Impact of Multimorbidity on Disability and Quality of Life in the Spanish Older Population

Abstract

BackgroundPopulation aging is closely related to high prevalence of chronic conditions in developed countries. In this context, health care policies aim to increase life span cost-effectively while maintaining quality of life and functional ability. There is still, however, a need for further understanding of how chronic conditions affect these health aspects. The aim of this paper is to assess the individual and combined impact of chronic physical and mental conditions on quality of life and disability in Spain, and secondly to show gender trends.MethodsCross-sectional data were collected from the COURAGE study. A total of 3,625 participants over 50 years old from Spain were included. Crude and adjusted multiple linear regressions were conducted to detect associations between individual chronic conditions and disability, and between chronic conditions and quality of life. Separate models were used to assess the influence of the number of diseases on the same variables. Additional analogous regressions were performed for males and females.ResultsAll chronic conditions except hypertension were statistically associated with poor results in quality of life and disability. Depression, anxiety and stroke were found to have the greatest impact on outcomes. The number of chronic conditions was associated with substantially lower quality of life [β for 4+ diseases: −18.10 (−20.95,−15.25)] and greater disability [β for 4+ diseases: 27.64 (24.99,30.29]. In general, women suffered from higher rates of multimorbidity and poorer results in quality of life and disability.ConclusionsChronic conditions impact greatly on quality of life and disability in the older Spanish population, especially when co-occurring diseases are added. Multimorbidity considerations should be a priority in the development of future health policies focused on quality of life and disability. Further studies would benefit from an expanded selection of diseases. Policies should also deal with gender idiosyncrasy in certain cases.

Multimorbidity and Health-Related Quality of Life among Older Adults

“…This result is consistent across studies that consider only a limited number of chronic conditions, some as low as 11 conditions [11], and those that incorporate a larger number of chronic conditions, one incorporating as high as 45 conditions [12]. The latter study which also derives weighted counts showed that severity should be an important consideration in HRQoL studies among those with multimorbidity.…”

“…A second study that considered synergistic effects in a different set of two pairs of conditions found that the combined worsening effect of the first pair (diabetes and cataract) on HRQoL was barely significant [11]. In contrast, the combined effect of the second pair (asthma and COPD) in this study was significant but implied a dampening effect on HRQoL.…”

“…Most of the current studies on HRQoL among older adults with multimorbidity use study designs that consider chronic conditions as the unit of analysis [11,13,14]. The lists of chronic conditions used in these studies are usually limited to those that are common among geriatric populations.…”

“…In these studies, the focus is on the main effects of chronic conditions and synergistic effects of a selected number of pairs of conditions when all the conditions in the list are analyzed simultaneously. These studies show that most chronic conditions are associated with worsening of HRQoL with conditions such as stroke, depression, and anxiety accounting for the strongest associations [11,13].…”

“…Studies have shown that the co-occurrence of three or more chronic conditions in older adults is common [15,16] but there are no current studies exploring the effects, for example, of most prevalent triplets or higher order combinations of chronic conditions on HRQoL. Studies that consider the effects the crude number of chronic conditions co-occurring in an individual have on HRQoL show that the effects of multimorbidity as triplets or higher order combinations may be much more substantial than the one implied by multimorbidity as pairs [11].…”