Multimorbidity, functional limitations, and outcomes: Interactions in a population-based cohort of older adults

Abstract

Objective: To understand the interaction of multimorbidity and functional limitations in determining health-care utilization and survival in older adults. Methods: Olmsted County, Minnesota, residents aged 60–89 years in 2005 were categorized into four cohorts based on the presence or absence of multimorbidity (≥3 chronic conditions from a list of 18) and functional limitations (≥1 limitation in an activity of daily living from a list of 9), and were followed through December 31, 2016. Andersen–Gill and Cox regression estimated hazard ratios (HRs) for emergency department (ED) visits, hospitalizations, and death using persons with neither multimorbidity nor functional limitations as the reference (interaction analyses). Results: Among 13,145 persons, 34% had neither multimorbidity nor functional limitations, 44% had multimorbidity only, 4% had functional limitations only, and 18% had both. Over a median follow-up of 11 years, 5906 ED visits, 2654 hospitalizations, and 4559 deaths occurred. Synergistic interactions on an additive scale of multimorbidity and functional limitations were observed for all outcomes; however, the magnitude of the interactions decreased with advancing age. The HR (95% confidence interval) for death among persons with both multimorbidity and functional limitations was 5.34 (4.40–6.47) at age 60–69, 4.16 (3.59–4.83) at age 70–79, and 2.86 (2.45–3.35) at age 80–89 years. Conclusion: The risk of ED visits, hospitalizations, and death among persons with both multimorbidity and functional limitations is greater than additive. The magnitude of the interaction was strongest for the youngest age group, highlighting the importance of interventions to prevent and effectively manage multimorbidity and functional limitations early in life.

High‐need high‐cost patients: A Concept Analysis

“…Patients with both multiple chronic conditions and functional limitations have higher health service utilization, higher spending, and poorer overall health compared to chronically ill adults without any functional limitation 3,15 . This group is largely identified as adults over the age of 65 who are insured by Medicare or are dually eligible for Medicaid 3,9,12 . The most frequent chronic conditions stated explicitly in the literature for HNHC patients include hypertension, coronary artery disease, congestive heart failure, diabetes, asthma, and chronic obstructive pulmonary disease 16,17 …”

“…In a state of positive feedback, HNHC patients have poor clinical outcomes, caregiver burnout, increased risk of mortality, and persistent high spending which drives up national healthcare expenditures 3,12,13,17 . In positive feedback, fragmented care and high health service use can contribute to poor clinical outcomes including redundant health testing, polypharmacy, medication errors, and conflicting care plans 25,37‐39 .…”

“…Additionally, many common characteristics used to describe HNHC patients are implied rather than explicitly stated which can further exacerbate challenges in identifying this population and developing sustainable interventions 1 . Further, defining the specific attributes of HNHC patients is essential as this population will likely expand as the United States increases in numbers of older and chronically ill adults 11‐13 …”

Community health worker interventions for older adults with complex health needs: A systematic review

“…Search terms for CHWs were kept broad given the variability in titles used to describe this type of interventionist, and were based on search strategies used in previous systematic reviews of CHW interventions 16,17,25,28‐32 . For complex health needs, we searched for terms related to multimorbidity, frailty, disability, and high‐utilization as four broad, often overlapping categories associated with complex needs and adverse outcomes in older adults 2‐12 …”

Multi-Morbidity and Polypharmacy in Older People: Challenges and Opportunities for Clinical Practice

“…Further examples relevant for older people are congestive cardiac failure and dementia—where individuals often have several co-existent long-term conditions such as diabetes and hypertension and have impairments in activities of daily living (ADL) and physical function [ 21 ]. Patients such as these who are multi-morbid and have functional limitations can experience the poorest health outcome from the inability to self-manage chronic long-term conditions as well as the ensuing polypharmacy [ 22 ].…”