The association of multimorbidity and disability in a community-based sample of elderly aged 80 or older in Shanghai, China

Abstract

BackgroundBoth multimorbidity and activities of daily living (ADL) disability and instrument activities of daily living (IADL) disability are common among elderly individuals. ADL/IADL disability may reduce individuals’ capacities for independent living and quality of life. This study aimed to examine the association between multimorbidity and ADL/IADL disability.MethodsA multi-stage cluster sample of 2058 residents aged 80 or older was investigated in Shanghai, China. Multimorbidity was defined as the simultaneous presence of two or more chronic diseases with ten common chronic conditions under consideration. Subjects who responded that they “need partial or full assistance” to any ADL/IADL items were defined as having ADL/IADL disability. We examined the association of multimorbidity with ADL/IADL disability, adjusted for socio-demographic characteristics by using logistic regression.ResultsOf respondents, 23.23 % had ADL disability, 37.90 % had IADL disability, and 49.17 % had multimorbidity. After adjusted socio-demographic characteristics, a graded association was showed between ADL disability and the quantity of chronic conditions: odds ratio (OR) for 1 condition, 1.53(95 % confidence interval [CI], 1.04-2.24); OR for 2 conditions, 2.06(95 % CI, 1.43-2.96); OR for 3 conditions, 3.23(95 % CI, 2.14-4.86); OR for 4 or more conditions, 5.61(95 % CI, 3.26-9.66). Similar associations were also observed between the quantity of chronic conditions and IADL disability.ConclusionsThe quantity of chronic conditions had relatively strong association with both ADL and IADL disability. Initiating prevention of additional chronic conditions and interventions on clusters of diseases may decrease the potential risk of ADL/IADL disability. Additionally, more attention should been given to the older low-income women living with relatives/non-relatives with multimorbidity.

Relationship between Individual Social Capital and Functional Ability among Older People in Anhui Province, China

“…Previous studies from China and abroad have both found that advanced age [10,11], frailty [12,13], depression [14] underweight or obesity, physical inactivity, a poor self-rated health, less engagement in level social activities, and pain [15] were most commonly associated with the incidence of ADL or IADL disability. Furthermore, many studies have identified that comorbidity accelerated the decline of functional ability of the elderly [3,11]. For instance, Brian and his colleagues [16] found that older Puerto Rican adults with comorbid diabetes and depressive symptoms were prone to developing ADL disability and mortality.…”

“…For instance, Brian and his colleagues [16] found that older Puerto Rican adults with comorbid diabetes and depressive symptoms were prone to developing ADL disability and mortality. Su et al [3] found that among Chinese community-dwelling elderly people, multimorbidity (comorbid with chronic diseases) was significantly associated with ADL and IADL impairment; similar findings were also observed in a study conducted in Netherlands [17].Studies have recently found that social capital, which reflects how individuals or groups can get resources by their inter-social networks and support, has substantial influence on elderly health [18]. The role of social capital in living arrangements [19], mental health [20], and life satisfaction was observed among elderly people from previous studies in China [21].…”

Distinguishing Comorbidity, Disability, and Frailty

“…All of these studies used existing data from large, population-based studies -- four conducted in the U.S. [28–31] and one each in Australia [21], China [32], and Taiwan [33]. All of them treated multimorbidity as the presence of at least two or more health conditions, typically assessed by self-reported doctor-diagnosis or treatment.…”

“…The number of health conditions assessed varied across studies, ranging from eight [30, 31] to 31 [21]. The majority of studies examined multimorbidity combinations, or patterns, to see if different combinations were differentially associated with disability or functional limitations; two focused on the magnitude of the association of increasing numbers of multimorbid conditions with disability [32, 33] or physical function [30]. …”

“…A study using data from a representative community-based sample in Shanghai, China, and multiple logistic regression models adjusted for sociodemographic characteristics, found a consistent, graded association between number of multimorbid chronic conditions and ADL and IADL disability, even without taking into account severity or heterogeneity of diseases [32]. For ADL disability, odds ratios (ORs) ranged from 1.53 for one condition to 5.61 for ≥ 4 conditions.…”