Chronic condition clusters and associated disability over time

Abstract

Objectives Recent evidence shows that more complex clusters of chronic conditions are associated with poorer health outcomes. Less clear is the extent to which these clusters are associated with different types of disability (activities of daily living (ADL) and functional mobility (FM)) over time; the aim of this study was to investigate this relationship. Methods This was a longitudinal analysis using the National Health and Aging Trends Study (NHATS) ( n = 6179). Using latent class analysis (LCA), we determined the optimal clusters of chronic conditions, then assigned each person to a best-fit class. Next, we used mixed-effects models with repeated measures to examine the effects of group (best-fit class), time (years from baseline), and the group by time interaction on each of the outcomes in separate models over 4 years. Results We identified six chronic condition clusters: Minimal Disease, Cognitive/Affective, Multiple Morbidity, Osteoporosis, Vascular, and Cancer. Chronic condition cluster was related to ADL and FM outcomes, indicating that groups experienced differential disability over time. At time point 4, all chronic condition groups had worse FM than Minimal Disease. Discussion The clusters of conditions identified here are plausible when considered clinically and in the context of previous research. All groups with chronic conditions carry risk for disability in FM and ADL; increased screening for disability in primary care could identify early disability and prevent decline.

The bidirectional relationship between activities of daily living and frailty during short-and long-term follow-up period among the middle-aged and older population: findings from the Chinese nationwide cohort study

“…For instance, frailty individuals commonly had a higher prevalence of chronic diseases than non-frailty people ( 56 ). People with chronic conditions demonstrated higher incidence rates of disability across all ADL items ( 57 – 59 ), our results also supported this view. Over time, the decline of BADL such as bathing, walking, toileting, dressing, transferring and eating, as well as IADL such as performing housework, shopping, cooking, taking medicine and financial management will increase.…”

“…The inability to perform essential ADL leads to dependence on others and/or mechanical aids, and negatively affects daily activities, safe conditions and quality of life ( 78 ), all those increase slowness, weakness, low physical activity, and exhaustion resulting in frailty ( 79 , 80 ). In addition, the middle-aged and older participants with disability in ADL often suffer from chronic diseases ( 59 ), and the ability to take medicine in IADL may be restricted, which is not conducive to disease control, thus aggravating physical weakness and presenting frailty ( 3 , 6 ).…”

Multimorbidity patterns and the association with health status of the oldest-old in long-term care facilities in China: a two-step analysis

“…Age has been found to be a strong associated factor of the multimorbidity patterns [ 11 , 12 ]. One study investigating rural community-resident aged 60 years and older revealed a four-cluster multimorbidity structure.…”