Objectives To evaluate the predictive value of muscle strength and physical performance in the oldest old for all‐cause mortality; hospitalization; and the onset of disability, defined as a decline in activities of daily living ( ADL s), independent of muscle mass, inflammatory markers, and comorbidities. Design A prospective, observational, population‐based follow‐up study. Setting Three well‐circumscribed areas of Belgium. Participants Five hundred sixty participants aged 80 and older were followed for 33.5 months (interquartile range 31.1–35.6 months). Measurements Grip strength, Short Physical Performance Battery ( SPPB ) score, and muscle mass were measured at baseline; ADL s at baseline and after 20 months; and all‐cause mortality and time to first hospitalization from inclusion onward. Kaplan‐Meier curves and Cox proportional hazards models were calculated for all‐cause mortality and hospitalization. Logistic regression analysis was used to determine predictors of decline in ADL s. Results Kaplan–Meier curves showed significantly higher all‐cause mortality and hospitalization in subjects in the lowest tertile of grip strength and SPPB score. The adjusted Cox proportional hazards model showed that participants with high grip strength or a high SPPB score had a lower risk of mortality and hospitalization, independent of muscle mass, inflammatory markers, and comorbidity. A relationship was found between SPPB score and decline in ADL s, independent of muscle mass, inflammation, and comorbidity. Conclusion In people aged 80 and older, physical performance is a strong predictor of mortality, hospitalization, and disability, and muscle strength is a strong predictor of mortality and hospitalization. All of these relationships were independent of muscle mass, inflammatory markers, and comorbidity.
Background: vitamin D deficiency is a well-known cause of bone loss and fractures but its association, especially among the oldest old, with muscle weakness is less obvious. Objective: to investigate the relationship between 25-hydroxyvitamin D (25-OHD) and muscle performance in persons aged 80 years and older. Methods: baseline results of the Belfrail study, a prospective, population-based cohort study were used to study balance, grip strength and gait speed in relation to 25-OHD serum levels in 367 subjects. Results: a sufficient 25-OHD serum level of 30 ng/ml or more was found in 12.8% of the population. The prevalence of vitamin deficiency (20–29 ng/ml), insufficiency (10–19 ng/ml) and severe insufficiency (<10 ng/ml) was 21.5, 33 and 32.7%, respectively. No significant relation between balance, gait speed and grip strength, and serum 25-OHD was detected neither in bivariate analysis nor after adjustment for age, gender, level of education, institutionalisation, smoking status, body mass index, co-morbidity, level of activity, season, CRP, renal function, serum calcium parathyroid hormone levels, vitamin D intake and use of loop or thiazide diuretics. Conclusion: in this cohort of octogenarians vitamin D deficiency was highly prevalent. We could not confirm the findings of previous studies showing an association between serum 25-OHD and physical performance in elderly.
Objectives To test new cardiovascular (CV) risk models in very old adults with and without a history of CV disease (CVD), based on traditional risk factors and biomarkers. Design Cross-validated prospective cohort study. The models were tested in the BELFRAIL Study and externally validated in the Leiden 85-plus Study. Setting General practice, Belgium and The Netherlands. Participants The BELFRAIL cohort consisted of 266 patients aged 80 years or older without a history of CVD and 260 with a history of CVD. The Leiden 85-plus Study consisted of 264 patients aged 85 years without a history of CVD and 282 with a history of CVD. Outcome measures The model with traditional risk factors and biomarkers, as well as the model using only biomarkers, was compared with the model with only traditional risk factors to predict 3-year CV morbidity and mortality. A competing-risk analysis was performed, and the continuous net reclassification improvement (NRI), integrated discrimination improvement (IDI) and net benefit were used to compare the predictive value of the different models. Results Traditional risk factors poorly predicted CV mortality and morbidity. In participants without a history of CVD, adding N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) improved the prediction (NRI 0.56 (95% CI 0.16 to 0.99) and relative IDI 4.01 (95% CI 2.19 to 6.28)). In participants with a history of CVD, the NRI with the addition of NT-pro-BNP and high-sensitivity C reactive protein was 0.38 (95% CI 0.09 to 0.70), and the relative IDI was 0.53 (95% CI 0.23 to 0.90). Moreover, in participants without a history of CVD, NT-pro-BNP performed well as a stand-alone predictor (NRI 0.32 (95% CI −0.12 to 0.74) and relative IDI 3.44 (95% CI 1.56 to 6.09)). Conclusions This study tested new risk models to predict CV morbidity and mortality in very old adults. Especially, NT-pro-BNP showed a strong added predictive value. This opens perspectives for clinicians who are in need of an easily applicable strategy for CV risk prediction in very old adults.
Chronische nierinsufficientie is een chronische pathologie die mede door de vergrijzing erg vaak voorkomt. Het door het RIZIV ingevoerde zorgtraject chronische nierinsufficientie heeft als doel een kader te bieden voor de complexe zorg voor deze patienten. Hoewel het invoeren van dit zorgtraject heel wat voordelen biedt, stellen wij ons in dit artikel vragen bij de huidige inclusiecriteria voor dit zorgtraject. Deze criteria zijn immers maar beperkt wetenschappelijk onder- bouwd en zeer veel ouderen komen in aanmerking. We stellen alternatieve criteria voor gebaseerd op longitudinale studies. De parameters gebruikt in deze criteria zijn: de geschatte glomerulairefiltratiesnelheid (eGFR), de leeftijd van de patient, de aan- of afwezigheid van proteinurie, de aanwezigheid van verwikkelingen van nierlijden en de evolutie van al deze parameters in de tijd
