Relative contribution of various chronic diseases and multi-morbidity to potential disability among Dutch elderly

Abstract

BackgroundThe amount of time spent living with disease greatly influences elderly people’s wellbeing, disability and healthcare costs, but differs by disease, age and sex.MethodsWe assessed how various single and combined diseases differentially affect life years spent living with disease in Dutch elderly men and women (65+) over their remaining life course. Multistate life table calculations were applied to age and sex-specific disease prevalence, incidence and death rates for the Netherlands in 2007. We distinguished congestive heart failure, coronary heart disease (CHD), breast and prostate cancer, colon cancer, lung cancer, diabetes, COPD, stroke, dementia and osteoarthritis.ResultsAcross ages 65, 70, 75, 80 and 85, CHD caused the most time spent living with disease for Dutch men (from 7.6 years at age 65 to 3.7 years at age 85) and osteoarthritis for Dutch women (from 11.7 years at age 65 to 4.8 years at age 85). Of the various co-occurrences of disease, the combination of diabetes and osteoarthritis led to the most time spent living with disease, for both men (from 11.2 years at age 65 to 4.9 -years at age 85) and women (from 14.2 years at age 65 to 6.0 years at age 85).ConclusionsSpecific single and multi-morbid diseases affect men and women differently at different phases in the life course in terms of the time spent living with disease, and consequently, their potential disability. Timely sex and age-specific interventions targeting prevention of the single and combined diseases identified could reduce healthcare costs and increase wellbeing in elderly people.

Three-year trajectories in Functional Limitations and Cognitive Decline among Dutch 75+ year olds, using nine-month intervals

“…While rheumatic diseases increased the chance of gradually declining physical functioning, a nding also reported by for example Botes et al (46), they also increased the probability of high levels of cognitive functioning. This positive relation between rheumatic diseases and cognition has been widely studied, and despite the growing body of evidence suggesting that aspirin does not have a protective effect on cognition (47,48), studies do indicate that non-steroidal anti-in ammatory drugs (NSAIDs) decrease the risk of cognitive decline (49).…”

Diabetes and Palliative Care: A Framework to Help Clinicians Proactively Plan for Personalized care

“…More recently, there is increasing recognition that people with chronic disease could benefit from palliative care; thus the term broadened in meaning and scope to include non-communicable chronic diseases [30]. Most adults with chronic disease need palliative care as a result of cardiovascular disease [9,11]. Diabetes is the leading cause of cardiovascular disease, and, in turn, cardiovascular disease is the leading underlying cause of diabetes-related deaths [3, 6,31].…”

“…Many older people have several coexisting comorbidities/geriatric syndromes, including cardiovascular disease, renal disease, sensory impairments, lower limb pathology, cognitive changes/dementia, some forms of cancer and frailty that individually and collectively affect life expectancy [6][7][8][9]. Frailty predicts admission to a care home and mortality and increases the risk of death [10,11]. Frailty is assessed in various ways, including phenotype and accumulation of deficits.…”

“…Diabetes and the associated comorbidities affect the quality of life, compromise function and self-care and increase the need for hospital admissions and readmissions and eventually lead to death [11,13,17]. Over 50% of people aged 65-80 experience moderate to severe disability and increased dependency.…”

Precision Medicine in Lifestyle Medicine: The Way of the Future?

“…Ideally, we do not want to simply increase life span; we want to increase health span 2 and compress morbidity. 3-5…”