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Lai FTT, Wong SYS, Yip BHK, Guthrie B, Mercer SW, Chung RY, Chung GKK, Chau PYK, Wong ELY, Woo J, Yeoh EK. Multimorbidity in middle age predicts more subsequent hospital admissions than in older age: A nine-year retrospective cohort study of 121,188 discharged in-patients. Eur J Intern Med 2019; 61:103-111. [PMID: 30581041 DOI: 10.1016/j.ejim.2018.12.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Revised: 11/24/2018] [Accepted: 12/11/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Previous research has suggested a differential short-term effect of multimorbidity on hospitalization by age, with younger groups affected more. This study compares the nine-year hospitalization pattern by age and multimorbidity status in a retrospective cohort of discharged in-patients, who represent a high-need portion of the population. METHODS We examined routine clinical records of all patients aged 45+ years with chronic conditions discharged from public general hospitals in 2005 in Hong Kong. Patterns of annual frequencies of hospital admissions and number of hospitalized days over nine years (2005-2014) were compared by multimorbidity status (1, 2, 3+ conditions) and age group (45-64, 65-74, 75+). RESULTS Among 121,188 included patients, 33.9% had 2+ conditions and 12.3% had 3+. Hospitalization patterns varied by age and multimorbidity status. For those having only 1 condition, annual number of admissions was similar by age, but older patients had more hospitalized days (4.40 days per person-year for the 45-64 group versus 10.29 for the 75+ group in the 5th year). For those with 3+ conditions, younger patients had more admissions (4.39 admissions per person-year for the 45-64 group versus 1.87 for the 75+ group in the 5th year) but similar number of hospitalized days with older patients. Interaction analysis showed effect of multimorbidity on hospitalization was stronger in younger groups (P < 0.05). CONCLUSION Middle-aged discharged in-patients with multimorbidity are admitted more often than their older counterparts and have similar total hospitalized days per year. Further research is needed to investigate chronic care needs of younger people with multimorbidity.
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Affiliation(s)
- Francisco T T Lai
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Sha Tin, New Territories, Hong Kong.
| | - Samuel Y S Wong
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Sha Tin, New Territories, Hong Kong.
| | - Benjamin H K Yip
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Sha Tin, New Territories, Hong Kong.
| | - Bruce Guthrie
- The Centre for Population Health Sciences, The Usher Institute, The University of Edinburgh, Edinburgh, Scotland, United Kingdom.
| | - Stewart W Mercer
- The Centre for Population Health Sciences, The Usher Institute, The University of Edinburgh, Edinburgh, Scotland, United Kingdom.
| | - Roger Y Chung
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Sha Tin, New Territories, Hong Kong.
| | - Gary K K Chung
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Sha Tin, New Territories, Hong Kong.
| | - Patsy Y K Chau
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Sha Tin, New Territories, Hong Kong.
| | - Eliza L Y Wong
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Sha Tin, New Territories, Hong Kong.
| | - Jean Woo
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong.
| | - Eng-Kiong Yeoh
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Sha Tin, New Territories, Hong Kong.
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Shea-Shumsky NB, Schoeneberger S, Grigsby J. Executive functioning as a predictor of stroke rehabilitation outcomes. Clin Neuropsychol 2019; 33:854-872. [DOI: 10.1080/13854046.2018.1546905] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
| | | | - Jim Grigsby
- Departments of Psychology and Medicine, University of Colorado Denver, Denver, CO, USA
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103
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Impact of Frailty on Outcomes After Primary and Revision Total Hip Arthroplasty. J Arthroplasty 2019; 34:56-64.e5. [PMID: 30340916 DOI: 10.1016/j.arth.2018.09.078] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 09/04/2018] [Accepted: 09/18/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Frailty and disability from arthritis are closely intertwined and little is known about the impact of frailty on total hip arthroplasty (THA) outcomes. We hypothesized that higher preoperative frailty is associated with more adverse events following THA. METHODS All patients (≥50 years) undergoing unilateral primary or revision THA at a single institution from 2005 through 2016 were included. We analyzed the association of frailty (measured by a frailty deficit index) with postoperative outcomes in hospital, within 90 days, and within 1 year using multivariable logistic and Cox regression, adjusting for age. RESULTS Among 8640 patients undergoing THA (6502 primary and 2138 revisions; median age 68 years), 22.7%, 32.9%, and 44.4% were classified as frail, vulnerable, and nonfrail, respectively. Frail patients tended to be female, older, sicker (American Society of Anesthesiologists ≥3), and received general anesthesia more frequently. Relative to nonfrail patients, frail patients had significantly increased odds of wound complications/hematoma (odds ratio 2.01) and reoperation (odds ratio 2.74) while in hospital, and increased risks for mortality (1-year hazards ratio [HR] 5.65), infection (1-year HR 3.63), dislocation (1-year HR 2.10), wound complications/hematoma (1-year HR 2.61), and reoperation (1-year HR 2.22) within 90 days and 1 year. Frailty was also associated with >5.5-fold increased mortality risk 1 year following THA. No significant associations with aseptic loosening, periprosthetic fracture, or heterotopic ossification were observed. CONCLUSION A higher preoperative frailty index is associated with increased mortality and perioperative complications following primary and revision THA. The proposed frailty deficit index provides clinically important information for healthcare providers to use when counseling patients prior to decision for surgery.
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Alcusky M, Hume AL, Fisher M, Tjia J, Goldberg RJ, McManus DD, Lapane KL. Dabigatran Versus Rivaroxaban for Secondary Stroke Prevention in Patients with Atrial Fibrillation Rehabilitated in Skilled Nursing Facilities. Drugs Aging 2018; 35:1089-1098. [PMID: 30421391 PMCID: PMC6326174 DOI: 10.1007/s40266-018-0610-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Thromboembolic and bleeding risk are elevated in older patients with atrial fibrillation and prior stroke. We compared dabigatran with rivaroxaban for secondary prevention in a national population after skilled nursing facility (SNF) discharge. METHODS Medicare fee-for-service beneficiaries aged ≥ 65 years with atrial fibrillation hospitalized for ischemic stroke (November 2011-October 2013) and subsequently admitted to an SNF were studied. Dabigatran (n = 332) and rivaroxaban users (n = 378) were compared in a retrospective, active comparator, new-user cohort. The index medication claim occurred within 120 days after hospital discharge and exposure continued until a 14-day treatment gap ('as treated'). The primary net clinical benefit outcome was the time to recurrent stroke, transient ischemic attack, intracranial hemorrhage, extracranial bleed, myocardial infarction, venous thromboembolism, or death. All-cause mortality was evaluated separately as a secondary outcome. Multivariable adjusted Cox models stratified by dosage estimated hazard ratios (aHR). RESULTS Among those receiving low dosages, the crude composite event rate was 40.4/100 person-years among dabigatran users and 33.7/100 person-years among rivaroxaban users. The composite outcome [aHR 1.48; 95% confidence interval (CI) 0.87-2.51] and all-cause mortality (aHR 1.67; 95% CI 0.84-3.31) rates were higher among low-dose dabigatran users. For those receiving standard doses, the crude composite event rates were 19.5/100 person-years for dabigatran users and 37.1/100 person-years for rivaroxaban users. Although no difference in mortality was observed, the composite outcome rate was lower among standard-dose dabigatran users (aHR 0.65; 95% CI 0.36-1.15). CONCLUSIONS In older adults treated with direct-acting oral anticoagulants after ischemic stroke, outcome rates varied considerably by drug and dosage.
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Affiliation(s)
- Matthew Alcusky
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA.
| | - Anne L Hume
- Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, Kingston, RI, USA
| | - Marc Fisher
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Jennifer Tjia
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Robert J Goldberg
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - David D McManus
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Kate L Lapane
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
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Vemuri P, Lesnick TG, Przybelski SA, Graff‐Radford J, Reid RI, Lowe VJ, Zuk SM, Senjem ML, Schwarz CG, Gunter JL, Kantarci K, Machulda MM, Mielke MM, Petersen RC, Knopman DS, Jack CR. Development of a cerebrovascular magnetic resonance imaging biomarker for cognitive aging. Ann Neurol 2018; 84:705-716. [PMID: 30264411 PMCID: PMC6282853 DOI: 10.1002/ana.25346] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 09/24/2018] [Accepted: 09/24/2018] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Recent availability of amyloid and tau positron emission tomography (PET) has provided us with a unique opportunity to measure the association of systemic vascular health with brain health after accounting for the impact of Alzheimer disease (AD) pathologies. We wanted to quantify early cerebrovascular health-related magnetic resonance imaging brain measures (structure, perfusion, microstructural integrity) and evaluate their utility as a biomarker for cerebrovascular health. METHODS We used 2 independent samples (discovery, n = 390; validation, n = 1,035) of individuals, aged ≥ 60 years, along the cognitive continuum with imaging from the population-based sample of Mayo Clinic Study of Aging. We ascertained vascular health by summing up recently existing cardiovascular and metabolic conditions (CMC) from health care records (hypertension, hyperlipidemia, cardiac arrhythmias, coronary artery disease, congestive heart failure, diabetes mellitus, and stroke). Using multiple regression models, we quantified associations between CMC and brain health after accounting for age, sex, education/occupation, and AD burden (from amyloid and tau PET). RESULTS Systemic vascular health was associated with medial temporal lobe thinning, widespread cerebral hypoperfusion, and loss of microstructural integrity in several white matter tracts including the corpus callosum and fornix. Further investigations suggested that microstructural integrity of the genu of the corpus callosum was suitable for assessing prodromal cerebrovascular health, had similar distributions in the discovery and independent validation datasets, and predicted cognitive performance above and beyond amyloid deposition. INTERPRETATION Systemic vascular health has significant impact on brain structure and function. Quantifying prodromal cerebrovascular health-related brain measures that are independent of AD pathology-related changes has great utility for cognitive aging. Ann Neurol 2018;84:713-724.
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Affiliation(s)
| | | | | | | | - Robert I. Reid
- Department of Information TechnologyMayo ClinicRochesterMN
| | - Val J. Lowe
- Department of RadiologyMayo ClinicRochesterMN
| | | | - Matthew L. Senjem
- Department of RadiologyMayo ClinicRochesterMN
- Department of Information TechnologyMayo ClinicRochesterMN
| | | | - Jeffrey L. Gunter
- Department of RadiologyMayo ClinicRochesterMN
- Department of Information TechnologyMayo ClinicRochesterMN
| | | | | | - Michelle M. Mielke
- Department of Health Sciences ResearchMayo ClinicRochesterMN
- Department of NeurologyMayo ClinicRochesterMN
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Perry RG, Mitchell JA, Hawkins J, Johnson-Lawrence V. The Role of Age and Multimorbidity in Shaping Older African American Men's Experiences with Patient⁻Provider Communication. Geriatrics (Basel) 2018; 3:E74. [PMID: 31011109 PMCID: PMC6371103 DOI: 10.3390/geriatrics3040074] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 10/06/2018] [Accepted: 10/17/2018] [Indexed: 11/16/2022] Open
Abstract
This study investigated factors associated with older African American men's unmet health communication needs in the context of patient-provider interactions. Responses to a health survey were analyzed for 430 African American men attending a Midwest community health fair. The outcome measure was the extent to which men could get their health-related questions answered during recent medical visits. Men's mean age was 54; 39% had one chronic condition and 22% had two or more comorbidities. The 53% who usually or always had their questions answered were older, had less comorbidity, higher educational attainment, higher annual incomes, were more likely to be married and have any type of insurance, and have a personal physician. Access to care was the primary factor in shaping men's opportunities to ask health-related questions, and older multimorbid and low-income African American men may face increased barriers to healthcare access, and thus barriers to patient-centered care and communication.
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Affiliation(s)
- Ramona G Perry
- School of Social Work, University of Michigan School of Social Work, Ann Arbor, MI 48103, USA.
| | - Jamie A Mitchell
- School of Social Work, University of Michigan School of Social Work, Ann Arbor, MI 48103, USA.
| | - Jaclynn Hawkins
- School of Social Work, University of Michigan School of Social Work, Ann Arbor, MI 48103, USA.
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107
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Vetrano DL, Calderón-Larrañaga A, Marengoni A, Onder G, Bauer JM, Cesari M, Ferrucci L, Fratiglioni L. An International Perspective on Chronic Multimorbidity: Approaching the Elephant in the Room. J Gerontol A Biol Sci Med Sci 2018; 73:1350-1356. [PMID: 28957993 PMCID: PMC6132114 DOI: 10.1093/gerona/glx178] [Citation(s) in RCA: 97] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 09/15/2017] [Indexed: 01/07/2023] Open
Abstract
Multimorbidity is a common and burdensome condition that may affect quality of life, increase medical needs, and make people live more years of life with disability. Negative outcomes related to multimorbidity occur beyond what we would expect from the summed effect of single conditions, as chronic diseases interact with each other, mutually enhancing their negative effects, and eventually leading to new clinical phenotypes. Moreover, multimorbidity mirrors an accelerated global susceptibility and a loss of resilience, which are both hallmarks of aging. Due to the complexity of its assessment and definition, and the lack of clear evidence steering its management, multimorbidity represents one of the main current challenges for clinicians, researchers, and policymakers. The authors of this article recently reflected on these issues during two twin international symposia at the 2016 European Union Geriatric Medicine Society (EUGMS) meeting in Lisbon, Portugal, and the 2016 Gerontological Society of America (GSA) meeting in New Orleans, USA. The present work summarizes the most relevant aspects related to multimorbidity, with the ultimate goal to identify knowledge gaps and suggest future directions to approach this condition.
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Affiliation(s)
- Davide L Vetrano
- Aging Research Center, Karolinska Institutet and Stockholm University, Sweden
- Department of Geriatrics, Catholic University of Rome, Italy
| | - Amaia Calderón-Larrañaga
- Aging Research Center, Karolinska Institutet and Stockholm University, Sweden
- EpiChron Research Group, Aragon Health Sciences Institute (IACS), Spain
| | - Alessandra Marengoni
- Aging Research Center, Karolinska Institutet and Stockholm University, Sweden
- Department of Clinical and Experimental Sciences, University of Brescia, Italy
| | - Graziano Onder
- Department of Geriatrics, Catholic University of Rome, Italy
| | - Jürgen M Bauer
- Center for Geriatric Medicine, University of Heidelberg, Germany
| | - Matteo Cesari
- Gérontopôle, Centre Hospitalier Universitaire de Toulouse III, France
| | - Luigi Ferrucci
- Intramural Research Program, National Institute on Aging, Baltimore, Maryland
| | - Laura Fratiglioni
- Aging Research Center, Karolinska Institutet and Stockholm University, Sweden
- Stockholm Gerontology Research Center, Sweden
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108
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Whitney DG, Hurvitz EA, Devlin MJ, Caird MS, French ZP, Ellenberg EC, Peterson MD. Age trajectories of musculoskeletal morbidities in adults with cerebral palsy. Bone 2018; 114:285-291. [PMID: 29981509 DOI: 10.1016/j.bone.2018.07.002] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 06/29/2018] [Accepted: 07/04/2018] [Indexed: 01/15/2023]
Abstract
BACKGROUND Individuals with cerebral palsy (CP) are at an increased risk for age-related morbidities due to functional impairments, maladapted growth, and altered body composition. While musculoskeletal (MSK) deficits are present in children, little is understood about MSK morbidity throughout the lifespan in those with CP. The purpose of this study was to examine the age-related trajectories of MSK morbidity and multimorbidity throughout adulthood in those with CP. METHODS A clinic-based sample of adults with CP (n = 1395; ≥18 years) was examined to determine prevalence of MSK morbidities at the University of Michigan Medical Center. Logistic regression was used to determine the effects of age on individual MSK morbidities and multimorbidity (i.e., ≥2 morbidities) after adjusting for sex, race, weight, and smoking. RESULTS With the 18-30 year age group as the reference, the adjusted odds of osteopenia was lower in the 41-50 and >50 year age groups, the odds of osteoporosis and rheumatoid arthritis was higher in 41-50 and >50 year age groups, and the odds of osteoarthritis was higher in 31-40, 41-50, and >50 year age groups. The adjusted odds of MSK multimorbidity increased substantially with increasing age for 31-40 year olds (OR: 1.919; 95% CI 1.05-3.52), 41-50 year olds (OR: 4.30; 95% CI 2.40-7.69), and >50 year olds (OR: 6.05; 95% CI 3.56-10.27). CONCLUSIONS Adults with CP are at high risk for MSK morbidities across all ages. Future studies are needed to examine the global aging trajectories of MSK health among adults with CP. Study findings highlight the importance of maximizing MSK accretion, and developing programs to assist individuals with CP and their caregivers to maintain MSK mass and function throughout the lifespan.
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Affiliation(s)
- Daniel G Whitney
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, 325 E. Eisenhower, Ann Arbor, MI 48108, United States
| | - Edward A Hurvitz
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, 325 E. Eisenhower, Ann Arbor, MI 48108, United States
| | - Maureen J Devlin
- Department of Anthropology, University of Michigan, 101 West Hall, 1085 S. University Ave., Ann Arbor, MI 48109, United States
| | - Michelle S Caird
- Department of Orthopedic Surgery, Michigan Medicine, University of Michigan, 1540 E Hospital Dr., Ann Arbor, MI 48109, United States
| | - Zachary P French
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, 325 E. Eisenhower, Ann Arbor, MI 48108, United States
| | - Elie C Ellenberg
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, 325 E. Eisenhower, Ann Arbor, MI 48108, United States
| | - Mark D Peterson
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, 325 E. Eisenhower, Ann Arbor, MI 48108, United States.
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Chukayeva II, Samorodskaya IV, Larina VN. The prevalence of multimorbidity: discussion about the terminology, registration and its effect on patient's health care utilization. TERAPEVT ARKH 2018; 90:125-130. [PMID: 30701947 DOI: 10.26442/terarkh2018908125-130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The purpose of the present review is to bring into focus the issues regarding terminological and registration aspects of multimorbidity we come across in the modern literature. Key questions regarding the definitions for the most widely used terms «comorbidity», «polymorbidity» and «multimorbidity» are discussed. We also considered the aspects of their origin and distinctive features between the concepts. The interaction between illnesses can exacerbate one another, modify the clinical picture and course of illnesses, the nature and severity of complications, lead to a progressive worsening of the prognosis and quality of life in patients. It has been proposed that the terms of "comorbidity» (in case of presence of the pathogenesis interrelation) or "polimorbidity» (in case of absence of the pathogenesis interrelation) are the most appropriate diagnostic and treatment patterns for practice and epidemiological study. «Multimorbidity» seems to be a more appropriate term for clinical practice usage, because it involves not only diagnosis but also interaction between diagnosises, symptoms/syndromes, the mobility or self-care problems et al. The algorithm of the managing patients with multimorbidity is presented. >.
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Affiliation(s)
- I I Chukayeva
- N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia, Moscow, Russia
| | - I V Samorodskaya
- State Research Center for Preventive Medicine, Ministry of Health of Russia, Moscow, Russia
| | - V N Larina
- N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia, Moscow, Russia
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Wetterling T, Junghanns K. [Does multimorbidity in older psychiatric patients lead to higher transfer rates between psychiatric and somatic departments?]. Z Gerontol Geriatr 2018; 52:568-574. [PMID: 30030608 DOI: 10.1007/s00391-018-1425-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Revised: 05/19/2018] [Accepted: 06/21/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Multimorbidity is an increasing challenge in geriatric medicine, also in psychiatric patients. The question arises where an adequate treatment should be carried out. METHODS This exploratory study was part of the Gerontopsychiatry study Berlin (Gepsy-B), an investigation of all admissions of older inpatients (>65 years) to a psychiatric hospital within 3 years. A total of 1266 admissions to a hospital in Berlin could be analyzed. RESULTS Of the patients primarily admitted to the psychiatric department, 17.4% had to be transferred to a somatic department with a preponderance of patients with higher multimorbidity (11.7 ± 3.7 vs. 9.9 ± 3.8 somatic diagnoses, U‑test p < 0.001). Of the patients 19.7% were transferred from somatic departments to the psychiatric department mainly due to delirium. They were also often multimorbid (mean number of somatic diagnoses: 11.7 + 3.7 vs. 10.3 + 3.8, U‑test p < 0.001). CONCLUSION Multimorbidity results in more frequent transfer of older patients in hospital.
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Affiliation(s)
- Tilman Wetterling
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Vivantes Klinikum Kaulsdorf, Myslowitzer Str. 45, 12621, Berlin, Deutschland.
| | - Klaus Junghanns
- UKSH-Campus Lübeck, Zentrum für Integrative Psychiatrie, Lübeck, Deutschland
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111
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Multimorbidity Trends in United States Adults, 1988-2014. J Am Board Fam Med 2018; 31:503-513. [PMID: 29986975 PMCID: PMC6368177 DOI: 10.3122/jabfm.2018.04.180008] [Citation(s) in RCA: 137] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 04/03/2018] [Accepted: 04/03/2018] [Indexed: 12/15/2022] Open
Abstract
IMPORTANCE The simultaneous presence of multiple conditions in one patient (multi-morbidity) is a key challenge facing primary care. OBJECTIVE The purpose of this study was to determine the prevalence of multi-morbidity and to document changes in prevalence during the last 25 years. DESIGN/SETTING Cross-sectional study using multiple years (1988-2014) of the National Health and Nutrition Examination Survey (NHANES) were analyzed. SETTING Multiple years (1988 to 2014) of the National Health and Nutrition Examination Survey (NHANES) from the United States were analyzed. PARTICIPANTS Noninstitutionalized adults. MAIN OUTCOMES AND MEASURES Number of chronic conditions per individual analyzed by age, race, gender, and socioeconomic factors. RESULTS A total of 57,303 individuals were surveyed regarding the presence of multi-morbidity in separate surveys spanning 1988-2014. The overall current prevalence in 2013-2014 of >2 morbidities was 59.6% (95% CI 58.1%-61.1%), 38.5% had 3 or more, and 22.7% had 4 or more morbidities, which was significantly higher than in 1988 (45.7%, 95% CI 43.5%-47.8%, with >2 morbidities). Among individuals with 2 or more morbidities, 54.1% have obesity compared to 41.9% in 1988. Among adults age >65, prevalence was 91.8% for 2 or more morbidities. Whites and Blacks had significantly higher prevalence (59.2% and 60.1%) than Hispanic or "other" race (45.0%, P < .0001). Women (58.4%) had more current multi-morbidities (>2) than men (55.9%, P = .01). CONCLUSIONS AND RELEVANCE Multimorbidity is common and has been increasing over the last 25 years. This finding has implications for public health policy and anticipated health costs for the coming years.
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112
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Czarkowska-Paczek B, Wyczalkowska-Tomasik A, Paczek L. Laboratory blood test results beyond normal ranges could not be attributed to healthy aging. Medicine (Baltimore) 2018; 97:e11414. [PMID: 29995788 PMCID: PMC6076198 DOI: 10.1097/md.0000000000011414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Aging is related to a decline in the function of many organs. The results of blood tests are essential for clinical management and could change over a lifespan reflecting aging. The aim of this study was to examine serum levels of liver, kidney, and bone marrow function and to study their dynamics as a function of age and sex.The cross-sectional study conducted in Poland included 180 healthy individuals (20-90 years) divided into subgroups by sex and decade. These included subgroups of ≥65 or <65 years (men and women). We investigated serum levels of creatinine, estimated glomerular filtration rate, estimated effective renal blood/plasma flow, urine pH, urine neutrophil gelatinase-associated lipocalin (NGAL) as well as serum levels of transaminases, bilirubin, total cholesterol (TC), international normalized ratio (INR), and blood morphology.All parameters were within normal range in all groups. Urine NGAL was higher in men aged ≥65 years than women (25.67 ± 53.65 vs 16.49 ± 34.66, P = .001); serum levels of TC and platelet (PLT) count were higher in women than men aged ≥65 years (221.0 ± 41.7 vs 188.4 ± 48.2 and 250.3 ± 47.8 vs 202.5 ± 57.9, P = .003 and P = .038, respectively). The INR was lower in women (0.97 ± .06 vs 1.19 ± 0.48, P = .03).These blood tests were normal in healthy people aged ≥65 years. Higher PLT and TC and lower INR in women might indicate a higher risk of cardiovascular diseases. These changes in blood tests were not attributed to aging itself.
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Affiliation(s)
| | | | - Leszek Paczek
- Department of Immunology, Transplantology, and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
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Zemedikun DT, Gray LJ, Khunti K, Davies MJ, Dhalwani NN. Patterns of Multimorbidity in Middle-Aged and Older Adults: An Analysis of the UK Biobank Data. Mayo Clin Proc 2018; 93:857-866. [PMID: 29801777 DOI: 10.1016/j.mayocp.2018.02.012] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 02/05/2018] [Accepted: 02/14/2018] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To assess the prevalence, disease clusters, and patterns of multimorbidity using a novel 2-stage approach in middle-aged and older adults from the United Kingdom. PATIENTS AND METHODS Data on 36 chronic conditions from 502,643 participants aged 40 to 69 years with baseline measurements between March 13, 2006, and October 1, 2010, from the UK Biobank were extracted. We combined cluster analysis and association rule mining to assess patterns of multimorbidity overall and by age, sex, and ethnicity. A maximum of 3 clusters and 30 disease patterns were mined. Comparisons were made using lift as the main measure of association. RESULTS Ninety-five thousand seven hundred-ten participants (19%) had 2 or more chronic conditions. The first cluster included only myocardial infarction and angina (lift=13.3), indicating that the likelihood of co-occurrence of these conditions is 13 times higher than in isolation. The second cluster consisted of 26 conditions, including cardiovascular, musculoskeletal, respiratory, and neurodegenerative diseases. The strongest association was found between heart failure and atrial fibrillation (lift=23.6). Diabetes was at the center of this cluster with strong associations with heart failure, chronic kidney disease, liver failure, and stroke (lift>2). The third cluster contained 8 highly prevalent conditions, including cancer, hypertension, asthma, and depression, and the strongest association was observed between anxiety and depression (lift=5.0). CONCLUSION Conditions such as diabetes, hypertension, and asthma are the epicenter of disease clusters for multimorbidity. A more integrative multidisciplinary approach focusing on better management and prevention of these conditions may help prevent other conditions in the clusters.
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Affiliation(s)
- Dawit T Zemedikun
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, UK; Department of Health Sciences, Centre for Medicine, University of Leicester, Leicester, UK
| | - Laura J Gray
- Department of Health Sciences, Centre for Medicine, University of Leicester, Leicester, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
| | - Melanie J Davies
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
| | - Nafeesa N Dhalwani
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK.
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114
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Olson JE, Takahashi PY, St Sauver JM. Understanding the Patterns of Multimorbidity. Mayo Clin Proc 2018; 93:824-825. [PMID: 29976373 DOI: 10.1016/j.mayocp.2018.05.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 05/22/2018] [Indexed: 11/21/2022]
Affiliation(s)
- Janet E Olson
- Department of Health Sciences Research, Division of Epidemiology, Mayo Clinic, Rochester, MN.
| | - Paul Y Takahashi
- Department of Medicine, Division of Community Internal Medicine, Mayo Clinic, Rochester, MN
| | - Jennifer M St Sauver
- Department of Health Sciences Research, Division of Epidemiology, Mayo Clinic, Rochester, MN
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115
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Avedisova AS, Zhabin MO, Akzhigitov RG, Gudkova AA. [The problem of multiple somatic and/or psychiatric pathology basic concepts and prevalence]. Zh Nevrol Psikhiatr Im S S Korsakova 2018; 118:5-13. [PMID: 29927396 DOI: 10.17116/jnevro2018118515] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The literature of the last decades shows the growing interest to multiple pathologies in medicine including psychiatry and neurology. Multiple pathology is often determined as multimorbidity or comorbidity. Multiple pathology is a common phenomenon, which is the rule rather than the exception. In the medical care system, it is burden for the patient and for the physician in clinical, organizational and economic aspects. The review addresses all these issues in the aspect of terminology and prevalence.
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Affiliation(s)
- A S Avedisova
- Serbsky National Medical Research Center for Psychiatry and Narcology, Moscow, Russia; Solov'ev Research and Clinical Center for Neuropsychiatry, Moscow, Russia
| | - M O Zhabin
- Serbsky National Medical Research Center for Psychiatry and Narcology, Moscow, Russia; Solov'ev Research and Clinical Center for Neuropsychiatry, Moscow, Russia
| | - R G Akzhigitov
- Solov'ev Research and Clinical Center for Neuropsychiatry, Moscow, Russia
| | - A A Gudkova
- Solov'ev Research and Clinical Center for Neuropsychiatry, Moscow, Russia
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116
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Kühlewindt T, Thienemann F. [Diseases as a 'Stumbling Block' - a Case of Multimorbidity in Clinical Practice]. PRAXIS 2018; 107:677-681. [PMID: 29921186 DOI: 10.1024/1661-8157/a003006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Diseases as a `Stumbling Block` - a Case of Multimorbidity in Clinical Practice Abstract. Here we report on a 83 year-old patient with cardiac syncope and consecutive traumatic brain injury with intracranial haemorrhage receiving anticoagulation for recurrent pulmonary embolism: a 'medical dilemma' due to the syncope with consecutive traumatic event and the underlying condition. A pre-existing underlying cardiac disease was identified as the cause of the syncope and the intracranial haemorrhage was most likely due to oral anticoagulation for recurrent pulmonary embolisms. The intracranial bleeding inhibited an optimal management of the underlying cardiac condition and the patient deceased shortly thereafter.
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Affiliation(s)
- Tobias Kühlewindt
- 1 Klinik und Poliklinik für Innere Medizin, Universitätsspital Zürich, Schweiz
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117
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Stanley J, Semper K, Millar E, Sarfati D. Epidemiology of multimorbidity in New Zealand: a cross-sectional study using national-level hospital and pharmaceutical data. BMJ Open 2018; 8:e021689. [PMID: 29794103 PMCID: PMC5988147 DOI: 10.1136/bmjopen-2018-021689] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES To describe the prevalence of multimorbidity (presence of two or more long-term health conditions) in the New Zealand (NZ) population, and compare risk of health outcomes by multimorbidity status. DESIGN Cross-sectional analysis for prevalence of multimorbidity, with 1-year prospective follow-up for health outcomes. SETTING NZ general population using national-level routine health data on hospital discharges and pharmaceutical dispensing. PARTICIPANTS All NZ adults (aged 18+, n=3 489 747) with an active National Health Index number at the index date (1 January 2014). OUTCOME MEASURES Prevalence of multimorbidity was calculated using two data sources: prior routine hospital discharge data (61 ICD-10 coded diagnoses from the M3 multimorbidity index); and recent pharmaceutical dispensing records (30 conditions from the P3 multimorbidity index). METHODS Prevalence of multimorbidity was calculated separately for the two data sources, stratified by age group, sex, ethnicity and socioeconomic deprivation, and age and sex standardised to the total population. One-year risk of poor health outcomes (mortality, ambulatory sensitive hospitalisation (ASH) and overnight hospital admission) was compared by multimorbidity status using logistic regression adjusted for confounders. RESULTS Prevalence of multimorbidity was 7.9% using past hospital discharge data, and 27.9% using past pharmaceutical dispensing data. Prevalence increased with age, with a clear socioeconomic gradient and differences in prevalence by ethnicity. Age and sex standardised risk of 1-year mortality was 2.7% for those with multimorbidity (defined on hospital discharge data), and 0.5% for those without multimorbidity (age and sex-adjusted OR 4.8, 95% CI 4.7 to 5.0). Risk of ASH was also increased for those with multimorbidity (eg, pharmaceutical discharge definition: age and sex-standardised risk 6.2%, compared with 1.8% for those without multimorbidity; age and sex-adjusted OR 3.6, 95% CI 3.5 to 3.6). CONCLUSIONS Multimorbidity is common in the NZ adult population, with disparities in who is affected. Providing for the needs of individuals with multimorbidity requires collaborative and coordinated work across the health sector.
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Affiliation(s)
- James Stanley
- C3 Research Group, Department of Public Health, University of Otago, Wellington, Wellington, New Zealand
| | - Kelly Semper
- C3 Research Group, Department of Public Health, University of Otago, Wellington, Wellington, New Zealand
| | - Elinor Millar
- C3 Research Group, Department of Public Health, University of Otago, Wellington, Wellington, New Zealand
| | - Diana Sarfati
- C3 Research Group, Department of Public Health, University of Otago, Wellington, Wellington, New Zealand
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118
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Forman DE, Maurer MS, Boyd C, Brindis R, Salive ME, Horne FM, Bell SP, Fulmer T, Reuben DB, Zieman S, Rich MW. Multimorbidity in Older Adults With Cardiovascular Disease. J Am Coll Cardiol 2018; 71:2149-2161. [PMID: 29747836 PMCID: PMC6028235 DOI: 10.1016/j.jacc.2018.03.022] [Citation(s) in RCA: 189] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 02/26/2018] [Accepted: 03/01/2018] [Indexed: 11/19/2022]
Abstract
Multimorbidity occurs in adults of all ages, but the number and complexity of comorbid conditions commonly increase with advancing age such that cardiovascular disease (CVD) in older adults typically occurs in a context of multimorbidity. Current clinical practice and research mainly target single disease-specific care that does not embrace the complexities imposed by concurrent conditions. In this paper, emerging concepts regarding CVD in combination with multimorbidity are reviewed, including recommendations for incorporating multimorbidity into clinical decision making, critical knowledge gaps, and research priorities to optimize care of complex older patients.
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Affiliation(s)
- Daniel E Forman
- Department of Medicine, Section of Geriatric Cardiology, Veterans Affairs Geriatric Research Education, and Clinical Center, University of Pittsburgh, Pittsburgh, Pennsylvania.
| | - Mathew S Maurer
- Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, New York
| | - Cynthia Boyd
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ralph Brindis
- Phillip R. Lee Institute for Health Policy Studies, University of California-San Francisco, San Francisco, California
| | - Marcel E Salive
- Division of Geriatrics and Clinical Gerontology, National Institute on Aging, Bethesda, Maryland
| | | | - Susan P Bell
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - David B Reuben
- Division of Geriatrics, David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, California
| | - Susan Zieman
- Division of Geriatrics and Clinical Gerontology, National Institute on Aging, Bethesda, Maryland
| | - Michael W Rich
- Division of Cardiology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
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119
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Medina-Inojosa JR, Somers VK, Thomas RJ, Jean N, Jenkins SM, Gomez-Ibarra MA, Supervia M, Lopez-Jimenez F. Association Between Adiposity and Lean Mass With Long-Term Cardiovascular Events in Patients With Coronary Artery Disease: No Paradox. J Am Heart Assoc 2018; 7:e007505. [PMID: 29739793 PMCID: PMC6015302 DOI: 10.1161/jaha.117.007505] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 03/20/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND Prognosis based on body fat percentage (BF%) in patients with coronary artery disease has not been extensively studied. We tested the hypothesis that patients with coronary artery disease and increased BF% have a higher risk for major adverse cardiovascular events (MACEs) and that fat-free mass is associated with better prognosis. METHODS AND RESULTS We included 717 patients referred to cardiac rehabilitation after coronary artery disease events or procedures who underwent air displacement plethysmography to assess BF%; 75% were men, with a mean age 61.4±11.4 years and a mean body mass index of 30±5.4 kg/m2. Follow-up was performed using a record linkage system. Patients were classified in sex-specific quartiles of BF% and fat-free mass index. The composite outcome of MACEs included acute coronary syndromes, coronary revascularization, stroke, or death from any cause. After a median follow-up of 3.9 years, 201 patients had a MACE. After adjusting for covariates, body mass index was not associated with MACEs (P=0.12). However, the risk of MACEs for those in the highest BF% quartile was nearly double when compared with those in the lowest quartile (hazard ratio, 1.89; 95% confidence interval, 1.30-2.77; P=0.0008). In contrast, fat-free mass was inversely associated with MACEs. The risk of MACEs for those in the fourth fat-free mass quartile was lower (adjusted hazard ratio, 0.53; 95% confidence interval, 0.35-0.82; P=0.004), when compared with those in the first quartile. CONCLUSIONS In patients with coronary artery disease, there is no obesity paradox when measuring BF% instead of body mass index. BF% is associated with a higher risk of MACEs, whereas fat-free mass is associated with a lower risk of MACEs. Body mass index was not associated with MACEs.
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Affiliation(s)
- Jose R Medina-Inojosa
- Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Virend K Somers
- Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Randal J Thomas
- Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Nathalie Jean
- Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Sarah M Jenkins
- Division of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Miguel Angel Gomez-Ibarra
- Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Marta Supervia
- Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Francisco Lopez-Jimenez
- Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
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120
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Whitney DG, Hurvitz EA, Ryan JM, Devlin MJ, Caird MS, French ZP, Ellenberg EC, Peterson MD. Noncommunicable disease and multimorbidity in young adults with cerebral palsy. Clin Epidemiol 2018; 10:511-519. [PMID: 29750055 PMCID: PMC5935087 DOI: 10.2147/clep.s159405] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose Individuals with cerebral palsy (CP) are at increased risk for frailty and chronic disease due to factors experienced throughout the lifespan, such as excessive sedentary behaviors and malnutrition. However, little is known about noncommunicable diseases (NCDs) and multimorbidity profiles in young adults with CP. The study objective was to compare NCD and multimorbidity profiles between young adults with and without CP. Methods A clinic-based sample of adults (18-30 years) with (n=452) and without (n=448) CP was examined at the University of Michigan Medical Center. The prevalence and predictors of 13 NCDs were evaluated, including existing diagnoses or historical record of musculoskeletal, cardiometabolic, and pulmonary morbidities. The level of motor impairment was determined by the Gross Motor Function Classification System (GMFCS) and stratified by less vs more severe motor impairment (GMFCS I-III vs IV-V). Logistic regression was used to determine the odds of NCD morbidity and multimorbidity in adults with CP compared to adults without CP, and for GMFCS IV-V compared to GMFCS I-III in those with CP, after adjusting for age, sex, body mass index, and smoking. Results Adults with CP had a higher prevalence of osteopenia, osteoporosis, hypertension, myocardial infarction, hyperlipidemia, asthma, and multimorbidity compared to adults without CP, and higher odds of musculoskeletal (odds ratio [OR]: 6.97) and cardiometabolic morbidity (OR: 1.98), and multimorbidity (OR: 2.67). Adults with CP with GMFCS levels IV-V had a higher prevalence of osteopenia/osteoporosis, osteoarthritis, hypertension, other cardiovascular conditions, pulmonary embolism, and multimorbidity, and higher odds of musculoskeletal (OR: 3.41), cardiometabolic (OR: 2.05), pulmonary morbidity (OR: 1.42), and multimorbidity (OR: 3.45) compared to GMFCS I-III. Conclusion Young adults with CP have a higher prevalence of chronic NCDs and multimorbidity compared to young adults without CP, which is pronounced in those with more severe motor impairment. These findings reiterate the importance of early screening for prevention of NCDs in CP.
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Affiliation(s)
- Daniel G Whitney
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Edward A Hurvitz
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Jennifer M Ryan
- Department of Epidemiology and Public Health Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland.,Department of Clinical Sciences, Brunel University London, Uxbridge, UK
| | - Maureen J Devlin
- Department of Anthropology, University of Michigan, Ann Arbor, MI, USA
| | - Michelle S Caird
- Department of Orthopedic Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Zachary P French
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Elie C Ellenberg
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Mark D Peterson
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
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Vella Azzopardi R, Beyer I, Vermeiren S, Petrovic M, Van Den Noortgate N, Bautmans I, Gorus E. Increasing use of cognitive measures in the operational definition of frailty-A systematic review. Ageing Res Rev 2018; 43:10-16. [PMID: 29408342 DOI: 10.1016/j.arr.2018.01.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 01/14/2018] [Accepted: 01/18/2018] [Indexed: 01/27/2023]
Abstract
Ageing is associated both with frailty and cognitive decline. The quest for a unifying approach has led to a new concept: cognitive frailty. This systematic review explores the contribution of cognitive assessment in frailty operationalization. PubMed, Web of Knowledge and PsycINFO were searched until December 2016 using the keywords aged; frail elderly; aged, 80 and over; frailty; diagnosis; risk assessment and classification, yielding 2863 hits. Seventy-nine articles were included, describing 94 frailty instruments. Two instruments were not sufficiently specified and excluded. 46% of the identified frailty instruments included cognition. Of these, 85% were published after 2010, with a significant difference for publication date (X2 = 8.45, p < .05), indicating increasing awareness of the contribution of cognitive deficits to functional decline. This review identified 7 methods of cognitive assessment: dementia as co-morbidity; objective cognitive-screening instruments; self-reported; specific signs and symptoms; delirium/clouding of consciousness; non-specific cognitive terms and mixed assessments. Although cognitive assessment has been increasingly integrated in recently published frailty instruments, this has been heterogeneously operationalized. Once the domains most strongly linked to functional decline will have been identified and operationalized, this will be the groundwork for the identification of reversible components, and for the development of preventive interventional strategies.
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122
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Dankel SJ, Loenneke JP, Loprinzi PD. The Impact of Overweight/Obesity Duration and Physical Activity on Medical Multimorbidity: Examining the WATCH Paradigm. Am J Health Promot 2018; 32:1747-1750. [DOI: 10.1177/0890117118768893] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: The “fat-but-fit” paradigm has been evaluated. However, the duration of overweight/obesity within the “fat-but-fit” paradigm (ie, assessing body mass at more than 1 time point) has not been extensively evaluated, which was this study’s purpose. Design: Cross-sectional. Setting: National Health and Nutrition Examination Survey 2003 to 2006. Participants: Ages 36 to 85; N = 3621. Measures: Physical activity assessed via accelerometry. Medical multimorbidity was assessed via physician diagnosis of 13 chronic diseases. Height and body mass were directly measured for current body mass index (BMI), and 10-year prior BMI was calculated using current height and self-reported weight 10 years prior. Six mutually exclusive groups were created: (1) active, normal weight now and 10 years ago; (2) inactive, normal weight now and 10 years ago; (3) active, overweight/obese now but not 10 years ago; (4) active, overweight/obese now and 10 years ago; (5) inactive, overweight/obese now but not 10 years ago; and (6) inactive, overweight/obese now and 10 years ago. Analysis: Logistic regression. Results: Compared to group 1, adjusted odds ratios (ORs) were as follows: group 2: OR = 2.0 ( P = .004), group 3: OR = 1.7 ( P = .004), group 4: OR = 2.5 ( P < .001), group 5: OR = 2.9 ( P < .001), and group 6: OR = 4.8 ( P < .001). Conclusions: All patterns of weight change/duration and activity level altered the odds of medical multimorbidity, suggesting that the duration of overweight/obesity should also be taken into consideration when assessing the “fat-but-fit” paradigm.
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Affiliation(s)
- Scott J. Dankel
- Department of Health, Exercise Science, and Recreation Management, Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, Oxford, MS, USA
| | - Jeremy P. Loenneke
- Department of Health, Exercise Science, and Recreation Management, Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, Oxford, MS, USA
| | - Paul D. Loprinzi
- Department of Health, Exercise Science, and Recreation Management, Center for Health Behavior Research, The University of Mississippi, Oxford, MS, USA
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Leonardi S, Bueno H, Ahrens I, Hassager C, Bonnefoy E, Lettino M. Optimised care of elderly patients with acute coronary syndrome. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2018; 7:287-295. [DOI: 10.1177/2048872618761621] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Sergio Leonardi
- Fondazione IRCCS Policlinico S. Matteo, Coronary Care Unit, Pavia, Italy
| | - Hector Bueno
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Spain
- Instituto de investigación i+12 and Cardiology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
- Facultad de Medicina, Universidad Complutense de Madrid, Spain
| | - Ingo Ahrens
- Department of Cardiology and Medical Intensive Care, Augustinerinnen Hospital, Germany
- Faculty of Medicine, University of Freiburg, Germany
| | - Christian Hassager
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Eric Bonnefoy
- Intensive Cardiac Care Unit, Hospices Civils de Lyon, France
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Grace SL, Medina-Inojosa JR, Thomas RJ, Krause H, Douglas KV, Palmer B, Lopez-Jimenez F. Antidepressant Use by Class: Association with Major Adverse Cardiac Events in Patients with Coronary Artery Disease. PSYCHOTHERAPY AND PSYCHOSOMATICS 2018; 87. [PMID: 29533962 PMCID: PMC6010164 DOI: 10.1159/000486794] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND To assess use of antidepressants by class in relation to cardiology practice recommendations, and the association of antidepressant use with the occurrence of major adverse cardiovascular events (MACE) including death. METHODS This is a historical cohort study of all patients who completed cardiac rehabilitation (CR) between 2002 and 2012 in a major CR center. Participants completed the Patient Health Questionnaire (PHQ-9) at the start and end of the program. A linkage system enabled ascertainment of antidepressant use and MACE through 2014. RESULTS There were 1,694 CR participants, 1,266 (74.7%) of whom completed the PHQ-9 after the program. Depressive symptoms decreased significantly from pre- (4.98 ± 5.20) to postprogram (3.57 ± 4.43) (p < 0.001). Overall, 433 (34.2%) participants were on antidepressants, most often selective serotonin reuptake inhibitors (SSRI; n = 299; 23.6%). The proportion of days covered was approximately 70% for all 4 major antidepressant classes; discontinuation rates ranged from 37.3% for tricyclics to 53.2% for serotonin-norepinephrine reuptake inhibitors (SNRI). Antidepressant use was significantly associated with lower depressive symptoms after CR (before, 7.33 ± 5.94 vs. after, 4.69 ± 4.87; p < 0.001). After a median follow-up of 4.7 years, 264 (20.9%) participants had a MACE. After propensity matching based on pre-CR depressive symptoms among other variables, participants taking tricyclics had significantly more MACE than those not taking tricyclics (HR = 2.46; 95% CI 1.37-4.42), as well as those taking atypicals versus not (HR = 1.59; 95% CI 1.05-2.41) and those on SSRI (HR = 1.45; 95% CI 1.07-1.97). There was no increased risk with use of SNRI (HR = 0.89; 95% CI 0.43-1.82). CONCLUSION The use of antidepressants was associated with lower depression, but the use of all antidepressants except SNRI was associated with more adverse events.
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Affiliation(s)
- Sherry L. Grace
- Cardiovascular Prevention and Rehabilitation Program, University Health Network, University of Toronto, 399 Bathurst Street, Toronto, Ontario, Canada, M5T 2S8,School of Kinesiology and Health Science, York University, 4700 Keele Street, Toronto, Ontario, Canada, M3J 1P3
| | - Jose R. Medina-Inojosa
- Department of Cardiovascular Medicine, Division of Preventive Cardiology, Mayo Clinic, 200 First Street SW, Rochester, Minnesota, 55905, United States
| | - Randal J. Thomas
- Department of Cardiovascular Medicine, Division of Preventive Cardiology, Mayo Clinic, 200 First Street SW, Rochester, Minnesota, 55905, United States
| | - Heather Krause
- Datassist, Centre for Social Innovation, 215 Spadina Avenue, Toronto, Ontario, Canada, M5T2C7
| | - Kristin Vickers Douglas
- Department of Psychology and Psychiatry, Mayo Clinic Mayo Clinic, 200 First Street SW, Rochester, Minnesota, 55905, United States
| | - Brian Palmer
- Department of Psychology and Psychiatry, Mayo Clinic Mayo Clinic, 200 First Street SW, Rochester, Minnesota, 55905, United States
| | - Francisco Lopez-Jimenez
- Department of Cardiovascular Medicine, Division of Preventive Cardiology, Mayo Clinic, 200 First Street SW, Rochester, Minnesota, 55905, United States
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Rocca WA, Gazzuola Rocca L, Smith CY, Grossardt BR, Faubion SS, Shuster LT, Stewart EA, Mielke MM, Kantarci K, Miller VM. Cohort profile: the Mayo Clinic Cohort Study of Oophorectomy and Aging-2 (MOA-2) in Olmsted County, Minnesota (USA). BMJ Open 2017; 7:e018861. [PMID: 29162577 PMCID: PMC5719295 DOI: 10.1136/bmjopen-2017-018861] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE This cohort study was established to investigate the effects of unilateral and bilateral oophorectomy on the ageing processes in women. PARTICIPANTS We used the records-linkage system of the Rochester Epidemiology Project (REP, http://www.rochesterproject.org) to identify 570 women who underwent unilateral oophorectomy and 1653 women who underwent bilateral oophorectomy in Olmsted County, Minnesota from 1988 through 2007 (20 years). Each woman was matched by age (±1 year) to a population-based referent woman who had not undergone any oophorectomy (570 referent women) or bilateral oophorectomy (1653 referent women). These four cohorts are being followed to assess morbidity and mortality and to study imaging and biological markers related to ageing. FINDINGS TO DATE An extensive medical record abstraction using the REP has been completed for each woman to obtain demographic, reproductive and adult life characteristics and extensive clinical information about the surgical procedure and subsequent oestrogen replacement therapy (or other sex steroid therapy). The cohorts have been used to date to study the accumulation of multiple chronic conditions following bilateral oophorectomy in women with or without chronic conditions at the time of the oophorectomy (or index date). From the cohorts, we have also derived a sample of 128 pairs of women for a case-control study linking adverse childhood or adult experiences to the risk of bilateral oophorectomy. FUTURE PLANS We hypothesise that the abrupt hormonal changes caused by bilateral oophorectomy in younger women have a major effect on the ageing processes across the full body. Therefore, we plan to investigate the risk of a wide range of chronic conditions following bilateral oophorectomy. Specific studies are underway for kidney diseases, psychiatric diseases and neurological diseases. In addition, we plan to invite a subsample of women from the bilateral oophorectomy cohort to participate in an in-person study involving brain imaging and the collection of biomarkers.
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Affiliation(s)
- Walter A Rocca
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Women's Health Research Center, Mayo Clinic, Rochester, Minnesota, USA
| | - Liliana Gazzuola Rocca
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Carin Y Smith
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Brandon R Grossardt
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Stephanie S Faubion
- Women's Health Research Center, Mayo Clinic, Rochester, Minnesota, USA
- Women's Health Clinic, Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Lynne T Shuster
- Women's Health Research Center, Mayo Clinic, Rochester, Minnesota, USA
- Women's Health Clinic, Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Elizabeth A Stewart
- Women's Health Research Center, Mayo Clinic, Rochester, Minnesota, USA
- Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA
| | - Michelle M Mielke
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Women's Health Research Center, Mayo Clinic, Rochester, Minnesota, USA
| | - Kejal Kantarci
- Women's Health Research Center, Mayo Clinic, Rochester, Minnesota, USA
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Virginia M Miller
- Women's Health Research Center, Mayo Clinic, Rochester, Minnesota, USA
- Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Abstract
Multimorbidity is the most significant condition affecting older adults, and it impacts every component of health care management and delivery. Multimorbidity significantly increases with age. For individuals with a diagnosis of cardiovascular disease, multimorbidity has a significant effect on the presentation of the disease and the diagnosis, management, and patient-centered preferences in care. Evidence-based therapeutics have focused on cardiovascular focused morbidity. Over the next 25 years, the proportion of adults aged 65 and older is estimated to increase three-fold. The needs of these patients require a fundamental shift in care from single disease practices to a more patient-centered framework.
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Affiliation(s)
- Susan P Bell
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medicine Center, Nashville, TN, USA; Division of Geriatric Medicine, Center for Quality Aging, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Avantika A Saraf
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medicine Center, Nashville, TN, USA; Division of Geriatric Medicine, Center for Quality Aging, Vanderbilt University Medical Center, Nashville, TN, USA
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127
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Vemuri P, Lesnick TG, Przybelski SA, Knopman DS, Lowe VJ, Graff-Radford J, Roberts RO, Mielke MM, Machulda MM, Petersen RC, Jack CR. Age, vascular health, and Alzheimer disease biomarkers in an elderly sample. Ann Neurol 2017; 82:706-718. [PMID: 29023983 DOI: 10.1002/ana.25071] [Citation(s) in RCA: 121] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 10/05/2017] [Accepted: 10/05/2017] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To investigate the associations between age, vascular health, and Alzheimer disease (AD) imaging biomarkers in an elderly sample. METHODS We identified 430 individuals along the cognitive continuum aged >60 years with amyloid positron emission tomography (PET), tau PET, and magnetic resonance imaging (MRI) scans from the population-based Mayo Clinic Study of Aging. A subset of 329 individuals had fluorodeoxyglucose (FDG) PET. We ascertained presently existing cardiovascular and metabolic conditions (CMC) from health care records and used the summation of presence/absence of hypertension, hyperlipidemia, cardiac arrhythmias, coronary artery disease, congestive heart failure, diabetes mellitus, and stroke as a surrogate for vascular health. We used global amyloid from Pittsburgh compound B PET, entorhinal cortex tau uptake (ERC-tau) from tau-PET, and neurodegeneration in AD signature regions from MRI and FDG-PET as surrogates for AD pathophysiology. We dichotomized participants into CMC = 0 (CMC- ) versus CMC > 0 (CMC+ ) and tested for age-adjusted group differences in AD biomarkers. Using structural equation models (SEMs), we assessed the impact of vascular health on AD biomarker cascade (amyloid leads to tau leads to neurodegeneration) after considering the direct and indirect age, sex, and apolipoprotein E effects. RESULTS CMC+ participants had significantly greater neurodegeneration than CMC- participants but did not differ by amyloid or ERC-tau. The SEMs showed that (1) vascular health had a significant direct and indirect impact on neurodegeneration but not on amyloid; and (2) vascular health, specifically the presence of hyperlipidemia, had a significant direct impact on ERC-tau. INTERPRETATION Vascular health had quantifiably greater impact on neurodegeneration in AD regions than on amyloid deposition. Longitudinal studies are warranted to clarify the relationship between tau deposition and vascular health. Ann Neurol 2017;82:706-718.
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Affiliation(s)
| | | | | | | | - Val J Lowe
- Department of Radiology, Mayo Clinic, Rochester, MN
| | | | | | - Michelle M Mielke
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN.,Department of Neurology, Mayo Clinic, Rochester, MN
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Davis J, Penha J, Mbowe O, Taira DA. Prevalence of Single and Multiple Leading Causes of Death by Race/Ethnicity Among US Adults Aged 60 to 79 Years. Prev Chronic Dis 2017; 14:E101. [PMID: 29049018 PMCID: PMC5652239 DOI: 10.5888/pcd14.160241] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Introduction Diabetes, cancer, cardiovascular disease (CVD) (coronary artery disease, heart attack, and angina pectoris), and chronic lung disease (emphysema, chronic bronchitis, and chronic obstructive pulmonary disease) are major causes of death in the United States. The objective of this study was to assess racial/ethnic differences in the prevalence of these conditions as cause of death among people aged 60 to 79 years with one or more of these conditions. Methods We used data on the prevalence of major chronic conditions from the National Health Interview Survey on 56,290 adults aged 60 to 79 years who reported having any of the chronic conditions assessed in the National Health Interview Survey for 2006 through 2014. We compared trends with age for 11 single and multiple conditions. Analyses employed multinomial logistic regression models. Results Hispanics and non-Hispanic blacks had the greatest prevalence of diabetes, and non-Hispanic whites had the greatest prevalence of cancer and chronic lung disease. The prevalence of multiple chronic diseases in an individual varied less by race/ethnicity. An exception was the prevalence of having both diabetes and CVD, which was higher among Hispanics and non-Hispanic blacks than non-Hispanic whites. Non-Hispanic blacks aged 65 years and 75 years had higher odds of having diabetes and cancer than non-Hispanic whites at the same ages. Hispanics had lower odds of having CVD with cancer or chronic lung disease than non-Hispanic whites. Women had a lower age-specific prevalence than men for most of the 11 single and multiple conditions. Most chronic diseases showed an inverse relationship with education and a higher prevalence in the South than in other regions. Conclusion Strong racial/ethnic differences exist in the prevalence of single chronic conditions, but differences are lower for prevalence of multiple conditions. Comparing races/ethnicities, the same disease dyads and triads may occur more often in different orders.
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Affiliation(s)
- James Davis
- Office of Biostatistics and Quantitative Health Sciences, John A. Burns School of Medicine, 651 Ilalo St, Biosciences Bldg, 211C, Honolulu, HI 96813.
| | - Janell Penha
- Department of Pharmacy Practice, Daniel K. Inouye College of Pharmacy at the University of Hawai'i at Hilo, Hilo, Hawai'i
| | - Omar Mbowe
- Office of Biostatistics and Quantitative Health Sciences, John A. Burns School of Medicine, Honolulu, Hawai'i
| | - Deborah A Taira
- Department of Pharmacy Practice, Daniel K. Inouye College of Pharmacy at the University of Hawai'i at Hilo, Hilo, Hawai'i
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Thavorn K, Maxwell CJ, Gruneir A, Bronskill SE, Bai Y, Koné Pefoyo AJ, Petrosyan Y, Wodchis WP. Effect of socio-demographic factors on the association between multimorbidity and healthcare costs: a population-based, retrospective cohort study. BMJ Open 2017; 7:e017264. [PMID: 28988178 PMCID: PMC5640069 DOI: 10.1136/bmjopen-2017-017264] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES To estimate the attributable costs of multimorbidity and assess whether the association between the level of multimorbidity and health system costs varies by socio-demographic factors in young (<65 years) and older (≥65 years) adults living in Ontario, Canada. DESIGN A population-based, retrospective cohort study SETTING: The province of Ontario, Canada PARTICIPANTS: 6 639 089 Ontarians who were diagnosed with at least one of 16 selected medical conditions on 1 April 2009. MAIN OUTCOME MEASURES From the perspective of the publicly funded healthcare system, total annual healthcare costs were derived from linked provincial health administrative databases using a person-level costing method. We used generalised linear models to examine the association between the level of multimorbidity and healthcare costs and the extent to which socio-demographic variables modified this association. RESULTS Attributable total costs of multimorbidity ranged from C$377 to C$2073 for young individuals and C$1026 to C$3831 for older adults. The association between the degree of multimorbidity and healthcare costs was significantly modified by age (p<0.001), sex (p<0.001) and neighbourhood income (p<0.001) in both age groups, and the positive association between healthcare costs and levels of multimorbidity was statistically stronger for older than younger adults. For individuals aged 65 years or younger, the increase in healthcare costs was more gradual in women than in their male counterparts, however, for those aged 65 years or older, the increase in healthcare costs was significantly greater among women than men. Lastly, we also observed that the positive association between the level of multimorbidity and healthcare costs was significantly greater at higher levels of marginalisation. CONCLUSION Socio-demographic factors are important effect modifiers of the relationship between multimorbidity and healthcare costs and should therefore be considered in any discussion of the implementation of healthcare policies and the organisation of healthcare services aimed at controlling healthcare costs associated with multimorbidity.
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Affiliation(s)
- Kednapa Thavorn
- Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Canada
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - Colleen J Maxwell
- Institute for Clinical Evaluative Sciences, Toronto, Canada
- Schools of Pharmacy, University of Waterloo, Ontario, Canada
| | - Andrea Gruneir
- Institute for Clinical Evaluative Sciences, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
- Department of Family Medicine, University of Alberta, Alberta, Canada
| | - Susan E Bronskill
- Institute for Clinical Evaluative Sciences, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - YuQing Bai
- Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - Anna J Koné Pefoyo
- Department of Health Sciences, Lakehead University, Thunder Bay, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Yelena Petrosyan
- Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Walter P Wodchis
- Institute for Clinical Evaluative Sciences, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Toronto Rehabilitation Institute, Toronto, Canada
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130
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Rocca WA, Gazzuola Rocca L, Smith CY, Grossardt BR, Faubion SS, Shuster LT, Kirkland JL, Stewart EA, Miller VM. Bilateral Oophorectomy and Accelerated Aging: Cause or Effect? J Gerontol A Biol Sci Med Sci 2017; 72:1213-1217. [PMID: 28329133 DOI: 10.1093/gerona/glx026] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 02/01/2017] [Indexed: 12/22/2022] Open
Abstract
Background The cause-effect relationship between bilateral oophorectomy and accelerated aging remains controversial. We conducted new analyses to further address this controversy. Methods The Rochester Epidemiology Project records-linkage system was used to identify all premenopausal women who underwent bilateral oophorectomy for a noncancerous condition before age 50 years between 1988 and 2007 in Olmsted County, MN. Each woman was randomly matched to a referent woman born in the same year (±1 year) who had not undergone bilateral oophorectomy. We studied the rate of accumulation of 18 common chronic conditions over a median of approximately 14 years of follow-up (historical cohort study). Analyses were restricted to women free of any of the 18 chronic conditions at the time of oophorectomy (or index date). Results After adjustments for race/ethnicity, education, body mass index, smoking, and age and calendar year at the index date, women who underwent oophorectomy before age 46 years experienced an accelerated rate of accumulation of the 18 chronic conditions considered together (hazard ratio = 1.24; 95% confidence interval: 1.12, 1.37; p < .001). The single-year incidence rate of new conditions was most different in the first 6 years after oophorectomy but the difference attenuated thereafter. Findings did not vary by surgical indication for the oophorectomy. Conclusions Bilateral oophorectomy is associated with a higher risk of multimorbidity among women who did not have any of the 18 selected conditions at baseline. The association did not vary by surgical indication for oophorectomy. Our findings suggest that bilateral oophorectomy is causally linked to accelerated aging.
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Affiliation(s)
- Walter A Rocca
- Division of Epidemiology, Department of Health Sciences Research.,Department of Neurology.,Women's Health Research Center
| | | | - Carin Y Smith
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research
| | - Brandon R Grossardt
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research
| | - Stephanie S Faubion
- Women's Health Research Center.,Women's Health Clinic, Division of General Internal Medicine
| | - Lynne T Shuster
- Women's Health Clinic, Division of General Internal Medicine
| | | | - Elizabeth A Stewart
- Women's Health Research Center.,Department of Surgery.,Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota
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Gawron LM, Redd A, Suo Y, Pettey W, Turok DK, Gundlapalli AV. Long-acting Reversible Contraception Among Homeless Women Veterans With Chronic Health Conditions: A Retrospective Cohort Study. Med Care 2017; 55 Suppl 9 Suppl 2:S111-S120. [PMID: 28806374 PMCID: PMC5654542 DOI: 10.1097/mlr.0000000000000765] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND US women Veterans are at increased risk of homelessness and chronic health conditions associated with unintended pregnancy. Veterans Health Administration (VHA) provision of long-acting reversible contraception (LARC) can assist in healthy pregnancy planning. OBJECTIVES To evaluate perinatal risk factors and LARC exposure in ever-homeless women Veterans. RESEARCH DESIGN A retrospective cohort study of women Veterans using VHA administrative data from fiscal years 2002-2015. SUBJECTS We included 41,747 ever-homeless women Veterans age 18-44 years and 46,391 housed women Veterans matched by military service period. A subgroup of 7773 ever-homeless and 8674 matched housed women Veterans deployed in Iraq and Afghanistan [Operations Enduring Freedom/Iraqi Freedom/New Dawn (OEF/OIF/OND)] conflicts comprised a second analytic cohort. MEASURES Descriptive statistics compared demographic, military, health conditions, and LARC exposure in ever-homeless versus housed women Veterans. Multivariable logistic regression explored factors associated with LARC exposure in the OEF/OIF/OND subgroup. RESULTS All health conditions were significantly higher in ever-homeless versus housed Veterans: mental health disorder in 84.5% versus 48.7% (P<0.001), substance abuse in 35.8% versus 8.6% (P<0.001), and medical conditions in 74.7% versus 55.6% (P<0.001). LARC exposure among all VHA users was 9.3% in ever-homeless Veterans versus 5.4% in housed Veterans (P<0.001). LARC exposure in the OEF/OIF/OND cohort was 14.1% in ever-homeless Veterans versus 8.2% in housed Veterans (P<0.001). In the OEF/OIF/OND cohort, homelessness along Veterans with medical and mental health indicators were leading LARC exposure predictors. CONCLUSIONS The VHA is successfully engaging homeless women Veterans and providing LARC access. The prevalence of perinatal risk factors in ever-homeless women Veterans highlights a need for further programmatic enhancements to improve reproductive planning.
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Affiliation(s)
- Lori M. Gawron
- Informatics, Decision Enhancement, and Analytic Sciences Center, VA Salt Lake City Health Care System, Salt Lake City, UT
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT
| | - Andrew Redd
- Informatics, Decision Enhancement, and Analytic Sciences Center, VA Salt Lake City Health Care System, Salt Lake City, UT
| | - Ying Suo
- Informatics, Decision Enhancement, and Analytic Sciences Center, VA Salt Lake City Health Care System, Salt Lake City, UT
| | - Warren Pettey
- Informatics, Decision Enhancement, and Analytic Sciences Center, VA Salt Lake City Health Care System, Salt Lake City, UT
| | - David K. Turok
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT
| | - Adi V. Gundlapalli
- Informatics, Decision Enhancement, and Analytic Sciences Center, VA Salt Lake City Health Care System, Salt Lake City, UT
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT
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132
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Wilson-Genderson M, Heid AR, Pruchno R. Onset of Multiple Chronic Conditions and Depressive Symptoms: A Life Events Perspective. Innov Aging 2017; 1:igx022. [PMID: 30480117 PMCID: PMC6177053 DOI: 10.1093/geroni/igx022] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND While the association between depressive symptoms and chronic illness has been the subject of many studies, little is known about whether depressive symptoms differ as a function of the illnesses people have as they transition to living with multiple chronic conditions. METHODS Self-reports of five diagnosed chronic conditions (arthritis, diabetes, heart disease, hypertension, and pulmonary disease) and depressive symptoms were provided by 3,396 people participating in three waves of the ORANJ BOWLSM research panel. Longitudinal multilevel modeling was used to examine the effects that transitioning to having a diagnosis of multiple chronic conditions has on depressive symptoms. RESULTS Between 2006 and 2014, controlling for age, gender, income, race, and a lifetime diagnosis of depression, people who transitioned to having a diagnosis of multiple chronic conditions had significantly higher levels of depressive symptoms than people who did not make this transition. The diagnosis of arthritis, diabetes, heart disease, and pulmonary disease, but not hypertension had independent effects, increasing depressive symptoms. CONCLUSIONS Having a diagnosis of multiple chronic conditions leads to increases in depressive symptoms, but not all illnesses have the same effect. Findings highlight the need for clinicians to be aware of mental health risks in patients diagnosed with multiple chronic conditions, particularly those with a diagnosis of arthritis, diabetes, heart disease, and pulmonary disease. Clinical care providers should take account of these findings, encouraging psychosocial supports for older adults who develop multiple chronic conditions to minimize the negative psychological impact of illness diagnosis.
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Affiliation(s)
| | - Allison R Heid
- New Jersey Institute for Successful Aging, Rowan University School of Osteopathic Medicine, Stratford
| | - Rachel Pruchno
- New Jersey Institute for Successful Aging, Rowan University School of Osteopathic Medicine, Stratford
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Feely A, Lix LM, Reimer K. Estimating multimorbidity prevalence with the Canadian Chronic Disease Surveillance System. Health Promot Chronic Dis Prev Can 2017; 37:215-222. [PMID: 28703703 PMCID: PMC5650032 DOI: 10.24095/hpcdp.37.7.02] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION The Public Health Agency of Canada's Canadian Chronic Disease Surveillance System (CCDSS) uses a validated, standardized methodology to estimate prevalence of individual chronic diseases, such as diabetes. Expansion of the CCDSS for surveillance of multimorbidity, the co-occurrence of two or more chronic diseases, could better inform health promotion and disease prevention. The objective of this study was to assess the feasibility of using the CCDSS to estimate multimorbidity prevalence. METHODS We used administrative health data from seven provinces and three territories and five validated chronic conditions (i.e. cardiovascular disease, respiratory disease, mental illness, hypertension and diabetes) to estimate multimorbidity prevalence. We produced age-standardized (using Canada's 1991 population) and age-specific estimates for two multimorbidity definitions: (1) two or more conditions, and (2) three or more conditions from the five validated conditions, by sex, fiscal year and geography. RESULTS Among Canadians aged 40 years and over in the fiscal year 2011/12, the prevalence of two or more and three or more chronic conditions was 26.5% and 10.2%, respectively, which is comparable to other estimates based on administrative health data. The increase in multimorbidity prevalence with increasing age was similar across provinces. The difference in prevalence for males and females varied by province and territory. We observed substantial variation in estimates over time. Results were consistent for the two definitions of multimorbidity. CONCLUSION The CCDSS methodology can produce comparative estimates of multimorbidity prevalence across provinces and territories, but there are challenges in using it to estimate temporal trends. Further expansion of the CCDSS in the number and breadth of validated case definitions will improve the accuracy of multimorbidity surveillance for the Canadian population.
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Affiliation(s)
- Allison Feely
- Department of Statistics, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Lisa M Lix
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kim Reimer
- British Columbia Ministry of Health, Victoria, British Columbia, Canada
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134
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Gandhi K, Lim E, Davis J, Chen JJ. Racial Disparities in Health Service Utilization Among Medicare Fee-for-Service Beneficiaries Adjusting for Multiple Chronic Conditions. J Aging Health 2017. [PMID: 28621152 DOI: 10.1177/0898264317714143] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To examine racial disparities in health services utilization in Hawaii among Medicare fee-for-service beneficiaries aged 65 years and above. METHOD All-cause utilization of inpatient, outpatient, emergency, home health agency, and skilled nursing facility admissions were investigated using 2012 Medicare data. For each type of service, multivariable logistic regression model was used to investigate racial disparities adjusting for sociodemographic factors and multiple chronic conditions. RESULTS Of the 84,212 beneficiaries, 27.8% were White, 27.4% were Asian, 27.3% were Pacific Islanders; 70.3% had two or more chronic conditions and 10.5% had six or more. Compared with Whites, all racial groups experienced underutilization across all types of services. As the number of chronic conditions increased, the utilization of inpatient, home health care, and skilled nursing facility dramatically increased. DISCUSSION Disparities persist among Asians and Pacific Islanders who encounter the problem of underutilization of various health services compared with Whites.
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Affiliation(s)
- Krupa Gandhi
- 1 Office of Biostatistics and Quantitative Health Sciences, University of Hawaii, Honolulu, USA
| | - Eunjung Lim
- 1 Office of Biostatistics and Quantitative Health Sciences, University of Hawaii, Honolulu, USA
| | - James Davis
- 1 Office of Biostatistics and Quantitative Health Sciences, University of Hawaii, Honolulu, USA
| | - John J Chen
- 1 Office of Biostatistics and Quantitative Health Sciences, University of Hawaii, Honolulu, USA
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135
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Cremer N, Hurvitz EA, Peterson MD. Multimorbidity in Middle-Aged Adults with Cerebral Palsy. Am J Med 2017; 130:744.e9-744.e15. [PMID: 28065772 PMCID: PMC5502778 DOI: 10.1016/j.amjmed.2016.11.044] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 11/22/2016] [Accepted: 11/30/2016] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Individuals with cerebral palsy have less lean body mass, greater relative adiposity, and lower fitness and physical activity participation, and yet the prevalence of age-related multimorbidity in this population has yet to be established. The study objective was to examine the prevalence of lifestyle-related chronic conditions and multimorbidity in a sample of middle-aged adults with cerebral palsy. METHODS A clinic-based sample of middle-aged adults with cerebral palsy was examined using Electronic Medical Records Search Engine software. Our cohort included 435 individuals aged 40 to 60 years, with an International Classification of Diseases, Clinical Modification, 9th and 10th Revisions Diagnosis Code for cerebral palsy. Prevalence of 12 chronic conditions was evaluated, including existing diagnoses or historical record of osteopenia/osteoporosis, myocardial infarction, stroke, coronary artery disease, impaired glucose tolerance/type 2 diabetes, other cardiovascular conditions, rheumatoid arthritis, osteoarthritis, asthma, emphysema, prehypertension/hypertension, and hyperlipidemia. Multivariate logistic models were used to estimate multimorbidity (ie, ≥2 chronic conditions), adjusting for age, sex, smoking status, obesity, and Gross Motor Function Classification System (GMFCS). RESULTS There were 137 unique multimorbidity combinations. Multimorbidity was significantly more prevalent among obese versus nonobese individuals for both GMFCS I-III (75.8% vs 53.6%) and GMFCS IV-V (79.0% vs 64.2%), but was also significantly higher in nonobese individuals with GMFCS IV-V (64.2%) compared with nonobese individuals with GMFCS I-III (53.6%). Both the obesity status (odds ratio, 2.20; 95% confidence interval, 1.32-2.79) and the GMFCS IV-V category (odds ratio, 1.81; 95% confidence interval, 1.32-3.68) were independently associated with multimorbidity. CONCLUSIONS Middle-aged adults with cerebral palsy have high estimates of multimorbidity; both obesity and higher GMFCS levels are independently associated with greater risk.
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Affiliation(s)
- Nicole Cremer
- University of Michigan, University of Michigan Medical School, Ann Arbor
| | - Edward A Hurvitz
- Department of Physical Medicine & Rehabilitation, University of Michigan, Ann Arbor
| | - Mark D Peterson
- Department of Physical Medicine & Rehabilitation, University of Michigan, Ann Arbor.
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Parker EA, Feinberg TM, Wappel S, Verceles AC. Considerations When Using Predictive Equations to Estimate Energy Needs Among Older, Hospitalized Patients: A Narrative Review. Curr Nutr Rep 2017; 6:102-110. [PMID: 28868211 DOI: 10.1007/s13668-017-0196-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The aim of this narrative review was to summarize the accuracy of predictive equations used to estimate energy expenditure in older, hospitalized adults. More than 50% of patients admitted to intensive care units are older adults. Currently accepted prediction equations used to determine energy intake in the older, hospitalized patient were not specifically developed for the aging population. Rates of multimorbidity, polypharmacy and malnutrition, conditions that influence energy expenditure, are higher in older adults compared to younger adults. For these reasons, current equations may not accurately assess energy needs in this population. As the evidence demonstrating the importance of nutritional supplementation in older, hospitalized adults grows, more accurate energy assessment methods that account for age-related conditions are needed to predict nutritional requirements.
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Affiliation(s)
- Elizabeth A Parker
- Department of Family & Community Medicine, Center for Integrative Medicine, University of Maryland School of Medicine, 520 W. Lombard Street, Baltimore, MD, USA, (410) 706-6189,
| | - Termeh M Feinberg
- Department of Family & Community Medicine, Center for Integrative Medicine, University of Maryland School of Medicine, 520 W. Lombard Street, Baltimore, MD, USA, (410) 706-6173,
| | - Stephanie Wappel
- University of Maryland Medical Center, Pulmonary & Critical Care Medicine, 110 South Paca Street, Baltimore, MD, USA,
| | - Avelino C Verceles
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Maryland School of Medicine, 110 South Paca Street, Baltimore, MD, USA, (410) 328-8141,
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137
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Wetterling T, Junghanns K. Substance Abuse in Older Psychiatric Inpatients. SUCHT-ZEITSCHRIFT FUR WISSENSCHAFT UND PRAXIS 2017. [DOI: 10.1024/0939-5911/a000476] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Abstract. Aim: This study investigates the characteristics of older patients with substance abuse disorders admitted to a psychiatric department serving about 250.000 inhabitants. Methods: The clinical diagnoses were made according to ICD-10. The data of the patients with substance abuse were compared to a matched sample of psychiatric inpatients without substance abuse as well as to a group of former substance abusers with long-term abstinence. Results: 19.3 % of the 941 patients aged > 65 years showed current substance abuse, 9.4 % consumed alcohol, 7.9 % took benzodiazepines or z-drugs (zolpidem and zopiclone), and 7.0 % smoked tobacco. Multiple substance abuse was rather common (30.8 %). About 85 % of the substance abusers had psychiatric comorbidity, and about 30 % showed severe withdrawal symptoms. As with the rest of the patients, somatic multimorbidity was present in about 70 % of the substance abusers. Remarkable was the lower rate of dementia in current substance abusers. Conclusion: These results underscore that substance abuse is still a challenge in the psychiatric inpatient treatment of older people.
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Affiliation(s)
- Tilman Wetterling
- Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Klinikum Kaulsdorf, Berlin, Germany
| | - Klaus Junghanns
- Department of Psychiatry and Psychotherapy, University of Lübeck, Germany
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138
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Jegan NRA, Brugger M, Viniol A, Strauch K, Barth J, Baum E, Leonhardt C, Becker A. Psychological risk and protective factors for disability in chronic low back pain - a longitudinal analysis in primary care. BMC Musculoskelet Disord 2017; 18:114. [PMID: 28320375 PMCID: PMC5360090 DOI: 10.1186/s12891-017-1482-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 03/08/2017] [Indexed: 12/21/2022] Open
Abstract
Background Utilizing psychological resources when dealing with chronic low back pain might aid the prevention of disability. The observational study at hand examined the longitudinal impact of resilience and coping resources on disability in addition to established risk factors. Methods Four hundred eighty four patients with chronic low back pain (>3 months) were recruited in primary care practices and followed up for one year. Resilience, coping, depression, somatization, pain and demographic variables were measured at baseline. At follow-up (participation rate 89%), data on disability was collected. We first calculated bivariate correlations of all the predictors with each other and with follow-up disability. We then used a multiple regression to evaluate the impact of all the predictors on disability together. Results More than half of the followed up sample showed a high degree of disability at baseline (53.7%) and had suffered for more than 10 years from pain (50.4%). Besides gender all of the predictors were bivariately associated with follow-up disability. However in the main analysis (multiple regression), disability at follow up was only predicted by baseline disability, age and somatization. There was no relationship between resilience and disability, nor between coping resources and disability. Conclusions Although it is known that there are cross-sectional relationships between resilience/coping resources and disability we were not able to replicate it in the multiple regression. This can have several reasons: a) the majority of patients in our sample were much more disabled and suffered for a longer time than in other studies. Therefore our results might be limited to this specific population and resilience and coping resources might still have a protective influence in acute or subacute populations. b) We used a rather broad operationalization of resilience. There is emerging evidence that focusing on more concrete sub facets like (pain) self-efficacy and acceptance might be more beneficial. Trial registration German Clinical Trial Register, DRKS00003123 (June 28th 2011). Electronic supplementary material The online version of this article (doi:10.1186/s12891-017-1482-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nikita Roman A Jegan
- Department of General Practice and Family Medicine, Philipps-University Marburg, Karl-von-Frisch-Str. 4, 35032, Marburg, Germany.
| | - Markus Brugger
- Institute of Medical Informatics, Biometry and Epidemiology, Chair of Genetic Epidemiology, Ludwig-Maximilians-Universität, Munich, Germany.,Institute of Genetic Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
| | - Annika Viniol
- Department of General Practice and Family Medicine, Philipps-University Marburg, Karl-von-Frisch-Str. 4, 35032, Marburg, Germany
| | - Konstantin Strauch
- Institute of Medical Informatics, Biometry and Epidemiology, Chair of Genetic Epidemiology, Ludwig-Maximilians-Universität, Munich, Germany.,Institute of Genetic Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
| | - Jürgen Barth
- Institute for Complementary and Integrative Medicine, University Hospital Zurich und University Zurich, Zurich, Switzerland
| | - Erika Baum
- Department of General Practice and Family Medicine, Philipps-University Marburg, Karl-von-Frisch-Str. 4, 35032, Marburg, Germany
| | - Corinna Leonhardt
- Department of General Practice and Family Medicine, Philipps-University Marburg, Karl-von-Frisch-Str. 4, 35032, Marburg, Germany
| | - Annette Becker
- Department of General Practice and Family Medicine, Philipps-University Marburg, Karl-von-Frisch-Str. 4, 35032, Marburg, Germany
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139
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Manemann SM, Chamberlain AM, Boyd CM, Weston SA, Killian J, Leibson CL, Cheville A, St Sauver J, Dunlay SM, Jiang R, Roger VL. Skilled Nursing Facility Use and Hospitalizations in Heart Failure: A Community Linkage Study. Mayo Clin Proc 2017; 92:S0025-6196(17)30087-3. [PMID: 28365097 PMCID: PMC5597448 DOI: 10.1016/j.mayocp.2017.01.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 01/24/2017] [Accepted: 01/26/2017] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To examine the effect of skilled nursing facility (SNF) use on hospitalizations in patients with heart failure (HF) and to examine predictors of hospitalization in patients with HF admitted to a SNF. PATIENTS AND METHODS Olmsted County, Minnesota, residents with first-ever HF from January 1, 2000, through December 31, 2010, were identified, and clinical data were linked to SNF utilization data from the Centers for Medicare and Medicaid Services. Andersen-Gill models were used to determine the association between SNF use and hospitalizations and to determine predictors of hospitalization. RESULTS Of 1498 patients with incident HF (mean ± SD age, 75±14 years; 45% male), 605 (40.4%) were admitted to a SNF after HF diagnosis (median follow-up, 3.6 years; range, 0-13.0 years). Of those with a SNF admission, 225 (37%) had 2 or more admissions. After adjustment for age, sex, ejection fraction, and comorbidities, SNF use was associated with a 50% increased risk of hospitalization compared with no SNF use (adjusted hazard ratio, 1.52; 95% CI, 1.31-1.76). In SNF users, arrhythmia, asthma, chronic kidney disease, and the number of activities of daily living requiring assistance were independently associated with an increased risk of hospitalization. CONCLUSION Approximately 40% of patients with HF were admitted to a SNF at some point after diagnosis. Compared with SNF nonusers, SNF users were more likely to be hospitalized. Characteristics associated with hospitalization in SNF users were mostly noncardiovascular, including reduced ability to perform activities of daily living. These findings underscore the effect of physical functioning on hospitalizations in patients with HF in SNFs and the importance of strategies to improve physical functioning.
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Affiliation(s)
| | | | - Cynthia M Boyd
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University, Baltimore, MD
| | - Susan A Weston
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Jill Killian
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | | | - Andrea Cheville
- Division of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN
| | | | - Shannon M Dunlay
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN; Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Ruoxiang Jiang
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Véronique L Roger
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN; Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN; Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN.
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140
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Holzer BM, Siebenhuener K, Bopp M, Minder CE. Evidence-based design recommendations for prevalence studies on multimorbidity: improving comparability of estimates. Popul Health Metr 2017; 15:9. [PMID: 28270157 PMCID: PMC5341353 DOI: 10.1186/s12963-017-0126-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 02/28/2017] [Indexed: 12/21/2022] Open
Abstract
Background In aging populations, multimorbidity causes a disease burden of growing importance and cost. However, estimates of the prevalence of multimorbidity (prevMM) vary widely across studies, impeding valid comparisons and interpretation of differences. With this study we pursued two research objectives: (1) to identify a set of study design and demographic factors related to prevMM, and (2) based on (1), to formulate design recommendations for future studies with improved comparability of prevalence estimates. Methods Study data were obtained through systematic review of the literature. UsingPubMed/MEDLINE, Embase, CINAHL, Web of Science, BIOSIS, and Google Scholar, we looked for articles with the terms “multimorbidity,” “comorbidity,” “polymorbidity,” and variations of these published in English or German in the years 1990 to 2011. We selected quantitative studies of the prevalence of multimorbidity (two or more chronic medical conditions) with a minimum sample size of 50 and a study population with a majority of Caucasians. Our database consisted of prevalence estimates in 108 age groups taken from 45 studies. To assess the effects of study design variables, we used meta regression models. Results In 58% of the studies, there was only one age group, i.e., no stratification by age. The number of persons per age group ranged from 136 to 5.6 million. Our analyses identified the following variables as highly significant: “mean age,” “number of age groups”, and “data reporting quality” (all p < 0.0001). “Setting,” “disease classification,” and “number of diseases in the classification” were significant (0.01 < p ≤ 0.03), and “data collection period” and “data source” were non-significant. A separate analysis showed that prevMM was significantly higher in women than men (sign test, p = 0.0015). Conclusions Comparable prevalence estimates are urgently needed for realistic description of the magnitude of the problem of multimorbidity. Based on the results of our analyses of variables affecting prevMM, we make some design recommendations. Our suggestions were guided by a pragmatic approach and aimed at facilitating the implementation of a uniform methodology. This should aid progress towards a more uniform operationalization of multimorbidity. Electronic supplementary material The online version of this article (doi:10.1186/s12963-017-0126-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Barbara M Holzer
- Department of Internal Medicine, University Hospital Zurich, Zurich, Switzerland. .,Center of Competence Multimorbidity, University of Zurich, Zurich, Switzerland. .,University Research Priority Program 'Dynamics of Healthy Aging', University of Zurich, Zurich, Switzerland.
| | - Klarissa Siebenhuener
- Department of Internal Medicine, University Hospital Zurich, Zurich, Switzerland.,Center of Competence Multimorbidity, University of Zurich, Zurich, Switzerland
| | - Matthias Bopp
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.,Center of Competence Multimorbidity, University of Zurich, Zurich, Switzerland
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141
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Lim E, Gandhi K, Davis J, Chen JJ. Prevalence of Chronic Conditions and Multimorbidities in a Geographically Defined Geriatric Population With Diverse Races and Ethnicities. J Aging Health 2016; 30:421-444. [PMID: 27913765 DOI: 10.1177/0898264316680903] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The objective of this study is to examine racial/ethnic differences in prevalence of chronic conditions and multimorbidities in the geriatric population of a state with diverse races/ethnicities. METHOD Fifteen chronic conditions and their dyads and triads were investigated using Hawaii Medicare 2012 data. For each condition, a multivariable logistic regression model was used to investigate differences in race/ethnicity, adjusting for subject characteristics. RESULTS Of the 84,212 beneficiaries, 27.8% were Whites, 54.6% Asians, and 5.2% Hispanics. Racial/ethnic disparities were prevalent for most conditions. Compared with Whites, Asians, Hispanics, and Others showed significantly higher prevalence rates in hypertension, hyperlipidemia, diabetes, and most dyads or triads of the chronic conditions. However, Whites had higher prevalence rates in arthritis and dementia. DISCUSSION Race/ethnicity may need to be considered when making clinical decisions and developing health care programs to reduce health disparities and improve quality of life for older individuals with chronic conditions.
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Affiliation(s)
- Eunjung Lim
- 1 Office of Biostatistics and Health Sciences, University of Hawaii, Honolulu, USA
| | - Krupa Gandhi
- 1 Office of Biostatistics and Health Sciences, University of Hawaii, Honolulu, USA
| | - James Davis
- 1 Office of Biostatistics and Health Sciences, University of Hawaii, Honolulu, USA
| | - John J Chen
- 1 Office of Biostatistics and Health Sciences, University of Hawaii, Honolulu, USA
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142
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Rocca WA, Gazzuola-Rocca L, Smith CY, Grossardt BR, Faubion SS, Shuster LT, Kirkland JL, Stewart EA, Miller VM. Accelerated Accumulation of Multimorbidity After Bilateral Oophorectomy: A Population-Based Cohort Study. Mayo Clin Proc 2016; 91:1577-1589. [PMID: 27693001 PMCID: PMC5097693 DOI: 10.1016/j.mayocp.2016.08.002] [Citation(s) in RCA: 147] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 08/04/2016] [Accepted: 08/08/2016] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To study the association between bilateral oophorectomy and the rate of accumulation of multimorbidity. PATIENTS AND METHODS In this historical cohort study, the Rochester Epidemiology Project records-linkage system was used to identify all premenopausal women who underwent bilateral oophorectomy before age 50 years between January 1, 1988, and December 31, 2007, in Olmsted County, Minnesota. Each woman was randomly matched to a referent woman born in the same year (±1 year) who had not undergone bilateral oophorectomy. We studied the rate of accumulation of 18 common chronic conditions over a median of approximately 14 years of follow-up. RESULTS Although women who underwent bilateral oophorectomy already had a higher multimorbidity burden at the time of oophorectomy, they also experienced an increased risk of subsequent multimorbidity. After adjustments for 18 chronic conditions present at baseline, race/ethnicity, education, body mass index, smoking, age at baseline, and calendar year at baseline, women who underwent oophorectomy before age 46 years experienced an increased risk of depression, hyperlipidemia, cardiac arrhythmias, coronary artery disease, arthritis, asthma, chronic obstructive pulmonary disease, and osteoporosis. In addition, they experienced an accelerated rate of accumulation of the 18 chronic conditions considered together (hazard ratio, 1.22; 95% CI, 1.14-1.31; P<.001). Several of these associations were reduced in women who received estrogen therapy. CONCLUSION Bilateral oophorectomy is associated with a higher risk of multimorbidity, even after adjustment for conditions present at baseline and for several possible confounders. However, several of these associations were reduced in women who received estrogen therapy.
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Affiliation(s)
- Walter A Rocca
- Division of Epidemiology, Mayo Clinic, Rochester, MN; Department of Health Sciences Research, Mayo Clinic, Rochester, MN; Department of Neurology, Mayo Clinic, Rochester, MN; Women's Health Research Center, Mayo Clinic, Rochester, MN.
| | | | - Carin Y Smith
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Brandon R Grossardt
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Stephanie S Faubion
- Women's Health Research Center, Mayo Clinic, Rochester, MN; Women's Health Clinic, Division of General Internal Medicine, Mayo Clinic, Rochester, MN
| | - Lynne T Shuster
- Women's Health Clinic, Division of General Internal Medicine, Mayo Clinic, Rochester, MN
| | - James L Kirkland
- Robert and Arlene Kogod Center on Aging, Mayo Clinic, Rochester, MN
| | - Elizabeth A Stewart
- Women's Health Research Center, Mayo Clinic, Rochester, MN; Department of Surgery, Mayo Clinic, Rochester, MN; Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN
| | - Virginia M Miller
- Women's Health Research Center, Mayo Clinic, Rochester, MN; Department of Surgery, Mayo Clinic, Rochester, MN
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143
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Cromley EK, Wilson-Genderson M, Heid AR, Pruchno RA. Spatial Associations of Multiple Chronic Conditions Among Older Adults. J Appl Gerontol 2016; 37:1411-1435. [PMID: 27697796 DOI: 10.1177/0733464816672044] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Multimorbidity, the presence of two or more chronic conditions in an individual, presents a major challenge for meeting the health care needs of older adults. This study advances understanding of multiple chronic conditions by using local colocation quotients to reveal spatial associations for five chronic conditions (arthritis, diabetes, heart disease, hypertension, and pulmonary disease) in a statewide panel of older adults in New Jersey. Among adults with three or more conditions, large concentrations of Arthritis-Heart Disease-Pulmonary Disease, Arthritis-Hypertension-Pulmonary Disease, and Diabetes-Heart Disease-Hypertension were observed, each triad located in different regions of the state. Individuals with other triads of conditions, in contrast, were distributed among all older adults in the sample as expected with no areas of local concentration. The study provides gerontologists with a new and effective method for uncovering geographical patterns in combinations of chronic conditions among the populations they serve, thereby enabling more effective interventions.
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144
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Cardiovascular risk factors and diseases in women undergoing hysterectomy with ovarian conservation. Menopause 2016; 23:121-8. [PMID: 26173076 DOI: 10.1097/gme.0000000000000506] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study aims to determine the association of preexisting cardiovascular risk factors and cardiovascular diseases with hysterectomy with bilateral ovarian conservation using a case-central design. METHODS Using the Rochester Epidemiology Project records-linkage system, we identified all Olmsted County, MN women who underwent hysterectomy with ovarian conservation between January 1, 1965 and December 31, 2002 (cases). Each case was age-matched (± 1 y) with a randomly selected woman who resided in the county and did not undergo hysterectomy or oophorectomy before the index date (date of hysterectomy in her matched case). Using electronic codes, we identified cardiovascular risk factors (diabetes, hypertension, hyperlipidemia, obesity, metabolic syndrome, and polycystic ovary syndrome) and cardiovascular diseases (coronary artery disease, congestive heart failure, myocardial infarction, and stroke) that occurred before the index date. Analyses were stratified by age at hysterectomy and indication for surgical operation. RESULTS During the study period, 3,816 women underwent hysterectomy with ovarian conservation for a benign indication. Preexisting hyperlipidemia, obesity, and metabolic syndrome were significantly more frequent in cases than in controls in univariable analyses. In multivariable analyses, obesity remained significantly associated overall, for nearly all age groups, and across all indications. Stroke was significantly more frequent in cases than in controls among women younger than 36 years. Congestive heart failure and stroke were significantly less common in cases than in controls among women older than 50 years. CONCLUSIONS Hysterectomy with ovarian conservation is associated with cardiovascular risk factors, particularly obesity. Obesity may contribute to underlying gynecologic conditions leading to hysterectomy; however, surgical selection may also play a role.
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145
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Violán C, Foguet-Boreu Q, Roso-Llorach A, Rodriguez-Blanco T, Pons-Vigués M, Pujol-Ribera E, Valderas JM. [Multimorbidity patterns in young adults in Catalonia: an analysis of clusters]. Aten Primaria 2016; 48:479-92. [PMID: 26706180 PMCID: PMC6877846 DOI: 10.1016/j.aprim.2015.10.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 10/01/2015] [Accepted: 10/17/2015] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The aim of this study was to identify multimorbidity patterns in patients from 19 to 44 years attended in primary care in Catalonia in 2010. DESIGN Cross-sectional study. SETTING 251 primary care centres. PARTICIPANTS 530,798 people with multimorbidity, aged 19 to 44 years. MAIN OUTCOME MEASURES Multimorbidity was defined as the coexistence of ≥2 more International Classification system (ICD-10) registered in the electronic health record. Multimorbidity patterns were identified using hierarchical cluster analysis and by sex and age group (19-24 and 25-44). RESULTS Of the 882,708 people from initial population, 530,798 (60.1%) accomplished multimorbidity criterion. Mean age was 33.0 years (SD: 7.0) and 53.3% were women. Multimorbidity was higher in the 25-to 44-years-old group with respect the younger group (60.5 vs. 58.1%, p<0.001), being higher in women. Most prevalent cluster in all groups included, among others, by dental caries, smoking, dorsalgia, common cold and other anxiety disorders. For both sexes in the 25-to 44-years-old group appeared the cardiovascular-endocrine-metabolic pattern (obesity, lipid disorders and arterial hypertension). CONCLUSIONS Multimorbidity affects more than half of persons between 19 to 44-years-old. The most prevalent cluster is formed by grouping common diseases (dental caries, common cold, smoking, anxiety disorders and dorsalgias). Another pattern to highlight is the cardiovascular-endocrine-metabolic pattern in the 25- to 44 years-old group. Knowledge of patterns of multimorbidity in young adults could be used to design individualized preventive strategies.
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Affiliation(s)
- Concepción Violán
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, España; Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, España; Institut Català de la Salut, Cataluña, España.
| | - Quintí Foguet-Boreu
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, España; Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, España; Hospital de Campdevànol, Campdevànol, España
| | - Albert Roso-Llorach
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, España; Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, España
| | - Teresa Rodriguez-Blanco
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, España; Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, España
| | - Mariona Pons-Vigués
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, España; Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, España
| | - Enriqueta Pujol-Ribera
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, España; Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, España; Institut Català de la Salut, Cataluña, España
| | - Jose M Valderas
- Health Services & Policy Research Group, School of Medicine, University of Exeter, Exeter, EX1 2LU, Gran Bretaña
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146
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Psychological Symptom Amplification: Are Psychological Symptoms Subject to "Somatization"-Like Processes? Harv Rev Psychiatry 2016; 24:302-7. [PMID: 27384399 DOI: 10.1097/hrp.0000000000000104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Many patients demonstrate amplified somatic symptom experiences that are felt by providers to cause excessive distress and functional impairment, and that can be diagnostically misleading. Terms attached to these presentations include somatization, medically unexplained symptoms, and, most recently, somatic symptom disorder. The analogous amplification of psychological symptoms has not been considered. Accordingly, this column makes a case for discussion and investigation of psychological symptom amplification (PSA), a process made possible by the medical legitimization of certain types of human suffering. As various forms of psychological suffering gain greater medical legitimacy, PSA becomes increasingly relevant. Circumstantial evidence suggests that unrecognized PSA may distort research findings and clinical efficacy in psychiatry. The largely symptom-based nature of psychiatric diagnosis makes PSA a challenging, but necessary, object of further scientific and clinical scrutiny.
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147
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Chamberlain AM, Finney Rutten LJ, Manemann SM, Yawn BP, Jacobson DJ, Fan C, Grossardt BR, Roger VL, St Sauver JL. Frailty Trajectories in an Elderly Population-Based Cohort. J Am Geriatr Soc 2016; 64:285-92. [PMID: 26889838 DOI: 10.1111/jgs.13944] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To identify distinct frailty trajectories (clusters of individuals following a similar progression of frailty over time) in an aging population and to estimate associations between frailty trajectories and emergency department visits, hospitalizations, and all-cause mortality. DESIGN Population-based cohort study. SETTING Olmsted County, Minnesota. PARTICIPANTS Olmsted County, Minnesota residents aged 60-89 in 2005. MEASUREMENTS Longitudinal changes in frailty between 2005 and 2012 were measured by constructing a yearly Rockwood frailty index incorporating body mass index, 17 comorbidities, and 14 activities of daily living. The frailty index measures variation in health status as the proportion of deficits present of the 32 considered (range 0-1). RESULTS Of the 16,443 Olmsted County residents aged 60-89 in 2005, 12,270 (74.6%) had at least 3 years of frailty index measures and were retained for analysis. The median baseline frailty index increased with age (0.11 for 60-69, 0.14 for 70-79, 0.19 for 80-89). Three distinct frailty trajectories were identified in individuals aged 60-69 at baseline and two trajectories in those aged 70-79 and 80-89. Within each decade of age, increasing frailty trajectories were associated with greater risks of emergency department visits, hospitalization, and all-cause mortality, even after adjustment for baseline frailty index. CONCLUSION The number of frailty trajectories differed according to age. Within each age group, those in the highest frailty trajectory had greater healthcare use and worse survival. Frailty trajectories may offer a way to target aging individuals at high risk of hospitalization or death for therapeutic or preventive interventions.
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Affiliation(s)
| | - Lila J Finney Rutten
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota.,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Sheila M Manemann
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Barbara P Yawn
- Department of Research, Olmsted Medical Center, Rochester, Minnesota
| | - Debra J Jacobson
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota.,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Chun Fan
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | | | - Véronique L Roger
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota.,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota.,Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Jennifer L St Sauver
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota.,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
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148
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Manemann SM, Chamberlain AM, Boyd CM, Gerber Y, Dunlay SM, Weston SA, Jiang R, Roger VL. Multimorbidity in Heart Failure: Effect on Outcomes. J Am Geriatr Soc 2016; 64:1469-74. [PMID: 27348135 DOI: 10.1111/jgs.14206] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To investigate the effect of the number and type of comorbid conditions on death and hospitalizations in individuals with incident heart failure (HF). DESIGN Population-based cohort study. SETTING Olmsted County, Minnesota. PARTICIPANTS Olmsted County, Minnesota, residents with incident HF from 2000 to 2010 (mean age 76 ± 14, 56% female) (N = 1,714). MEASUREMENTS The prevalence of 16 chronic conditions obtained at HF diagnosis classified into three groups: cardiovascular (CV) related, other physical, and mental. RESULTS The mean number of conditions per participant was 2.6 ± 1.5 for CV-related conditions, 1.3 ± 1.1 for other physical conditions, and 0.30 ± 0.61 for mental conditions. After a mean follow-up of 4.2 years, 1,073 deaths and 6,306 hospitalizations had occurred. After adjustment for age, sex, ejection fraction, in- or outpatient status, and number of other conditions, an increase of one other physical condition was associated with a 14% (HR = 1.14, 95% CI = 1.08-1.20) greater risk of death and a 26% (HR = 1.26, 95% CI = 1.20-1.32) greater risk of hospitalization, and an increase of one mental condition was associated with a 31% (HR = 1.31, 95% CI = 1.19-1.44) greater risk of death and an 18% (HR = 1.18, 95% CI = 1.07-1.29) greater risk of hospitalization. In contrast, an increase of one CV-related condition was not associated with greater risk of death and was associated with a 10% (HR = 1.10, 95% CI = 1.06-1.15) greater risk of hospitalization. CONCLUSION CV-related conditions are the most common type of comorbid conditions in individuals with HF, but other physical and mental conditions are more strongly associated with death and hospitalizations. This underscores the effect of non-CV conditions on outcomes in HF.
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Affiliation(s)
- Sheila M Manemann
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | | | - Cynthia M Boyd
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University, Baltimore, Maryland
| | - Yariv Gerber
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota.,Department of Epidemiology and Preventive Medicine, School of Public Health, Tel Aviv University, Tel Aviv, Israel
| | - Shannon M Dunlay
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota.,Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Susan A Weston
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Ruoxiang Jiang
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Véronique L Roger
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota.,Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
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149
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Chamberlain AM, St. Sauver JL, Jacobson DJ, Manemann SM, Fan C, Roger VL, Yawn BP, Finney Rutten LJ. Social and behavioural factors associated with frailty trajectories in a population-based cohort of older adults. BMJ Open 2016; 6:e011410. [PMID: 27235302 PMCID: PMC4885446 DOI: 10.1136/bmjopen-2016-011410] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE The goal of this study was to identify distinct frailty trajectories (clusters of individuals following a similar progression of frailty over time) in an ageing population and to determine social and behavioural factors associated with frailty trajectories. DESIGN Population-based cohort study. SETTING Olmsted County, Minnesota. PARTICIPANTS Olmsted County, Minnesota residents aged 60-89 in 2005. PRIMARY OUTCOME MEASURE Changes in frailty over an 8-year period from 2005 to 2012, measured by constructing a yearly frailty index. Frailty trajectories by decade of age were determined using k-means cluster modelling for longitudinal data. RESULTS After adjustment for age and sex, all social and behavioural factors (education, marital status, living arrangements, smoking status and alcohol use) were significantly associated with frailty trajectories in those aged 60-69 and 70-79 years. After further adjustment for baseline frailty, the likelihood of being in the high frailty trajectory was greatest among those reporting concerns from relatives/friends about alcohol consumption (OR (95% CI) 2.26 (1.19 to 4.29)) and those with less than a high school education (OR (95% CI) 1.98 (1.32 to 2.96)) in the 60-69 year olds. In the 70-79 year olds, the largest associations were observed among those with concerns from oneself about alcohol consumption (OR (95% CI) 1.92 (1.23 to 3.00)), those with less than a high school education (OR (95% CI) 1.57 (1.12 to 2.22)), and those living with family (vs spouse; OR (95% CI) 1.76 (1.05 to 2.94)). No factors remained associated with frailty trajectories in the 80-89 year olds after adjustment for baseline frailty. CONCLUSIONS Social and behavioural factors are associated with frailty, with stronger associations observed in younger ages. Recognition of social and behavioural factors associated with increasing frailty may inform interventions for individuals at risk of worsening frailty, specifically when targeted at younger individuals.
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Affiliation(s)
- Alanna M Chamberlain
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jennifer L St. Sauver
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | - Debra J Jacobson
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | - Sheila M Manemann
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Chun Fan
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Véronique L Roger
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Barbara P Yawn
- Department of Research, Olmsted Medical Center, Rochester, Minnesota, USA
| | - Lila J Finney Rutten
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
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150
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Bartley MM, Geda YE, Christianson TJH, Pankratz VS, Roberts RO, Petersen RC. Frailty and Mortality Outcomes in Cognitively Normal Older People: Sex Differences in a Population-Based Study. J Am Geriatr Soc 2016; 64:132-7. [PMID: 26782862 DOI: 10.1111/jgs.13821] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To characterize frailty in cognitively normal older adults at baseline and to investigate the relationship between frailty and mortality. DESIGN Population-based prospective cohort study: Mayo Clinic Study of Aging. SETTING Olmsted County, Minnesota. PARTICIPANTS Cognitively normal older persons aged 70 and older (mean age 78.8±5.2, 50.2% male; N=2,356). MEASUREMENTS Frailty was assessed at baseline using a 36-item Frailty Index. Four frailty subgroups were identified based on the Frailty Index (≤0.10 (fit), 0.11-0.20 (at risk), 0.21-0.30 (frail), >0.30 (frailest)). All participants underwent comprehensive clinical and cognitive assessments. The association between frailty and mortality was assessed using Cox proportional hazards models. RESULTS The median Frailty Index was 0.17 (interquartile range 0.11-0.22). Frailty increased with age and was more common in older men than in older women. Over a median follow-up of 6.5 years (range 7 days to 8.9 years), 500 of the 2,356 participants died, including 292 men. The frailest participants had the greatest risk of death (hazard ratio (HR)=3.91, 95% confidence interval (CI)=2.69-5.68). The association was stronger in women (HR=5.26, 95% CI=2.88-9.61) than men (HR=3.15, 95% CI=1.98-5.02). CONCLUSION Baseline frailty was common, especially in older men, and increased with age. Frailty was associated with significantly greater risk of death, particularly in women. These sex differences should be considered when designing a geriatric care plan.
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Affiliation(s)
| | - Yonas E Geda
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota.,Department of Psychiatry and Psychology, Mayo Clinic, Scottsdale, Arizona.,Department of Neurology, Mayo Clinic, Scottsdale, Arizona
| | - Teresa J H Christianson
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - V Shane Pankratz
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Rosebud O Roberts
- Department of Neurology, Mayo Clinic, Rochester, Minnesota.,Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Ronald C Petersen
- Department of Neurology, Mayo Clinic, Rochester, Minnesota.,Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
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