Zoekresultaten

Co-Presence of Multimorbidity and Disability with Frailty: An Examination of Heterogeneity in the Frail Older Population.

BACKGROUND: Frailty is often associated with multimorbidity and disability. OBJECTIVES: We investigated heterogeneity in the frail older population by characterizing five subpopulations according to quantitative biological markers, multimorbidity and disability, and examined their association with mortality and nursing home admission. DESIGN: Observational study. PARTICIPANTS: Participants (n=4,414) were from the population-based Age Gene/Environment Susceptibility Reykjavik Study. MEASUREMENTS: Frailty was defined by ≥ 3 of five characteristics: weight loss, weakness, reduced energy levels, slowness and physical inactivity. Multimorbidity was assessed using a simple disease count, based on 13 prevalent conditions. Disability was assessed by five activities of daily living; participants who had difficulty with one or more tasks were considered disabled. Differences among frail subpopulations were based on the co-presence of multimorbidity and disability. Differences among the following subpopulations were examined: 1) Non-frail (reference group); 2) Frail only; 3) Frail with disability; 4) Frailty with multimorbidity; 5) Frail with disability and multimorbidity. RESULTS: Frailty was present in 10.7% (n=473). Frailty was associated with increased risk for mortality (OR 1.40; 95% CI 1.15-1.69) and nursing home admission (OR 1.50; 95% CI 1.16-1.93); risks differed by subpopulations. Compared to the non-frail, the frail only group had poorer cognition and increased inflammation levels but did not have increased risk for mortality (OR 1.40; 95% CI 0.84-2.33) or nursing home admission (OR 1.01; 95% CI 0.46-2.21). Compared to the non-frail, the other frail subpopulations had significantly poorer cognition, increased inflammation levels, more white matter lesions, higher levels of calcium, glucose and red cell distribution width and increased risk for mortality and nursing home admission. CONCLUSIONS: The adverse health risks associated with frailty in the general older adult population may primarily be driven by increased disease burden and disability.

Primary healthcare competencies needed in the management of personcentred integrated care for chronic illness and multimorbidity: Results of a scoping review

The effect of multimorbidity on health related functioning: Temporary or persistent? Results from a longitudinal cohort study

Objective: Multimorbidity is known for its negative effects on health related functioning. It remains unclear if these effects are stable over time. The aim was to investigate if the relation between single morbidity/multimorbidity and health related functioning is temporary or persistent. Methods: Data were collected as part of the Maastricht Aging Study (MAAS), a prospective study into the determinants of cognitive aging. Participants (n=1184), 24–81 years old, were recruited from a patient database in primary care (Registration Network Family Practices). Morbidity status (i.e. healthy, single morbidity or multimorbidity) and the Short Form Health Survey (SF-36) were both assessed at baseline, at 3- and 6-year follow-up. Results: At baseline but not at 3- and 6-year follow-up, participants with single morbidity reported poorer physical functioning than their healthy counterparts. Multimorbidity was associated with poorer physical functioning at all measurements. Participants with multimorbidity showed a steep decrease in physical functioning between 3- and 6-year follow-up. Multimorbidity appeared to be unrelated to mental functioning. At baseline and at 3-year follow-up, participants who had a change in morbidity status reported poorer physical functioning than their healthy counterparts. Conclusions: Poorer physical functioning that accompanies multimorbidity is persistent and may even increase over time. People, who acquire one or more diseases during the 3-year follow-up, already showed poorer physical functioning at baseline compared to people who remained healthy during these years. Post-hoc analyses, using the SCL-90 as an outcome measure, did show that multimorbidity was related to depressive and anxiety complaints. However, these complaints seem to decline over time.

Multimorbidity and its relation to subjective memory complaints in a large general population of older adults.

BACKGROUND: Multimorbidity has been suggested to be associated with a variety of negative health-related outcomes. The present study was designed to evaluate the association between multimorbidity and subjective memory complaints. METHODS: This cross-sectional study was based on data obtained from a postal survey designed by the Public Health Service (Gemeentelijke Gezondheids Dienst, GGD) involving 15,188 persons aged 55 years and over living independently in Limburg, the Netherlands. Multivariate logistic regression analyses, adjusted for potentially important covariates, were performed to evaluate the association between self-reported multimorbidity and three outcomes related to subjective memory complaints. RESULTS: Multimorbidity was indeed related to subjective memory complaints. The association between multimorbidity and subjective memory complaints was positively influenced by age. Moreover, multimorbidity was related to the degree of worrying about memory complaints in people who perceived themselves as forgetful. Multimorbidity was also associated with reporting a larger increase in these subjective memory complaints during the past year. In this latter case, multimorbidity had more prognostic capability in men than in women. Psychological distress was related to all three subjective memory-related outcome measures. CONCLUSIONS: In our sample, which was representative of the Dutch population, multimorbidity was associated with subjective memory complaints. The relationship between multimorbidity and subjective memory complaints differed between men and women and between age groups.

Patterns of multimorbidity in people with severe or profound intellectual and motor disabilities

BACKGROUND: People with severe or profound intellectual and motor disabilities (SPIMD) experience multimorbidity and have complex health needs. Multimorbidity increases mortality, decreases functioning, and negatively influences quality of life. Information regarding patterns of multimorbidity in people with SPIMD may lead to proactive prevention, specifically detection and treatment of physical health problems at an early stage and prevention of secondary complications.AIM: The aim of this study was to explore patterns of multimorbidity in individuals with SPIMD.METHODS AND PROCEDURES: Data from medical records and care plans on reported physical health problems of 99 adults with SPIMD were analysed. To explore the co-occurrence of physical health problems, cross tabulations and a 5-set Venn Diagram were used.OUTCOMES AND RESULTS: The most common combination of two physical health problems comprise the most prevalent physical health problems, which included visual impairment, constipation, epilepsy, spasticity, and scoliosis. These five issues occurred as a multimorbidity combination in 37% of the participants. In 56% of the participants a multimorbidity combination of four health problems emerged, namely constipation, visual impairment, epilepsy, and spasticity.CONCLUSIONS AND IMPLICATIONS: People experiencing SPIMD have interrelated health problems. As a consequence, a broad variety of potential interactions between physical health problems and their treatments may occur. Identifying multimorbidity patterns can provide guidance for accurate monitoring of persistent health problems and, early detection of secondary complications. However, the results require confirmation with larger samples in further studies.

Acute and chronic diseases as part of multimorbidity in acutely hospitalized older patients

BackgroundTo describe the prevalence of multimorbidity and to study the association between acute and chronic diseases in acutely hospitalized older patientsMethodsProspective cohort study conducted between 2006 and 2008 in three teaching hospitals in the Netherlands. 639 patients aged 65 years and older, hospitalized for > 48 h were included. Two physicians scored diseases, using ICD-9 codes. Chronic multimorbidity was defined as the presence of ≥ 2 chronic diseases, and acute multimorbidity as ≥ 1 acute diseases upon pre-existent chronic diseases. Logistic regression analyses were conducted to analyse cluster associations between a chronic index disease and the concurrent chronic or acute disease, corrected for age and sex.ResultsThe mean age of patients was 78 years, over 50% had ADL impairments. Prevalence of chronic multimorbidity was 69%, and acute multimorbidity was present in 88%. Hypertension (OR 1.16; 95% CI 1.08–1.24), diabetes (type I or type 2) (OR 1.12; 95% CI 1.04–1.21), heart failure (OR 1.25; 95% CI 1.14–1.38) and COPD (OR 1.19; 95% CI 1.05–1.34) were associated with acute renal failure. Hypertension (OR 1.10; 95% CI 1.04–1.17) and atrial fibrillation (OR 1.17; 95% CI 1.08–1.27) were associated with an adverse drug event. Gastro-intestinal bleeding was clustered with atrial fibrillation (OR 1.11; 95% CI 1.04–1.19) and gastric ulcer (OR 1.16; 95% CI 1.07–1.25).ConclusionBoth acute and chronic multimorbidity was frequently present in hospitalized older patients. We identified specific associations between acute and chronic diseases. There is a need for strategies addressing multimorbidity during the exacerbation of chronic diseases.