Multimorbidity Patterns and 5-Year Mortality in Institutionalized Older Adults

Vetrano, Davide Liborio; Damiano, Cecilia; Tazzeo, Clare; Zucchelli, Alberto; Marengoni, Alessandra; Luo, Hao; Zazzara, Maria Beatrice; Hout, Hein van; Onder, Graziano

doi:10.1016/j.jamda.2022.01.067

Cited by 17 publications

(15 citation statements)

References 25 publications

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“…30 Different multimorbidity patterns have been found to have different effects on self-rated health, catastrophic health expenditures, risk of frailty, and 5-year mortality in older adults. [31][32][33][34] In this study, multimorbidity was divided into three patterns: relatively healthy pattern, respiratory pattern, and cardiovascular pattern.…”

Section: Discussionmentioning

confidence: 99%

Association of multimorbidity patterns with motoric cognitive risk syndrome among older adults: Evidence from a China longitudinal study

Xiong,

Wang,

Zhu

et al. 2023

Int J Geriat Psychiatry

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ObjectivesMotoric cognitive risk syndrome (MCR), a pre‐dementia syndrome, is characterized by slow gait and subjective cognitive complaints among older adults. This study assessed the relationship between multimorbidity, its patterns, and MCR.MethodsData for this study were obtained from three waves (2011, 2013, and 2015) of the China Health and Retirement Longitudinal Study. Participants who were aged 60 years and older and had complete data at baseline as well as complete data about MCR at follow‐up were selected. Patients without MCR at baseline were selected for further analyses. Longitudinal associations between multimorbidity, its patterns, and MCR were examined using a Cox proportional hazards model. Multimorbidity patterns were classified using latent class analysis.ResultsA total of 4923 respondents were included at baseline, 43.47% of whom had multimorbidity. Additionally, the prevalence of MCR at baseline was 12.61%. After adjusting for covariates, multimorbidity was positively associated with MCR (hazard ratio [HR] = 1.33, 95% confidence interval [CI] = 1.06–1.68). A higher number of multimorbidity was also significantly associated with an increased risk of developing MCR (HR = 1.10, 95% CI = 1.02–1.19). Three multimorbidity patterns were selected: relatively healthy pattern, respiratory pattern, and cardiovascular pattern. Older adults with the cardiovascular pattern were 1.57 times more likely to develop MCR than those with the relatively healthy pattern (HR = 1.57, 95% CI = 1.16–2.13). There was no significant difference between the relatively healthy pattern and the respiratory pattern (HR = 1.31, 95% CI = 0.91–1.92).ConclusionsMCR is highly prevalent among older Chinese adults. MCR may be exacerbated by multimorbidity. For older adults with multimorbidity (especially cardiovascular multimorbidity), attention should be paid to MCR to achieve early detection, diagnosis, and treatment.

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Section: Discussionmentioning

confidence: 99%

Association of multimorbidity patterns with motoric cognitive risk syndrome among older adults: Evidence from a China longitudinal study

Xiong,

Wang,

Zhu

et al. 2023

Int J Geriat Psychiatry

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“…Component loadings (range − 1/ + 1) were used to determine how the diseases related to the identified components, with a high component loading indicating that a disease was well represented by the considered component. The components were then named in accordance with the diseases that most characterized them [5]. Four patterns of multimorbidity were identified: heart diseases (including ischemic heart disease, heart failure, arrythmia and atrial fibrillation); dementia and sensory impairments (dementia, hearing and visual impairment); heart, respiratory and psychiatric diseases (ischemic heart disease, chronic obstructive pulmonary disease, heart failure, neurotic stress related disease and depression); and diabetes, musculoskeletal and vascular diseases (cerebrovascular diseases, diabetes, hypertension and musculoskeletal disease).…”

Section: Discussionmentioning

confidence: 99%

“…Different multimorbidity patterns, characterized by the combination of cardiovascular, pulmonary, and neuropsychiatric diseases, have been defined [4]. These patterns are differentially associated with health outcomes, confirming that the effects of multimorbidity are strictly dependent on the underlying diseases combinations [5,6].…”

Section: Introductionmentioning

confidence: 87%

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Frailty, multimorbidity patterns and mortality in institutionalized older adults in Italy

et al. 2022

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Background Little is known on how frailty influences clinical outcomes in persons with specific multimorbidity patterns. Aims To investigate the interplay between multimorbidity and frailty in the association with mortality in older individuals living in nursing homes (NH). Methods We considered 4,131 NH residents aged 60 years and over, assessed through the interRAI LTCF instrument between 2014 and 2018. Follow-up was until 2019. Considering four multimorbidity patterns identified via principal component analysis, subjects were stratified in tertiles (T) with respect to their loading values. Frailty Index (FI) considered 23 variables and a cut-off of 0.24 distinguished between high and low frailty levels. For each pattern, all possible combinations of tertiles and FI were evaluated. Their association (Hazard Ratio [HR] and 95% confidence interval) with mortality was tested in Cox regression models. Results In the heart diseases and dementia and sensory impairments patterns, the hazard of death increases progressively with patterns expression and frailty severity (being HR T3 vs. T1 = 2.36 [2.01-2.78]; HR T3 vs. T1 = 2.12 [1.83-2.47], respectively). In heart, respiratory and psychiatric diseases and diabetes, musculoskeletal and vascular diseases patterns, frailty seems to have a stronger impact on mortality than patterns' expression. Discussion Frailty increases mortality risk in all the patterns and provides additional prognostic information in NH residents with different multimorbidity patterns. Conclusions These findings support the need to routinely assess frailty. Older people affected by specific groups of chronic diseases need a specific care approach and have high risk of negative health outcomes.

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“…La multimorbilidad, definida como la presencia de dos o más enfermedades en una persona, es otra situación crítica durante el envejecimiento. Un ejemplo de ello es el estudio de Melo y colaboradores en Bra-sil, que identificó que el 53 % de los adultos mayores presentaban dos o más enfermedades (66), siendo los grupos más comunes las enfermedades cardíacas, las demencias y deficiencias sensoriales; las enfermedades cardíacas, respiratorias y psiquiátricas; la diabetes, enfermedades musculoesqueléticas y vasculares (67), por lo que es lógico pensar que el tratamiento de estas condiciones requieren el uso de varios fármacos a la vez. La Encuesta de Salud de España en 2017, reveló que el 27,3 % de los adultos mayores usan 5 o más medicamentos al día, y 0,9 % utilizan 10 o más medicamentos (68).…”

Section: Envejecimiento Estado Nutricional Y Dietas Restrictivasunclassified

Cambios gastrointestinales en el envejecimiento: impacto sobre la alimentación y el estado nutricional.

López¹,

Álvarez²,

Lloreda³

2022

Med.

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Durante el envejecimiento se presentan una serie de cambios biológicos y psicológicos que tienen un impacto social y económico en la población a medida que avanza su edad. Uno de los sistemas con cambios fisiológicos que guarda una estrecha relación con el estado nutricional es el tracto gastrointestinal. Cada una de sus secciones presenta modificaciones que alteran, en una u otra medida, la motilidad, la digestión o la absorción de la energía y nutrientes, con efectos deletéreos como la pérdida de la masa musculoesquelética, la disminución en la funcionalidad y la alteración en la calidad de vida, que finalmente contribuye al aumento de la incidencia de desnutrición proteico calórica y sarcopenia. La vejez es una etapa en la que la presencia de enfermedades crónicas incrementa los problemas nutricionales debido al impacto propio de las patologías, sus efectos gastrointestinales, el uso de medicamentos y la inadecuada indicación de dietas restrictivas, que sin la apropiada orientación de un profesional en nutrición y dietética, pueden favorecer y exacerbar la desnutrición. Esta revisión describe los cambios en la función gastrointestinal que ocurren durante el envejecimiento y los efectos sobre el estado nutricional, y expone las consecuencias de las modificaciones en términos del perfil, contenido de nutrientes y consistencia de la alimentación del adulto mayor.

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Multimorbidity Patterns and 5-Year Mortality in Institutionalized Older Adults

Cited by 17 publications

References 25 publications

Association of multimorbidity patterns with motoric cognitive risk syndrome among older adults: Evidence from a China longitudinal study

Association of multimorbidity patterns with motoric cognitive risk syndrome among older adults: Evidence from a China longitudinal study

Frailty, multimorbidity patterns and mortality in institutionalized older adults in Italy

Cambios gastrointestinales en el envejecimiento: impacto sobre la alimentación y el estado nutricional.

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