The Factors Associated with 3-Year Mortality Stratified by Physical and Mental Multimorbidity and Area of Residence Deprivation in Primary Care Community-Living Older Adults

Abstract

Objectives: To examine the risk factors of mortality stratified by physical and mental multimorbidity (PMM) and area socioeconomic status. Methods: Cox regression analyses were used to study 3-year all-cause mortality in primary care older adults stratified by PMM status, and area of residence material and social deprivation. Results: There were socioeconomic differences in the associations between PMM and mortality. Continuity of care decreased mortality risk in moderately and most deprived areas. Satisfaction with medical consultations decreased mortality risk in moderately deprived areas. Current smoking increased mortality in those living in moderately and most deprived areas. Physical activity reduced mortality only in individuals without PMM. Higher cognition was associated with reduced mortality in individuals living in moderately deprived areas. Discussion: Public health policies should be further encouraged in primary care, aiming at increased continuity of care, quality of interactions with patients, and prevention strategies including smoking cessation programs and physical activity promotion.

Minimally Adequate Treatment for Depression and Anxiety Associated With Mortality in Primary Care Older Adults

“…While controlling for a number of individual socioeconomic, clinical, and lifestyle factors, it was interesting to note, that patient perceptions relating to physician availability to speak of emotional problems and perceived effectiveness of consulting health professional in resolving emotional problems was not associated with mortality. Increased continuity of care and patientperceived adequate number of visits to speak about emotional problems in the present study were associated with a reduced risk of mortality, which has been reported elsewhere [60][61][62] .…”

Optimizing Older Adult Mental Health in Support of Healthy Ageing: A Pluralistic Framework to Inform Transformative Change across Community and Healthcare Domains

“…AFEs are designed to ensure that older adults gain equitable access to social determinants of health (housing, food, security, employment, recreation and leisure, and health care) [ 35 ]. Many determinants of mental health harms including stigma and discrimination [ 29 , 35 ], social isolation [ 14 , 40 ], lack of physical activity [ 64 , 65 ], and income barriers [ 35 , 66 ] are thus mitigated by AFEs [ 67 ]. The features of AFEs that optimize mobility, physical activity, and meaningful social interactions are preventative of generalized anxiety [ 64 ], cognitive impairment [ 37 ], and social isolation and loneliness [ 68 ].…”

“…Micro (older adults): Environments planned without consideration of the requirements of older adults have a direct negative impact on their mental health and negatively impact how older adults are positioned socially, economically, and politically, thus, heightening experiences of social exclusion and marginalization [ 39 , 67 ]. For instance, environmental obstacles that impede meaningful social engagement and erode social networks heighten the risk of social [ 64 ] and socio-economic marginalization [ 35 , 66 ]. They also diminish opportunities to participate in civic life [ 40 ] (Zimmer and McDonough, 2022).…”

“…Macro (community and healthcare systems): Community and healthcare systems built on infrastructures (e.g., policies, standards, and regulations) that do not consider and respond to the requirements of older adults promote normative processes (e.g., ways of getting around, ways of working) that systematically hinder access to resources that support mental health and healthy ageing [61,63]. For instance, features in the built environment that commonly challenge older adults include a lack of inclusive transportation options [35], safe environments to engage in leisure and physical activity [34,65], and accessible public green spaces [65,66]. These missed opportunities can produce lower social capital (i.e., reciprocal social networks) [39,67] and increase psychological distress (Franke et al, 2020) and social isolation [41,68].…”

The Subjective Evaluation of Health Status of Multimorbid Patients in Primary Health Care

“…Dėl didėjančio sergamumo lėtinėmis ligomis vis dažniau pastebimas poliligotumasbūklė, kai vienam asmeniui diagnozuojama daugiau nei viena lėtinė liga [4]. Dėl senėjančios visuomenės ir ištobulėjusios medicinos poliligotų žmonių skaičius ateityje neabejotinai didės [5]. Įvairiose Europos valstybėse apie pasireiškusias dvi bei daugiau lėtinių ligų praneša iki 40 proc.…”