Assessing and Measuring Chronic Multimorbidity in the Older Population: A Proposal for Its Operationalization

Abstract

BackgroundAlthough the definition of multimorbidity as “the simultaneous presence of two or more chronic diseases” is well established, its operationalization is not yet agreed. This study aims to provide a clinically driven comprehensive list of chronic conditions to be included when measuring multimorbidity.MethodsBased on a consensus definition of chronic disease, all four-digit level codes from the International Classification of Diseases, 10th revision (ICD-10) were classified as chronic or not by an international and multidisciplinary team. Chronic ICD-10 codes were subsequently grouped into broader categories according to clinical criteria. Last, we showed proof of concept by applying the classification to older adults from the Swedish National study of Aging and Care in Kungsholmen (SNAC-K) using also inpatient data from the Swedish National Patient Register.ResultsA disease or condition was considered to be chronic if it had a prolonged duration and either (a) left residual disability or worsening quality of life or (b) required a long period of care, treatment, or rehabilitation. After applying this definition in relation to populations of older adults, 918 chronic ICD-10 codes were identified and grouped into 60 chronic disease categories. In SNAC-K, 88.6% had ≥2 of these 60 disease categories, 73.2% had ≥3, and 55.8% had ≥4.ConclusionsThis operational measure of multimorbidity, which can be implemented using either or both clinical and administrative data, may facilitate its monitoring and international comparison. Once validated, it may enable the advancement and evolution of conceptual and theoretical aspects of multimorbidity that will eventually lead to better care.

Natural history of prediabetes in older adults from a population‐based longitudinal study

“…Data on chronic medical conditions included self‐reports and medication use, SNAC‐K clinical examination results, and information from the Swedish National Inpatient/Outpatient Registers. International Classification of Disease (ICD 10) was used to identify medical conditions . Cerebrovascular diseases and heart diseases (atrial fibrillation, cardiac valve disease, heart failure, bradycardias, conduction diseases, ischaemic heart disease) were identified.…”

Risk Factors for Injurious Falls in Older Adults: The Role of Sex and Length of Follow‐Up

“…Chronic diseases were diagnosed on the basis of information from medical records, clinical examination, and history. A disease was defined as chronic if it was of prolonged duration and resulted in residual disability or poor quality of life or required a long period of care, treatment, or rehabilitation . We evaluated specific diseases (stroke, Parkinson's disease, heart disease, rheumatic disease, arthritis, diabetes mellitus) and multimorbidity (defined as having ≥2 chronic diseases) .…”

“…A disease was defined as chronic if it was of prolonged duration and resulted in residual disability or poor quality of life or required a long period of care, treatment, or rehabilitation . We evaluated specific diseases (stroke, Parkinson's disease, heart disease, rheumatic disease, arthritis, diabetes mellitus) and multimorbidity (defined as having ≥2 chronic diseases) . Low systolic blood pressure (SBP) was defined as less than 130 mmHg …”

Secular Trend throughout 30 Years of Chronic Diseases in a Family Medicine Office in Toledo, Spain: 1985-1995-2016

“…Thus, were excluded the repeated consultations of same patient, including only the first visit. Chronic disease defined as "any alteration or deviation from normal that has one or more of the following characteristics: is permanent, leaves residual impairment, is caused by a non-reversible pathological alteration, requires special training of the patient for rehabilitation, and/or can be expected to require a long period of control, observation or treatment" [22][23][24]. Only diagnostic groups with data from the three cross-sectional studies were included.…”