Associations between cognitive status and geriatric syndromes in institutionalized oldest old

Abstract

Oldest old are the fastest growing age group in most countries of the world, including the Russian Federation. Disability and institutionalization in oldest old is associated with an increased risk of cognitive impairment. The relationship between cognitive status and other geriatric syndromes has not been studied sufficiently in institutionalized oldest old. Objective. To assess the relationship between cognitive status and geriatric syndromes in persons ≥ 90 years, who live in long term care facilities (LTCF). Material and methods. The study involved patients aged ≥ 90 years, who were examined in the LTCF of Moscow. All patients underwent a neuropsychological examination, which included Mini-mental State Examination (MMSE), Frontal Assessment Battery (FAB), 5-word test, clock-drawing test and verbal fluency. A comprehensive geriatric assessment was carried out for all the subjects. To diagnose the frailty, we used the Short Physical Performance Battery (SPPB). The Bartel index was used to assess performance of activities of daily living. Instrumental activities of daily living were assessed using the Lawton scale. Nutritional status was assessed based on the Mini-Nutritional Assessment. The pain intensity syndrome was assessed by visual analogue scale. To detect dinopenia we used dynamometry with manual dynamometer. Statistical data analysis was performed using the statistical program SPSS 23.0 (SPSS Inc., USA). Fischer’s two-sided accurate test was used for two groups comparison. The relationships between the variables were evaluated using binary logistic regression with calculation of the odds ratio (OR) and 95% confidence interval (CI). Results. Dementia was diagnosed in 69% of patients. According to multivariate analysis, sensory defi ciency (OR 4.23; CI 95% 1.96–9.09; p < 0.001), malnutrition (OR 2.68; CI 95% 1.10–6.52; p = 0.030), fecal incontinence (OR 4.37; CI 95% 2.14–8.90; p < 0.001), frailty (OR 4.23; CI 95%; 1.96–9.09; p < 0.001) are associated with the presence of dementia; an increase in age for every 1 year correlates with an increase in the chances of having dementia by 15%. Urinary incontinence and chronic pain syndrome were noted in more than half of oldest old, constipation syndrome and falls syndrome were detected in more than a third of the subjects, and more than 2/3 of oldest old had dinopenia. Conclusion. The majority of institutionalized oldest old suffer from dementia, while an increase in the chances of having it is associated with frailty, sensory deficiency, malnutrition and an increase in the age of oldest old.