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Patterns of Multimorbidity in the Aged Population. Results from the KORA-Age Study  [PDF]
Inge Kirchberger, Christa Meisinger, Margit Heier, Anja-Kerstin Zimmermann, Barbara Thorand, Christine S. Autenrieth, Annette Peters, Karl-Heinz Ladwig, Angela D?ring
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0030556
Abstract: Multimorbidity is a common problem in aged populations with a wide range of individual and societal consequences. The objective of the study was to explore patterns of comorbidity and multimorbidity in an elderly population using different analytical approaches. Data were gathered from the population-based KORA-Age project, which included 4,127 persons aged 65–94 years living in the city of Augsburg and its two surrounding counties in Southern Germany. Information on the presence of 13 chronic conditions was collected in a standardized telephone interview and a self-administered questionnaire. Patterns of comorbidity and multimorbidity were analyzed using prevalence figures, logistic regression models and exploratory tetrachoric factor analysis. The prevalence of multimorbidity (≥2 diseases) was 58.6% in the total sample. Hypertension and diabetes (Odds Ratio [OR] 2.95, 99.58% confidence interval [CI] [2.19–3.96]), as well as hypertension and stroke (OR 2.00, 99.58% CI [1.26–3.16]) most often occurred in combination. This association was independent of age, sex and the presence of other conditions. Using factor analysis, we identified four patterns of multimorbidity: the first pattern includes cardiovascular and metabolic diseases, the second includes joint, liver, lung and eye diseases, the third covers mental and neurologic diseases and the fourth pattern includes gastrointestinal diseases and cancer. 44% of the persons were assigned to at least one of the four multimorbidity patterns; 14% could be assigned to both the cardiovascular/metabolic and the joint/liver/lung/eye pattern. Further common pairs were the mental/neurologic pattern combined with the cardiovascular/metabolic pattern (7.2%) or the joint/liver/lung/eye pattern (5.3%), respectively. Our results confirmed the existence of co-occurrence of certain diseases in elderly persons, which is not caused by chance. Some of the identified patterns of multimorbidity and their overlap may indicate common underlying pathological mechanisms.
Coping with multimorbidity in old age – a qualitative study
Christin L?ffler, Hanna Kaduszkiewicz, Carl-Otto Stolzenbach, Waldemar Streich, Angela Fuchs, Hendrik van den Bussche, Friederike Stolper, Attila Altiner
BMC Family Practice , 2012, DOI: 10.1186/1471-2296-13-45
Abstract: 19 narrative in-depth interviews with multimorbid patients were conducted. The data was analysed using grounded theory. Of the 19 interviewed patients 13 were female and 6 male. Mean age was 75?years. Participating patients showed a relatively homogeneous socio-economic status. Patients were recruited from the German city of Hamburg and the state of North Rhine-Westphalia.Despite suffering from multimorbidity, interviewees held positive attitudes towards life: At the social level, patients tried to preserve their autonomy to the most possible extent. At the emotional level, interviewees oscillated between anxiety and strength - having, however, a positive approach to life. At the practical level, patients aimed at keeping their diseases under control. The patients tended to be critical in regards to medication.These findings might have implications for the treatment of multimorbid patients in primary care and further research: The generally presumed passivity of older individuals towards medical treatment, which can be found in literature, is not evident among our sample of older patients. In future, treatment of these patients might take their potential for pro-active cooperation more strongly into account than it is currently the case.Today, multimorbidity is a common problem among the elderly and its occurrence rises with age [1-3]. Research has shown that in Europe, for instance, more than 60% of people aged 65+ can be classified as multimorbid [4,5]. Figures for the US show a similar pattern [6,7]. Whereas numerous studies focus on chronic conditions – both from the physicians’ as well as the patients’ point of view – few studies address multimorbidity. This is rather surprising, since multimorbidity is a particular challenge – not only for General Practitioners (GPs), but also for patients. In 2005, Boyd and colleagues, for instance, reviewed clinical practice guidelines for the 15 most common chronic diseases in the US. They conclude that strict adherence to
Distribution and determinants of functioning and disability in aged adults - results from the German KORA-Age study
Ralf Strobl, Martin Müller, Rebecca Emeny, Annette Peters, Eva Grill
BMC Public Health , 2013, DOI: 10.1186/1471-2458-13-137
Abstract: The objective of our study is to examine the frequency, distribution and determinants of functioning and disability in aged persons and to assess the contribution of diseases to the prevalence of disability.Data originate from the MONICA/KORA study, a population-based epidemiological cohort. Survivors of the original cohorts who were 65 and older were examined by telephone interview in 2009. Disability was assessed with the Health Assessment Questionnaire Disability Index (HAQ-DI). Minimal disability was defined as HAQ-DI > 0. Logistic regression was used to adjust for potential confounders and additive regression to estimate the contribution of diseases to disability prevalence.We analyzed a total of 4117 persons (51.2% female) with a mean age of 73.6 years (SD = 6.1). Minimal disability was present in 44.7% of all participants. Adjusted for age and diseases, disability was positively associated with female sex, BMI, low income, marital status, physical inactivity and poor nutritional status, but not with smoking and education. Problems with joint functions and eye diseases contributed most to disability prevalence in all age groups.In conclusion, this study could show that there are vulnerable subgroups of aged adults who should receive increased attention, specifically women, those with low income, those over 80, and persons with joint or eye diseases. Physical activity, obesity and malnutrition were identified as modifiable factors for future targeted interventions.
Operationalizing multimorbidity and autonomy for health services research in aging populations - the OMAHA study
Martin Holzhausen, Judith Fuchs, Markus Busch, Andrea Ernert, Julia Six-Merker, Hildtraud Knopf, Ulfert Hapke, Beate Gaertner, Ina Kurzawe-Seitz, Roswitha Dietzel, Nadine Sch?del, Justus Welke, Juliane Wiskott, Matthias Wetzstein, Peter Martus, Christa Scheidt-Nave
BMC Health Services Research , 2011, DOI: 10.1186/1472-6963-11-47
Abstract: OMAHA is a longitudinal epidemiological study including a comprehensive assessment at baseline and at 12-month follow-up as well as brief intermediate telephone interviews at 6 and 18 months. In order to evaluate different sampling procedures and modes of data collection, the study is conducted in two different population-based samples of men and women aged 65 years and older. A geographically defined sample was recruited from an age and sex stratified random sample from the register of residents in Berlin-Mitte (Berlin OMAHA study cohort, n = 299) for assessment by face-to-face interview and examination. A larger nationwide sample (German OMAHA study cohort, n = 730) was recruited for assessment by telephone interview among participants in previous German Telephone Health Surveys. In both cohorts, we successfully applied a multi-dimensional set of instruments to assess multimorbidity, functional disability in daily life, autonomy, quality of life (QoL), health care services utilization, personal and social resources as well as socio-demographic and biographical context variables. Response rates considerably varied between the Berlin and German OMAHA study cohorts (22.8% vs. 59.7%), whereas completeness of follow-up at month 12 was comparably high in both cohorts (82.9% vs. 81.2%).The OMAHA study offers a wide spectrum of data concerning health, functioning, social involvement, psychological well-being, and cognitive capacity in community-dwelling older people in Germany. Results from the study will add to methodological and content-specific discourses on human resources for maintaining quality of life and autonomy throughout old age, even in the face of multiple health complaints.Multimorbidity, e. g. the concurrent existence of multiple health problems in the same person, is a highly prevalent phenomenon in old age and of growing public health impact in aging societies [1-3]. The terms multimorbidity and comorbidity have been used interchangeably. In fact, comorbi
Assessing Subjective Age and Adjustment to Aging in a Portuguese and German Older Population: A Comparative Multiple Correspondence Analysis  [cached]
Sofia von Humboldt,Isabel Leal,Filipa Pimenta
International Journal of Psychological Studies , 2012, DOI: 10.5539/ijps.v4n2p141
Abstract: Purpose: This study aims at examining the contributors to adjustment to aging (AtA) and subjective age (SA) identified by older adults and to investigate the latent constructs that can work as major determinants in AtA and SA in an older Portuguese and German population. Method: Measures were completed, using a variety of appropriate methods, including demographics and interviews. Complete data were available for 102 older adults aged between 74-100 years (M=81.2; SD = 6.70). Data was subjected to content analysis. Representation of the associations and latent constructs were analyzed by a Multiple Correspondence Analysis (MCA). Results: Findings showed a model for each nationality. SA and AtA for Portuguese elderly were explained by a three-factor overall model: “active”, “concentrated” and “attuned”. A three-dimension overall model formed by "harmonized”, “focused” and “young-at-heart” was indicated as a best-fit solution for German elderly. Conclusion: SAis differently related to AtA in older adults in both samples. The findings presented in this paper highlighted the under-developed potential of an adjustment and age overall model for this population.
Lifecourse socioeconomic circumstances and multimorbidity among older adults
Reginald D Tucker-Seeley, Yi Li, Glorian Sorensen, SV Subramanian
BMC Public Health , 2011, DOI: 10.1186/1471-2458-11-313
Abstract: Cross-sectional analysis of 7,305 participants age 50 and older from the 2004 Health and Retirement Study (HRS) who also gave permission for their HRS records to be linked to their Social Security Records in the United States. Zero-inflated Poisson regression models were used to simultaneously model the likelihood of the absence of morbidity and the expected number of chronic conditions.Childhood financial hardship and lifetime earnings were not associated with the absence of morbidity. However, childhood financial hardship was associated with an 8% higher number of chronic conditions; and, an increase in lifetime earnings, operationalized as average annual earnings during young and middle adulthood, was associated with a 5% lower number of chronic conditions reported. We also found a significant interaction between childhood financial hardship and lifetime earnings on multimorbidity.This study shows that childhood financial hardship and lifetime earnings are associated with multimorbidity, but not associated with the absence of morbidity. Lifetime earnings modified the association between childhood financial hardship and multimorbidity suggesting that this association is differentially influential depending on earnings across young and middle adulthood. Further research is needed to elucidate lifecourse socioeconomic pathways associated with the absence of morbidity and the presence of multimorbidity among older adults.Chronic conditions generally cluster and individuals with one chronic condition are likely to have other conditions as well. As such, many older adults now manage two or more chronic conditions at the same time (i.e. multimorbidity)[1,2]; and evidence suggests that the presence of multimorbidity is expected to continue to rise [3-5]. The influence of childhood material conditions and lifetime earnings on multimorbidity has yet to be investigated. Considering the impending shift in the US population demographic as the baby-boomers reach age 65, which
The German MultiCare-study: Patterns of multimorbidity in primary health care – protocol of a prospective cohort study
Ingmar Sch?fer, Heike Hansen, Gerhard Sch?n, Wolfgang Maier, Susanne H?fels, Attila Altiner, Angela Fuchs, Ferdinand M Gerlach, Juliana J Petersen, Jochen Gensichen, Sven Schulz, Steffi Riedel-Heller, Melanie Luppa, Siegfried Weyerer, Jochen Werle, Horst Bickel, Kerstin Barth, Hans-Helmut K?nig, Anja Rudolph, Birgitt Wiese, Jana Prokein, Monika Bullinger, Olaf Knesebeck, Marion Eisele, Hanna Kaduszkiewicz, Karl Wegscheider, Hendrik Bussche
BMC Health Services Research , 2009, DOI: 10.1186/1472-6963-9-145
Abstract: The study is designed as a multicentre prospective, observational cohort study of 3.050 patients aged 65 to 85 at baseline with at least three different diagnoses out of a list of 29 illnesses and syndromes. The patients will be recruited in approx. 120 to 150 GP surgeries in 8 study centres distributed across Germany. Information about the patients' morbidity will be collected mainly in GP interviews and from chart reviews. Functional status, resources/risk factors, health care utilization and additional morbidity data will be assessed in patient interviews, in which a multitude of well established standardized questionnaires and tests will be performed.The main aim of the cohort study is to monitor the course of the illness process and to analyse for which reasons medical conditions are stable, deteriorating or only temporarily present. First, clusters of combinations of diseases/disorders (multimorbidity patterns) with a comparable impact (e.g. on quality of life and/or functional status) will be identified. Then the development of these clusters over time will be analysed, especially with regard to prognostic variables and the somatic, psychological and social consequences as well as the utilization of health care resources. The results will allow the development of an instrument for prediction of the deterioration of the illness process and point at possibilities of prevention. The practical consequences of the study results for primary care will be analysed in expert focus groups in order to develop strategies for the inclusion of the aspects of multimorbidity in primary care guidelines.Multimorbidity is a highly frequent condition in older people that is supposed to significantly affect the patients' quality of life, functional status and life expectancy. But multimorbidity also is a complex phenomenon with an almost endless number of possible disease combinations of unclear implications. Therefore, it is not surprising that there is only marginal evidence on
Multimorbidity - not just an older person's issue. Results from an Australian biomedical study
Anne W Taylor, Kay Price, Tiffany K Gill, Robert Adams, Rhiannon Pilkington, Natalie Carrangis, Zumin Shi, David Wilson
BMC Public Health , 2010, DOI: 10.1186/1471-2458-10-718
Abstract: Multimorbidity was assessed across three age groups from data collected in a major biomedical cohort study (North West Adelaide Health Study). Using randomly selected adults, diabetes, asthma, and chronic obstructive pulmonary disease were determined clinically and cardio-vascular disease, osteoporosis, arthritis and mental health by self-report (ever been told by a doctor). A range of demographic, social, risk and protective factors including high blood pressure and high cholesterol (assessed bio-medically), health service use, quality of life and medication use (linked to government records) were included in the multivariate modelling.Overall 4.4% of the 20-39 year age group, 15.0% of the 40-59 age group and 39.2% of those aged 60 years of age or older had multimorbidity (17.1% of the total). Of those with multimorbidity, 42.1% were aged less than 60 years of age. A variety of variables were included in the final logistic regression models for the three age groups including family structure, marital status, education attainment, country of birth, smoking status, obesity measurements, medication use, health service utilisation and overall health status.Multimorbidity is not just associated with older persons and flexible care management support systems, appropriate guidelines and care-coordination programs are required across a broader age range. Issues such as health literacy and polypharamacy are also important considerations. Future research is required into assessing multimorbidity across the life course, prevention of complications and assessment of appropriate self-care strategies.Persons with multimorbidity, the simultaneous occurrence of two or more chronic conditions [1,2] are at increased risk of less than best practice care [3,4]. They tend to have more frequent and longer hospitalisations [1,5], greater use of polypharmacy (causing adverse drug effects) [3,6], spend more on their health [4,7,8] and use a greater range of other health care services [3,4]
Managing the Needs of Older Patients with Multimorbidity—A Systematic Review of the Challenges Faced by the Healthcare Services  [PDF]
Anne Lise Holm, Astrid Karin Berland, Elisabeth Severinsson
Open Journal of Nursing (OJN) , 2016, DOI: 10.4236/ojn.2016.610086
Abstract: Research fails to provide an overview of the challenges involved in caring for older patients with multimorbidity. Multimorbidity is defined as the presence of two or more chronic conditions in the same person, leading to a high risk of care dependency. The aim of this review was to illuminate the challenges faced by the healthcare services in managing the needs of older patients with multimorbidity. A systematic review was performed, a total of 1,965 abstracts were read and nine quantitative studies included. Data were analysed by thematic synthesis, revealing six themes: A frequent problem in older female patients; High healthcare expenditure and costs, Medication management problems, Social inequities, Complex healthcare and consultation needs and High mortality. The study highlights that healthcare professionals struggle to obtain suitable guidelines for the care of patients with multimorbidity while trying to respond to their needs. Patient-centred integration across settings and coordination in clinical practice are necessary. The healthcare system today does not seem to focus on patient safety and preventing harm. Older patients should be reviewed by a healthcare professional responsible for coordinating their care. To ensure safe and effective care for elderly persons with multimorbidity, the healthcare services should abandon the current focus on managing innumerable individual diseases and conditions.
Incidence and Predictors of Multimorbidity in the Elderly: A Population-Based Longitudinal Study  [PDF]
René Melis, Alessandra Marengoni, Sara Angleman, Laura Fratiglioni
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0103120
Abstract: Background We aimed to calculate 3-year incidence of multimorbidity, defined as the development of two or more chronic diseases in a population of older people free from multimorbidity at baseline. Secondly, we aimed to identify predictors of incident multimorbidity amongst life-style related indicators, medical conditions and biomarkers. Methods Data were gathered from 418 participants in the first follow up of the Kungsholmen Project (Stockholm, Sweden, 1991–1993, 78+ years old) who were not affected by multimorbidity (149 had none disease and 269 one disease), including a social interview, a neuropsychological battery and a medical examination. Results After 3 years, 33.6% of participants who were without disease and 66.4% of those with one disease at baseline, developed multimorbidity: the incidence rate was 12.6 per 100 person-years (95% CI: 9.2–16.7) and 32.9 per 100 person-years (95% CI: 28.1–38.3), respectively. After adjustments, worse cognitive function (OR, 95% CI, for 1 point lower Mini-Mental State Examination: 1.22, 1.00–1.48) was associated with increased risk of multimorbidity among subjects with no disease at baseline. Higher age was the only predictor of multimorbidity in persons with one disease at baseline. Conclusions Multimorbidity has a high incidence at old age. Mental health-related symptoms are likely predictors of multimorbidity, suggesting a strong impact of mental disorders on the health of older people.
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