The effect of cognitive impairment on the predictive value of multimorbidity for the increase in disability in the oldest old: the Leiden 85-plus Study

Abstract

Background: prevention of disability is an important aim of healthcare for older persons. Selection of persons at risk is a first crucial step in this process.Objectives: this study investigates the predictive value of multimorbidity for the development of disability in the general population of very old people and the role of cognitive impairment in this association.Design: the Leiden 85-plus Study (1997–2004) is an observational prospective cohort study with 5 years of follow-up.Setting: general population of the city of Leiden, the Netherlands.Subjects: population based sample of 594 participants aged 85 years.Methods: disability in activities of daily living (ADL) was measured annually for 5 years with the Groningen Activity Restriction Scale (range 9–36, 9 = optimal). Multimorbidity is defined as the presence of two or more chronic diseases at age 85 years. Cognitive function was measured at baseline with the mini-mental state examination (MMSE).Results: at baseline participants with multimorbidity had higher ADL disability scores compared with those without [median 11 inter-quartile range (IQR 9–16) versus 9 (IQR 9–13) ADL points, Mann–Whitney U test P < 0.001]. Stratified into four MMSE groups, ADL disability increased over time in all groups, even in participants without multimorbidity (P trend <0.001). Multimorbidity predicted accelerated increase in ADL disability in participants with MMSE of 28–30 points (n = 205, 0.67 points/year, P < 0.001), but not in participants with lower MMSE scores (all P > 0.100).Conclusion: the predictive value of multimorbidity for the increase in ADL disability varies with cognitive function in very old people. In very old people with good cognitive function, multimorbidity predicts accelerated increase in ADL disability. This relation is absent in very old people with cognitive impairment.

Clinically diagnosed infections predict disability in activities of daily living among the oldest-old in the general population: the Leiden 85-plus Study

“…Interestingly, in a previous analysis in the Leiden 85-plus Study, we found that chronic multimorbidity predicts an accelerated increase in ADL disability in very old persons with a good cognitive function [24]. This study shows that also an acute illness predicts an accelerated increase in ADL disability in the oldest-old without ADL disability at 86 years.…”

Does functional assessment of individuals aged 80-plus give rise to scientific discussion – considerations based on literature review

“…The biggest difficulties were reported with cutting nails and the smallest with eating meals. A study [22] conducted in the Netherlands on a group of 594 patients aged 85+ showed that in multi-disease patients the median value in the ADL scale amounted to 11 points, while Swedish research [23] revealed that in 51% of the persons studied aged 87-93 years, there was a decrease in ADL results within three years.…”

“…Drewes [22] used a 9-36 score in his study. Every activity could be scored in a four-point scale where 1 represents full independence and 4 full dependence.…”

Research Priorities in Geriatric Palliative Care: Multimorbidity

“…20 In the longitudinal Leiden 85-plus Study (1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004), the presence of two or more chronic conditions predicted accelerated ADL disability over time among individuals with normal cognitive function. 22 In addition, several studies have shown an association between multimorbidity and mortality across a range of conditions, [23][24][25][26] although this relationship is inconsistent and may be mediated by disability. 27,28 The quality of care for patients with multiple chronic conditions appears to vary based on both the number and types of conditions involved.…”