Risk Factors for Functional Decline in Nonagenarians: A One-Year Follow-Up

Abstract

Background: Disability and a decline in functional capacity are common in old age. Objective: To determine predictors of functional decline in nonagenarians’ basic activities of daily living (ADL) after 1 year of follow-up. Methods: A sample of 97 nonagenarians subjects not previously severely dependent (Barthel Index >59) was evaluated. This sample included 72 women (74.2%) and the mean (SD) age was 93.4 ± 2.7 years. The following data were collected: sociodemographic data, Barthel Index (BI), Lawton-Brody Index (LI), Mental State Examination (MEC), a short version of the Mini-Nutritional Assessment, comorbidity (Charlson Index), lower-extremity function, Gait Rating Scale from the Tinetti Performance-Oriented Mobility Scale and prevalent chronic diseases. Subjects who had a 10-point or higher decline in the BI in 1 year were compared to subjects who had no decline or a maximum decline of 9 points. In addition, subjects whose total BI score fell below 60 were compared to the group of subjects who maintained scores between 60 and 100. The Student’s t test, the χ² or the Fisher’s exact test, and a multiple logistic regression analysis (with the identified risk factors of age and gender) were performed. Results: 39 nonagenarians experienced a 10-point or higher decline in the BI in 1 year. A lower LI score (p = 0.003) and visual impairment (p = 0.01) were associated with functional decline. The multiple regression analysis showed that there was a significant association with LI (odds ratio (OR) 0.74, confidence interval 95% 0.60–0.91, p < 0.005). The 18 nonagenarians who had a BI <60 had a BI >60 at baseline. Lower scores on the LI (p = 0.004) and on the MEC (p = 0.01), a history of a previous stroke (p = 0.009) and higher Charlson Index scores (p = 0.03) were associated with recently acquired, severe dependency. A multiple regression analysis showed a significant association between LI (OR 0.65, 0.47–0.89, p < 0.008) and a history of previous strokes (OR 3.39, 1.01–11.34, p < 0.04). Conclusions: According to the definition used to describe functional basic ADL decline, poor performance in instrumental ADL at baseline and a history of a stroke appear to be independent risk factors. Prevention strategies could be intensified in this subgroup of nonagenarians.

The association of multimorbidity and disability in a community-based sample of elderly aged 80 or older in Shanghai, China

“…As we all knew, advanced age is probably one of the most important factor related to functional decline, even some studies suggest the increase in relative risk of functional loss is about 2.0 for each 10-year increase in age [28]. However, in Formiga’s study, age lost the association with ADL disability in nonagenarian population [29]. In this study, we demonstrated a consistent and graded association between the increase of age and likelihood of disability in ADL/IADL just like the quantity of chronic conditions, and exponential relationship even displayed a dramatic increase among nonagenarian population.…”

Prognostic Differences of the Mini Nutritional Assessment Short Form and Long Form in Relation to 1‐Year Functional Decline and Mortality in Community‐Dwelling Older Adults Receiving Home Care

“…Studies from the acute care setting reported severe but reversible functional changes within a few months and proved that MNA‐LF scores and the former MNA‐SF categorization were able to predict the predefined functional decline . In two studies with community‐dwelling subjects aged 90 and older, MNA‐SF scores failed to predict 1‐ and 2‐year functional decline . Another study investigated 4‐year functional decline in a population‐based sample of older Taiwanese adults and compared the MNA forms based on sum scores.…”

Impact of valvular heart disease on activities of daily living of nonagenarians: the leiden 85-plus study a population based study

“…The relation between the impairments of basic activities of daily living and instrumental activities of daily living and cardiovascular co-morbidities has not been extensively studied[20,21]. Maugeri et al related several parameters (e.g.…”

“…The authors demonstrated significant functional disability in those individuals with heart failure, whereas individuals with preserved systolic LV function obtained better scores in the tests[21]. In contrast, Formiga et al evaluated the predictors of functional decline in 97 nonagenarians at 1 year follow-up and identified a history of stroke as an independent risk factor whereas the history of ischemic cardiomyopathy or heart failure were not related to functional decline[20]. …”