Combinations of Chronic Conditions, Functional Limitations, and Geriatric Syndromes that Predict Health Outcomes

Abstract

BACKGROUND:The strategic framework on multiple chronic conditions released by the US Department of Health and Human Services calls for identifying homogeneous subgroups of older adults to effectively target interventions aimed at improving their health. OBJECTIVE: We aimed to identify combinations of chronic conditions, functional limitations, and geriatric syndromes that predict poor health outcomes. DESIGN, SETTING AND PARTICIPANTS Data from the 2010-2012 Health and Retirement Study provided a representative sample of U.S. adults 50 years of age or older (n=16,640). MAIN MEASURES: Outcomes were: Self-reported fair/poor health, self-rated worse health at 2 years, and 2-year mortality. The main independent variables included self-reported chronic conditions, functional limitations, and geriatric syndromes. We conducted tree-based classification and regression analysis to identify the most salient combinations of variables to predict outcomes. KEY RESULTS: Twenty-nine percent and 23 % of respondents reported fair/poor health and self-rated worse health at 2 years, respectively, and 5 % died in 2 years. The top combinations of conditions identified through our tree analysis for the three different outcome measures (and percent respondents with the outcome) were: a) for fair/poor health status: difficulty walking several blocks, depressive symptoms, and severe pain (> 80 %); b) for selfrated worse health at 2 years: 68.5 years of age or older, difficulty walking several blocks and being in fair/poor health (60 %); and c) for 2-year mortality: 80.5 years of age or older, and presenting with limitations in both ADLs and IADLs (> 40 %). CONCLUSIONS: Rather than chronic conditions, functional limitations and/or geriatric syndromes were the most prominent conditions in predicting health outcomes. These findings imply that accounting for chronic conditions alone may be less informative than also accounting for the co-occurrence of functional limitations and geriatric syndromes, as the latter conditions appear to drive health outcomes in older individuals.

Sedentary time in older adults: a critical review of measurement, associations with health, and interventions

“…Impaired mobility is highly prevalent and is associated with more than double the risk of mortality among older adults 16. In fact, functional limitations have been shown to be a stronger predictor of mortality than chronic conditions 14. Nineteen studies were identified that examined the relationship between ST and function, with a variety of outcomes used to represent ‘function’.…”

“…They found a graded increase in hazard ratios for all-cause mortality with each additional condition that was present 16. Recently, Koroukian et al 14 examined the combinations of chronic conditions, functional limitations and geriatric syndromes that predict poor health in older adults. Using a representative sample of more than 16 000 older adults, they showed that functional limitations and geriatric syndromes were stronger predictors of poor self-reported health and 2-year mortality than the presence of chronic conditions such as diabetes or heart disease 14.…”

Relação Entre Funcionalidade E Autopercepção De Saúde Entre Idosos Jovens E Longevos Brasileiros

“…Idosos jovens com ≥68,5 anos, com dificuldade para caminhar várias quadras, sintomas depressivos e má APS apresentavam o risco para piora da APS em dois anos. Já, longevos com ≥ 80,5 anos, apresentando limitações tanto em ABVD como em AIVD, tinham aumento do risco para morte em dois anos (KOROUKIAN et al, 2016).…”

“…No entanto, o estudo de Koroukian et al (2016) encontrou maiores percentuais de baixa APS e piora da mesma em dois anos, principalmente nas limitações em ABVD, onde 76 dos indivíduos com limitação em ABVD tinham pior APS, ao passo que 65 daqueles com prejuízo das AIVD concorriam com esse declínio. Nesta pesquisa, observamos médias de independência em ABVD, maiores do que as de AIVD, e AIVD teve maior correlação com a APS do que ABVD.…”

Impact of Self-Report and eGFR-Based Chronic Kidney Disease on the Risk of Chronic Kidney Disease-Related Complications and Geriatric Syndromes in Community-Dwelling Older Adults

“…Several studies suggested that chronic conditions and geriatric syndromes interacted synergistically with respect to their association with health outcomes among older adults [9], but others revealed that morbidity might be less informative for outcome prediction than geriatric syndromes [10]. The controversy in results from the existing literature may be related to the accuracy of the comorbidity of interest.…”