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Yew PY, Devera R, Liang Y, Khalifa RAE, Sun J, Chi NC, Chou YC, Tonellato PJ, Chi CL. Unraveling the multiple chronic conditions patterns among people with Alzheimer's disease and related dementia: A machine learning approach to incorporate synergistic interactions. Alzheimers Dement 2024. [PMID: 38859733 DOI: 10.1002/alz.13923] [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: 11/06/2023] [Revised: 03/03/2024] [Accepted: 03/24/2024] [Indexed: 06/12/2024]
Abstract
INTRODUCTION Most people with Alzheimer's disease and related dementia (ADRD) also suffer from two or more chronic conditions, known as multiple chronic conditions (MCC). While many studies have investigated the MCC patterns, few studies have considered the synergistic interactions with other factors (called the syndemic factors) specifically for people with ADRD. METHODS We included 40,290 visits and identified 18 MCC from the National Alzheimer's Coordinating Center. Then, we utilized a multi-label XGBoost model to predict developing MCC based on existing MCC patterns and individualized syndemic factors. RESULTS Our model achieved an overall arithmetic mean of 0.710 AUROC (SD = 0.100) in predicting 18 developing MCC. While existing MCC patterns have enough predictive power, syndemic factors related to dementia, social behaviors, mental and physical health can improve model performance further. DISCUSSION Our study demonstrated that the MCC patterns among people with ADRD can be learned using a machine-learning approach with syndemic framework adjustments. HIGHLIGHTS Machine learning models can learn the MCC patterns for people with ADRD. The learned MCC patterns should be adjusted and individualized by syndemic factors. The model can predict which disease is developing based on existing MCC patterns. As a result, this model enables early specific MCC identification and prevention.
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Affiliation(s)
- Pui Ying Yew
- Institute for Health Informatics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Ryan Devera
- Department of Computer Science & Engineering, University of Minnesota, Minneapolis, Minnesota, USA
| | - Yue Liang
- Institute for Health Informatics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Razan A El Khalifa
- Bioinformatics and Computational Biology, University of Minnesota, Rochester, Minnesota, USA
| | - Ju Sun
- Department of Computer Science & Engineering, University of Minnesota, Minneapolis, Minnesota, USA
| | - Nai-Ching Chi
- College of Nursing, University of Iowa, Iowa City, Iowa, USA
| | - Ying-Chyi Chou
- Department of Business Administration, Tunghai University, Taichung, Taiwan
| | - Peter J Tonellato
- Department of Biomedical Informatics, Biostatistics and Medical Epidemiology, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Chih-Lin Chi
- Institute for Health Informatics, University of Minnesota, Minneapolis, Minnesota, USA
- School of Nursing, University of Minnesota, Minneapolis, Minnesota, USA
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Mao D, Li G, Li Y, Wang S, Zhang M, Ma M, Ren X. Study on the Impact of Dietary Patterns on Cardiovascular Metabolic Comorbidities among Adults. RESEARCH SQUARE 2024:rs.3.rs-4451883. [PMID: 38883798 PMCID: PMC11177970 DOI: 10.21203/rs.3.rs-4451883/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
Background The prevalence of cardiovascular metabolic comorbidities (CMM) among adults is relatively high, imposing a heavy burden on individuals, families, and society. Dietary patterns play a significant role in the occurrence and development of CMM. This study aimed to identify the combined types of CMM in adult populations and investigate the impact of dietary patterns on CMM. Methods Participants in this study were from the sixth wave of the China Health and Nutrition Survey (CHNS). Dietary intake was assessed using a three-day 24-hour dietary recall method among 4,963 participants. Latent profile analysis was used to determine dietary pattern types. Two-step cluster analysis was performed to identify the combined types of CMM based on the participants' conditions of hyperuricemia, dyslipidemia, diabetes, renal dysfunction, hypertension, and stroke. Logistic regression analysis with robust standard errors was used to determine the impact of dietary patterns on CMM. Results Participants were clustered into three dietary patterns (Pattern 1 to 3) and five CMM types (Class I to V). Class I combined six diseases, with a low proportion of diabetes. Class II also combined six diseases but with a high proportion of diabetes. Class III combined four diseases, with a high proportion of hypertension. Class IV combined three diseases, with the highest proportions of hyperuricemia, diabetes, and renal dysfunction. Class V combined two diseases, with high proportions of dyslipidemia and renal dysfunction. Patients with Class III CMM had a significantly higher average age than the other four classes (P ≤ 0.05). Compared to those with isolated dyslipidemia, individuals with a low-grain, high-fruit, milk, and egg (LCHFM) dietary pattern had a higher risk of developing dyslipidemia combined with renal dysfunction (Class V CMM) with an odds ratio of 2.001 (95% CI 1.011-3.960, P≤ 0.05). Conclusion For individuals with isolated dyslipidemia, avoiding a low-grain, high-fruit, milk, and egg (LCHFM) dietary pattern may help reduce the risk of developing dyslipidemia combined with renal dysfunction (Class V CMM).
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Affiliation(s)
- Danhui Mao
- Third Hospital of Shanxi Medical University, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital
| | - Gongkui Li
- Third Hospital of Shanxi Medical University, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital
| | - Yajing Li
- Third Hospital of Shanxi Medical University, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital
| | | | | | | | - Xiaojun Ren
- Third Hospital of Shanxi Medical University, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital
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Lleal M, Baré M, Herranz S, Orús J, Comet R, Jordana R, Baré M. Trajectories of chronic multimorbidity patterns in older patients: MTOP study. BMC Geriatr 2024; 24:475. [PMID: 38816787 PMCID: PMC11137950 DOI: 10.1186/s12877-024-04925-2] [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: 11/21/2023] [Accepted: 03/27/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND Multimorbidity is associated with negative results and poses difficulties in clinical management. New methodological approaches are emerging based on the hypothesis that chronic conditions are non-randomly associated forming multimorbidity patterns. However, there are few longitudinal studies of these patterns, which could allow for better preventive strategies and healthcare planning. The objective of the MTOP (Multimorbidity Trajectories in Older Patients) study is to identify patterns of chronic multimorbidity in a cohort of older patients and their progression and trajectories in the previous 10 years. METHODS A retrospective, observational study with a cohort of 3988 patients aged > 65 was conducted, including suspected and confirmed COVID-19 patients in the reference area of Parc Taulí University Hospital. Real-world data on socio-demographic and diagnostic variables were retrieved. Multimorbidity patterns of chronic conditions were identified with fuzzy c-means cluster analysis. Trajectories of each patient were established along three time points (baseline, 5 years before, 10 years before). Descriptive statistics were performed together with a stratification by sex and age group. RESULTS 3988 patients aged over 65 were included (58.9% females). Patients with ≥ 2 chronic conditions changed from 73.6 to 98.3% in the 10-year range of the study. Six clusters of chronic multimorbidity were identified 10 years before baseline, whereas five clusters were identified at both 5 years before and at baseline. Three clusters were consistently identified in all time points (Metabolic and vascular disease, Musculoskeletal and chronic pain syndrome, Unspecific); three clusters were only present at the earliest time point (Male-predominant diseases, Minor conditions and sensory impairment, Lipid metabolism disorders) and two clusters emerged 5 years before baseline and remained (Heart diseases and Neurocognitive). Sex and age stratification showed different distribution in cluster prevalence and trajectories. CONCLUSIONS In a cohort of older patients, we were able to identify multimorbidity patterns of chronic conditions and describe their individual trajectories in the previous 10 years. Our results suggest that taking these trajectories into consideration might improve decisions in clinical management and healthcare planning. TRIAL REGISTRATION NUMBER NCT05717309.
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Affiliation(s)
- Marina Lleal
- Clinical Epidemiology and Cancer Screening Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, Sabadell, Spain
- Department of Paediatrics, Obstetrics and Gynaecology, Preventive Medicine and Public Health, Autonomous University of Barcelona (UAB), Bellaterra, Spain
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Instituto de Salud Carlos III, Madrid, Spain
| | - Montserrat Baré
- Creu Alta Primary Care Centre, Institut Català de la Salut, Sabadell, Spain
| | - Susana Herranz
- Acute Geriatric Unit, Centre Sociosanitari Albada, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Josefina Orús
- Cardiology Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Ricard Comet
- Acute Geriatric Unit, Centre Sociosanitari Albada, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Rosa Jordana
- Internal Medicine Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Marisa Baré
- Clinical Epidemiology and Cancer Screening Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, Sabadell, Spain.
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Instituto de Salud Carlos III, Madrid, Spain.
- Can Rull- Can Llong Primary Care Centre, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, Sabadell, Spain.
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Rajovic N, Zagorac S, Cirkovic A, Matejic B, Jeremic D, Tasic R, Cumic J, Masic S, Grupkovic J, Mitrovic V, Milic N, Gluscevic B. Musculoskeletal Diseases as the Most Prevalent Component of Multimorbidity: A Population-Based Study. J Clin Med 2024; 13:3089. [PMID: 38892800 PMCID: PMC11172850 DOI: 10.3390/jcm13113089] [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: 04/16/2024] [Revised: 05/12/2024] [Accepted: 05/16/2024] [Indexed: 06/21/2024] Open
Abstract
Background/Objectives: Due to their high frequency, common risk factors, and similar pathogenic mechanisms, musculoskeletal disorders (MSDs) are more likely to occur with other chronic illnesses, making them a "component disorder" of multimorbidity. Our objective was to assess the prevalence of multimorbidity and to identify the most common clusters of diagnosis within multimorbidity states, with the primary hypothesis that the most common clusters of multimorbidity are MSDs. Methods: The current study employed data from a population-based 2019 European Health Interview Survey (EHIS). Multimorbidity was defined as a ≥2 diagnosis from the list of 17 chronic non-communicable diseases, and to define clusters, the statistical method of hierarchical cluster analysis (HCA) was performed. Results: Out of 13,178 respondents, multimorbidity was present among 4398 (33.4%). The HCA method yielded six multimorbidity clusters representing the most common diagnoses. The primary multimorbidity cluster, which was prevalent among both genders, age groups, incomes per capita, and statistical regions, consisted of three diagnoses: (1) lower spine deformity or other chronic back problem (back pain), (2) cervical deformity or other chronic problem with the cervical spine, and (3) osteoarthritis. Conclusions: Given the influence of musculoskeletal disorders on multimorbidity, it is imperative to implement appropriate measures to assist patients in relieving the physical discomfort and pain they endure. Public health information, programs, and campaigns should be utilized to promote a healthy lifestyle. Policymakers should prioritize the prevention of MSDs by encouraging increased physical activity and a healthy diet, as well as focusing on improving functional abilities.
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Affiliation(s)
- Nina Rajovic
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (N.R.); (A.C.)
| | - Slavisa Zagorac
- Clinic for Orthopedic Surgery and Traumatology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (S.Z.); (J.G.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (D.J.); (J.C.); (B.G.)
| | - Andja Cirkovic
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (N.R.); (A.C.)
| | - Bojana Matejic
- Institute of Social Medicine, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
| | - Danilo Jeremic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (D.J.); (J.C.); (B.G.)
- Institute for Orthopedic Surgery “Banjica”, 11000 Belgrade, Serbia
| | - Radica Tasic
- Medical School, College of Vocational Studies, 11000 Belgrade, Serbia;
| | - Jelena Cumic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (D.J.); (J.C.); (B.G.)
- Department of Anesthesiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Srdjan Masic
- Department for Primary Health Care and Public Health, Faculty of Medicine Foca, University of East Sarajevo, 71123 East Sarajevo, Bosnia and Herzegovina;
| | - Jovana Grupkovic
- Clinic for Orthopedic Surgery and Traumatology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (S.Z.); (J.G.)
| | - Vekoslav Mitrovic
- Department for Neurology and Psychiatry, Faculty of Medicine Foca, University of East Sarajevo, 71123 East Sarajevo, Bosnia and Herzegovina
| | - Natasa Milic
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (N.R.); (A.C.)
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN 55902, USA
| | - Boris Gluscevic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (D.J.); (J.C.); (B.G.)
- Institute for Orthopedic Surgery “Banjica”, 11000 Belgrade, Serbia
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Iversen KG, Haaber RS, Stisen MB, Klenø AS, Lindberg-Larsen M, Pedersen AB, Mechlenburg I. The impact of comorbidity status on knee function 1 year after total knee arthroplasty: a population-based cohort study. Acta Orthop 2024; 95:243-249. [PMID: 38758022 PMCID: PMC11100490 DOI: 10.2340/17453674.2024.40706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 04/22/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND AND PURPOSE Few studies have examined the impact of comorbidity on functional and clinical knee scores after primary total knee arthroplasty (TKA). We compared the effect of having a high Charlson Comorbidity Index (CCI), relative to a low CCI, on changes in the American Knee Society Score (AKSS) functional and clinical scores from baseline to week 52 after TKA in patients with knee osteoarthritis (OA). METHODS This population-based cohort study included 22,533 patients identified in the Danish Knee Arthroplasty Register from 1997 to 2021. Patients were classified as having low, medium, or high comorbidity based on CCI. The outcome was defined as the mean change (from preoperative to 1-year post-TKA) in functional and clinical knee scores measured by the AKSS (0-100). The association was analyzed using multiple linear regression by calculating mean change scores adjusting for sex, age, weight, cohabiting status, and baseline AKSS. RESULTS The prevalence of patients with low, medium, and high comorbidity was 75%, 21%, and 4%, respectively. The mean change score in functional AKSS for patients with high comorbidity was -6 points (95% confidence interval [CI] -7 to -5) compared with low comorbidity. The mean change score in clinical AKSS for patients with high comorbidity was -1 point (CI -2 to 0) compared with low comorbidity. CONCLUSION Patients with knee OA and medium or high comorbidity can expect similar improvements in functional and clinical AKSS after TKA to patients with low comorbidity.
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Affiliation(s)
- Katrine Glintborg Iversen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus; Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus.
| | - Rikke Sommer Haaber
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus; Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus
| | - Martin Bækgaard Stisen
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus; Department of Clinical Medicine, Aarhus University, Aarhus
| | - André Sejr Klenø
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus; Department of Clinical Medicine, Aarhus University, Aarhus
| | - Martin Lindberg-Larsen
- Department of Orthopaedic Surgery, Odense University Hospital; University of Southern Denmark, Odense, Denmark
| | - Alma Becic Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus; Department of Clinical Medicine, Aarhus University, Aarhus
| | - Inger Mechlenburg
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus; Department of Clinical Medicine, Aarhus University, Aarhus
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Feng F, Zhang Y, Zhang X, Mu B, Qu W, Wang P. Natural Nano-Minerals (NNMs): Conception, Classification and Their Biomedical Composites. ACS OMEGA 2024; 9:17760-17783. [PMID: 38680370 PMCID: PMC11044256 DOI: 10.1021/acsomega.4c00674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 03/15/2024] [Accepted: 03/25/2024] [Indexed: 05/01/2024]
Abstract
Natural nano-minerals (NNMs) are minerals that are derived from nature with a size of less than 100 nm in at least one dimension in size. NNMs have a number of excellent properties due to their unique nanostructure and have been applied in various fields in recent years. They are rising stars in various disciplines, such as materials, biomedicine, and chemistry, taking advantage of their huge surface area, multiple active sites, excellent adsorption capacity, large quantity, low cost, and nontoxicity, etc. To provide a more comprehensive overview of NNMs and the biomedical applications of NNMs-based nanocomposites, this review classifies NNMs into three types by dimension, lists the structure and properties of typical NNMs, and illustrates their biomedical applications. Furthermore, a novel concept of natural nanomineral medical materials (NNMMs) is proposed, focusing on the medical value of NNMs. In addition, this review attempts to address the current challenges and delineate future directions for the advancement of NNMs. With the deepening of biomedical applications, it is believed that NNMMMs will inevitably play an important role in the field of human health and contribute to its promotion.
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Affiliation(s)
- Feng Feng
- Engineering Research Center of Ministry of Education for Geological Carbon Storage and Low Carbon Utilization of Resources, Beijing Key Laboratory of Materials Utilization of Nonmetallic Minerals and Solid Wastes, National Laboratory of Mineral Materials, School of Materials Science and Technology, China University of Geosciences (Beijing), Beijing100083, China
| | - Yihe Zhang
- Engineering Research Center of Ministry of Education for Geological Carbon Storage and Low Carbon Utilization of Resources, Beijing Key Laboratory of Materials Utilization of Nonmetallic Minerals and Solid Wastes, National Laboratory of Mineral Materials, School of Materials Science and Technology, China University of Geosciences (Beijing), Beijing100083, China
| | - Xiao Zhang
- Engineering Research Center of Ministry of Education for Geological Carbon Storage and Low Carbon Utilization of Resources, Beijing Key Laboratory of Materials Utilization of Nonmetallic Minerals and Solid Wastes, National Laboratory of Mineral Materials, School of Materials Science and Technology, China University of Geosciences (Beijing), Beijing100083, China
| | - Bin Mu
- Key Laboratory of Clay Mineral Applied Research of Gansu Province, Lanzhou Institute of Chemical Physics, Chinese Academy of Sciences, Lanzhou, Gansu 730000, China
| | - Wenjie Qu
- Engineering Research Center of Ministry of Education for Geological Carbon Storage and Low Carbon Utilization of Resources, Beijing Key Laboratory of Materials Utilization of Nonmetallic Minerals and Solid Wastes, National Laboratory of Mineral Materials, School of Materials Science and Technology, China University of Geosciences (Beijing), Beijing100083, China
| | - Peixia Wang
- National Anti-Drug Laboratory Beijing Regional Center, Beijing, 100164, China
- Beijing Narcotics Control Technology Center, Beijing, 100164, China
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Cunha C, Voss G, Andrade R, Delerue-Matos A. Is Formal Social Participation Associated with Cognitive Function in Middle-Aged and Older Adults? A Systematic Review with Meta-Analysis of Longitudinal Studies. Behav Sci (Basel) 2024; 14:262. [PMID: 38667058 PMCID: PMC11047523 DOI: 10.3390/bs14040262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 03/08/2024] [Accepted: 03/20/2024] [Indexed: 04/29/2024] Open
Abstract
This systematic review with meta-analysis aimed to explore the association between formal social participation and cognitive function in middle-aged and older adults using data from longitudinal studies. A comprehensive search was conducted in Scopus, PubMed, and Web of Science for longitudinal studies that assessed the association between formal social participation and cognitive function in middle-aged and older adults published between January 2010 to 19 August 2022. Risk of bias was judged using the RoBANS tool. Meta-analysis using a random-effects model was computed with odds ratio (OR) and 95% confidence interval (CI) for cognitive decline probability. Sensitivity analyses were made to explore any changes to the pooled statistical heterogeneity and pooled effect size. Certainty of evidence was judged using the GRADE framework. We included 15 studies comprising 136,397 participants from 5 countries. Meta-analyses showed that formal social participation was associated with reduced cognitive decline (OR = 0.78, 95% CI 0.75-0.82, p < 0.001), with very low certainty of evidence. Formal social participation appears to enhance cognition in middle-aged and older adults, but further high-quality research is needed given the very low certainty of evidence.
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Affiliation(s)
- Cláudia Cunha
- Communication and Society Research Centre, Institute of Social Sciences, University of Minho, 4710-057 Braga, Portugal;
| | - Gina Voss
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal;
| | - Renato Andrade
- Clínica Espregueira—FIFA Medical Centre of Excellence, 4350-415 Porto, Portugal;
- Dom Henrique Research Centre, 4350-415 Porto, Portugal
- Porto Biomechanics Laboratory (LABIOMEP), Faculty of Sports, University of Porto, 4200-450 Porto, Portugal
| | - Alice Delerue-Matos
- Communication and Society Research Centre, Institute of Social Sciences, University of Minho, 4710-057 Braga, Portugal;
- Department of Sociology, Institute of Social Sciences, University of Minho, 4710-057 Braga, Portugal
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Vennu V. Association between chronic disease, sensory impairment, walking limitation, and activities of daily living of community-dwelling older Indians. Medicine (Baltimore) 2024; 103:e37318. [PMID: 38428896 PMCID: PMC10906618 DOI: 10.1097/md.0000000000037318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 01/30/2024] [Indexed: 03/03/2024] Open
Abstract
Due to the paucity of existing evidence, this study aims to investigate the relationship between chronic disease, sensory impairment, walking limitation, and difficulty in activities of daily living (ADLs) in community-dwelling older Indians. This cross-sectional study included data from 31,394 individuals aged ≥ 60 years from the 2017 to 2018 Longitudinal Ageing Study in India. Participants were divided into 2 groups: 12,993 with chronic disease, sensory impairment, and a walking limitation, and 18,401 healthy individuals without such conditions. Participants with any chronic disease were further divided into 2 groups: sensory impairment (n = 12,462), and a walking limitation (n = 4745). Self-reported close-ended questionnaires with yes or no were used to assess each chronic disease (such as hypertension, diabetes, lung disorders, joint disorders, or heart disease), sensory impairment (vision or hearing), and walking limitation. A walking limitation was defined as being when a person could only walk at their usual pace for less than 500 meters on a flat surface. ADLs were assessed and classified as physical ADLs including basic physical requirements like dressing. Instrumental ADLs (IADLs) included more complicated community-based tasks like meal preparation. Findings showed that older Indians with chronic disease, sensory impairment, and a walking limitation were more likely to be significantly associated with physical ADLs (adjusted odds ratio [aOR] = 1.85, 95% confidence interval [CI] = 1.34-1.57, P < .0001) and IADLs (aOR = 1.45, 95% CI = 1.70-2.03, P < .0001) than those without such conditions. Among older Indians with chronic disease, sensory impairment was more likely associated with physical ADLs (aOR = 1.98, 95% CI = 1.82-2.16, P < .0001) and IADLs (aOR = 1.26, 95% CI = 1.15-1.37, P < .0001) followed by a walking limitation (aOR = 1.53, 95% CI = 1.42-1.65, P < .0001; aOR = 1.27, 95% CI = 1.17-1.38, P < .0001, respectively). These findings suggest that older Indians with chronic disease, sensory impairment, and walking limitation, can experience increased difficulty in overall and individual physical ADL and IADL than those without these conditions. Older Indians with any chronic condition who had sensory impairment or a walking limitation were also more likely to have difficulty with physical ADLs and IADLs.
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Affiliation(s)
- Vishal Vennu
- Department of Rehabilitation, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
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Smith L, Yon DK, Butler L, Kostev K, Brayne C, Barnett Y, Underwood BR, Shin JI, Rahmati M, Neufeld SAS, Ragnhildstveit A, López Sánchez GF, Koyanagi A. Factors That Influence Meeting the Recommended Weekly Physical Activity Target Among Older People With Physical Multimorbidity: Evidence From 6 Low- and Middle-Income Countries. J Phys Act Health 2024; 21:247-255. [PMID: 38154018 DOI: 10.1123/jpah.2023-0473] [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: 08/25/2023] [Revised: 09/30/2023] [Accepted: 11/27/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND There is a scarcity of studies on the association between physical multimorbidity and lower levels of physical activity among older adults from low- and middle-income countries, while the potential mediating variables in this association are largely unknown. METHODS Cross-sectional, community-based, nationally representative data from the World Health Organization Study on global AGEing and adult health were analyzed. Data on 11 chronic physical conditions were collected. Scoring <150 minutes of moderate- to high-intensity physical activity per week was considered low physical activity. Multivariable logistic regression and mediation analysis were done to assess associations and quality of life measures which might influence these associations. RESULTS Data on 14,585 people aged ≥65 years were analyzed (mean [SD] age 72.6 (11.5) y, maximum age 114 y; 55.0% women). After adjustment for potential confounders, compared with no chronic conditions, ≥3 conditions were associated with a significant 1.59 to 2.42 times higher odds for low physical activity. Finally, mobility mediated the largest proportion of the association between ≥3 chronic physical conditions and low physical activity (mediated percentage 50.7%), followed by activities of daily living disability (30.7%), cognition (24.0%), affect (23.6%), and pain/discomfort (22.0%). CONCLUSIONS Physical multimorbidity was associated with higher odds for low physical activity among older adults residing in low- and middle-income countries. Mobility, disability, cognition, affect, and pain/discomfort explained the largest proportion of this association. Given the universal benefits of regular and sustained participation in physical activity, it would be prudent to implement interventions among older people with physical multimorbidity to increase levels of physical activity. Future studies should assess the impact of addressing the identified potential mediators among people with multimorbidity on physical activity levels.
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Affiliation(s)
- Lee Smith
- Centre for Health Performance and Wellbeing, Anglia Ruskin University, Cambridge, United Kingdom
| | - Dong Keon Yon
- Department of Medicine, Kyung Hee University College of Medicine, Seoul, South Korea
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine,Seoul, South Korea
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea
- Department of Pediatrics, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Laurie Butler
- Centre for Health Performance and Wellbeing, Anglia Ruskin University, Cambridge, United Kingdom
- Centre for Health Performance and Wellbeing, Anglia Ruskin University, Cambridge, United Kingdom
| | | | - Carol Brayne
- Cambridge Public Health, University of Cambridge, Cambridge, United Kingdom
| | - Yvonne Barnett
- Centre for Health Performance and Wellbeing, Anglia Ruskin University, Cambridge, United Kingdom
| | - Benjamin R Underwood
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, United Kingdom
- Faculty of Science and Engineering, Anglia Ruskin University, Cambridge, United Kingdom
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, South Korea
- Severance Underwood Meta-Research Center, Institute of Convergence Science, Yonsei University, Seoul, Republic of Korea
| | - Masoud Rahmati
- Department of Physical Education and Sport Sciences, Faculty of Literature and Human Sciences, Lorestan University, Khoramabad, Iran
- Department of Physical Education and Sport Sciences, Faculty of Literature and Humanities, Vali-E-Asr University of Rafsanjan, Rafsanjan, Iran
| | - Sharon A S Neufeld
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Anya Ragnhildstveit
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Guillermo F López Sánchez
- Division of Preventive Medicine and Public Health, Department of Public Health Sciences, School of Medicine, University of Murcia, Murcia, Spain
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Barcelona, Spain
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10
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Hu M, Yu H, Zhang Y, Xiang B, Wang Q. Gender-specific association of the accumulation of chronic conditions and disability in activities of daily living with depressive symptoms. Arch Gerontol Geriatr 2024; 118:105287. [PMID: 38029545 DOI: 10.1016/j.archger.2023.105287] [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: 08/29/2023] [Revised: 11/19/2023] [Accepted: 11/24/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND In the era of rapid aging with a rising prevalence of multimorbidity, complex interactions between physical and psychological conditions have challenged the health care system. However, little is known about the association of the accumulation of chronic conditions and disability in activities of daily living with depressive symptoms, especially in developed countries. METHODS This population-based cohort study used data from the Health and Retirement Study. A total of 22,335 middle-aged and older adults participated in the 2014 (T1), 2016 (T2), and 2018 (T3) waves of the cohort were included. The accumulation of chronic conditions and disability were defined as the number of chronic diseases and the five activities of daily living. Depressive symptoms were measured by the Center for Epidemiologic Studies Depression Scale. A longitudinal mediation model with a cross-lagged panel model was run. As robust check, the models were applied with a longer follow-up period (from 2012 to 2018). Additionally, results were estimated in China. RESULTS Bidirectional associations have been found among the accumulation of chronic conditions, disability, and depressive symptoms, especially between disability and depression. Disability (T2) mediated 11.11 % and 16.87 % of the association between the accumulation of chronic conditions (T1) and depression (T3) for men and women in the United States. The results were consistent in robust analysis. CONCLUSIONS This study found that men and women routinely experienced disability and depressive symptoms because of the accumulation of chronic conditions. In terms of depressive symptoms, women were more sensitive to the accumulation of chronic conditions through disability.
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Affiliation(s)
- Mengxiao Hu
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, PR China; National Institute of Health Data Science of China, Shandong University, Jinan, 250012, Shandong, PR China
| | - Haiyang Yu
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, PR China; National Institute of Health Data Science of China, Shandong University, Jinan, 250012, Shandong, PR China
| | - Yike Zhang
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, PR China; National Institute of Health Data Science of China, Shandong University, Jinan, 250012, Shandong, PR China
| | - Bowen Xiang
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, PR China; National Institute of Health Data Science of China, Shandong University, Jinan, 250012, Shandong, PR China
| | - Qing Wang
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, PR China; National Institute of Health Data Science of China, Shandong University, Jinan, 250012, Shandong, PR China; Yellow River National Strategic Research Institute, Shandong University, Jinan, 250012, Shandong, PR China.
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11
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Dormosh N, Abu-Hanna A, Calixto I, Schut MC, Heymans MW, van der Velde N. Topic evolution before fall incidents in new fallers through natural language processing of general practitioners' clinical notes. Age Ageing 2024; 53:afae016. [PMID: 38364820 PMCID: PMC10939375 DOI: 10.1093/ageing/afae016] [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: 07/20/2023] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Falls involve dynamic risk factors that change over time, but most studies on fall-risk factors are cross-sectional and do not capture this temporal aspect. The longitudinal clinical notes within electronic health records (EHR) provide an opportunity to analyse fall risk factor trajectories through Natural Language Processing techniques, specifically dynamic topic modelling (DTM). This study aims to uncover fall-related topics for new fallers and track their evolving trends leading up to falls. METHODS This case-cohort study utilised primary care EHR data covering information on older adults between 2016 and 2019. Cases were individuals who fell in 2019 but had no falls in the preceding three years (2016-18). The control group was randomly sampled individuals, with similar size to the cases group, who did not endure falls during the whole study follow-up period. We applied DTM on the clinical notes collected between 2016 and 2018. We compared the trend lines of the case and control groups using the slopes, which indicate direction and steepness of the change over time. RESULTS A total of 2,384 fallers (cases) and an equal number of controls were included. We identified 25 topics that showed significant differences in trends between the case and control groups. Topics such as medications, renal care, family caregivers, hospital admission/discharge and referral/streamlining diagnostic pathways exhibited a consistent increase in steepness over time within the cases group before the occurrence of falls. CONCLUSIONS Early recognition of health conditions demanding care is crucial for applying proactive and comprehensive multifactorial assessments that address underlying causes, ultimately reducing falls and fall-related injuries.
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Affiliation(s)
- Noman Dormosh
- Department of Medical Informatics, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Aging and Later Life & Methodology, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Ameen Abu-Hanna
- Department of Medical Informatics, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Aging and Later Life & Methodology, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Iacer Calixto
- Department of Medical Informatics, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Methodology & Mental Health, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Martijn C Schut
- Department of Medical Informatics, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Department of Laboratory Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Methodology & Quality of Care, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Martijn W Heymans
- Department of Epidemiology and Data Science, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Methodology & Personalized Medicine, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Nathalie van der Velde
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Aging and Later Life, Amsterdam Public Health, Amsterdam, The Netherlands
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12
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Li T, Hu W, Han Q, Wang Y, Ma Z, Chu J, He Q, Feng Z, Sun N, Shen Y. Trajectories of quality of life and cognition in different multimorbidity patterns: Evidence from SHARE. Arch Gerontol Geriatr 2024; 117:105219. [PMID: 37812973 DOI: 10.1016/j.archger.2023.105219] [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: 07/23/2023] [Revised: 10/01/2023] [Accepted: 10/03/2023] [Indexed: 10/11/2023]
Abstract
OBJECTIVES The study aimed to observe the trajectory of quality of life (QoL) and cognition, and to a analyze the bidirectional association between cognition and QoL for diverse multimorbidity patterns. METHODS In total, 16,153 older participants age ≥50 years were included from the Survey of Health, Ageing and Retirement in Europe (SHARE). We used latent class analysis (LCA) to identify multimorbidity patterns in the baseline population. We used linear mixed models (LMM) to examine the trajectory of cognition and QoL in different multimorbidity patterns. A cross-lagged model was employed to analyze the bidirectional association between cognition and QoL in diverse multimorbidity patterns. RESULTS Latent class analysis identified four multimorbidity patterns: high and low comorbidity burden (HC and LC), cardiometabolic (CA), and osteoarthrosis (OS). The HC group had the poorest cognitive function and QoL (p for trend < 0.001). Delayed and immediate episodic memory in the OS group declined at a highest rate (p for trend < 0.001). Additionally, a bidirectional association between cognition and QoL was observed. The effect of cognitive function on QoL was relatively stronger than the reverse in the CA and LC groups. CONCLUSIONS The rate of decline in cognition and QoL over the time differs in diverse multimorbidity patterns, and patients with four or more chronic diseases should be specially considered. Notably, early monitoring of cognitive function and can help break the vicious cycle between cognitive deterioration and poor QoL in patients with OS or CA diseases.
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Affiliation(s)
- Tongxing Li
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou 215123, China
| | - Wei Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou 215123, China
| | - Qiang Han
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou 215123, China
| | - Yu Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou 215123, China
| | - Ze Ma
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou 215123, China
| | - Jiadong Chu
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou 215123, China
| | - Qida He
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou 215123, China
| | - Zhaolong Feng
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou 215123, China
| | - Na Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou 215123, China
| | - Yueping Shen
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou 215123, China.
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13
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Barrio-Cortes J, Castaño-Reguillo A, Benito-Sánchez B, Beca-Martínez MT, Ruiz-Zaldibar C. Utilization of Primary Healthcare Services in Patients with Multimorbidity According to Their Risk Level by Adjusted Morbidity Groups: A Cross-Sectional Study in Chamartín District (Madrid). Healthcare (Basel) 2024; 12:270. [PMID: 38275550 PMCID: PMC10815081 DOI: 10.3390/healthcare12020270] [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: 11/17/2023] [Revised: 01/16/2024] [Accepted: 01/18/2024] [Indexed: 01/27/2024] Open
Abstract
Patients with multimorbidity have increased and more complex healthcare needs, posing their management a challenge for healthcare systems. This study aimed to describe their primary healthcare utilization and associated factors. A population-based cross-sectional study was conducted in a Spanish basic healthcare area including all patients with chronic conditions, differentiating between having multimorbidity or not. Sociodemographic, functional, clinical and service utilization variables were analyzed, stratifying the multimorbid population by the Adjusted Morbidity Groups (AMG) risk level, sex and age. A total of 6036 patients had multimorbidity, 64.2% being low risk, 28.5% medium risk and 7.3% high risk. Their mean age was 64.1 years and 63.5% were women, having on average 3.5 chronic diseases, and 25.3% were polymedicated. Their mean primary care contacts/year was 14.9 (7.8 with family doctors and 4.4 with nurses). Factors associated with primary care utilization were age (B-coefficient [BC] = 1.15;95% Confidence Interval [CI] = 0.30-2.01), female sex (BC = 1.04; CI = 0.30-1.78), having a caregiver (BC = 8.70; CI = 6.72-10.69), complexity (B-coefficient = 0.46; CI = 0.38-0.55), high-risk (B-coefficient = 2.29; CI = 1.26-3.32), numerous chronic diseases (B-coefficient = 1.20; CI = 0.37-2.04) and polypharmacy (B-coefficient = 5.05; CI = 4.00-6.10). This study provides valuable data on the application of AMG in multimorbid patients, revealing their healthcare utilization and the need for a patient-centered approach by primary care professionals. These results could guide in improving coordination among professionals, optimizing multimorbidity management and reducing costs derived from their extensive healthcare utilization.
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Affiliation(s)
- Jaime Barrio-Cortes
- Foundation for Biosanitary Research and Innovation in Primary Care (FIIBAP), 28003 Madrid, Spain
- Faculty of Health, Camilo José Cela University, 28692 Madrid, Spain
| | | | - Beatriz Benito-Sánchez
- Foundation for Biosanitary Research and Innovation in Primary Care (FIIBAP), 28003 Madrid, Spain
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Cerullo G, Figueiredo T, Coelho C, Campos CS, Videira-Silva A, Carrilho J, Midão L, Costa E. Palliative Care in the Ageing European Population: A Cross-Country Comparison. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:113. [PMID: 38276807 PMCID: PMC10815293 DOI: 10.3390/ijerph21010113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/11/2024] [Accepted: 01/17/2024] [Indexed: 01/27/2024]
Abstract
With Europe's ageing population and rising demand for palliative care, it is crucial to examine the use of palliative care among older adults during their last years of life and understand the factors influencing their access and end-of-life circumstances. This study employed a cohort of SHARE participants aged 65 years or older who had passed away between Wave 6 (2015) and Wave 7 (2017). Information on death circumstances, palliative care utilization, and associated variables were analysed. The study revealed that nearly 13.0% of individuals across these countries died under palliative care, with Slovenia having the lowest rate (0.3%) and France the highest (30.4%). Palliative care utilization in the last 30 days before death was observed in over 24.0% of participants, with the Czech Republic having the lowest rate (5.0%) and Greece the highest (48.8%). A higher risk of using or dying in palliative care was significantly associated with cognitive impairment (low verbal fluency), physical inactivity, and good to excellent self-perceived health. This work highlights the urgent need for enhanced global access to palliative care and advocates for the cross-country comparison of effective practices within Europe, tailored to the unique healthcare needs of older adults.
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Affiliation(s)
- Giovanni Cerullo
- Palliative Care, Centro Hospitalar Universitário do Algarve, 8000-386 Algarve, Portugal;
- Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
| | - Teodora Figueiredo
- CINTESIS@RISE, Biochemistry Lab, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal; (T.F.); (C.C.); (C.S.C.); (J.C.); (L.M.)
- Department of Biological Sciences, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal
- Porto4Ageing—Competences Centre on Active and Healthy Ageing, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal
| | - Constantino Coelho
- CINTESIS@RISE, Biochemistry Lab, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal; (T.F.); (C.C.); (C.S.C.); (J.C.); (L.M.)
- Department of Biological Sciences, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal
- Porto4Ageing—Competences Centre on Active and Healthy Ageing, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal
| | - Cláudia Silva Campos
- CINTESIS@RISE, Biochemistry Lab, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal; (T.F.); (C.C.); (C.S.C.); (J.C.); (L.M.)
- Department of Biological Sciences, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal
- Porto4Ageing—Competences Centre on Active and Healthy Ageing, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal
| | - António Videira-Silva
- Pediatric University Clinic, Faculty of Medicine, University of Lisbon, 1649-028 Lisbon, Portugal;
- Research Centre in Physical Activity, Health and Leisure, Faculty of Sport, University of Porto, 4200-450 Porto, Portugal
- Centro de Investigação em Desporto, Educação Física, Exercício e Saúde (CIDEFES), Universidade Lusófona, 1749-024 Lisbon, Portugal
| | - Joana Carrilho
- CINTESIS@RISE, Biochemistry Lab, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal; (T.F.); (C.C.); (C.S.C.); (J.C.); (L.M.)
- Department of Biological Sciences, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal
- Porto4Ageing—Competences Centre on Active and Healthy Ageing, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal
| | - Luís Midão
- CINTESIS@RISE, Biochemistry Lab, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal; (T.F.); (C.C.); (C.S.C.); (J.C.); (L.M.)
- Department of Biological Sciences, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal
- Porto4Ageing—Competences Centre on Active and Healthy Ageing, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal
| | - Elísio Costa
- CINTESIS@RISE, Biochemistry Lab, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal; (T.F.); (C.C.); (C.S.C.); (J.C.); (L.M.)
- Department of Biological Sciences, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal
- Porto4Ageing—Competences Centre on Active and Healthy Ageing, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal
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15
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Bellass S, Scharf T, Errington L, Bowden Davies K, Robinson S, Runacres A, Ventre J, Witham MD, Sayer AA, Cooper R. Experiences of hospital care for people with multiple long-term conditions: a scoping review of qualitative research. BMC Med 2024; 22:25. [PMID: 38229088 PMCID: PMC10792930 DOI: 10.1186/s12916-023-03220-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 12/07/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND Multiple long-term conditions-the co-existence of two or more chronic health conditions in an individual-present an increasing challenge to populations and healthcare systems worldwide. This challenge is keenly felt in hospital settings where care is oriented around specialist provision for single conditions. The aim of this scoping review was to identify and summarise published qualitative research on the experiences of hospital care for people living with multiple long-term conditions, their informal caregivers and healthcare professionals. METHODS We undertook a scoping review, following established guidelines, of primary qualitative research on experiences of hospital care for people living with multiple long-term conditions published in peer-reviewed journals between Jan 2010 and June 2022. We conducted systematic electronic searches of MEDLINE, CINAHL, PsycInfo, Proquest Social Science Premium, Web of Science, Scopus and Embase, supplemented by citation tracking. Studies were selected for inclusion by two reviewers using an independent screening process. Data extraction included study populations, study design, findings and author conclusions. We took a narrative approach to reporting the findings. RESULTS Of 8002 titles and abstracts screened, 54 papers reporting findings from 41 studies conducted in 14 countries were identified as eligible for inclusion. The perspectives of people living with multiple long-term conditions (21 studies), informal caregivers (n = 13) and healthcare professionals (n = 27) were represented, with 15 studies reporting experiences of more than one group. Findings included poor service integration and lack of person-centred care, limited confidence of healthcare professionals to treat conditions outside of their specialty, and time pressures leading to hurried care transitions. Few studies explored inequities in experiences of hospital care. CONCLUSIONS Qualitative research evidence on the experiences of hospital care for multiple long-term conditions illuminates a tension between the desire to provide and receive person-centred care and time pressures inherent within a target-driven system focussed on increasing specialisation, reduced inpatient provision and accelerated journeys through the care system. A move towards more integrated models of care may enable the needs of people living with multiple long-term conditions to be better met. Future research should address how social circumstances shape experiences of care.
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Affiliation(s)
- Sue Bellass
- Department of Sport and Exercise Sciences, Manchester Metropolitan University, Manchester, UK.
| | - Thomas Scharf
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
| | - Linda Errington
- School of Biomedical Nutritional and Sport Sciences, Newcastle University, Newcastle Upon Tyne, UK
| | - Kelly Bowden Davies
- Department of Sport and Exercise Sciences, Manchester Metropolitan University, Manchester, UK
| | - Sian Robinson
- AGE Research Group, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
- NIHR Newcastle Biomedical Research Centre, Newcastle University, Newcastle Upon Tyne NHS Foundation Trust and Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Adam Runacres
- Department of Sport and Exercise Sciences, Manchester Metropolitan University, Manchester, UK
| | - Jodi Ventre
- NIHR ARC Greater Manchester, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Miles D Witham
- AGE Research Group, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
- NIHR Newcastle Biomedical Research Centre, Newcastle University, Newcastle Upon Tyne NHS Foundation Trust and Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Avan A Sayer
- AGE Research Group, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
- NIHR Newcastle Biomedical Research Centre, Newcastle University, Newcastle Upon Tyne NHS Foundation Trust and Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Rachel Cooper
- AGE Research Group, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
- NIHR Newcastle Biomedical Research Centre, Newcastle University, Newcastle Upon Tyne NHS Foundation Trust and Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle Upon Tyne, UK
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16
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Reis Júnior WM, Ferreira LN, Molina-Bastos CG, Bispo Júnior JP, Reis HFT, Goulart BNG. Prevalence of functional dependence and chronic diseases in the community-dwelling Brazilian older adults: an analysis by dependence severity and multimorbidity pattern. BMC Public Health 2024; 24:140. [PMID: 38200484 PMCID: PMC10777626 DOI: 10.1186/s12889-023-17564-w] [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: 04/19/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Despite the advancements in knowledge about health care for older adults, essential gaps persist regarding the effects of chronic diseases as epidemiological markers of the state of functional dependence. This study aimed to identify the prevalence of moderate and severe functional dependence in Brazilian older adults and its association with chronic diseases and verify the multimorbidity patterns by dependence status. METHODS This cross-sectional analytical study used data from 11,177 community-dwelling Brazilian older adults from the 2013 National Health Survey conducted in Brazil. The dependent variables were moderate and severe functional dependence in basic activities of daily living (BADLs) and instrumental ADLs (IADLs). The independent variables were defined based on the questions applied to measure each morbidity in a self-reported manner and asked, "Has a doctor ever diagnosed you as having (each disease)? Multimorbidity was simultaneously considered present for older adults with ≥ 2 chronic morbidities. The association between functional dependence on BADLs and IADLs separately by severity and the independent variables was verified from crude and adjusted estimates of the point prevalence ratios and their 95% confidence intervals using the regression model Poisson with robust variance. To group diseases into patterns, exploratory factor analysis was used. RESULTS The prevalences of moderate and severe BADL dependence were 10.2% (95% CI, 9.6-10.7) and 4.8% (95% CI, 4.4-5.2), respectively. Moderate and severe IADL dependence prevalences were 13.8% (95% CI, 13.1-14.4) and 15.6% (95% CI, 14.9%-16.2), respectively. When changing the condition from moderate to severe dependence in BADLs, in the presence of other mental illnesses and stroke, the probability of dependence increased more than four times in the case of other mental illnesses and more than five times for stroke. There was a linear trend for dependence severity, both moderate and severe, whereas, for severe dependence on IADLs, this same factor maintained a linear trend toward an increase in probability as the number of diseases simultaneously increased. CONCLUSIONS Chronic diseases are associated with functional dependence, with greater emphasis on mental illnesses and stroke in severe disability, considering their acute adverse effects.
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Affiliation(s)
| | | | | | | | | | - Bárbara Niegia Garcia Goulart
- Department of Health 1, State University of Southwest Bahia, Jequié, Bahia, Brazil.
- Federal University of Rio Grande Do Sul, Rio Grande Do Sul. Rua Ramiro Barcelos, 2777 Room 307, Porto Alegre, RS, CEP 90035-003, Brazil.
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17
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Kabir A, Conway DP, Ansari S, Tran A, Rhee JJ, Barr M. Impact of multimorbidity and complex multimorbidity on healthcare utilisation in older Australian adults aged 45 years or more: a large population-based cross-sectional data linkage study. BMJ Open 2024; 14:e078762. [PMID: 38199624 PMCID: PMC10806611 DOI: 10.1136/bmjopen-2023-078762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 11/24/2023] [Indexed: 01/12/2024] Open
Abstract
OBJECTIVES As life expectancy increases, older people are living longer with multimorbidity (MM, co-occurrence of ≥2 chronic health conditions) and complex multimorbidity (CMM, ≥3 chronic conditions affecting ≥3 different body systems). We assessed the impacts of MM and CMM on healthcare service use in Australia, as little was known about this. DESIGN Population-based cross-sectional data linkage study. SETTING New South Wales, Australia. PARTICIPANTS 248 496 people aged ≥45 years who completed the Sax Institute's 45 and Up Study baseline questionnaire. PRIMARY OUTCOME High average annual healthcare service use (≥2 hospital admissions, ≥11 general practice visits and ≥2 emergency department (ED) visits) during the 3-year baseline period (year before, year of and year after recruitment). METHODS Baseline questionnaire data were linked with hospital, Medicare claims and ED datasets. Poisson regression models were used to estimate adjusted and unadjusted prevalence ratios for high service use with 95% CIs. Using a count of chronic conditions (disease count) as an alternative morbidity metric was requested during peer review. RESULTS Prevalence of MM and CMM was 43.8% and 15.5%, respectively, and prevalence increased with age. Across three healthcare settings, MM was associated with a 2.02-fold to 2.26-fold, and CMM was associated with a 1.83-fold to 2.08-fold, increased risk of high service use. The association was higher in the youngest group (45-59 years) versus the oldest group (≥75 years), which was confirmed when disease count was used as the morbidity metric in sensitivity analysis.When comparing impact using three categories with no overlap (no MM/CMM, MM with no CMM, and CMM), CMM had greater impact than MM across all settings. CONCLUSION Increased healthcare service use among older adults with MM and CMM impacts on the demand for primary care and hospital services. Which of MM or CMM has greater impact on risk of high healthcare service use depends on the analytic method used. Ageing populations living longer with increasing burdens of MM and CMM will require increased Medicare funding and provision of integrated care across the healthcare system to meet their complex needs.
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Affiliation(s)
- Alamgir Kabir
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
- The George Institute for Global Health, Sydney, NSW, Australia
| | - Damian P Conway
- Population and Community Health, South Eastern Sydney Local Health District, Sydney, New South Wales, Australia
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Sameera Ansari
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
- Faculty of Health Sciences and Medicine, Bond University, Robina, Queensland, Australia
| | - An Tran
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
| | - Joel J Rhee
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Margo Barr
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
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18
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Hagelskjær V, Wæhrens EE, von Bülow C, Nielsen KT. Qualitative realist evaluation of an occupational therapy intervention programme (ABLE), addressing ability to perform activities of daily living among persons with chronic conditions. BMC Health Serv Res 2024; 24:9. [PMID: 38172780 PMCID: PMC10765686 DOI: 10.1186/s12913-023-10498-4] [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: 02/08/2023] [Accepted: 12/19/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Chronic conditions are associated with problems related to performance of activities of daily living (ADL) stressing a need to develop and evaluate intervention programmes addressing such problems. Hence, the ABLE programme was developed, and its feasibility evaluated. Implementing intervention programmes in community-based rehabilitation settings requires understanding of how the programme works in various contexts. Applying a realist evaluation approach, the aim of this study was to identify and evaluate interactions between contexts, mechanisms, and outcomes in the ABLE 2.0, to confirm, refine, or reject aspects of the initial programme theory. METHODS Realist evaluation using qualitative data collected in the ABLE 2.0 randomised controlled trial (n = 78). Based on the ABLE 2.0 initial programme theory, qualitative realist interviews were conducted among receivers (n = 8) and deliverers (n = 3) of the ABLE 2.0 in a Danish municipality. Transcripts were coded, and context-mechanism-outcome configurations were extracted and grouped into contiguous themes. Results were then held up against the initial programme theory. RESULTS Four contiguous themes were identified including a total of n = 28 context-mechanism-outcome configurations: building a foundation for the entire intervention; establishing the focus for further intervention; identifying and implementing relevant compensatory solutions; and re-evaluating ADL ability to finalise intervention. Overall, the ABLE 2.0 initial programme theory was confirmed. The evaluation added information on core facilitating mechanisms including active involvement of the client in the problem-solving process, a collaborative working relationship, mutual confidence, and a consultative occupation-based process using compensatory solutions. Several contextual factors were required to activate the desired mechanisms in terms of supportive management, referral procedures encouraging the problem-solving process, delivery in the client's home, skilled occupational therapists, and clients feeling ready for making changes. CONCLUSIONS The ABLE 2.0 represents a coherent problem-solving occupational therapy process, applicable across sex, age, and diagnoses with the potential to enhance ADL ability among persons with chronic conditions, when delivered as part of community-based rehabilitation services. Knowledge about the interactions between contextual factors, mechanisms, and outcomes in the ABLE 2.0 is central in case of future implementation of the programme in community-based rehabilitation settings. TRIAL REGISTRATION The trial was prospectively registered on www. CLINICALTRIALS gov (registration date: 05/03/2020; identifier: NCT04295837 ) prior to data collection that occurred between August 2020 and October 2021.
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Affiliation(s)
- Vita Hagelskjær
- Occupation Centered occupational therapy, The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark.
- Occupational Science, User Perspectives and Community-based Interventions, Department of Public Health, University of Southern Denmark, Odense, Denmark.
- Department of Occupational Therapy, VIA University College, Holstebro, Denmark.
| | - Eva Ejlersen Wæhrens
- Occupation Centered occupational therapy, The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- Occupational Science, User Perspectives and Community-based Interventions, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Cecilie von Bülow
- Occupation Centered occupational therapy, The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Kristina Tomra Nielsen
- Occupation Centered occupational therapy, The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Occupational Therapy, University College of Northern Denmark, Aalborg, Denmark
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19
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Deng M, Lu Y, Li X, Zhou X, Hou G. Association between sarcopenia and multimorbidity among middle-aged and older adults in China: Findings from the China Health and Retirement Longitudinal Study. Exp Gerontol 2024; 185:112348. [PMID: 38128847 DOI: 10.1016/j.exger.2023.112348] [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: 10/02/2023] [Revised: 12/09/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Little is known about the association between sarcopenia and multimorbidity among middle-aged and older adults. This study investigated whether sarcopenia is associated with multimorbidity in middle-aged and older Chinese individuals. MATERIALS AND METHODS A total of 12,760 participants from China Health and Retirement Longitudinal Study (CHARLS) 2015, with data on 14 specified chronic diseases and sarcopenia status were included in the cross-sectional analysis. A total of 7345 participants without multimorbidity from the CHARLS 2015 were included and followed up in 2018 in the longitudinal analysis. Logistic regression models were used in a cross-sectional investigation to assess the association between sarcopenia status and multimorbidity. In a longitudinal analysis, the relationships between sarcopenia status and multimorbidity were investigated using Cox proportional hazards models. RESULTS Multimorbidity was prevalent in the no sarcopenia, possible sarcopenia, and sarcopenia groups at 38.8 % (3765/9713), 56.6 % (1199/2118), and 48.5 % (451/929), respectively. Multivariable regression revealed that both possible sarcopenia (β = 0.088, P<0.001) and sarcopenia (β = 0.028, P = 0.009), contributed to the number of chronic diseases. Logistic regression revealed that possible sarcopenia (OR: 1.56, 95 % CI: 1.39-1.76) was associated with multimorbidity. In the longitudinal analysis, participants in the possible sarcopenia group (HR: 1.19, 95 % CI:1.03-1.38) were more prone to experience new onset multimorbidity than did participants in the no sarcopenia group. CONCLUSIONS Possible sarcopenia is associated with the development of multimorbidity in middle-aged and older Chinese populations. Health screening of populations with possible sarcopenia can facilitate early detection of multimorbidity.
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Affiliation(s)
- Mingming Deng
- National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, PR China
| | - Ye Lu
- Department of Pulmonary and Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Xuelian Li
- Department of Epidemiology, School of Public Health, China Medical University, Shenyang, China
| | - Xiaoming Zhou
- Respiratory Department, Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Gang Hou
- National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, PR China.
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20
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Beridze G, Abbadi A, Ars J, Remelli F, Vetrano DL, Trevisan C, Pérez LM, López-Rodríguez JA, Calderón-Larrañaga A. Patterns of multimorbidity in primary care electronic health records: A systematic review. JOURNAL OF MULTIMORBIDITY AND COMORBIDITY 2024; 14:26335565231223350. [PMID: 38298757 PMCID: PMC10829499 DOI: 10.1177/26335565231223350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 12/12/2023] [Indexed: 02/02/2024]
Abstract
Background Multimorbidity, the coexistence of multiple chronic conditions in an individual, is a complex phenomenon that is highly prevalent in primary care settings, particularly in older individuals. This systematic review summarises the current evidence on multimorbidity patterns identified in primary care electronic health record (EHR) data. Methods Three databases were searched from inception to April 2022 to identify studies that derived original multimorbidity patterns from primary care EHR data. The quality of the included studies was assessed using a modified version of the Newcastle-Ottawa Quality Assessment Scale. Results Sixteen studies were included in this systematic review, none of which was of low quality. Most studies were conducted in Spain, and only one study was conducted outside of Europe. The prevalence of multimorbidity (i.e. two or more conditions) ranged from 14.0% to 93.9%. The most common stratification variable in disease clustering models was sex, followed by age and calendar year. Despite significant heterogeneity in clustering methods and disease classification tools, consistent patterns of multimorbidity emerged. Mental health and cardiovascular patterns were identified in all studies, often in combination with diseases of other organ systems (e.g. neurological, endocrine). Discussion These findings emphasise the frequent coexistence of physical and mental health conditions in primary care, and provide useful information for the development of targeted preventive and management strategies. Future research should explore mechanisms underlying multimorbidity patterns, prioritise methodological harmonisation to facilitate the comparability of findings, and promote the use of EHR data globally to enhance our understanding of multimorbidity in more diverse populations.
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Affiliation(s)
- Giorgi Beridze
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Aging Research Center, Stockholm, Sweden
| | - Ahmad Abbadi
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Aging Research Center, Stockholm, Sweden
| | - Joan Ars
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Aging Research Center, Stockholm, Sweden
- RE-FiT Barcelona Research group, Vall d'Hebron Institute of Research (VHIR) and Parc Sanitari Pere Virgili, Barcelona, Spain
- Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Francesca Remelli
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Davide L Vetrano
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Aging Research Center, Stockholm, Sweden
- Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Caterina Trevisan
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Aging Research Center, Stockholm, Sweden
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Laura-Mónica Pérez
- RE-FiT Barcelona Research group, Vall d'Hebron Institute of Research (VHIR) and Parc Sanitari Pere Virgili, Barcelona, Spain
| | - Juan A López-Rodríguez
- Research Unit, Primary Health Care Management, Madrid, Spain
- Department of Medical Specialties and Public Health, Faculty of Health Sciences Rey Juan Carlos University, Madrid, Spain
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Carlos III Health Institute, Madrid, Spain
| | - Amaia Calderón-Larrañaga
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Aging Research Center, Stockholm, Sweden
- Stockholm Gerontology Research Center, Stockholm, Sweden
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Carlos III Health Institute, Madrid, Spain
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Song D, Liu D, Yang M, Chen S, Ning W, Li X, Yang J, Li Y, Guo Y, Chen Y, Shang S, Zhang H. Quality of life in elderly patients with Neuro-co-Cardiological Diseases: Rasch analysis and confirmatory factor analysis of WHOQOL-BREF and SF-36 instruments. Arch Gerontol Geriatr 2024; 116:105172. [PMID: 37716028 DOI: 10.1016/j.archger.2023.105172] [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: 07/28/2023] [Revised: 08/25/2023] [Accepted: 08/28/2023] [Indexed: 09/18/2023]
Abstract
PURPOSE The quality of life (QOL) in elderly patients with neuro-co-cardiological diseases multimorbidity (NCCD) exhibits distinct features, but there is a scarcity of research in this specialized area. This study seeks to comprehensively assess the QOL of elderly patients with NCCD, employing both the WHOQOL-BREF and SF-36 instruments, while concurrently evaluating the validity and reliability of these two measurement scales. METHODS The study participants were derived from the Elderly Individuals with Neuro-co-Cardiological Diseases Registered Cohort Study (EINCCDRCS). WHOQOL-BREF and SF-36 were used for QOL assessment. Rasch analysis, and Confirmatory Factor Analysis were conducted. Internal consistency, ceiling, and floor effects were also analyzed. RESULTS 202 patients from the EINCCDRCS were included in the study. Both scales showed good reliability and validity. SF-36 demonstrated better distribution and targeting compared to WHOQOL-BREF. Some items exhibited potential bias in specific patient groups. However, the 'Role limitations due to emotional problems' component showed suboptimal performance in certain assessments, suggesting its consideration for removal in practical use. Differential item functioning was observed in patients with anxiety, depression, and cognitive impairment, highlighting the impact of these conditions on the QOL of elderly NCCD patients. CONCLUSIONS Both WHOQOL-BREF and SF-36 are effective instruments for assessing QOL in elderly NCCD patients, showing good reliability and validity for both scales. SF-36 generally outperforms WHOQOL-BREF overall. Patients diagnosed with anxiety and depression, as well as cognitive impairment, exhibited differences in QOL assessment. Further attention to these findings can improve QOL assessment and care for this population.
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Affiliation(s)
- Dixiang Song
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Deshan Liu
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Min Yang
- Department of Cardiology, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shengyun Chen
- Department of Cerebralvascular center, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Weihai Ning
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Xin Li
- Department of Cerebralvascular center, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Jie Yang
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing, China
| | - Yongle Li
- Department of Cardiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Yifan Guo
- Department of Cardiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Yushan Chen
- Department of Cardiology, the First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Shasha Shang
- Department of Cardiology, the First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Hongwei Zhang
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, China.
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22
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Stewart J, Bradley J, Smith S, McPeake J, Walsh T, Haines K, Leggett N, Hart N, McAuley D. Do critical illness survivors with multimorbidity need a different model of care? Crit Care 2023; 27:485. [PMID: 38066562 PMCID: PMC10709866 DOI: 10.1186/s13054-023-04770-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 11/30/2023] [Indexed: 12/18/2023] Open
Abstract
There is currently a lack of evidence on the optimal strategy to support patient recovery after critical illness. Previous research has largely focussed on rehabilitation interventions which aimed to address physical, psychological, and cognitive functional sequelae, the majority of which have failed to demonstrate benefit for the selected outcomes in clinical trials. It is increasingly recognised that a person's existing health status, and in particular multimorbidity (usually defined as two or more medical conditions) and frailty, are strongly associated with their long-term outcomes after critical illness. Recent evidence indicates the existence of a distinct subgroup of critical illness survivors with multimorbidity and high healthcare utilisation, whose prior health trajectory is a better predictor of long-term outcomes than the severity of their acute illness. This review examines the complex relationships between multimorbidity and patient outcomes after critical illness, which are likely mediated by a range of factors including the number, severity, and modifiability of a person's medical conditions, as well as related factors including treatment burden, functional status, healthcare delivery, and social support. We explore potential strategies to optimise patient recovery after critical illness in the presence of multimorbidity. A comprehensive and individualized approach is likely necessary including close coordination among healthcare providers, medication reconciliation and management, and addressing the physical, psychological, and social aspects of recovery. Providing patient-centred care that proactively identifies critical illness survivors with multimorbidity and accounts for their unique challenges and needs is likely crucial to facilitate recovery and improve outcomes.
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Affiliation(s)
- Jonathan Stewart
- Centre for Experimental Medicine, Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, Northern Ireland.
| | - Judy Bradley
- Centre for Experimental Medicine, Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, Northern Ireland
| | - Susan Smith
- Department of Public Health and Primary Care, Trinity College Dublin, Dublin 2, Ireland
| | - Joanne McPeake
- The Healthcare Improvement Studies Institute, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Timothy Walsh
- Usher Institute, University of Edinburgh, Edinburgh, Scotland, UK
| | - Kimberley Haines
- Department of Critical Care, Melbourne Medical School, University of Melbourne, Melbourne, Australia
| | - Nina Leggett
- Department of Critical Care, Melbourne Medical School, University of Melbourne, Melbourne, Australia
| | - Nigel Hart
- Centre for Medical Education, Queen's University Belfast, Belfast, Northern Ireland
| | - Danny McAuley
- Centre for Experimental Medicine, Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, Northern Ireland
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23
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Nazar G, Díaz-Toro F, Petermann-Rocha F, Lanuza F, Troncoso C, Leiva-Ordóñez AM, Concha-Cisternas Y, Celis-Morales C. Multimorbidity and 11-year mortality in adults: a prospective analysis using the Chilean National Health Survey. Health Promot Int 2023; 38:daad176. [PMID: 38128083 DOI: 10.1093/heapro/daad176] [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] [Indexed: 12/23/2023] Open
Abstract
Research on morbidity and mortality often emphasizes individual diseases over the cumulative effects of multimorbidity, especially in low- and middle-income countries. This study aimed to analyze the association between multimorbidity and all-cause mortality in a representative sample of the Chilean population. This longitudinal study used data from 3701 subjects aged ≥15 years who participated in the Chilean National Health Survey conducted between 2009 and 2010. We included 16 self-reported highly prevalent morbidities. All-cause mortality data from an 11-year follow-up were collected from the Chilean Civil Registry. The Cox proportional hazard model, adjusted for confounders, determined the association between multimorbidity categories and all-cause mortality. Of the total sample, 24.3% reported no morbidity, while 50.4% two or more. After adjustment, participants with four or more morbidities had a 1.66 times higher mortality risk [95% confidence interval (CI): 1.03-2.67] than those without morbidities. The mortality risk increased by 10% for each additional morbidity [HR: 1.09 (CI: 1.04-1.16)]. Multimorbidity was common in the Chilean population and increased the mortality risk, which greatly challenges the health system to provide an integral and coordinated approach to healthcare.
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Affiliation(s)
- Gabriela Nazar
- Departamento de Psicología, Universidad de Concepción, Concepción, 834-0518, Chile
| | - Felipe Díaz-Toro
- Facultad de Enfermería, Universidad Andres Bello, Santiago, 8370134, Chile
| | - Fanny Petermann-Rocha
- Facultad de Medicina, Centro de Investigación Biomédica, Universidad Diego Portales, Santiago, 8370134, Chile
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, G12 8TA, United Kingdom
| | - Fabián Lanuza
- Departamento de Procesos Diagnósticos y Evaluación, Facultad de Ciencias de la Salud, Universidad Católica de Temuco, 4813302, Chile
| | - Claudia Troncoso
- Facultad de Medicina. Departamento de Salud Pública, Centro de Investigación en Educación y Desarrollo (CIEDE-UCSC), Universidad Católica de la Santísima Concepción, Concepción, 4090541, Chile
| | - Ana María Leiva-Ordóñez
- Facultad de Medicina, Instituto de Anatomía, Histología y Patología, Universidad Austral de Chile, Valdivia, 4811230, Chile
| | - Yeny Concha-Cisternas
- Facultad de Salud, Escuela de Kinesiología, Universidad Santo Tomás, Talca, 3465548, Chile
- Facultad de Educación, Pedagogía en Educación Física, Universidad Autónoma de Chile, Talca, Chile
| | - Carlos Celis-Morales
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, G12 8TA, United Kingdom
- Human Performance Laboratory, Education, Physical Activity and Health Research Unit, Universidad Católica del Maule, Talca, 34809112, Chile
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24
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Dooley EE, Chen L, Ghazi L, Hornikel B, Martinez-Amezcua P, Palta P, Bowling CB, Muntner P, Lewis CE, Pettee Gabriel K. Multimorbidity is associated with lower total 24-hour movement activity among US adults. Prev Med Rep 2023; 36:102483. [PMID: 37954962 PMCID: PMC10632122 DOI: 10.1016/j.pmedr.2023.102483] [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: 08/28/2023] [Revised: 09/28/2023] [Accepted: 10/19/2023] [Indexed: 11/14/2023] Open
Abstract
Objective Having chronic conditions may result in reduced physical and cognitive function but less is known about multimorbidity with daily movement. We examined the association of multimorbidity and device-measured total daily movement in a nationally representative sample of US adults aged ≥ 30 years from the 2011-2014 National Health and Nutrition Examination Surveys. Methods Any multimorbidity (≥2 conditions) and complex multimorbidity (≥3 conditions across ≥ 3 body systems) were quantified using 16 chronic conditions via self-report and/or clinical thresholds. Total movement over 24-hours (Monitor-Independent Movement Summary units [MIMS-units]) was measured using a wrist-worn device (ActiGraph GT3X). Multivariable linear regression examined the association of 1) each chronic condition, 2) number of conditions, 3) any multimorbidity, and 4) complex multimorbidity with total movement. Covariates included age, gender, race/ethnicity, educational attainment, and smoking status. Results Among US adults (N = 7304, mean age: 53.2 ± 0.34 years, 53.2% female, 69.4% Non-Hispanic White), 62.2% had any multimorbidity with 34.2% having complex multimorbidity. After adjustment, a higher number of chronic conditions was associated with incrementally lower total movement (β MIMS-units [95% CI] compared to those with no chronic conditions; one: -419 [-772, -66], two: -605 [-933, -278], three: -1201 [-1506, -895], four: -1908 [-2351, -1465], 5+: -2972 [-3384, -2560]). Complex multimorbidity presence was associated with -1709 (95% CI: -2062, -1357) and -1269 (-1620, -918) lower total movement compared to those without multimorbidity and multimorbidity but not complex, respectively. Conclusions Multimorbidity was associated with lower 24-h movement among US adults and may be helpful for identifying adults at risk for low movement.
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Affiliation(s)
- Erin E. Dooley
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ligong Chen
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Lama Ghazi
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Bjoern Hornikel
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Pablo Martinez-Amezcua
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Priya Palta
- Department of Neurology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - C. Barrett Bowling
- U.S. Department of Veterans Affairs, Durham Veterans Affairs Geriatric Research Education and Clinical Center, Durham Veterans Affairs Medical Center (VAMC), Durham, NC, USA
- Department of Medicine, Duke University, Durham, NC, USA
| | - Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Cora E. Lewis
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kelley Pettee Gabriel
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
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25
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Peng D, Xu S, Zou T, Wang Y, Ouyang W, Zhang Y, Dong C, Li D, Guo J, Shen Q, Hu X, Zhou W, Li X, Qin Q. Safety, tolerability, pharmacokinetics and effects of diet on AD16, a novel neuroinflammatory inhibitor for Alzheimer's disease: a randomized phase 1 study. BMC Med 2023; 21:459. [PMID: 37996817 PMCID: PMC10666448 DOI: 10.1186/s12916-023-03126-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 10/23/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND AD16 is a Class 1.1 new drug candidate for Alzheimer's disease (AD), which has demonstrated potential benefits in AD by reducing neuroinflammation in preclinical studies. Herein, the pharmacokinetics (PK), safety, and tolerability of single and multiple-dose AD16 and the effect of food were assessed in healthy Chinese adults. METHODS Single-center, randomized, placebo-controlled, double-blind studies were conducted for single and multiple ascending doses. A total of 62 subjects were enrolled in single-dose groups; 10 each in 5, 10, 20, 30, and 40 mg groups, and 6 each in 60 and 80 mg dose groups. Twenty subjects were divided equally into 30 and 40 mg groups for the multiple-dose study. To determine the effect of a high-fat diet on AD16, 16 subjects were administered a single 20 mg dose of AD16 under the fasted and fed condition in a single-center, randomized, open-label, two-cycle, two-crossover study. Moreover, safety and PK parameters were also assessed. RESULTS Plasma exposure to a single oral dose of AD16 increased at an approximate dose-increasing rate. The pharmacodynamic dose of the AD16 can be maintained through the accumulation effect of the drug within the safety window. Compared to fasting, ingesting a high-fat meal decelerated the rate of AD16 absorption, albeit without effect on its overall absorption. No dose-related toxicities were seen in any of the studies, all treatment-emergent adverse events were grade I/II, and no serious adverse event occurred. CONCLUSIONS The present study exhibited favorable safety, tolerability, and PK profile of AD16, supporting its further research as a potential drug treatment for AD. TRIAL REGISTRATION ClinicalTrials.gov; NCT05787028, NCT05787041, NCT05806177. The SAD and FE studies were retrospectively registered on 28 March 2023. The MAD study was retrospectively registered on 10 April 2023.
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Affiliation(s)
- Daizhuang Peng
- National Institution of Drug Clinical Trial, Xiangya Hospital, Central South University, Changsha, 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, China
- International Science and Technology Innovation Cooperation Base for Early Clinical Trials of Biological Agents in Hunan Province, Changsha, China
| | - Sumei Xu
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, China
- Phase I Clinical Research Center, Xiangya Hospital, Central South University, Changsha, China
| | - Ting Zou
- National Institution of Drug Clinical Trial, Xiangya Hospital, Central South University, Changsha, 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Yahui Wang
- The South China Center for Innovative Pharmaceuticals, Guangzhou, China
| | - Wenjuan Ouyang
- Xiangya Changde Hospital, Central South University, Changde, China
| | - Yalan Zhang
- First People's Hospital of Chongqing Liangjiang New Area, Chongqing, China
| | - Chengmei Dong
- National Institution of Drug Clinical Trial, Xiangya Hospital, Central South University, Changsha, 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, China
- International Science and Technology Innovation Cooperation Base for Early Clinical Trials of Biological Agents in Hunan Province, Changsha, China
| | - Dai Li
- National Institution of Drug Clinical Trial, Xiangya Hospital, Central South University, Changsha, 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, China
- Phase I Clinical Research Center, Xiangya Hospital, Central South University, Changsha, China
| | - Jie Guo
- National Institution of Drug Clinical Trial, Xiangya Hospital, Central South University, Changsha, 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Qiuying Shen
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, China
- Phase I Clinical Research Center, Xiangya Hospital, Central South University, Changsha, China
| | - Xiaolei Hu
- National Institution of Drug Clinical Trial, Xiangya Hospital, Central South University, Changsha, 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, China
- Phase I Clinical Research Center, Xiangya Hospital, Central South University, Changsha, China
| | - Wenzhi Zhou
- National Institution of Drug Clinical Trial, Xiangya Hospital, Central South University, Changsha, 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Xiaomin Li
- National Institution of Drug Clinical Trial, Xiangya Hospital, Central South University, Changsha, 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, China
- Phase I Clinical Research Center, Xiangya Hospital, Central South University, Changsha, China
| | - Qun Qin
- National Institution of Drug Clinical Trial, Xiangya Hospital, Central South University, Changsha, 410008, China.
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, China.
- International Science and Technology Innovation Cooperation Base for Early Clinical Trials of Biological Agents in Hunan Province, Changsha, China.
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26
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Kalra K, Moumneh MB, Nanna MG, Damluji AA. Beyond MACE: a multidimensional approach to outcomes in clinical trials for older adults with stable ischemic heart disease. Front Cardiovasc Med 2023; 10:1276370. [PMID: 38045910 PMCID: PMC10690830 DOI: 10.3389/fcvm.2023.1276370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 11/02/2023] [Indexed: 12/05/2023] Open
Abstract
The global population of older adults is expanding rapidly resulting in a shift towards managing multiple chronic diseases that coexist and may be exacerbated by cardiovascular illness. Stable ischemic heart disease (SIHD) is a predominant contributor to morbidity and mortality in the older adult population. Although results from clinical trials demonstrate that chronological age is a predictor of poor health outcomes, the current management approach remains suboptimal due to insufficient representation of older adults in randomized trials and the inadequate consideration for the interaction between biological aging, concurrent geriatric syndromes, and patient preferences. A shift towards a more patient-centered approach is necessary for appropriately and effectively managing SIHD in the older adult population. In this review, we aim to demonstrate the distinctive needs of older adults who prioritize holistic health outcomes like functional capacity, cognitive abilities, mental health, and quality of life alongside the prevention of major adverse cardiovascular outcomes reported in cardiovascular clinical trials. An individualized, patient-centered approach that involves shared decision-making regarding outcome prioritization is needed when any treatment strategy is being considered. By prioritizing patients and addressing their unique needs for successful aging, we can provide more effective care to a patient population that exhibits the highest cardiovascular risks.
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Affiliation(s)
- Kriti Kalra
- Inova Center of Outcomes Research, Inova Heart and Vascular, Fairfax, VA, United States
| | - Mohamad B. Moumneh
- Inova Center of Outcomes Research, Inova Heart and Vascular, Fairfax, VA, United States
| | - Michael G. Nanna
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, United States
| | - Abdulla A. Damluji
- Inova Center of Outcomes Research, Inova Heart and Vascular, Fairfax, VA, United States
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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27
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Quiñones AR, McAvay G, Vander Wyk B, Han L, Nagel C, Allore HG. A Joint Model for Disability, Self-Rated Health, and Mortality Among Medicare Beneficiaries-Differences by Chronic Disease and Race/Ethnicity. J Aging Health 2023:8982643231210027. [PMID: 37879084 DOI: 10.1177/08982643231210027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
OBJECTIVES Quantifying interdependence in multiple patient-centered outcomes is important for understanding health declines among older adults. METHODS Medicare-linked National Health and Aging Trends Study data (2011-2015) were used to estimate a joint longitudinal logistic regression model of disability in activities of daily living (ADL), fair/poor self-rated health (SRH), and mortality. We calculated personalized concurrent risk (PCR) and typical concurrent risk (TCR) using regression coefficients. RESULTS For fair/poor SRH, highest odds were associated with COPD. For mortality, highest odds were associated with dementia, hip fracture, and kidney disease. Dementia and hip fracture were associated with highest odds of ADL disability. Hispanic respondents had highest odds of ADL disability. Hispanic and NH Black respondents had higher odds of fair/poor SRH, ADL disability, and mortality. PCRs/TCRs demonstrated wide variability for respondents with similar sociodemographic-multimorbidity profiles. DISCUSSION These findings highlight the variability of personalized risk in examining interdependent outcomes among older adults.
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Affiliation(s)
- Ana R Quiñones
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
- OHSU-PSU School of Public Health, Portland, OR, USA
| | - Gail McAvay
- Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Brent Vander Wyk
- Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Ling Han
- Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Corey Nagel
- College of Nursing, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Heather G Allore
- Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Department of Biostatistics, Yale University, New Haven, CT, USA
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28
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Caballero FF, Lana A, Struijk EA, Arias-Fernández L, Yévenes-Briones H, Cárdenas-Valladolid J, Salinero-Fort MÁ, Banegas JR, Rodríguez-Artalejo F, Lopez-Garcia E. Prospective Association Between Plasma Concentrations of Fatty Acids and Other Lipids, and Multimorbidity in Older Adults. J Gerontol A Biol Sci Med Sci 2023; 78:1763-1770. [PMID: 37156635 DOI: 10.1093/gerona/glad122] [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: 11/21/2022] [Indexed: 05/10/2023] Open
Abstract
Biological mechanisms that lead to multimorbidity are mostly unknown, and metabolomic profiles are promising to explain different pathways in the aging process. The aim of this study was to assess the prospective association between plasma fatty acids and other lipids, and multimorbidity in older adults. Data were obtained from the Spanish Seniors-ENRICA 2 cohort, comprising noninstitutionalized adults ≥65 years old. Blood samples were obtained at baseline and after a 2-year follow-up period for a total of 1 488 subjects. Morbidity was also collected at baseline and end of the follow-up from electronic health records. Multimorbidity was defined as a quantitative score, after weighting morbidities (from a list of 60 mutually exclusive chronic conditions) by their regression coefficients on physical functioning. Generalized estimating equation models were employed to assess the longitudinal association between fatty acids and other lipids, and multimorbidity, and stratified analyses by diet quality, measured with the Alternative Healthy Eating Index-2010, were also conducted. Among study participants, higher concentrations of omega-6 fatty acids [coef. per 1-SD increase (95% CI) = -0.76 (-1.23, -0.30)], phosphoglycerides [-1.26 (-1.77, -0.74)], total cholines [-1.48 (-1.99, -0.96)], phosphatidylcholines [-1.23 (-1.74, -0.71)], and sphingomyelins [-1.65 (-2.12, -1.18)], were associated with lower multimorbidity scores. The strongest associations were observed for those with a higher diet quality. Higher plasma concentrations of omega-6 fatty acids, phosphoglycerides, total cholines, phosphatidylcholines, and sphingomyelins were prospectively associated with lower multimorbidity in older adults, although diet quality could modulate the associations found. These lipids may serve as risk markers for multimorbidity.
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Affiliation(s)
- Francisco Félix Caballero
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid and CIBER of Epidemiology and Public Health, Madrid, Spain
| | - Alberto Lana
- Department of Medicine, Universidad de Oviedo/ISPA, Oviedo, Spain
| | - Ellen A Struijk
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid and CIBER of Epidemiology and Public Health, Madrid, Spain
| | | | - Humberto Yévenes-Briones
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid and CIBER of Epidemiology and Public Health, Madrid, Spain
| | - Juan Cárdenas-Valladolid
- Dirección Técnica de Sistemas de Información. Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Fundación de Investigación e Innovación Biosanitaria de Atención Primaria, Madrid, Spain
- Enfermería, Universidad Alfonso X El Sabio, Villanueva de la Cañada, Spain
| | - Miguel Ángel Salinero-Fort
- Subdirección General de Investigación Sanitaria, Consejería de Sanidad, Fundación de Investigación e Innovación Sanitaria de Atención Primaria, Madrid, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas, Grupo de Envejecimiento y Fragilidad de las personas mayores. IdIPAZ, Madrid, Spain
| | - José R Banegas
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid and CIBER of Epidemiology and Public Health, Madrid, Spain
| | - Fernando Rodríguez-Artalejo
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid and CIBER of Epidemiology and Public Health, Madrid, Spain
- IMDEA-Food Institute. CEI UAM+CSIC, Madrid, Spain
| | - Esther Lopez-Garcia
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid and CIBER of Epidemiology and Public Health, Madrid, Spain
- IMDEA-Food Institute. CEI UAM+CSIC, Madrid, Spain
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29
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Keramat SA, Lee V, Patel R, Hashmi R, Comans T. Cognitive impairment and health-related quality of life amongst older Australians: evidence from a longitudinal investigation. Qual Life Res 2023; 32:2911-2924. [PMID: 37289356 PMCID: PMC10473991 DOI: 10.1007/s11136-023-03449-3] [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: 05/23/2023] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Australia's population is steadily growing older, with older persons expected to make up over 20% of the population by 2066. Ageing is strongly associated with a significant drop in cognitive ability, ranging from mild cognitive impairment to severe cognitive impairment (dementia). This study examined the association between cognitive impairment and health-related quality of life (HRQoL) in older Australians. METHODS Two waves of longitudinal data from the nationally representative Household, Income and Labour Dynamics in Australia (HILDA) survey were utilised, with the age cut-off for older Australians defined as above 50. The final analysis included 10,737 person-year observations from 6892 unique individuals between 2012 and 2016. This study utilised the Backwards Digit Span (BDS) test and Symbol Digit Modalities test (SDMT) to assess cognitive function. HRQoL was measured using the physical and mental component summary scores of the SF-36 Health Survey (PCS and MCS). Additionally, HRQoL was measured using health state utility values (SF-6D score). A longitudinal random-effects GLS regression model was used to analyse the association between cognitive impairment and HRQoL. RESULTS This study found that approximately 89% of Australian adults aged 50 or older had no cognitive impairment, 10.16% had moderate cognitive impairment, and 0.72% had severe cognitive impairment. This study also found that moderate and severe cognitive impairment were both negatively associated with HRQoL. Older Australians with moderate cognitive impairment scored worse on the PCS (β = - 1.765, SE = 0.317), MCS (β = - 1.612, SE = 0.326), and SF-6D (β = - 0.024, SE = 0.004) than peers without cognitive impairment given other covariates reference categories remain constant. Older adults experiencing severe cognitive had lower PCS (β = - 3.560, SE = 1.103), and SF-6D (β = - 0.034, SE = 0.012) scores compared to their counterparts with no cognitive impairment given other covariates reference categories remain constant. CONCLUSION We found evidence that HRQoL is negatively associated with cognitive impairment. Our findings will be beneficial for the future cost-effectiveness intervention targeted at reducing cognitive impairment since it provides information on the disutility associated with moderate and severe cognitive impairment.
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Affiliation(s)
- Syed Afroz Keramat
- Faculty of Medicine, Centre for Health Services Research, The University of Queensland, Brisbane, QLD, Australia.
| | - Vanessa Lee
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Rajat Patel
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Rubayyat Hashmi
- The Australian Centre for Housing Research, The University of Adelaide, Adelaide, Australia
| | - Tracy Comans
- Faculty of Medicine, Centre for Health Services Research, The University of Queensland, Brisbane, QLD, Australia
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30
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West CE, Karim M, Falaguera MJ, Speidel L, Green CJ, Logie L, Schwartzentruber J, Ochoa D, Lord JM, Ferguson MAJ, Bountra C, Wilkinson GF, Vaughan B, Leach AR, Dunham I, Marsden BD. Integrative GWAS and co-localisation analysis suggests novel genes associated with age-related multimorbidity. Sci Data 2023; 10:655. [PMID: 37749083 PMCID: PMC10520009 DOI: 10.1038/s41597-023-02513-4] [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: 05/19/2023] [Accepted: 08/22/2023] [Indexed: 09/27/2023] Open
Abstract
Advancing age is the greatest risk factor for developing multiple age-related diseases. Therapeutic approaches targeting the underlying pathways of ageing, rather than individual diseases, may be an effective way to treat and prevent age-related morbidity while reducing the burden of polypharmacy. We harness the Open Targets Genetics Portal to perform a systematic analysis of nearly 1,400 genome-wide association studies (GWAS) mapped to 34 age-related diseases and traits, identifying genetic signals that are shared between two or more of these traits. Using locus-to-gene (L2G) mapping, we identify 995 targets with shared genetic links to age-related diseases and traits, which are enriched in mechanisms of ageing and include known ageing and longevity-related genes. Of these 995 genes, 128 are the target of an approved or investigational drug, 526 have experimental evidence of binding pockets or are predicted to be tractable, and 341 have no existing tractability evidence, representing underexplored genes which may reveal novel biological insights and therapeutic opportunities. We present these candidate targets for exploration and prioritisation in a web application.
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Affiliation(s)
- Clare E West
- Centre for Medicines Discovery, University of Oxford, Oxford, UK.
- Open Targets, Wellcome Genome Campus, Hinxton, UK.
| | - Mohd Karim
- Open Targets, Wellcome Genome Campus, Hinxton, UK
- European Molecular Biology Laboratory, European Bioinformatics Institute (EMBL-EBI), Wellcome Genome Campus, Hinxton, UK
| | - Maria J Falaguera
- Open Targets, Wellcome Genome Campus, Hinxton, UK
- European Molecular Biology Laboratory, European Bioinformatics Institute (EMBL-EBI), Wellcome Genome Campus, Hinxton, UK
| | - Leo Speidel
- Francis Crick Institute, London, UK
- Genetics Institute, University College London, London, UK
| | | | - Lisa Logie
- Drug Discovery Unit, University of Dundee, Dundee, UK
- Medicines Discovery Catapult, 35 Mereside Alderley Park, Macclesfield, Cheshire, UK
| | - Jeremy Schwartzentruber
- European Molecular Biology Laboratory, European Bioinformatics Institute (EMBL-EBI), Wellcome Genome Campus, Hinxton, UK
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, UK
| | - David Ochoa
- Open Targets, Wellcome Genome Campus, Hinxton, UK
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, UK
| | - Janet M Lord
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
| | | | - Chas Bountra
- Centre for Medicines Discovery, University of Oxford, Oxford, UK
| | - Graeme F Wilkinson
- Medicines Discovery Catapult, 35 Mereside Alderley Park, Macclesfield, Cheshire, UK
| | - Beverley Vaughan
- Centre for Medicines Discovery, University of Oxford, Oxford, UK
| | - Andrew R Leach
- Open Targets, Wellcome Genome Campus, Hinxton, UK
- European Molecular Biology Laboratory, European Bioinformatics Institute (EMBL-EBI), Wellcome Genome Campus, Hinxton, UK
| | - Ian Dunham
- Open Targets, Wellcome Genome Campus, Hinxton, UK
- European Molecular Biology Laboratory, European Bioinformatics Institute (EMBL-EBI), Wellcome Genome Campus, Hinxton, UK
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, UK
| | - Brian D Marsden
- Centre for Medicines Discovery, University of Oxford, Oxford, UK
- Kennedy Institute of Rheumatology, University of Oxford, Oxford, UK
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31
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Uleman JF, Melis RJF, Hoekstra AG, Olde Rikkert MGM, Quax R. Exploring the potential impact of multi-factor precision interventions in Alzheimer's disease with system dynamics. J Biomed Inform 2023; 145:104462. [PMID: 37516375 DOI: 10.1016/j.jbi.2023.104462] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 06/09/2023] [Accepted: 07/26/2023] [Indexed: 07/31/2023]
Abstract
Numerous clinical trials based on a single-cause paradigm have not resulted in efficacious treatments for Alzheimer's disease (AD). Recently, prevention trials that simultaneously intervened on multiple risk factors have shown mixed results, suggesting that careful design is necessary. Moreover, intensive pilot precision medicine (PM) trial results have been promising but may not generalize to a broader population. These observations suggest that a model-based approach to multi-factor precision medicine (PM) is warranted. We systematically developed a system dynamics model (SDM) of AD for PM using data from two longitudinal studies (N=3660). This method involved a model selection procedure in identifying interaction terms between the SDM components and estimating individualized parameters. We used the SDM to explore simulated single- and double-factor interventions on 14 modifiable risk factors. We quantified the potential impact of double-factor interventions over single-factor interventions as 1.5 [95% CI: 1.5-2.6] and of SDM-based PM over a one-size-fits-all approach as 3.5 [3.1, 3.8] ADAS-cog-13 points in 12 years. Although the model remains to be validated, we tentatively conclude that multi-factor PM could come to play an important role in AD prevention.
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Affiliation(s)
- Jeroen F Uleman
- Department of Geriatric Medicine, Radboudumc Alzheimer Center, Donders Institute for Medical Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands; Institute for Advanced Study, University of Amsterdam, Amsterdam, the Netherlands.
| | - René J F Melis
- Institute for Advanced Study, University of Amsterdam, Amsterdam, the Netherlands; Department of Geriatric Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Alfons G Hoekstra
- Computational Science Lab, Faculty of Science, Informatics Institute, University of Amsterdam, Amsterdam, the Netherlands
| | - Marcel G M Olde Rikkert
- Department of Geriatric Medicine, Radboudumc Alzheimer Center, Donders Institute for Medical Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Rick Quax
- Institute for Advanced Study, University of Amsterdam, Amsterdam, the Netherlands; Computational Science Lab, Faculty of Science, Informatics Institute, University of Amsterdam, Amsterdam, the Netherlands
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32
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Chu WM, Ho HE, Yeh CJ, Wei JCC, Arai H, Lee MC. Additive effect of frailty with distinct multimorbidity patterns on mortality amongst middle-aged and older adults in Taiwan: A 16-year population-based study. Geriatr Gerontol Int 2023; 23:684-691. [PMID: 37555551 DOI: 10.1111/ggi.14647] [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: 12/28/2022] [Revised: 06/22/2023] [Accepted: 07/16/2023] [Indexed: 08/10/2023]
Abstract
AIM This study aimed to explore the association between multimorbidity patterns with/without frailty and future mortality among Taiwanese middle-aged and older adults through a population-based cohort study design. METHODS Data were collected from the Taiwan Longitudinal Study on Aging. The data were obtained from Wave 3, with the multimorbidity patterns in the years of 1996 being analyzed through latent class analysis. Frailty was defined using the modified Fried criteria. The association between each disease group with/without frailty and mortality was examined using logistic regression, with the reference group as the Relatively healthy group without frailty. Survival analysis was performed using Cox regression, and the follow-up period of mortality was from 1 January 1996 to 31 December 2012. RESULTS A total of 4748 middle-aged and older adults with an average age of 66.3 years (SD: 9.07 years) were included. Four disease patterns were identified in 1996, namely the Cardiometabolic (21.0%), Arthritis-cataract (11.9%), Relatively healthy (61.6%), and Multimorbidity (5.5%) groups. After adjusting for all covariates, the Relatively healthy group with frailty showed the highest risk for mortality (odds ratio: 3.66, 95% confidence interval [95% CI]: 2.24-5.95), followed by the Cardiometabolic group with frailty (odds ratio: 3.58, 95% CI: 1.96-6.54), Multimorbidity group with frailty (odds ratio: 2.28, 95% CI: 1.17-4.44), Multimorbidity group without frailty (odds ratio: 1.44, 95% CI: 1.01-2.04), and the Cardiometabolic group without frailty (odds ratio: 1.24, 95% CI: 1.04-1.49). CONCLUSIONS Frailty plays an important role in mortality among middle-aged and older adults with distinct multimorbidity patterns. Middle-aged and older adults with a relatively healthy multimorbidity pattern or a cardiometabolic multimorbidity pattern with frailty encountered dismal outcomes. Geriatr Gerontol Int 2023; 23: 684-691.
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Affiliation(s)
- Wei-Min Chu
- Department of Family Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- Geriatrics and Gerontology Research Center, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Education and Innovation Center for Geriatrics and Gerontology, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Hsin-En Ho
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Family Medicine, Taichung Armed Forces General Hospital, Taichung, Taiwan
- School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Chih-Jung Yeh
- School of Public Health, Chung-Shan Medical University, Taichung, Taiwan
| | - James Cheng-Chung Wei
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Allergy, Immunology and Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan
- Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
| | - Hidenori Arai
- National Center for Geriatrics and Gerontology, Obu, Japan
| | - Meng-Chih Lee
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Family Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan
- Institute of Population Sciences, National Health Research Institutes, Miaoli County, Taiwan
- College of Management, Chaoyang University of Technology, Taichung, Taiwan
- Study Group of Integrated Health and Social Care Project, Ministry of Health and Welfare, Taipei, Taiwan
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Gaertner B, Scheidt-Nave C, Koschollek C, Fuchs J. Health status of the old and very old people in Germany: results of the Gesundheit 65+ study. JOURNAL OF HEALTH MONITORING 2023; 8:7-29. [PMID: 37829119 PMCID: PMC10565703 DOI: 10.25646/11663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 07/12/2023] [Indexed: 10/14/2023]
Abstract
Background The demographic change makes comprehensive health reporting on health at older age an important topic. Methods Gesundheit 65+ is a longitudinal epidemiological study on the health status of persons aged 65 and older in Germany. Based on a two-stage stratified random sample from 128 local population registers, 3,694 persons participated in the baseline survey between June 2021 and April 2022 (47.9 % women, mean age 78.8 years). Weighted prevalences for 19 indicators of the baseline survey are presented overall and by age, sex, education and region of residence. Results Overall, 52.0 % of all participants of the baseline survey reported to be in good or very good health, and 78.5 % reported high or very high satisfaction with their life. This was in contrast to the large number of health/functional limitations whose prevalences ranged from 5.3 % for severe visual limitations to 69.2 % for multimorbidity. The health status of women was clearly worse than that of men, and the health status of persons aged 80 and older was worse than between 65 and 79 years of age. There was a clear educational gradient evident in the health status, but there were no differences between West and East Germany. Conclusions Gesundheit 65+ provides a comprehensive database for description of the health status of old and very old people in Germany, on the basis of which recommendations for action for policy and practice can be derived.
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Affiliation(s)
- Beate Gaertner
- Robert Koch Institute, Berlin, Germany Department of Epidemiology and Health Monitoring
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34
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Yi Y, Lee Y, Kang S, Kwon YH, Seo YM, Baek JY, Jang IY, Lee E, Koh Y, Jung HW, Park CM. Unmet Needs and Barriers in Providing Hospital Care for Older Adults: A Qualitative Study Using the Age-Friendly Health System Framework. Clin Interv Aging 2023; 18:1321-1332. [PMID: 37588681 PMCID: PMC10426405 DOI: 10.2147/cia.s409348] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 07/26/2023] [Indexed: 08/18/2023] Open
Abstract
Purpose This study aims to identify unmet needs and barriers for improving inpatient care for older adults at an academic hospital in Korea by using a qualitative focus group design and the Age-Friendly Health Systems (AFHS) framework. Patients and Methods A total of 14 healthcare providers and employees participated in focus group interviews. Participants included medical doctors, registered nurses, a receptionist, a patient transporter, a pharmacist, a physical therapist, and a social worker. The data were analyzed qualitatively, as per the Consolidated Criteria for Reporting Qualitative Research guidelines. The analysis method encompassed a thematic framework analysis via the AFHS 4Ms framework, consisting of the four domains "What Matters", "Medication", "Mentation", and "Mobility". Results Multiple barriers and unmet needs were identified using the AFHS 4Ms framework in the provision of inpatient care for older adults at the hospital. The main barriers identified in the "What matters" domain are a lack of shared decision-making and individualized care plans, as well as economic and safety-conscious preferences among some older patients. In the "Medications" domain, the main barriers to providing adequate and safe pharmacotherapy include patient and caregiver-related factors, increased complexity of medication use, and lack of institutional support systems. In the "Mentation" domain, the main issues identified are communication barriers related to patients, caregiver factors, and insufficient delirium management due to a lack of adequate processes/environments such as delirium identification. In the "Mobility" domain, the main challenges include reduced mobility and geriatric complications, unnecessary mobility restrictions, and the increased risk of falls due to lack of resources and environmental factors. Conclusion The study highlighted the need for improvements in inpatient care for older adults at an academic hospital in Korea. Identified unmet needs and barriers can be used to guide a more patient-centered approaches for an age-friendly inpatient environment.
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Affiliation(s)
- Youngseok Yi
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Yura Lee
- Department of Information Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Selin Kang
- Department of Economics, The Graduate School, Yonsei University, Seoul, South Korea
| | - Young Hye Kwon
- Department of Nursing, Asan Medical Center, Seoul, South Korea
| | - Yeon Mi Seo
- Department of Nursing, Asan Medical Center, Seoul, South Korea
| | - Ji Yeon Baek
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Il-Young Jang
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Eunju Lee
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Younsuck Koh
- Department of Pulmonary and Critical Care Medicine, Health Screening and Promotion Center, Asan Medical Center, Seoul, South Korea
| | - Hee-Won Jung
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Chan Mi Park
- Marcus Institute for Aging Research, Hebrew Senior Life, Harvard Medical School, Boston, MA, USA
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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.
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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.
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Liu Y, Liu Q, Zhang Z, Yang Y, Zhou Y, Yan H, Wang X, Li X, Zhao J, Hu J, Yang S, Tian Y, Yao Y, Qiu Z, Song Y, Yang Y. The regulatory role of PI3K in ageing-related diseases. Ageing Res Rev 2023; 88:101963. [PMID: 37245633 DOI: 10.1016/j.arr.2023.101963] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/23/2023] [Accepted: 05/25/2023] [Indexed: 05/30/2023]
Abstract
Ageing is a physiological/pathological process accompanied by the progressive damage of cell function, triggering various ageing-related disorders. Phosphatidylinositol 3-kinase (PI3K), which serves as one of the central regulators of ageing, is closely associated with cellular characteristics or molecular features, such as genome instability, telomere erosion, epigenetic alterations, and mitochondrial dysfunction. In this review, the PI3K signalling pathway was firstly thoroughly explained. The link between ageing pathogenesis and the PI3K signalling pathway was then summarized. Finally, the key regulatory roles of PI3K in ageing-related illnesses were investigated and stressed. In summary, we revealed that drug development and clinical application targeting PI3K is one of the focal points for delaying ageing and treating ageing-related diseases in the future.
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Affiliation(s)
- Yanqing Liu
- Key Laboratory of Resource Biology and Biotechnology in Western China, Ministry of Education, Faculty of Life Sciences and Medicine, Northwest University, Xi'an 710069, China
| | - Qiong Liu
- Key Laboratory of Resource Biology and Biotechnology in Western China, Ministry of Education, Faculty of Life Sciences and Medicine, Northwest University, Xi'an 710069, China
| | - Zhe Zhang
- Key Laboratory of Resource Biology and Biotechnology in Western China, Ministry of Education, Faculty of Life Sciences and Medicine, Northwest University, Xi'an 710069, China
| | - Yaru Yang
- Key Laboratory of Resource Biology and Biotechnology in Western China, Ministry of Education, Faculty of Life Sciences and Medicine, Northwest University, Xi'an 710069, China
| | - Yazhe Zhou
- Key Laboratory of Resource Biology and Biotechnology in Western China, Ministry of Education, Faculty of Life Sciences and Medicine, Northwest University, Xi'an 710069, China
| | - Huanle Yan
- Key Laboratory of Resource Biology and Biotechnology in Western China, Ministry of Education, Faculty of Life Sciences and Medicine, Northwest University, Xi'an 710069, China
| | - Xin Wang
- Key Laboratory of Resource Biology and Biotechnology in Western China, Ministry of Education, Faculty of Life Sciences and Medicine, Northwest University, Xi'an 710069, China
| | - Xiaoru Li
- Key Laboratory of Resource Biology and Biotechnology in Western China, Ministry of Education, Faculty of Life Sciences and Medicine, Northwest University, Xi'an 710069, China
| | - Jing Zhao
- Key Laboratory of Resource Biology and Biotechnology in Western China, Ministry of Education, Faculty of Life Sciences and Medicine, Northwest University, Xi'an 710069, China
| | - Jingyan Hu
- Key Laboratory of Resource Biology and Biotechnology in Western China, Ministry of Education, Faculty of Life Sciences and Medicine, Northwest University, Xi'an 710069, China
| | - Shulin Yang
- Key Laboratory of Resource Biology and Biotechnology in Western China, Ministry of Education, Faculty of Life Sciences and Medicine, Northwest University, Xi'an 710069, China
| | - Yifan Tian
- Key Laboratory of Resource Biology and Biotechnology in Western China, Ministry of Education, Faculty of Life Sciences and Medicine, Northwest University, Xi'an 710069, China
| | - Yu Yao
- Key Laboratory of Resource Biology and Biotechnology in Western China, Ministry of Education, Faculty of Life Sciences and Medicine, Northwest University, Xi'an 710069, China
| | - Zhenye Qiu
- Key Laboratory of Resource Biology and Biotechnology in Western China, Ministry of Education, Faculty of Life Sciences and Medicine, Northwest University, Xi'an 710069, China
| | - Yanbin Song
- Department of Cardiology, Affiliated Hospital, Yan'an University, 43 North Street, Yan'an 716000, China.
| | - Yang Yang
- Key Laboratory of Resource Biology and Biotechnology in Western China, Ministry of Education, Faculty of Life Sciences and Medicine, Northwest University, Xi'an 710069, China.
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Hoogendijk EO, Onder G, Smalbil L, Vetrano DL, Hirdes JP, Howard EP, Morris JN, Fialová D, Szczerbińska K, Kooijmans EC, Hoogendoorn M, Declercq A, De Almeida Mello J, Leskelä RL, Häsä J, Edgren J, Ruppe G, Liperoti R, Joling KJ, van Hout HP. Optimising the care for older persons with complex chronic conditions in home care and nursing homes: design and protocol of I-CARE4OLD, an observational study using real-world data. BMJ Open 2023; 13:e072399. [PMID: 37385750 PMCID: PMC10314651 DOI: 10.1136/bmjopen-2023-072399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 06/08/2023] [Indexed: 07/01/2023] Open
Abstract
INTRODUCTION In ageing societies, the number of older adults with complex chronic conditions (CCCs) is rapidly increasing. Care for older persons with CCCs is challenging, due to interactions between multiple conditions and their treatments. In home care and nursing homes, where most older persons with CCCs receive care, professionals often lack appropriate decision support suitable and sufficient to address the medical and functional complexity of persons with CCCs. This EU-funded project aims to develop decision support systems using high-quality, internationally standardised, routine care data to support better prognostication of health trajectories and treatment impact among older persons with CCCs. METHODS AND ANALYSIS Real-world data from older persons aged ≥60 years in home care and nursing homes, based on routinely performed comprehensive geriatric assessments using interRAI systems collected in the past 20 years, will be linked with administrative repositories on mortality and care use. These include potentially up to 51 million care recipients from eight countries: Italy, the Netherlands, Finland, Belgium, Canada, USA, Hong Kong and New Zealand. Prognostic algorithms will be developed and validated to better predict various health outcomes. In addition, the modifying impact of pharmacological and non-pharmacological interventions will be examined. A variety of analytical methods will be used, including techniques from the field of artificial intelligence such as machine learning. Based on the results, decision support tools will be developed and pilot tested among health professionals working in home care and nursing homes. ETHICS AND DISSEMINATION The study was approved by authorised medical ethical committees in each of the participating countries, and will comply with both local and EU legislation. Study findings will be shared with relevant stakeholders, including publications in peer-reviewed journals and presentations at national and international meetings.
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Affiliation(s)
- Emiel O Hoogendijk
- Amsterdam UMC, location Vrije Universiteit Amsterdam, Department of General Practice, De Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam UMC, location Vrije Universiteit Amsterdam, Department of Epidemiology and Data Science, De Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Public Health research institute, Ageing and later life research program, Amsterdam, The Netherlands
| | - Graziano Onder
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Louk Smalbil
- Department of Computer Science, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Davide L Vetrano
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Stockholm Gerontology Research Center, Stockholm, Sweden
| | - John P Hirdes
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Elizabeth P Howard
- Connell School of Nursing, Boston College, Chestnut Hill, Boston, MA, USA
- The Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
| | - John N Morris
- The Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
| | - Daniela Fialová
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy, Charles University, Hradec Králové, Czech Republic
- Department of Geriatrics and Gerontology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Katarzyna Szczerbińska
- Laboratory for Research on Aging Society, Chair of Epidemiology and Preventive Medicine, Medical Faculty, Jagiellonian University Medical College, Kraków, Poland
| | - Eline Cm Kooijmans
- Amsterdam UMC, location Vrije Universiteit Amsterdam, Department of General Practice, De Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Public Health research institute, Ageing and later life research program, Amsterdam, The Netherlands
| | - Mark Hoogendoorn
- Department of Computer Science, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Anja Declercq
- LUCAS, Center for Care Research and Consultancy, KU Leuven, Leuven, Belgium
- Center for Sociological Research, KU Leuven, Leuven, Belgium
| | | | | | - Jokke Häsä
- Data and Analytics Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Johanna Edgren
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Georg Ruppe
- European Geriatric Medicine Society (EUGMS), Vienna, Austria
| | - Rosa Liperoti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Karlijn J Joling
- Amsterdam Public Health research institute, Ageing and later life research program, Amsterdam, The Netherlands
- Amsterdam UMC, location Vrije Universiteit Amsterdam, Department of Medicine for Older People, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Hein Pj van Hout
- Amsterdam UMC, location Vrije Universiteit Amsterdam, Department of General Practice, De Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Public Health research institute, Ageing and later life research program, Amsterdam, The Netherlands
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Muneera K, Muhammad T, Pai M, Ahmed W, Althaf S. Associations between intrinsic capacity, functional difficulty, and fall outcomes among older adults in India. Sci Rep 2023; 13:9829. [PMID: 37330570 PMCID: PMC10276857 DOI: 10.1038/s41598-023-37097-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 06/15/2023] [Indexed: 06/19/2023] Open
Abstract
The construct of intrinsic capacity (IC) in the context of integrated care for older adults emphasizes functional assessment from a holistic perspective. It provides reliable and comparable insights on subsequent functioning and disability. Given the paucity of research on IC and health outcomes in low- and middle-income countries (LMICs), the present study examined the association of IC with geriatric conditions of functional limitations and multiple fall outcomes among older adults in India. The data used for analysis come from the first wave of the Longitudinal Aging Study in India (LASI), 2017-2018. The final sample size contains 24,136 older adults (11,871 males and 12,265 females) age 60 years or above. Multivariable binary logistic regression is employed to examine the association of IC and other explanatory factors with outcome variables of difficulty in activities of daily living (ADL) and instrumental activities of daily living (IADL), falls, fall injury, and multiple falls. Of the total sample, 24.56% of older adults were observed to be in the high IC category. The prevalence of ADL difficulty, IADL difficulty, falls, multiple falls and fall-related injury is estimated to be 19.89%, 45.00%, 12.36%, 5.49% and 5.57%, respectively. Older adults who reported high IC had a significantly lower prevalence of ADL difficulty (12.26% vs 22.38%) and IADL difficulty (31.13% vs 49.52%) than those who reported low IC. Similarly, a lower prevalence of falls (9.42% vs 13.34%), fall-related injury (4.10% vs 6.06%) and multiple falls (3.46% vs 6.16%) were reported among those who had high IC. After adjusting for a large number of confounders such as age, sex, health-related attributes and lifestyle behaviors, older adults with high IC had significantly lower odds of ADL difficulty [aOR: 0.63, CI: 0.52-0.76], IADL difficulty [aOR: 0.71, CI: 0.60-0.83], falls [aOR: 0.80, CI: 0.67-0.96], multiple falls [aOR: 0.73, CI: 0.58-0.96] and fall-related injury [aOR: 0.78, CI: 0.61-0.99]. That a high IC was independently associated with a lower risk of functional difficulty and fall outcomes in later life is of enormous value in predicting subsequent functional care needs. More specifically, the findings here imply that because regular IC monitoring can predict poor health outcomes in older adults, improvements in IC should be prioritized while formulating disability and fall prevention strategies.
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Affiliation(s)
- K Muneera
- National Institute of Technology, Calicut, Kerala, 673601, India
| | - T Muhammad
- International Institute for Population Sciences, Mumbai, Maharashtra, 400088, India.
| | - Manacy Pai
- Department of Sociology and Criminology, Kent State University, Kent, OH, 44242, USA
| | - Waquar Ahmed
- School of Health Systems Studies, Tata Institute of Social Sciences, Mumbai, India
| | - S Althaf
- National Institute of Technology, Calicut, Kerala, 673601, India
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Tuena C, Borghesi F, Bruni F, Cavedoni S, Maestri S, Riva G, Tettamanti M, Liperoti R, Rossi L, Ferrarin M, Stramba-Badiale M. Technology-Assisted Cognitive Motor Dual-Task Rehabilitation in Chronic Age-Related Conditions: Systematic Review. J Med Internet Res 2023; 25:e44484. [PMID: 37213200 PMCID: PMC10242476 DOI: 10.2196/44484] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 03/09/2023] [Accepted: 03/30/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND Cognitive-motor dual-task (CMDT) is defined as the parallel processing of motor (eg, gait) and cognitive (eg, executive functions) activities and is an essential ability in daily life. Older adults living with frailty, chronic conditions (eg, neurodegenerative diseases), or multimorbidity pay high costs during CMDT. This can have serious consequences on the health and safety of older adults with chronic age-related conditions. However, CMDT rehabilitation can provide useful and effective therapies for these patients, particularly if delivered through technological devices. OBJECTIVE This review aims to describe the current technological applications, CMDT rehabilitative procedures, target populations, condition assessment, and efficacy and effectiveness of technology-assisted CMDT rehabilitation in chronic age-related conditions. METHODS We performed this systematic review, following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, on 3 databases (Web of Science, Embase, and PubMed). Original articles that were published in English; involved older adults (>65 years) with ≥1 chronic condition and/or frailty; and tested, with a clinical trial, a technology-assisted CMDT rehabilitation against a control condition were included. Risk of bias (Cochrane tool) and the RITES (Rating of Included Trials on the Efficacy-Effectiveness Spectrum) tool were used to evaluate the included studies. RESULTS A total of 1097 papers were screened, and 8 (0.73%) studies met the predefined inclusion criteria for this review. The target conditions for technology-assisted CMDT rehabilitation included Parkinson disease and dementia. However, little information regarding multimorbidity, chronicity, or frailty status is available. The primary outcomes included falls, balance, gait parameters, dual-task performance, and executive functions and attention. CMDT technology mainly consists of a motion-tracking system combined with virtual reality. CMDT rehabilitation involves different types of tasks (eg, obstacle negotiation and CMDT exercises). Compared with control conditions, CMDT training was found to be pleasant, safe, and effective particularly for dual-task performances, falls, gait, and cognition, and the effects were maintained at midterm follow-up. CONCLUSIONS Despite further research being mandatory, technology-assisted CMDT rehabilitation is a promising method to enhance motor-cognitive functions in older adults with chronic conditions.
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Affiliation(s)
- Cosimo Tuena
- Applied Technology for Neuro-Psychology Lab, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | | | | | - Silvia Cavedoni
- Applied Technology for Neuro-Psychology Lab, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Sara Maestri
- Applied Technology for Neuro-Psychology Lab, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Giuseppe Riva
- Applied Technology for Neuro-Psychology Lab, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
- Humane Technology Lab, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Mauro Tettamanti
- Laboratory of Geriatric Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Rosa Liperoti
- Fondazione Policlinico Universitario Agostino Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Lorena Rossi
- Scientific Direction, IRCCS INRCA, Ancona, Italy
| | - Maurizio Ferrarin
- Fondazione Don Carlo Gnocchi, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Marco Stramba-Badiale
- Department of Geriatrics and Cardiovascular Medicine, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
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You L, Guo L, Li N, Zhong J, Er Y, Zhao M. Association between multimorbidity and falls and fear of falling among older adults in eastern China: a cross-sectional study. Front Public Health 2023; 11:1146899. [PMID: 37275486 PMCID: PMC10234124 DOI: 10.3389/fpubh.2023.1146899] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 04/18/2023] [Indexed: 06/07/2023] Open
Abstract
Background Growing evidence has reported an association between multimorbidity and falls and fear of falling (FOF) in older adults, however, the results regarding this association from China are limited. Our study aimed to investigate the association between multimorbidity and falls and FOF in older adults in eastern China. Methods We conducted a cross-sectional study in Zhejiang Province, Eastern China, which recruited a provincial representative sample of adults aged ≥ 60 years. A structured questionnaire including demographic characteristics, chronic diseases, history of falls in the past 12 months, and FOF, was administered by all participants. The exposure variable was multimorbidity, which was defined as the presence of two or more chronic diseases and medical conditions in the same individual. The outcomes included a history of falls and FOF. Multivariate logistic regression was used to evaluate the association between multimorbidity and falls and FOF in older adults. Results In total of 7,774 participants were included in the analysis, among whom 3,898 (50.1%) were female, with a mean ± standard deviation age is 72.9 ± 8.4 years. Multimorbidity was associated with the increased risk of falling in older adults [adjusted odds ratio (OR), 1.99; 95% confidence interval (CI):1.55-2.36]. The ORs for having experienced single fall and repeated falls were 1.85 (95% CI: 1.42-2.42) and 3.45 (95% CI: 1.47-6.97), respectively, with multimorbidity compared with those without chronic diseases. The older adults with multimorbidity were more likely to report FOF compared with those without chronic diseases (adjusted OR, 1.49; 95%CI:1.30-1.70). Moreover, the association between multimorbidity and FOF remained significant in the older adults with a history of fall (OR, 1.57; 95%CI:1.04-2.38). Conclusion The association between multimorbidity and falls and FOF is significant in the Chinese population and the effects of multimorbidity on falls and FOF do not vary according to the frequency and history of falls in older adults.
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Affiliation(s)
- Liuqing You
- Zhejiang Provincial Center for Disease Control and Prevention, Zhejiang, China
| | - Lihua Guo
- Zhejiang Provincial Center for Disease Control and Prevention, Zhejiang, China
| | - Na Li
- Zhejiang Provincial Center for Disease Control and Prevention, Zhejiang, China
| | - Jieming Zhong
- Zhejiang Provincial Center for Disease Control and Prevention, Zhejiang, China
| | - Yuliang Er
- National Center for Chronic and Non-Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Ming Zhao
- Zhejiang Provincial Center for Disease Control and Prevention, Zhejiang, China
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Jain S, Rosenbaum PR, Reiter JG, Ramadan OI, Hill AS, Hashemi S, Brown RT, Kelz RR, Fleisher LA, Silber JH. Defining Multimorbidity in Older Patients Hospitalized with Medical Conditions. J Gen Intern Med 2023; 38:1449-1458. [PMID: 36385407 PMCID: PMC10160274 DOI: 10.1007/s11606-022-07897-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 10/26/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND The term "multimorbidity" identifies high-risk, complex patients and is conventionally defined as ≥2 comorbidities. However, this labels almost all older patients as multimorbid, making this definition less useful for physicians, hospitals, and policymakers. OBJECTIVE Develop new medical condition-specific multimorbidity definitions for patients admitted with acute myocardial infarction (AMI), heart failure (HF), and pneumonia patients. We developed three medical condition-specific multimorbidity definitions as the presence of single, double, or triple combinations of comorbidities - called Qualifying Comorbidity Sets (QCSs) - associated with at least doubling the risk of 30-day mortality for AMI and pneumonia, or one-and-a-half times for HF patients, compared to typical patients with these conditions. DESIGN Cohort-based matching study PARTICIPANTS: One hundred percent Medicare Fee-for-Service beneficiaries with inpatient admissions between 2016 and 2019 for AMI, HF, and pneumonia. MAIN MEASURES Thirty-day all-location mortality KEY RESULTS: We defined multimorbidity as the presence of ≥1 QCS. The new definitions labeled fewer patients as multimorbid with a much higher risk of death compared to the conventional definition (≥2 comorbidities). The proportions of patients labeled as multimorbid using the new definition versus the conventional definition were: for AMI 47% versus 87% (p value<0.0001), HF 53% versus 98% (p value<0.0001), and pneumonia 57% versus 91% (p value<0.0001). Thirty-day mortality was higher among patients with ≥1 QCS compared to ≥2 comorbidities: for AMI 15.0% versus 9.5% (p<0.0001), HF 9.9% versus 7.0% (p <0.0001), and pneumonia 18.4% versus 13.2% (p <0.0001). CONCLUSION The presence of ≥2 comorbidities identified almost all patients as multimorbid. In contrast, our new QCS-based definitions selected more specific combinations of comorbidities associated with substantial excess risk in older patients admitted for AMI, HF, and pneumonia. Thus, our new definitions offer a better approach to identifying multimorbid patients, allowing physicians, hospitals, and policymakers to more effectively use such information to consider focused interventions for these vulnerable patients.
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Affiliation(s)
- Siddharth Jain
- Center for Outcomes Research, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
- The Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, PA, USA.
| | - Paul R Rosenbaum
- The Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, PA, USA
- Department of Statistics, The Wharton School, The University of Pennsylvania, Philadelphia, PA, USA
| | - Joseph G Reiter
- Center for Outcomes Research, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Omar I Ramadan
- The Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, PA, USA
- Department of Surgery, The Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA, USA
| | - Alexander S Hill
- Center for Outcomes Research, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Sean Hashemi
- Center for Outcomes Research, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Rebecca T Brown
- The Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, PA, USA
- Division of Geriatric Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
- Geriatrics and Extended Care, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
| | - Rachel R Kelz
- The Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, PA, USA
- Department of Surgery, The Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA, USA
| | - Lee A Fleisher
- The Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, PA, USA
- Department of Anesthesiology and Critical Care, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Center for Perioperative Outcomes Research and Transformation, The University of Pennsylvania, Philadelphia, PA, USA
| | - Jeffrey H Silber
- Center for Outcomes Research, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- The Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, PA, USA
- Department of Anesthesiology and Critical Care, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- The Department of Pediatrics, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Department of Health Care Management, The Wharton School, The University of Pennsylvania, Philadelphia, PA, USA
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Khalid S, Innes K, Umer A, Lilly C, Gross D, Sambamoorthi U. Assessment of Joint and Interactive Effects of Multimorbidity and Chronic Pain on ADRD Risk in the Elder Population. RESEARCH SQUARE 2023:rs.3.rs-2743755. [PMID: 37090532 PMCID: PMC10120756 DOI: 10.21203/rs.3.rs-2743755/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
Objective Multimorbidity and non-cancer chronic pain conditions (NCPC) are independently linked to elevated risk for cognitive impairment and incident Alzheimer's Disease and Related Dementias (ADRD)-both - We present the study of potential joint and interactive effects of these conditions on the risk of incident ADRD in older population. Methods This retrospective-cohort study drew baseline and 2-year follow-up data from linked Medicare claims and Medicare Current Beneficiary Survey (MCBS). Baseline multimorbidity and NCPC were ascertained using claims data. ADRD was ascertained at baseline and follow-up. Results NCPC accompanied by multimorbidity (vs. absence of NCPC or multimorbidity) had a significant and upward association with incident ADRD (adjusted odds ratio (AOR): 1.72, 95% CI 1.38, 2.13, p < 0.0001). Secondary analysis by number of comorbid conditions suggested that the joint effects of NCPC and multimorbidity on ADRD risk may increase with rising number contributing chronic conditions. Interaction analyses indicated significantly elevated excess risk for incident ADRD.
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Bynum JPW. Function and Frailty: Value Added in Medicare. Ann Intern Med 2023; 176:578-579. [PMID: 37011393 DOI: 10.7326/m23-0563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
Affiliation(s)
- Julie P W Bynum
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
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Shirazi D, Haudenschild C, Lynch DH, Fanous M, Kahkoska AR, Jimenez D, Spangler H, Driesse T, Batsis JA. Obesity, multiple chronic conditions, and the relationship with physical function: Data from the national health and aging trends survey. Arch Gerontol Geriatr 2023; 107:104913. [PMID: 36565604 PMCID: PMC9975009 DOI: 10.1016/j.archger.2022.104913] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 12/17/2022] [Accepted: 12/18/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND The population of older adults living with multiple chronic conditions (MCC) continues to grow. MCC is independently associated with functional limitation and obesity. The aim of our study was to evaluate the association between obesity and MCC, and secondarily, the combined presence of obesity and functional limitations with MCC. METHODS We analyzed cross-sectional survey data from the National Health and Aging Trends Survey (NHATS) 2011 baseline data, a nationally representative Medicare beneficiary cohort of adults in the United States. We evaluated the coexistent prevalence of obesity and MCC overall, and by standard body mass index (BMI) categories. We then evaluated the prevalence of functional limitations (mobility, self-care, and household activities) and Fried-defined frailty status in persons with a BMI ≥ 30 kg/m2. Logistic regression was used to measure the association between MCC and BMI, and functional limitations and MCC among those with obesity. RESULTS In the 6,600 participants, the prevalence of concurrent obesity and MCC was 30.4%. Of those with obesity, the prevalence of MCC was 84.0%, and were more likely to have MCC (adjusted OR: 2.17, 95% CI 1.86, 2.54) compared to a normal BMI. Obesity and functional limitations or frailty were more likely have MCC than individuals with obesity alone. CONCLUSIONS We found that individuals with obesity is strongly associated with MCC and that functional limitations and frailty status have a greater association with having MCC than individuals with obesity without MCC. Future longitudinal analyses are needed to ascertain this relationship.
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Affiliation(s)
- Daniela Shirazi
- Division of Geriatric Medicine, University of North Carolina at Chapel Hill, 5017 Old Clinic Building, Chapel Hill, NC 27517, United States; California University of Science and Medicine, CA, United States
| | | | - David H Lynch
- Division of Geriatric Medicine, University of North Carolina at Chapel Hill, 5017 Old Clinic Building, Chapel Hill, NC 27517, United States
| | - Marco Fanous
- Division of Geriatric Medicine, University of North Carolina at Chapel Hill, 5017 Old Clinic Building, Chapel Hill, NC 27517, United States
| | - Anna R Kahkoska
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, United States
| | - Daniel Jimenez
- University of Miami Miller School of Medicine, MI, United States
| | - Hillary Spangler
- Division of Geriatric Medicine, University of North Carolina at Chapel Hill, 5017 Old Clinic Building, Chapel Hill, NC 27517, United States
| | - Tiffany Driesse
- Division of Geriatric Medicine, University of North Carolina at Chapel Hill, 5017 Old Clinic Building, Chapel Hill, NC 27517, United States
| | - John A Batsis
- Division of Geriatric Medicine, University of North Carolina at Chapel Hill, 5017 Old Clinic Building, Chapel Hill, NC 27517, United States; Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, United States.
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Halder M, Saha J, Roy A, Roy D, Chouhan P. Functional disability and its associated factors among the elderly in rural India using LASI Wave 1 data. J Public Health (Oxf) 2023. [DOI: 10.1007/s10389-023-01890-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
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Chen C, Zhao Y, Su B, Wu Y, Zhong P, Zheng X. Association between multimorbidity and memory-related diseases among middle-aged and older adults: Evidence from the China Health and Retirement Longitudinal Study. Front Public Health 2023; 11:1115207. [PMID: 37006557 PMCID: PMC10065148 DOI: 10.3389/fpubh.2023.1115207] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 02/13/2023] [Indexed: 03/19/2023] Open
Abstract
ObjectivesThis study aimed to examine the cross-sectional and longitudinal association between multimorbidity and memory-related diseases (MDs) among Chinese middle-aged and older adults.MethodsThis study included 8,338 subjects who participated in the China Health and Retirement Longitudinal Study (CHARLS). Logistic regression and Cox proportional hazards regression models were used to explore the association and effect of multimorbidity on MDs.ResultsThe overall prevalence of MDs was 2.52%, and the mean multimorbidity number was 1.87. In a cross-sectional analysis, compared with the no multimorbidity group, groups of multimorbidity with four or more non-communicable diseases (NCDs) were more likely to have MDs (OR: 6.49, 95%CI: 4.35–9.68). Within 2.7 years of follow-up, 82 cases of MDs (1.12%) were reported, and participants with multimorbidity were more likely to have new-onset MDs than participants without multimorbidity (HR: 2.93, 95%CI: 1.74–4.96).ConclusionMultimorbidity is associated with MDs among Chinese middle-aged and older adults. This relationship gradually strengthens with the severity of multimorbidity, which indicates that early prevention for people with multimorbidity may reduce the risk of MDs.
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Affiliation(s)
- Chen Chen
- Department of Aging and Health, School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yihao Zhao
- Department of Chronic Diseases, School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Binbin Su
- Department of Health Economics, School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yu Wu
- Department of Aging and Health, School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Panliang Zhong
- Department of Aging and Health, School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xiaoying Zheng
- Department of Aging and Health, School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- *Correspondence: Xiaoying Zheng
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Gaitatzis A, Majeed A. Multimorbidity in People with Epilepsy. Seizure 2023; 107:136-145. [PMID: 37023627 DOI: 10.1016/j.seizure.2023.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 03/24/2023] [Accepted: 03/26/2023] [Indexed: 03/31/2023] Open
Abstract
Multimorbidity is an emerging priority in healthcare due to associations with the ageing population, frailty, polypharmacy, health and social care demands. It affects 60-70% of adults and 80% of children with epilepsy. Neurodevelopmental conditions are commonly seen in children with epilepsy, while cancer, cardiovascular and neurodegenerative conditions often afflict older people with epilepsy. Mental health problems are common across the lifespan. Genetic, environmental, social and lifestyle factors contribute to multimorbidity and its consequences. Multimorbid people with epilepsy (PWE) are at higher risk of depression and suicide, premature death, suffer lower health-related quality of life, and require more hospital admissions and health care costs. The best management of multimorbid PWE requires a paradigm shift from the traditional single disease-single comorbidity approach and a refocus on a person-centred approach. Improvements in health care must be informed by assessing the burden of multimorbidity associated with epilepsy, delineating disease clusters, and measuring the effects on health outcomes.
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Kojima T, Hamaya H, Ishii S, Hattori Y, Akishita M. Association of disability level with polypharmacy and potentially inappropriate medication in community dwelling older people. Arch Gerontol Geriatr 2023; 106:104873. [PMID: 36446253 DOI: 10.1016/j.archger.2022.104873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 11/07/2022] [Accepted: 11/21/2022] [Indexed: 11/25/2022]
Abstract
AIMS To investigate the influence of disability severity level on polypharmacy and the prescription of potentially inappropriate medication (PIM) using health insurance and long-term care (LTC) insurance claim data. METHODS Data were obtained from a health-care insurance and long-term care insurance claims database of citizens of Kure city, Japan, in April 2017. Data including age, sex, and drug profile were obtained, and the level of LTC needs was used to measure disability level. Factors associated with polypharmacy (≥5 prescribed drugs) and PIM prescription (≥1 PIM) defined by STOPP-J were analyzed statistically. RESULTS Among 67,169 people aged ≥65 (mean age 77.2 ± 7.9, male 40.7%), the frequency of polypharmacy increased with age until 85-89 (male 58.3%, female 57.6%) in both genders, and polypharmacy was most prevalent in those at the mildest LTC level (support level: male 68.9%, female 73.7%). PIM prescriptions was also frequent in those with LTC needs. On multiple logistic regression analysis, polypharmacy was significantly associated with older age and LTC needs, and PIM prescription was associated with older age and higher LTC level, suggesting that there is a large difference in prescription according to the person's age and disability level. CONCLUSION Polypharmacy was prevalent especially in older persons which peaked at the age of 85-89 or at mild disability level, and PIM prescription was prevalent in those with older age and higher care levels. When optimizing polypharmacy or PIM prescription in older patients, healthcare providers should focus on not only age but also disability level.
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Affiliation(s)
- Taro Kojima
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
| | - Hironobu Hamaya
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shinya Ishii
- Department of Medicine for Integrated Approach to Social Inclusion, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yukari Hattori
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masahiro Akishita
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Botoseneanu A, Markwardt S, Quiñones AR. Multimorbidity and Functional Disability among Older Adults: The Role of Inflammation and Glycemic Status - An Observational Longitudinal Study. Gerontology 2023; 69:826-838. [PMID: 36858034 PMCID: PMC10442862 DOI: 10.1159/000528648] [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: 01/07/2022] [Accepted: 12/07/2022] [Indexed: 03/03/2023] Open
Abstract
INTRODUCTION Specific multimorbidity combinations, in particular those including arthritis, stroke, and cognitive impairment, have been associated with high burden of activities of daily living (ADL)-instrumental activities of daily living (IADL) disability in older adults. The biologic underpinnings of these associations are still unclear. METHODS Observational longitudinal study using data from the Health and Retirement Study (N = 8,618, mean age = 74 years, 58% female, 25% non-white) and negative binomial regression models stratified by sex to evaluate the role of inflammatory and glycemic biomarkers (high-sensitivity C-reactive protein (hs-CRP) and HbA1c) in the association between specific multimorbidity combinations (grouped around one of eight index diseases: arthritis, cancer, cognitive impairment, diabetes, heart disease, hypertension, lung disease, and stroke; assessed between 2006 and 2014) and prospective ADL-IADL disability (2 years later, 2008-2016). Results were adjusted for sociodemographic characteristics, body mass index, number of coexisting diseases, and baseline ADL-IADL score. RESULTS Multimorbidity combinations indexed by arthritis (IRR = 1.1, 95% CI = 1.01-1.20), diabetes (IRR = 1.19, 95% CI = 1.09-1.30), and cognitive impairment (IRR = 1.11, 95% CI = 1.01-1.23) among men and diabetes-indexed multimorbidity combinations (IRR = 1.07, 95% CI = 1.01-1.14) among women were associated with higher ADL-IADL scores at increasing levels of HbA1c. Across higher levels of hs-CRP, multimorbidity combinations indexed by arthritis (IRR = 1.06, 95% CI = 1.02-1.11), hypertension (IRR = 1.06, 95% CI = 1.02-1.11), heart disease (IRR = 1.06, 95% CI = 1.01-1.12), and lung disease (IRR = 1.14, 95% CI = 1.07-1.23) were associated with higher ADL-IADL scores among women, while there were no significant associations among men. CONCLUSION The findings suggest potential for anti-inflammatory management among older women and optimal glycemic control among older men with these particular multimorbidity combinations as focus for therapeutic/preventive options for maintaining functional health.
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Affiliation(s)
- Anda Botoseneanu
- Department of Health & Human Services, University of Michigan, Dearborn, MI, USA
- Institute of Gerontology, University of Michigan, Ann Arbor, MI, USA
| | - Sheila Markwardt
- School of Public Health, Oregon Health & Science University, Portland, OR, USA
| | - Ana R. Quiñones
- School of Public Health, Oregon Health & Science University, Portland, OR, USA
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
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Cognitive Function, and Its Relationships with Comorbidities, Physical Activity, and Muscular Strength in Korean Older Adults. Behav Sci (Basel) 2023; 13:bs13030212. [PMID: 36975236 PMCID: PMC10045882 DOI: 10.3390/bs13030212] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 02/25/2023] [Accepted: 02/28/2023] [Indexed: 03/06/2023] Open
Abstract
Background: Little is known regarding how much physical activity (PA) and lower-body muscle strength (LBMS) together can help to reduce the negative effect of comorbidities on cognitive function. This study examined the moderating effects of PA and LBMS in determining the relationship between comorbidities and cognitive function in older Korean adults. Materials and Methods: This is a population-based cross-sectional study. Data for this study were taken from the 2020 Korea Longitudinal Study on Aging (KLoSA) in South Korea using a computer-assisted personal interview. The 2020 KLoSA survey included a total of 10,097 older individuals aged 65 and older (6062 females and 4035 men). Comorbidities were determined based on physician-diagnosed chronic conditions. PA and LBMS were measured with a self-reported questionnaire and a sit-to-stand test, respectively. Cognitive function was assessed using the Korean version of the Mini-Mental Status Examination for dementia screening. Results: Multimorbidity was correlated with an increased risk (odds ratio, OR = 1.415, p < 0.001) of cognitive impairment. Insufficient PA and weak LBMS were correlated with an increased risk of cognitive impairment (OR = 1.340, p < 0.001; OR = 1.719, p < 0.001, respectively). Particularly, PA modulates the negative impact of comorbidities on cognitive function (β = −0.3833; 95% CI = −0.4743 to −0.2023) independent of all measured covariates. Weak LBMS was found to be an independent predictor of cognitive function (β = −2.5078, p < 0.001) regardless of comorbidities. Conclusions: The study findings suggest that a lifestyle intervention targeting regular PA and muscular fitness should be a therapeutic means against cognitive decline associated with normal aging and/or chronic diseases.
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