<p>Patterns of Multimorbidity and Differences in Healthcare Utilization and Complexity Among Acutely Hospitalized Medical Patients (≥65 Years) – A Latent Class Approach</p>

Abstract

The majority of acutely admitted older medical patients are multimorbid, receive multiple drugs, and experience a complex treatment regime. To be able to optimize treatment and care, we need more knowledge of the association between different patterns of multimorbidity and healthcare utilization and the complexity thereof. The purpose was therefore to investigate patterns of multimorbidity in a Danish national cohort of acutely hospitalized medical patients aged 65 and older and to determine the association between these multimorbid patterns with the healthcare utilization and complexity. Patients and Methods: Longitudinal cohort study of 129,900 (53% women) patients. Latent class analysis (LCA) was used to develop patterns of multimorbidity based on 22 chronic conditions ascertained from Danish national registers. A latent class regression was used to test for differences in healthcare utilization and healthcare complexity among the patterns measured in the year leading up to the index admission. Results: LCA identified eight distinct multimorbid patterns. Patients belonging to multimorbid patterns including the major chronic conditions; diabetes and chronic obstructive pulmonary disease was associated with higher odds of healthcare utilization and complexity than the reference pattern ("Minimal chronic conditions"). The pattern with the highest number of chronic conditions did not show the highest healthcare utilization nor complexity. Conclusion: Our study showed that chronic conditions cluster together and that these patterns differ in healthcare utilization and complexity. Patterns of multimorbidity have the potential to be used in epidemiological studies of healthcare planning but should be confirmed in other population-based studies.

Multimorbidity Patterns and Unplanned Hospitalisation in a Cohort of Older Adults

“…In addition, depression, which is a major constituent of this pattern, is associated with increased risk of emergency hospital admissions [ 35 ]. The findings of our study are consistent with a recent Danish study, which revealed that the neuropsychiatric and mental disorders patterns had higher odds of experiencing acute hospital admissions [ 24 ]. Similarly, another Italian study showed that multimorbidity dyads including depression had a higher risk of increased annual hospitalisation days [ 23 ].…”

“…Despite the varying study populations and methodologies, three patterns of multimorbidity involving cardiometabolic diseases, psychogeriatric problems and mechanical and somatoform disorders have been consistently suggested to be very prevalent in the older population [ 20 ]. The few studies that have looked at multimorbidity patterns and hospital care utilisation have some limitations, such as including only subjects aged 80 years or older [ 21 , 22 ] or already-hospitalised patients [ 23 , 24 ].…”

The incidence of multimorbidity and patterns in accumulation of chronic conditions: A systematic review

“…After removing duplicates and non-original articles, 2,926 studies were identified, of which 109 were retained for full-text screening. A total of 73 articles were excluded following full-text review or qualitative synthesis, 34 …”

Longitudinal course of GDF15 levels before acute hospitalization and death in the general population

“…Frailty and multimorbidity are commonly observed in hospitalized older patients and indicate a state of vulnerability [12][13][14]. This vulnerability likely develops well before hospitalization, but few studies have examined or characterized changes in health in the years or months leading up to an acute hospitalization.…”