Cardiac Structure and Function and Dependency in the Oldest Old David Leibowitz, MD, à Jeremy M. Jacobs, MD, w Irit Stessman-Lande, w Aharon Cohen, MD, w Dan Gilon, MD, à Eliana Ein-Mor, MA, w and Jochanan Stessman, MD w OBJECTIVES: To examine the association between car- diac function and activities of daily living (ADLs) in an age- homogenous, community-dwelling population born in 1920 and 1921. DESIGN: Cross-sectional analysis of a prospective cohort study. SETTING: Community-dwelling elderly population. PARTICIPANTS: Participants were recruited from the Je- rusalem Longitudinal Cohort Study, which has followed an age-homogenous cohort of Jerusalem residents born in 1920 and 1921. Four hundred eighty-nine of the partici- pants (228 male, 261 female) from the most recent set of data collection in 2005 and 2006 underwent echocardiog- raphy at their place of residence in addition to structured interviews and physical examination. MEASUREMENTS: A home-based comprehensive assess- ment was performed to assess health and functional status, including performance of ADLs. Dependence was defined as needing assistance with one or more basic ADLs. Stan- dard echocardiographic assessment of cardiac structure and function, including ejection fraction (EF) and diastolic function as assessed using early diastolic mitral annular tissue velocity measurements obtained using tissue Doppler, was performed. RESULTS: Of the participants with limitation in at least one ADL, significantly more had low EF (o55%) than the group that was independent (52.6 % vs 39.1%; P 5.01). In addition, participants with dependence in ADL had higher left ventricular mass index (LVMI) (129.3 vs 119.7 g/m 2 ) and left atrial volume index (LAVI) (41.3 vs 36.7 mL/m 2 ). There were no differences between the groups in percentage of participants with impaired diastolic function or average ratio of early diastolic transmitral flow velocity to early diastolic mitral annular tissue velocity (11.5 vs 11.8; P 5.64). CONCLUSION: In this age-homogenous cohort of the oldest old, high LVMI and LAVI and indices of systolic but not diastolic function as assessed according to Doppler were associated with limitations in ADLs. J Am Geriatr Soc 59:1429–1434, 2011. Key words: oldest old; echocardiography; activities of daily living; ventricular function P eople aged 85 and older (the ‘‘oldest old’’) are the world’s most rapidly growing age group, and many of the oldest old experience significant disability, with high social and economic costs. 1–3 Identifying potentially treat- able predictors of functional decline is important to assist in designing preventive strategies. This population has a high frequency of cardiovascular morbidity, which presumably affects disability, and mortality. 4 Most previous studies addressing disability in the oldest old focus on diseases and social factors and not on measures of cardiac function. 5–9 Studies of cardiac function using echocardiography performed in the geriatric population have generally in- cluded a broad range of ages and been performed in the hospital or clinic setting, possibly contributing to a biased study population in this age group because older adults find it harder to leave their homes. 10–12 The recent introduc- tion of portable echocardiography machines has made it possible to study people in the home and thereby include a more-representative population of the oldest old. The aim of this study was to examine the association between in- dices of cardiac structure and function and disability in an age-homogenous, community-dwelling population of participants born in 1920 and 1921. METHODS Study Population Participants were recruited from the Jerusalem Longitudi- nal Cohort Study, which was initiated in 1990 and has fol- lowed an age-homogenous cohort of West Jerusalem residents born between June 1920 and May 1921. The Address correspondence to David Leibowitz, Coronary Care Unit, Hadassah- Hebrew University Medical Center, Mount-Scopus, Jerusalem 91240, Israel. E-mail: oleibo@hadassah.org.il DOI: 10.1111/j.1532-5415.2011.03534.x From the à Heart Institute and w Department of Geriatrics and Rehabilitation, Hadassah-Hebrew University Medical Center and Hebrew University Had- assah Medical School, Jerusalem, Israel. JAGS 59:1429–1434, 2011 r 2011, Copyright the Authors Journal compilation r 2011, The American Geriatrics Society 0002-8614/11/$15.00