Clinical Interventions in Aging (Apr 2016)
Evidence of functional declining and global comorbidity measured at baseline proved to be the strongest predictors for long-term death in elderly community residents aged 85 years: a 5-year follow-up evaluation, the OCTABAIX study
Abstract
Francesc Formiga,1,2 Assumpta Ferrer,3 Gloria Padros,4 Abelardo Montero,1,2 Carme Gimenez-Argente,1 Xavier Corbella1,2,5 On behalf of the Octabaix study members 1Internal Medicine Department, Geriatric Unit, Hospital Universitari de Bellvitge, Institut Català de la Salut, 2Bellvitge Biomedical Research Institute, IDIBELL, L’Hospitalet de Llobregat, 3Primary Care Centre “El Plà”, Direcció d’Atenció Primària Costa de Ponent, Institut Català de la Salut, Sant Feliu de Llobregat, 4South Metropolitan Clinical Laboratory, Direcció d’Atenció Primària Costa de Ponent, Institut Català de la Salut, L’Hospitalet de Llobregat, 5Albert J Jovell Institute of Public Health and Patients, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain Objective: To investigate the predictive value of functional impairment, chronic conditions, and laboratory biomarkers of aging for predicting 5-year mortality in the elderly aged 85 years.Methods: Predictive value for mortality of different geriatric assessments carried out during the OCTABAIX study was evaluated after 5 years of follow-up in 328 subjects aged 85 years. Measurements included assessment of functional status comorbidity, along with laboratory tests on vitamin D, cholesterol, CD4/CD8 ratio, hemoglobin, and serum thyrotropin.Results: Overall, the mortality rate after 5 years of follow-up was 42.07%. Bivariate analysis showed that patients who survived were predominantly female (P=0.02), and they showed a significantly better baseline functional status for both basic (P<0.001) and instrumental (P<0.001) activities of daily living (Barthel and Lawton index), better cognitive performance (Spanish version of the Mini-Mental State Examination) (P<0.001), lower comorbidity conditions (Charlson) (P<0.001), lower nutritional risk (Mini Nutritional Assessment) (P<0.001), lower risk of falls (Tinetti gait scale) (P<0.001), less percentage of heart failure (P=0.03) and chronic obstructive pulmonary disease (P=0.03), and took less chronic prescription drugs (P=0.002) than nonsurvivors. Multivariate Cox regression analysis identified a decreased score in the Lawton index (hazard ratio 0.86, 95% confidence interval: 0.78–0.91) and higher comorbidity conditions (hazard ratio 1.20, 95% confidence interval: 1.08–1.33) as independent predictors of mortality at 5 years in the studied population.Conclusion: The ability to perform instrumental activities of daily living and the global comorbidity assessed at baseline were the predictors of death, identified in our 85-year-old community-dwelling subjects after 5 years of follow-up. Keywords: oldest old, mortality, comorbidity, instrumental activity of daily living
