journal articles
CLINICAL AND FUNCTIONAL CHARACTERISTICS OF NONAGENARIANS HOSPITALIZED IN A GERIATRIC UNIT: A DESCRIPTIVE STUDY
J. Petermans, S. Mathieu, S. Allepaerts, S. Gillain, J. Pincemail, A. Samalea Suarez, L. Seidel, J.O. Defraigne, D. Gillain
J Aging Res Clin Practice 2013;2(3):303-309
Introduction: The nonagenarian population will increase in the next 30 years. Physically and cognitively, they look "more robust". We purposed to look for characteristics which make them different from elderly of lower age when hospitalized in GU. Material and methods: 61 nonagenarians (mean age: 92.4) and 60 old over 75 years (mean age: 81.9) hospitalized in GU were studied. Each of the patients underwent, in addition to the medical history and the usual clinical examination a geriatric assessment. This evaluation included Katz's and Lawton's indices which were completed based on the functional state prior to hospitalization outside any acute phenomenon, a walking test and the hand-grip test. The Montreal Cognitive Assessment was used to assess the cognitive condition. These evaluations were all performed at the end of hospitalization. The nutritional condition was also verified with the short MNA test. The water swallow test according to Di Pipo was also performed to detect any risk of aspiration. Each group was followed by a telephone call, 3, 6 and 12 months after discharge. Death, condition of living, evolution of the illness, weight, falls and rate of hospitalization were performed. The two groups were compared by the Mann-Withney non-parametric tests, for continuous variables, and chi-square for categorical variables. Results were significant at p<0.05. Results: Nonagenarians had the same ADL scores as octogenarians but their IADL scores were higher (P=0.040). They had lower power at the handgrip test (P=0.035), tended to have worse walking test (P=0.10) and took fewer medications (P=0.0017).No significant differences are observed in the other assessment. The length of hospital stay does not differ. The median for the two groups is 15 days. The death rate at the hospital is also the same. (6 nonagenarians and 4 persons under 90 years). Concerning the number of persons contacted after the discharge, there is only a significant difference at 12 months between the 2 groups (p=0.035). After 3 months 10 nonagenarians are dead against 6 for the octogenarians (p=ns), 3 months after discharge, 40.0% of the octogenarians are living at home, with help for only 14.8% of the nonagenarians (p=0.013). After 6 and 12 months there are no statistical differences in the situation of living between the 2 groups. No difference is observed between the 2 groups according the evolution of the illness of the weight and of the incidence of falls but the rate of hospitalization is particularly low in the 2 populations; from 21.6% after 3 months to 19.2% after 6 months in the octogenarians and from 14% after 3 months to 0% after 12 months in the nonagenarians (p = 0,017). Conclusion: This study shows that nonagenarians admitted to GU have albeit the same functional pattern than octogenarians but take fewer medications. Despite the fact that their walking speed is lower (< than 0.6m/sec) is associated with a risk of greater functional and/or cognitive decline their outcomes don’t differs very significantly from the younger’s even if they are more in nursing home during the 6 months after discharge. No difference in this topic is observed after one year. With 10 years older their functional profile look as well efficient as octogenarians.