Impact of Chronic Conditions and Multimorbidity on the Disability Burden in the Older Population in Belgium

Abstract

The present findings provide a deeper understanding of the role of chronic conditions and multimorbidity on the disability burden in the older population in Belgium. Although the disease pairs showed a low contribution to the disability burden, their occurrence presented a high impact on disability. Prevention strategies to tackle disability should target the main contributors to the disability burden and the most disabling conditions/disease pairs, especially in the clinical practice.

Contribution of chronic diseases to the prevalence of disability in basic and instrumental activities of daily living in elderly Brazilians: the National Health Survey (2013)

“…These diseases thus appear to have greater impact on the performance of basic activities, raising the hypothesis that biological or psychosocially primary mechanisms associated with these diseases may explain the relationship with this level of disability 27 , suggesting the importance of further studies on the subject. This result thus emphasizes the importance of elucidating the impact of chronic diseases on different levels of disability, an issue not addressed by previous studies 14,15,17,18 , which did not differentiate between the impacts of diseases on BADL versus IADL. These findings should be considered in the follow-up of patients with diagnosis of chronic diseases, given the relevance of these conditions as factors contributing to disability in basic activities, which lead to a growing burden for family and society 28 .…”

“…According to the PNS, 45% of the Brazilian adult population reports some chronic non-communicable disease, and among these the highest prevalence of disability was due to stroke, followed by arthritis, back pain, and musculoskeletal conditions, highlighting the relevance of these conditions for disability 47 . In general, the relationship between chronic diseases and disability has been investigated in cross-sectional studies using regression models that only estimate associations 5,6,7,8,9,10,11,12,13,30,31,32 , while few studies have used the attribution method to calculate the specific contribution of each disease to disability as the outcome 14,15,16,17,18,19 . Of these, only one study 15 assessed the contribution of chronic diseases to the prevalence of disability in elderly Brazilians from the perspective of disparities between the sexes, using data from the PNS (2013).…”

“…Of these, only one study 15 assessed the contribution of chronic diseases to the prevalence of disability in elderly Brazilians from the perspective of disparities between the sexes, using data from the PNS (2013). However, in the study, the outcome of disability was investigated from a binomial approach (with versus without disability), and the analysis failed to include a comparison of these contributions between different age groups, as had been explored in other populations 14,17,18 . The current study was thus the first to assess possible differences in the contribution of chronic diseases to the prevalence of disability, considering sex, age bracket, and different levels of disability in elderly Brazilians.…”

“…The diseases most commonly associated with functional decline are cardiovascular disease, lung disease, hypertension, diabetes, and joint disease, which have a greater effect on functionality. However, some authors propose other analytical approaches in addition to the verification of statistical association, for example estimation of the contribution of chronic diseases to disability 14,15,16,17,18,19 . In the Netherlands 17 , from 2001 to 2007, musculoskeletal diseases (arthritis and back pain) and cardiovascular diseases (stroke, heart disease, and peripheral vascular diseases) were the conditions that most contributed to disability in the population 55 years or older.…”

“…In the Netherlands 17 , from 2001 to 2007, musculoskeletal diseases (arthritis and back pain) and cardiovascular diseases (stroke, heart disease, and peripheral vascular diseases) were the conditions that most contributed to disability in the population 55 years or older. Likewise, in individuals 55 years or older 14 , the estimated contribution of chronic diseases to disability in Belgium (from 1997 to 2008) showed that musculoskeletal diseases, cardiovascular disease, and lung disease made the largest contribution. In Brazil, a recent study 15 of 10,290 elderly individuals representing the elderly Brazilian population participating in the National Health Survey (PNS) investigated these contributions, exploring differences by sex, and showed that stroke, back pain, and arthritis were the diseases that most contributed to disability in men and diabetes, heart disease, and arthritis in women.…”