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Rosen CB, Roberts SE, Wirtalla CJ, Keele LJ, Kaufman EJ, Halpern SD, Reilly PM, Neuman MD, Kelz RR. The Conditional Effects of Multimorbidity on Operative Versus Nonoperative Management of Emergency General Surgery Conditions: A Retrospective Observational Study Using an Instrumental Variable Analysis. Ann Surg 2023; 278:e855-e862. [PMID: 37212397 PMCID: PMC10524950 DOI: 10.1097/sla.0000000000005901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
OBJECTIVE To understand how multimorbidity impacts operative versus nonoperative management of emergency general surgery (EGS) conditions. BACKGROUND EGS is a heterogenous field, encompassing operative and nonoperative treatment options. Decision-making is particularly complex for older patients with multimorbidity. METHODS Using an instrumental variable approach with near-far matching, this national, retrospective observational cohort study of Medicare beneficiaries examines the conditional effects of multimorbidity, defined using qualifying comorbidity sets, on operative versus nonoperative management of EGS conditions. RESULTS Of 507,667 patients with EGS conditions, 155,493 (30.6%) received an operation. Overall, 278,836 (54.9%) were multimorbid. After adjustment, multimorbidity significantly increased the risk of in-hospital mortality associated with operative management for general abdominal patients (+9.8%; P = 0.002) and upper gastrointestinal patients (+19.9%, P < 0.001) and the risk of 30-day mortality (+27.7%, P < 0.001) and nonroutine discharge (+21.8%, P = 0.007) associated with operative management for upper gastrointestinal patients. Regardless of multimorbidity status, operative management was associated with a higher risk of in-hospital mortality among colorectal patients (multimorbid: + 12%, P < 0.001; nonmultimorbid: +4%, P = 0.003), higher risk of nonroutine discharge among colorectal (multimorbid: +42.3%, P < 0.001; nonmultimorbid: +55.1%, P < 0.001) and intestinal obstruction patients (multimorbid: +14.6%, P = 0.001; nonmultimorbid: +14.8%, P = 0.001), and lower risk of nonroutine discharge (multimorbid: -11.5%, P < 0.001; nonmultimorbid: -11.9%, P < 0.001) and 30-day readmissions (multimorbid: -8.2%, P = 0.002; nonmultimorbid: -9.7%, P < 0.001) among hepatobiliary patients. CONCLUSIONS The effects of multimorbidity on operative versus nonoperative management varied by EGS condition category. Physicians and patients should have honest conversations about the expected risks and benefits of treatment options, and future investigations should aim to understand the optimal management of multimorbid EGS patients.
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Affiliation(s)
- Claire B Rosen
- Department of Surgery, Hospital of the University of Pennsylvania
| | | | - Chris J Wirtalla
- Department of Medicine, Hospital of the University of Pennsylvania
| | - Luke J Keele
- Department of Surgery, Hospital of the University of Pennsylvania
| | | | - Scott D Halpern
- Department of Anesthesiology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Patrick M Reilly
- Department of Surgery, Hospital of the University of Pennsylvania
| | - Mark D Neuman
- Department of Anesthesiology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Rachel R Kelz
- Department of Surgery, Hospital of the University of Pennsylvania
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Thanakiattiwibun C, Siriussawakul A, Virotjarumart T, Maneeon S, Tantai N, Srinonprasert V, Chaiwat O, Sriswasdi P. Multimorbidity, healthcare utilization, and quality of life for older patients undergoing surgery: A prospective study. Medicine (Baltimore) 2023; 102:e33389. [PMID: 37000055 PMCID: PMC10063272 DOI: 10.1097/md.0000000000033389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 02/22/2023] [Accepted: 03/08/2023] [Indexed: 04/01/2023] Open
Abstract
Multimorbidity (≥2 chronic illnesses) is a worldwide healthcare challenge. Patients with multimorbidity have a reduced quality of life and higher mortality than healthy patients and use healthcare resources more intensively. This study investigated the prevalence of multimorbidity; examined the effects of multimorbidity on healthcare utilization; healthcare costs of multimorbidity; and compared the associations between the health-related quality of life (HRQoL) of older patients undergoing surgery and multimorbidity, the Charlson Comorbidity Index (CCI), the Simple Frailty Questionnaire (FRAIL), and the American Society of Anesthesiologists (ASA) physical status classifications. This prospective cohort study enrolled 360 patients aged > 65 years scheduled for surgery at a university hospital. Data were collected on their demographics, preoperative medical profiles, healthcare costs, and healthcare utilization (the quantification or description of the use of services, such as the number of preoperative visits, multiple-department consultations, surgery waiting time, and hospital length of stay). Preoperative-assessment data were collected via the CCI, FRAIL questionnaire, and ASA classification. HRQoL was derived using the EQ-5D-5L questionnaire. The 360 patients had a mean age of 73.9 ± 6.6 years, and 37.8% were men. Multimorbidity was found in 285 (79%) patients. The presence of multimorbidity had a significant effect on healthcare utilization (≥2 preoperative visits and consultations with ≥2 departments). However, there was no significant difference in healthcare costs between patients with and without multimorbidity. At the 3-month postoperative, patients without multimorbidity had significantly higher scores for HRQoL compared to those with multimorbidity (HRQoL = 1.00 vs 0.96; P < .007). While, patients with ASA Class > 2 had a significantly lower median HRQoL than patients with ASA Class ≤2 at postoperative day 5 (HRQoL = 0.76; P = .018), 1-month (HRQoL = 0.90; P = .001), and 3-months (HRQoL = 0.96; P < .001) postoperatively. Multimorbidity was associated with a significant increase in the healthcare utilization of the number of preoperative visits and a greater need for multiple-department consultations. In addition, multimorbidity resulted in a reduced HRQoL during hospital admission and 3-months postoperatively. In particular, the ASA classification > 2 apparently reduced postoperative HRQoL at day 5, 1-month, and 3-months lower than the ASA classification ≤2.
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Affiliation(s)
- Chayanan Thanakiattiwibun
- Integrated Perioperative Geriatric Excellent Research Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Arunotai Siriussawakul
- Integrated Perioperative Geriatric Excellent Research Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Satanun Maneeon
- Department of Pharmacy, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Siriraj Health Policy Unit, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Narisa Tantai
- Department of Pharmacy, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Siriraj Health Policy Unit, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Varalak Srinonprasert
- Integrated Perioperative Geriatric Excellent Research Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Siriraj Health Policy Unit, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Division of Geriatrics, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Onuma Chaiwat
- Integrated Perioperative Geriatric Excellent Research Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Patcharee Sriswasdi
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Rosen CB, Roberts SE, Wirtalla CJ, Ramadan OI, Keele LJ, Kaufman EJ, Halpern SD, Kelz RR. Analyzing Impact of Multimorbidity on Long-Term Outcomes after Emergency General Surgery: A Retrospective Observational Cohort Study. J Am Coll Surg 2022; 235:724-735. [PMID: 36250697 PMCID: PMC9583235 DOI: 10.1097/xcs.0000000000000303] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Little is known about the impact of multimorbidity on long-term outcomes for older emergency general surgery patients. STUDY DESIGN Medicare beneficiaries, age 65 and older, who underwent operative management of an emergency general surgery condition were identified using Centers for Medicare & Medicaid claims data. Patients were classified as multimorbid based on the presence of a Qualifying Comorbidity Set (a specific combination of comorbid conditions known to be associated with increased risk of in-hospital mortality in the general surgery setting) and compared with those without multimorbidity. Risk-adjusted outcomes through 180 days after discharge from index hospitalization were calculated using linear and logistic regressions. RESULTS Of 174,891 included patients, 45.5% were identified as multimorbid. Multimorbid patients had higher rates of mortality during index hospitalization (5.9% vs 0.7%, odds ratio [OR] 3.05, p < 0.001) and through 6 months (17.1% vs 3.4%, OR 2.33, p < 0.001) after discharge. Multimorbid patients experienced higher rates of readmission at 1 month (22.9% vs 11.4%, OR 1.48, p < 0.001) and 6 months (38.2% vs 21.2%, OR 1.48, p < 0.001) after discharge, lower rates of discharge to home (42.5% vs 74.2%, OR 0.52, p < 0.001), higher rates of discharge to rehabilitation/nursing facility (28.3% vs 11.3%, OR 1.62, p < 0.001), greater than double the use of home oxygen, walker, wheelchair, bedside commode, and hospital bed (p < 0.001), longer length of index hospitalization (1.33 additional in-patient days, p < 0.001), and higher costs through 6 months ($5,162 additional, p < 0.001). CONCLUSIONS Older, multimorbid patients experience worse outcomes, including survival and independent function, after emergency general surgery than nonmultimorbid patients through 6 months after discharge from index hospitalization. This information is important for setting recovery expectations for high-risk patients to improve shared decision-making.
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Affiliation(s)
- Claire B Rosen
- Department of Surgery, Hospital of the University of Pennsylvania; Philadelphia, PA
- The Perelman School of Medicine at the University of Pennsylvania; Philadelphia, PA
| | - Sanford E Roberts
- Department of Surgery, Hospital of the University of Pennsylvania; Philadelphia, PA
- The Perelman School of Medicine at the University of Pennsylvania; Philadelphia, PA
| | - Chris J Wirtalla
- The Perelman School of Medicine at the University of Pennsylvania; Philadelphia, PA
| | - Omar I Ramadan
- Department of Surgery, Hospital of the University of Pennsylvania; Philadelphia, PA
| | - Luke J Keele
- The Perelman School of Medicine at the University of Pennsylvania; Philadelphia, PA
| | - Elinore J Kaufman
- Department of Surgery, Hospital of the University of Pennsylvania; Philadelphia, PA
- The Perelman School of Medicine at the University of Pennsylvania; Philadelphia, PA
| | - Scott D Halpern
- The Perelman School of Medicine at the University of Pennsylvania; Philadelphia, PA
- Department of Medicine, Hospital of the University of Pennsylvania; Philadelphia, PA
| | - Rachel R Kelz
- Department of Surgery, Hospital of the University of Pennsylvania; Philadelphia, PA
- The Perelman School of Medicine at the University of Pennsylvania; Philadelphia, PA
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Zhang X, Padhi A, Wei T, Xiong S, Yu J, Ye P, Tian W, Sun H, Peiris D, Praveen D, Tian M. Community prevalence and dyad disease pattern of multimorbidity in China and India: a systematic review. BMJ Glob Health 2022; 7:bmjgh-2022-008880. [PMID: 36113890 PMCID: PMC9486196 DOI: 10.1136/bmjgh-2022-008880] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 08/18/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Driven by the increasing life expectancy, China and India, the two most populous countries in the world are experiencing a rising burden of multimorbidity. This study aims to explore community prevalence and dyad patterns of multimorbidity in China and India. METHODS We conducted a systematic review of five English and Chinese electronic databases. Studies involving adults 18 years or older at a community level, which reported multimorbidity prevalence and/or patterns were included. A modified Newcastle-Ottawa Scale was used for quality assessment. Despite large heterogeneity among reported studies, a systematic synthesis of the results was conducted to report the findings. RESULTS From 13 996 studies retrieved, 59 studies met the inclusion criteria (46 in China, 9 in India and 4 in both). The median prevalence of multimorbidity was 30.7% (IQR 17.1, 49.4), ranging from 1.5% to 90.5%. There was a large difference in multimorbidity prevalence between China and India, with median prevalence being 36.1% (IQR 19.6, 48.8) and 28.3% (IQR 8.9, 56.8), respectively. Among 27 studies that reported age-specific prevalence, 19 studies found multimorbidity prevalence increased with age, while 8 studies observed a paradoxical reduction in the oldest age group. Of the 34 studies that reported sex-specific prevalence, 86% (n=32) observed a higher prevalence in females. The most common multimorbidity patterns from 14 studies included hypertensive diseases combined with diabetes mellitus, arthropathies, heart diseases and metabolic disorders. All included studies were rated as fair or poor quality. CONCLUSION Multimorbidity is highly prevalent in China and India with hypertensive diseases and other comorbidities being the most observed patterns. The overall quality of the studies was low and there was a lack of representative samples in most studies. Large epidemiology studies, using a common definition of multimorbidity and national representative samples, with sex disaggregation are needed in both countries. PROSPERO REGISTRATION NUMBER CRD42020176774.
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Affiliation(s)
- Xinyi Zhang
- School of Public Health, Harbin Medical University, Harbin, Heilongjiang, China.,The George Institute for Global Health, China, Beijing, China
| | - Asutosh Padhi
- The George Institute for Global Health, India, Hyderabad, Telangana, India
| | - Ting Wei
- The George Institute for Global Health, China, Beijing, China
| | - Shangzhi Xiong
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Jie Yu
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Pengpeng Ye
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia.,National Centre for Non-Communicable Disease Control and Prevention, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - Wenijng Tian
- School of Public Health, Harbin Medical University, Harbin, Heilongjiang, China
| | - Hongru Sun
- School of Public Health, Harbin Medical University, Harbin, Heilongjiang, China
| | - David Peiris
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Devarsetty Praveen
- The George Institute for Global Health, India, Hyderabad, Telangana, India.,The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia.,Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Maoyi Tian
- School of Public Health, Harbin Medical University, Harbin, Heilongjiang, China .,The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
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Rosen CB, Wirtalla C, Keele LJ, Roberts SE, Kaufman EJ, Holena DN, Halpern SD, Kelz RR. Multimorbidity Confers Greater Risk for Older Patients in Emergency General Surgery Than the Presence of Multiple Comorbidities: A Retrospective Observational Study. Med Care 2022; 60:616-622. [PMID: 35640050 PMCID: PMC9262850 DOI: 10.1097/mlr.0000000000001733] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Little is known about the impact of multimorbidity on outcomes for older emergency general surgery patients. OBJECTIVE The aim was to understand whether having multiple comorbidities confers the same amount of risk as specific combinations of comorbidities (multimorbidity) for a patient undergoing emergency general surgery. RESEARCH DESIGN Retrospective observational study using state discharge data. SUBJECTS Medicare beneficiaries who underwent an operation for an emergency general surgery condition in New York, Florida, or Pennsylvania (2012-2013). MEASURES Patients were classified as multimorbid using Qualifying Comorbidity Sets (QCSs). Outcomes included in-hospital mortality, hospital length of stay and discharge status. RESULTS Of 312,160 patients, a large minority (37.4%) were multimorbid. Non-QCS patients did not have a specific combination of comorbidities to satisfy a QCS, but 64.1% of these patients had 3+ comorbid conditions. Multimorbidity was associated with increased in-hospital mortality (10.5% vs. 3.9%, P <0.001), decreased rates of discharge to home (16.2% vs. 37.1%, P <0.001), and longer length of stay (10.4 d±13.5 vs. 6.7 d±9.3, P <0.001) when compared with non-QCS patients. Risks varied between individual QCSs. CONCLUSIONS Multimorbidity, defined by satisfying a specific QCS, is strongly associated with poor outcomes for older patients requiring emergency general surgery in the United States. Variation in risk of in-hospital mortality, discharge status, and length of stay between individual QCSs suggests that multimorbidity does not carry the same prognostic weight as having multiple comorbidities-the specifics of which are important in setting expectations for individual, complex patients.
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Affiliation(s)
- Claire B. Rosen
- Department of Surgery, Hospital of the University of Pennsylvania; 3400 Spruce Street, Philadelphia, PA 19104
- Perelman School of Medicine; 3400 Civic Center Blvd, Philadelphia, PA 19104
| | - Chris Wirtalla
- Perelman School of Medicine; 3400 Civic Center Blvd, Philadelphia, PA 19104
| | - Luke J. Keele
- Perelman School of Medicine; 3400 Civic Center Blvd, Philadelphia, PA 19104
| | - Sanford E. Roberts
- Department of Surgery, Hospital of the University of Pennsylvania; 3400 Spruce Street, Philadelphia, PA 19104
- Perelman School of Medicine; 3400 Civic Center Blvd, Philadelphia, PA 19104
| | - Elinore J. Kaufman
- Department of Surgery, Hospital of the University of Pennsylvania; 3400 Spruce Street, Philadelphia, PA 19104
- Perelman School of Medicine; 3400 Civic Center Blvd, Philadelphia, PA 19104
| | - Daniel N. Holena
- Department of Surgery, Hospital of the University of Pennsylvania; 3400 Spruce Street, Philadelphia, PA 19104
- Perelman School of Medicine; 3400 Civic Center Blvd, Philadelphia, PA 19104
| | - Scott D. Halpern
- Department of Surgery, Hospital of the University of Pennsylvania; 3400 Spruce Street, Philadelphia, PA 19104
- Department of Medicine, Hospital of the University of Pennsylvania; 3400 Spruce Street, Philadelphia, PA 19104
| | - Rachel R. Kelz
- Department of Surgery, Hospital of the University of Pennsylvania; 3400 Spruce Street, Philadelphia, PA 19104
- Perelman School of Medicine; 3400 Civic Center Blvd, Philadelphia, PA 19104
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Rodríguez-Queraltó O, Guerrero C, Formiga F, Calvo E, Lorente V, Sánchez-Salado JC, Llaó I, Mateus G, Alegre O, Ariza-Solé A. Geriatric Assessment and In-Hospital Economic Cost of Elderly Patients With Acute Coronary Syndromes. Heart Lung Circ 2021; 30:1863-1869. [PMID: 34083151 DOI: 10.1016/j.hlc.2021.05.077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 03/27/2021] [Accepted: 05/04/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Elderly patients with acute coronary syndromes (ACS) are at higher risk for complications and health care resources expenditure. No previous study has assessed the specific contribution of frailty and other geriatric syndromes to the in-hospital economic cost in this setting. METHOD Unselected patients with ACS aged ≥75 years were prospectively included. A comprehensive geriatric assessment was performed during hospitalisation. Hospitalisation-related cost per patient was calculated with an analytical accountability method, including hospital stay-related expenditures, interventions, and consumption of devices. Expenditure was expressed in Euros (2019). The contribution of geriatric syndromes and clinical factors to the economic cost was assessed with a linear regression method. RESULTS A total of 194 patients (mean age 82.6 years) were included. Mean length of hospital stay was 11.3 days. The admission-related economic cost was €6,892.15 per patient. Most of this cost was attributable to hospital length of stay (77%). The performance of an invasive strategy during the admission was associated with economic cost (p=0.008). Of all the ageing-related variables, comorbidity showed the most significant association with economic cost (p=0.009). Comorbidity, disability, nutritional risk, and frailty were associated with the hospital length of stay-related component of the economic cost. The final predictive model of economic cost included age, previous heart failure, systolic blood pressure, Killip class at admission, left main disease, and Charlson index. CONCLUSIONS Management of ACS in elderly patients is associated with a significant economic cost, mostly due to hospital length of stay. Comorbidity mostly contributes to in-hospital resources expenditure, as well as the severity of the coronary event.
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Affiliation(s)
| | - Carme Guerrero
- Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Francesc Formiga
- Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Elena Calvo
- Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Victòria Lorente
- Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - Isaac Llaó
- Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Gemma Mateus
- Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Oriol Alegre
- Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Albert Ariza-Solé
- Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
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Park S, Castaneda-Gameros D, Oh IH. Latent profile analysis of walking, sitting, grip strength, and perceived body shape and their association with mental health in older Korean adults with hypertension: A national observational study. Medicine (Baltimore) 2019; 98:e17287. [PMID: 31574848 PMCID: PMC6775383 DOI: 10.1097/md.0000000000017287] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Evidence suggests that mental health is associated with multiple factors such as physical activity, sedentary behavior, and physical function in older adults. The present study used latent profile analysis to identify classes of older adults based on their health profile among a representative sample of Korean older adults with hypertension. Differences in mental health between these classes were also examined.Seven hundred and sixty seven participants (mean age = 70.23, SD = 6.08; men 45.6%) were included in the analysis.There were 3 latent classes (class 1: a physically inactive lifestyle with low physical function and body perception; class 2: a physically moderate lifestyle with moderate physical function and low body perception; class 3: a physically active lifestyle with high physical function and body perception). According to class comparisons, older adults in class 3 had significantly lower anxiety/depression levels than classes 1 and 2. Older adults in class 3 had significantly lower stress levels than class 1.It is possible that among older adults, having a positive attitude of one's body shape may also be important for improving anxiety/depression along with having a physically active lifestyle and maintaining physical function.
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Affiliation(s)
- Saengryeol Park
- Department of Preventive Medicine, School of Medicine, Kyung Hee University, Seoul, South Korea
| | - Diana Castaneda-Gameros
- Research and Evaluation Division, Knowledge Directorate, Public Health Wales, Cardiff, United Kingdom
| | - In-Hwan Oh
- Department of Preventive Medicine, School of Medicine, Kyung Hee University, Seoul, South Korea
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Abstract
BACKGROUND There are numerous definitions of multimorbidity (MM). None systematically examines specific comorbidity combinations accounting for multiple testing when exploring large datasets. OBJECTIVES Develop and validate a list of all single, double, and triple comorbidity combinations, with each individual qualifying comorbidity set (QCS) more than doubling the odds of mortality versus its reference population. Patients with at least 1 QCS were defined as having MM. RESEARCH DESIGN Cohort-based study with a matching validation study. SUBJECTS All fee-for-service Medicare patients between age 65 and 85 without dementia or metastatic solid tumors undergoing general surgery in 2009-2010, and an additional 2011-2013 dataset. MEASURES 30-day all-location mortality. RESULTS There were 576 QCSs (2 singles, 63 doubles, and 511 triples), each set more than doubling the odds of dying. In 2011, 36% of eligible patients had MM. As a group, multimorbid patients (mortality rate=7.0%) had a mortality Mantel-Haenszel odds ratio=1.90 (1.77-2.04) versus a reference that included both multimorbid and nonmultimorbid patients (mortality rate=3.3%), and Mantel-Haenszel odds ratio=3.72 (3.51-3.94) versus only nonmultimorbid patients (mortality rate=1.6%). When matching 3151 pairs of multimorbid patients from low-volume hospitals to similar patients in high-volume hospitals, the mortality rates were 6.7% versus 5.2%, respectively (P=0.006). CONCLUSIONS A list of QCSs identified a third of older patients undergoing general surgery that had greatly elevated mortality. These sets can be used to identify vulnerable patients and the specific combinations of comorbidities that make them susceptible to poor outcomes.
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Meranius MS, Josefsson K. Health and social care management for older adults with multimorbidity: a multiperspective approach. Scand J Caring Sci 2016; 31:96-103. [DOI: 10.1111/scs.12322] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 11/30/2015] [Indexed: 11/26/2022]
Affiliation(s)
| | - Karin Josefsson
- School of Health, Care and Social Welfare; Mälardalen University; Västerås Sweden
- Faculty of Caring Science, Work Life and Social Welfare; University of Borås; Borås Sweden
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Schlenk EA, Bilt JV, Lo-Ciganic WH, Jacob ME, Woody SE, Conroy MB, Kwoh CK, Albert SM, Boudreau R, Newman AB, Zgibor JC. Pilot Enhancement of the Arthritis Foundation Exercise Program with a Healthy Aging Program. Res Gerontol Nurs 2015; 9:123-32. [PMID: 26501346 DOI: 10.3928/19404921-20151019-04] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Accepted: 09/21/2015] [Indexed: 01/14/2023]
Abstract
Older adults with arthritis or joint pain were targeted for a pilot program enhancing the Arthritis Foundation Exercise Program with the 10 Keys™ to Healthy Aging Program. Using a one-group, pre-post design, feasibility was examined and improvements in preventive behaviors, arthritis outcomes, and cardiometabolic outcomes were explored. A 10-week program was developed, instructors were recruited and trained, and four sites and 51 participants were recruited. Measures included attendance, adherence, satisfaction, preventive behaviors, Western Ontario and McMaster Universities Osteoarthritis Index (pain and stiffness), glucose, and cholesterol. Three fourths of participants attended >50% of the sessions. At 6 and 12 months, more than one half performed the exercises 1 to 2 days per week, whereas 28% and 14% exercised 3 to 7 days per week, respectively. Participants (92%) rated the program as excellent/very good. Nonsignificant changes were observed in expected directions. Effect sizes were small for arthritis and cardiometabolic outcomes. This program engaged community partners, demonstrated feasibility, and showed improvements in some preventive behaviors and health risk profiles. [Res Gerontol Nurs. 2016; 9(3):123-132.].
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Chu SH, Baek JW, Kim ES, Stefani KM, Lee WJ, Park YR, Youm Y, Kim HC. Gender differences in hypertension control among older korean adults: Korean social life, health, and aging project. J Prev Med Public Health 2015; 48:38-47. [PMID: 25652709 PMCID: PMC4322514 DOI: 10.3961/jpmph.14.043] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 12/08/2014] [Indexed: 01/29/2023] Open
Abstract
Objectives: Controlling blood pressure is a key step in reducing cardiovascular mortality in older adults. Gender differences in patients’ attitudes after disease diagnosis and their management of the disease have been identified. However, it is unclear whether gender differences exist in hypertension management among older adults. We hypothesized that gender differences would exist among factors associated with hypertension diagnosis and control among community-dwelling, older adults. Methods: This cross-sectional study analyzed data from 653 Koreans aged ≥60 years who participated in the Korean Social Life, Health, and Aging Project. Multiple logistic regression was used to compare several variables between undiagnosed and diagnosed hypertension, and between uncontrolled and controlled hypertension. Results: Diabetes was more prevalent in men and women who had uncontrolled hypertension than those with controlled hypertension or undiagnosed hypertension. High body mass index was significantly associated with uncontrolled hypertension only in men. Multiple logistic regression analysis indicated that in women, awareness of one’s blood pressure level (odds ratio [OR], 2.86; p=0.003) and the number of blood pressure checkups over the previous year (OR, 1.06; p=0.011) might influence the likelihood of being diagnosed with hypertension. More highly educated women were more likely to have controlled hypertension than non-educated women (OR, 5.23; p=0.013). Conclusions: This study suggests that gender differences exist among factors associated with hypertension diagnosis and control in the study population of community-dwelling, older adults. Education-based health promotion strategies for hypertension control might be more effective in elderly women than in elderly men. Gender-specific approaches may be required to effectively control hypertension among older adults.
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Affiliation(s)
- Sang Hui Chu
- Department of Clinical Nursing Science, Nursing Policy Research Institute, Yonsei University College of Nursing, Seoul, Korea
| | - Ji Won Baek
- Department of Sociology, Yonsei University College of Social Sciences, Seoul, Korea
| | - Eun Sook Kim
- Department of Nursing, Yonsei University Graduate School, Seoul, Korea
| | - Katherine M Stefani
- Department of Public Health, Yonsei University Graduate School, Seoul, Korea
| | - Won Joon Lee
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Yeong-Ran Park
- Division of Silver Industry, Kangnam University, Yongin, Korea
| | - Yoosik Youm
- Department of Sociology, Yonsei University College of Social Sciences, Seoul, Korea
| | - Hyeon Chang Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
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Fu S, Huang N, Chou YJ. Trends in the prevalence of multiple chronic conditions in Taiwan from 2000 to 2010: a population-based study. Prev Chronic Dis 2014; 11:E187. [PMID: 25340359 PMCID: PMC4208993 DOI: 10.5888/pcd11.140205] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Introduction Chronic conditions are the leading causes of death and disability worldwide. Providing care to people diagnosed with a chronic disease is challenging, and controlling multiple chronic conditions (MCCs) can be overwhelming, particularly in rapidly aging societies. The objective of this study was to examine the prevalence of MCCs from 2000 to 2010 in Taiwan. Methods A random sample of 1 million representative National Health Insurance beneficiaries in 3 years (2000, 2005, and 2010) was obtained from the Taiwan National Health Insurance Research Database to examine the prevalence of MCCs. Chronic Condition Indicator and Clinical Classifications Software were used to determine and classify codes from the International Classification of Diseases, Ninth Revision. People who had 2 or more conditions among the 15 categories of conditions were defined as having MCCs. Results The prevalence of MCCs increased from 9.6% in 2000 to 17.1% in 2010. The highest prevalence of MCCs was found among people aged 65 years or older (42.3% in 2000 and 64.5% in 2010, a relative increase of 52.5%). However, the highest rate of increase was found among people younger than 18 years (0.5% in 2000 and 1.6% in 2010, a relative increase of 220.0%). Conclusion MCCs are increasingly prevalent among the older (≥65 y) population and among children and adolescents. Prevention and early intervention programs targeted to certain age groups may be required. If the increase in MCCs continues rapidly, the management of people diagnosed with MCCs would challenge the capacity of the health care system in Taiwan.
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Affiliation(s)
- Serena Fu
- Institute of Public Health, School of Medicine, National Yang Ming University, Taipei, Taiwan
| | - Nicole Huang
- Institute of Public Health, School of Medicine, National Yang Ming University, and Taipei City Hospital, Taipei, Taiwan
| | - Yiing-Jenq Chou
- Institute of Public Health, School of Medicine, National Yang Ming University, No. 155, Section 2, Li-Nong St, Taipei 112, Taiwan. E-mail:
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