Complex health problems in the oldest old in Sweden 1992–2002

Abstract

Most studies on health trends in the elderly population focus on specific conditions, studied one at a time. However, health problems are often interrelated and exist simultaneously in late life. Individuals with health problems in several domains present special challenges to care services. To estimate future needs for care it may be relevant to study trends of complex health problems as well as single health items. This study identified serious problems in three domains (diseases/ symptoms, mobility, cognition/communication) in two representative samples of the Swedish population aged 77 and older (1992: n=537; 2002: n=561). People with serious problems in two or three domains were considered to have complex health problems. Changes between 1992 and 2002 in the prevalence of persons having serious problems in no, one and two/three domains were analyzed with logistic regressions. When examining each domain separately all three showed a significant increase of serious problems. For diseases/symptoms the increase remained significant after controlling for different age and gender distributions in the two surveys. Results showed a significant increase in the prevalence of having problems in one domain, as well as having problems in two or three domains (complex problems). Results persisted when adjusting for different distributions in age, gender and education between 1992 and 2002. Results suggest a worsening of health during the 10-year period and an increase of complex problems. This emphasizes the necessity of cooperation and collaboration between different kinds of medical and social services for elderly people.

Complex health problems among the oldest old in Sweden: increased prevalence rates between 1992 and 2002 and stable rates thereafter

“…Measures were selected to represent a variety of health domains that are related to the need for different types of services (Meinow et al 2006). In general, symptoms and diseases imply needs for medical care, while mobility problems imply needs for social services and/or informal care.…”

“…Underweight is considered to be a good predictor of mortality among old people (Seidell and Visscher 2000). The summed index ranged from 0 to 42 and a cut-off for severe problems for this domain was determined at the highest quintile for the 1992 sample (corresponding to 9 on the summed scale) Eur J Ageing (2015) 12:285-297 287 (Meinow et al 2006). Accordingly, the persons belonging to the highest quintile had, e.g., at least three severe symptoms/diseases or two severe and three mild.…”

“…Persons with severe problems in at least two domains were considered to have complex health problems. An earlier study revealed an increase in the prevalence of complex health problems between 1992 and 2002 (Meinow et al 2006). This study investigates (i) whether this trend persisted in a 2011 wave of the same survey, (ii) to what extent changes in prevalence rates were due to compositional changes with regard to age, sex, and education, and (iii) whether trends in prevalence rates differed by sociodemographic factors (sex, age, and education).…”

“…The simultaneous presence of 1 multiple health problems is one of the greatest challenges in eldercare (Valderas et al 2009). This entails the medical challenge of balancing treatment strategies (Barnett et al 2012;Rockwood and Mitnitski 2011), as well as integrating medical care in the long-term care (LTC) plan that can include rehabilitation, social services, and informal care (Meinow et al 2006). To develop effective models for communication and coordination between providers, it is necessary to identify patterns of health problems and follow how they change over time.…”

“…From a policy and planning perspective such indicators reflect the extent of complex care needs in the older population involving different sources of medical and social services (Meinow et al 2006). In clinical research growing attention to complex health profiles has led to the creation of composite measures such as multimorbidity (Barnett et al 2012;Marengoni et al 2011), frailty (Fried et al 2004;RodriguezManas et al 2012), and multiple chronic conditions (Freid et al 2012).…”