Dynamics of multimorbidity and frailty, and their contribution to mortality, nursing home and home care need: A primary care cohort of 1 456 052 ageing people

Carrasco-Ribelles, Lucía A.; Roso-Llorach, Albert; Cabrera-Bean, Margarita; Costa-Garrido, Anna; Zabaleta‐del‐Olmo, Edurne; Torán-Monserrat, Pere; Orfila, Francesc; Violán, Concepción

doi:10.1016/j.eclinm.2022.101610

Cited by 17 publications

(14 citation statements)

References 32 publications

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“…For instance, previous results from our group described a higher involvement of gut-derived aromatic amino acids in women, which are strongly related to cognitive function and could lead to a higher risk of developing age-related nervous system diseases, as described in this work [ 38 ]. Furthermore, our study reveals that multisystem involvement is lower in women than in men at longer lifespans, contrarily to most of the current literature, which describes higher multimorbidity in women, specifically at older ages [ 32 , 39 ]. One possible explanation is that we evaluated the number of systems affected instead of global multimorbidity.…”

Section: Discussionsupporting

confidence: 59%

“…We also observed how globally, the number of systems free of disease decreased until the ages of death 87–88 and started increasing thereafter, indicating that up to these ages (87–88) individuals die with more systems affected as their lifespan increases whereas after these ages, individuals progressively die with less systems affected as their lifespan increases. Similarly, a previous study performed with the SIDIAP database described how before 85 years of age frailty is mainly associated with the number of concurrent diseases, and that from 85 years onwards frailty is associated with disability and other signs and symptoms [ 32 ]. These results support the existence of a major survival hurdle at 87–88 years old, defining two main groups of individuals in terms of their lifespan: those who die before and those who die after.…”

Section: Discussionmentioning

confidence: 98%

“…In women, the capacity to delay the onset of more lethal diseases and multisystem involvement could be greater, while men may be able to survive them for longer times. This could partly explain why life expectancy in women is greater, as mortality is closely associated with disease-related frailty [ 32 ]. In line with this hypothesis, we previously described sex-specific metabolic regulation during aging [ 38 ], that could provide women a better adaptation to the aging process and a higher resistance to multisystem diseases.…”

Section: Discussionmentioning

confidence: 99%

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Human lifespan and sex-specific patterns of resilience to disease: a retrospective population-wide cohort study

Sol,

Ortega-Bravo,

Portero-Otín

et al. 2024

BMC Med

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Background Slower paces of aging are related to lower risk of developing diseases and premature death. Therefore, the greatest challenge of modern societies is to ensure that the increase in lifespan is accompanied by an increase in health span. To better understand the differences in human lifespan, new insight concerning the relationship between lifespan and the age of onset of diseases, and the ability to avoid them is needed. We aimed to comprehensively study, at a population-wide level, the sex-specific disease patterns associated with human lifespan. Methods Observational data from the SIDIAP database of a cohort of 482,058 individuals that died in Catalonia (Spain) at ages over 50 years old between the 1st of January 2006 and the 30th of June 2022 were included. The time to the onset of the first disease in multiple organ systems, the prevalence of escapers, the percentage of life free of disease, and their relationship with lifespan were evaluated considering sex-specific traits. Results In the study cohort, 50.4% of the participants were women and the mean lifespan was 83 years. The results show novel relationships between the age of onset of disease, health span, and lifespan. The key findings include: Firstly, the onset of both single and multisystem diseases is progressively delayed as lifespan increases. Secondly, the prevalence of escapers is lower in lifespans around life expectancy. Thirdly, the number of disease-free systems decreases until individuals reach lifespans around 87–88 years old, at which point it starts to increase. Furthermore, long-lived women are less susceptible to multisystem diseases. The associations between health span and lifespan are system-dependent, and disease onset and the percentage of life spent free of disease at the time of death contribute to explaining lifespan variability. Lastly, the study highlights significant system-specific disparities between women and men. Conclusions Health interventions focused on delaying aging and age-related diseases should be the most effective in increasing not only lifespan but also health span. The findings of this research highlight the relevance of Electronic Health Records in studying the aging process and open up new possibilities in age-related disease prevention that should assist primary care professionals in devising individualized care and treatment plans.

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Section: Discussionsupporting

confidence: 59%

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

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Human lifespan and sex-specific patterns of resilience to disease: a retrospective population-wide cohort study

Sol,

Ortega-Bravo,

Portero-Otín

et al. 2024

BMC Med

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“…The interplay between functional impairment and MM is complex and in uenced by the existence of bidirectional relationships (10,11). Indeed, on one hand the accumulation of chronic diseases may lead to functional impairment (12,13); on the other hand, functional decline has been reported to be associated with increased risk to develop multiple chronic diseases, thus enhancing the severity and the burden of MM (12,14).…”

Section: Introductionmentioning

confidence: 99%

Interactions between patterns of multimorbidity and functional status among hospitalized older patients: a novel approach using cluster analysis and association rule mining.

Piacenza,

Rosa,

Soraci

et al. 2024

Preprint

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Background Multimorbidity (MM) is generally defined as the presence of 2 or more chronic diseases in the same patient and seems to be frequently associated with frailty and poor quality of life. However, the complex interplay between MM and functional status in hospitalized older patients has not been fully elucidated so far. Here, we implemented a 2-step approach, combining cluster analysis and association rule mining to explore how patterns of MM and disease associations change as a function of disability. Methods this retrospective cohort study included 3,366 hospitalized older patients discharged from acute care units of Ancona and Cosenza sites of Italian National Institute on Aging (INRCA-IRCCS) between 2011 and 2017. Cluster analysis and association rule mining (ARM) were used to explore patterns of MM and disease associations in the whole population and after stratifying by dependency in activities of daily living (ADL) at discharge. Sensitivity analyses in men and women were conducted to test for robustness of study findings. Results Out of 3,366 included patients, 78% were multimorbid. According to functional status, 22.2% of patients had no disability in ADL (functionally independent group), 22.7% had 1 ADL dependency (mildly dependent group), and 57.4% 2 or more ADL impaired (moderately-severely dependent group). Two main MM clusters were identified in the whole general population and in single ADL groups. ARM revealed interesting within-cluster disease associations, characterized by high lift and confidence. Specifically, in the functionally independent group, the most significant ones involved atrial fibrillation (AF)-anemia and chronic kidney disease (CKD) (lift = 2.32), followed by coronary artery disease (CAD)-AF and heart failure (HF) (lift = 2.29); in patients with moderate-severe ADL disability, the most significant ARM involved CAD-HF and AF (lift = 1.97), thyroid dysfunction and AF (lift = 1.75), cerebrovascular disease (CVD)-CAD and AF (lift = 1.55), and hypertension-anemia and CKD (lift = 1.43). Conclusions Hospitalized older patients have high rates of MM and functional impairment. Combining cluster analysis to ARM may assist physicians in discovering unexpected disease associations in patients with different ADL status. This could be relevant in the view of individuating personalized diagnostic and therapeutic approaches, according to the modern principles of precision medicine.

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“…Several studies report that women have a higher prevalence of frailty than men across all age groups [20]. This is observed both in older people living in the community and in long-term nursing homes (LTNHs) [21,22]. However, women tolerate this frailty better, as evidenced by a lower mortality rate at any level of frailty or age compared to men [17,23].…”

Section: Introductionmentioning

confidence: 99%

Sex Differences in Frailty Factors and Their Capacity to Identify Frailty in Older Adults Living in Long-Term Nursing Homes

Arizaga-Iribarren

Irazusta

Mugica-Errazquin

et al. 2022

IJERPH

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Frailty is a phenomenon that precedes adverse health events in older people. However, there is currently no consensus for how to best measure frailty. Several studies report that women have a higher prevalence of frailty than men, but there is a gap in studies of the high rates of frailty in older people living in long-term nursing homes (LTNHs) stratified by sex. Therefore, we analyzed health parameters related to frailty and measured their capacity to identify frailty stratified by sex in older people living in LTNHs. According to the Fried Frailty Phenotype (FFP), anxiety increased the risk of frailty in women, while for men functionality protected against the risk of frailty. Regarding the Tilburg Frailty Indicator (TFI), functionality had a protective effect in men, while for women worse dynamic balance indicated a higher risk of frailty. The analyzed parameters had a similar capacity for detecting frailty measured by the TFI in both sexes, while the parameters differed in frailty measured by the FFP. Our study suggests that assessment of frailty in older adults should incorporate a broad definition of frailty that includes not only physical parameters but also psycho-affective aspects as measured by instruments such as the TFI.

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Dynamics of multimorbidity and frailty, and their contribution to mortality, nursing home and home care need: A primary care cohort of 1 456 052 ageing people

Cited by 17 publications

References 32 publications

Human lifespan and sex-specific patterns of resilience to disease: a retrospective population-wide cohort study

Human lifespan and sex-specific patterns of resilience to disease: a retrospective population-wide cohort study

Interactions between patterns of multimorbidity and functional status among hospitalized older patients: a novel approach using cluster analysis and association rule mining.

Sex Differences in Frailty Factors and Their Capacity to Identify Frailty in Older Adults Living in Long-Term Nursing Homes

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