1
|
Gregory MA, Schaeffer MJ, Reeves JTH, Griffith LE, Wolfson C, Basta NE, McMillan JM, Kirkland S, Raina P, Paterson TSE. The Effects of Cognitive Ability, Mental Health, and Self-Quarantining on Functional Ability of Older Adults During the COVID-19 Pandemic: Results From the Canadian Longitudinal Study on Aging. J Geriatr Psychiatry Neurol 2024; 37:307-317. [PMID: 38116645 PMCID: PMC11089823 DOI: 10.1177/08919887231218755] [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] [Indexed: 12/21/2023]
Abstract
OBJECTIVES Determine whether levels of anxiety and depression, cognitive ability, and self-quarantining during and prior to the pandemic predict decreases in perceived functional ability. DESIGN AND SETTING Longitudinal data collected from the Canadian Longitudinal Study on Aging (CLSA) COVID-19 Questionnaire Study (2020) and core CLSA study (Follow-Up 1; 2014-2018). PARTICIPANTS 17 541 CLSA participants. MEASUREMENTS Self-quarantining behaviours from questionnaires administered at Baseline (April 2020), Monthly, and Exit (December 2020) time points of the CLSA COVID-19 Questionnaire Study, levels of anxiety and depression at Baseline, perceived change in functional ability at Exit, and performance on neuropsychological tests (Rey Auditory Verbal Learning Task, Mental Alternation Task, Animal Fluency Test) and functional ability (Older Americans Resources and Services [OARS] Multidimensional Assessment Questionnaire) from the core CLSA study. RESULTS Greater cognitive ability pre-pandemic (B = -.003, P < .01), higher levels of anxiety (B = -.024, P < .01) and depressive symptoms (B = -.110, P < .01) at Baseline, and higher frequency of engaging in self-quarantining throughout the COVID-19 survey period (B = -.098, P < .01) were associated with perceived loss in functional ability at Exit. Self-quarantining behaviour was associated with perceived loss in functional ability only at average and high levels of depressive symptoms (B = -.013, P < .01). CONCLUSIONS Older adults with higher cognitive and lower functional ability prior to the pandemic were at greater risk of decreased perceived functional ability during the first year of the pandemic, as were those who experienced greater levels of anxiety and depressive symptoms during the pandemic. Strategies/interventions to preserve functional ability in older adults with cognitive independence prior to future pandemics are warranted.
Collapse
Affiliation(s)
| | | | | | - Lauren E Griffith
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- McMaster Institute for Research on Aging, McMaster University, Hamilton, ON, Canada
| | - Christina Wolfson
- Department of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health, McGill University, Montreal, QC, Canada
| | - Nicole E Basta
- Department of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health, McGill University, Montreal, QC, Canada
| | - Jacqueline M McMillan
- Department of Medicine, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - Susan Kirkland
- Department of Community Health & Epidemiology and Division of Geriatric Medicine, Dalhousie University, Halifax, NS, Canada
| | - Parminder Raina
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- McMaster Institute for Research on Aging, McMaster University, Hamilton, ON, Canada
| | - Theone S E Paterson
- Department of Psychology, University of Victoria, Victoria, BC, Canada
- Neuropsychology and Cognitive Health, Baycrest Health Sciences Centre, Toronto, ON, Canada
| |
Collapse
|
2
|
Beaney T, Clarke J, Salman D, Woodcock T, Majeed A, Aylin P, Barahona M. Identifying multi-resolution clusters of diseases in ten million patients with multimorbidity in primary care in England. COMMUNICATIONS MEDICINE 2024; 4:102. [PMID: 38811835 PMCID: PMC11137021 DOI: 10.1038/s43856-024-00529-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 05/20/2024] [Indexed: 05/31/2024] Open
Abstract
BACKGROUND Identifying clusters of diseases may aid understanding of shared aetiology, management of co-morbidities, and the discovery of new disease associations. Our study aims to identify disease clusters using a large set of long-term conditions and comparing methods that use the co-occurrence of diseases versus methods that use the sequence of disease development in a person over time. METHODS We use electronic health records from over ten million people with multimorbidity registered to primary care in England. First, we extract data-driven representations of 212 diseases from patient records employing (i) co-occurrence-based methods and (ii) sequence-based natural language processing methods. Second, we apply the graph-based Markov Multiscale Community Detection (MMCD) to identify clusters based on disease similarity at multiple resolutions. We evaluate the representations and clusters using a clinically curated set of 253 known disease association pairs, and qualitatively assess the interpretability of the clusters. RESULTS Both co-occurrence and sequence-based algorithms generate interpretable disease representations, with the best performance from the skip-gram algorithm. MMCD outperforms k-means and hierarchical clustering in explaining known disease associations. We find that diseases display an almost-hierarchical structure across resolutions from closely to more loosely similar co-occurrence patterns and identify interpretable clusters corresponding to both established and novel patterns. CONCLUSIONS Our method provides a tool for clustering diseases at different levels of resolution from co-occurrence patterns in high-dimensional electronic health records, which could be used to facilitate discovery of associations between diseases in the future.
Collapse
Affiliation(s)
- Thomas Beaney
- Department of Primary Care and Public Health, Imperial College London, London, W6 8RP, UK.
- Department of Mathematics, Imperial College London, London, SW7 2AZ, UK.
| | - Jonathan Clarke
- Department of Mathematics, Imperial College London, London, SW7 2AZ, UK
| | - David Salman
- Department of Primary Care and Public Health, Imperial College London, London, W6 8RP, UK
- MSk Lab, Department of Surgery and Cancer, Imperial College London, London, W12 0BZ, UK
| | - Thomas Woodcock
- Department of Primary Care and Public Health, Imperial College London, London, W6 8RP, UK
| | - Azeem Majeed
- Department of Primary Care and Public Health, Imperial College London, London, W6 8RP, UK
| | - Paul Aylin
- Department of Primary Care and Public Health, Imperial College London, London, W6 8RP, UK
| | - Mauricio Barahona
- Department of Mathematics, Imperial College London, London, SW7 2AZ, UK
| |
Collapse
|
3
|
Chapon R, Alixant P, Laroche D, Ornetti P, Beaurain J, le Van T, Berhouma M, Ricolfi L. Influence of Posture on Gait Parameters in Severe Symptomatic Lumbar Stenosis Before and After Decompression Surgery. World Neurosurg 2024; 183:e109-e115. [PMID: 38030072 DOI: 10.1016/j.wneu.2023.11.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 11/22/2023] [Accepted: 11/23/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND We searched to quantify the influence of sagittal vertical axis (SVA) on the improvement of spatiotemporal gait parameters using a gait motion analysis (GMA) before and after decompression surgery in patients suffering from lumbar spinal stenosis (LSS). METHODS Thirty-nine patients with severe LisSS planned for lumbar decompression underwent a full-body biplanar radiographs (EOS) to quantify the SVA and have benefited from a 3-dimensional GMA 1 month before surgery (M0) and 6 month (M6) after surgery. The first step of this study was to confirm the validation of 3-dimensional sagittal vertical axis (3D SVA) for posture analysis. An analysis of modification of the 3D SVA and spatiotemporal gait parameters was then carried out in order to identify any correlation. RESULTS Decompression surgery did not significantly improve 3D SVA between M0 and M6 (respectively 49.1 [50.3] vs. 49.84 [19.02], P = 0.42). Concerning spatiotemporal parameters, we found significant difference for all parameters between M0 and M6. A strong correlation (R2 > 0.65) between static SVA (EOS) and 3D SVA was demonstrated using a statistical regression equation. There was also a statistically significant correlation between SVA (static and 3-dimension) and improvement in spatiotemporal gait parameters after decompression surgery. CONCLUSIONS This study analyses the relationship between postural change (SVA) and improvement in gait parameters measured during GMA before and after decompression surgery for LSS. This specific analysis of gait parameters may represent a prognostic assessment tool for the recovery of patients undergoing surgery for a LSS.
Collapse
Affiliation(s)
- Renan Chapon
- Department of Neurosurgery, University Hospital of Dijon Burgundy, Dijon, France
| | - Philibert Alixant
- Department of Neurosurgery, University Hospital of Dijon Burgundy, Dijon, France.
| | - Davy Laroche
- CIC INSERM 1432, Technological Investigation Platform, University Hospital of Dijon Burgundy, University of Burgundy, Dijon, France
| | - Paul Ornetti
- CIC INSERM 1432, Technological Investigation Platform, University Hospital of Dijon Burgundy, University of Burgundy, Dijon, France; Department of Rheumatology, University Hospital of Dijon Burgundy, Dijon, France
| | - Jacques Beaurain
- Department of Neurosurgery, University Hospital of Dijon Burgundy, Dijon, France
| | - Tuan le Van
- Department of Neurosurgery, University Hospital of Dijon Burgundy, Dijon, France
| | - Moncef Berhouma
- Department of Neurosurgery, University Hospital of Dijon Burgundy, Dijon, France; Functional and Molecular Imaging Team (CNRS 6302 - ICMUB), Molecular Chemistry Institute, University of Burgundy, Dijon, France
| | - Louis Ricolfi
- Department of Orthopaedic surgery, University Hospital of Dijon Burgundy, Dijon, France
| |
Collapse
|
4
|
Keramat SA, Perales F, Alam K, Rashid R, Haque R, Monasi N, Hashmi R, Siddika F, Siddiqui ZH, Ali MA, Gebremariam ND, Kondalsamy-Chennakesavan S. Multimorbidity and health-related quality of life amongst Indigenous Australians: A longitudinal analysis. Qual Life Res 2024; 33:195-206. [PMID: 37587324 PMCID: PMC10784343 DOI: 10.1007/s11136-023-03500-3] [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] [Accepted: 07/27/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND The burden of multimorbidity has been observed worldwide and it has significant consequences on health outcomes. In Australia, health-related quality of life (HRQoL) is comparatively low amongst Aboriginal and/or Torres Strait Islanders, yet no studies have examined the effect of multimorbidity on HRQoL within this at-risk population. This study seeks to fill that gap by employing a longitudinal research design. METHODS Longitudinal data were derived from three waves (9, 13, and 17) of the household, income and labour dynamics in Australia (HILDA) Survey. A total of 1007 person-year observations from 592 Aboriginal and/or Torres Strait Islander individuals aged 15 years and above were included. HRQoL was captured using the 36-item Short-Form Health Survey (SF-36), and multimorbidity was defined using self-reports of having been diagnosed with two or more chronic health conditions. Symmetric fixed-effects linear regression models were used to assess how intraindividual changes in multimorbidity were associated with intraindividual changes in HRQoL. RESULTS Approximately 21% of Indigenous Australians were classified as experiencing multimorbidity. Respondents had statistically significantly lower HRQoL on the SF-36 sub-scales, summary measures, and health-utility index in those observations in which they experienced multimorbidity. Among others, multimorbidity was associated with lower scores on the SF-36 physical-component scale (β = - 6.527; Standard Error [SE] = 1.579), mental-component scale (β = - 3.765; SE = 1.590) and short-form six-dimension utility index (β = - 0.075; SE = 0.017). CONCLUSION This study demonstrates that having multiple chronic conditions is statistically significantly associated with lower HRQoL amongst Indigenous Australians. These findings suggest that comprehensive and culturally sensitive health strategies addressing the complex needs of individuals with multimorbidity should be implemented to improve the HRQoL of Indigenous Australians.
Collapse
Affiliation(s)
- Syed Afroz Keramat
- Faculty of Medicine, Centre for Health Services Research, The University of Queensland, Brisbane, QLD, Australia.
- Economics Discipline, Khulna University, Khulna, 9208, Bangladesh.
| | - Francisco Perales
- School of Social Science, The University of Queensland, Michie Building (#9), St Lucia, Brisbane, QLD, 4067, Australia
| | - Khorshed Alam
- School of Business and Centre for Health Research, University of Southern Queensland, Toowoomba, QLD, 4350, Australia
| | - Rumana Rashid
- Economics Discipline, Khulna University, Khulna, 9208, Bangladesh
| | - Rezwanul Haque
- School of Business and Centre for Health Research, University of Southern Queensland, Toowoomba, QLD, 4350, Australia
| | - Nahid Monasi
- School of Business and Centre for Health Research, University of Southern Queensland, Toowoomba, QLD, 4350, Australia
| | - Rubayyat Hashmi
- School of Business and Centre for Health Research, University of Southern Queensland, Toowoomba, QLD, 4350, Australia
| | - Farzana Siddika
- Department of Mathematics and Natural Sciences, BRAC University, Dhaka, Bangladesh
| | - Zubayer Hassan Siddiqui
- Department of Business Administration, Bangladesh University of Professionals, Dhaka, Bangladesh
| | - Mohammad Afshar Ali
- School of Business and Centre for Health Research, University of Southern Queensland, Toowoomba, QLD, 4350, Australia
| | | | | |
Collapse
|
5
|
Lopes Vieira MM, Borges VS, Oliveira EJP, Bof de Andrade F. Functional limitation in the older Brazilian adults: Association with multimorbidity and socioeconomic conditions. PLoS One 2023; 18:e0294935. [PMID: 38032910 PMCID: PMC10688755 DOI: 10.1371/journal.pone.0294935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 11/11/2023] [Indexed: 12/02/2023] Open
Abstract
The aim of this study was to assess the association between multimorbidity and the presence of functional limitation in basic (BADL) and instrumental activities of daily living (IADL) among Brazilian older adults and to verify whether this association is moderated by socioeconomic conditions. Cross-sectional study with data from the Brazilian National Health Survey (PNS) (2019) for the Brazilian population aged 60 years and over. The dependent variables were functional limitation, based on self-reported difficulty in performing one or more activities of daily living, including six BADL (feeding, bathing, using the toilet, dressing, crossing a room on the same floor and getting out of bed) and four IADL (shopping, managing money, taking medication and using transportation). The independent variables were multimorbidity (presence of two or more self-reported chronic diseases) and socioeconomic measures (per capita household income, asset score, and education level). The association between multimorbidity and outcomes was assessed using adjusted logistic regression models. The moderating effect of socioeconomic conditions on the association between multimorbidity and functional limitations was assessed by including an interaction term. The final sample consisted of 22,725 individuals. The prevalence of functional limitation was 8.5% (95%CI: 7.9-9.2) and 18.6% (95%CI: 17.8-19.5) in BADL and IADL, respectively. Multimorbidity was associated with BADL [OR: 2.30 (95%CI: 1.93-2.74)] and IADL [OR: 2.26 (95%CI: 1.98-2.57)]. The odds of functional limitation were higher among individuals with lower levels of education and income, but there was no interaction between multimorbidity and socioeconomic position measures. Multimorbidity was associated with functional limitation (BADL and IADL) and socioeconomic conditions, and this association was constant across socioeconomic position levels.
Collapse
Affiliation(s)
| | | | | | - Fabíola Bof de Andrade
- René Rachou Institute, Oswaldo Cruz Foundation (FIOCRUZ), Belo Horizonte, Minas Gerais, Brasil
| |
Collapse
|
6
|
Silva DSMD, Silva MF, Assumpção DD, Francisco PMSB, Neri AL, Yassuda MS, Borim FSA. [Influence of multimorbidity patterns on the activities in the day-to-day lives of the elderly: nine-year follow-up of the Fibra Study]. CIENCIA & SAUDE COLETIVA 2023; 28:2003-2014. [PMID: 37436314 DOI: 10.1590/1413-81232023287.14842022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 01/03/2023] [Indexed: 07/13/2023] Open
Abstract
The scope of this article was to evaluate the influence of multimorbidity and associated effects on the activities in the day-to-day lives of community-dwelling elderly individuals. It involved a cohort study with data from the FIBRA Study, the baseline (2008-2009) and follow-up (2016-2017). The basic activities in daily living (ADL) were evaluated using Katz's index, and the chronic diseases were classified as: (1) multimorbidity and multimorbidity patterns; (2) cardiopulmonary; (3) vascular-metabolic; and (4) mental-musculoskeletal. The chi-square test and Poisson regression data were used for analysis. A total of 861 older adults with no functional dependency at baseline were analyzed. Elderly individuals with multimorbidity (RR = 1.58; 95%CI: 1.19-2.10) and classified according to cardiopulmonary (RR = 2.43; 95%CI: 1.77-3.33), vascular-metabolic (RR = 1.50; 95%CI: 1.19-1.89) and mental-musculoskeletal (RR = 1.30; 95%CI: 1.03-1.65) had a higher risk of presenting functional decline in ADL in the follow-up compared to those who didn't have the same disease patterns. Multimorbidity and its patterns increased the risk of functional disability in older adults over the nine-year period.
Collapse
Affiliation(s)
- Diego Salvador Muniz da Silva
- Programa de Pós-Graduação em Gerontologia, Faculdade de Ciências Médicas, Universidade Estadual de Campinas. R. Tessália Vieira de Camargo 126, Cidade Universitária Zeferino Vaz. 13083-887 Campinas SP Brasil.
| | - Marcela Fernandes Silva
- Programa de Pós-Graduação em Gerontologia, Faculdade de Ciências Médicas, Universidade Estadual de Campinas. R. Tessália Vieira de Camargo 126, Cidade Universitária Zeferino Vaz. 13083-887 Campinas SP Brasil.
| | - Daniela de Assumpção
- Programa de Pós-Graduação em Gerontologia, Faculdade de Ciências Médicas, Universidade Estadual de Campinas. R. Tessália Vieira de Camargo 126, Cidade Universitária Zeferino Vaz. 13083-887 Campinas SP Brasil.
| | - Priscila Maria Stolses Bergamo Francisco
- Programa de Pós-Graduação em Gerontologia, Faculdade de Ciências Médicas, Universidade Estadual de Campinas. R. Tessália Vieira de Camargo 126, Cidade Universitária Zeferino Vaz. 13083-887 Campinas SP Brasil.
| | - Anita Liberalesso Neri
- Programa de Pós-Graduação em Gerontologia, Faculdade de Ciências Médicas, Universidade Estadual de Campinas. R. Tessália Vieira de Camargo 126, Cidade Universitária Zeferino Vaz. 13083-887 Campinas SP Brasil.
- Departamento de Psicologia Médica e Psiquiatria, Faculdade de Ciências Médicas, Universidade Estadual de Campinas. Campinas SP Brasil
| | - Mônica Sanches Yassuda
- Programa de Pós-Graduação em Gerontologia, Faculdade de Ciências Médicas, Universidade Estadual de Campinas. R. Tessália Vieira de Camargo 126, Cidade Universitária Zeferino Vaz. 13083-887 Campinas SP Brasil.
- Programa de Pós-Graduação em Gerontologia, Escola de Artes, Ciências e Humanidades, Universidade de São Paulo. São Paulo SP Brasil
| | - Flávia Silva Arbex Borim
- Programa de Pós-Graduação em Gerontologia, Faculdade de Ciências Médicas, Universidade Estadual de Campinas. R. Tessália Vieira de Camargo 126, Cidade Universitária Zeferino Vaz. 13083-887 Campinas SP Brasil.
| |
Collapse
|
7
|
Luo Y, Chen Y, Wang K, De Fries CM, Huang Z, Xu H, Yang Z, Hu Y, Xu B. Associations between multimorbidity and frailty transitions among older Americans. J Cachexia Sarcopenia Muscle 2023; 14:1075-1082. [PMID: 36852679 PMCID: PMC10067509 DOI: 10.1002/jcsm.13197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 01/02/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND The associations of multimorbidity patterns with transitions between frailty states remain unclear in older individuals. METHODS We used data from the National Health and Aging Trends Study 2011-2019. Frailty was measured annually using the Fried frailty phenotype. Multimorbidity patterns at baseline were identified using latent class analysis based on 14 chronic conditions. We used the semi-Markov multi-state model to investigate the influences of multimorbidity characterized by condition counts and patterns on subsequent frailty transitions over follow-ups. RESULTS Among 9450 participants aged ≥65 years at baseline, 34.8% were non-frail, 48.1% were pre-frail and 17.0% were frail. Over a median follow-up of 4.0 years, 16 880 frailty transitions were observed, with 10 527 worsening and 6353 improving. For 7675 participants with multimorbidity, four multimorbidity patterns were identified: osteoarticular pattern (62.4%), neuropsychiatric-sensory pattern (17.2%), cardiometabolic pattern (10.3%) and complex multimorbidity pattern (10.1%). Compared with no disease, multimorbidity was significantly associated with an increased risk of worsening transitions, including from non-frail to pre-frail (hazard ratio [HR] = 1.35; 95% confidence interval [CI] = 1.21-1.52), from non-frail to frail (HR = 1.68; 95% CI = 1.04-2.73), from pre-frail to frail (HR = 2.19; 95% CI = 1.66-2.90) and from pre-frail to death (HR = 1.64; 95% CI = 1.11-2.41). Compared with the osteoarticular pattern, neuropsychiatric-sensory, cardiometabolic and complex multimorbidity patterns had a significantly higher risk of worsening frailty (all P < 0.05). CONCLUSIONS Multimorbidity was associated with dynamic transitions between frailty states and death among older American adults, and the associations varied across multimorbidity patterns. The findings could offer significant implications for public health policymakers in planning interventions and healthcare resources. They also might inform clinicians regarding providing targeted clinical treatment and health management based on multimorbidity patterns of older people.
Collapse
Affiliation(s)
- Yan Luo
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.,Medical Informatics Center, Peking University, Beijing, China
| | - Yuming Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.,Medical Informatics Center, Peking University, Beijing, China
| | - Kaipeng Wang
- Graduate School of Social Work, University of Denver, Denver, CO, USA
| | - Carson M De Fries
- Graduate School of Social Work, University of Denver, Denver, CO, USA
| | - Ziting Huang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.,Medical Informatics Center, Peking University, Beijing, China
| | - Huiwen Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.,Medical Informatics Center, Peking University, Beijing, China
| | - Zhou Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.,Medical Informatics Center, Peking University, Beijing, China
| | - Yonghua Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.,Medical Informatics Center, Peking University, Beijing, China
| | - Beibei Xu
- Medical Informatics Center, Peking University, Beijing, China
| |
Collapse
|
8
|
Botoseneanu A, Elman MR, Allore HG, Dorr DA, Newsom JT, Nagel CL, Quiñones AR. Depressive Multimorbidity and Trajectories of Functional Status among Older Americans: Differences by Racial/Ethnic Group. J Am Med Dir Assoc 2023; 24:250-257.e3. [PMID: 36535384 PMCID: PMC10280885 DOI: 10.1016/j.jamda.2022.11.015] [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] [Received: 05/13/2022] [Revised: 10/08/2022] [Accepted: 11/21/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE This study aims to evaluate the impact of depressive multimorbidity (ie, including depressive symptoms) on the long-term development of activities of daily living (ADL) and instrumental activities of daily living (IADL) limitations according to racial/ethnic group in a representative sample of US older adults. DESIGN Prospective, observational, population-based 16-year follow-up study of nationally representative sample. SETTING AND PARTICIPANTS Sample of older non-Hispanic Black, Hispanic, and nonHispanic White Americans from the Health and Retirement Study (2000‒2016, N = 16,364, community-dwelling adults ≥65 years of age). METHODS Data from 9 biennial assessments were used to evaluate the accumulation of ADL-IADL limitations (range 0‒11) among participants with depressive (8-item Center for Epidemiologic Studies Depression score≥4) vs somatic (ie, physical conditions only) multimorbidity vs those without multimorbidity (no or 1 condition). Generalized estimating equations included race/ethnicity (non-Hispanic Black, Hispanic, non-Hispanic White), baseline age, sex, body mass index, education, partnered, and net worth. RESULTS Depressive and somatic multimorbidity were associated with 5.18 and 2.95 times greater accumulation of functional limitations, respectively, relative to no disease [incidence rate ratio (IRR) = 5.18, 95% confidence interval, CI (4.38,6.13), IRR = 2.95, 95% CI (2.51,3.48)]. Hispanic and Black respondents experienced greater accumulation of ADL-IADL limitations than White respondents [IRR = 1.27, 95% CI (1.14, 1.41), IRR = 1.31, 95% CI (1.20, 1.43), respectively]. CONCLUSIONS AND IMPLICATIONS Combinations of somatic diseases and high depressive symptoms are associated with greatest accumulation of functional limitations over time in adults ages 65 and older. There is a more rapid growth in functional limitations among individuals from racial/ethnic minority groups. Given the high prevalence of multimorbidity and depressive symptomatology among older adults and the availability of treatment options for depression, these results highlight the importance of screening/treatment for depression, particularly among older adults with socioeconomic vulnerabilities, to slow the progression of functional decline in later life.
Collapse
Affiliation(s)
- Anda Botoseneanu
- Department of Health and Human Services, University of Michigan, Dearborn, MI, USA; Institute of Gerontology, University of Michigan, Ann Arbor, MI, USA.
| | - Miriam R Elman
- OHSU-PSU School of Public Health, Oregon Health and Science University, Portland, OR, USA
| | - Heather G Allore
- Department of Internal Medicine, School of Medicine, Yale University, New Haven, CT, USA; Department of Biostatistics, School of Public Health, Yale University, New Haven, CT, USA
| | - David A Dorr
- Department of Medical Informatics and Clinical Epidemiology, OHSU, Portland, OR, USA
| | - Jason T Newsom
- Department of Psychology, Portland State University, Portland, OR, USA
| | - Corey L Nagel
- College of Nursing, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Ana R Quiñones
- OHSU-PSU School of Public Health, Oregon Health and Science University, Portland, OR, USA; Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
| |
Collapse
|
9
|
Sinclair AJ, Abdelhafiz AH. Multimorbidity, Frailty and Diabetes in Older People-Identifying Interrelationships and Outcomes. J Pers Med 2022; 12:1911. [PMID: 36422087 PMCID: PMC9695437 DOI: 10.3390/jpm12111911] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/09/2022] [Accepted: 11/14/2022] [Indexed: 08/11/2023] Open
Abstract
Multimorbidity and frailty are highly prevalent in older people with diabetes. This high prevalence is likely due to a combination of ageing and diabetes-related complications and other diabetes-associated comorbidities. Both multimorbidity and frailty are associated with a wide range of adverse outcomes in older people with diabetes, which are proportionally related to the number of morbidities and to the severity of frailty. Although, the multimorbidity pattern or cluster of morbidities that have the most adverse effect are not yet well defined, it appears that mental health disorders enhance the multimorbidity-related adverse outcomes. Therefore, comprehensive diabetes guidelines that incorporate a holistic approach that includes screening and management of mental health disorders such as depression is required. The adverse outcomes predicted by multimorbidity and frailty appear to be similar and include an increased risk of health care utilisation, disability and mortality. The differential effect of one condition on outcomes, independent of the other, still needs future exploration. In addition, prospective clinical trials are required to investigate whether interventions to reduce multimorbidity and frailty both separately and in combination would improve clinical outcomes.
Collapse
Affiliation(s)
- Alan J. Sinclair
- Foundation for Diabetes Research in Older People (fDROP), King’s College, London WC2R 2LS, UK
- Rotherham General Hospital Foundation Trust, Rotherham S60 2UD, UK
| | - Ahmed H. Abdelhafiz
- Foundation for Diabetes Research in Older People (fDROP), King’s College, London WC2R 2LS, UK
- Department of Geriatric Medicine, Rotherham General Hospital, Rotherham S60 2UD, UK
| |
Collapse
|
10
|
Yamamoto Y, Murata Y, Tanaka N, Shigemura T, Maruyama J, Nakane R, Wada Y. Mobile application for home exercise adherence in patients with knee osteoarthritis: A pilot study. Medicine (Baltimore) 2022; 101:e31181. [PMID: 36281120 PMCID: PMC9592287 DOI: 10.1097/md.0000000000031181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND The adherence to home exercise is generally low despite its well-known effect on knee osteoarthritis. Therefore, we developed a home exercise application, LongLifeSupport, to provide patients with daily basic exercise videos and an automatic recording calendar. We hypothesized that this application would encourage patients to exercise and help maintain their motivation; this pilot study aimed to determine their exercise adherence rates. Using outcome measures, we also aimed to determine the effect of home exercise using this application and the factors for its continuation. METHODS Twenty patients with knee osteoarthritis were included. The participants exercised for 12 weeks. Using pre- and post-tests, we examined their satisfaction with continuation (only in the post-test), Japanese knee osteoarthritis measure score, short physical performance battery score, bilateral knee extension muscle strength, and short test battery for locomotive syndrome. Furthermore, we investigated correlations between adherence rates and pretest scores of Japanese knee osteoarthritis measure and short test battery and between pretest scores and variations in Japanese knee osteoarthritis measure and short test battery. RESULTS The mean adherence rate was 82.4%. The participants showed ease of continuation (100%) and significant improvements in the degree of knee pain, pain, and stiffness, and daily life conditions using the Japanese knee osteoarthritis measure score, total score, walk seconds, and chair stand seconds of the short physical performance battery, as well as the extension muscle strength of the right- and pain-side knee. No significant correlations were identified between the adherence rate and the pretest or variation. CONCLUSION The adherence rate to the application was over 80%. Participants with knee osteoarthritis showed almost full satisfaction, reduced pain, and improved physical ability. Therefore, the use of this application provided a safe exercise program and maintained the exercise motivation of participants. Thus, it may be useful for unsupervised home exercise.
Collapse
Affiliation(s)
- Yohei Yamamoto
- Department of Orthopedic Surgery, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan
- *Correspondence: Yohei Yamamoto, Department of Orthopedic Surgery, Teikyo University Chiba Medical Center, 3426-3 Anesaki, 299-0111 Ichihara, Chiba, Japan (e-mail: )
| | - Yasuaki Murata
- Department of Orthopedic Surgery, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan
| | - Naofumi Tanaka
- Department of Rehabilitation, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan
| | - Tomonori Shigemura
- Department of Orthopedic Surgery, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan
| | - Juntaro Maruyama
- Department of Orthopedic Surgery, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan
| | - Ryo Nakane
- Department of Orthopedic Surgery, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan
| | - Yuichi Wada
- Department of Orthopedic Surgery, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan
| |
Collapse
|
11
|
Carman W, Ishida M, Trounson JS, Mercer SW, Anindya K, Sum G, Armstrong G, Oldenburg B, McPake B, Lee JT. Epidemiology of physical-mental multimorbidity and its impact among Aboriginal and Torres Strait Islander in Australia: a cross-sectional analysis of a nationally representative sample. BMJ Open 2022; 12:e054999. [PMID: 36220313 PMCID: PMC9557280 DOI: 10.1136/bmjopen-2021-054999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES This study aimed to examine the differences in multimorbidity between Aboriginal and Torres Strait Islander people and non-Indigenous Australians, and the effect of multimorbidity on health service use and work productivity. SETTING Cross-sectional sample of the Household, Income and Labour Dynamics in Australia wave 17. PARTICIPANTS A nationally representative sample of 16 749 respondents aged 18 years and above. OUTCOME MEASURES Multimorbidity prevalence and pattern, self-reported health, health service use and employment productivity by Indigenous status. RESULTS Aboriginal respondents reported a higher prevalence of multimorbidity (24.2%) compared with non-Indigenous Australians (20.7%), and the prevalence of mental-physical multimorbidity was almost twice as high (16.1% vs 8.1%). Multimorbidity pattern varies significantly among the Aboriginal and non-Indigenous Australians. Multimorbidity was associated with higher health service use (any overnight admission: adjusted OR=1.52, 95% CI=1.46 to 1.58), reduced employment productivity (days of sick leave: coefficient=0.25, 95% CI=0.19 to 0.31) and lower perceived health status (SF6D score: coefficient=-0.04, 95% CI=-0.05 to -0.04). These associations were found to be comparable in both Aboriginal and non-Indigenous populations. CONCLUSIONS Multimorbidity prevalence was significantly greater among Aboriginal and Torres Strait Islanders compared with the non-Indigenous population, especially mental-physical multimorbidity. Strategies are required for better prevention and management of multimorbidity for the aboriginal population to reduce health inequalities in Australia.
Collapse
Affiliation(s)
- William Carman
- Nossal Institute for Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Marie Ishida
- Nossal Institute for Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Justin S Trounson
- Centre for Forensic Behavioural Science, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Stewart W Mercer
- The Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - Kanya Anindya
- Nossal Institute for Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Grace Sum
- Saw Swee Hock School of Public Health, National University Singapore, Singapore
| | - Gregory Armstrong
- Nossal Institute for Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Brian Oldenburg
- Nossal Institute for Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Barbara McPake
- Nossal Institute for Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - John Tayu Lee
- Nossal Institute for Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Primary Care and Public Health, Imperial College London, London, UK
- Department of Health Service Research, Faculty of Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| |
Collapse
|
12
|
Shin J, Kim GS. Patterns of change and factors associated with IADL function decline in community-dwelling older adults with arthritis. Sci Rep 2022; 12:16840. [PMID: 36207328 PMCID: PMC9546837 DOI: 10.1038/s41598-022-19791-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 09/05/2022] [Indexed: 11/23/2022] Open
Abstract
Arthritis is a major cause of functional decline, which affects the quality of life (QoL) of older adults. This study analyzed instrumental activities of daily living (IADL) patterns in older adults with arthritis and the risk factors of functional decline. Data from the Korean Longitudinal Study of Aging (KLoSA), in which the participants were community-dwelling older adults aged ≥ 65 years and conducted every two years, were used to examine patterns in IADL performance between 2006 and 2016. The participants comprised 1,822 older adults, divided into an arthritis group and a non-arthritis group. A Generalized Estimating Equations (GEE) model and Kaplan–Meier analysis was used for the data analysis. The arthritis groups showed a statistically significant decrease in IADL function in 2012 (β = 1.283, p = 0.026), 2014 (β = 1.323, p = 0.028), and 2016 (β = 1.484, p = 0.014). The GEE model identified psychological conditions (depressive symptoms, cognitive function) and number of chronic diseases in the arthritis group as risk factors for increased IADL dependence. Healthcare providers should develop strategies to manage long-term functional decline, including programs to manage and prevent chronic diseases, cognitive function decline, and keep depressive symptoms under control, beginning within six years of arthritis diagnosis.
Collapse
Affiliation(s)
- Jinhee Shin
- College of Nursing, Woosuk University, Wanju, Jeollabuk-do, 55338, Republic of Korea
| | - Gwang Suk Kim
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, Republic of Korea.
| |
Collapse
|
13
|
Yan J, Wang M, Cao Y. Patterns of multimorbidity in association with falls among the middle-aged and older adults: results from the China Health and Retirement Longitudinal Study. BMC Public Health 2022; 22:1814. [PMID: 36153523 PMCID: PMC9508710 DOI: 10.1186/s12889-022-14124-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 08/31/2022] [Indexed: 12/02/2022] Open
Abstract
Background Chronic diseases are important risk factors of falls. However, most studies explored the effect of a single chronic disease on falls and few studies explored the combined effect of multiple chronic diseases on falls. In this study, we examined the associations between falls and multimorbidity and multimorbidity patterns. Methods Data collected between 2011 and 2018 were obtained from the China Health and Retirement Longitudinal Study (CHARLS). Multimorbidity was defined as the coexistence of ≥ 2 chronic diseases in the same person. The multimorbidity patterns were identified with exploratory factor analysis (EFA). The longitudinal associations of multimorbidity and multimorbidity patterns with falls were examined with generalized estimating equations methodology. Results Compared with patients without chronic conditions, patients with one, two, and ≥ 3 chronic diseases had 37%, 85%, and 175% increased risk of falls, respectively. The EFA identified four multimorbidity patterns and the factor scores in the cardiac-metabolic pattern [adjusted odds ratio (aOR): 1.16, 95% confidence interval (95% CI): 1.12–1.20)], visceral-arthritic pattern (aOR: 1.31, 95% CI: 1.28–1.35), respiratory pattern (aOR: 1.12, 95% CI: 1.10–1.16), and mental-sensory pattern (aOR: 1.31, 95% CI: 1.28–1.35) were all associated with a higher risk of falls. Conclusion Multimorbidity and multimorbidity patterns are related to falls. Older adults with multiple chronic diseases require early interventions to prevent falls.
Collapse
|
14
|
Shi Z, Zhang Z, Shi K, Yu B, Jiang Z, Yang L, Lin J, Fang Y. Association between multimorbidity trajectories and incident disability among mid to older age adults: China Health and Retirement Longitudinal Study. BMC Geriatr 2022; 22:741. [PMID: 36096760 PMCID: PMC9469590 DOI: 10.1186/s12877-022-03421-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 08/17/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although multimorbidity is a risk factor for disability, the relationship between the accumulative patterns of multimorbidity and disability remains poorly understood. The objective of this study was to identify the latent groups of multimorbidity trajectories among mid to older age adults and to examine their associations with incident disability. METHODS We included 5,548 participants aged ≥ 45 years who participated in the China Health and Retirement Longitudinal Study from 2011 to 2018 and had no multimorbidity (≥ 2 chronic conditions) at baseline. The group-based multi-trajectory modeling was used to identify distinct trajectory groups of multimorbidity based on the latent dimensions underlying 13 chronic conditions. The association between multimorbidity trajectories and incident disability was analyzed using the generalized estimating equation model adjusting for potential confounders. RESULTS Of the 5,548 participants included in the current analysis, 2,407 (43.39%) developed multimorbidity during the follow-up. Among participants with new-onset multimorbidity, four trajectory groups were identified according to the combination of newly diagnosed diseases: "Cardiometabolic" (N = 821, 34.11%), "Digestive-arthritic" (N = 753, 31.28%), "Cardiometabolic/Brain" (N = 618, 25.68%), and "Respiratory" (N = 215, 8.93%). Compared to participants who did not develop multimorbidity, the risk of incident disability was most significantly increased in the "Cardiometabolic/Brain" trajectory group (OR = 2.05, 95% CI: 1.55-2.70), followed by the "Cardiometabolic" (OR = 1.96, 95% CI: 1.52 -2.53) and "Digestive-arthritic" (OR = 1.70, 95% CI: 1.31-2.20) trajectory groups. CONCLUSIONS The growing burden of multimorbidity, especially the comorbid of cardiometabolic and brain diseases, may be associated with a significantly increased risk of disability for mid to older age adults. These findings improve our understanding of multimorbidity patterns that affect the independence of living and inform the development of strategies for the primary prevention of disability.
Collapse
Affiliation(s)
- Zaixing Shi
- School of Public Health, Xiamen University, Xiamen, 361102, China.,State Key Laboratory of Molecular Vaccine and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, 361102, China.,Key Laboratory of Health Technology Assessment of Fujian Province, School of Public Health, Xiamen University, Xiamen, 361102, China
| | - Zeyun Zhang
- School of Public Health, Xiamen University, Xiamen, 361102, China
| | - Kanglin Shi
- School of Public Health, Xiamen University, Xiamen, 361102, China
| | - Bohan Yu
- School of Public Health, Xiamen University, Xiamen, 361102, China
| | - Zhongquan Jiang
- School of Public Health, Xiamen University, Xiamen, 361102, China
| | - Li Yang
- School of Public Health, Xiamen University, Xiamen, 361102, China
| | - Jianlin Lin
- School of Public Health, Xiamen University, Xiamen, 361102, China
| | - Ya Fang
- School of Public Health, Xiamen University, Xiamen, 361102, China. .,State Key Laboratory of Molecular Vaccine and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, 361102, China. .,Key Laboratory of Health Technology Assessment of Fujian Province, School of Public Health, Xiamen University, Xiamen, 361102, China.
| |
Collapse
|
15
|
Honda Y, Nakamura M, Aoki T, Ojima T. Multimorbidity patterns and the relation to self-rated health among older Japanese people: a nationwide cross-sectional study. BMJ Open 2022; 12:e063729. [PMID: 36538382 PMCID: PMC9438194 DOI: 10.1136/bmjopen-2022-063729] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Classifying individuals into multimorbidity patterns can be useful to identify the target population with poorer clinical outcomes. Self-rated health (SRH) is one of the core outcomes in multimorbidity patients. Although studies have reported that multimorbidity is associated with poor SRH, whether certain patterns have stronger associations remains unknown. Therefore, this study aimed to identify the prevalence and patterns of multimorbidity and investigate the association between multimorbidity patterns and SRH in an older Japanese population. DESIGN Cross-sectional study. SETTING Data were obtained from the 2013 Comprehensive Survey of Living Conditions, a nationally representative survey of the general Japanese population. PARTICIPANTS This study mainly examined 23 730 participants aged ≥65 years who were not hospitalised or institutionalised. PRIMARY OUTCOME MEASURE Poor SRH was defined as choosing 'not very good' or 'bad' from five options: 'excellent', 'fairly good', 'average', 'not very good' and 'bad'. RESULTS The prevalence of multimorbidity was 40.9% and that of poor SRH was 23.8%. Three multimorbidity patterns were identified by exploratory factor analysis: (1) degenerative/mental health, (3) malignant/digestive/urological/haematological and (3) cardiovascular/metabolic. Multivariable modified Poisson regression analysis revealed that high malignant/digestive/urological/haematological, degenerative/mental health and cardiovascular/metabolic pattern scores, corresponding to the number of affected body systems in each pattern, were significantly associated with poor SRH (adjusted risk ratio (aRR)=1.68, 95% CI: 1.60 to 1.76; aRR=1.63, 95% CI: 1.58 to 1.69; and aRR=1.31, 95% CI: 1.26 to 1.36, respectively). When including the Kessler 6 score, a screening scale for psychological distress, in the analysis, the association between each multimorbidity pattern score and poor SRH decreased. CONCLUSIONS Malignant/digestive/urological/haematological and degenerative/mental health patterns may be associated with a high risk for poor SRH. Further research should focus on interventions to improve SRH in multimorbidity patients.
Collapse
Affiliation(s)
- Yuki Honda
- Department of Community Health and Preventive Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
- Department of General Internal Medicine, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Mieko Nakamura
- Department of Community Health and Preventive Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Takuya Aoki
- Division of Clinical Epidemiology, Research Center for Medical Sciences, The Jikei University School of Medicine, Minato-ku, Japan
| | - Toshiyuki Ojima
- Department of Community Health and Preventive Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| |
Collapse
|
16
|
Zhou J, Wei MY, Zhang J, Liu H, Wu C. Association of multimorbidity patterns with incident disability and recovery of independence among middle-aged and older adults. Age Ageing 2022; 51:afac177. [PMID: 35930720 DOI: 10.1093/ageing/afac177] [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] [Received: 03/12/2022] [Revised: 05/17/2022] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE to identify multimorbidity patterns among middle-aged and older adults in China and examine how these patterns are associated with incident disability and recovery of independence. METHODS data were from The China Health and Retirement Longitudinal Study. We included 14,613 persons aged ≥45 years. Latent class analysis (LCA) was conducted to identify multimorbidity patterns with clinical meaningfulness. Multinomial logistic models were used to determine the adjusted association between multimorbidity patterns and incident disability and recovery of independence. RESULTS we identified four multimorbidity patterns: 'low morbidity' (67.91% of the sample), 'pulmonary-digestive-rheumatic' (17.28%), 'cardiovascular-metabolic-neuro' (10.77%) and 'high morbidity' (4.04%). Compared to the 'low morbidity' group, 'high morbidity' (OR = 2.63, 95% CI = 1.97-3.51), 'pulmonary-digestive-rheumatic' (OR = 1.89, 95% CI = 1.63-2.21) and 'cardiovascular-metabolic-neuro' pattern (OR = 1.61, 95% CI = 1.31-1.97) had higher odds of incident disability in adjusted multinomial logistic models. The 'cardiovascular-metabolic-neuro' (OR = 0.60, 95% CI = 0.44-0.81), 'high morbidity' (OR = 0.68, 95% CI = 0.47-0.98) and 'pulmonary-digestive-rheumatic' group (OR = 0.75, 95% CI = 0.60-0.95) had lower odds of recovery from disability than the 'low morbidity' group. Among people without disability, the 'cardiovascular-endocrine-neuro' pattern was associated with the highest 2-year mortality (OR = 2.42, 95% CI = 1.56-3.72). CONCLUSIONS multimorbidity is complex and heterogeneous, but our study demonstrates that clinically meaningful patterns can be obtained using LCA. We highlight four multimorbidity patterns with differential effects on incident disability and recovery from disability. These studies suggest that targeted prevention and treatment approaches are needed for people with multimorbidity.
Collapse
Affiliation(s)
- Jiayi Zhou
- School of Public Health, LKS Faculty of Medicine, University of Hong Kong, Hong Kong 999077, China
- Global Health Research Center, Duke Kunshan University, Kunshan 215316, China
| | - Melissa Y Wei
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
| | - Jingyi Zhang
- College of Arts and Sciences, Hanover, NH 02747, USA
| | - Hua Liu
- Department of Neurosurgery, The Affiliated Kunshan Hospital of Jiangsu University, Suzhou, China
| | - Chenkai Wu
- Global Health Research Center, Duke Kunshan University, Kunshan 215316, China
| |
Collapse
|
17
|
Puri P, Singh SK, Pati S. Identifying non-communicable disease multimorbidity patterns and associated factors: a latent class analysis approach. BMJ Open 2022; 12:e053981. [PMID: 35820748 PMCID: PMC9277367 DOI: 10.1136/bmjopen-2021-053981] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 05/27/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE In the absence of adequate nationally-representative empirical evidence on multimorbidity, the existing healthcare delivery system is not adequately oriented to cater to the growing needs of the older adult population. Therefore, the present study identifies frequently occurring multimorbidity patterns among older adults in India. Further, the study examines the linkages between the identified patterns and socioeconomic, demographic, lifestyle and anthropometric correlates. DESIGN The present findings rest on a large nationally-representative sample from a cross-sectional study. SETTING AND PARTICIPANTS The study used data on 58 975 older adults (45 years and older) from the Longitudinal Ageing Study in India, 2017-2018. PRIMARY AND SECONDARY OUTCOME MEASURES The study incorporated a list of 16 non-communicable diseases to identify commonly occurring patterns using latent class analysis. The study employed multinomial logistic regression models to assess the association between identified disease patterns with unit-level socioeconomic, demographic, lifestyle and anthropometric characteristics. RESULTS The present study demonstrates that older adults in the country can be segmented into six patterns: 'relatively healthy', 'hypertension', 'gastrointestinal disorders-hypertension-musculoskeletal disorders', 'musculoskeletal disorders-hypertension-asthma', 'metabolic disorders' and 'complex cardiometabolic disorders'. Additionally, socioeconomic, demographic, lifestyle and anthropometric factors are significantly associated with one or more identified disease patterns. CONCLUSIONS The identified classes 'hypertension', 'metabolic disorders' and 'complex cardiometabolic disorders' reflect three stages of cardiometabolic morbidity with hypertension as the first and 'complex cardiometabolic disorders' as the last stage of disease progression. This underscores the need for effective prevention strategies for high-risk hypertension group. Also, targeted interventions are essential to reduce the burden on the high-risk population and provide equitable health services at the community level.
Collapse
Affiliation(s)
- Parul Puri
- Department of Survey Research and Data Analytics, International Institute for Population Sciences, Mumbai, Maharashtra, India
| | - Shri Kant Singh
- Department of Survey Research and Data Analytics, International Institute for Population Sciences, Mumbai, Maharashtra, India
| | - Sanghamitra Pati
- Department of Health Research, Indian Council of Medical Research Chandrasekharpur, Bhubaneswar, Orissa, India
| |
Collapse
|
18
|
Berner K, Tawa N, Louw Q. Multimorbidity patterns and function among adults in low- and middle-income countries: a scoping review protocol. Syst Rev 2022; 11:139. [PMID: 35799277 PMCID: PMC9261061 DOI: 10.1186/s13643-022-01996-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 05/28/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND A fifth of adults in low- and middle-income countries (LMICs) have multimorbid conditions, which are linked to socio-economic deprivation and aging. Multimorbidity is associated with high rates of functional problems and disability, increased healthcare utilization, and lower quality of life. Literature on multimorbidity and associations with function is mostly from high-income countries (HICs) and focused among older adults. Moreover, data regarding disease patterns and their impact on person-centered outcomes are limited. There is a need for research into understanding common patterns of multimorbidity, and their association with functional impairments, particularly in LMICs. Such information may contribute towards evidence-based and context-relevant strategic policy, planning, and delivery models for health and rehabilitation services, which is imperative in attaining Universal Health Coverage (UHC). The planned scoping review aims to provide an overview of the scope and nature of existing literature on multimorbidity patterns and function among adults in LMICs. METHODS A scoping review will be conducted using a five-step framework and reported according to the PRISMA-ScR guidelines. A comprehensive electronic search of PubMed/MEDLINE, Scopus, EBSCOhost, Scielo, Cochrane and Google Scholar will be conducted and updated from the last pilot search ran in September 2020. Studies of any design will be included if they are reported in English, published (between January 1976 and the last search date) in a peer-reviewed journal, and describe multimorbidity patterns and associations with physical functional impairments, activity limitations or participation restrictions among adults in LMICs. Search results will be independently screened by two reviewers and data extraction will cover study characteristics, participants' characteristics, multimorbidity measures, patterns analysis, and functional measures. Descriptive statistics and narrative synthesis will be used to synthesize and summarize findings. DISCUSSION Patients with multimorbidity have unique and cross-cutting needs, hence the need for integrated and person-centered approaches to policy, planning, and delivery of medical and rehabilitation services. Considering the shift towards UHC and primary healthcare-led management of chronic diseases, the proposed scoping review is timely. Findings will provide insights into the current extent and scope of multimorbidity research, and guide future inquiry in the field. TRIAL REGISTRATION Open Science Framework (OSF), https://osf.io/gcy7z/.
Collapse
Affiliation(s)
- Karina Berner
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, P.O. Box 241, Cape Town, 8000, South Africa.
| | - Nassib Tawa
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, P.O. Box 241, Cape Town, 8000, South Africa.,Centre for Research in Spinal Health and Rehabilitation Medicine, Department of Rehabilitation Sciences, College of Health Sciences, Jomo Kenyatta University of Agriculture and Technology, P. O. Box 62000, Nairobi, 00200, Kenya
| | - Quinette Louw
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, P.O. Box 241, Cape Town, 8000, South Africa
| |
Collapse
|
19
|
Social Interaction, Lifestyle, and Depressive Status: Mediators in the Longitudinal Relationship between Cognitive Function and Instrumental Activities of Daily Living Disability among Older Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074235. [PMID: 35409918 PMCID: PMC8998450 DOI: 10.3390/ijerph19074235] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 03/29/2022] [Accepted: 03/31/2022] [Indexed: 12/04/2022]
Abstract
(1) Background: Cognitive decline is associated with instrumental activities of daily living (IADL) disability. Intervention targeting the mediators of this association will provide a path to avoid cognition-related IADL disability. (2) Methods: This study used data of wave 2008 (baseline) and wave 2014 of Chinese Longitudinal Healthy Longevity Surveys. Structural equation modeling was conducted to examine the mediating effect of social interaction, lifestyle (fruit and vegetable intake; exercise habits), and depressive status on the association between four baseline cognitive function dimensions (measured by the Chinese version of the Mini-Mental State Examination) and five (2014) IADL dimensions (visiting neighbors, shopping, preparing meals, washing clothes, and taking public transportation). (3) Results: Among 1976 older adults, 29.1% developed IADL disability 6 years later. The cognition−disability association was completely mediated by social interaction (estimate = −0.095, p < 0.001), lifestyle (estimate = −0.086, p < 0.001), and depressive status (estimate = −0.017, p = 0.003). The mediating effects of social interaction (46.3% variances explained) and lifestyle (42.0% variances explained) were both larger than that of depressive status (8.3% variances explained). (4) Conclusions: The development of interventions aimed at improving social interaction, depression, and lifestyle could be of value to prevent cognition-related IADL disability.
Collapse
|
20
|
Lord S, Teh R, Gibson R, Smith M, Wrapson W, Thomson M, Rolleston A, Neville S, McBain L, Del Din S, Taylor L, Kayes N, Kingston A, Abey-Nesbit R, Kerse N. Optimising function and well-being in older adults: protocol for an integrated research programme in Aotearoa/New Zealand. BMC Geriatr 2022; 22:215. [PMID: 35296250 PMCID: PMC8925165 DOI: 10.1186/s12877-022-02845-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 02/15/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Maintaining independence is of key importance to older people. Ways to enable health strategies, strengthen and support whanāu (family) at the community level are needed. The Ageing Well through Eating, Sleeping, Socialising and Mobility (AWESSOM) programme in Aotearoa/New Zealand (NZ) delivers five integrated studies across different ethnicities and ages to optimise well-being and to reverse the trajectory of functional decline and dependence associated with ageing. METHODS Well-being, independence and the trajectory of dependence are constructs viewed differently according to ethnicity, age, and socio-cultural circumstance. For each AWESSoM study these constructs are defined and guide study development through collaboration with a wide range of stakeholders, and with reference to current evidence. The Compression of Functional Decline model (CFD) underpins aspects of the programme. Interventions vary to optimise engagement and include a co-developed whānau (family) centred initiative (Ngā Pou o Rongo), the use of a novel LifeCurve™App to support behavioural change, development of health and social initiatives to support Pacific elders, and the use of a comprehensive oral health and cognitive stimulation programme for cohorts in aged residential care. Running parallel to these interventions is analysis of large data sets from primary care providers and national health databases to understand complex multi-morbidities and identify those at risk of adverse outcomes. Themes or target areas of sleep, physical activity, oral health, and social connectedness complement social capital and community integration in a balanced programme involving older people across the ability spectrum. DISCUSSION AWESSoM delivers a programme of bespoke yet integrated studies. Outcomes and process analysis from this research will inform about novel approaches to implement relevant, socio-cultural interventions to optimise well-being and health, and to reverse the trajectory of decline experienced with age. TRIAL REGISTRATION The At-risk cohort study was registered by the Australian New Zealand Clinical Trials registry on 08/12/2021 (Registration number ACTRN 12621001679875 ).
Collapse
Affiliation(s)
- Sue Lord
- School of Clinical Sciences, Faculty of Health & Environmental Sciences, Auckland University of Technology, Akoranga Drive, Northcote, Auckland, 0627, New Zealand.
| | - Ruth Teh
- School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Rosie Gibson
- School of Health Sciences, Massey University, Wellington, New Zealand
| | - Moira Smith
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Wendy Wrapson
- AUT Public Health and Mental Health Research Institute, Auckland University of Technology, Auckland, New Zealand
| | - Murray Thomson
- Department of Oral Sciences, University of Otago, Dunedin, New Zealand
| | | | - Stephen Neville
- School of Clinical Sciences, Faculty of Health & Environmental Sciences, Auckland University of Technology, Akoranga Drive, Northcote, Auckland, 0627, New Zealand
| | | | - Silvia Del Din
- Clinical Ageing Research Unit, Newcastle University, Newcastle Upon Tyne, UK
| | - Lynne Taylor
- School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Nicola Kayes
- School of Clinical Sciences, Faculty of Health & Environmental Sciences, Auckland University of Technology, Akoranga Drive, Northcote, Auckland, 0627, New Zealand
| | - Andrew Kingston
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
| | - Rebecca Abey-Nesbit
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK.,Department of Medicine, Canterbury District Health Board, Christchurch, New Zealand
| | - Ngaire Kerse
- School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | | |
Collapse
|
21
|
Luo Y, Huang Z, Liu H, Xu H, Su H, Chen Y, Hu Y, Xu B. Development and Validation of a Multimorbidity Index Predicting Mortality Among Older Chinese Adults. Front Aging Neurosci 2022; 14:767240. [PMID: 35370612 PMCID: PMC8965437 DOI: 10.3389/fnagi.2022.767240] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 02/16/2022] [Indexed: 12/13/2022] Open
Abstract
Objective This study aimed to develop and validate a multimorbidity index using self-reported chronic conditions for predicting 5-year mortality risk. Methods We analyzed data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) and included 11,853 community-dwelling older adults aged 65–84 years. Restrictive association rule mining (ARM) was used to identify disease combinations associated with mortality based on 13 chronic conditions. Data were randomly split into the training (N = 8,298) and validation (N = 3,555) sets. Two multimorbidity indices with individual diseases only (MI) and disease combinations (MIDC) were developed using hazard ratios (HRs) for 5-year morality in the training set. We compared the predictive performance in the validation set between the models using condition count, MI, and MIDC by the concordance (C) statistic, the Integrated Discrimination Improvement (IDI), and the Net Reclassification Index (NRI). Results A total of 13 disease combinations were identified. Compared with condition count (C-statistic: 0.710), MIDC (C-statistic: 0.713) showed significantly better discriminative ability (C-statistic: p = 0.016; IDI: 0.005, p < 0.001; NRI: 0.038, p = 0.478). Compared with MI (C-statistic: 0.711), the C-statistic of the model using MIDC was significantly higher (p = 0.031), while the IDI was more than 0 but not statistically significant (IDI: 0.003, p = 0.090). Conclusion Although current multimorbidity status is commonly defined by individual chronic conditions, this study found that the multimorbidity index incorporating disease combinations showed supreme performance in predicting mortality among community-dwelling older adults. These findings suggest a need to consider significant disease combinations when measuring multimorbidity in medical research and clinical practice.
Collapse
Affiliation(s)
- Yan Luo
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
- Medical Informatics Center, Peking University, Beijing, China
| | - Ziting Huang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
- Medical Informatics Center, Peking University, Beijing, China
| | - Hui Liu
- Medical Informatics Center, Peking University, Beijing, China
| | - Huiwen Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
- Medical Informatics Center, Peking University, Beijing, China
| | - Hexuan Su
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
- Medical Informatics Center, Peking University, Beijing, China
| | - Yuming Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
- Medical Informatics Center, Peking University, Beijing, China
| | - Yonghua Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
- Medical Informatics Center, Peking University, Beijing, China
| | - Beibei Xu
- Medical Informatics Center, Peking University, Beijing, China
- *Correspondence: Beibei Xu,
| |
Collapse
|
22
|
Ho HE, Yeh CJ, Wei JCC, Chu WM, Lee MC. Multimorbidity patterns and their relationships with incident disability and frailty among older adults in Taiwan: a 16-year, population-based cohort study. Arch Gerontol Geriatr 2022; 101:104688. [DOI: 10.1016/j.archger.2022.104688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/15/2022] [Accepted: 03/15/2022] [Indexed: 11/25/2022]
|
23
|
Puri P, Singh SK. Patterns and predictors of non-communicable disease multimorbidity among older adults in India: evidence from longitudinal ageing study in India (LASI), 2017-2018. J Public Health Policy 2022; 43:109-128. [PMID: 34997210 DOI: 10.1057/s41271-021-00321-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2021] [Indexed: 12/13/2022]
Abstract
Escalating non-communicable disease multimorbidity rates among older adults is an emerging public health concern in India, but the literature sparsely addresses the epidemiology of multimorbidity. We explore levels, patterns, combinations and predictors of multimorbidity among older adults using information on 59,764 individuals, aged 45 years and older, from the first wave of Longitudinal Ageing Study in India (LASI), 2017-2018. We computed multimorbidity score for sixteen non-communicable diseases to identify frequently occurring morbidity patterns (dyads and triads) and assess the relationship between multimorbidity and selected background characteristics. Near third of the older adult population is affected by multimorbidity, with hypertension, gastrointestinal disorders, musculoskeletal disorders, diabetes and skin diseases being the most common. Policymakers should seek strategies to increase early detection and prevention of chronic diseases, delay the age at onset of disease for those who are not affected and improve management for those affected with multiple disease conditions.
Collapse
Affiliation(s)
- Parul Puri
- International Institute for Population Sciences, Govandi Station Road, Mumbai, Maharashtra, India.
| | - Shri Kant Singh
- Department of Survey Research and Data Analytics, International Institute for Population Sciences, Mumbai, Maharashtra, India
| |
Collapse
|
24
|
Vetrano DL, Damiano C, Tazzeo C, Zucchelli A, Marengoni A, Luo H, Zazzara MB, van Hout H, Onder G. Multimorbidity Patterns and 5-Year Mortality in Institutionalized Older Adults. J Am Med Dir Assoc 2022; 23:1389-1395.e4. [PMID: 35218731 DOI: 10.1016/j.jamda.2022.01.067] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 01/12/2022] [Accepted: 01/22/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The aim was to characterize multimorbidity patterns in a large sample of older individuals living in nursing homes (NHs) and to investigate their association with mortality, also considering the effect of functional status. DESIGN Observational and retrospective study. SETTING AND PARTICIPANTS We analyzed data on 4131 NH residents in Italy, aged 60 years and older, assessed through the interRAI long-term care facility instrument. Entry date was between 2014 and 2018, and participants were followed until 2019. METHODS Multimorbidity patterns were identified through principal component analysis; for the identified components, subjects were stratified in quintiles (Q) with respect to their loading values, with the higher quantiles indicating greater expression of the component's pattern. Their association [hazard ratio (HR) and 95% CI] with mortality was tested in Cox regression models. Analyses were stratified by disability status. RESULTS Four patterns of multimorbidity were identified: (1) heart diseases; (2) dementia and sensory impairments; (3) heart, respiratory, and psychiatric diseases; and (4) diabetes, musculoskeletal, and vascular diseases. For the heart diseases pattern [HR Q5 vs Q1 = 1.83 (1.53-2.20)] and the dementia and sensory impairments pattern [HR Q5 vs Q1 = 1.23 (1.06-1.42)], as the specific multimorbidity expression increases, the risk of mortality increases. On stratifying by disability status, the association between the multimorbidity patterns and mortality was not always present. CONCLUSIONS AND IMPLICATIONS Different multimorbidity patterns are differentially associated with mortality in older residents of NHs, confirming that multimorbidity's prognosis is strictly dependent on the underlying disease combinations. This knowledge may be useful to implement personalized preventive and therapeutic care pathways for institutionalized older adults, which respond to individuals' health needs.
Collapse
Affiliation(s)
- Davide L Vetrano
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Cecilia Damiano
- Università Cattolica del Sacro Cuore, Department of Geriatric and Orthopaedic Sciences, Rome, Italy.
| | - Clare Tazzeo
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Alberto Zucchelli
- Department of Informatic Engineering, University of Brescia, Brescia, Italy
| | - Alessandra Marengoni
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Hao Luo
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China
| | - Maria Beatrice Zazzara
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Department of Gerontology, Neuroscience and Orthopedics, Rome, Italy
| | - Hein van Hout
- Departments of General Practice and Medicine of Older Persons, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands
| | - Graziano Onder
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità, Rome, Italy
| |
Collapse
|
25
|
Puri P, Singh SK. Exploring the non-communicable disease (NCD) network of multi-morbid individuals in India: A network analysis. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000512. [PMID: 36962702 PMCID: PMC10021153 DOI: 10.1371/journal.pgph.0000512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 06/09/2022] [Indexed: 11/18/2022]
Abstract
Nationally representative evidence discussing the interplay of non-communicable diseases (diseases) are scarce in India. Therefore, the present study aims to fill this research void by providing empirical evidence on disease networking using a large nationally representative cross-sectional sample segregated by gender among older adults in India. The analysis utilized data on 10,606 multimorbid women and 7,912 multimorbid men from the Longitudinal Ageing Study in India (LASI), 2017-18. Multimorbidity was defined as the co-occurrence of two or more diseases in an individual using a list of 16 self-reported diseases. Weighted networks were visualized to illustrates the complex relationships between the diseases using network analysis. The findings suggest that women possess a higher burden of multimorbidity than men. Hypertension, musculoskeletal disorder, gastrointestinal disorder, diabetes mellitus, and skin diseases were reported as the most recurrent diseases. 'Hypertension-musculoskeletal disorder', 'diabetes mellitus-hypertension', 'gastrointestinal disorders-hypertension' and 'gastrointestinal disorders- musculoskeletal disorder' were recurrent disease combinations among the multimorbid individuals. The study generated compelling evidence to establish that there are statistically significant differences between the prevalence of diseases and how they interact with each other between women and men. These findings further accentuate that disease networks are slightly more complex among women. In totality, the study visualizes disease association, identifies the most influential diseases to the network, and those which acts as a bridge between other diseases, causing multimorbidity among the older adult population in India.
Collapse
Affiliation(s)
- Parul Puri
- Department of Survey Research and Data Analytics, International Institute for Population Sciences, Mumbai, Maharashtra, India
| | - Shri Kant Singh
- Department of Survey Research and Data Analytics, International Institute for Population Sciences, Mumbai, Maharashtra, India
| |
Collapse
|
26
|
Tang LH, Andreasson KH, Thygesen LC, Jepsen R, Møller A, Skou ST. Persistent pain and long-term physical and mental conditions and their association with psychological well-being; data from 10,744 individuals from the Lolland-Falster health study. JOURNAL OF MULTIMORBIDITY AND COMORBIDITY 2022; 12:26335565221128712. [PMID: 36386291 PMCID: PMC9659769 DOI: 10.1177/26335565221128712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Persistent pain (PP) and long-term conditions are all associated with psychological well-being. Less is known about their associations with reduced psychological well-being when co-occurring. We investigated how PP and long-term physical and mental conditions relate to psychological well-being when occurring together. METHOD Data collected in the Danish population-based Lolland-Falster Health study were used in this cross-sectional study. Participants aged ≥18 years completing questions concerning PP, long-term conditions and psychological well-being were included. PP and long-term conditions were defined as conditions lasting 6 months or longer. Psychological well-being was assessed by the World Health Organization Well-Being Index (WHO-5). Multiple linear regression investigated combinations of PP and physical and mental long-term conditions and their associations with WHO-5. RESULTS Of 11,711 participants, 10,744 had available data. One third had PP (n = 3250), while 6144 (57%), 213 (2%) and 946 (9%) reported having only physical conditions, only mental conditions or both, respectively. All combinations of PP and long-term conditions were negatively associated with WHO-5. PP in combination with mental (-23.1 (95% CI -28.3 to -17.8)) or both physical and mental conditions (-25.1 (-26.7 to -23.52) yielded the strongest negative associations. Two or more pain sites together with long-term physical and mental conditions was associated with a lower WHO-5 score (-6.2 (-8.9 to -3.5) compared to none or one pain site. CONCLUSION The presence of PP and long-term conditions, in particular mental conditions, were strongly associated with worse psychological well-being. This highlights the importance of assessing psychological well-being in individuals with PP and long-term conditions.
Collapse
Affiliation(s)
- Lars H Tang
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark
- Department of Regional Health Research, University of Southern Denmark, Denmark
| | - Karen H Andreasson
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark
| | - Lau C Thygesen
- National Institute of Public Health, University of Southern Denmark, Denmark
| | - Randi Jepsen
- Lolland-Falster Health Study, Centre for Epidemiological Research, Nykøbing Falster Hospital, Nykøbing F., Denmark
| | - Anne Møller
- The Research Unit for General Practice and Section of General Practice, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Søren T Skou
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
27
|
Zazzara MB, Vetrano DL, Carfì A, Liperoti R, Damiano C, Onder G. Comorbidity patterns in institutionalized older adults affected by dementia. ALZHEIMER'S & DEMENTIA: DIAGNOSIS, ASSESSMENT & DISEASE MONITORING 2022; 14:e12320. [PMID: 35734097 PMCID: PMC9197250 DOI: 10.1002/dad2.12320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 03/28/2022] [Accepted: 04/14/2022] [Indexed: 11/23/2022]
Abstract
Introduction Dementia is common in nursing homes (NH) residents. Defining dementia comorbidities is instrumental to identify groups of persons with dementia that differ in terms of health trajectories and resources consumption. We performed a cross‐sectional study to identify comorbidity patterns and their associated clinical, behavioral, and functional phenotypes in institutionalized older adults with dementia. Methods We analyzed data on 2563 Italian NH residents with dementia, collected between January 2014 and December 2018 using the multidimensional assessment instrument interRAI Long‐Term Care Facility (LTCF). A standard principal component procedure was used to identify comorbidity patterns. Linear regression analyses were used to ascertain correlates of expression of the different patterns. Results Among NH residents with dementia, we identified three different comorbidity patterns: (1) heart diseases, (2) cardiovascular and respiratory diseases and sensory impairments, and (3) psychiatric diseases. Older age significantly related to increased expression of the first two patterns, while younger patients displayed increased expression of the third one. Recent hospital admissions were associated with increased expression of the heart diseases pattern (β = 0.028; 95% confidence interval [CI] 0.003 to 0.05). Depressive symptoms and delirium episodes increased the expression of the psychiatric diseases pattern (β = 0.130, 95% CI 0.10 to 0.17, and β 0.130, CI 0.10 to 0.17, respectively), while showed a lower expression of the heart diseases pattern. Discussion We identified different comorbidity patterns within NH residents with dementia that differ in term of clinical and functional profiles. The prompt recognition of health needs associated to a comorbidity pattern may help improve long‐term prognosis and quality of life of these individuals. Highlights Defining dementia comorbidities patterns in institutionalized older adults is key. Institutionalized older adults with dementia express different care needs. Comorbidity patterns are instrumental to identify different patients’ phenotypes. Phenotypes vary in terms of health trajectories and demand different care plans. Prompt recognition of phenotypes in nursing homes can positively impact on outcomes.
Collapse
Affiliation(s)
| | - Davide Liborio Vetrano
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University Stockholm Sweden
- Stockholm Gerontology Research Center Stockholm Sweden
| | - Angelo Carfì
- Fondazione Policlinico Universitario A. Gemelli IRCCS Rome Italy
| | - Rosa Liperoti
- Fondazione Policlinico Universitario A. Gemelli IRCCS Rome Italy
| | - Cecilia Damiano
- Department of Cardiovascular Endocrine‑Metabolic Diseases and Aging, Istituto Superiore di Sanità Rome Italy
| | - Graziano Onder
- Department of Cardiovascular Endocrine‑Metabolic Diseases and Aging, Istituto Superiore di Sanità Rome Italy
| |
Collapse
|
28
|
Liu H, Zhang X, Chen B, Fang B, Lou VWQ, Hu J. The Differential Impact of Multimorbidity Patterns and Subsequent Accumulation on Longitudinal Trajectories of Physical Function Decline in a Population-based Cohort of Older People. J Gerontol A Biol Sci Med Sci 2021; 77:1629-1636. [PMID: 34951651 DOI: 10.1093/gerona/glab384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Although both the patterns and accumulation of multimorbidity are important for predicting physical function, studies have not simultaneously examined their impact on functional decline. This study aimed to associate multimorbidity patterns and subsequently developed conditions with longitudinal trajectories of functional decline, and it tested whether the effects of newly developed conditions on functional decline varied across distinct multimorbidity patterns. METHODS We included 6,634 participants aged at least 60 years from the China Health and Retirement Longitudinal Survey. Latent class analysis identified multimorbidity patterns from 14 chronic conditions. Mixed negative binomial models estimated the changes in physical function measured across four waves as a function of multimorbidity patterns, subsequently developed conditions and their interactions. RESULTS Five distinct patterns were identified three years before wave 1: stomach/arthritis (15.7%), cardiometabolic (6.7%), arthritis/hypertension (47.9%), hepatorenal/multi-system (18.3%), and lung/asthma (11.4%). The hepatorenal/multi-system and the lung/asthma pattern were associated with worse baseline physical function, and the hypertension/arthritis pattern was associated with greater decline of physical function. The effect of developing new conditions on decline of physical function over time was most evident for individuals from the cardiometabolic pattern. DISCUSSION Considering both the combinations and progressive nature of multimorbidity is important for identifying individuals at greater risk of disability. Future studies are warranted to differentiate the factors responsible for the progression of chronic conditions in distinct multimorbidity patterns and investigate the potential implications for improved prediction of functional decline.
Collapse
Affiliation(s)
- Huiying Liu
- Department of Sociology, Central South University, Changsha, Hunan province, China.,Sau Po Centre on Ageing, University of Hong Kong, Hong Kong, China
| | - Xinyan Zhang
- Department of Sociology, Central South University, Changsha, Hunan province, China
| | - Beizhuo Chen
- Department of Sociology, Central South University, Changsha, Hunan province, China
| | - Boye Fang
- Sun Yat-Sen University, School of Sociology & Anthropology, Guangzhou, Guangdong province, CN
| | - Vivian W Q Lou
- Sau Po Centre on Ageing, University of Hong Kong, Hong Kong, China.,Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, China
| | - Jian Hu
- Department of Hematology, Xiangya Hospital, Central South University, Changsha, Hunan province, China
| |
Collapse
|
29
|
de Oliveira Campos G, Fenner Bertani R, Thiago Bonardi JM, Ferriolli E, Moriguti JC, Kilza DA Costa Lima N. Acute effects of different types of exercise on the blood pressure of hypertensive older women: a randomized study. J Sports Med Phys Fitness 2021; 61:1404-1410. [PMID: 34652088 DOI: 10.23736/s0022-4707.20.11755-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The magnitude and duration of the hypotensive effect of exercise may be influence by the type of exercise performed. The aim of the present study was to compare systolic (SBP) and diastolic (DBP) blood pressure for 24 hours after a single session of continuous aerobic (CA), interval aerobic (IA), resistance (RE) exercise and control (C), among hypertensive older women under treatment. METHODS The study was conducted on 30 women aged 67.5±5.2 years participating in all sessions applied in random order. After each session, blood pressure was obtained by an oscillometric device and they were submitted to 24-hour ambulatory blood pressure monitoring. RESULTS Immediately after the sessions, a lower SBP value was observed in groups CA and IA compared to groups C and RE. During the 24 hours after sessions, there was a greater reduction of SBP after IA than after other types of exercise, with the reduction after RE being greater than after CA and C (P<0.01). In wakefulness period, the reduction of SBP after IA was more intensive, and, during sleep, IA and RE promoted greater reductions of SBP, with reduction of DBP only after RE (P<0.01). CONCLUSIONS Immediately after the exercise sessions there was a fall in SBP only after aerobic exercises. However, aerobic exercise in the interval mode and RE were more effective in reducing BP over a period of 24 hours.
Collapse
Affiliation(s)
| | - Rodrigo Fenner Bertani
- Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - José M Thiago Bonardi
- Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Eduardo Ferriolli
- Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Julio C Moriguti
- Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Nereida Kilza DA Costa Lima
- Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil -
| |
Collapse
|
30
|
Strandberg TE, Lindström L, Jyväkorpi S, Urtamo A, Pitkälä KH, Kivimäki M. Phenotypic frailty and multimorbidity are independent 18-year mortality risk indicators in older men : The Helsinki Businessmen Study (HBS). Eur Geriatr Med 2021; 12:953-961. [PMID: 33661507 PMCID: PMC8463371 DOI: 10.1007/s41999-021-00472-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 02/12/2021] [Indexed: 01/10/2023]
Abstract
PURPOSE Multimorbidity, prefrailty, and frailty are frequent in ageing populations, but their independent relationships to long-term prognosis in home-dwelling older people are not well recognised. METHODS In the Helsinki Businessmen Study (HBS) men with high socioeconomic status (born 1919-1934, n = 3490) have been followed-up from midlife. In 2000, multimorbidity (≥ 2 conditions), phenotypic prefrailty and frailty were determined in 1365 home-dwelling men with median age of 73 years). Disability was assessed as a possible confounder. 18-year mortality follow-up was established from registers and Cox regression used for analyses. RESULTS Of the men, 433 (31.7%) were nonfrail and without multimorbidity at baseline (reference group), 500 (36.6%) and 82 (6.0%) men had prefrailty or frailty, respectively, without multimorbidity, 84 (6.2%) men had multimorbidity only, and 201 (14.7%) and 65 (4.8%) men had prefrailty or frailty together with multimorbidity. Only 30 (2.2%) and 86 (6.3%) showed signs of ADL or mobility disability. In the fully adjusted analyses (including ADL disability, mental and cognitive status) of 18-year mortality, frailty without multimorbidity (hazard ratio 1.62, 95% confidence interval 1.13-2.31) was associated with similar mortality risk than multimorbidity without frailty (1.55, 1.17-2.06). The presence of both frailty and multimorbidity indicated a strong mortality risk (2.93, 2.10-4.07). CONCLUSION Although multimorbidity is generally considered a substantial health problem, our long-term observational study emphasises that phenotypic frailty alone, independently of disability, may be associated with a similar risk, and a combination of multimorbidity and frailty is an especially strong predictor of mortality.
Collapse
Affiliation(s)
- Timo E Strandberg
- University of Helsinki, Clinicum, and Helsinki University Hospital, Haartmaninkatu 4, PO Box 340, 00029, Helsinki, Finland.
- Center for Life Course Health Research, University of Oulu, Oulu, Finland.
| | | | | | | | - Kaisu H Pitkälä
- University of Helsinki, Clinicum, and Helsinki University Hospital, Haartmaninkatu 4, PO Box 340, 00029, Helsinki, Finland
| | | |
Collapse
|
31
|
Aoki T, Fukuhara S, Fujinuma Y, Yamamoto Y. Effect of multimorbidity patterns on the decline in health-related quality of life: a nationwide prospective cohort study in Japan. BMJ Open 2021; 11:e047812. [PMID: 34127493 PMCID: PMC8204170 DOI: 10.1136/bmjopen-2020-047812] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Longitudinal studies, which consider multimorbidity patterns, are useful for better clarifying the effect of multimorbidity on health-related quality of life (HRQoL) and for identifying the target population with poorer clinical outcomes among patients with multimorbidity. This study aimed to examine the effects of different multimorbidity patterns on the decline in HRQoL. DESIGN Nationwide prospective cohort study. SETTING Japanese adult residents. PARTICIPANTS Residents aged ≥50 years selected by the quota sampling method. PRIMARY OUTCOME MEASURE Clinically relevant decline in HRQoL was defined as a 0.50 SD (5-point) decrease in the 36-Item Short Form Health Survey (SF-36) component summary scores for 1 year. RESULTS In total, 1211 participants completed the follow-up survey. Among the multimorbidity patterns identified using confirmatory factor analysis, multivariable logistic regression analyses revealed that high cardiovascular/renal/metabolic and malignant/digestive/urologic pattern scores were significantly associated with the clinically relevant decline in SF-36 physical component summary score (adjusted OR (aOR)=1.25, 95% CI: 1.08 to 1.44 and aOR=1.28, 95% CI: 1.04 to 1.58, respectively). High cardiovascular/renal/metabolic pattern score was also significantly associated with the clinically relevant decline in SF-36 role/social component summary score (aOR=1.23, 95% CI: 1.06 to 1.42). CONCLUSIONS Our study revealed that multimorbidity patterns have different effects on the clinically relevant decline in HRQoL for 1 year. These findings can be useful in identifying populations at high risk and with poor clinical outcomes among patients with chronic diseases and multimorbidity for efficient resource allocation.
Collapse
Affiliation(s)
- Takuya Aoki
- Division of Clinical Epidemiology, Research Center for Medical Sciences, The Jikei University School of Medicine, Tokyo, Japan
- Section of Clinical Epidemiology, Department of Community Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shunichi Fukuhara
- Section of Clinical Epidemiology, Department of Community Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Department of General Medicine, Shirakawa Satellite for Teaching And Research (STAR), Fukushima Medical University, Fukushima, Japan
- Center for Innovative Research for Communities and Clinical Excellence (CIRC2LE), Fukushima Medical University, Fukushima, Japan
| | - Yasuki Fujinuma
- Centre for Family Medicine Development, Japanese Health and Welfare Co-operative Federation, Tokyo, Japan
| | - Yosuke Yamamoto
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Institute for Health Outcomes and Process Evaluation Research (iHope International), Kyoto, Japan
| |
Collapse
|
32
|
Wang Z, Peng W, Li M, Li X, Yang T, Li C, Yan H, Jia X, Hu Z, Wang Y. Association between multimorbidity patterns and disability among older people covered by long-term care insurance in Shanghai, China. BMC Public Health 2021; 21:418. [PMID: 33639902 PMCID: PMC7912511 DOI: 10.1186/s12889-021-10463-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 02/15/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Functional disability and multimorbidity are common among older people. However, little is known about the relationship between functional disability and different multimorbidity combinations. We aimed to identify multimorbidity patterns and explore the associations between these patterns and functional disability. METHODS We investigated a multi-stage random sample of 1871 participants aged ≥60 years and covered by long-term care insurance in Shanghai, China. Multimorbidity was defined as the simultaneous presence of two or more chronic diseases in an individual. Participants completed scales to assess basic and instrumental activities of daily living (BADL and IADL, respectively). Multimorbidity patterns were identified via exploratory factor analysis. Binary logistic regression models were used to determine adjusted associations between functional disability and number and patterns of multimorbidity. RESULTS Multimorbidity was present in 74.3% of participants. The prevalence of BADL disability was 50.7% and that of IADL disability was 90.7%. There was a strong association between multimorbidity and disability. We identified three multimorbidity patterns: musculoskeletal, cardio-metabolic, and mental-degenerative diseases. The cardio-metabolic disease pattern was associated with both BADL (OR 1.28, 95%CI 1.16-1.41) and IADL (OR 1.41, 95%CI 1.19-1.68) disability. The mental-degenerative disease pattern was associated with BADL disability (OR 1.55, 95%CI 1.40-1.72). CONCLUSIONS Multimorbidity and functional disability are highly prevalent among older people covered by long-term care insurance in Shanghai, and distinct multimorbidity patterns are differentially associated with functional disability. Appropriate long-term healthcare and prevention strategies for older people may help reduce multimorbidity, maintain functional ability, and improve health-related quality of life.
Collapse
Affiliation(s)
- Zijing Wang
- School of Health Service Management, Anhui Medical University, Hefei, 230032, China
| | - Wenjia Peng
- Epidemiology and Health Statistics, School of Public Health, Bengbu Medical College, Bengbu, Anhui, China
| | - Mengying Li
- School of Public Health, Key Laboratory of Public Health Safety, NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, 200032, China
| | - Xinghui Li
- School of Public Health, Key Laboratory of Public Health Safety, NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, 200032, China
| | - Tingting Yang
- School of Public Health, Key Laboratory of Public Health Safety, NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, 200032, China
| | - Cancan Li
- School of Health Service Management, Anhui Medical University, Hefei, 230032, China
| | - Huosheng Yan
- School of Health Service Management, Anhui Medical University, Hefei, 230032, China
| | - Xianjie Jia
- Epidemiology and Health Statistics, School of Public Health, Bengbu Medical College, Bengbu, Anhui, China
| | - Zhi Hu
- School of Health Service Management, Anhui Medical University, Hefei, 230032, China.
| | - Ying Wang
- School of Public Health, Key Laboratory of Public Health Safety, NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, 200032, China.
| |
Collapse
|
33
|
Marengoni A, Akugizibwe R, Vetrano DL, Roso-Llorach A, Onder G, Welmer AK, Calderón-Larrañaga A. Patterns of multimorbidity and risk of disability in community-dwelling older persons. Aging Clin Exp Res 2021; 33:457-462. [PMID: 33580869 PMCID: PMC7914228 DOI: 10.1007/s40520-020-01773-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 12/03/2020] [Indexed: 11/28/2022]
Abstract
The aim was to analyze the association between specific patterns of multimorbidity and risk of disability in older persons. Data were gathered from the Swedish National Study on Aging and Care in Kungsholmen (SNAC-K); 2066 60 + year-old participants living in the community and free from disability at baseline were grouped according to their multimorbidity patterns and followed-up for six years. The association between multimorbidity patterns and disability in basic (ADL) and instrumental (IADL) activities of daily living was examined through multinomial models. Throughout the follow-up, 434 (21.0%) participants developed at least one ADL and 310 (15.0%) at least one IADL. Compared to the unspecific pattern, which included diseases not exceeding their expected prevalence in the total sample, belonging to the cardiovascular/anemia/dementia, the sensory impairment/cancer and the musculoskeletal/respiratory/gastrointestinal patterns was associated with a higher risk of developing both ADL and IADL, whereas subjects in the metabolic/sleep disorders pattern showed a higher risk of developing only IADL. Multimorbidity patterns are differentially associated with incident disability, which is important for the design of future prevention strategies aimed at delaying functional impairment in old age, and for a better healthcare resource planning.
Collapse
Affiliation(s)
- Alessandra Marengoni
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
| | - Roselyne Akugizibwe
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Davide L Vetrano
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Centro Medicina Dell'Invecchiamento, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Albert Roso-Llorach
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Gran Via Corts Catalanes 587, Barcelona, Spain
- Universitat Autònoma de Barcelona, Campus de la UAB, Bellaterra (Cerdanyola del Vallès), Spain
| | - Graziano Onder
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore Di Sanità, Rome, Italy
| | - Anna-Karin Welmer
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Karolinska University Hospital, Stockholm, Sweden
- Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Amaia Calderón-Larrañaga
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| |
Collapse
|
34
|
Tang LH, Thygesen LC, Willadsen TG, Jepsen R, la Cour K, Frølich A, Møller A, Jørgensen LB, Skou ST. The association between clusters of chronic conditions and psychological well-being in younger and older people-A cross-sectional, population-based study from the Lolland-Falster Health Study, Denmark. JOURNAL OF COMORBIDITY 2021; 10:2235042X20981185. [PMID: 33415082 PMCID: PMC7750742 DOI: 10.1177/2235042x20981185] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 11/09/2020] [Accepted: 11/12/2020] [Indexed: 11/22/2022]
Abstract
Aim: To investigate the association between clusters of conditions and
psychological well-being across age groups. Method: This cross-sectional study used data collected in the Danish population-based
Lolland-Falster Health Study. We included adults over the age of 18 years.
Self-reported chronic conditions were divided into 10 groups of conditions.
The primary outcome was psychological well-being (the WHO-5 Well-Being
Index). Factor analysis constructed the clusters of conditions, and
regression analysis investigated the association between clusters and
psychological well-being. Results: Of 10,781 participants, 31.4% were between 18 and 49 years, 35.7% were
between 50 and 64 years and 32.9% were above ≥65 years. 35.2% had conditions
represented in 1 and 32.9% in at least 2 of 10 condition groups. Across age
groups, living with one or more chronic conditions was associated with
poorer psychological well-being. Two chronic condition patterns were
identified; one comprised cardiovascular, endocrine, kidney, musculoskeletal
and cancer conditions, the second mental, lung, neurological,
gastrointestinal and sensory conditions. Both patterns were associated with
poorer psychological well-being (Pattern 1: −4.5 (95% CI: −5.3 to −3.7),
Pattern 2: −9.1 (95% CI −13.8 to −8.2). For pattern 2, participants ≥65
years had poorer psychological well-being compared to younger (−12.6 (95% CI
−14.2 to −11.0) vs −6.6 (95% CI: −7.8 to −5.4) for 18–49 years and −8.7 (95%
CI: −10.1 to −7.3) for 50–64 years, interaction: p ≤ 0.001) Conclusion: Living with one or more chronic conditions is associated with poorer
psychological well-being. Findings point toward a greater focus on
supporting psychological well-being in older adults with both mental and
somatic conditions.
Collapse
Affiliation(s)
- Lars Hermann Tang
- Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark.,Department of Regional Health Research, University of Southern Denmark, Denmark.,National Centre for Rehabilitation and Palliative Care, University of Southern Denmark and Odense University Hospital, Nyborg, Denmark
| | - Lau Caspar Thygesen
- National Institute of Public Health, University of Southern Denmark, Denmark
| | - Tora Grauers Willadsen
- The Research Unit for General Practice and Section of General Practice, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Randi Jepsen
- Lolland-Falster Health Study, Centre for Epidemiological Research, Nykøbing Falster Hospital, Nykøbing F., Denmark
| | - Karen la Cour
- National Centre for Rehabilitation and Palliative Care, University of Southern Denmark and Odense University Hospital, Nyborg, Denmark
| | - Anne Frølich
- The Research Unit for General Practice and Section of General Practice, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark.,Innovation and Research Centre for Multimorbidity, Slagelse hospital (NSR), Region Zealand, Denmark
| | - Anne Møller
- The Research Unit for General Practice and Section of General Practice, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Lars Bo Jørgensen
- Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark.,Department of Rheumatology, Zealand University Hospital, Denmark.,Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Søren T Skou
- Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark.,Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
35
|
Nishimura A, Ohtsuki M, Kato T, Nagao‐Nishiwaki R, Senga Y, Kato K, Ogura T, Sudo A. Is locomotion training effective for middle-aged workers? J Occup Health 2021; 63:e12303. [PMID: 34931396 PMCID: PMC8689112 DOI: 10.1002/1348-9585.12303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 10/19/2021] [Accepted: 11/25/2021] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVES Locomotion training (LT) consisting of single-leg standing and squatting was developed to help prevent locomotive syndrome (LS), and is typically used in older people. The objective of this study was to examine the effects of LT on young and middle-aged people. METHODS This study was performed at two companies. Workers in company A engaged in LT five times/week for 1 year, whereas workers in company B did not. Baseline and follow-up checkups consisted of questionnaires and physical performance tests, including three kinds of locomotion tests. RESULTS In total, 88 and 101 workers in companies A and B, respectively, met the inclusion criteria. LS stage, stand-up test results, and scores on a geriatric locomotive function scale significantly improved among workers in company A, but only stand-up test results significantly improved among workers in company B. Quadriceps power increased in company A, but did not change in company B. Especially, workers with LS in company A had more significant changes than those without LS and those in company B. CONCLUSIONS The results of this longitudinal study suggest that LT is useful even for young and middle-aged workers. LT was especially more effective for workers than those without LS.
Collapse
Affiliation(s)
- Akinobu Nishimura
- Department of Orthopaedic SurgeryMie University Graduate School of MedicineTsu City, MieJapan
- Department of Orthopaedic and Sports MedicineMie University Graduate School of MedicineTsu City, MieJapan
| | - Makoto Ohtsuki
- Department of Clinical NutritionSuzuka University of Medical ScienceSuzuka City, MieJapan
| | - Toshihiro Kato
- Department of RehabilitationSuzuka Kaisei HospitalSuzuka City, MieJapan
| | - Rie Nagao‐Nishiwaki
- Department of NursingFaculty of Health ScienceSuzuka University of Medical ScienceSuzuka City, MieJapan
| | - Yoshiyuki Senga
- Department of Orthopaedic SurgeryMie University Graduate School of MedicineTsu City, MieJapan
| | - Ko Kato
- Department of Orthopaedic SurgerySuzuka Kaisei HospitalSuzuka City, MieJapan
| | - Toru Ogura
- Department of Clinical Research Support CenterMie University Graduate School of MedicineTsu City, MieJapan
| | - Akihiro Sudo
- Department of Orthopaedic SurgeryMie University Graduate School of MedicineTsu City, MieJapan
- Department of Orthopaedic and Sports MedicineMie University Graduate School of MedicineTsu City, MieJapan
| |
Collapse
|
36
|
Kudesia P, Salimarouny B, Stanley M, Fortin M, Stewart M, Terry A, Ryan BL. The incidence of multimorbidity and patterns in accumulation of chronic conditions: A systematic review. JOURNAL OF MULTIMORBIDITY AND COMORBIDITY 2021; 11:26335565211032880. [PMID: 34350127 PMCID: PMC8287424 DOI: 10.1177/26335565211032880] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 06/24/2021] [Indexed: 12/17/2022]
Abstract
Multimorbidity, the presence of 1+ chronic condition in an individual, remains one of the greatest challenges to health on a global scale. Although the prevalence of multimorbidity has been well-established, its incidence is not fully understood. This systematic review determined the incidence of multimorbidity across the lifespan; the order in which chronic conditions accumulate to result in multimorbidity; and cataloged methods used to determine and report accumulation of chronic conditions resulting in multimorbidity. Studies were identified by searching MEDLINE, Embase, CINAHL, and Cochrane electronic databases. Two independent reviewers evaluated studies for inclusion and performed quality assessments. Of 36 included studies, there was high heterogeneity in study design and operational definitions of multimorbidity. Studies reporting incidence (n = 32) reported a median incidence rate of 30.7 per 1,000 person-years (IQR 39.5 per 1,000 person-years) and a median cumulative incidence of 2.8% (IQR 28.7%). Incidence was notably higher for persons with older age and 1+ chronic conditions at baseline. Studies reporting patterns in accumulation of chronic conditions (n = 5) reported hypertensive and heart diseases, and diabetes, as among the common starting conditions resulting in later multimorbidity. Methods used to discern patterns were highly heterogenous, ranging from the use of latent growth trajectories to divisive cluster analyses, and presentation using alluvial plots to cluster trajectories. Studies reporting the incidence of multimorbidity and patterns in accumulation of chronic conditions vary greatly in study designs and definitions used. To allow for more accurate estimations and comparison, studies must be transparent and consistent in operational definitions of multimorbidity applied.
Collapse
Affiliation(s)
- Prtha Kudesia
- Schulich Interfaculty Program in Public Health, University of Western
Ontario, London, Ontario, Canada
| | - Banafsheh Salimarouny
- Schulich Interfaculty Program in Public Health, University of Western
Ontario, London, Ontario, Canada
| | - Meagan Stanley
- Allyn & Betty Taylor Library, University of Western
Ontario, London, Ontario, Canada
| | - Martin Fortin
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Moira Stewart
- Centre for Studies in Family Medicine & Department of Family
Medicine, Schulich School of Medicine & Dentistry, University of Western
Ontario, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Schulich School of
Medicine & Dentistry, University of Western Ontario, London, Ontario,
Canada
| | - Amanda Terry
- Schulich Interfaculty Program in Public Health, University of Western
Ontario, London, Ontario, Canada
- Centre for Studies in Family Medicine & Department of Family
Medicine, Schulich School of Medicine & Dentistry, University of Western
Ontario, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Schulich School of
Medicine & Dentistry, University of Western Ontario, London, Ontario,
Canada
| | - Bridget L Ryan
- Centre for Studies in Family Medicine & Department of Family
Medicine, Schulich School of Medicine & Dentistry, University of Western
Ontario, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Schulich School of
Medicine & Dentistry, University of Western Ontario, London, Ontario,
Canada
| |
Collapse
|
37
|
McClellan SP, Haque K, García-Peña C. Diabetes multimorbidity combinations and disability in the Mexican Health and Aging Study, 2012-2015. Arch Gerontol Geriatr 2020; 93:104292. [PMID: 33186887 DOI: 10.1016/j.archger.2020.104292] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 10/29/2020] [Accepted: 10/30/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The aim of this study was to investigate the relationship between specific combinations of chronic conditions and disability in Mexican older adults with diabetes. METHODS This was a prospective cohort study of Mexican adults (n = 2558) with diabetes and aged 51 or older that used data from the 2012 and 2015 waves of the Mexican Health and Aging Study. The main outcome was an index that measured ability to perform activities of daily living and instrumental activities of daily living. The main independent variables were diabetes multimorbidity combinations, defined as diabetes and at least one other chronic condition. The authors calculated the prevalence of each multimorbidity combination present in the sample in 2012 and used negative binomial regression models to estimate the association of the most prevalent of these combinations with disability incidence in 2015. RESULTS The three most prevalent combinations were: 1) diabetes-hypertension (n = 637, 31.9%) 2) diabetes-hypertension-depression (n = 388, 19.4%) and 3) diabetes-depression (n = 211, 10.6%). In fully adjusted models comparing participants with specific multimorbidity combinations to participants with diabetes alone, the combinations that had an increased association with disability were diabetes-hypertension-depression, diabetes-depression and diabetes-hypertension-arthritis-depression. In nested models, the addition of arthritis to combinations including depression increased this association. CONCLUSIONS Consistent with prior studies, multimorbidity combinations including depression were associated with increased risk of disability. However, the effect size of this relationship was lower than what had been previously been reported internationally. This highlights the need for globally oriented multimorbidity research.
Collapse
Affiliation(s)
- Sean P McClellan
- Department of Family Medicine, University of Illinois at Chicago College of Medicine, Chicago, IL, United States.
| | - Kanwal Haque
- Department of Family Medicine, University of Illinois at Chicago College of Medicine, Chicago, IL, United States
| | | |
Collapse
|
38
|
Schmidt TP, Wagner KJP, Schneider IJC, Danielewicz AL. [Multimorbidity patterns and functional disability in elderly Brazilians: a cross-sectional study with data from the Brazilian National Health Survey]. CAD SAUDE PUBLICA 2020; 36:e00241619. [PMID: 33146279 DOI: 10.1590/0102-311x00241619] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 04/10/2020] [Indexed: 12/15/2022] Open
Abstract
The presence of multimorbidity patterns has been related to functional disability in basic activities (BADLs) and instrumental activities of daily living (IADLs), which are essential for elder individuals' self-care and autonomy. The study thus aimed to estimate the association between multimorbidity patterns and presence of functional disability in elderly Brazilians. This was a cross-sectional study using data from the Brazilian National Health Survey (PNS 2013) in a sample of elderly Brazilians (≥ 60 years). The measures of functional disability were from self-completed questionnaires, categorized in basic activities of daily living (BADLs) and instrumental activities of daily living (IADLs). The multimorbidity patterns analyzed here were: (1) cardiorespiratory; (2) vascular-metabolic; and (3) mental-musculoskeletal. The adjustment variables included age, sex, schooling, and region of Brazil. Multivariate logistic regression analyses were performed, estimating crude and adjusted odds ratios (OR) with Stata 16.0. Elderly individuals classified in the mental-musculoskeletal patterns showed the highest odds of disability in BADLs (OR = 2.72; 95%CI: 2.33; 3.18), while those with the cardiopulmonary pattern showed the highest odds of disability in IADLs (OR = 2.65; 95%CI: 1.95; 3.60), compared to those without the same patterns. All the multimorbidity patterns analyzed here were associated with disability in BADLs and IADLs and should thus be considered when planning measures to prevent disabilities in elderly individuals with multimorbidity.
Collapse
|
39
|
Mueller-Schotte S, Zuithoff NPA, Van der Schouw YT, Schuurmans MJ, Bleijenberg N. Trends in Risk of Limitations in Instrumental Activities of Daily Living Over Age in Older Persons With and Without Multiple Chronic Conditions. J Gerontol A Biol Sci Med Sci 2020; 75:197-203. [PMID: 30772903 PMCID: PMC6909894 DOI: 10.1093/gerona/glz049] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Indexed: 01/09/2023] Open
Abstract
Background To investigate trends over age by comorbidity status for the risk of limitations in individual activities of daily living for community-living older persons. Methods A longitudinal population-based study was conducted in 9,319 community-living Dutch persons aged 60 years and older. Self-reported multiple chronic conditions (MCC) and nine instrumental activities of daily livings (IADLs) were assessed in 15 studies of the Dutch National Care for the Elderly Program (TOPICS-MDS). Risks of limitations in IADLs, odds ratios (per 5 years), and rate ratios (per 5 years) were calculated with mixed logistic and negative binomial regression models with age as the underlying timescale, stratified by number of MCC (no, 1–2, ≥ 3 MCC), and corrected for confounders. Results At inclusion, the number of IADL limitations was highest for the “≥3 MCC” group (2.00 interquartile range [1.00–4.00]) and equal for “no MCC” or “1–2 MCC” (1.00 interquartile range [0.00–2.00]). Trends of individual IADLs depicted a higher risk in IADL limitation with increasing age over 2 years of follow-up, except for handling finances for the “no MCC” group. The longitudinal age effect on IADL limitations varied subject to MCC, being strongest for the “no MCC” group for most IADLs; grooming and telephone use were almost unaltered by age and MCC. Conclusion We observed a decline in IADL functioning with increasing age over 2 years of follow-up in persons with and without MCC. The impact of MCC on IADL decline varied per IADL activity.
Collapse
Affiliation(s)
- Sigrid Mueller-Schotte
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht (UMC Utrecht).,Department for the Chronically Ill, University of Applied Sciences Utrecht, The Netherlands.,Department of Optometry and Orthoptics, University of Applied Sciences Utrecht, The Netherlands
| | - Nicolaas P A Zuithoff
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht (UMC Utrecht)
| | - Yvonne T Van der Schouw
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht (UMC Utrecht)
| | - Marieke J Schuurmans
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht (UMC Utrecht).,Department for the Chronically Ill, University of Applied Sciences Utrecht, The Netherlands
| | - Nienke Bleijenberg
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht (UMC Utrecht).,Department for the Chronically Ill, University of Applied Sciences Utrecht, The Netherlands
| |
Collapse
|
40
|
Morozumi M, Ando K, Kobayashi K, Seki T, Ishizuka S, Machino M, Tanaka S, Ito S, Kanbara S, Inoue T, Ishiguro N, Hasegawa Y, Imagama S. Relationship between lumbopelvic discordance and locomotive syndrome in a middle-aged community-living population: The Yakumo study. J Orthop Sci 2020; 25:693-699. [PMID: 31759838 DOI: 10.1016/j.jos.2019.09.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 08/09/2019] [Accepted: 09/18/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND Locomotive syndrome (LS) affects the quality and activities of daily living. Although spinal sagittal balance influences LS, no report elucidated the relationship between LS risk and lumbopelvic discordance. This study aimed to investigate the relationship between lumbopelvic discordance and LS in a middle-aged community. METHODS The subjects (n = 135) were divided into three groups based on the LS risk stage, which was evaluated through spinopelvic sagittal alignment and lumbopelvic mismatch prevalence (Pelvic incidence-Lumbar lordosis >10°:PI-LL mismatch).Then, the subjects were divided into two groups (lumbopelvic matched and mismatched groups) and analyzed based on the demographic data, physical test, stabilometry, and body pain using the visual analog scale. RESULTS There were 76, 37 and 22 subjects in stages 0, 1, and 2, respectively. The pelvic incidence-lumbar lordosis (PI-LL) mismatched group had a higher prevalence in LS risk stage 2 than in LS risk stage 0. The prevalence of PI-LL mismatch was significantly different among the groups. Post hoc test revealed the differences in spinopelvic alignment among the stages. In each LS risk stage, the degree of PI-LL was significantly higher in stage 2 than that in stages 0 and 1. On comparing the PI-LL matched (n = 67) and mismatched groups (n = 68) with a stabilometer, the envelopment area tracing by the movement of the center of pressure and locus length/second was greater in the PI-LL mismatched group than that in the PI-LL matched group with/without eyes opened. CONCLUSIONS The prevalence of LS risk stage 2 was more frequently observed in the PI-LL mismatched group. The degree of PI-LL was evaluated through the LS risk stages. Physical dysfunction in the PI-LL mismatched group was related to trunk imbalance based on stabilometry. These findings will help manage LS and PI-LL mismatched subjects.
Collapse
Affiliation(s)
- Masayoshi Morozumi
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Kei Ando
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Kazuyoshi Kobayashi
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Taisuke Seki
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Shinya Ishizuka
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Masaaki Machino
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Satoshi Tanaka
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Sadayuki Ito
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Shunsuke Kanbara
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Taro Inoue
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Naoki Ishiguro
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Yukiharu Hasegawa
- Department of Orthopaedic Surgery, Kansai University of Welfare Sciences, 3-11-1, Asahigaoka, Kashihara, Osaka, 5820026, Japan
| | - Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan.
| |
Collapse
|
41
|
Twelve-year clinical trajectories of multimorbidity in a population of older adults. Nat Commun 2020; 11:3223. [PMID: 32591506 PMCID: PMC7320143 DOI: 10.1038/s41467-020-16780-x] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 05/22/2020] [Indexed: 11/08/2022] Open
Abstract
Multimorbidity-the co-occurrence of multiple diseases-is associated to poor prognosis, but the scarce knowledge of its development over time hampers the effectiveness of clinical interventions. Here we identify multimorbidity clusters, trace their evolution in older adults, and detect the clinical trajectories and mortality of single individuals as they move among clusters over 12 years. By means of a fuzzy c-means cluster algorithm, we group 2931 people ≥60 years in five clinically meaningful multimorbidity clusters (52%). The remaining 48% are part of an unspecific cluster (i.e. none of the diseases are overrepresented), which greatly fuels other clusters at follow-ups. Clusters contribute differentially to the longitudinal development of other clusters and to mortality. We report that multimorbidity clusters and their trajectories may help identifying homogeneous groups of people with similar needs and prognosis, and assisting clinicians and health care systems in the personalization of clinical interventions and preventive strategies.
Collapse
|
42
|
Yao SS, Meng X, Cao GY, Huang ZT, Chen ZS, Han L, Wang K, Su HX, Luo Y, Hu Y, Xu B. Associations between Multimorbidity and Physical Performance in Older Chinese Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17124546. [PMID: 32599778 PMCID: PMC7344642 DOI: 10.3390/ijerph17124546] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/13/2020] [Accepted: 06/15/2020] [Indexed: 02/06/2023]
Abstract
Background: Evidence on the association between physical performance and multimorbidity is scarce in Asia. This study aimed to identify multimorbidity patterns and their association with physical performance among older Chinese adults. Methods: Individuals aged ≥60 years from the China Health and Retirement Longitudinal Study 2011-2015 (N = 10,112) were included. Physical performance was measured by maximum grip strength (kg) and average gait speed (m/s) categorized as fast (>0.8 m/s), median (>0.6-0.8 m/s), and slow (≤0.6 m/s). Multimorbidity patterns were explored using exploratory factor analysis. Generalized estimating equation was conducted. Results: Four multimorbidity patterns were identified: cardio-metabolic, respiratory, mental-sensory, and visceral-arthritic. An increased number of chronic conditions was associated with decreased normalized grip strength (NGS). Additionally, the highest quartile of factor scores for cardio-metabolic (β = -0.06; 95% Confidence interval (CI) = -0.07, -0.05), respiratory (β = -0.03; 95% CI = -0.05, -0.02), mental-sensory (β = -0.04; 95% CI = -0.05, -0.03), and visceral-arthritic (β = -0.04; 95% CI = -0.05, -0.02) patterns were associated with lower NGS compared with the lowest quartile. Participants with ≥4 chronic conditions were 2.06 times more likely to have a slow gait speed. Furthermore, the odds ratios for the highest quartile of factor scores of four patterns with slow gait speed compared with the lowest quartile ranged from 1.26-2.01. Conclusion: Multimorbidity was related to worse physical performance, and multimorbidity patterns were differentially associated with physical performance. A shift of focus from single conditions to the requirements of a complex multimorbid population was needed for research, clinical guidelines, and health-care services. Grip strength and gait speed could be targeted to routinely measure clinical performance among older adults with multimorbidity, especially mental-sensory disorders, in clinical settings.
Collapse
Affiliation(s)
- Shan-Shan Yao
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China; (S.-S.Y.); (G.-Y.C.); (Z.-T.H.); (Z.-S.C.); (H.-X.S.); (Y.L.); (Y.H.)
- Medical Informatics Center, Peking University, Beijing 100191, China
| | - Xiangfei Meng
- Department of Psychiatry, McGill University, Montreal, QC H3A1A1, Canada;
| | - Gui-Ying Cao
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China; (S.-S.Y.); (G.-Y.C.); (Z.-T.H.); (Z.-S.C.); (H.-X.S.); (Y.L.); (Y.H.)
- Medical Informatics Center, Peking University, Beijing 100191, China
| | - Zi-Ting Huang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China; (S.-S.Y.); (G.-Y.C.); (Z.-T.H.); (Z.-S.C.); (H.-X.S.); (Y.L.); (Y.H.)
- Medical Informatics Center, Peking University, Beijing 100191, China
| | - Zi-Shuo Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China; (S.-S.Y.); (G.-Y.C.); (Z.-T.H.); (Z.-S.C.); (H.-X.S.); (Y.L.); (Y.H.)
- Medical Informatics Center, Peking University, Beijing 100191, China
| | - Ling Han
- Department of Medicine, Yale School of Medicine, New Haven, CT 06510, USA;
| | - Kaipeng Wang
- Graduate School of Social Work, University of Denver, Denver, CO 80208, USA;
| | - He-Xuan Su
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China; (S.-S.Y.); (G.-Y.C.); (Z.-T.H.); (Z.-S.C.); (H.-X.S.); (Y.L.); (Y.H.)
- Medical Informatics Center, Peking University, Beijing 100191, China
| | - Yan Luo
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China; (S.-S.Y.); (G.-Y.C.); (Z.-T.H.); (Z.-S.C.); (H.-X.S.); (Y.L.); (Y.H.)
- Medical Informatics Center, Peking University, Beijing 100191, China
| | - Yonghua Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China; (S.-S.Y.); (G.-Y.C.); (Z.-T.H.); (Z.-S.C.); (H.-X.S.); (Y.L.); (Y.H.)
- Medical Informatics Center, Peking University, Beijing 100191, China
| | - Beibei Xu
- Medical Informatics Center, Peking University, Beijing 100191, China
- Correspondence: ; Tel.: +86-(010)-82805904
| |
Collapse
|
43
|
Jacob ME, Ni P, Driver J, Leritz E, Leveille SG, Jette AM, Bean JF. Burden and Patterns of Multimorbidity: Impact on Disablement in Older Adults. Am J Phys Med Rehabil 2020; 99:359-365. [PMID: 32301768 PMCID: PMC7275931 DOI: 10.1097/phm.0000000000001388] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE The aim of this study was to assess the impact of the burden and patterns of multimorbidity on disability domains. DESIGN In a cross-sectional study of 425 older adults from the Boston Rehabilitative Impairment Study of the Elderly, participants self-reported 13 chronic conditions and underwent assessment of body function (leg strength, velocity, and power, trunk extensor endurance, leg range of motion, foot sensation), activities (400-m walk test, Short Physical Performance Battery, Late Life Function and Disability Instrument function scores) and participation (Late Life Function and Disability Instrument participation scores). The association between multimorbidity patterns (identified by latent class analysis) and disablement measures, as well as multimorbidity burden (captured by a multimorbidity score) and disablement measures, was tested. RESULTS Latent class analysis identified three classes-low multimorbidity, high multimorbidity, and predominantly musculoskeletal conditions. Class membership (multimorbidity pattern) was not associated with disablement measures, but multimorbidity score was associated with poor performance in all domains. A 1-point higher multimorbidity score was associated with lower scores in body functions (by 0.06 SD unit), activities (0.07-0.10 SD units), as well as participation (0.07-0.09 units). CONCLUSION Multimorbidity counts may be an excellent tool for risk stratification and identification of persons in need of rehabilitation. TO CLAIM CME CREDITS Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon completion of this article, the reader should be able to (1) describe and distinguish the effect of multimorbidity burden and multimorbidity patterns on three disability domains in older adults; (2) identify and discuss possible reasons why high multimorbidity burden may result in a restriction among social participation in older adults; and (3) detect disability risk among older patients during clinical assessment by using a simple count of common chronic conditions. LEVEL Advanced ACCREDITATION: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Collapse
Affiliation(s)
- Mini E. Jacob
- Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Diseases, University of Texas Health Sciences Center, San Antonio
| | | | - Jane Driver
- New England Geriatric Research Education and Clinical Center, VA Boston Healthcare System
- Division of Aging, Brigham and Women’s Hospital, Harvard Medical School
| | - Elizabeth Leritz
- New England Geriatric Research Education and Clinical Center, VA Boston Healthcare System
- Department of Psychiatry, Harvard Medical School
| | | | - Alan M. Jette
- Department of Physical Therapy, MGH Institute of Health Professions
| | - Jonathan F. Bean
- New England Geriatric Research Education and Clinical Center, VA Boston Healthcare System
- Department of Physical Medicine and Rehabilitation, Harvard Medical School
- Spaulding Rehabilitation Hospital
| |
Collapse
|
44
|
Li H, Wang A, Gao Q, Wang X, Luo Y, Yang X, Li X, Wang W, Zheng D, Guo X. Prevalence of somatic-mental multimorbidity and its prospective association with disability among older adults in China. Aging (Albany NY) 2020; 12:7218-7231. [PMID: 32335543 PMCID: PMC7202546 DOI: 10.18632/aging.103070] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 03/29/2020] [Indexed: 01/09/2023]
Abstract
We aimed to identify prevalent somatic-mental multimorbidity (SMM) and examine its prospective association with disability among a nationally representative sample. A total of 6728 participants aged 60 years and older in the China Health and Retirement Longitudinal Study were included. A total of 14 somatic or mental conditions were assessed in 2013. SMM was defined as any combination of two or more conditions in which at least one condition was somatic and at least one condition was mental. Disability risk was measured using the combined Activities of Daily Living (ADL)-Instrumental Activities of Daily Living (IADL) index (range 0–11; higher index indicates higher disability) in 2013 and 2015. Overall, the prevalence of SMM was 35.7% (95% confidence interval (CI): 34.1%-37.3%) in 2013. After adjustment for sociodemographic characteristics, lifestyles and baseline ADL-IADL index, over a maximum follow-up period of 2 years, SMM was associated with a 2.61 (95% CI: 2.12-3.22)-fold increase in ADL-IADL disability risk compared with that of healthy participants. In conclusion, SMM was prevalent in older Chinese adults, and it was associated with a higher risk of prospective disability.
Collapse
Affiliation(s)
- Haibin Li
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China.,Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
| | - Anxin Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Qi Gao
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China.,Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
| | - Xiaonan Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China.,Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
| | - Yanxia Luo
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China.,Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
| | - Xinghua Yang
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China.,Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
| | - Xia Li
- Department of Mathematics and Statistics, La Trobe University, Melbourne, Victoria, Australia
| | - Wei Wang
- Global Health and Genomics, School of Medical Sciences and Health, Edith Cowan University, Perth, Western Australia, Australia
| | - Deqiang Zheng
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China.,Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
| | - Xiuhua Guo
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China.,Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
| |
Collapse
|
45
|
Operationalizing the Disablement Process for Research on Older Adults: A Critical Review. Can J Aging 2020; 39:600-613. [PMID: 32000871 DOI: 10.1017/s0714980819000758] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Self-care disability is difficulty with or dependence on others to perform activities of daily living, such as eating and dressing. Disablement is worsening self-care disability measured over time. The disablement process model (DPM) is often used to conceptualize gerontology research on self-care disability and disablement; however, no summary of variables that align with person-level DPM constructs exists. This review summarizes the results of 88 studies to identify the nature and role of variables associated with disability and disablement in older adults according to the person-level constructs (e.g., demographic characteristics, chronic pathologies) in the DPM. It also examines the evidence for cross-sectional applications of the DPM and identifies common limitations in extant literature to address in future research. Researchers can apply these results to guide theory-driven disability and disablement research using routinely collected health data from older adults.
Collapse
|
46
|
Storeng SH, Vinjerui KH, Sund ER, Krokstad S. Associations between complex multimorbidity, activities of daily living and mortality among older Norwegians. A prospective cohort study: the HUNT Study, Norway. BMC Geriatr 2020; 20:21. [PMID: 31964341 PMCID: PMC6974981 DOI: 10.1186/s12877-020-1425-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 01/13/2020] [Indexed: 01/07/2023] Open
Abstract
Background With increasing age, having multiple chronic conditions is the norm. It is of importance to study how co-existence of diseases affects functioning and mortality among older persons. Complex multimorbidity may be defined as three or more conditions affecting at least three different organ systems. The aim of this study was to investigate how complex multimorbidity affects activities of daily living and mortality amongst older Norwegians. Methods Participants were 60–69-year-olds at baseline in the Nord-Trøndelag Health Study 1995-1997 (HUNT2) n = 9058. Multinomial logistic regression models were used to investigate the association between complex multimorbidity in HUNT2, basic and instrumental activities of daily living in HUNT3 (2006–2008) and mortality during follow-up (n = 5819/5836). Risk ratios (RR) and risk differences (RD) in percentage points (pp) with 95% confidence intervals (CI) were reported. Results 47.8% of 60–69-year-olds met the criteria of complex multimorbidity at baseline (HUNT2). Having complex multimorbidity was strongly associated with the need for assistance in IADL in HUNT3 11 years later (RR = 1.80 (1.58–2.04) and RD = 8.7 (6.8–10.5) pp) and moderately associated with mortality during the follow-up time (RR = 1.22 (1.12–1.33) and RD = 5.1 (2.9–7.3) pp). Complex multimorbidity was to a lesser extent associated with basic activities of daily living 11 years later (RR = 1.24 (0.85–1.83) and RD = 0.4 (− 0.3–1.1) pp). Conclusions This is the first study to show an association between complex multimorbidity and activities of daily living. Complex multimorbidity should receive more attention in order to prevent future disability amongst older persons.
Collapse
Affiliation(s)
- Siri H Storeng
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, NTNU, Trondheim, Norway.
| | - Kristin H Vinjerui
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, NTNU, Trondheim, Norway.,HUNT Research Centre, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, NTNU, Levanger, Norway
| | - Erik R Sund
- HUNT Research Centre, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, NTNU, Levanger, Norway.,Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway
| | - Steinar Krokstad
- HUNT Research Centre, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, NTNU, Levanger, Norway.,Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| |
Collapse
|
47
|
Yao SS, Cao GY, Han L, Huang ZT, Chen ZS, Su HX, Hu Y, Xu B. Associations Between Somatic Multimorbidity Patterns and Depression in a Longitudinal Cohort of Middle-Aged and Older Chinese. J Am Med Dir Assoc 2020; 21:1282-1287.e2. [PMID: 31928934 DOI: 10.1016/j.jamda.2019.11.028] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 11/25/2019] [Accepted: 11/30/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Depressive symptoms are commonly seen among patients with multiple chronic somatic conditions, or somatic multimorbidity (SMM); however, little is known about the relationships between depressive symptoms and different SMM combinations. Our study aimed to delineate the patterns of SMM and their longitudinal associations with depressive symptoms among a nationally representative sample of middle-aged and older Chinese adults. DESIGN We employed a longitudinal design. SETTING AND PARTICIPANTS Older adults (N = 10,084) aged ≥45 years from the China Health and Retirement Longitudinal Study 2011-2015 participated (mean age = 57.7 years at baseline; 53.3% men). METHODS Sixteen chronic somatic conditions were ascertained at baseline via questionnaires. Depression was assessed with the Center for Epidemiological Studies Depression Scale at baseline and during follow-up. Patterns of SMM were identified via exploratory factor analyses. Generalized estimating equations were used to evaluate the longitudinal associations between patterns of SMM and the presence of depressive symptoms at follow-up. RESULTS Compared with participants with no somatic condition, those with 1, 2, and 3 or more somatic conditions had a 21%, 66%, and 111% greater risk, respectively, for the presence of depressive symptoms. Increased factor scores for 4 patterns identified, cardio-metabolic pattern [adjusted odds ratio (AOR) 1.12, 95% confidence interval (CI) 1.06, 1.20], respiratory pattern (AOR 1.25, 95% CI 1.17, 1.33), arthritic-digestive-visual pattern (AOR 1.29, 95% CI 1.22, 1.37), and hepatic-renal-skeletal pattern (AOR 1.09, 95% CI 1.02, 1.16), were all associated with a higher risk of having depressive symptoms. CONCLUSIONS AND IMPLICATIONS All SMM patterns were independently associated with depression among middle-aged and older Chinese adults, with greater odds for people with comorbid arthritic-digestive-visual conditions and respiratory conditions. Clinical practitioners should treat the middle-aged and older population under a multiple-condition framework combining SMM and mental disorders.
Collapse
Affiliation(s)
- Shan-Shan Yao
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China; Medical Informatics Center, Peking University, Beijing, China
| | - Gui-Ying Cao
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China; Medical Informatics Center, Peking University, Beijing, China
| | - Ling Han
- Department of Medicine, Yale School of Medicine, New Haven, CT
| | - Zi-Ting Huang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China; Medical Informatics Center, Peking University, Beijing, China
| | - Zi-Shuo Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China; Medical Informatics Center, Peking University, Beijing, China
| | - He-Xuan Su
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China; Medical Informatics Center, Peking University, Beijing, China
| | - Yonghua Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China; Medical Informatics Center, Peking University, Beijing, China
| | - Beibei Xu
- Medical Informatics Center, Peking University, Beijing, China.
| |
Collapse
|
48
|
Gimeno-Miguel A, Gracia Gutiérrez A, Poblador-Plou B, Coscollar-Santaliestra C, Pérez-Calvo JI, Divo MJ, Calderón-Larrañaga A, Prados-Torres A, Ruiz-Laiglesia FJ. Multimorbidity patterns in patients with heart failure: an observational Spanish study based on electronic health records. BMJ Open 2019; 9:e033174. [PMID: 31874886 PMCID: PMC7008407 DOI: 10.1136/bmjopen-2019-033174] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES To characterise the comorbidities of heart failure (HF) in men and women, to explore their clustering into multimorbidity patterns, and to measure the impact of such patterns on the risk of hospitalisation and mortality. DESIGN Observational retrospective population study based on electronic health records. SETTING EpiChron Cohort (Aragón, Spain). PARTICIPANTS All the primary and hospital care patients of the EpiChron Cohort with a diagnosis of HF on 1 January 2011 (ie, 8488 women and 6182 men). We analysed all the chronic diseases registered in patients' electronic health records until 31 December 2011. PRIMARY OUTCOME We performed an exploratory factor analysis to identify the multimorbidity patterns in men and women, and logistic and Cox proportional-hazards regressions to investigate the association between the patterns and the risk of hospitalisation in 2012, and of 3-year mortality. RESULTS Almost all HF patients (98%) had multimorbidity, with an average of 7.8 chronic diseases per patient. We identified six different multimorbidity patterns, named cardiovascular, neurovascular, coronary, metabolic, degenerative and respiratory. The most prevalent were the degenerative (64.0%) and cardiovascular (29.9%) patterns in women, and the metabolic (49.3%) and cardiovascular (43.2%) patterns in men. Every pattern was associated with higher hospitalisation risks; and the cardiovascular, neurovascular and respiratory patterns significantly increased the likelihood of 3-year mortality. CONCLUSIONS Multimorbidity is the norm rather than the exception in patients with heart failure, whose comorbidities tend to cluster together beyond simple chance in the form of multimorbidity patterns that have different impact on health outcomes. This knowledge could be useful to better understand common pathophysiological pathways underlying this condition and its comorbidities, and the factors influencing the prognosis of men and women with HF. Further large scale longitudinal studies are encouraged to confirm the existence of these patterns as well as their differential impact on health outcomes.
Collapse
Affiliation(s)
- Antonio Gimeno-Miguel
- EpiChron Research Group. IIS Aragón, Aragon Health Sciences Institute, Zaragoza, Spain
- REDISSEC, Zaragoza, Spain
| | - Anyuli Gracia Gutiérrez
- Research Group on Heart Failure, IIS Aragón, Internal Medicine Service, Lozano Blesa University Hospital, Zaragoza, Spain
| | - Beatriz Poblador-Plou
- EpiChron Research Group. IIS Aragón, Aragon Health Sciences Institute, Zaragoza, Spain
- REDISSEC, Zaragoza, Spain
| | - Carlos Coscollar-Santaliestra
- EpiChron Research Group. IIS Aragón, Aragon Health Sciences Institute, Zaragoza, Spain
- Primary Care Health Centre San Pablo, SALUD, Zaragoza, Spain
| | - J Ignacio Pérez-Calvo
- Research Group on Heart Failure, IIS Aragón, Internal Medicine Service, Lozano Blesa University Hospital, Zaragoza, Spain
- University of Zaragoza Faculty of Medicine, Zaragoza, Spain
| | - Miguel J Divo
- Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Amaia Calderón-Larrañaga
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm University, Stockholm, Sweden
| | - Alexandra Prados-Torres
- EpiChron Research Group. IIS Aragón, Aragon Health Sciences Institute, Zaragoza, Spain
- REDISSEC, Zaragoza, Spain
| | - Fernando J Ruiz-Laiglesia
- Research Group on Heart Failure, IIS Aragón, Internal Medicine Service, Lozano Blesa University Hospital, Zaragoza, Spain
| |
Collapse
|
49
|
Mikami Y, Amano J, Kawamura M, Nobiro M, Kamijyo Y, Kawae T, Maeda N, Hirata K, Kimura H, Adachi N. Whole-body vibration enhances effectiveness of "locomotion training" evaluated in healthy young adult women. J Phys Ther Sci 2019; 31:895-900. [PMID: 31871373 PMCID: PMC6879400 DOI: 10.1589/jpts.31.895] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 08/07/2019] [Indexed: 11/24/2022] Open
Abstract
[Purpose] Locomotion training is recommended as a countermeasure against locomotive syndrome. Recently, whole-body vibration has been clinically applied in rehabilitation medicine. Therefore, we aimed to investigate the preliminary effectiveness of whole-body vibration on locomotion training. [Participants and Methods] Overall, 28 healthy adult females were randomly assigned to either a locomotion training group using a whole-body vibration device (whole-body vibration group, n=14) or training on the flat floor (non-whole-body vibration group: n=14). Participants conducted two sets of locomotion training twice a day and three times a week for 12 weeks. [Results] A significant difference was observed in the group factor for all outcome measures and in the before and after the training factor for Timed Up and Go test. After the training, knee muscle strength, dynamic balance, and mobility function in the whole-body vibration group were significantly improved compared with the non-whole-body vibration group. In the whole-body vibration group, the Timed Up and Go time after the training was significantly shorter compared with that before training. [Conclusion] The results suggest that locomotion training with whole-body vibration can improve the physical functions in healthy adult females and locomotion training using whole-body vibration might enhance the effectiveness of locomotion training.
Collapse
Affiliation(s)
- Yukio Mikami
- Department of Rehabilitation Medicine, Wakayama Medical University: 811-1 Kimiidera, Wakayama 641-8509, Japan.,Department of Rehabilitation Medicine, Hiroshima University Hospital, Japan
| | - Junko Amano
- Department of Rehabilitation Medicine, Amano Rehabilitation Hospital, Japan
| | - Mikiko Kawamura
- Department of Rehabilitation Medicine, Amano Rehabilitation Hospital, Japan
| | - Miki Nobiro
- Department of Rehabilitation Medicine, Amano Rehabilitation Hospital, Japan
| | - Yoshiichiro Kamijyo
- Department of Rehabilitation Medicine, Wakayama Medical University: 811-1 Kimiidera, Wakayama 641-8509, Japan
| | - Toshihiro Kawae
- Department of Physical Therapy, Faculty of Makuhari Human Care, Tohto University, Japan
| | - Noriaki Maeda
- Hiroshima University Hospital, Sports Medical Center, Japan.,Division of Sport Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
| | | | - Hiroaki Kimura
- Hiroshima University Hospital, Sports Medical Center, Japan.,Department of Rehabilitation Medicine, Hiroshima University Hospital, Japan
| | - Nobuo Adachi
- Hiroshima University Hospital, Sports Medical Center, Japan.,Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, Japan
| |
Collapse
|
50
|
Busija L, Lim K, Szoeke C, Sanders KM, McCabe MP. Do replicable profiles of multimorbidity exist? Systematic review and synthesis. Eur J Epidemiol 2019; 34:1025-1053. [PMID: 31624969 DOI: 10.1007/s10654-019-00568-5] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 10/09/2019] [Indexed: 12/20/2022]
Abstract
This systematic review aimed to synthesise multimorbidity profiling literature to identify replicable and clinically meaningful groupings of multimorbidity. We searched six electronic databases (Medline, EMBASE, PsycINFO, CINAHL, Scopus, and Web of Science) for articles reporting multimorbidity profiles. The identified profiles were synthesised with multidimensional scaling, stratified by type of statistical analysis used in the derivation of profiles. The 51 studies that met inclusion criteria reported results of 98 separate analyses of multimorbidity profiling, with a total of 407 multimorbidity profiles identified. The statistical techniques used to identify multimorbidity profiles were exploratory factor analysis, cluster analysis of diseases, cluster analysis of people, and latent class analysis. Reporting of methodological details of statistical methods was often incomplete. The discernible groupings of multimorbidity took the form of both discrete categories and continuous dimensions. Mental health conditions and cardio-metabolic conditions grouped along identifiable continua in the synthesised results of all four methods. Discrete groupings of chronic obstructive pulmonary disease with asthma, falls and fractures with sensory deficits and of Parkinson's disease and cognitive decline where partially replicable (identifiable in the results of more than one method), while clustering of musculoskeletal conditions and clustering of reproductive systems were each observed only in one statistical approach. The two most replicable multimorbidity profiles were mental health conditions and cardio-metabolic conditions. Further studies are needed to understand aetiology and evolution of these multimorbidity groupings. Guidelines for strengthening the reporting of multimorbidity profiling studies are proposed.
Collapse
Affiliation(s)
- Ljoudmila Busija
- Biostatistics Consulting Platform, Research Methodology Division, School of Public Health and Preventive Medicine, Monash University, Level 4, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
| | - Karen Lim
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - Cassandra Szoeke
- School of Behavioural and Health Sciences, Faculty of Health Sciences, Australian Catholic University, Melbourne, Australia
| | - Kerrie M Sanders
- Department of Medicine - Western Health, Melbourne Medical School, The University of Melbourne, Melbourne, Australia
| | - Marita P McCabe
- Health and Ageing Research Group, Swinburne University of Technology, Hawthorn, Australia
| |
Collapse
|