Impact of Multiple Chronic Conditions on Activity Limitations Among Older Mexican-American Care Recipients

Abstract

IntroductionOlder Mexican Americans are living longer with multiple chronic conditions (MCCs). This has placed greater demands on caregivers to assist with basic activities of daily living (ADL) or instrumental activities of daily living (IADL). To understand the needs of older Mexican-American care recipients, we examined the impact of MCC on ADL and IADL limitations.MethodsWe analyzed data from 485 Mexican American care-receiving/caregiving dyads. Selected MCCs in the analysis were diabetes, hypertension, stroke, heart disease, arthritis, emphysema/chronic obstructive pulmonary disease, cognitive impairment, depression, and cancer. Care recipients were dichotomized as having 3 or more conditions or as having 2 or fewer conditions. Three comorbidity clusters were established on the basis of the most prevalent health conditions among participants with comorbid arthritis and hypertension. These clusters included arthritis and hypertension plus: diabetes (cluster 1), cognitive impairment (cluster 2), and heart disease (cluster 3).ResultsCare recipients with 3 or more chronic conditions (n = 314) had higher odds of having mobility limitations (OR = 1.98; 95% CI, 1.34–2.94), self-care limitations (OR = 2.53; 95% CI, 1.70–3.81), >3 ADL limitations (OR = 2.00; 95% CI, 1.28–3.17), and >3 IADL limitations (OR = 1.88; 95% CI, 1.26–2.81). All clusters had increased odds of ADL and severe ADL limitations. Of care recipients in cluster 2, those with arthritis, hypertension, and cognitive impairment had significantly higher odds of mobility limitations (OR = 2.33; 95% CI, 1.05–5.24) than those with just arthritis and hypertension.ConclusionMCCs were associated with more ADL and IADL limitations among care recipients, especially for those with hypertension and arthritis plus diabetes, cognitive impairment, or heart disease. These findings can assist in developing programs to meet the needs of older Mexican-American care recipients.

Neighborhood socioeconomic characteristics, healthcare spatial access, and emergency department visits for ambulatory care sensitive conditions for elderly

“…In the U.S., 73.5% of elderly Hispanics live with others compared to 59.9% of elderly Non-Hispanics ( He and Larsen, 2014 ). Older Mexican Americans who suffer from multiple chronic conditions such as diabetes and heart disease had more mobility and ADL limitations ( Collins et al, 2018 ). In Texas, 65.7% of elderly with a disability live with others ( He and Larsen, 2014 ).…”

Co-occurrence of decrements in physical and cognitive function is common in older oncology patients receiving chemotherapy

“…In another study that aimed to identify modifiable factors that affected older adults functional status during cancer treatment (Kirkhus et al, 2019), while a higher number of comorbidities was associated with functional decline in the univariate analysis, it was not a significant predictor in the multivariable model. These inconsistent findings in older oncology patients contrast with the geriatric literature that suggests that a worse comorbidity profile is associated with declines in both PF and CF (Collins et al, 2018;Snowden et al, 2017;Steeves et al, 2019). These inconsistent findings may be related to the fact that in previous studies of older oncology patients changes in PF and CF were evaluated separately or patients with decrements in PF were excluded from participation.…”

Treatment of Hypertension in Complex Older Adults: How Many Medications Are Needed?

“…This was chosen for two reasons. First, mobility is both strongly associated with chronic disease burden (Collins et al, 2018) and risk for death (Perera et al, 2005; Studenski et al, 2011). Second, mobility disability is more common in community-dwelling populations (as in the MEPS study) than disability in activities of daily living (ADL; Kaye, 2013).…”

“…We specifically compared the risks of cardiovascular events and death between those on ≥ 3 versus 1-2 classes using data from the nationally representative Medical Expenditure Panel Survey (MEPS). We also specifically investigated whether the associations between the exposure and outcomes varied by the presence of mobility disability, a measure of both chronic disease burden (Collins et al, 2018) and risk for death (Perera, Studenski, Chandler, & Guralnik, 2005; Studenski et al, 2011).…”