Patterns of chronic co-morbid medical conditions in older residents of U.S. nursing homes: Differences between the sexes and across the agespan

Abstract

Objective There are limited data on combinations of co-morbid conditions to guide efforts to improve therapeutic strategies in patients with multiple co-morbid conditions. To some extent, this may be due to limited data on combinations of co-morbid conditions in patient groups. Our goal was to determine the most common co-morbid medical conditions in older residents of U. S. nursing homes and identify sex differences in prevalences and changes across the agespan of nursing residents. Design Cross sectional analysis of National Nursing Home Survey (NNHS) –a nationally representative sample with comprehensive medical data on nursing home residents. Setting 1174 Nursing homes. Participants Long term stay residents of U.S. Nursing Homes aged 65 years and older (11,734 :8745 women, 2989 men). Measurements Determination of the prevalences of the most frequent two and three disease combinations identified using Clinical Classifications Software (CCS) for ICD-9-CM and a composite vascular disease diagnosis (atherosclerosis and/or coronary artery disease, and/or peripheral arterial disease, and/or cerebrovascular disease or stroke) from the most recent and only NNHS survey with comprehensive medical diagnosis information. Results Frequent 2-disease combinations were: hypertension (HTN) + dementia (DEM) in 27%, HTN + any Vascular (Vasc) disease (26%), HTN + depression(DEP) 21%, HTN + arthritis(ARTH) 20%, DEM + Vasc (21%), DEM+Depression 19%, Arthritis + DEM 17%, DEP + Vasc (16%), ARTH + Vasc (15%), followed by HTN + GERD (14%) and ARTH + DEP (14%). Frequent 3-disease combinations: HTN +Vasc+ DEP in 13%, HTN +DEM +DEP (11%), and HTN+Arthritis+DEM (10%). HTN was in 80% of the top 3-disease combinations, Vasc in 50%, HTN+VASC in 35%, DEM or DEP in 40%, ARTH in 25% and GERD in 20%. Combinations with anemia, arthritis, dementia, heart failure, osteroporosis, thyroid disease were higher in women, COPD combinations higher in men. As age increased, dementia, depression, arthritis, and anemia with hypertension were common co-morbid combinations, diabetes and heart failure were not. Conclusions Hypertension, vascular disease, dementia, arthritis, depression, and gastro-esophageal reflux disease were part of the most prevalent co-morbid conditions. Multimorbidity patterns can be identified in nursing home residents and vary with age and by sex.

Person‐directed care planning in nursing homes: A scoping review

“…Other individual‐level factors that vary across nursing home residents—their beliefs about their appropriate roles (e.g., passive vs. active) and their functional and cognitive capacities—affect their motivation, willingness, and ability to engage in PDCP (Carman et al, 2013). The issue of cognitive capacity presents particular challenges to PDCP in LTC settings where dementia—which is characterised by global cognitive deterioration, including impairments in memory, language expression and comprehension, and the ability to determine goals or carry through with plans to achieve goals—is prevalent (Moore, Boscardin, Steinman, & Schwartz, 2014). …”

Hearing Loss: Why Does It Matter for Nursing Homes?

“…8 Lacking the cognitive reserve to separate speech from noise, residents with cognitive impairment may be particularly vulnerable to failure to understand speech in noisy environments. Other conditions common among nursing home residents (eg, depression and chronic pain 14 ) are likely to further decrease motivation to invest listening effort.…”

“…This too is unlikely; in fact, long-stay residents probably have a higher risk of hearing loss than their same-aged peers in the community due to the association between hearing loss and chronic conditions such as cardiovascular disease, diabetes and dementia, which are highly prevalent among nursing home residents. 14 …”

Influence of age and sex on hospitalization of nursing home residents: A cross-sectional study from Germany

“…Such findings might be influenced by differences between sexes, because females make up a larger proportion of residents, are older and generally have a higher disease burden than males [16, 17]. However, analyses on hospitalizations of nursing home residents are usually not presented stratified by sex and such differences do not receive much attention in the literature.…”

“…Therefore, it is also not clear whether differences are present in male and female residents with comparable health status or if predictors of hospitalization differ between sexes. Such differences between sexes do not receive much attention in research on nursing home residents, although it has been shown that patterns of care needs, chronic medical conditions and service utilization differ between male and female residents [16, 17]. However, understanding sex-dependent differences is essential to identify oversupply or undersupply of health services and to optimise care.…”