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Objectives To describe the prevalence of the risk of being undernourished in a community-dwelling population of 85-year-olds, and to study associated factors. Methods A cross-sectional community-based survey of 328 inhabitants assigned to seven primary healthcare teams was carried out. Geriatric assessment was based on sociodemographic variables, the Barthel Index (BI), the Lawton Index (LI), the Spanish version of the Mini-Mental State Examination, the Charlson Comorbidity Index, chronic diseases, social risk measured by Gijon's Social-Familial Evaluation Scale, prescriptions and blood tests. Nutritional status was assessed using the Mini Nutritional Assessment (MNA). Participants were defined as being at risk of undernourishment when they had a MNA score above or equal to 23.5. A comparative analysis was carried out between patients with and without risk of being undernourished, and a multiple logistic regression analysis was carried out. Results The prevalence risk of being undernourished was 34.5%. A statistically significant association was found with being female (OR 2.44, 95% CI 1.28–4.54), LI (OR 1.47, 95% CI 1.29–1.66), social risk (OR 1.15, 95% CI 1.02–1.29) and prescription drugs taken (OR 5.58, 95% CI 2.09–14.92). Cardiovascular prescription showed a protective association (OR 4.34, 95% CI 1.78–10.0). No statistical differences between the risks of being undernourished were found in the laboratory analysis. Conclusions There is a high risk of being undernourished in 85-year-old subjects. This nutritional status was positively associated with being female, disability, increased social risk and a high number of prescription drugs, whereas there was a protective relationship with cardiovascular prescription. In evaluations of nutritional status in the community, a multidisciplinary assessment is more valid than analytical findings. Geriatr Gerontol Int 2014; 14: 702–709.

The primary goal of osteoporosis treatment is to prevent the occurrence of fragility fractures, and thereby reduce morbidity and mortality. Among the various approaches to the treatment of this disease include ensuring proper calcium intake and to obtain adequate levels of vitamin D. Virtually all clinical trials with drugs used to treat osteoporosis systematically include calcium and vitamin D supplements. In light of the recent publication of clinical trials and meta-analyses, a possible increase in cardiovascular risk, particularly in the form of a myocrdial infarction, is hypothesised in patients taking calcium supplements. However, data published to date are inconclusive. Until the development of new scientific evidence, it seems reasonable to recommend, whenever practicable and individualized for each patient, increasing calcium intake with food and reserve supplements for patients with very low calcium intake in the diet. It would also be advisable for the administration of total daily dose to be fractionated throughout the day and with meals, and to obtain appropriate levels of vitamin D (25-hydroxycholecalciferol or calcidiol), along with the basic treatment for osteoporosis that is decided to be prescribed to patients.

Whether a repeat renal biopsy is helpful during lupus nephritis (LN) flares remains debatable. In order to analyze the clinical utility of repeat renal biopsy in this complex situation, we retrospectively reviewed our series of 54 LN patients who had one or more repeat biopsies performed only on clinical indications. Additionally, we reviewed 686 well-documented similar cases previously reported (PubMed 1990–2015). The analysis of all patients reviewed showed that histological transformations are common during a LN flare, ranging from 40% to 76% of cases. However, the prevalence of transformations and the clinical value of repeat biopsy vary when they are analyzed according to proliferative or nonproliferative lesions. The great majority of patients with class II (78% in our series and 77.5% in the literature review) progressed to a higher grade of nephritis (classes III, IV, or V), resulting in worse renal prognosis. The frequency of pathological conversion in class V is lower (33% and 43%, respectively) but equally clinically relevant, since almost all cases switched to a proliferative class. Therefore, repeat biopsy is highly advisable in patients with nonproliferative LN at baseline biopsy, because these patients have a reasonable likelihood of switch to a proliferative LN that may require more aggressive immunosuppression. In contrast, the majority of patients (82% and 73%) with proliferative classes in the reference biopsy (III, IV or mixed III/IV + V), remained into proliferative classes on repeat biopsy. Although rebiopsy in this group does not seem as necessary, it is still advisable since it will allow us to identify the 18% to 20% of patients that switch to a nonproliferative class. In addition, consistent with the reported clinical experience, repeat biopsy might also be helpful to identify selected cases with clear progression of proliferative lesions despite the initial treatment, for whom it is advisable to intensify inmunosuppression. Thus, our experience and the literature data support that repeat biopsy also brings more advantges than threats in this group. The results of the repeat biopsy led to a change in the immunosuppresive treatment in more than half of the patients on average, intensifying it in the majority of the cases, but also reducing it in 5% to 30%.

Background Multimorbidity is associated with higher mortality, increased disability, a decline in functional status and a lower quality of life. The objective of the study is to explore patterns of multimorbidity in an elderly population. Methods 328 community inhabitants aged 85 years were included. Socio-demographic variables and data from the global geriatric assessment were evaluated. Information on the presence of sixteen common chronic conditions was collected: hypertension, diabetes mellitus, dyslipidemia, ischemic cardiomyopathy, heart failure, stroke, chronic obstructive pulmonary disease, (COPD), atrial fibrillation, peripheral arterial disease, Parkinson's disease, cancer, dementia, anemia, chronic kidney disease (CKD), visual impairment and deafness. Hierarchical cluster analysis was performed. Results The rate of multimorbidity (> 1 disease) was 95.1%. Men had a higher percentage of COPD and malignancy. Four main clusters were identified. The highest value of the bivariate correlation matrix was that between heart failure and visual impairment. These two diseases were included in a cluster with atrial fibrillation, CKD, heart failure, stroke, high blood pressure and diabetes mellitus. Conclusions The large majority of oldest old subjects had multimorbidity. The results confirm the non-random co-occurrence of certain diseases in this age group.

Falls are a source of morbidity and mortality in the oldest old. The purpose of this study was to describe the prevalence of falls among community-dwelling 85-year-olds and to study the factors associated with falling. A cross-sectional study, including geriatric assessment, was conducted within the framework of the Octabaix Study. Functional status was measured with Barthel Index (BI) and Lawton Index (LI), cognitive impairment was assessed with the Mini-Mental State Examination (MMSE), the Spanish version of which is called MEC, Comorbidity by Charlson Index (CCI), and data were gathered on nutritional risk, social risk, falls, and drugs. The fall prevalence among the 328 octogenarians studied was 28.4%. A bivariate analysis revealed an association with being female (p = 0.017) and poorer functional status according to BI (p = 0.027). Logistic analysis showed an association with female gender (OR = 1.96; 95%CI = 1.15–3.33; p = 0.014), BI (OR = 0.98; 95%CI = 0.97–0.99; p = 0.007) and MEC (OR = 1.05; 95%CI = 1.01–1.09; p = 0.027). The prevalence of falls among 85-year-olds is high and similar to that described in those aged 65 or over. The analyses show that being female, a degree of disability and a good score on cognitive status were independent risk factors for falls among these community-dwelling.

Objectives To describe the prevalence of diabetes mellitus (DM) in community-dwelling 85-year-olds and to study the factors associated. Design Cross-sectional. Setting Community-based survey study of seven primary healthcare centers. Participants Three hundred twenty-eight people born in 1924 and registered with primary healthcare centers. Measurements Information on sociodemographic variables, Barthel Index (BI), Spanish version of the Mini-Mental State Examination (MEC), Mini Nutritional Assessment (MNA), Braden scale for risk of pressure ulcers, Charlson Comorbidity Index, chronic diseases, social risk, quality of life, chronic drug prescriptions, and blood tests was recorded. Participants were defined as having DM according to self-report, physician diagnosis, antidiabetic prescriptions, or plasma glucose concentration 7 mmol/L or more. A comparative analysis was performed between participants with and without DM. Results The prevalence of DM in 328 octogenarians studied was 25.9%. Logistic regression showed an association between DM and BI (odds ratio (OR) = 1.03, 95% confidence interval (CI) = 1.00–1.05, P = .007), Braden risk score (OR = 0.87, 95% CI = 0.79–0.97, P = .01), thyroid disease (OR = 0.23, 95% CI = 0.06–0.92, P = .04), chronic drug prescriptions (OR = 1.28, 95% CI = 1.15–1.42, P

Resumen Introduccion el aumento de la expectativa de vida debe ser a expensas de conseguir un aumento en la vida activa o libre de incapacidad. Evaluamos la capacidad funcional y cognitiva de los habitantes > 89 anos de una poblacion urbana (estudio Nona- SantFeliu) y comprobamos si existen diferencias segun el sexo. Material y metodos estudio poblacional, longitudinal y observacional. Al comienzo del estudio (primer corte transversal) se presentan los datos de todos los > 89 anos de una ciudad: datos sociodemograficos, actividades basicas mediante el indice de Barthel (IB), actividades instrumentales mediante el indice de Lawton (IL), capacidad cognitiva con miniexamen cognoscitivo de Lobo (MEC) y comorbilidad (indice de Charlson). Resultados de 186 nonagenarios entrevistados, 143 (76,5%) eran mujeres; la edad media ± desviacion estandar era de 93,1 ± 3,1 anos, y 149 (80,2%) eran viudos/as. El 26% estaba institucionalizado. El valor medio del IB fue de 60,8 ± 30,0: el 56% era independientes o con dependencia leve; IL medio, 2,1 ± 2,8. En el MEC obtuvieron una media de 21,0 ± 11,0 puntos, y en el 56% fue superior a 23. La media del indice Charlson era de 1,4 ± 1,7. No existen diferencias significativas por sexos. Conclusiones a pesar de su avanzada edad, la mayoria de nonagenarios tienen un leve deterioro funcional y cognitivo, con baja comorbilidad. No se detectaron diferencias significativas segun el sexo. Futuros estudios deben ayudarnos en la deteccion de personas nonagenarias con gran riesgo de deterioro en poco tiempo, para iniciar intervenciones que retrasen la aparicion de una mayor discapacidad.

Los agentes inotropicos clasicos, tales como los agonistas betaadrenergicos y los inhibidores de la fosfodiesterasa III, tienen efectos hemodinamicos beneficiosos pero transitorios en pacientes con insuficiencia cardiaca aguda y cronica. En este contexto, la evidencia disponible indica que el tratamiento inotropico a largo plazo tiene un impacto negativo en la morbimortalidad de pacientes con insuficiencia cardiaca. Por esta razon, la propuesta de uso de estos agentes incluye el tratamiento de episodios de descompensacion rebelde al tratamiento, la utilizacion como puente (trasplante, revascularizacion, recuperacion) o como medida paliativa. Presentamos una revision de los aspectos generales de los inotropicos que incluye los principales estudios clinicos realizados y algunas caracteristicas de su uso combinado con bloqueadores beta. Ademas, describimos un abordaje terapeutico prometedor y diferencial representado por los agentes sensibilizadores del calcio (levosimendan).

Sarcoidosis is an antigen-mediated disease of unknown aetiology, characterized by the presence of non-caseating epithelioid cell granulomas in multiple organs. Cutaneous involvement in sarcoidosis is classified as specific, when biopsy reveals non-caseating granulomas, and non-specific, typically erythema nodosum. Granulomatous skin lesions occur in 9% to 37% of patients. The skin is the second most commonly involved organ after the lung. A skin biopsy is easy to perform and enables an early diagnosis with a minor invasive procedure. Some types of specific lesions have prognostic significance and may help to predict the outcome of the systemic disease. Maculopapules, subcutaneous nodules and scar sarcoidosis are usually transient or tend to follow the course of the systemic disease. Skin plaques and lupus pernio are associated with chronic sarcoidosis. Although most cutaneous lesions of sarcoidosis do not cause significant morbidity and do not require treatment, some have cosmetic importance because they may be disfiguring and can have a strong psychosocial impact. Treatment of these lesions is a challenge since they do not respond well to conventional treatments. This manuscript reviews the clinical characteristics of the more frequent types of specific cutaneous lesions of sarcoidosis, the relationship between cutaneous involvement and systemic disease, the prognostic significance of lesions and the present state of treatment of difficult cases of cutaneous sarcoidosis.

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.

The primary goal of osteoporosis treatment is to prevent the occurrence of fragility fractures, and thereby reduce morbidity and mortality. Among the various approaches to the treatment of this disease include ensuring proper calcium intake and to obtain adequate levels of vitamin D. Virtually all clinical trials with drugs used to treat osteoporosis systematically include calcium and vitamin D supplements. In light of the recent publication of clinical trials and meta-analyses, a possible increase in cardiovascular risk, particularly in the form of a myocrdial infarction, is hypothesised in patients taking calcium supplements. However, data published to date are inconclusive. Until the development of new scientific evidence, it seems reasonable to recommend, whenever practicable and individualized for each patient, increasing calcium intake with food and reserve supplements for patients with very low calcium intake in the diet. It would also be advisable for the administration of total daily dose to be fractionated throughout the day and with meals, and to obtain appropriate levels of vitamin D (25-hydroxycholecalciferol or calcidiol), along with the basic treatment for osteoporosis that is decided to be prescribed to patients.

To describe our cohort of 27 biopsy-proven patients and their long-term follow-up, with special attention to prognostic factors.Twenty seven patients were retrospectively collected. They were controlled in the Internal Medicine Department of the Bellvitge's Hospital (Spain) between 1974 and 2010. Evaluation was performed at one, 3 and 5 year follow-up.There were 22 women (81.5%). Mean age at onset of nephritis was 34.83 years (SD 13.45). Partial or complete remission was achieved by 21 patients (80.77%) in the one-year follow-up, 22 patients (84.61%) in the third-year follow-up and 21 patients (77.77%) in the fifth-year follow-up. A change in the histology class was diagnosed in 4 patients. Seven patients suffered flares of nephritis. Seven patients died in the long term follow-up, 3 out of this 7 died because of systemic erythematosus lupus.Nephritis onset beyond 45 years old is the factor mostly related with a poor prognosis. That is the reason why we recommend co-therapy with immunosuppressors from the beginning in such patients.

In order to analyze the prevalence of hyponatremia in in-hospital elderly patients and its prognosis factor value, we performed a transversal prospective study in an Acute Geriatric Unit (AGU).Two hundred and sixty in-hospital patients were collected prospectively in an AGU. Sociodemographic and lab data were collected as well as the Barthel, Pfeiffer and Charlson tests. A questionnaire was performed in hospital. Hyponatremia was considered when the plasmatic sodium was ≤134 mmol/l.The sample consisted of 137 women (52.7%) and 123 men (47.3%). Mean age was 83.6 years (SD 7.9). Mean plasmatic sodium values were 137.3 mmol/l (range 112-168). Emergency lab tests showed 60 patients with hyponatremia (23.7%), 35 (13.6%) in the AGU. Cardiopulmonary were the most related diseases. Mean hospital length of stay was 12.8 days (SD 12.8). In-hospital mortality was 12.9%. We observed a statistic relationship between the presence of hyponatremia and a greater mean length of stay (15.53 vs 11.99 days, P=.003). No relationship was found between hyponatremia and mortality (15 vs 12.7%, P=.588).Hyponatremia in patients admitted in an AGU is a prevalent disorder related with a greater hospital length of stay, but not with mortality.

Los estudiantes de medicina efectúan una parte de sus rotaciones en entornos como salas de hospitalización, consultas externas y centros de salud, donde comparten las experiencias clínicas con un médico al que llamaremos"tutor". La reforma de los planes docentes abordados por las facultades de medicina pone el acento en este tipo de prácticas [1,2]. El presente trabajo se enmarca en un esfuerzo de la Facultad de Medicina de la Universitat de Barcelona para hacer presente las habilidades de comunicación en la tarea docente [3,4], e indica algunas pautas para la recepción y acomodación de estos estudiantes, así como situaciones delicadas que deben ser resueltas con asertividad...

Little is known about the role of high-density lipoprotein cholesterol (HDL-C) in oldest-old subjects. The aim of this study is to evaluate the association between HDL-C levels and physical and cognitive performance indicators in nonagenarians, and also to determine the influence of HDL-C levels on the 3-year mortality risk.The data analyzed were taken from the NonaSantfeliu Study. Functional status was determined by the Lawton-Brody Index (LI) for instrumental activities of daily living (IADL) and the Barthel Index (BI) for basic activities (BADL). Cognition was assessed using the Spanish version of the Mini-Mental State Examination (MEC).The sample consisted of 49 women (79%) and 13 men, aged 94.3 ± 2.6 years. Mean HDL-C levels were 60 ± 16 mg/dL, and 16 subjects (25.8%) had low HDL-C values. HDL-C levels did correlate with BI (r = 0.28, P = 0.02) and LI (r = 0.32, P = 0.01), but not with MEC (r = 0.18, P = 0.15). Normal HDL-C levels at baseline were significantly associated with higher BI scores (P0.006, odds ratio [OR] = 1.03, 95% confidence interval [CI] = 1.01-1.05) and a lower number of prescription drugs used (P0.04, OR = 0.71, 95% CI = 0.49-0.99). Baseline HDL-C levels were significantly lower among the group of nonagenarians who died within the 3 years of follow up (P = 0.02). However, after adjusting for potential confounders, the association between HDL-C and mortality lost significance.Higher levels of HDL-C correlate with better functional status and less use of prescribed drugs in nonagenarians. However, the relationship between low HDL-C levels and long-term mortality in this population remains unclear.

OBJECTIVE: To examine gender differences according to health status in the oldest old people of the community. DESIGN: Cross-sectional multicentre study, within the framework of a clinical trial on falls and malnutrition. SETTING: 7 primary health centres. PARTICIPANTS: Non-institutionalised patients of 85 years or over. METHODS: The data collected included, socioeconomic data, cardiovascular risk factors, Barthel Index (BI), cognitive status with the Mini-Mental State Examination (MMSE), Charlson Index to measure comorbidity, nutritional risk evaluated by Nutritional Assessment questionnaire (MNA), mean visual analogue self-rating scale in Euroqol- 5D (EQ-VAS) to assess health related quality life and, Gijón social risk test, and prescribed drugs. RESULTS: A total of 312 subjects were included, of which 61.6% were women, 53% widows and a third of them lived alone. High blood pressure was observed in 76%, dyslipidemia in 51.2%, diabetes in 17.4%, median BI 95 (rank 0-100), MMSE 28 (0-35), Charlson index 1 (0-7), MNA 25 (10-30), Gijón test 10 (5-21), EQ-VAS 60 (0-100) and the mean prescription drugs 6.1 ± 3.3. Women most frequently lived alone (P

People aged 85 years old and older constitute a growing population group. Falls and malnutrition are common in the elderly.To determine the effectiveness of an individualized multifactorial intervention to reduce falls and malnutrition in community-dwelling persons aged 85 years old.The OCTABAIX study is a randomized controlled clinical trial lasting 3 years in primary care in Costa de Ponent (seven primary care teams). Community-dwelling elders born in 1924 who agreed to participate in the study have been included. Three in-home visits will be made annually by a trained nurse or physician and will be complemented by two biannual analytical studies. Participants will be followed-up for hospitalizations, falls and weight using a monthly calendar. The specifically-designed algorithm to detect risk factors for falls and malnutrition will be used to provide recommendations and specific, standardized interventions for risk reduction in a randomly selected intervention group. Two face-to-face interventions will be carried out and telephone calls will be made to reinforce adherence. The control group will follow routine primary care recommendations. The primary outcome is a decline in the rate of falls and malnutrition.The OCTABAIX study aims to reduce the incidence of falls and the risk of malnutrition in the 328 patients included.The OCTABAIX study will help to determine the characteristics of persons aged 85 years old as well as the rate of falls and nutritional risk. The effectiveness of the measures adopted to reduce these geriatric syndromes will also be assessed.

The group of age showing a faster growth is the most elderly people. The objective of this study is to describe the health related quality of life in elderly subjects older than 89 year and to identify related factors.A cross-sectional study was done at the third year of a longitudinal study (NonaSantfeliu). We evaluated all survived patients who scored19 in the Spanish version of the Mental State Examination (MEC). Sociodemographic data were collected, functional status was determined by Lawton-Brody and Barthel Index (BI) and cognition with MEC. Charlson score was used to measure comorbidity and the nutritional risk was evaluated by the short version of Mini Nutritional Assessment questionnaire (short-MNA). Euroqol-5D (EQ-5D) was used to assess health related quality of life.The final sample was composed by 37 subjects, 25 women (68%) and 12 men, with a mean age of 94.32 (2.9) years. The mean score in EQ-5D was 0,51 (0,2) and the mean visual analogue self-rating scale (EQ-VAS) was 63 (2,9). Three variables: female gender (p=0,011; regression Beta coefficient : 18,99; IC 95%: 4,66-33,33 , poor BI score (p=0.010; regression Beta coefficient 0.38; IC 95%: 0.09-0.67) and high nutritional risk in short-MNA (p=0.001; regression Beta coefficient: 3.95; IC 95%: 2.50-5.41) were associated with quality of life in the multivariate analyses.A good health quality of life in the oldest old people was observed in this study. Gender, functional status and nutritional risk were associated with quality of life in nonagenarians.

Hyperammonemic encephalopathy is a rarely reported complication of multiple myeloma (MM). We describe an illustrative case of hyperammonemia in the setting of an immunoglobulin (Ig) D-lambda MM, and perform a systematic review of the English-written literature. Our search yielded 26 more cases. Median age was 64 years, and 54% of patients were male. All presented with progressive impairment of their level of consciousness. Median ammonium concentration was 109 micromol/L (interquartile range, 73-149 micromol/L). Most were IgA type (10 cases), and there were 2 cases of IgD type. Most cases were aggressive or chemotherapy-resistant forms of MM. Eight patients were diagnosed with MM at the same time as the episode of hyperammonemia. Only 1 patient had signs of portal hypertension as a result of concomitant hyperdynamic heart failure. Determination of amino acid in 10 patients showed high levels of glycine, low levels of tyrosine, and a low Fischer ratio. Two patients did not receive chemotherapy and died. Twenty-two out of 25 patients who received chemotherapy against MM showed a decrease in ammonium blood concentration, and of those, 15 survived the episode (68%). Overall mortality was 44%. In conclusion, hyperammonemia is a severe complication of MM, associated with a high mortality. It should be considered in any patient with MM and a low level of consciousness. Chemotherapy directed against MM seems to be the most effective measure in order to achieve normal ammonium levels and clinical improvement.

Heart failure (HF) is a cardiovascular disease with a permanent increase in prevalence, incidence and mortality. Current optimal therapies for HF are effective only for slowing, but not stopping, its progression. HF-related mortality is high, even at the time of the disease onset. Approximately 40% of HF-attributable deaths will be related to disease progression - however, its course is difficult to predict and therefore identifying patients experiencing the terminal stage of the disease is not correctly done. Most patients and their relatives do not identify HF as a progressive, terminal disease, and this perception also stands among health professionals - in consequence, end-stage HF patients often undergo active treatment procedures, event near the occurrence of death, although its implementation will be occasionally futile. Efforts should be undertaken by all health professionals to improve the identification and management of HF patients in the terminal stage of their disease.

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 Index59) 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, p0.005). The 18 nonagenarians who had a BI60 had a BI60 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, p0.008) and a history of previous strokes (OR 3.39, 1.01-11.34, p0.04).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.