BackgroundThe population is aging and multimorbidity is becoming a common problem in the elderly.ObjectiveTo explore the effect of multimorbidity patterns on mortality for all causes at 3- and 5-year follow-up periods.Materials and methodsA prospective community-based cohort (2009–2014) embedded within a randomized clinical trial was conducted in seven primary health care centers, including 328 subjects aged 85 years at baseline. Sociodemographic variables, sensory status, cardiovascular risk factors, comorbidity, and geriatric tests were analyzed. Multimorbidity patterns were defined as combinations of two or three of 16 specific chronic conditions in the same individual.ResultsOf the total sample, the median and interquartile range value of conditions was 4 (3–5). The individual morbidities significantly associated with death were chronic obstructive pulmonary disease (COPD; hazard ratio [HR]: 2.47; 95% confidence interval [CI]: 1.3; 4.7), atrial fibrillation (AF; HR: 2.41; 95% CI: 1.3; 4.3), and malignancy (HR: 1.9; 95% CI: 1.0; 3.6) at 3-year follow-up; whereas dementia (HR: 2.04; 95% CI: 1.3; 3.2), malignancy (HR: 1.84; 95% CI: 1.2; 2.8), and COPD (HR: 1.77; 95% CI: 1.1; 2.8) were the most associated with mortality at 5-year follow-up, after adjusting using Barthel functional index (BI). The two multimorbidity patterns most associated with death were AF, chronic kidney disease (CKD), and visual impairment (HR: 4.19; 95% CI: 2.2; 8.2) at 3-year follow-up as well as hypertension, CKD, and malignancy (HR: 3.24; 95% CI: 1.8; 5.8) at 5 years, after adjusting using BI.ConclusionMultimorbidity as specific combinations of chronic conditions showed an effect on mortality, which would be higher than the risk attributable to individual morbidities. The most important predicting pattern for mortality was the combination of AF, CKD, and visual impairment after 3 years. These findings suggest that a new approach is required to target multimorbidity in octogenarians.

Objective: Subclinical thyroid disorders are common in older individuals. Health risks associated with subclinical hypothyroidism in older adults are unclear. The aim of the study is to evaluate whether thyroid status in elderly subjects correlates with physical and cognitive function at baseline and with 3-year mortality. Design: A population-based, prospective cohort of the OCTABAIX study (307 inhabitants aged 85 years at baseline). Methods: Chronic drug prescription, functional status (Barthel and Lawton indices) and cognitive status according to the Spanish version of the Mini-Mental State Examination were recorded. Quality of life was assessed using the visual analogue scale of the quality of life test. Concentrations of TSH and thyroxine were measured. Participants were classified in accordance with clinical categories of thyroid function. Results: Twenty (6.5%) individuals had subclinical hypothyroidism and five (1.6%) had subclinical hyperthyroidism. Compared with euthyroid subjects (nZ280; 91.8%), subclinical hypo-and hyperthyroidism subjects were not significantly associated with poor physical or cognitive function at baseline. Fifty-one (15.1%) subjects died during the 36 months of follow-up. TSH values and subclinical hypo-and hyperthyroidism were not associated with an increased overall mortality risk (hazard ratio (HR) 1.086, 95% CI 0.987-1.196 and HR 0.905, 95% CI 0.902-1.053 respectively). Conclusions: This study does not support the association of TSH or thyroid disorders with physical or cognitive function at baseline or with 3-year mortality in the oldest old subjects.

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OBJECTIVES:To describe the prevalence of diabetes mellitus (DM) in community-dwelling 85-year-olds and to study the factors associated. DESIGN: Cross-sectional. SETTING: Community-based survey study of seven primary healthcare centers. PARTICIPANTS: Three hundred twenty-eight people born in 1924 and registered with primary healthcare centers. MEASUREMENTS: Information on sociodemographic variables, Barthel Index (BI), Spanish version of the MiniMental State Examination (MEC), Mini Nutritional Assessment (MNA), Braden scale for risk of pressure ulcers, Charlson Comorbidity Index, chronic diseases, social risk, quality of life, chronic drug prescriptions, and blood tests was recorded. Participants were defined as having DM according to self-report, physician diagnosis, antidiabetic prescriptions, or plasma glucose concentration 7 mmol/L or more. A comparative analysis was performed between participants with and without DM. RESULTS: The prevalence of DM in 328 octogenarians studied was 25.9%. Logistic regression showed an association between DM and BI (odds ratio (OR) = 1.03, 95% confidence interval (CI) = 1.00-1.05, P = .007), Braden risk score (OR = 0.87, 95% CI = 0.79-0.97, P = .01), thyroid disease (OR = 0.23, 95% CI = 0.06-0.92, P = .04), chronic drug prescriptions (OR = 1.28, 95% CI = 1.15-1.42, P < .001), white-cell count (OR = 1.34, 95% CI = 1.15-1.56, P < .001), low-density lipoprotein cholesterol (LDL-C; OR = 0.63, 95% CI = 0.43-0.92, P = .02) and folic acid level (OR = 1.04, 95% CI = 1.01-1.07, P = .005). CONCLUSION:There is a high prevalence of DM at 85 years old. The presence of DM was positively associated with disability, drug prescription, white blood cell count, and folic acid level, whereas there was an inverse relationship between DM and Braden scale score, thyroid disease, and LDL-C. The effect of morbidities on DM may require a multidisciplinary approach to manage its complexity. J Am Geriatr Soc 60:462-467, 2012.