NonaSantfeliu Study Research Articles

Estudio NonaSantfeliu. Valoración inicial y 10 años de seguimiento

NonaSantfeliu study: A review is presented of the studies that are part of the initial overall assessment and the studies performed during the 10 years of follow-up of a cohort of nonagenarians. It is a population-based study of 186 subjects, 76.5% women, mean age at baseline of 93.06 years, a quarter (26%) being institutionalized. The mean of baseline Barthel index was 60.8, and the mean for the Lobo's cognitive minimental was 21. Nonagenarian males with low comorbidity had more successful aging criteria than women with high comorbidity quantified with the Charlson Index. The survival rate at 10 years follow-up was very low, and 95.6% of the population had died. This represented an annual mortality rate of 9.5%. A common denominator on assessing all different annual cuts, is that the most important factors associated with mortality are those related to geriatric assessment, such as a function, cognition, dementia, and cumulative comorbidity and multiple medications, compared to more traditional risk factors described in younger populations.

Vital status after five-year follow-up of nonagenarians with functional and/or cognitive impairment at baseline: the NonaSantfeliu study.

To evaluate vital status after five years of follow-up in a cohort of nonagenarians with functional and/or cognitive impairment at baseline. Prospective cohort study. A community-based study. Nonagenarians enrolled in the NonaSantfeliu study. Functional status was determined by the Lawton-Brody and Barthel indexes (BI), while cognition was assessed using the Spanish version of the Mini-Mental State Examination (MEC). Nonagenarians scoring up to 59 points on the BI were defined as individuals with significant functional impairment. Nonagenarians with cognitive decline were defined as those individuals with a score of 23 or less on the MEC. Subjects scoring < 60 on the BI and < 24 on the MEC were considered to show combined impairment (both functional and cognitive). Sixty-three of 71 (88.8%) subjects with a BI < 60 and 73 of 84 (86.9%) with a MEC score < 24 had died after five years. Forty-eight of 53 nonagenarians (90%) with combined impairment died during the same follow-up period. A prior diagnosis of heart failure was the only variable associated with higher mortality in the three groups of subjects. Most of the nonagenarian subjects with functional and/or cognitive impairment at baseline had died at five-year follow-up.

Serum high‐density lipoprotein cholesterol levels, their relationship with baseline functional and cognitive status, and their utility in predicting mortality in nonagenarians

Little is known about the role of high-density lipoprotein cholesterol (HDL-C) in oldest-old subjects. The aim of this study is to evaluate the association between HDL-C levels and physical and cognitive performance indicators in nonagenarians, and also to determine the influence of HDL-C levels on the 3-year mortality risk. The data analyzed were taken from the NonaSantfeliu Study. Functional status was determined by the Lawton-Brody Index (LI) for instrumental activities of daily living (IADL) and the Barthel Index (BI) for basic activities (BADL). Cognition was assessed using the Spanish version of the Mini-Mental State Examination (MEC). The sample consisted of 49 women (79%) and 13 men, aged 94.3 ± 2.6 years. Mean HDL-C levels were 60 ± 16 mg/dL, and 16 subjects (25.8%) had low HDL-C values. HDL-C levels did correlate with BI (r = 0.28, P = 0.02) and LI (r = 0.32, P = 0.01), but not with MEC (r = 0.18, P = 0.15). Normal HDL-C levels at baseline were significantly associated with higher BI scores (P < 0.006, odds ratio [OR] = 1.03, 95% confidence interval [CI] = 1.01-1.05) and a lower number of prescription drugs used (P < 0.04, OR = 0.71, 95% CI = 0.49-0.99). Baseline HDL-C levels were significantly lower among the group of nonagenarians who died within the 3 years of follow up (P = 0.02). However, after adjusting for potential confounders, the association between HDL-C and mortality lost significance. Higher levels of HDL-C correlate with better functional status and less use of prescribed drugs in nonagenarians. However, the relationship between low HDL-C levels and long-term mortality in this population remains unclear.

Vital status after five-year follow-up of nonagenarians with functional and/or cognitive impairment at baseline: The nonasantfeliu study

Vital status after five-year follow-up of nonagenarians with functional and/or cognitive impairment at baseline: The nonasantfeliu study

Predictors of long-term survival in nonagenarians: the NonaSantfeliu study

few studies have prospectively evaluated long-term predictors of mortality in nonagenarians. to determine predictors of death in a nonagenarian cohort after 5 years of follow-up. a prospective community-based study. a community-based study. one hundred and eighty-six nonagenarians both living in the community and institutionalised. 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. 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. better cognitive status and lesser comorbidity at baseline are the best predictors to identify which nonagenarians survived after a 5-year follow-up period.

Decline in the performance of activities of daily living over three years of follow-up in nonagenarians: The NonaSantfeliu study

Purpose Among individuals of similar age, some appear to be resistant to decline in physical function while others appear more vulnerable. This paper aimed to identify the risk factors that serve as predictors of loss in basic and instrumental activities of daily living (ADL) in nonagenarians without a previously severe disability over a 36-month follow-up. Subjects and methods A sample of 63 nonagenarians with a Barthel Index (BI) > 59 and Lawton Index (LI) ≥ 1 was evaluated. Subjects with a 10-point or greater decline in the BI over the follow-up period were compared with the remainder. Those with a decline of greater than 1 point on the LI were also compared with the rest. Finally, subjects who showed a decline on both measures were compared with the remainder. Results BI scores decreased by 57.1%. Multiple logistic regression analysis showed a significant association between prior poor LI score and less functional loss on the BI (OR 0.62, 95% CI 0.46–0.83). A decline with respect to the LI was observed in 52.3% of cases. Regression analysis showed an association between lower baseline LI score and functional decline on the LI (OR 0.28, 95% CI 0.15–0.51). Twenty-five (39.6%) nonagenarians experienced a decrease on both (BI and LI). Regression analysis showed that patients with lower LI experienced less functional decline on the BI and in terms of instrumental ADL (OR 0.46, 95% CI 0.31–0.66). Conclusion Among nonagenarians, subjects with higher prior scores on instrumental ADL scales are the most likely to show a more important loss in their functional status.

Predictors of 3-year mortality in subjects over 95 years of age. The NonaSantfeliu study.

To examine the survival rates of subjects aged 95 or over after a follow-up period of 3 years, and to determine predictive factors for mortality risk. A prospective cohort study. A community-based study. Forty-eight subjects aged 95 or over. Sociodemographic data, Barthel Index, Lawton-Brody Index, Spanish version of the Mini-Mental State Examination, short version of the Mini Nutritional Assessment, comorbidity (Charlson Index), and prevalent chronic diseases were evaluated. Patients who died were compared with the rest. Thirty-six deaths (75%) were recorded during follow-up. The Cox multivariate analysis showed that lower Barthel Index scores and a history of heart failure were independently associated with long-term mortality. In subjects aged 95 or over, poor functional status and history of heart failure were the two independent risk factors for 3-year mortality.

Predictors of 3-year mortality in subjects over 95 years of age. The nonasantfeliu study

Predictors of 3-year mortality in subjects over 95 years of age. The nonasantfeliu study

Falls in nonagenarians living in their own homes: the Nonasantfeliu study.

To evaluate the prevalence of falls and their circumstances in non-institutionalized people older than 89 years and living in an urban community. Cross-sectional cohort study. Community-based study. 137 nonagenarians living at home. We evaluated sociodemographic data, capacity to perform basic activities according to the Barthel Index (BI) and instrumental activities on the Lawton-Brody Index (LI), cognition with the Spanish version of the Mini-Mental State Examination (MEC), near visual acuity by the Snellen test, and auditory acuity with the whisper test. Ninety-nine women (72%) and 38 men with an average age of 93.07 years (0.7) were included. 48.1% of them had suffered a fall during the last year, and in 20% of cases this had happened on more than one occasion. In 5.7% of cases, falls led to fractures. Factors associated with falls were a lower LI and a greater number of prescribed drugs. In the multivariate analysis the only factor related to falls was the number of drugs taken (p>0.001, odds ratio 0.785, 95% confidence interval 0.676-0.912). Measures to prevent falls among nonagenarians should be intensified due to their high frequency. In this age group the increase in the percentage of falls is mainly related to the higher number of drugs taken.

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

Few 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. One 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. The 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). Better 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 2-year mortality in nonagenarians with cognitive impairment at baseline: The NonaSantfeliu study

We aimed to identify a set of predictors of mortality at 2-year follow-up in a cohort of nonagenarians with cognitive impairment at baseline. The following variables were evaluated; functional status determined by the indices of Barthel Index for basic and Lawton and Brody for instrumental activities of daily living, while cognition was assessed using the Spanish version of the mini-mental state examination (MEC). Cognitive impairment was graded as severe for those having MEC scores of 0–17 and mild for scores of 18–23. A total of 77 nonagenarians with a MEC score of 23 or below were included: 61 women (79.25%) and 16 men, with a mean age of 93.7 (3.4) years. The rate of mortality was 55.8%. According to MEC scores the proportion of deaths during the 2-year follow-up period ranged from 35.2% (6 out of 17) among mildly impaired participants to 61.6% (37 out of 60) among severely impaired participants ( p = 0.05). Multivariate regression analysis showed that the risk of dying in this cohort was associated with being older ( p < 0.01, OR 1.23, 95% CI 1.03–1.4) and having a previous history of heart failure ( p < 0.0001, OR 8.72, 95% CI 2.66–28.5). In conclusion age and heart failure predict mortality among nonagenarians with prior cognitive impairment.

Predictors of two-year mortality in nonagenarians with severe functional impairment at baseline: the NonaSantfeliu study

Predictors of two-year mortality in nonagenarians with severe functional impairment at baseline: the NonaSantfeliu study

Predictive items of one-year mortality in nonagenarians. The NonaSantfeliu Study

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. 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). 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. This study supported the importance of age, heart failure and nutritional status in predicting 1- year mortality in nonagenarians.

Falls in nonagenarians after 1-year of follow-up: The NonaSantfeliu study

An increase in the rate of falls may be an indicator of frailty. This study included a 12-month follow-up investigation into the rate of falls, in people over 89 years, living in an urban community and analyzed the differences between inhabitants with falls and those without falls. The study was conducted within the framework of the NonaSantfeliu study and 140 nonagenarians participated. Sociodemograhic data, Barthel index (BI), activities of daily living (ADL), Spanish version (MEC) of the mini mental state examination (MMSE), the mini nutritional assessment (MNA) questionnaire, near visual acuity by Snellen test and auditory acuity with the Whisper test were evaluated. The fall rate was 47.1%. The 1-year incidence of falls was 26.4%. The incidence of recurrent falls (two or more falls per year) was 10% ( n = 14). The prevalence of previous falls within the year preceding the study was 45.7%, 64 of 140 nonagenarians fell and 17 (26.5%) of them fell again during the follow-up. Seventy-six out of 140 (54.3%) nonagenarians had not fallen during the year prior to the study and during the year of follow-up, 20 (26.3%) of them had a new fall. In conclusion, the rate of falls among nonagenarians is high. These results emphasize the need to increase the awareness, to provide recommendations and to incorporate strategies to prevent falls.

Evaluación funcional y cognitiva en una población urbana de mayores de 89 años. Estudio NonaSantFeliu

Introduction the increase in life expectancy should be characterized by an increase in disability-free life. We assessed functional and cognitive capacity in an urban population older than 89 years, as well as possible gender variations. Material and methods the NonaSantFeliu study is a longitudinal, observational, population-based study. We present the first crosssectional survey of 186 inhabitants older than 89 years in a city. Sociodemographic data were gathered. We assessed basic activities of daily living with the Barthel Index (BI), instrumental activities with the Lawton Index (LI), cognitive status with the Mini-Mental State Examination (MMSE) and comorbidity with the Charlson Index (CI). Results of 186 examined nonagenarians, 143 (76.5%) were women. The mean age SD was 93.1 ± 3.1 years. One-hundred forty nine (80.2%) were widowed and 26% were institutionalized. The mean BI was 60.8 ± 30; 56% were functionally independent or had slight dependence. The mean LI was 2.1 ± 2.8. The mean MMSE score was 21 ± 11; 56% had an MMSE score higher than 23. The mean CI was 1.4 ± 1.7. No significant differences were found by gender. Conclusions despite their advanced age, most of the nonagenarians showed mild functional and cognitive impairment with low comorbidity. No significant differences were observed by gender. Future studies should help to detect nonagenarians at high risk of rapid impairment to allow early initiation of interventions to delay the development of further incapacity.