Associations between prevalent multimorbidity combinations and prospective disability and self-rated health among older adults in Europe

Abstract

Background Multimorbidity is associated with greater likelihood of disability, health-related quality of life, and mortality, greater than the risk attributable to individual diseases. The objective of this study is to examine the association between unique multimorbidity combinations and prospective disability and poor self-rated health (SRH) in older adults in Europe. Methods We conducted a prospective analysis using data from the Survey of Health, Ageing and Retirement in Europe in 2013 and 2015. We used hierarchical models to compare respondents with multiple chronic conditions to healthy respondents and respondents reporting only one chronic condition and made within-group comparisons to examine the marginal contribution of specific chronic condition combinations. Results Less than 20% of the study population reported having zero chronic conditions, while 50% reported having at least two chronic conditions. We identified 380 unique disease combinations among people who reported having at least two chronic conditions. Over 35% of multimorbidity could be attributed to five specific multimorbidity combinations, and over 50% to ten specific combinations. Overall, multimorbidity combinations that included high depressive symptoms were associated with increased odds of reporting poor SRH, and increased rates of ADL-IADL disability. Conclusions Multimorbidity groups that include high depressive symptoms may be more disabling than combinations that include only somatic conditions. These findings argue for a continued integration of both mental and somatic chronic conditions in the conceptualization of multimorbidity, with important implications for clinical practice and healthcare delivery. Electronic supplementary material The online version of this article (10.1186/s12877-019-1214-z) contains supplementary material, which is available to authorized users.

Severity Levels of Disability Among Older Adults in Low- and Middle-Income Countries: Results From the Study on Global Ageing and Adult Health (SAGE)

“…The associations between the nine chronic conditions included in this study and severe disability levels were significant (just hypertension was marginally significant) and corroborate what has been reported in the geriatric literature about the role of chronic conditions and multimorbidity on the disablement process ( 6 , 51 ). However, it must be noted that we only explored the singular effect of each chronic condition on disability, and it remains possible that different combinations of these diseases increase the likelihood of severe disability ( 51 ).…”

“…The WHODAS 2.0 scale is widely used to measure last-month limitations in activity and daily-life participation. It covers six domains explored through a total of 12 items (two per domain): [1] cognition and communication, [2] self-care, [3] mobility, [4] interpersonal relations, [5] life activities, and [6] participation. The results of the 12 items are added up to obtain a global score expressed on a continuous scale from 0 (no disability) to 100 (full disability) (31).…”

“…Some studies have estimated the severity levels of disability using WHODAS 2.0 (either 12-or 36-item version), following two general approaches. First, using the ICF-recommended classification, a population is classified as: no disability [0-4], mild disability [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24], moderate disability , severe disability , and extreme disability [96-100]. Second, using some multivariate statistical method, individuals are classified according to the association pattern observed among the items of WHODAS 2.0.…”

“…Burden imposed by disability in old age is one of the major challenges faced by healthcare systems worldwide not only in high-income countries (HICs) but also in low-and middle-income countries (LMICs) (3). Disability can occur simultaneously with some geriatric syndromes (falls, frailty, cognitive impairment) (4,5) and chronic conditions (hypertension, myocardial infarction, arthritis, diabetes, stroke) (6,7) and is a major risk factor for adverse outcomes such as falls (8), hospitalizations (9), and mortality (10).…”

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

“…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].…”