Abstract
This study explores the combination of four common health problems in older people and whether problems on four domains result in an additional effect on indicators of poor health. For this purpose, a total of 2681 participants (32% male, mean age 82 years) of the Integrated Systematic Care for Older People (ISCOPE) study were screened on the presence of health problems on four domains (functional, somatic, mental, social) with the postal ISCOPE questionnaire. Extensive interview data on health indicators were obtained at baseline and at 12-months follow-up, including disability (Groningen Activities Restriction Scale, GARS), cognitive function (Mini-Mental State Examination, MMSE), depressive symptoms (Geriatric Depression Scale-15, GDS), loneliness (loneliness scale of De Jong Gierveld), and health-related quality of life (EQ-5D). General practitioner (GP) contact time (min/year) was estimated via GP electronic medical records. Of the study population, 9% had no health problems according to the screening, 8% had problems on one domain, 27% on two, 38% on three and 18% on four domains. At baseline, the number of health domains with problems was associated with poorer scores on the GARS, the MMSE, the GDS-15, the loneliness scale, the EQ-5D and with more GP contact time (p <0.001). Problems on all four domains had an additional negative effect on these health indicators (all pinteraction <0.001). At follow-up, an increased number of domains with problems was associated with an increased decline in health indicators (all p<0.001) and with an additional negative effect on GP contact time of the presence of problems on all four domains (pinteraction <0.001). We conclude that combinations of functional, somatic, mental and social problems are associated with poor health indicators in community-dwelling older people. Since problems on four domains have an additional effect on health, individuals with combined functional, somatic, mental and social problems could benefit from integrated care.Trial registrationNetherlands Trial Register: NTR1946.
Highlights
The prevalence of many diseases and conditions increases with age
After the general practitioners (GPs) excluded people with a life expectancy of 3 months, who were admitted to a nursing home, who were non-Dutch speaking, or who should be excluded for other relevant reasons (n = 590), 11,476 older persons received an invitation to participate in the study
The present study shows that the number of domains with problems at baseline is associated with more disability, impaired cognition, depressive symptoms, feelings of loneliness, poorer Health-related quality of life (HRQoL) and more GP contact time, and that having problems on 4 domains is associated with an additional negative impact on these health indicators at baseline, and on GP contact time at follow-up
Summary
Older persons often have a variety of health problems including functional, somatic, mental and social problems These problems have all been individually associated with poor health indicators including deteriorated functional status, decreased quality of life and increased healthcare use [1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16]. Older people often have a combination of multiple health problems It is unclear if these problems interact and what the consequences are of the occurrence of a combination of health problems on functioning, wellbeing and healthcare use. This study investigates the consequences of problems on four health domains (functional, somatic, mental and social domain) on various health indicators, and whether the problems on four domains have an interactive effect on health indicators at baseline and at 12-month follow-up
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