Abstract
BackgroundFunctional disability and multimorbidity are common among older people. However, little is known about the relationship between functional disability and different multimorbidity combinations. We aimed to identify multimorbidity patterns and explore the associations between these patterns and functional disability.MethodsWe investigated a multi-stage random sample of 1871 participants aged ≥60 years and covered by long-term care insurance in Shanghai, China. Multimorbidity was defined as the simultaneous presence of two or more chronic diseases in an individual. Participants completed scales to assess basic and instrumental activities of daily living (BADL and IADL, respectively). Multimorbidity patterns were identified via exploratory factor analysis. Binary logistic regression models were used to determine adjusted associations between functional disability and number and patterns of multimorbidity.ResultsMultimorbidity was present in 74.3% of participants. The prevalence of BADL disability was 50.7% and that of IADL disability was 90.7%. There was a strong association between multimorbidity and disability. We identified three multimorbidity patterns: musculoskeletal, cardio-metabolic, and mental-degenerative diseases. The cardio-metabolic disease pattern was associated with both BADL (OR 1.28, 95%CI 1.16–1.41) and IADL (OR 1.41, 95%CI 1.19–1.68) disability. The mental-degenerative disease pattern was associated with BADL disability (OR 1.55, 95%CI 1.40–1.72).ConclusionsMultimorbidity and functional disability are highly prevalent among older people covered by long-term care insurance in Shanghai, and distinct multimorbidity patterns are differentially associated with functional disability. Appropriate long-term healthcare and prevention strategies for older people may help reduce multimorbidity, maintain functional ability, and improve health-related quality of life.
Highlights
Functional disability and multimorbidity are common among older people
This study aimed to explore the relationship between multimorbidity patterns and basic activities of daily living (BADL)/instrumental activities of daily living (IADL) disability among older people covered by long-term care insurance (LTCI) in Shanghai, China
This study revealed there was a significant association between the number of chronic diseases and the likelihood of BADL disability and IADL disability among older people, which was consistent with previous studies [51, 52]
Summary
Functional disability and multimorbidity are common among older people. The mortality rate among older people in China is decreasing, their physical and cognitive functions are decreasing [2]. Since 2016, China has implemented a long-term care insurance (LTCI) policy to relieve the problems created by population aging and associated issues in the healthcare system [3]. The LTCI is a pre-plot social insurance system among 15 selected cities in China, which provides basic life care and daily nursing services to the disabled and older adults, and shares the nursing expenses incurred by people who cannot take care of themselves due to chronic diseases or physical and psychological disability [3, 4]. The Shanghai LTCI provides benefits mainly via institutional care services, home care services, and community care services [5], which includes basic life help and health care and psychological comfort [6]
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