Association Of Chronic Conditions Research Articles

Association of chronic conditions and physical multimorbidity with new-onset incontinence in a nationwide prospective cohort study of older adults ≥ 50years in China.

The relationship between multimorbidity (i.e. ≥ 2 chronic conditions) and incontinence (i.e. urinary and/or faecal incontinence) is underexplored. This study investigated the association between multimorbidity and incident incontinence in Chinese adults aged ≥50years. Data from the 2011 and 2015 waves of the China Health and Retirement Longitudinal Study were used. The association between 12 chronic conditions, multimorbidity and new-onset incontinence was analysed using weighted logistic regression models. Mediation analysis was conducted to explore the potential mediators (self-reported health, subjective memory, depressive symptoms, disability, cognitive function, handgrip strength, mobility limitations, medications and frailty status) between multimorbidity and incontinence. Among 9,986 individuals aged ≥50years who were continent at baseline, 5.3% (n = 521) were newly incontinent 4years later (incident cases). The risk of incident incontinence increased with physical multimorbidity (OR 2.04, 95% CI 1.62-2.57). Compared to no chronic condition, having 1, 2, 3 and ≥ 4 chronic conditions were associated with incident incontinence with OR (95% CI): 1.41 (1.01-1.97), 1.74 (1.24-2.44), 2.82 (1.93-4.12) and 3.99 (2.29-6.95), respectively. The association between multimorbidity and incontinence was mediated by self-reported health (41.2%), medications (26.6%), mobility limitations (20.9%), depressive symptoms (12.8%), disability (11.6%), subjective memory (8.7%) and frailty status (8.3%). This longitudinal study found that physical multimorbidity and specific chronic conditions may increase the risk of new-onset incontinence among Chinese adults aged ≥50years. Self-reported health, medications and mobility limitations seemed to be important intermediate conditions between multimorbidity and incident incontinence.

Multiple chronic conditions and associated health care expenses in US adults with cancer: a 2010\u20132015 Medical Expenditure Panel Survey study

BackgroundCancer increases the risk of developing one or more chronic conditions, yet little research describes the associations between health care costs, utilization patterns, and chronic conditions in adults with cancer. The objective of this study was to examine the treated prevalence of chronic conditions and the association between chronic conditions and health care expenses in US adults with cancer.MethodsThis retrospective observational study used US Medical Expenditure Panel Survey (MEPS) Household Component (2010–2015) data sampling adults diagnosed with cancer and one or more of 18 select chronic conditions. The measures used were treated prevalence of chronic conditions, and total and chronic condition-specific health expenses (per-person, per-year). Generalized linear models assessed chronic condition-specific expenses in adults with cancer vs. without cancer and the association of chronic conditions on total health expenses in adults with cancer, respectively, by controlling for demographic and health characteristics. Accounting for the complex survey design in MEPS, all data analyses and statistical procedures applied longitudinal weights for national estimates.ResultsAmong 3657 eligible adults with cancer, 83.9% (n = 3040; representing 16 million US individuals per-year) had at least one chronic condition, and 29.7% reported four or more conditions. Among those with cancer, hypertension (59.7%), hyperlipidemia (53.6%), arthritis (25.6%), diabetes (22.2%), and coronary artery disease (18.2%) were the five most prevalent chronic conditions. Chronic conditions accounted for 30% of total health expenses. Total health expenses were $6388 higher for those with chronic conditions vs. those without (p < 0.001). Health expenses associated with chronic conditions increased by 34% in adults with cancer vs. those without cancer after adjustment.ConclusionsIn US adults with cancer, the treated prevalence of common chronic conditions was high and health expenses associated with chronic conditions were higher than those without cancer. A holistic treatment plan is needed to improve cost outcomes.

Chronic conditions and multimorbidity in population aged 90 years and over: associations with mortality and long-term care admission.

prevalence of many chronic conditions is rising in the aging population worldwide. However, the long-term impact of these conditions and multimorbidity on other health outcomes in very old age is rarely studied. the data were based on four waves of the Vitality 90+ Study conducted in 2001, 2003, 2007 and 2010. Associations of chronic conditions and multimorbidity with mortality were analysed in a total sample of 2,862 people aged over 90, and associations with long-term care (LTC) admission in a subsample of 1,954 participants living at home in baseline. Risk of death and LTC admission were assessed with Cox and competing risks regression with time-dependent covariates. Population attributable fractions (PAF) for mortality and LTC admission were calculated for chronic conditions based on the regression models. heart disease, diabetes and dementia predicted mortality in men and women. In addition, depression was associated with increased mortality in women. Parkinson's disease, dementia and hip fracture predicted LTC admission in women. Multimorbidity increased the risk of death and LTC admission in women but not in men. For both genders, dementia had the highest PAF for mortality and LTC admission. heart disease and diabetes are still important predictors of mortality in very old age. However, the role of dementia is pronounced in this age group. Of the studied conditions, dementia is the main contributor both to mortality and LTC admission. Multimorbidity has predictive value concerning both mortality and LTC admission, at least in oldest old women.

Successful Aging in the Context of the Disablement Process: Working and Volunteering as Moderators on the Association Between Chronic Conditions and Subsequent Functional Limitations.

This study evaluated the successful aging model by assessing the impact of two forms of productive engagement-working and volunteering-as potential interventions in the process of disablement. The Health and Retirement Study was used to (a) estimate two-stage selection equations of (i) currently working part time and full time and (ii) currently volunteering less than 100 hours and volunteering 100 hours or more per year (net of chronic health problems) and (b) assess whether, net of selection, working, and volunteering moderate the association between chronic conditions and subsequent functional limitations. Chronic conditions were associated with elevated levels of subsequent functional limitations, whereas both working and volunteering were associated with lower levels of subsequent functional limitations. Moreover, workers and volunteers of less than 100 hours per year experienced a reduction in the association of chronic conditions on subsequent functional limitations. This research highlights the role of productive engagement as a key element in successful aging. Not only do work and volunteering have direct associations with health outcomes themselves, but they also act as potential interventions in the process of disablement by attenuating the way in which chronic conditions are translated into subsequent functional limitations. This suggests that (a) future research should apply successful aging models to health processes as well as health outcomes and (b) policy makers should support social institutions that foster late-life productive engagement.

Associations of chronic conditions, APOE4 allele, stress factors, and health behaviors with self-rated health.

BackgroundSelf-rated health (SRH) has been widely used to measure the overall health status of older adults. Research has shown that SRH is determined by a large array of factors, such as chronic disease conditions, genetic markers (e.g., Apolipoprotein E, APOE, NM_000041), stress factors, and health behaviors. However, few studies have incorporated these factors simultaneously in the analytic framework of SRH. The aim of this study is to examine the associations of these four sets of factors with SRH.MethodsUsing a dataset from a population-based, random-cluster survey of 1,005 elderly respondents aged 54–91 conducted in Taiwan in 2000, we use logistic regressions to examine associations of chronic health conditions, the APOE4 allele stress factors, and health behaviors with SRH. The four disease conditions include diabetes, heart diseases, gastric ulcers, and chronic obstructive pulmonary disease. Stress factors are measured by traumatic events (having an earthquake-damaged house) and chronic life stress (financial difficulty). Health behaviors include smoking, drinking alcohol, vegetable and fruit intake, daily milk intake, and physical exercise.ResultsDiabetes, heart diseases, gastric ulcers, and chronic obstructive pulmonary disease are found to be associated with 2.63 (95 % CI: 1.75–3.95), 1.72 (95 % CI: 1.15–2.58), 1.94 (95 % CI: 1.35–2.80), and 2.54 (95 % CI: 1.66–3.92) odds ratios of poor SRH. The APOE4 allele is found to be significantly associated with poor SRH with odd ratio of 1.58 (95 % CI: 1.02–2.41). Financial difficulty is associated with increased likelihood of poor SRH, with odds ratios of 1.76 (95 % CI: 1.22–2.54) Doing exercise more than 5 times per week are associated with reduced likelihood of poor SRH by 44 % (odds ratio is 0.56, 95 % CI: 0.39–1.82). The interaction term between gender and gastric ulcer showed that the impact of gastric ulcer on SRH is more pronounced in women than in men, with an odds ratio of 2.63 (95 % CI: 1.24–5.58).ConclusionsChronic conditions and the APOE4 allele are significantly associated with increased likelihood of reporting poor health, and the associations appear differently among women and men. To better understand the mechanism of how people self-assess their overall health, chronic conditions and genetic components should be considered together with conventional factors such as life stress and health behaviors.

Associations of chronic conditions, APOE4 allele, stress factors, and health behaviors with self-rated health

Associations of chronic conditions, APOE4 allele, stress factors, and health behaviors with self-rated health

Gender Differences in Depressive Symptoms Among Older Korean American Immigrants

Despite consistent reports over many years of a greater prevalence of depression among women, mechanisms underlying the gender difference remain unclear. Mechanisms relevant to immigrant elderly populations are virtually unexplored. The present study examined gender variations in depressive symptoms using a community sample of 230 older Korean American immigrants (Mage = 69.8; standard deviation = 7.05) in Florida. We were interested in examining not only mean differences but gender differences in the impact of demographic variables (age, marital status, and education), health constraints (chronic conditions and functional disability), and personal resources (sense of control, social network, and acculturation) on depressive symptoms. Consistent with previous literature, women scored higher on depressive symptoms than men. In a hierarchical regression model, women and those with more chronic conditions, greater functional disability, and lower sense of control were found to have more depressive symptoms. The interaction of gender-by-chronic conditions was found to be significant, and further analysis indicated that the association of chronic conditions with mental well-being was stronger for women. The findings suggest that among older Korean immigrants, women are at particular risk of declining psychological well-being in the face of physical health problems and call attention to the need for interventions designed to promote their physical and mental health.

E: Training of residents and registrars in C-L psychiatry, 17.06.00, 15:45–17:15

Objective: The purpose of this study was to examine whether number and type of chronic conditions are related to psychological distress, fatigue, and the use of psychoactive medications. Methods: Data were taken from a community-based sample of adults who had responded to a health survey mailing (N = 9428). Chronic conditions were assessed by self-report. Information on the use of psychoactive medications was extracted from a claims database of prescribed drugs. Chronic conditions were compared controlling for confounding factors. Results: Strong associations were found between the number of chronic conditions, on the one hand, and psychological distress and fatigue, on the other. There was a less strong association between these factors and the use of medication for anxiety and stress, the use of sleeping pills or tranquilizers, and the use of antidepressants. There was only a partial association between type of condition, psychological distress, and fatigue. Migraine had the broadest impact, having an effect on psychological distress and fatigue and on the use of anxiolytics, as well as the use of antidepressants. Conclusion: The association of chronic conditions with psychological distress, fatigue, and the use of psychoactive medications appeared to be related more to the number of conditions than to the type of condition.

Chronic conditions, psychological distress and the use of psychoactive medications

Objective: The purpose of this study was to examine whether number and type of chronic conditions are related to psychological distress, fatigue, and the use of psychoactive medications. Methods: Data were taken from a community-based sample of adults who had responded to a health survey mailing (N = 9428). Chronic conditions were assessed by self-report. Information on the use of psychoactive medications was extracted from a claims database of prescribed drugs. Chronic conditions were compared controlling for confounding factors. Results: Strong associations were found between the number of chronic conditions, on the one hand, and psychological distress and fatigue, on the other. There was a less strong association between these factors and the use of medication for anxiety and stress, the use of sleeping pills or tranquilizers, and the use of antidepressants. There was only a partial association between type of condition, psychological distress, and fatigue. Migraine had the broadest impact, having an effect on psychological distress and fatigue and on the use of anxiolytics, as well as the use of antidepressants. Conclusion: The association of chronic conditions with psychological distress, fatigue, and the use of psychoactive medications appeared to be related more to the number of conditions than to the type of condition.