Socioeconomic Position and Malnutrition among Older Adults: Results from the FRADEA Study.

OBJECTIVES: Low socioeconomic position (SEP) is related to many health-related conditions in older adults. However, there is a lack of knowledge on the association between SEP and malnutrition, a condition with serious consequences for older people in terms of quality of life and adverse health events. In the current study, we investigated socioeconomic inequalities in malnutrition and sub-domains of malnutrition in a sample of Spanish older adults. DESIGN: Cross-sectional population-based study. SETTING: Urban area of Albacete, Spain. PARTICIPANTS: 836 participants over age 70 from the first measurement wave (2007-2009) of the Frailty and Dependence in Albacete (FRADEA) study, a population-based cohort study. MEASUREMENTS: Educational level and occupational level were the indicators of SEP. Nutritional risk was measured with the Mini Nutrition Assessment® Short Form (MNA®-SF). Logistic regression analyses were performed. RESULTS: For both socioeconomic indicators there was a statistically significant association with nutritional risk (OR low education=1.99, 95% CI=1.18-3.35; OR low occupational level=1.71, 95% CI=1.08-2.72). However, these associations disappeared after adjusting for age and sex (OR low education=1.51, 95% CI=0.88-2.60 ; OR low occupational level=1.32, 95% CI=0.80-2.17). In adjusted models, statistically significant associations between SEP and sub-domains of the MNA®-SF were observed, but these associations were not consistent across socioeconomic indicators. CONCLUSIONS: This study found that malnutrition is a condition that can appear in any older adult, regardless of their socioeconomic group. These findings suggest that interventions to prevent malnutrition in older adults can be targeted at a general older population, and do not have to be SEP specific.

Frailty and Fear of Falling: The FISTAC Study.

OBJECTIVE: To analyze the association between frailty and Fear of Falling (FoF) in a cohort of older adults with previous falls. DESIGN: Cross-sectional study (FISTAC). SETTING: Falls Unit, Complejo Hospitalario Universitario of Albacete (Spain). PARTICIPANTS: 183 adults older than 69 years, from the Falls Unit, with a history of a previous fall in the last year. MEASUREMENTS: FoF was assessed at baseline using the Falls Efficacy Scale International (FES-I) and three questions previously validated. Frailty was assessed with the frailty phenotype criteria. Age, gender, comorbidity, nutritional status, cognitive status and risk of depression were determined. RESULTS: Mean age 78.4, 80.3% women. FoF was present in 140 (76.5%) participants with the three questions and 102 (55.7%) presented high concern of falling with the FES-I. 88.8% of frail older adults presented FoF compared to 62.4% of those who were not frail, and only 37.8% of non frail had a high concern of falling, compared to 77.2% of those who were frail measured with the FES-I. Frail participants had an adjusted risk of FoF that was 3.18 (95% CI 1.32 to 7.65) higher compared to those who were not frail assessed with the three questions and 3.93 (95% CI 1.85 to 8.36) higher concern of falling when using the FES-I scale. Only female sex and depression risk were also associated to FoF in the final adjusted models. CONCLUSION: Frailty is independently associated with the FoF syndrome in older faller subjects.

Use of Health Resources and Healthcare Costs associated with Frailty: The FRADEA Study.

BACKGROUND: Frailty is associated with adverse health outcomes, but its association with hospital healthcare costs has not been analyzed. The main objective was to estimate the adjusted annual costs and use of hospital healthcare resources in frail older adults compared to non frail ones. DESIGN: FRADEA Study. Mean follow-up 1044 days (SD 314). SETTING: Albacete city, Spain. PARTICIPANTS: 830 adults ≥70 years. MEASUREMENTS: Age, sex, comorbidity measured with the Charlson index and Fried´s Frailty phenotype as independent variables, and use of hospital resources (hospital admissions, emergency visits, and specialist visits), and hospital healthcare costs as outcome variables. Outcome data were collected from Minimum Data Set of the Complejo Hospitalario Universitario Albacete. The cost base year was 2013. Logistic regression and two-part models were used to analyze the association between frailty and the use of healthcare resources. Generalized Linear Models were applied to estimate the impact of frailty and comorbidity on the healthcare costs. RESULTS: The average cost associated with the use of health resources was 1,922€/year. Frail participants had an average total cost of health resources of 2,476€/year, pre-frail 2,056€/year, and non-frail 1,217€/year. 67% of the total health cost was associated with hospital admission cost, 29% with specialist visits cost and 4% with emergency visits cost. Frailty and comorbidity were the most important factors associated with the use of hospital healthcare resources. Adjusted healthcare costs were 592€/year and 458€/year greater in frail and pre-frail participants respectively, compared to non-frail ones, and having a Charlson index ≥ 3, was associated with an increased costs of 2,289€/year. CONCLUSION: Frailty and comorbidity are meaningful and complementary associated with increased hospital healthcare resources use, and related costs.

Age, frailty, disability, institutionalization, multimorbidity or comorbidity. Which are the main targets in older adults?

OBJECTIVES: Age, frailty, disability, institutionalization, multimorbidity or comorbidity are main risk factors for serious health adverse outcomes in older adults. However, the adjusted relevance of each of them in order to determine which characteristics must be of importance for health policies in this population group, has not been established. DESIGN: Concurrent population-based cohort study. SETTING: Albacete city, Spain. PARTICIPANTS: 842 participants over age 70 from the FRADEA Study. MEASUREMENTS: Age, gender, institutionalization, frailty (Fried's criteria), previous disability in basic activities of daily living (BADL) (Barthel index), comorbidity (Charlson index), and multimorbidity (≥ 2 from 14 selected diseases) were recorded in the basal visit. The combined event of mortality or incident disability in BADL was determined in the follow-up visit. The risk of presenting adverse events was determined by Kaplan-Meier analysis and logistic regression adjusted for age, sex, and institutionalization. RESULTS: Mean follow-up 520 days. 63 participants died (7.5%). Among the remaining 779, 191 lost at least one BADL (24.5%). The combined event of mortality or disability was present in 254 participants (30.2%). Age (OR 1.10, 95%CI 1.06-1.14), frailty (OR 3.07, 95%CI 1.63-5.77), disability (OR 2.19, 95%CI 1.43-3.36) and institutionalization (OR 2.73, 95%CI 1.68-4.44) were independently associated with the combined adverse event, but not comorbidity or multimorbidity. In subjects younger than 80, only frailty, disability and institutionalization were risk factors, and in those aged ≥ 80, only age, disability and institutionalization were. CONCLUSIONS: Health policies for older adults must take into account mainly frailty and disability in subjects younger than 80 and disability in those older than 80.

Nutritional risk, nutritional status and incident disability in older adults. The FRADEA study.

OBJECTIVES: To analyze if body mass index (BMI) and waist circumference (WC) as measures of nutritional status, and the Mini Nutritional Assessment Short Form (MNA-SF) as a nutritional risk measure are associated with increased risk of incident disability in basic activities of daily living (BADL) in a population based cohort of Spanish older adults. DESIGN: Concurrent cohort study. SETTING: Albacete City, Spain. PARTICIPANTS: 678 subjects over age 70 from the FRADEA Study (Frailty and Dependence in Albacete). MEASUREMENTS: BMI, WC and MNA-SF were recorded at the basal visit of the FRADEA Study. Incident disability in BADL was defined as loss of the ability to perform bathing, grooming, dressing, toilet use, or feeding from basal to follow-up visit, using the Barthel index. The association between nutritional status and nutritional risk with incident BADL disability was determined by Kaplan-Meier analysis and logistic regression adjusted for age, sex, basal function, comorbidity, cognitive decline, depression risk and frailty status. RESULTS: Each point less of MNA-SF (OR 1.17, 95%CI 1.04-1.31) and MNA-SF<14 (OR 2.33, 95%CI 1.39-3.89), but not MNA-SF<12 (OR 1.47, 95%CI 0.89-2.42) had a greater adjusted risk of incident disability in BADL. Neither BMI (OR 1.02, 95%CI 0.97-1.06) nor WC (OR 1.01, 95%CI 0.99-1.03) were associated. Weight loss (OR 1.75, 95%CI 1.08-2.83) and mobility impairment (OR 3.35, 95%CI 1.67-6.73) remained as adjusted predictors of incident BADL disability, while anorexia almost reached the significance (OR 1.65, 95%CI 0.94-2.87). CONCLUSION: Nutritional risk measured with the MNA-SF is associated with incident disability in BADL in older adults, while nutritional status measured with BMI or WC is not.

Association between Functional Assessment Instruments and Frailty in Older Adults: The FRADEA Study.

OBJECTIVES: To determine the association between functional assessment instruments and frailty. DESIGN: Concurrent cohort study. SETTING: Albacete Health Area (Spain). PARTICIPANTS: 993 subjects aged ≥ 70 years, participating in the FRADEA Study. MEASUREMENTS: The following functional instruments were applied: Barthel index, Lawton index and Short Form-Late Life Function and Disability Instrument (SF-LLFDI) as disability questionnaires; Holden´s Functional Ambulation Classification (FAC) as ambulation scale, and seven performance tests: gait speed (m/s), Timed up and go (TUG) (sec), unipodal balance time (sec), 5-chair-sit-to-stand test (sec), Short Physical Performance Battery (SPPB), hand grip strength (kg) and elbow flexion strength (kg). Frailty was assessed by Fried´s criteria. The association between functional instruments and frailty was assessed, ROC curves were constructed and the area under the curves (AUC) calculated. The best cut-point was identified for each instrument and their sensitivity (S) and specificity (SP) are described. RESULTS: 16.9% participants were frail. The AUC, best cut-point, S and SP for each instrument were respectively: Barthel (0.916; ≤ 85; 0.90, 0.82), Lawton (0.917; ≤ 3; 0.86, 0.93), SF-LLFDI (0.948; ≤ 90; 0.87, 0.91), FAC (0.885; ≤ 4; 0.81, 0.83), gait speed (0.938; ≤ 0.62; 0.90, 0.90), TUG (0.984; ≥ 17.8; 0.93, 0.98), unipodal balance time (0.753; ≤ 5; 0.73, 0.71), 5-chair-sit-to-stand test (0.880; ≥ 15; 0.78, 0.76), SPPB (0.956; ≤ 6; 0.88, 0.88), hand grip strength (0.807; ≤ 26; 0.75, 0.75) and elbow flexion strength (0.924; ≤ 15; 0.89, 0.87). CONCLUSION: The best performance tests to identify frail subjects are the Timed Up and Go test, gait speed and the SPPB, and the best questionnaire is the SF-LLFDI.

Discriminación por edad en los tratamientos oncológicos de ancianos con cáncer de colon y mama. Estudio de casos y controles / Age discrimination in oncological treatments in elderly patients with colon and breast cancer. A case-control study

Objetivo: comprobar si en nuestro medio la edad cronológica es un factor condicionante del tratamiento del cáncer de mama y colorrectal. Material y métodos: estudio de casos y controles (mayores y menores de 75 años) ajustados por histología, estadio tumoral y escala ECOG en pacientes con cáncer de colon y mama atendidos en la Unidad de Oncología del Complejo Hospitalario de Albacete durante los años 1998-1999. Resultados: los pacientes jóvenes con cáncer de colon recibieron más frecuentemente tratamiento curativo-adyuvante que los mayores (odds ratio [OR] = 2,69; intervalo de confianza [IC] del 95%, 1,04-6,94), así como quimioterapia curativa (OR = 5,3; IC del 95%, 3-9,5) y quimioterapia paliativa (OR = 7,8; IC del 95%, 1,6-37,7). Las mujeres jóvenes con cáncer de mama recibieron con más frecuencia tratamiento con quimioterapia curativa (OR = 28,6; IC del 95%, 7,3-112,7) y radioterapia curativa (OR = 3,2; IC del 95%, 1,2-8,5) y las mujeres mayores de 75 años recibieron más frecuentemente hormonoterapia curativa (OR = 3,9; IC del 95%, 1,3-11,5). La prescripción de opiáceos y la derivación a la unidad de medicina paliativa fueron similares en ambos grupos de edad. Conclusión: la edad es en nuestro medio un factor discriminante a la hora de administrar tratamientos oncológicos curativos

Aim: to investigate whether chronological age exerts any influence on the mode of therapy for breast or colorectal neoplasms in our environment. Material and methods: we performed a case-control study with grouping by age (75 years as cut-off) and adjusted for histology, tumour staging, and Eastern Cooperative Oncology Group (ECOG) scale in patients with neoplasms of the colon and breast attending the Oncology Unit at the Complejo Hospitalario de Albacete from 1998 to 1999. Results: in the colon cancer group, younger patients were more frequently treated with curative-adjuvant therapy (OR = 2.69, 95% CI 1.04 to 6.94), curative chemotherapy (OR = 5.3, CI 95% 3.0 to 9.5), or with palliative chemotherapy (OR = 7.8, 95% CI 1.6 to 37.7) than those aged more than 75 years old. In the breast cancer group, younger women more frequently received curative chemotherapy (OR = 28.6, 95% CI 7.3 to 112.7) and curative radiotherapy (OR = 3.2, 95% CI 1.2 to 8.5) than patients aged more than 75 years old, whereas this latter group more frequently received curative hormonotherapy (OR = 3.9, CI 95% 1.3 to 11.5). Prescription for opiates and referral rates to the Palliative Care Unit were similar in both age groups. Conclusion: in our regional setting, age is a discriminant factor affecting the different treatment modalities for neoplasms of the colon and breast

Uso apropiado del término fragilidad / Appropiate use of the term fragility

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Síndrome confusional agudo secundario a estado epilépticono convulsivo / Acute confusional syndrome secondary to nonconvulsive status epilepticus

Presentamos el caso de un anciano de 78 años que ingresó por un síndrome confusional agudo secundario a un estatus epiléptico no convulsivo, confirmado mediante electroencefalograma y que se controló con carbamacepina. Se discute la importancia del diagnóstico temprano de esta patología así como sus consecuencias y pronóstico (AU)