Jordi Mascaró

Predictive items of functional decline and 2-year mortality in nonagenarians—the NonaSantfeliu study

BACKGROUNDnFew 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.nnnMETHODSnOne 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.nnnRESULTSnThe 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).nnnCONCLUSIONnBetter 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.

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.

Hospitalizaciones por EPOC en el paciente anciano

INTRODUCTIONnHospitalizations for decompensation of chronic obstructive pulmonary disease (COPD) mainly occur in the elderly. The aim of this study was to describe the characteristics of octogenarians admitted for COPD and to compare these characteristics with those in a younger group.nnnMATERIAL AND METHODSnAll patients hospitalized for COPD in an acute care hospital over three time periods were studied. All patients met spirometric criteria for COPD. A questionnaire evaluating items on prior admissions, days of hospital stay and readmissions in the subsequent year was completed. Data on comorbidity (the Charlson index), functional dependency (Katz index), depression (Yesavage scale), domiciliary medication, socioeconomic position, social resources, and quality of life, among other factors, were gathered.nnnRESULTSnWe studied 390 patients, with a mean age of 72 years (SD 9.6), of whom 88 (22%) were aged more than 80 years old. The mean length of hospital stay was 11.4 days, FEV(1) at discharge was 39% of the theoretical value, and 55% of the patients were readmitted in the following year, with no differences between age groups. Patients older than 80 years had a lower body mass index (P<.03), greater comorbidity (P<.001), greater functional dependency (P<.001) and worse scores on the Pffeifer (P<.001) and Yesavage scales (P<.01).nnnCONCLUSIONSnOctogenarians hospitalized for COPD exacerbations have greater comorbidity, depressive features and functional dependency than younger patients. Nevertheless, no differences were found in the length of hospital stay or in readmissions in the following year.

REVISIÓNAnemia en el ancianoAnemia in the elderly

Anemia is a common disorder in the elderly and is associated with increased morbidity and mortality. In elderly subjects, in whom anemia is highly prevalent, there are several aspects, such as a hemoglobin at a level which should concern us limit, or identifying its causes, that are not easy to establish. This review focuses on knowing what is considered to be normal hemoglobin levels in adults and the common causes and potential consequences of anemia in elderly patients. It provides a diagnostic algorithm and an approach to treatment that addresses new treatments such as parenteral iron drugs and erythropoiesis-stimulating agents.

Assessing nutritional status in the elderly: evaluation of Chumlea´s equations for weight

BACKGROUNDnWeight is one of the most important parameters in assessing nutritional status. However, weight can be difficult to measure in elderly people who are unable to stand. Chumlea et al. created two equations to estimate weight in non-ambulatory patients using readily available body measurements.nnnOBJECTIVEnThe aim of the study is to analyze the usefulness of Chumlea equations in assessing nutritional status of elderly hospitalized patients.nnnMETHODSnWe measured weight, height, arm and calf circumference, subscapular skinfold and knee height of 82 hospitalized elderly patients, all of whom were able to stand. Estimated weight (EW) was obtained by Chumlea equations. Body mass index (BMI) and Mini Nutritional Assessment test (MNA) were calculated using actual weight and EW. Bland-Altmann analysis and intraclass correlation coefficient (ICC) between real and estimated parameters were assessed.nnnRESULTSnWe found a statistically significant ICC between actual weight and EW (r = 0.926), real BMI and estimated BMI (r = 0.910) and real MNA and estimated MNA (r = 0.982) (p < 0.001). Chumlea equations, however, underestimated weight: 54.05 (DS 11.88) vs 61.46 (DS 13.08); BMI: 22.30 (DS 4.61) vs 25.36 (DS 5.17) and MNA: 22.73 (DS 4.43) vs 23.30 (DS 4.33) (P<0.001). In spite of this underestimation, estimated MNA detected 100% of patients malnourished and 96% of those at risk of malnutrition.nnnCONCLUSIONSnResults obtained by Chumlea equations showed a good ICC with actual body weight and real BMI and MNA, but values were underestimated. These equations can be useful to detect undernourished hospitalized elderly patients.

Valoración y tratamiento del estreñimiento en el anciano

Resumen El estrenimiento o constipacion es un problema muy frecuente en las personas mayores y, ademas, tiene muchas implicaciones sanitarias y psicologicas. El envejecimiento supone la union de factores que convergen en la aparicion del estrenimiento tales como: inmovilidad, deshidratacion o simplemente la polimedicacion. La tendencia a banalizar este estrenimiento como enfermedad puede ocasionar complicaciones y problemas fisicos en las personas que lo presentan. Durante la siguiente revision analizaremos la epidemiologia, el correcto diagnostico y el tratamiento, tanto farmacologico como no farmacologico, del estrenimiento en personas mayores. El paciente anciano debera seguir unas normas no farmacologicas iniciales de movilidad, hidratacion e ingesta de fibra, y utilizar los laxantes cuando las medidas no farmacologicas no son suficientes. Asi, se analizaran los diferentes tratamientos y la conveniencia de cada uno en los distintos casos.