Prospective Disability in Different Combinations of Somatic and Mental Multimorbidity

Quiñones, Ana; Markwardt, Sheila; Thielke, Stephen; Rostant, Ola S.; Vásquez, Elizabeth; Botoseneanu, Anda

doi:10.1093/gerona/glx100

Cited by 55 publications

(58 citation statements)

References 25 publications

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“…Later studies including four cross-sectional and two cohort studies with 1 and 2 years follow-up time have also found associations between multimorbidity and ADL/IADL disability [34][35][36][37][38]. It may seem that disease combinations including depression and cognitive impairment increase the risk for ADL/IADL disability substantially compared to combinations of only somatic disease [37,39]. Other studies have found associations between the number of chronic conditions and function in both basic and instrumental activities of daily living [18,40,41].…”

Section: Discussionmentioning

confidence: 98%

“…A systematic review from 2015 concluded that multimorbidity predicts future functional decline in adults, but comparisons between studies are hampered by the heterogeneity in definitions and operationalizations of multimorbidity and functional decline and the included cohort studies had short follow-up time (1-3 years) [9]. Later studies including four cross-sectional and two cohort studies with 1 and 2 years follow-up time have also found associations between multimorbidity and ADL/IADL disability [34][35][36][37][38]. It may seem that disease combinations including depression and cognitive impairment increase the risk for ADL/IADL disability substantially compared to combinations of only somatic disease [37,39].…”

Section: Discussionmentioning

confidence: 99%

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Associations between complex multimorbidity, activities of daily living and mortality among older Norwegians. A prospective cohort study: the HUNT Study, Norway

et al. 2020

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Background: With increasing age, having multiple chronic conditions is the norm. It is of importance to study how coexistence of diseases affects functioning and mortality among older persons. Complex multimorbidity may be defined as three or more conditions affecting at least three different organ systems. The aim of this study was to investigate how complex multimorbidity affects activities of daily living and mortality amongst older Norwegians. Methods: Participants were 60-69-year-olds at baseline in the Nord-Trøndelag Health Study 1995-1997 (HUNT2) n = 9058. Multinomial logistic regression models were used to investigate the association between complex multimorbidity in HUNT2, basic and instrumental activities of daily living in HUNT3 (2006-2008) and mortality during follow-up (n = 5819/5836). Risk ratios (RR) and risk differences (RD) in percentage points (pp) with 95% confidence intervals (CI) were reported. Results: 47.8% of 60-69-year-olds met the criteria of complex multimorbidity at baseline (HUNT2). Having complex multimorbidity was strongly associated with the need for assistance in IADL in HUNT3 11 years later (RR = 1.80 (1.58-2.04) and RD = 8.7 (6.8-10.5) pp) and moderately associated with mortality during the follow-up time (RR = 1.22 (1.12-1.33) and RD = 5.1 (2.9-7.3) pp). Complex multimorbidity was to a lesser extent associated with basic activities of daily living 11 years later (RR = 1.24 (0.85-1.83) and RD = 0.4 (− 0.3-1.1) pp). Conclusions: This is the first study to show an association between complex multimorbidity and activities of daily living. Complex multimorbidity should receive more attention in order to prevent future disability amongst older persons.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Associations between complex multimorbidity, activities of daily living and mortality among older Norwegians. A prospective cohort study: the HUNT Study, Norway

et al. 2020

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“…Recent advancements provide clinical insights into the functional consequences of specific multimorbidity combinations with diabetes. 1,2,11,35,36 This knowledge is essential in order to design interventions and optimize the clinical care for patients with diabetes-multimorbidity. 8 Our research highlights the importance of depressive disorders and stroke within larger multimorbidity combinations in patients with diabetes.…”

Section: Discussionmentioning

confidence: 99%

“…Because the identification of all multimorbidity permutations is infeasible and potentially uninformative, examining prevalent and clinically meaningful chronic diseases remains the recommended approach. 2,[9][10][11] Overall, individuals with multimorbidity are more likely to develop functional limitations leading to premature disability and death, and specific combinations may signal high disability burdens. 12 The purpose of our study is to evaluate the association between prevalent diabetes-multimorbidity combinations and prospective disability in a nationally representative sample of middle-aged and older Americans.…”

Section: Introductionmentioning

confidence: 99%

Diabetes-Multimorbidity Combinations and Disability Among Middle-aged and Older Adults

2019

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BACKGROUND: Older adults with diabetes rarely have only one chronic disease. As a result, there is a need to re-conceptualize research and clinical practice to address the growing number of older Americans with diabetes and concurrent chronic diseases (diabetes-multimorbidity). OBJECTIVE: To identify prevalent multimorbidity combinations and examine their association with poor functional status among a nationally representative sample of middle-aged and older adults with diabetes. DESIGN: A prospective cohort study of the 2012-2014 Health and Retirement Study (HRS) data. We identified the most prevalent diabetes-multimorbidity combinations and estimated negative binomial models of diabetes-multimorbidity on prospective disability. PARTICIPANTS: Analytic sample included 3841 HRS participants with diabetes, aged 51 years and older. MAIN MEASURES: The main outcome measure was the combined activities of daily living (ADL)-instrumental activities of daily living (IADL) index (range 0-11; higher index denotes higher disability). The main independent variables were diabetes-multimorbidity combination groups, defined as the co-occurrence of diabetes and at least one of six somatic chronic diseases (hypertension, cardiovascular disease, lung disease, cancer, arthritis, and stroke) and/or two mental chronic conditions (cognitive impairment and high depressive symptoms (CESD score ≥ 4). KEY RESULTS: The three most prevalent multimorbidity combinations were, in rank-order diabetes-arthritishypertension (n = 694, 18.1%); diabetes-hypertension (n = 481, 12.5%); and diabetes-arthritis-hypertensionheart disease (n = 383, 10%). Diabetes-multimorbidity combinations that included high depressive symptoms or stroke had significantly higher counts of ADL-IADL limitations compared with diabetes-only. In head-tohead comparisons of diabetes-multimorbidity combinations, high depressive symptoms or stroke added to somatic multimorbidity combinations was associated with a higher count of ADL-IADL limitations (diabetes-arthritishypertension-high depressive symptoms vs. diabetes-arthritis-hypertension: IRR = 1.95 [1.13, 3.38]; diabetesarthritis-hypertension-stroke vs. diabetes-arthritis-hypertension: IRR = 2.09 [1.15, 3.82]) even after adjusting for age, gender, education, race/ethnicity, BMI, baseline ADL-IADL, and diabetes duration. Coefficients were robust to further adjustment for diabetes treatment. CONCLUSIONS: Depressive symptoms or stroke added onto other multimorbidity combinations may pose a substantial functional burden for middle-aged and older adults with diabetes.

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“…According to analyses of data from the SNAC‐K population‐based study, neuropsychiatric diseases, alone or in association with each other, are major determinants of disability and slow walking speed in older adults, whereas isolated cardiovascular multimorbidity is associated only with a decline in walking speed . Other longitudinal study results support these findings .…”

Section: Interplay Between Multimorbidity and Functionmentioning

confidence: 97%

Multimorbidity and functional impairment–bidirectional interplay, synergistic effects and common pathways

et al. 2018

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Calderón-Larrañaga A, Vetrano DL, Ferrucci L, Mercer SW, Marengoni A, Onder G, Eriksdotter M, Fratiglioni L. (Karolinska Institutet-Stockholm University, Stockholm, Sweden; Catholic University of the Sacred Heart, Rome, Italy; National Institutes of Health, Baltimore, MD, USA; University of Glasgow, Glasgow, UK; University of Brescia, Brescia, Italy; Karolinska Institutet, Stockholm, Sweden; Stockholm Gerontology Research Center, Stockholm, Sweden; Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy). Multimorbidity and functional impairment– bidirectional interplay, synergistic effects and common pathways. This review discusses the interplay between multimorbidity (i.e. co-occurrence of more than one chronic health condition in an individual) and functional impairment (i.e. limitations in mobility, strength or cognition that may eventually hamper a person’s ability to perform everyday tasks). On the one hand, diseases belonging to common patterns of multimorbidity may interact, curtailing compensatory mechanisms and resulting in physical and cognitive decline. On the other hand, physical and cognitive impairment impact the severity and burden of multimorbidity, contributing to the establishment of a vicious circle. The circle may be further exacerbated by people’s reduced ability to cope with treatment and care burden and physicians’ fragmented view of health problems, which cause suboptimal use of health services and reduced quality of life and survival. Thus, the synergistic effects of medical diagnoses and functional status in adults, particularly older adults, emerge as central to assessing their health and care needs. Furthermore, common pathways seem to underlie multimorbidity, functional impairment and their interplay. For example, older age, obesity, involuntary weight loss and sedentarism can accelerate damage accumulation in organs and physiological systems by fostering inflammatory status. Inappropriate use or overuse of specific medications and drug–drug and drug–disease interactions also contribute to the bidirectional association between multimorbidity and functional impairment. Additionally, psychosocial factors such as low socioeconomic status and the direct or indirect effects of negative life events, weak social networks and an external locus of control may underlie the complex interactions between multimorbidity, functional decline and negative outcomes. Identifying modifiable risk factors and pathways common to multimorbidity and functional impairment could aid in the design of interventions to delay, prevent or alleviate age-related health deterioration; this review provides an overview of knowledge gaps and future directions.

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Prospective Disability in Different Combinations of Somatic and Mental Multimorbidity

Cited by 55 publications

References 25 publications

Associations between complex multimorbidity, activities of daily living and mortality among older Norwegians. A prospective cohort study: the HUNT Study, Norway

Associations between complex multimorbidity, activities of daily living and mortality among older Norwegians. A prospective cohort study: the HUNT Study, Norway

Diabetes-Multimorbidity Combinations and Disability Among Middle-aged and Older Adults

Multimorbidity and functional impairment–bidirectional interplay, synergistic effects and common pathways

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