SURVIVAL AMONG SEVERELY DISABLED NURSING HOME RESIDENTS IN TERMS OF CARDIOVASCULAR DISEASES

Abstract

Objective: An expert opinion of the European Society of Hypertension-European Union Geriatric Medicine Society Working Group (2016) suggested that treating hypertension in old, frail subjects should be individualized. The impact of antihypertensive treatment on mortality in this population is unknown. The aim of the study was to estimate factors affecting survival among severely disabled nursing home residents in terms of cardiovascular diseases. Design and method: A retrospective cohort substudy with a 3-year follow-up was performed among nursing home residents with Barthel Index not greater than 40 points. The preliminary assessment included the implementation of scales: Mini Nutritional Assessment Short-Form (MNA-SF), Abbreviated Mental Test Score (AMTS) and clinical measurements: blood pressure (BP) and body mass index (BMI). Comorbidities, used drugs and mortality were extracted from medical records. Based on the median time of follow-up, the analyzed cohort was divided into 2 groups: deceased- residents who died within 3 years and those who survived >3 years of observation. Data are presented as means ± standard deviation or median [quartiles:1;3]. Results: In the comparative analysis, deceased (n = 48) and survivors (n = 40) did not differ significantly in terms of age (79.9 ± 8.2 vs. 79.2 ± 7.9), systolic BP (121 ± 12.7 vs. 121 ± 15.6 mmHg), diastolic BP (69 ± 10.1 vs. 69 ± 11.8 mmHg), Barthel Index: 12.5[0; 35] vs. 30[5; 40], comorbidities: 4[3; 5] vs. 4[3; 5], used drugs in general: 7[4; 10] vs. 7[4; 9] and antihypertensive drugs: 1[0.5; 2] vs. 2[1; 3]. Moreover, survivors were more frequently treated with aspirin (54% vs. 46%, p = 0.043), ACE inhibitors (58% vs. 42%, p = 0.017) and statins (83% vs. 17%, p = 0.054) than deceased. Hypertension was diagnosed more often among survivors (57% vs. 43%, p = 0.032, respectively). However, deceased had significantly lower scores in MNA-SF, BMI and AMTS. Logistic regression analysis showed that only MNA-SF (OR = 2.30 [95% CI; 1.15–4.58], p = 0.019) was a factor affecting survival after adjusting: age, comorbidities, AMTS and Barthel Index. Conclusions: Our results revealed that the presence of hypertension might be the protective factor for short-term mortality among older residents. However, survival was mainly related to better nutritional status among the institutionalized geriatric population.