Claudia Olmedo

Hospital Universitari de Bellvitge, l'Hospitalet de Llobregat, Catalonia, Spain

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Publications (17)24.08 Total impact

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    ABSTRACT: Background/Rationale: To determine how many 85-year-old community-dwelling patients with good cognitive performance at baseline maintain this level at 2-year follow-up. Methods: We realized a longitudinal community-based study including 169 inhabitants. Patients who maintained scores >23 on the Spanish version of the Mini-Mental State Examination (MEC) were compared with the rest. Results: A total of 144 individuals (85.2%) were found maintaining a MEC score >23. Under the combined criteria 110 (65%) presented no new cognitive decline. Multiple logistic regression analysis showed that maintaining a MEC score >23 was significantly associated with having a higher MEC score at baseline (P < .001, odds ratio 1.280, 95% confidence interval 1.104-1.484). Conclusion: Most oldest-old patients with good cognitive function at baseline maintain this level at 2-year follow-up.
    American Journal of Alzheimer s Disease and Other Dementias 02/2013; · 1.52 Impact Factor
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    ABSTRACT: 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. 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. 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). 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.
    The European Journal of Public Health 08/2008; 18(4):406-9. · 2.52 Impact Factor
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    ABSTRACT: To evaluate the prevalence of falls and their circumstances in non-institutionalized people older than 89 years and living in an urban community. Cross-sectional cohort study. Community-based study. 137 nonagenarians living at home. We evaluated sociodemographic data, capacity to perform basic activities according to the Barthel Index (BI) and instrumental activities on the Lawton-Brody Index (LI), cognition with the Spanish version of the Mini-Mental State Examination (MEC), near visual acuity by the Snellen test, and auditory acuity with the whisper test. Ninety-nine women (72%) and 38 men with an average age of 93.07 years (0.7) were included. 48.1% of them had suffered a fall during the last year, and in 20% of cases this had happened on more than one occasion. In 5.7% of cases, falls led to fractures. Factors associated with falls were a lower LI and a greater number of prescribed drugs. In the multivariate analysis the only factor related to falls was the number of drugs taken (p>0.001, odds ratio 0.785, 95% confidence interval 0.676-0.912). Measures to prevent falls among nonagenarians should be intensified due to their high frequency. In this age group the increase in the percentage of falls is mainly related to the higher number of drugs taken.
    The Journal of Nutrition Health and Aging 04/2008; 12(4):273-6. · 2.66 Impact Factor
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    ABSTRACT: An increase in the rate of falls may be an indicator of frailty. This study included a 12-month follow-up investigation into the rate of falls, in people over 89 years, living in an urban community and analyzed the differences between inhabitants with falls and those without falls. The study was conducted within the framework of the NonaSantfeliu study and 140 nonagenarians participated. Sociodemograhic data, Barthel index (BI), activities of daily living (ADL), Spanish version (MEC) of the mini mental state examination (MMSE), the mini nutritional assessment (MNA) questionnaire, near visual acuity by Snellen test and auditory acuity with the Whisper test were evaluated. The fall rate was 47.1%. The 1-year incidence of falls was 26.4%. The incidence of recurrent falls (two or more falls per year) was 10% (n=14). The prevalence of previous falls within the year preceding the study was 45.7%, 64 of 140 nonagenarians fell and 17 (26.5%) of them fell again during the follow-up. Seventy-six out of 140 (54.3%) nonagenarians had not fallen during the year prior to the study and during the year of follow-up, 20 (26.3%) of them had a new fall. In conclusion, the rate of falls among nonagenarians is high. These results emphasize the need to increase the awareness, to provide recommendations and to incorporate strategies to prevent falls.
    Archives of Gerontology and Geriatrics 01/2008; 46(1):15-23. · 1.53 Impact Factor
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    ABSTRACT: Few studies have prospectively evaluated predictors of mortality in nonagenarian cohorts. Our objective was to determine a set of predictors of all-cause mortality in a cohort of nonagenarians after one year of follow-up. 186 nonagenarians were evaluated prospectively, 137 of whom lived in their own homes (74%) and 49 (26%) were institutionalized. Functional status was determined by the Lawton-Brody (LI) and Barthel Index (BI), and cognition by the Spanish version of the Mini Mental State Examination (MEC). The Charlson score was used to measure global comorbidity. Nutritional status was evaluated by the short version of the Mini Nutritional Assessment questionnaire (short- MNA). The sample was composed of 143 women (76.5%) and 43 men, with a mean age of 93.06 (3.1) years. The rate of mortality was 19.3%. There were no differences in mortality between men and women. Although the BI and LI were both related to 1-year mortality in bivariate, unadjusted analysis, their contribution was minimal in multivariate analyses. Age, heart failure and short-MNA remained associated with mortality in the multivariate analyses. This study supported the importance of age, heart failure and nutritional status in predicting 1- year mortality in nonagenarians.
    Aging clinical and experimental research 09/2007; 19(4):265-8. · 1.14 Impact Factor
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    ABSTRACT: By means of a cross-sectional study, describe the differential characteristics between a group of inhabitants of a same municipality over 89 years of age who are permanently institutionalized and those of the same age who continue to live in the community, trying to identify a profile of nonagenarians with high risk of living in a nursing home. One hundred and eighty six nonagenarians were studied: 137 (74%) were living in their home and 49 (26%) in a nursing home. Sociodemographic data, ability to perform basic daily activities with Barthel Index (BI) or instrumental activities with Lawton and Brody Index (LI), cognition with the Spanish version of the Mini-Mental State Examination (MEC) and comorbidity (Charlson Index) were evaluated. Cardiovascular risk factors and other prevalent diseases were also studied. A total of 143 women (76.5%) and 43 men with a mean age of 93.06 years were studied. A predominance of women, single persons, worse IL, and greater consumption of drugs was observed in the bivariate analysis in the nonagenarians living in residences and widowers than in those living in the community. The multivariate analysis showed that the features of being single and having a lower IL were independent factors of living in a nursing home. The main difference between nonagenargian patients who live in the community and those in residences is that the latter are mainly single and have a low score on a scale that quantities instrumental activities of the daily life.
    Revista Clínica Española 03/2007; 207(3):121-4. · 1.31 Impact Factor
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    ABSTRACT: Objective By means of a cross-sectional study, describe the differential characteristics between a group of inhabitants of a same municipality over 89 years of age who are permanently institutionalized and those of the same age who continue to live in the community, trying to identify a profile of nonagenarians with high risk of living in a nursing home. Material and methods One hundred and eighty six nonagenarians were studied: 137 (74%) were living in their home and 49 (26%) in a nursing home. Sociodemographic data, ability to perform basic daily activities with Barthel Index (BI) or instrumental activities with Lawton and Brody Index (LI), cognition with the Spanish version of the Mini-Mental State Examination (MEC) and comorbidity (Charlson Index) were evaluated. Cardiovascular risk factors and other prevalent diseases were also studied. Results A total of 143 women (76.5%) and 43 men with a mean age of 93.06 years were studied. A predominance of women, single persons, worse IL, and greater consumption of drugs was observed in the bivariate analysis in the nonagenarians living in residences and widowers than in those living in the community. The multivariate analysis showed that the features of being single and having a lower IL were independent factors of living in a nursing home. Conclusions The main difference between nonagenargian patients who live in the community and those in residences is that the latter are mainly single and have a low score on a scale that quantities instrumental activities of the daily life.
    Revista Clínica Española 03/2007; 207(3):121-124. · 1.31 Impact Factor
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    ABSTRACT: Improving the care provided to elderly patients affected by end-stage chronic diseases dying in acute hospitals is a health priority. We evaluated the circumstances related to death in end-stage non-cancer patients dying in two acute care hospitals, and their caregiver's opinions about the death. Some 102 patients, over 64 years of age, with end-stage dementia (37%) or congestive heart failure (64%), were included in the study. Caregiver's opinions on the circumstances of death were obtained using a questionnaire. In addition, we collected data regarding written instructions on several items, including do not resuscitate (DNR) orders, decisions about care in terms of the level or intensity of interventions, information provided to relatives about the prognosis, total withdrawal of normal drug therapy, and provision of palliative care. Caregivers stated that the clinical information was accurate in 67.6% of cases, and the control of symptoms was good in 55%. However, the perception of pain persisted in 14% and uncontrolled dyspnoea in 45%. The end-of-life care was assessed as: excellent 30.5%, good 36%, fairly good 25.5%, bad 6%, and very bad 2%. DNR orders were specified in 89% of patients, decisions concerning the intensity of care in 64%, and 80% of relatives were aware of the prognosis. Drug therapy was withdrawn in 64% of cases, and terminal palliative care was initiated in 79.5%. Our results suggest that some aspects of the palliative care provided to elderly patients with end-stage chronic diseases, admitted to acute care hospitals, could be improved. Such aspects include the clinical information provided and the successful control of specific symptoms.
    Palliative Medicine 02/2007; 21(1):35-40. · 2.85 Impact Factor
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    ABSTRACT: Disability and a decline in functional capacity are common in old age. To determine predictors of functional decline in nonagenarians' basic activities of daily living (ADL) after 1 year of follow-up. A sample of 97 nonagenarians subjects not previously severely dependent (Barthel Index >59) was evaluated. This sample included 72 women (74.2%) and the mean (SD) age was 93.4 +/- 2.7 years. The following data were collected: sociodemographic data, Barthel Index (BI), Lawton-Brody Index (LI), Mental State Examination (MEC), a short version of the Mini-Nutritional Assessment, comorbidity (Charlson Index), lower-extremity function, Gait Rating Scale from the Tinetti Performance-Oriented Mobility Scale and prevalent chronic diseases. Subjects who had a 10-point or higher decline in the BI in 1 year were compared to subjects who had no decline or a maximum decline of 9 points. In addition, subjects whose total BI score fell below 60 were compared to the group of subjects who maintained scores between 60 and 100. The Student's t test, the chi(2) or the Fisher's exact test, and a multiple logistic regression analysis (with the identified risk factors of age and gender) were performed. 39 nonagenarians experienced a 10-point or higher decline in the BI in 1 year. A lower LI score (p = 0.003) and visual impairment (p = 0.01) were associated with functional decline. The multiple regression analysis showed that there was a significant association with LI (odds ratio (OR) 0.74, confidence interval 95% 0.60-0.91, p < 0.005). The 18 nonagenarians who had a BI <60 had a BI >60 at baseline. Lower scores on the LI (p = 0.004) and on the MEC (p = 0.01), a history of a previous stroke (p = 0.009) and higher Charlson Index scores (p = 0.03) were associated with recently acquired, severe dependency. A multiple regression analysis showed a significant association between LI (OR 0.65, 0.47-0.89, p < 0.008) and a history of previous strokes (OR 3.39, 1.01-11.34, p < 0.04). According to the definition used to describe functional basic ADL decline, poor performance in instrumental ADL at baseline and a history of a stroke appear to be independent risk factors. Prevention strategies could be intensified in this subgroup of nonagenarians.
    Gerontology 01/2007; 53(4):211-7. · 2.68 Impact Factor
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    ABSTRACT: Introductionthe increase in life expectancy should be characterized by an increase in disability-free life. We assessed functional and cognitive capacity in an urban population older than 89 years, as well as possible gender variations.
    Revista Española de Geriatría y Gerontología 11/2006; 41.
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    ABSTRACT: Objectivealterations in the sense organs are frequent in the elderly. Our aim was to analyze the status of visual function and hearing in nonagenarians in order to evaluate the relationship between sensory impairment and the ability to perform basic or instrumental activities of daily life.
    Revista Española de Geriatría y Gerontología 09/2006; 41(5).
  • Atención Primaria 06/2006; 37(8):466-7. · 0.89 Impact Factor
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    ABSTRACT: Introducción El envejecimiento progresivo de la población ha comportado un rápido aumento del grupo poblacional de los habitantes más ancianos, de manera que los > 89 años representan aproximadamente el 2% del total de > 65 años en España1. Las úlceras por presión (UPP) son un importante problema de salud por su prevalencia y morbilidad asociada2, que pueden afectar a pacientes en todos los ámbitos asistenciales. Una gran mayoría de ellas (alrededor del 70%)3 ocurren en personas > 70 años. Diversos estudios han mostrado que con una correcta implementación de políticas específicas destinadas a su prevención se consigue evitar su aparición en un considerable número de casos2,4. Objetivos Evaluar en nuestro medio la prevalencia e incidencia de UPP en un grupo de población muy frágil, como son los nonagenarios, y comprobar la efectividad de un programa de prevención basado en recomendaciones para prevenir su aparición y enseñanza de los cuidados, cuando haya, para conseguir su curación. Diseño Estudio de cohortes prospectivo. Emplazamiento Centros de atención primaria. Participantes El trabajo se realizó dentro del estudio NonaSantfeliu, descrito ya previamente5. Se incluyó en el estudio inicial a 186 nonagenarios, el período de observación fue de 12 meses y se realizaron 2 evaluaciones al inicio y al final del período por parte del personal médico y/o de enfermería entrenado en la valoración geriátrica. Al año se revaluó a 140 nonagenarios; se excluyó a 36 participantes por haber fallecido y a 10 por cambio de domicilio. Mediciones principales Mediante entrevista personal, exploración a domicilio o en el centro de atención primaria cuando fue posible y posterior revisión de historia clínica, se recogieron datos sociodemográficos, actividades básicas de la vida diaria con el índice de Barthel (IB), cognición con el Miniexamen cognitivo de Lobo (MEC), comorbilidad con el índice de Charlson, riesgo de UPP con la escala de Braden con una puntuación 0-23 (< 12, alto riesgo), y valores de la version abreviada del Mini-Nutritional Assesment (MNA-SF) del año previo. El MNA-SF que puntúa de 0-14 (< 11 se considera riesgo nutricional) puede, al detectar pacientes de riesgo nutricional, ser útil para identificar a los pacientes con mayor incidencia de nuevas UPP. Intervenciones Educación sanitaria a los pacientes y cuidadores, para una correcta aplicación de medidas preventivas, y enseñanza de los cuidados necesarios para la cura de las UPP según la guía de UPP del Institut Català de Salut. Resultados Se evaluó a 109 mujeres (77,8%) y 31 varones, con un promedio de edad al inicio del estudio de 92,7 ± 2,8 años. En total, 114 eran viudos (81,5%), 14 (10%) estaban casados, y 12 (8,5%) eran solteros. La mayoría, 102 (73%), seguía viviendo en la comunidad y 38 estaban institucionalizados. Al final del período la media del IB era de 56,9 ± 30,3, del MEC 22,4 ± 11, del índice de Charlson de 1,1 ± 1,5 y del MNA-SF de 11,4 ± 2,1. Los valores medios de la escala de Braden eran de 15,5 ± 2,4. El año previo, la prevalencia de UPP era del 7,1% (10) y al final del período de seguimiento, se habían curado todos los casos a excepción de un paciente. La incidencia de nuevas UPP fue del 3,5% (5 casos) con una prevalencia al año del 4,2% (3 mujeres y 3 varones). En la tabla 1 se puede observar las principales diferencias entre los pacientes con UPP al año de seguimiento y los pacientes sin UPP. En el análisis de regresión múltiple, tras ajustar por la edad y el sexo, la escala de Braden fue la única variable asociada significativamente con tener UPP en el momento de la evaluación (p = 0,011; odds ratio [OR] = 3,2; intervalo de confianza [IC] del 95%, 1,3-7,8). Discusión Las UPP han pasado de ser consideradas durante años un problema banal e inevitable a constituir en la actualidad un indicador de calidad asistencial debido a su gran impacto económico, tanto en el consumo de recursos humanos como materiales. La identificación de pacientes de riesgo y las recomendaciones preventivas son, sin duda, la mejor actuación para combatir las UPP2. El importante descenso observado en nuestro estudio, cercano al 50%, tras la implementación de medidas preventivas confirma la utilidad de la prevención, incluso en el paciente más anciano. Dado el reducido tamaño de la muestra, no se han observado diferencias en la prevalencia según el sexo, aunque se ha descrito una mayor prevalencia en mujeres6. Conclusiones Los programas de prevención de UPP son útiles en pacientes nonagenarios y debería intensificarse su implantación en los pacientes con riesgo en las escalas específicas para UPP, como la de Braden o con riesgo nutricional (MNASF).
    Atención Primaria 05/2006; 37(8):466-467. · 0.89 Impact Factor
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    ABSTRACT: Our objective was to analyze those factors predisposing to delirium in patients older than 84 years who were admitted because of hip fracture. We also compared the prevalence of delirium in this population with a younger group. One hundred and thirty patients (mean age 91.8 years) and 50 controls aged 65 to 84 years were included. Forty-three patients (33%) developed delirium. A poor previous functional capacity was the best marker identifying those at risk for developing delirium. Although the prevalence of delirium was higher in those older than 84 years, statistically significant differences were not reached. Disability prior to admission is the main risk factor predisposing to delirium during hospitalization in patients older than 84 years who are admitted because of hip fracture.
    Medicina Clínica 05/2005; 124(14):535-7. · 1.25 Impact Factor
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    ABSTRACT: Background and objective Our objective was to analyze those factors predisposing to delirium in patients older than 84 years who were admitted because of hip fracture. We also compared the prevalence of delirium in this population with a younger group. Patients and method One hundred and thirty patients (mean age 91.8 years) and 50 controls aged 65 to 84 years were included. Results Forty-three patients (33%) developed delirium. A poor previous functional capacity was the best marker identifying those at risk for developing delirium. Although the prevalence of delirium was higher in those older than 84 years, statistically significant differences were not reached. Conclusions Disability prior to admission is the main risk factor predisposing to delirium during hospitalization in patients older than 84 years who are admitted because of hip fracture.
    Medicina Clínica 04/2005; 124(14):535-537. · 1.25 Impact Factor
  • Aging clinical and experimental research 11/2004; 16(5):420-1. · 1.14 Impact Factor
  • Aging clinical and experimental research 07/2004; 16(3):255-6. · 1.14 Impact Factor

Publication Stats

166 Citations
24.08 Total Impact Points

Institutions

  • 2006–2008
    • Hospital Universitari de Bellvitge
      • Department of Internal Medicine
      l'Hospitalet de Llobregat, Catalonia, Spain
  • 2004
    • Hospital Clínic de Barcelona
      • Servicio de Medicina Interna General
      Barcino, Catalonia, Spain