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The European Journal of Public Health Advance Access published online on June 1, 2008
The European Journal of Public Health, doi:10.1093/eurpub/ckn020
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© The Author 2008. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

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

Assumpta Ferrer1, Francesc Formiga2, Domingo Ruiz3, Jordi Mascaró2, Claudia Olmedo1 and Ramón Pujol2

1 Geriatric Unit, Internal Medicine Service, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
2 Primary Health Care Centre "El Plà" CAP -I, Sant Feliu de Llobregat. Barcelona, Spain
3 Geriatric Unit, Internal Medicine Service, Hospital Sant Pau, Barcelona, Spain

Correspondence: Francesc Formiga, MD, Geriatric Unit, Internal Medicine Service, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat 08907, Barcelona, Spain. tel: +34 93 260 74 19, fax: +34 93 260 74 20, e-mail: fformiga{at}csub.scs.es

Received May 16, 2007 , accepted March 12, 2008

Background: 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.

Methods: 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. Results: 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).

Conclusion: 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.

Keywords: functional decline, mortality, nonagenarian, physical performance


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