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  • 1
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    Is there an association between social determinants and care dependency risk? A multi‐state model analysis of a longitudinal study
    Wiley ; 2020
    In:  Research in Nursing & Health Vol. 43, No. 3 ( 2020-06), p. 230-240
    Details
    In: Research in Nursing & Health, Wiley, Vol. 43, No. 3 ( 2020-06), p. 230-240
    Abstract: Despite a growing body of knowledge about the morbidities and functional impairment that frequently lead to care dependency, the role of social determinants is not yet well understood. The purpose of this study was to examine the effect of social determinants on care dependency onset and progression. We used data from the Berlin Initiative Study, a prospective, population‐based cohort study including 2,069 older participants living in Berlin. Care dependency was defined as requiring substantial assistance in at least two activities of daily living for 90 min daily (level 1) or 3+ hours daily (level 2). Multi‐state time to event regression modeling was used to estimate the effects of social determinants (partnership status, education, income, and sex), morbidities, and health behaviors, characteristics, and conditions. During the study period, 556 participants (27.5%) changed their status of care dependency. Participants without a partner at baseline were at a higher risk to become care‐dependent than participants with a partner (hazard ratio [HR], 95% confidence interval [CI] : 1.24 (1.02–1.51)). After adjustment for other social determinants, morbidities and health behaviors, characteristics, and conditions the risk decreased to a HR of 1.19 (95% CI: 0.79–1.79). Results indicate that older people without a partner may tend to be at higher risk of care dependency onset but not at higher risk of care dependency progression. Clinicians should inquire about and consider patients’ partnership status as they evaluate care needs.
    Type of Medium: Online Resource
    ISSN: 0160-6891 , 1098-240X
    URL: Issue
    URL: Article
    DOI: 10.1002/nur.v43.3
    DOI: 10.1002/nur.22022
    Language: English
    Publisher: Wiley
    Publication Date: 2020
    detail.hit.zdb_id: 2002160-4
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  • 2
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    Incidence of hospital-acquired acute kidney injury and trajectories of glomerular filtration rate in older adults
    Springer Science and Business Media LLC ; 2023
    In:  BMC Nephrology Vol. 24, No. 1 ( 2023-08-01)
    Details
    In: BMC Nephrology, Springer Science and Business Media LLC, Vol. 24, No. 1 ( 2023-08-01)
    Abstract: In older adults, epidemiological data on incidence rates (IR) of hospital-acquired acute kidney injury (AKI) are scarce. Also, little is known about trajectories of kidney function before hospitalization with AKI. Methods We used data from biennial face-to-face study visits from the prospective Berlin Initiative Study (BIS) including community-dwelling participants aged 70+ with repeat estimated glomerular filtration rate (eGFR) based on serum creatinine and cystatin C. Primary outcome was first incident of hospital-acquired AKI assessed through linked insurance claims data. In a nested case-control study, kidney function decline prior to hospitalization with and without AKI was investigated using eGFR trajectories estimated with mixed-effects models adjusted for traditional cardiovascular comorbidities. Results Out of 2020 study participants (52.9% women; mean age 80.4 years) without prior AKI, 383 developed a first incident AKI, 1518 were hospitalized without AKI, and 119 were never hospitalized during a median follow-up of 8.8 years. IR per 1000 person years for hospital-acquired AKI was 26.8 (95% confidence interval (CI): 24.1–29.6); higher for men than women (33.9 (29.5–38.7) vs. 21.2 (18.1–24.6)). IR (CI) were lowest for persons aged 70–75 (13.1; 10.0-16.8) and highest for ≥ 90 years (54.6; 40.0-72.9). eGFR trajectories declined more steeply in men and women with AKI compared to men and women without AKI years before hospitalization. These differences in eGFR trajectories remained after adjustment for traditional comorbidities. Conclusion AKI is a frequent in-hospital complication in individuals aged 70 + showing a striking increase of IR with age. eGFR decline was steeper in elderly patients with AKI compared to elderly patients without AKI years prior to hospitalization emphasising the need for long-term kidney function monitoring pre-admission to improve risk stratification.
    Type of Medium: Online Resource
    ISSN: 1471-2369
    URL: Article
    DOI: 10.1186/s12882-023-03272-5
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2023
    detail.hit.zdb_id: 2041348-8
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  • 3
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    MO510: CKD Progression in a Cohort of Older Community-Dwelling Adults– Results From the Berlin Initiative Study (BIS)
    Oxford University Press (OUP) ; 2022
    In:  Nephrology Dialysis Transplantation Vol. 37, No. Supplement_3 ( 2022-05-03)
    Details
    In: Nephrology Dialysis Transplantation, Oxford University Press (OUP), Vol. 37, No. Supplement_3 ( 2022-05-03)
    Abstract: Data on the estimated glomerular filtration rate (eGFR) over time in older populations are scarce. Identifying patterns of eGFR progression is essential for a better understanding of chronic kidney disease (CKD) in older adults. METHOD We used data from the BIS, a community-dwelling cohort of 2069 people aged 70 or older. Participants were recruited between 2009 and 2011. After baseline assessment, four follow-up visits were conducted biennially over a total observation period of 8 years. During all study visits, eGFR and CKD stages based on KIDGO guidelines were assessed using the creatinine and cystatin C-based BIS2 equation (eGFRBIS2). Additionally, we used the creatinine-based EKFC equation (eGFREKFC). In a sub-analysis, we included only non-deceased participants with complete attendance at all study visits and valid eGFR values at all measurements. RESULTS At baseline, the mean age was 80.4 years (SD = 6.7), and 52.6 % were females. Prevalence was highest for CKD stage 2 (45.4%) and 3 (49.3%). After 8 years, the prevalence for CKD stages 1 and 2 decreased, whereas stages 3 and 4 showed a consistent upward trend resulting in 18.4%,  72.4% and 8.9% of participants in stages 2, 3 and 4, respectively. Mean eGFRBIS2 decreased from 58.1 (SD = 15.2) to 48.3 (SD = 13.3) mL/min/1.73 m² after 8 years. Mean eGFREKFC showed a similar trend with estimates being slightly higher (60.4 versus 54.2 mL/min/1.73 m2 after 8 years). Same trends applied to the subgroup with complete attendance (mean age: 77.4 years). However, compared with the total population they showed a higher mean eGFRBIS2 (63.3 versus 58.1 mL/min/1.73 m²) and lower prevalence of CKD stages 3 and 4 (stage 2: 59.4 versus 45.4%; stage 3: 37.1 versus 49.3% stage 4: 1.2 versus 3.6%) at baseline. CONCLUSION We found that over the observation period of 8 years, mean eGFRBIS2 decreased by 9.8 mL/min/1.73 m2 resulting in an increasing prevalence of CKD stages 3 and 4 by 23.1 and 5.3%, respectively. This was observed in the total population as well as in the subgroup with complete study attendance.
    Type of Medium: Online Resource
    ISSN: 0931-0509 , 1460-2385
    URL: Article
    DOI: 10.1093/ndt/gfac071.041
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2022
    detail.hit.zdb_id: 1465709-0
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  • 4
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    Association of kidney function and albuminuria with frailty worsening and death in very old adults
    Oxford University Press (OUP) ; 2023
    In:  Age and Ageing Vol. 52, No. 5 ( 2023-05-01)
    Details
    In: Age and Ageing, Oxford University Press (OUP), Vol. 52, No. 5 ( 2023-05-01)
    Abstract: Studies analysing the association of albuminuria and prevalent frailty in community-dwelling very old adults are scarce and lack information on incident frailty. We investigated the association of kidney function decline and increase of albuminuria with frailty worsening or death in very old adults. Design Longitudinal analyses with biennial visits of the Berlin Initiative (cohort) Study and a frailty follow-up of 2.1 years. Setting/subjects 1,076 participants with a mean age of 84.3 (5.6) years of whom 54% were female. Methods Partial proportional odds models were used to assess the association of estimated glomerular filtration rate (eGFR) decline and/or albuminuria (albumin creatinine ratio, ACR) with frailty worsening or death. Results At frailty baseline, 1,076 participants with an eGFR of 50 (13) ml/min/1.73 m2, 48% being prefrail and 31% frail were included. After median 2.1 years, 960 (90%) participants had valid information on frailty transition: 187 (17.5%) worsened and 111 (10.3%) died. In the multivariable model, the odds of frailty worsening for participants with albuminuria in combination with eGFR & lt;60 ml/min/1.73 m2 were elevated [OR (95% CI): 2.47 (1.41–4.31)] compared to participants without albuminuria and eGFR ≥60 ml/min/1.73 m2 as there was a rapid eGFR decline of ≥3 ml/min/1.73 m2 per year [1.55 (1.04–2.33)] and albuminuria trajectories six years prior [1.53 (1.11–2.10)] to frailty baseline. The odds of death for each exposure were even higher. Conclusions In older adults, advanced stages of CKD and albuminuria alone were associated with 2-fold odds of frailty worsening independent of death.
    Type of Medium: Online Resource
    ISSN: 0002-0729 , 1468-2834
    URL: Article
    DOI: 10.1093/ageing/afad063
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2023
    detail.hit.zdb_id: 2065766-3
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  • 5
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    Control of blood pressure and risk of mortality in a cohort of older adults: the Berlin Initiative Study
    Oxford University Press (OUP) ; 2019
    In:  European Heart Journal Vol. 40, No. 25 ( 2019-07-01), p. 2021-2028
    Details
    In: European Heart Journal, Oxford University Press (OUP), Vol. 40, No. 25 ( 2019-07-01), p. 2021-2028
    Abstract: To assess whether blood pressure (BP) values below 140/90 mmHg during antihypertensive treatment are associated with a decreased risk of all-cause mortality in community-dwelling older adults. Methods and results Within the Berlin Initiative Study, we assembled a cohort of patients ≥70 years treated with antihypertensive drugs at baseline (November 2009–June 2011). End of prospective follow-up was December 2016. Cox proportional hazards models yielded adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of all-cause mortality associated with normalized BP [systolic BP (SBP) & lt;140 mmHg and diastolic BP (DBP) & lt;90 mmHg] compared with non-normalized BP (SBP ≥140 mmHg or DBP ≥90 mmHg) overall and after stratification by age or previous cardiovascular events. Among 1628 patients (mean age 81 years) on antihypertensive drugs, 636 exhibited normalized BP. During 8853 person-years of follow-up, 469 patients died. Compared with non-normalized BP, normalized BP was associated with an increased risk of all-cause mortality (incidence rates: 60.3 vs. 48.5 per 1000/year; HR 1.26; 95% CI 1.04–1.54). Increased risks were observed in patients ≥80 years (102.2 vs. 77.5 per 1000/year; HR 1.40; 95% CI 1.12–1.74) and with previous cardiovascular events (98.3 vs. 63.6 per 1000/year; HR 1.61; 95% CI 1.14–2.27) but not in patients aged 70–79 years (22.6 vs. 22.7 per 1000/year; HR 0.83; 95% CI 0.54–1.27) or without previous cardiovascular events (45.2 vs. 44.4 per 1000/year; HR 1.16, 95% CI 0.90–1.48). Conclusion Blood pressure values below 140/90 mmHg during antihypertensive treatment may be associated with an increased risk of mortality in octogenarians or elderly patients with previous cardiovascular events.
    Type of Medium: Online Resource
    ISSN: 0195-668X , 1522-9645
    URL: Article
    DOI: 10.1093/eurheartj/ehz071
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2019
    detail.hit.zdb_id: 2001908-7
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  • 6
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    Age and the Course of GFR in Persons Aged 70 and Above
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Clinical Journal of the American Society of Nephrology Vol. 17, No. 8 ( 2022-08), p. 1119-1128
    Details
    In: Clinical Journal of the American Society of Nephrology, Ovid Technologies (Wolters Kluwer Health), Vol. 17, No. 8 ( 2022-08), p. 1119-1128
    Abstract: In older adults, data on the age-related course of GFR are scarce, which might lead to misjudgment of the clinical relevance of reduced GFR in old age. Design, setting, participants, & measurements To describe the course of eGFR in older adults and derive reference values in population-based individuals, we used the longitudinal design of the Berlin Initiative Study (BIS) with a repeated estimation of GFR over a median of 6.1 years of follow-up. In 2069 community-dwelling older individuals (mean inclusion age 80 years, range 70–99), GFR was estimated biennially with the BIS-2 equation, including standardized creatinine and cystatin C levels, sex, and age. We described the crude and adjusted course using a mixed-effects model and analyzed the influence of death on the GFR course applying joint models. GFR slopes were compared using GFR equations on the basis of creatinine and/or cystatin C. Results We observed a decreasing, thus nonlinear, eGFR decline with increasing age in a population of old adults. The estimated 1-year slope for ages 75 and 90 diminished for men from −1.67 to −0.99 and for women from −1.52 to −0.97. The modeled mean eGFR for men aged ≥79 and women ≥78 was below 60 ml/min per 1.73 m 2 . Multivariable adjustment attenuated slopes only minimally. Taking death into account by applying joint models did not alter the nonlinear eGFR decline. Using eGFR equations on the basis of creatinine only showed linear slope patterns in contrast to nonlinear patterns for equations including cystatin C. Conclusions The eGFR decline depended on sex and age and changed only marginally after multivariable adjustment but decelerated with increasing age. Equations including cystatin C demonstrated a nonlinear slope challenging the previously assumed linearity of the decline of eGFR in old age.
    Type of Medium: Online Resource
    ISSN: 1555-9041 , 1555-905X
    URL: Article
    DOI: 10.2215/CJN.16631221
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
    detail.hit.zdb_id: 2216582-4
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  • 7
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    Polypharmacy and the Change of Self-Rated Health in Community-Dwelling Older Adults
    MDPI AG ; 2023
    In:  International Journal of Environmental Research and Public Health Vol. 20, No. 5 ( 2023-02-25), p. 4159-
    Details
    In: International Journal of Environmental Research and Public Health, MDPI AG, Vol. 20, No. 5 ( 2023-02-25), p. 4159-
    Abstract: Polypharmacy is associated with poorer self-rated health (SRH). However, whether polypharmacy has an impact on the SRH progression is unknown. This study investigates the association of polypharmacy with SRH change in 1428 participants of the Berlin Initiative Study aged 70 years and older over four years. Polypharmacy was defined as the intake of ≥5 medications. Descriptive statistics of SRH-change categories stratified by polypharmacy status were reported. The association of polypharmacy with being in SRH change categories was assessed using multinomial regression analysis. At baseline, mean age was 79.1 (6.1) years, 54.0% were females, and prevalence of polypharmacy was 47.1%. Participants with polypharmacy were older and had more comorbidities compared to those without polypharmacy. Over four years, five SRH-change categories were identified. After covariate adjustment, individuals with polypharmacy had higher odds of being in the stable moderate category (OR 3.55; 95% CI [2.43–5.20]), stable low category (OR 3.32; 95% CI [1.65–6.70] ), decline category (OR 1.87; 95% CI [1.34–2.62]), and improvement category (OR 2.01; [1.33–3.05] ) compared to being in the stable high category independent of the number of comorbidities. Reducing polypharmacy could be an impactful strategy to foster favorable SRH progression in old age.
    Type of Medium: Online Resource
    ISSN: 1660-4601
    URL: Article
    DOI: 10.3390/ijerph20054159
    Language: English
    Publisher: MDPI AG
    Publication Date: 2023
    detail.hit.zdb_id: 2175195-X
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  • 8
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    Gender differences in frailty transition and its prediction in community-dwelling old adults
    Springer Science and Business Media LLC ; 2022
    In:  Scientific Reports Vol. 12, No. 1 ( 2022-05-05)
    Details
    In: Scientific Reports, Springer Science and Business Media LLC, Vol. 12, No. 1 ( 2022-05-05)
    Abstract: Frailty is very common in old age and often associated with adverse events. Transitioning between frailty states is possible in both directions (improvement and worsening) offering targets for interventions. Frailty is more prevalent in women, but little is known about the impact of gender on frailty transition. The aim of this study is to identify gender differences for frailty transition in older adults and to develop gender-stratified prognostic prediction models for frailty transition. We performed a longitudinal analyses of the Berlin Initiative (cohort) Study with a frailty follow-up of 2.1 years. Description of frailty transition using the frailty phenotype and development of prognostic prediction models using multivariable logistic regressions for transition (improvement or worsening) stratified by gender following the TRIPOD statement were performed. In total, the study population consisted of 1158 community-dwelling adults with a mean age of 84.4 years and of whom 55% were women. Out of 1158 participants 225 (19%) were robust, 532 (46%) prefrail and 401 (35%) frail. After 2.1 (IQR 2.0–2.3) years, half of the participants had transitioned between frailty states. Men worsened more often and those who were already frail died more often than women. Gender-stratified prediction models for frailty transition demonstrated that some predictors (age, self-rated health, cognitive impairment, baseline frailty status) were included in all models. While stroke, diabetes mellitus, smoking and glomerular filtration rate were unique predictors in the models for females, osteoarthritis, hospitalization and education were predictors in the models for males. There are gender differences in frailty transition rates, patterns and prediction. This supports the importance of considering gender when addressing frailty and targeting interventions in old age.
    Type of Medium: Online Resource
    ISSN: 2045-2322
    URL: Article
    DOI: 10.1038/s41598-022-11358-7
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
    detail.hit.zdb_id: 2615211-3
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  • 9
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    Control of blood pressure in older patients with heart failure and the risk of mortality: a population-based prospective cohort study
    Oxford University Press (OUP) ; 2021
    In:  Age and Ageing Vol. 50, No. 4 ( 2021-06-28), p. 1173-1181
    Details
    In: Age and Ageing, Oxford University Press (OUP), Vol. 50, No. 4 ( 2021-06-28), p. 1173-1181
    Abstract: treatment goals for blood pressure (BP) lowering in older patients with heart failure (HF) are unclear. Objective to assess whether BP control & lt; 140/90 mmHg is associated with a decreased risk of mortality in older HF patients. Design population-based prospective cohort study. Setting/subjects participants of the Berlin Initiative Study, a prospective cohort of community-dwelling older adults launched in 2009. Clinical information was obtained in face-to-face interviews and linked to administrative healthcare data. Methods Cox proportional hazards models estimated adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) of cardiovascular death and all-cause mortality associated with normalised BP (systolic BP & lt; 140 mmHg and diastolic BP & lt; 90 mmHg) compared with non-normalised BP (systolic BP ≥ 140 mmHg or diastolic BP ≥ 90 mmHg) in HF patients. The primary analysis considered only baseline BP (‘time-fixed’); an additional analysis updated BP during follow-up (‘time-dependent’). Results at baseline, 544 patients were diagnosed with HF and treated with antihypertensive drugs (mean age 82.8 years; 45.4% female). During a median follow-up of 7.5 years and compared with non-normalised BP, normalised BP was associated with similar risks of cardiovascular death (HR, 1.24; 95% CI, 0.84–1.85) and all-cause mortality (HR, 1.16; 95% CI, 0.89–1.51) in the time-fixed analysis but with increased risks of cardiovascular death (HR, 1.79; 95% CI, 1.23–2.61) and all-cause mortality (HR, 1.48; 95% CI, 1.15–1.90) in the time-dependent analysis. Conclusions BP control & lt; 140/90 mmHg was not associated with a decreased risk of mortality in older HF patients. The increased risk in the time-dependent analysis requires further corroboration.
    Type of Medium: Online Resource
    ISSN: 0002-0729 , 1468-2834
    URL: Article
    DOI: 10.1093/ageing/afaa261
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2021
    detail.hit.zdb_id: 2065766-3
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  • 10
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    Kidney Measures and Risk of Incident Heart Failure Among Older Adults
    Elsevier BV ; 2023
    In:  JACC: Heart Failure ( 2023-6)
    Details
    In: JACC: Heart Failure, Elsevier BV, ( 2023-6)
    Type of Medium: Online Resource
    ISSN: 2213-1779
    URL: Article
    DOI: 10.1016/j.jchf.2023.05.019
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2023
    detail.hit.zdb_id: 2705621-1
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