title: Impact of valvular heart disease on activities of daily living of nonagenarians: the Leiden 85-plus study a population based study.
abstract: BACKGROUND
  Data on the prevalence of valvular heart disease in very old individuals are scarce and based mostly on in-hospital series. In addition, the potential detrimental effect of valvular heart disease on the activities of daily living is unknown. The present study evaluated the prevalence of significant valvular heart disease and the impact of valvular heart disease on the activities of daily living in community dwelling nonagenarians. Nested within the Leiden 85-plus study, a population based follow-up study of the oldest old, a sample of 81 nonagenarians was recruited.
  
  
  METHODS
  The left ventricular (LV) dimensions, function and the presence and severity of heart valvular disease were evaluated by echocardiography. Significant valvular heart disease included any mitral or aortic stenosis severity, moderate or severe mitral regurgitation, moderate or severe aortic regurgitation and moderate or severe tricuspid regurgitation. Activities of daily living were assessed using the Groningen Activity Restriction Scale (GARS).
  
  
  RESULTS
  LV cavity diameters (end-diastolic diameter 47 +/- 8 mm, end-systolic diameter 30 +/- 8 mm) and systolic LV function (LV ejection fraction 66 +/- 13%) were within normal for the majority of the participants. Significant valvular disease was present in 57 (70%) individuals, with mitral regurgitation and aortic regurgitation as the most frequent valve diseases (49% and 28% respectively). The GARS score between individuals with and without significant valvular heart disease was similar (36.2 +/- 9.2 vs. 34.4 +/- 13.2, p = 0.5).
  
  
  CONCLUSIONS
  Nonagenarian, outpatient individuals have a high prevalence of significant valvular heart disease. However, no relation was observed between the presence of significant valvular heart disease and the ability to perform activities of daily living.
authors.affiliation: Departments of Gerontology and Geriatrics, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands. t.van_bemmel@lumc.nl
authors.forename: Thomas
authors.initials: T
authors.lastname: van Bemmel
authors.forename: Victoria
authors.initials: V
authors.lastname: Delgado
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: Bax
authors.forename: Jacobijn
authors.initials: J
authors.lastname: Gussekloo
authors.forename: Gerard J
authors.initials: GJ
authors.lastname: Blauw
authors.forename: Rudi G
authors.initials: RG
authors.lastname: Westendorp
authors.forename: Eduard R
authors.initials: ER
authors.lastname: Holman
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology*; D000367:Age Factors; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000453:epidemiology* / Q000523:psychology*; D006801:Humans; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D011159:Population Surveillance; D011446:Prospective Studies