Abstract
BackgroundSince approximately two in three older adults (65+) report having two or more chronic diseases, causes and consequences of multimorbidity among older persons has important personal and societal issues. Indeed, having more than one chronic condition might involve synergetic effects, which can increase impact on disabilities and quality of life of older adults. Moreover, persons with multimorbidity require more health care treatments, implying burden for the person, her/his family and the health care system.MethodsUsing the 2008/09 Canadian Community Health Survey (CCHS), this paper assesses the convergent construct validity of six measures of multimorbidity for persons aged 65 and over. These measures include: 1) Multimorbidity Dichotomized (0, 1+ conditions); 2) Multimorbidity Dichotomized (0/1, 2+); 3) Multimorbidity Additive Scale; 4) Multimorbidity Weighted by the Health Utility (HUI3) Scale; 5) Multimorbidity Weighted by the OARS Activity of Daily Living (ADL) Scale; and 6) Multimorbidity Weighted by HUI3 (using beta coefficients). Convergent construct validity was assessed using correlations and OLS regression coefficients for each of the multimorbidity measures with the following social-psychological and health outcome variables: life satisfaction, perceived health, number of health professional visits, and medication use.ResultsOverall, the two dichotomies (scales #1 & #2) showed the weakest construct validity with the health outcome variables. The additive chronic illness scale (#3) and the multimorbidity weighted by ADLs (#5), performed better than the other two weighted scales using (HUI #4 & #6). Measurement errors apparent in the dichotomous multimorbidity measures were amplified for older women, especially for life satisfaction and perceived health, but decreased when using the scales, suggesting stronger validity of scales #3 through #6.ConclusionsTo properly represent multimorbidity, using dichotomous measures should be used with caution. When only prevalence data are available for chronic conditions, such as in the CCHSs or CLSA, an additive multimorbidity scale can better measure total illness burden than simple dichotomous or other discrete measures.
Highlights
Since approximately two in three older adults (65+) report having two or more chronic diseases, causes and consequences of multimorbidity among older persons has important personal and societal issues
The Multimorbidity Weighted by HUI3 (Beta) Scale that controlled for age and gender, did not perform better than the other weighted scales (Table 3)
The percentage increase in the correlations between the four additive chronic illness scales and the dichotomous measures ranged between 130% and 160% for life satisfaction and perceived health outcomes, and between
Summary
Since approximately two in three older adults (65+) report having two or more chronic diseases, causes and consequences of multimorbidity among older persons has important personal and societal issues. Multimorbidity, the focus of the present study, is defined as conditions where an individual has been diagnosed with more than one chronic disease – a condition that is slow in progression, long in duration, and typically limits function, productivity and quality of life [4,5]. This can be distinguished from comorbidity, which includes multiple chronic illnesses, but is defined in terms of an index disease, such as persons with cardiovascular disease who have diabetes [6]. Research within particular disease pillars (e.g., cardiovascular disease, cancer, arthritis, diabetes, etc.) has proliferated, a gap exists in the literature that addresses the simultaneous experience of living with multimorbidity
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