Multimorbidity and health-related quality of life in the older population: results from the German KORA-Age study

Abstract

BackgroundMultimorbidity in the older population is well acknowledged to negatively affect health-related quality of life (HRQL). Several studies have examined the independent effects of single diseases; however, little research has focused on interaction between diseases. The purpose of this study was to assess the impact of six self-reported major conditions and their combinations on HRQL measured by the EQ-5D.MethodsThe EQ-5D was administered in the population-based KORA-Age study of 4,565 Germans aged 65 years or older. A generalised additive regression model was used to assess the effects of chronic conditions on HRQL and to account for the nonlinear associations with age and body mass index (BMI). Disease interactions were identified by a forward variable selection method.ResultsThe conditions with the greatest negative impact on the EQ-5D index were the history of a stroke (regression coefficient -11.3, p < 0.0001) and chronic bronchitis (regression coefficient -8.1, p < 0.0001). Patients with both diabetes and coronary disorders showed more impaired HRQL than could be expected from their separate effects (coefficient of interaction term -8.1, p < 0.0001). A synergistic effect on HRQL was also found for the combination of coronary disorders and stroke. The effect of BMI on the mean EQ-5D index was inverse U-shaped with a maximum at around 24.8 kg/m2.ConclusionsThere are important interactions between coronary problems, diabetes mellitus, and the history of a stroke that negatively affect HRQL in the older German population. Not only high but also low BMI is associated with impairments in health status.

Priorities for Health Economic Methodological Research: Results of an Expert Consultation

“…57,58 Multi-morbidity also has implications for quality of life outcome measures which, like costs, do not behave additively over conditions. 59 Outcome measures are also problematic in particular patient groups, such as those with impaired cognitive abilities who may not be able to complete patient reported outcome measures; 60 and in particular interventions, such as palliative care, where the choice of outcome is not straightforward or uniform. 61 The latter point extends to the "care sector" generally, where fewer appropriate outcome tools are available than in the "cure sector", although recent research such as the Adult Social Care Outcomes Toolkit (ASCOT) has started to address this.…”

The Effect of Diabetes on Life Quality of Individuals with Type 2 Diabetes

“…Hastalarda özellikle, makrovasküler ve iskemik kalp atağı gibi hastalıkların yaşam kalitesini düşürdüğü belirtilmektedir. [15][16][17] Diyabetli hastalarda yeni yaşam tarzı ve hastalığa uyum süreci bireyin yaşam kalitesini azaltabilmektedir. 18 Goldney ve ark.nın yaptığı ça-lışmada diyabetin depresyona neden olarak yaşam kalitesini önemli derecede düşürdüğü gösterilmiş-tir.…”

Evaluación del modelo de descripción de pacientes: Grupo de Riesgo Clínico (CRG) como indicador y predictor de consumo de recursos y su relación con los Factores de Riesgo Cardiovascular y la Calidad de Vida Relacionada con la Salud

“…También M. Hunger (Hunger et al, 2011), sobre una población de unas 4.565 personas de 65 y más años de edad, procedentes del estudio KORA en Alemania, hace referencia a que la prevalencia de multimorbilidad en la población de edad mayor de 65 años oscila entre el 40% y el 56%.…”

“…La mayoría de los estudios han usado esta herramienta para medir la CVRS en enfermedades de forma individual. Cada vez se analizan más los efectos sinérgicos que tienen las combinaciones de enfermedades crónicas sobre la CV (Fortin et al, 2007) (Hunger et al, 2011).…”

“…Incluso la asociación entre la edad y la CVRS puede ser menor si la morbilidad es evaluada como un gran número de comorbilidades o como enfermedades severas (Hunger et al, 2011).…”