutritional and falls risk, quality of life, social risk, and long-term drug prescription. Vital status for the total cohort was evaluated after 3 years of follow-up. RESULTS Mortality after 3 years was 17.3%. Patients who did not survive had significantly poorer baseline functional status for basic and instrumental activities of daily living (Barthel and Lawton Index), higher co-morbidity (Charlson), higher nutritional risk (Mini Nutritional Assessment), higher risk of falls (Tinetti Gait Scale), poor quality of life (visual analog scale of the Quality of Life Test), and higher number of chronic drugs prescribed. Cox regression analysis identified the Lawton Index (hazard ratio [HR] 0.82, 95% confidence interval [CI] 0.73-0.89) and the number of chronic drugs prescribed (HR 1.09, 95% CI 1.01-1.18) as independent predictors of mortality at 3 years. CONCLUSIONS Among the variables studied, the ability to perform instrumental activities of daily living and using few drugs on a chronic basis at baseline are the best predictors of which oldest-old community-dwelling subjects survive after a 3-year follow-up period.

Characteristics of fall-related hip fractures in community-dwelling elderly patients according to cognitive status

Background and aims: Falls are a major cause of morbidity and mortality in older people who have cognitive impairment. The present study compared the characteristics of community-dwelling patients, with and without previous diagnosis of dementia, hospitalized because of a hip fracture. Methods: 1024 consecutive patients >65 years (77.2% women, mean age 82.9 yrs) admitted for fall-related hip fracture to six Spanish hospitals during a 20-month period were included. Sociodemo-graphic data, geriatric assessment and characteristics (location, time and possible cause: intrinsic, extrinsic or combined risk factor) of falls leading to hip fracture were evaluated. Results: A total of 154 (15%) patients had a previous diagnosis of dementia. Analysis showed a greater number of previous falls before admission for hip fracture in demented patients. Moreover, in non-demented patients, we found both a predominance of falls during the day and of extrinsic factors. Conclusion: Some differences were observed, according to the cognitive status of elderly patients suffering a hip fracture due to a fall. A high percentage of dementia patients had suffered repeated falls prior to the fall-related hip fracture.

Circunstancias asociadas a las caídas responsables de fractura de fémur en pacientes ancianos. Diferencias por grupo de edad y género

Objetivo La mayoria de fracturas de femur acontecen tras una caida. El objetivo de este estudio es identificar las circunstancias asociadas a las caidas que provocan fractura de femur en una poblacion anciana. Pacientes y metodos Se estudiaron las caracteristicas de las caidas responsables de la fractura de femur en 410 pacientes ingresados de forma consecutiva en 6 centros durante el ano 2004. Se valoro el lugar, la hora y la posible causa de la caida, ya fuese causa intrinseca, extrinseca o combinada. Resultados Se incluyeron 316 (77%) mujeres y 94 varones con una edad media de 81,9 anos. La media del indice de Barthel previo fue de 77,5. El promedio de caidas durante los 12 meses previos fue de 1,9. En el 24% de los casos se documentaron caidas de repeticion (mas de dos caidas) previamente a la caida que provoco la fractura de femur. La caida acontecio en el domicilio en el 68% de los casos y en el 80% de los casos fue diurna (8-20 horas). En el 45% de los pacientes se considero que la caida tuvo una causa intrinseca, en el 33% extrinseca y en el 22% combinada. Conclusiones La mayoria de las caidas responsables de fractura de femur en el anciano son diurnas, en el domicilio y de causa intrinseca. Se debe intensificar la identificacion de los pacientes con riesgo elevado de caidas para establecer medidas de prevencion de los factores de riesgo evitables.