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Formiga F.,Hospital Universitari Of Bellvitge | Padros G.,Institute Catala Of Salut | Almeda J.,Unitat de Suport a la Recerca de Costa de Ponent
Revista Espanola de Geriatria y Gerontologia | Year: 2010

Introduction: People aged 85 years old and older constitute a growing population group. Falls and malnutrition are common in the elderly. Objective: To determine the effectiveness of an individualized multifactorial intervention to reduce falls and malnutrition in community-dwelling persons aged 85 years old. Material and methods: The OCTABAIX study is a randomized controlled clinical trial lasting 3 years in primary care in Costa de Ponent (seven primary care teams). Community-dwelling elders born in 1924 who agreed to participate in the study have been included. Three in-home visits will be made annually by a trained nurse or physician and will be complemented by two biannual analytical studies. Participants will be followed-up for hospitalizations, falls and weight using a monthly calendar. The specifically-designed algorithm to detect risk factors for falls and malnutrition will be used to provide recommendations and specific, standardized interventions for risk reduction in a randomly selected intervention group. Two face-to-face interventions will be carried out and telephone calls will be made to reinforce adherence. The control group will follow routine primary care recommendations. The primary outcome is a decline in the rate of falls and malnutrition. Results: The OCTABAIX study aims to reduce the incidence of falls and the risk of malnutrition in the 328 patients included. Conclusions: The OCTABAIX study will help to determine the characteristics of persons aged 85 years old as well as the rate of falls and nutritional risk. The effectiveness of the measures adopted to reduce these geriatric syndromes will also be assessed. © 2009 SEGG.

Almeda J.,Unitat de Suport a la Recerca de Costa de Ponent | Almeda J.,CIBER ISCIII | Formiga F.,Hospital Universitari Of Bellvitge | Rojas Farreras S.,Unitat de Suport a la Recerca de Costa de Ponent USRR
Revista Espanola de Geriatria y Gerontologia | Year: 2011

Objectives: To analyse the prescription according to the STOPP (Screening Tool of Older Person's Prescriptions) and Beer's suitability criteria, and associated factors in patients over 85 years-old. Patients and methods: Cross-sectional study of inappropriate prescribing to over 85 year-olds. The data recorded were: sociodemographic variables, cardiovascular risk factors, chronic illnesses, multiple medication (or polypharmacy) (4 or more) and geriatric assessment. The inappropriate prescription (IP) was evaluated according to total and cardiovascular prescription. Results: The mean number of drugs in the total of 78 subjects was 6.1 (3.3). Of the total number, 34.6% patients had 1 IP drug; 19.2% had 2; 15.4% had 3 or more, and in total 69.2% of patients had at least one IP drug, and 37.2% had 1 or more IP cardiovascular drugs. The therapeutic groups involved in the overall IP were benzodiazepines (BZP) 23.1%, loop diuretics 17.9%, selective serotonin reuptake inhibitors (SSRIs) 16.7%, and non-steroidal anti-inflammatory drugs (NSAIDs) made up 10.3% of the total criteria. The bivariate analyse found a relationship between the number of drugs and multiple medication (P = .030 in both) and total IP, with no significance found in cardiovascular IP. The multivariate analysis showed an association between multiple medication (OR: 1.22; 95% CI: 1.02-1.47; P = .031) and total IP, and dyslipaemia (OR: 0.30; 95% CI: 0.10-0.87; P = .026) and AHT (OR: 0.15; 95% CI: 0.03-0.78; P = .024) for cardiovascular IP. Conclusions: More than half the over 85 year-old patients received an inappropriate prescription. Dyslipaemia and AHT are associated with an inappropriate cardiovascular prescription, and the most frequent drug groups were, BZP, diuretics, SSRIs, and NSAIDs. © 2010 SEGG.

Formiga Perez F.,Hospital Universitari Of Bellvitge | Almeda Ortega J.,Institute Catala Of La Salut | Almeda Ortega J.,CIBER ISCIII | Rojas-Farreras S.,Institute Catala Of La Salut | And 12 more authors.
Medicina Clinica | Year: 2011

Background and objectives: To study the association between blood pressure and mortality in a cohort of over 80 years olders of the community after four years of follow up. Patients and methods: An observational study cohort of 323 individuals aged over 80 years the population of Martorell. We collected sociodemographic data, comorbidity, evaluation of the basic activities of daily living and the average blood pressure. The mortality and its causes were evaluated after four years of follow up. The association between blood pressure and mortality was investigated using Cox survival analysis. Results: One hundred and thirty-five (41.8%) patients died, resulting in a mortality rate of 14.5% for year. In 60% of cases the cause of death was of cardiovascular origin. Subjects with systolic blood pressure (SBP) < 130 mmHg had a mortality of 63.5% compared to those in the range of SBP = 140-159 mmHg, who had a mortality of 25.5% (Hazard Ratio [HR]: 0.39; 95% CI: 0.21-0.72; p = 0.003). Female gender (HR: 0.62, 95% CI 0.39-0.97, p < 0.036), age (HR: 1.11, 95% CI: 1.04-1.18, p < 0.001), ischemic heart disease (HR: 2.14, 95% CI 1.23-3.70, p < 0.006), orthostatic hypotension (HR: 3.78, 95% CI: 1.88-7.60, p < 0.001), Barthel Index (HR: 0.97, 95% CI: 0.96-0.98, p < 0.001), and SBP = 140-159 mmHg (HR: 0.31, 95% CI: 0.13-0.72; p = 0.007) were independent factors associated with mortality at 4 years of follow up. Conclusions: There is a high cardiovascular mortality in people aged more than 80 years. The risk factors associated with mortality are being female, older age, history of heart disease, presence of orthostatic hypotension and worse function. SBP below 130 mmHg is associated with increased mortality. © 2010 Elsevier España, S.L. All rights reserved.

Formiga F.,Hospital Universitari Of Bellvitge | Formiga F.,Bellvitge Biomedical Research Institute | Chivite D.,Hospital Universitari Of Bellvitge | Chivite D.,Bellvitge Biomedical Research Institute | And 15 more authors.
Rejuvenation Research | Year: 2013

Objective: Few studies have prospectively evaluated the utility of geriatric assessment tools as predictors of mortality in the oldest population. We investigated predictors of death in an oldest-old cohort after 3 years of follow-up. Methods: The Octabaix study is a prospective, community-based study with a follow-up period of 3 years involving 328 subjects aged 85 at baseline. Data were collected on functional and cognitive status, co-morbidity, nutritional and falls risk, quality of life, social risk, and long-term drug prescription. Vital status for the total cohort was evaluated after 3 years of follow-up. Results: Mortality after 3 years was 17.3%. Patients who did not survive had significantly poorer baseline functional status for basic and instrumental activities of daily living (Barthel and Lawton Index), higher co-morbidity (Charlson), higher nutritional risk (Mini Nutritional Assessment), higher risk of falls (Tinetti Gait Scale), poor quality of life (visual analog scale of the Quality of Life Test), and higher number of chronic drugs prescribed. Cox regression analysis identified the Lawton Index (hazard ratio [HR] 0.82, 95% confidence interval [CI] 0.73-0.89) and the number of chronic drugs prescribed (HR 1.09, 95% CI 1.01-1.18) as independent predictors of mortality at 3 years. Conclusions: Among the variables studied, the ability to perform instrumental activities of daily living and using few drugs on a chronic basis at baseline are the best predictors of which oldest-old community-dwelling subjects survive after a 3-year follow-up period. © Mary Ann Liebert, Inc.

Formiga F.,Hospital Universitari Of Bellvitge | Formiga F.,Bellvitge Biomedical Research Institute | Ferrer A.,Primary Healthcare Center El Pla I | Mimbrera D.,Hospital Universitari Of Bellvitge | And 13 more authors.
Journal of the American Medical Directors Association | Year: 2012

Objective: To assess the prevalence of permanent atrial fibrillation (AF) in community-dwelling subjects aged 85 and to determine the anticoagulation therapy rate. Design: Community-based survey of inhabitants aged 85 years. Participants: Participants were 328 people born in 1924 and assigned to 7 primary health care teams. Measurements: Sociodemographic variables, Barthel Index, the Spanish version of the Mini-Mental State Examination, Mini Nutritional Assessment, Charlson Index, social risk, quality of life, and prevalent chronic diseases were assessed. Permanent AF was determined by patient interview, treatment prescriptions, and clinical records. Results: The sample included 202 women (61.6%) and 126 men. In 41 (12.5%) participants permanent AF was diagnosed; 25 (60.9%) were on anticoagulant oral therapy and 9 (21.9%) were receiving antiplatelet therapy. Using multiple logistic regression analysis, previous diagnosis of heart failure (P < .001, OR 4.170, 95% CI 1.927-9.024) and stroke history (P < .03, OR 2.439, 95% CI 1.101-5.401) were significantly associated with the diagnosis of permanent AF. Conclusion: AF is quite prevalent in 85-year-old subjects. A large percentage of patients with AF were receiving chronic anticoagulant therapy. The percentage of patients who were not receiving prophylactic treatment was low. © 2012 American Medical Directors Association, Inc.

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