Pathogenesis of multimorbidity—what is known?

Wetterling, Tilman

doi:10.1007/s00391-020-01752-z

Cited by 11 publications

(7 citation statements)

References 28 publications

(35 reference statements)

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“…Until recently, less was known about the interplay between obesity and MM in older adults 19 . The pathophysiology behind each of these disorders has been described in the literature 20,21 . Obesity contributes to dysfunction in lipid and glucose metabolism.…”

Section: Discussionmentioning

confidence: 99%

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The relationship between multimorbidity, obesity and functional impairment in older adults

Lynch

Petersen

Fanous

et al. 2022

J American Geriatrics Society

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Background Declining mortality rates and an aging population have contributed to increasing rates of multimorbidity (MM) in the United States. MM is strongly associated with a decline in physical function. Obesity is an important risk factor for the development of MM, and its prevalence continues to rise. Our study aimed to evaluate the associations between obesity, MM, and rates of functional limitations in older adults. Methods We analyzed body mass index (BMI) and self‐reported comorbidity data from 7261 individuals aged ≥60 years from the National Health and Nutrition Examination Surveys 2005–2014. Weight status was defined based on standard BMI categories. MM was defined as 2 or more comorbidities, while functional limitations were self‐reported. Adjusted logistic regression quantified the association between standard BMI categories and MM. We also examined the difference in the prevalence of limitations between those with and without MM. Results The overall proportion of individuals with concomitant MM and obesity was 27.0%. Compared to a normal BMI, older adults with obesity had higher odds of MM (Prevalence odds ratio 1.79, 95% CI 1.49, 2.12). Overall, 67.5% of patients with MM also reported a functional limitation, with rates of functional limitation increasing with increasing BMI. When evaluating functional limitations in those with MM by BMI class, 90% of patients classified as severely obese (BMI ≥40 kg/m2) with MM also had a concomitant functional limitation. Conclusions Compared to normal weight status, obesity is associated with an increased burden of MM and functional limitation among older adults. Our results underscore the importance of identifying and addressing obesity, MM, and functional limitation patterns and the need for evidence‐based interventions that address all three conditions in this population.

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Section: Discussionmentioning

confidence: 99%

“…19 The pathophysiology behind each of these disorders has been described in the literature. 20,21 Obesity contributes to dysfunction in lipid and glucose metabolism. Additionally, increasing BMI results in myocellular, hormonal, and inflammatory changes that influence pathophysiology in multiple organ systems.…”

Section: Discussionmentioning

confidence: 99%

The relationship between multimorbidity, obesity and functional impairment in older adults

Lynch

Petersen

Fanous

et al. 2022

J American Geriatrics Society

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“…The body of literature on the mechanisms connecting ageing and the development of multimorbidity is increasing [107][108][109][110] . The 'hallmarks of ageing' 111 include genomic instability, epigenetic effects, telomere attrition, loss of proteostasis, altered intercellular communication, mitochondrial dysfunction, deregulated nutrient sensing, cellular senescence and stem cell exhaustion.…”

Section: Ageing Inflammation and Multimorbiditymentioning

confidence: 99%

Multimorbidity

Skou

Mair

Fortin

et al. 2022

Nat Rev Dis Primers

443

283

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Interest in multimorbidity -commonly defined as the co-occurrence of at least two chronic conditions in the same individual 1 -has increased in the past few years owing to its substantial effect on the individual and the individual's family, as well as on health systems and on society, particularly in resource-poor settings 2-4 . Multimorbidity is distinct from the related concept of comorbidity, which refers to the combined effects of additional conditions in relation to the index condition in an individual [5][6][7][8] . By contrast, care for multimorbidity is patient-centred and does not routinely give priority to any single condition, although in clinical care, patients and clinicians will usually focus on the most pressing problems that the patient is experiencing.People with multimorbidity are more likely to die prematurely, be admitted to hospital and have an increased length of stay than people with a single chronic condition 9,10 . Multimorbidity is also associated with poorer function and health-related quality of life (HRQOL), depression and intake of multiple drugs (polypharmacy) and greater socioeconomic costs [11][12][13][14][15][16][17][18] . Most health care is designed to treat individual conditions rather than providing comprehensive, person-centred care 2,19,20 , which often leads to fragmented and sometimes contradictory care for people with multimorbidity and increases their treatment burden 21 Moreover, treating one condition at a time is inefficient and unsatisfactory for both people with multimorbidity and their health-care providers [22][23][24] .Multimorbidity is increasingly common owing to changes in lifestyle risk factors, notably physical inactivity and obesity, and population ageing that in part reflects improvements in survival from acute and chronic conditions 2,19,25,26 . Multimorbidity is associated with socioeconomic status and age 3,19,25,27 . However, although age is the strongest driver of multimorbidity, in absolute numbers, more people <65 years of age have multimorbidity than people ≥65 years of age, partly because more people in the general population are in that age group. Moreover, this emphasizes that multimorbidity is not just a feature of ageing 19,26 .Multimorbidity is further complicated in low-income and middle-income countries (LMICs) by the overlap of compounding factors, including adverse environmental and early life stressors linked to poverty, limited social infrastructure and poorer family coping mechanisms, that translate into chronic diseases occurring at earlier ages [28][29][30][31] . LMICs also have a higher prevalence of multimorbidity-related financial burden 32,33 and have weaknesses in health systems including a greater focus Treatment burdenThe workload associated with managing treatments and health-care recommendations and the impact of this on an individual and their supporters.

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“…With aging populations and the development of improved medical care, the number of patients with chronic diseases is increasing, particularly in the elderly (1)(2)(3). According to the International Diabetes Federation (IDF) (4), the global prevalence of diabetes in 2019 was approximately 9.3% (463 million individuals).…”

Section: Introductionmentioning

confidence: 99%

Cluster analysis for the overall health status of elderly, multimorbid patients with diabetes

Yan¹,

Yuan²,

Liu³

et al. 2023

Front. Public Health

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PurposeTo evaluate the overall health status and health-related abilities and problems of elderly patients with diabetes and multimorbidity compared with those with diabetes only. Additionally, we aimed to identify different subgroups of elderly, multimorbid patients with diabetes.MethodsThis cross-sectional study included 538 elderly patients with diabetes. The participants completed a series of questionnaires on self-rated health (SRH), diabetes self-management, self-efficacy, health literacy, depression, and diabetes distress. Differences in health-related abilities and problems were compared between elderly patients with diabetes and multimorbidity and those with diabetes only, with adjustments for covariates using propensity score matching. A cluster analysis was also performed to identify the overall health status subgroups of elderly, multimorbid patients with diabetes. Additionally, we conducted a multinomial logistic regression analysis to examine the predictors of health-related abilities and problem-cluster group membership.ResultsElderly patients with diabetes and multimorbidity experienced more health-related abilities and problems than those with diabetes only, particularly within the domains of depression (p < 0.001), and diabetes distress. The level of health literacy (p < 0.001) and self-management (p = 0.013) in elderly, multimorbid patients with diabetes was also significantly higher than that in elderly patients with diabetes only. Cluster analysis of elderly, multimorbid patients with diabetes revealed three distinct overall health status clusters. Multinomial logistic regression analysis indicated that age (OR = 1.090, p = 0.043), sex (OR = 0.503, p = 0.024), living situation (OR = 2.769, p = 0.011), BMI (OR = 0.838, p = 0.034), regular exercise (OR = 2.912, p = 0.041 in poor vs. good; OR = 3.510, p < 0.001 in intermediate vs. good), and cerebral infarction (OR = 26.280, p < 0.001) independently and significantly predicted cluster membership.ConclusionCompared with elderly patients with diabetes only, those with diabetes and multimorbidity experienced more health-related abilities and problems within the domains of depression, and diabetes distress. Additionally, the level of health literacy and self-management in elderly, multimorbid patients with diabetes was significantly higher than that in those with diabetes only. Among the multimorbid diabetes group, old age, male sex, living without a partner, slightly lower BMIs, not exercising regularly, and experiencing cerebral infarctions were all positively correlated with worse overall health status.

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Pathogenesis of multimorbidity—what is known?

Cited by 11 publications

References 28 publications

The relationship between multimorbidity, obesity and functional impairment in older adults

The relationship between multimorbidity, obesity and functional impairment in older adults

Multimorbidity

Cluster analysis for the overall health status of elderly, multimorbid patients with diabetes

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