Multimorbidity Combinations and Disability in Older Adults

Quiñones, Ana; Markwardt, Sheila; Botoseneanu, Anda

doi:10.1093/gerona/glw035

Cited by 165 publications

(168 citation statements)

References 29 publications

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“…Although all 9 diseases asked about in NHANES are on the list of 20 conditions in the US Department of Health and Human Services’ report that seeks to standardize the measurement of multimorbidity (14,28), some diseases that are on the list (eg, dementia, schizophrenia) could not be examined in our study because they are not asked about in NHANES. Still, our findings contribute to the understanding of multimorbidity and sex interactions with functional limitations (5). …”

Section: Discussionmentioning

confidence: 68%

“…These findings are consistent with previous studies that examined the association between self-reported multimorbidity and disability among older adults. Recent studies also found an association between self-reported multimorbidity with functional limitations and disability; they found that increasing levels of multimorbidity were associated with worsening functional capacity (4,5). …”

Section: Discussionmentioning

confidence: 96%

“…Covariates that could confound the relationship between multimorbidity and functional limitations are age, smoking, BMI, income, race/ethnicity, and education level; these covariates were identified in previous research (5,9,21). In addition, studies of older adults identified sex and marital status as effect modifiers (1,22).…”

Section: Methodsmentioning

confidence: 99%

“…The association between disability and a high number of chronic diseases is documented (4,5). Often, the etiological pathway from disease to disability is conceptualized as a trajectory from disease pathology to impairment, functional limitation, and finally, to disability.…”

Section: Introductionmentioning

confidence: 99%

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Multimorbidity and Functional Limitations Among Adults 65 or Older, NHANES 2005–2012

et al. 2016

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IntroductionThe development of functional limitations among adults aged 65 or older has profound effects on individual and population resources. Improved understanding of the relationship between functional limitations and co-occurring chronic diseases (multimorbidity) is an emerging area of interest. The objective of this study was to investigate the association between multimorbidity and functional limitations among community-dwelling adults 65 or older in the United States and explore factors that modify this association.MethodsWe conducted a cross-sectional analysis of adults aged 65 or older using data from the National Health and Nutrition Examination Survey (NHANES) from 2005 through 2012. We used negative binomial regression to estimate the association between multimorbidity (≥2 concurrent diseases) and functional limitations and to determine whether the association differed by sex or age.ResultsThe prevalence of multimorbidity in this population was 67% (95% confidence interval [CI], 65%–68%). Each additional chronic condition was associated with an increase in the number of functional limitations, and the association was stronger among those aged 75 or older than among those aged 65 to 74. For those aged 65 to 74, each additional chronic condition was associated with 1.35 (95% CI, 1.27–1.43) times the number of functional limitations for men and 1.62 times (95% CI, 1.31–2.02) the number of functional limitations for women. For those 75 or older, the associations increased to 1.71 (95% CI, 1.35–2.16) for men and 2.06 (95% CI, 1.51–2.81) for women for each additional chronic condition.ConclusionMultimorbidity was associated with increases in functional limitations, and the associations were stronger among women than among men and among adults aged 75 or older than among those aged 65 to 74. These findings underscore the importance of addressing age and sex differences when formulating prevention strategies.

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Section: Discussionmentioning

confidence: 68%

Section: Discussionmentioning

confidence: 96%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Multimorbidity and Functional Limitations Among Adults 65 or Older, NHANES 2005–2012

et al. 2016

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“…9 10 Patients with multimorbidity require specific medical care; however, the current clinical practice lacks practical guidelines to manage and treat these patients. [11][12][13][14] Current clinical practices for patients with multiple chronic diseases routinely deal with each individual disease rather than multiple diseases, and can result in increased expenses for patients…”

Section: Introductionmentioning

confidence: 99%

Multimorbidity as an important issue among women: results of a gender difference investigation in a large population-based cross-sectional study in West Asia

et al. 2017

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ObjectivesTo investigate the impact of gender on multimorbidity in northern Iran.DesignA cross-sectional analysis of the Golestan cohort data.SettingGolestan Province, Iran.Study population49 946 residents (age 40–75 years) of Golestan Province, Iran.Main outcome measuresResearchers collected data related to multimorbidity, defined as co-existence of two or more chronic diseases in an individual, at the beginning of a representative cohort study which recruited its participants from 2004 to 2008. The researchers utilised simple and multiple Poisson regression models with robust variances to examine the simultaneous effects of multiple factors.ResultsWomen had a 25.0% prevalence of multimorbidity, whereas men had a 13.4% prevalence (p<0.001). Women of all age-groups had a higher prevalence of multimorbidity. Of note, multimorbidity began at a lower age (40–49 years) in women (17.3%) compared with men (8.6%) of the same age (p<0.001). This study identified significant interactions between gender as well as socioeconomic status, ethnicity, physical activity, marital status, education level and smoking (p<0.01).ConclusionPrevention and control of multimorbidity requires health promotion programmes to increase public awareness about the modifiable risk factors, particularly among women.

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Effectiveness of a Nurse-Led Multidisciplinary Intervention vs Usual Care on Advance Care Planning for Vulnerable Older Adults in an Accountable Care Organization

et al. 2021

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Advance care planning (ACP), especially among vulnerable older adults, remains underused in primary care. Additionally, many ACP initiatives fail to integrate directly into the electronic health record (EHR), resulting in infrequent and disorganized documentation.OBJECTIVE To determine whether a nurse navigator-led ACP pathway combined with a health care professional-facing EHR interface improves the occurrence of ACP discussions and their documentation within the EHR. DESIGN, SETTING, AND PARTICIPANTSThis was a randomized effectiveness trial using the Zelen design, in which patients are randomized prior to informed consent, with only those randomized to the intervention subsequently approached to provide informed consent. Randomization began November 1, 2018, and follow-up concluded November 1, 2019. The study population included patients 65 years or older with multimorbidity combined with either cognitive or physical impairments, and/or frailty, assessed from 8 primary care practices in North Carolina. INTERVENTIONS Participants were randomized to either a nurse navigator-led ACP pathway (n = 379) or usual care (n = 380). MAIN OUTCOMES AND MEASURESThe primary outcome was documentation of a new ACP discussion within the EHR. Secondary outcomes included the usage of ACP billing codes, designation of a surrogate decision maker, and ACP legal form documentation. Exploratory outcomes included incident health care use. RESULTS Among 759 randomized patients (mean age 77.7 years, 455 women [59.9%]), the nurse navigator-led ACP pathway resulted in a higher rate of ACP documentation (42.2% vs 3.7%, P < .001) as compared with usual care. The ACP billing codes were used more frequently for patients randomized to the nurse navigator-led ACP pathway (25.3% vs 1.3%, P < .001). Patients randomized to the nurse navigator-led ACP pathway more frequently designated a surrogate decision maker (64% vs 35%, P < .001) and completed ACP legal forms (24.3% vs 10.0%, P < .001). During follow-up, the incidence of emergency department visits and inpatient hospitalizations was similar between the randomized groups (hazard ratio, 1.17; 95% CI, 0.92-1.50). CONCLUSIONS AND RELEVANCEA nurse navigator-led ACP pathway integrated with a health care professional-facing EHR interface increased the frequency of ACP discussions and their documentation. Additional research will be required to evaluate whether increased EHR documentation leads to improvements in goal-concordant care.TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03609658

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Multimorbidity Combinations and Disability in Older Adults

Cited by 165 publications

References 29 publications

Multimorbidity and Functional Limitations Among Adults 65 or Older, NHANES 2005–2012

Multimorbidity and Functional Limitations Among Adults 65 or Older, NHANES 2005–2012

Multimorbidity as an important issue among women: results of a gender difference investigation in a large population-based cross-sectional study in West Asia

Effectiveness of a Nurse-Led Multidisciplinary Intervention vs Usual Care on Advance Care Planning for Vulnerable Older Adults in an Accountable Care Organization

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