Aging underlies heterogeneity between comorbidity and multimorbidity frameworks

Abstract

Studies exploring differences between comorbidity (i.e., the co-existence of additional diseases with reference to an index condition) and multimorbidity (i.e., the presence of multiple diseases in which no one holds priority) are lacking. In this single-center, observational study conducted in an academic, internal medicine ward, we aimed to evaluate the prevalence of patients with two or more multiple chronic conditions (MCC), comorbidity, or multimorbidity, correlating them with other patients' characteristics. The three categories were compared to the Cumulative Illness Rating Scale (CIRS) comorbidity index, age, gender, polytherapy, 30-day readmission, in-hospital and 30-day mortalities. Overall, 1394 consecutive patients (median age 80 years, IQR 69-86; F:M ratio 1.16:1) were included. Of these, 1341 (96.2%; median age 78 years, IQR 65-84; F:M ratio 1.17:1) had MCC. Fifty-three patients (3.8%) had no MCC, 286 (20.5%) had comorbidity, and 1055 (75.7%) had multimorbidity, showing a statistically significant (p < 0.001) increasing age trend (median age 38 years vs 71 vs 82, respectively) and increasing mean CIRS comorbidity index (1.53 ± 0.95 vs 2.97 ± 1.43 vs 4.09 ± 1.70, respectively). The CIRS comorbidity index was always higher in multimorbid patients, but only in the subgroups 75-84 years and ≥ 85 years was a significant (p < 0.001) difference (1.24 and 1.36, respectively) noticed. At multivariable analysis, age was always independently associated with in-hospital mortality (p = 0.002), 30-day mortality (p < 0.001), and 30-day readmission (p = 0.037), while comorbidity and multimorbidity were not. We conclude that age determines the most important differences between comorbid and multimorbid patients, as well as major outcomes, in a hospital setting.

A latent class analysis of resilience and its association with patient-reported symptoms in patients with esophageal cancer after esophagectomy

“…Male patients aged 65 years or younger felt obligated to support themselves, and their family members relied on their limited income, This is due to the traditional Chinese view of men as career-oriented and providing a pivotal part of family income ( Su et al, 2019 ; Wu et al, 2022 ), therefore, men had experienced higher economic burdens and lower levels of resilience. Patients aged 71 years and older were more likely to have multimorbidity ( Lenti et al, 2022 ), and their physical function, physical activity, psychological state, and quality of life were all lower ( Seong et al, 2022 ). While, this finding is at odds with earlier research, which indicated neither an upgrading in resilience with age ( Harms et al, 2019 ) nor a decrease with age ( Tamura et al, 2021 ; Musich et al, 2022 ).…”

Association between Perceived Health-Related Quality of Life and Depression with Frailty in the FRASNET Study

“…This well agrees with the results of Ji and colleagues [ 42 ]. Alternatively, with respect to MMSE cognitive status, the binary tree indicated that only the number of daily drugs, considered an index of comorbidity [ 43 ], and leisure activities significantly influenced the frailty status with any impact of MMSE itself, showing the higher proportion of frail individuals among those with a higher number of drugs and without leisure activities, while the most robust group was retrieved from those with a lower number of daily drugs. The whole regression analysis reported a significant association also for MMSE, and a recent review also suggests a bidirectional relationship between frailty and cognitive impairment [ 44 ].…”

Rate and risk factors of in-hospital and early post-discharge mortality in patients admitted to an internal medicine ward

“…1,3,6,8,9,13,15,16 In our study, multimorbidity, Early mortality in hospitalised patients as assessed by CIRS, was not correlated with either in-hospital or post-discharge mortality. This is probably because, as already shown in the SMAC study, 39 upon admission, the majority of patients had a CIRS comorbidity index >3, and hence this factor was far too common to highlight heterogeneity within the population. In other studies, multimorbidity had different impacts on early mortality, sometimes being significantly associated, as in Smolin et al, Han et al and Aljishi et al (according to the Charlson Comorbidity Index), 7,8,15 or had no significant effect, as in Perysinaki et al (according to the simple enumeration of diseases).…”