Baseline Multimorbidity Research Articles

Multimorbidity patterns and cognitive change among Mexican older adults: findings from the Mexican Health and Aging Study

Introduction: Mexico faces unique challenges due to the confluence of population ageing, an increasing burden of chronic conditions and limited resources to address these concerns. Substantial evidence links both independent and co-occurring chronic conditions to the risk of cognitive decline, but the association between common multimorbidity patterns and change in cognitive function has not been examined among older adults in Mexico. Objective: The objective of our research was to identify the most common multimorbidity patterns among ageing Mexican adults in 2012, then examine the association between these multimorbidity patterns and change in cognitive function with advancing age. Methodology: Data from the Mexican Health and Aging Study (2012–21; n = 6,082) was used to identify multimorbidity patterns in 2012 (including hypertension, diabetes, cancer, lung disease, heart attack, stroke, arthritis and depressive symptoms), then latent growth modelling was used to examine associations between the mean cognitive trajectory and the baseline multimorbidity patterns. Results: Several baseline multimorbidity patterns were associated with variation in cognitive function. Diabetes and depressive symptoms were present in the majority of multimorbidity patterns associated with lower cognitive function at baseline, and respondents with either lone diabetes or hypertension+diabetes+arthritis at baseline experienced more rapid cognitive decline than those reporting no conditions at baseline. Conclusion: Our findings suggest that prevention and management of diabetes may reduce cognitive gaps that manifest prior to older adulthood and protect against rapid cognitive decline among older Mexican adults. Further examination of depressive symptoms as a component of multimorbidity and cognitive change is also warranted.

Preexisting multimorbidity predicts greater mortality risks related to long-term PM2.5 exposure.

Long-term health risk assessments related to ambient fine particulate matter (PM2.5) exposure have been more limited to general population but not towards individuals suffering from multimorbidity. While both multimorbidity and PM2.5 are independently linked to elevated mortality risk, their combined effects and interactions remain practically unexplored. A cross-cohort analysis was undertaken on data from 3 prospective cohorts, initially enrolling 869038 adults aged ≥18 years followed up during 2005-2022. Multimorbidity was identified at baseline surveys through a list of nine common chronic conditions. Cox proportional hazards models were utilized to quantify the associations of long-term PM2.5 exposure with all-cause, cardiovascular, and respiratory mortality among individuals with and without multimorbidity. Joint effects and interactions between baseline multimorbidity and PM2.5 level on the additive and multiplicative scales were examined. Risk differences of PM2.5-induced mortality were analyzed stratified by number of chronic conditions and multimorbidity patterns. Subgroup and sensitivity analyses were carried out to evaluate the consistency of the findings. Among 713119 eligible participants for primary analysis, 65490 prevalent cases of multimorbidity were identified at baseline over a median follow-up of 12.2 years. Compared to individuals without multimorbidity, associations of PM2.5 exposure with all-cause and cardiovascular mortality were more prominent among multimorbidity individuals (P <0.05 for heterogeneity). Our analysis unveiled a significant additive interaction between PM2.5 level and preexisting multimorbidity status, yielding estimated attributable proportions of 11.7%-17.8% and excess risks of 31.1%-72.6% for different mortality outcomes. Sex subgroup and sensitivity analyses consistently produced similar results. This large-scale multicohort analysis demonstrated markedly stronger associations between PM2.5 levels and risks of all-cause and cardiovascular mortality in multimorbidity populations compared to those without multimorbidity. PM2.5 exposure and preexisting multimorbidity showed synergistic effects in triggering mortality events, wherein the joint risks were intensified with elevated PM2.5 levels and an increased number of chronic conditions.

Association between multimorbidity and the risk of dementia: A systematic review and meta-analysis.

Multimorbidity has become increasingly prevalent and poses challenges in managing cognitive function. This study aimed to (1) systematically review and perform a meta-analysis to understand the relationship between multimorbidity and the risk of dementia and (2) examine the impact of different multimorbidity patterns on this relationship. A systematic review was conducted using PubMed, Embase, PsychINFO, CINAHL, and Cochrane Central to gather studies published up to December 16, 2023. For the meta-analysis, studies with consistent study designs, multimorbidity definitions, and stages of dementia were included. Heterogeneity was assessed using the I2 statistic, and Egger's and Begg's tests were used to evaluate publication bias. Of the 12,074 studies identified, 11 were deemed suitable for systematic review, and eight were included in the meta-analysis. Meta-analysis of the longitudinal studies revealed that baseline multimorbidity was significantly associated with an increased risk of dementia compared with individuals without multimorbidity (HR: 1.34, 95 % CI: 1.08-1.68). Meta-analysis of the cross-sectional studies indicated that multimorbidity was significantly associated with a higher risk of being in the prodromal stages of dementia than in individuals without multimorbidity (OR: 1.32, 95 % CI: 1.16-1.51). The risk of dementia varied according to diverse multimorbidity patterns, and the cardiovascular-metabolic condition-related patterns were the most common and associated with high dementia risk. Our findings provide quantitative evidence of a significant association between multimorbidity and the risk of dementia. To develop effective dementia prevention strategies, an in-depth understanding of specific multimorbidity patterns is invaluable for managing cognitive function.

Effects of multimorbidity and polypharmacy on physical function in community-dwelling older adults: A 3-year prospective cohort study from the SONIC

BackgroundWe prospectively examined the effect of baseline multimorbidity and polypharmacy on the physical function of community-dwelling older adults over a three-year period. MethodsThe analysis included 1,401 older adults (51.5 % women) who participated in both wave 1 and wave 2 (3-year follow-up) of the Septuagenarians, Octogenarians, and Nonagenarians Investigation with Centenarians (SONIC) study. Grip strength and walking speed were binarized into poor/not poor physical function according to the frailty definition. The number of chronic conditions and the number of prescribed medications were categorized into 3 and 4 groups, respectively. Multivariable logistic regression was used to examine associations between the number of chronic conditions, medication use at baseline, and poor physical function over a three-year period. ResultsAfter adjusting for confounding factors, hyperpolypharmacy (≥ 10 medications) demonstrated associations with weak grip strength (adjusted odds ratio [aOR] = 2.142, 95 % confidence interval [CI] = 1.100–4.171) and slow walking speed (aOR = 1.878, 95 % CI = 1.013–3.483), while co-medication (1–4 medications) was negatively associated with slow walking speed (aOR = 0.688, 95 % CI = 0.480–0.986). There was no significant association between the number of chronic conditions and physical function. ConclusionThe findings suggest that the number of medications can serve as a simple indicator to assess the risk of physical frailty. Given that many older individuals receive multiple medications for extended durations, medical management approaches must consider not only disease-specific treatment outcomes but also prioritize drug therapy while actively avoiding the progression towards frailty and geriatric syndromes.

#308 The impact of multimorbidity on the effects of empagliflozin in chronic kidney disease (CKD): exploratory analyses from the EMPA-KIDNEY trial

Abstract Background and Aims Sodium-glucose co-transporter-2 (SGLT2) inhibitors slow kidney disease progression and reduce cardiovascular risk in patients with CKD. Multimorbidity is common in CKD and associated with poor prognosis. Multimorbidity may identify patients with most to gain from, or at increased risk of adverse effects of, such treatment, so uncertainty exists around the risk-benefit profile. We assessed the effects of empagliflozin according to baseline multimorbidity, polypharmacy and health-related quality of life in EMPA-KIDNEY trial participants. Method EMPA-KIDNEY was a double-blind, placebo-controlled randomised trial which compared empagliflozin 10 mg once daily versus placebo among 6609 patients with CKD (Clinicaltrials.gov: NCT03594110). Eligible patients had an eGFR of 20 to &amp;lt;45; or 45 to &amp;lt;90 ml/min/1.73 m2 with a urinary albumin-to-creatinine ratio (uACR) ≥200 mg/g. Multimorbidity was defined by the presence or absence of eight self-reported conditions at randomisation (diabetes, heart failure, ischaemic heart disease [any history of myocardial infarction or angina], cerebrovascular disease [any history of stroke or transient ischaemic attack], peripheral arterial disease, atrial fibrillation, peripheral neuropathy and gout), in addition to CKD. Polypharmacy was derived from the number of concomitant medications recorded at randomisation. Health-related quality of life at randomisation was assessed using the EuroQoL EQ-5D-5L tool. To enable subgroup analyses, participants were categorised into approximate thirds of each variable's distribution. The relative effects of allocation to empagliflozin versus placebo on the trial's pre-specified efficacy and safety outcomes were assessed using Cox regression models adjusted for age, sex, region, eGFR, uACR and diabetes status. Tests for heterogeneity across subgroups were used to assess for any evidence that multimorbidity modifies relative treatment effects, and used to inform approaches to estimate absolute benefits. Results The median (Q1-Q3) number of comorbid conditions (other than CKD) recorded at randomisation was 1 (0-2); range 0-7. At randomisation, the median (Q1-Q3) number of concomitant medications recorded was 7 (5-10), range 0-36, and polypharmacy (≥5 medications) was prevalent in 5044/6609 (76%) of participants. There was considerable overlap between multimorbidity, polypharmacy and deficits in health-related quality of life (Fig. 1). Empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death by 28% (hazard ratio 0.72, 95% CI 0.64-0.82). There was no evidence of heterogeneity relative effects by categories reflecting multimorbidity, nor by level of polypharmacy or self-reported quality of life at randomisation (P value for heterogeneity all &amp;gt;0.05; Fig. 2). Absolute benefits for the primary outcome were at least as large in the highest categories of multimorbidity or polypharmacy versus the lowest (and for those with poorer versus greater health-related quality of life). Safety outcomes were infrequent with no evidence of a difference in effect by baseline levels of multimorbidity, polypharmacy or quality of life, including no excess of symptomatic dehydration or fractures. Conclusion In EMPA-KIDNEY, the estimated absolute benefits of empagliflozin on kidney disease progression or cardiovascular death substantially outweigh potential for harm, irrespective of multimorbidity, polypharmacy or quality of life. The analyses encourage safe widespread use of SGLT2 inhibitors in CKD.

Abstract P304: Sex Differences for the Progression of Cardiovascular Multimorbidity in Older Adults in the United States

Introduction: Understanding the progression of cardiovascular multimorbidity and recognizing differences are needed to develop effective strategies to improve health outcomes. There is a knowledge gap in the potential unequal burden and progression of cardiovascular multimorbidity. Our objective is to investigate sex differences in the progression of cardiovascular multimorbidity among older adults in the US and estimate relative life expectancies among patients with severe multimorbidity. Hypothesis: We hypothesized that life expectancy among older adults with severe cardiovascular multimorbidity is inversely related to the number of comorbid conditions and progresses more acutely in males. Methods: Repeated cross-sectional cohort study of inpatient, outpatient, and carrier claims for a 5% nationwide Medicare sample. We included Medicare beneficiaries aged 65 or older enrolled in Medicare Fee-For-Service program from 2010 to 2020 and living in the continental US. Multistate life table models were employed to estimate cardiovascular disease (CVD) progression and total life expectancies from ages 65 to 85 years. Progression probabilities and life expectancies were adjusted for age, non-cardiovascular comorbidities, and Medicaid dual eligibility. A microsimulation approach was utilized to derive life tables, and bootstrapping was used to estimate variability. The primary outcome was the development and progression of cardiovascular multimorbidity, defined by the number of major cardiovascular conditions (atrial fibrillation, acute myocardial infarction, heart failure, stroke, and chronic ischemic heart disease). Comorbidities were assessed using validated algorithms based on diagnostic codes billed over a 1-year lookback period, and beneficiaries were followed forward from their index date. Results: Of 2,189,633 beneficiaries, the median age was 69, median follow-up was 5 years, and 55.9% were female. For male beneficiaries, odds of developing cardiovascular comorbidities were significantly higher than for females, with odds ratios ranging from 1.20 (95% CI 1.19-1.21) for one CVD to 1.97 (95% CI 1.88-2.06) for 1 or more of the 4 CVD comorbidities. Men with 1 CVD at baseline had significant odds of developing 2 (OR: 1.10, 95% CI 1.09-1.11) and four CVDs (OR: 1.29, 95% CI 1.24-1.34), as well as a significant mortality risk (OR: 1.19, 95% CI 1.18-1.21). However, for men with 4 CVDs, the odds of progressing to 5 were not significant (OR: 1.00, 95% CI 0.97-1.04). Across levels of baseline multimorbidity, male beneficiaries had significantly elevated mortality risks compared to females, with the highest risk for those with no baseline CVD (OR: 1.50, 95% CI 1.48-1.52). Conclusions: These findings suggest persistent sex differences in cardiovascular multimorbidity progression, identifying a potentially important target for the improvement of health outcomes.

Associations of Inflammatory, Metabolic, Malnutrition, and Frailty Indexes with Multimorbidity Incidence and Progression, and Mortality Impact: Singapore Longitudinal Aging Study

Introduction: The detection of systemic risk factors aids in the formulation of strategies to prevent multimorbidity and its associated mortality impact. We aimed to determine the associations of inflammatory, metabolic, malnutrition, and frailty indexes with multimorbidity onset and progression and their predictions of multimorbidity-associated mortality risk. Methods: A prospective cohort study (Singapore Longitudinal Aging Study [SLAS]) of 5,089 community-dwelling older adults aged ≥55 years in two waves of recruitment (SLAS-1: March 2005-September 2007, SLAS-2: January 2013-August 2018). Baseline variables included inflammatory (neutrophil-lymphocyte ratio (NLR), lymphocyte-monocyte ratio (LMR)) and metabolic profiles (atherogenic index of plasma (AIP), triglyceride-glucose index of insulin resistance (TyG)), physical frailty, and nutritional risk (Mini Nutritional Assessment-Short Form (MNA-SF), Nutritional Screening Initiative (NSI), Elderly Nutritional Indicators for Geriatric Malnutrition Assessment (ENIGMA)). At follow-up, 3–5 years after the baseline interview, incident multimorbidity (≥2 chronic diseases) was determined among multimorbidity-free participants (N = 1,657) and worsening multimorbidity (increase of ≥2 chronic diseases) among participants with baseline multimorbidity (N = 1,207). Mortality in all participants and those with multimorbidity (N = 2,291) was determined up to 31 December, 2016. Odds ratio (OR), hazard ratio (HR), and 95% confidence intervals (95% CI) were estimated in multivariate logistic and Cox regression models, in base model adjustments for age, sex, ethnicity, housing type, smoking, and a number of comorbidities, and further stepwise selection adjustment for other systemic risk indexes. Results: At baseline, NLR, LMR, AIP, TyG, physical frailty, ENIGMA, NSI, and MNA-SF were significantly associated with prevalent multimorbidity (p < 0.001). Among multimorbidity-free participants, LMR, TyG, and ENIGMA were significantly associated with incident multimorbidity in both the base model and further stepwise selection models: LMR (OR = 0.87, 95% CI: 0.81–0.94), TyG (OR = 1.36, 95% CI: 1.06–1.75), and ENIGMA (OR = 1.15, 95% CI: 1.02–1.30). Among participants with baseline multimorbidity, NLR, LMR, and TyG significantly predicted worsened multimorbidity at follow-up in base model analysis, and LMR (OR = 0.72, 95% CI: 0.60–0.86) and TyG (OR = 1.96, 95% CI: 1.24–3.09) remained as independent predictors in further stepwise selection models. Among participants with prevalent multimorbidity, NLR, TyG, frailty, MNA, and ENIGMA were significantly associated with mortality risk with base model adjustments and further stepwise selection models: NLR (HR = 1.20, 95% CI: 1.10–1.32), TyG (HR = 1.27, 95% CI: 1.04–1.54), frailty (HR = 1.22, 95% CI: 1.10–1.36), ENIGMA (HR = 1.13, 95% CI: 1.05–1.22), MNA (HR = 0.91, 95% CI: 0.85–0.97). A combined systemic risk index shows increasing quartiles, adjusted for age, sex, housing, and smoking status, significantly predicting mortality risk. Discussion/Conclusion: The onset and progression of multimorbidity and its mortality impact are driven by systemic factors, including inflammation, metabolic dysfunction (insulin resistance), malnutrition, and frailty. The measurement of these systemic factors using simple, inexpensive clinical and blood chemistry tools can help in strategies to prevent and reduce its mortality impact.

THE IMPACTS OF LIFESTYLE ON DEPRESSION AND LIFE SATISFACTION AMONG CHINESE OLDER ADULTS: A 7-YEAR FOLLOW-UP STUDY

Abstract This study aims to explore the long-term effects of lifestyle-related factors and physical health on life satisfaction among older adults by transitions in mental health conditions. Using data derived from the China Health and Retirement Longitudinal Study (CHARLS), the analytic sample included 643 older adults. Linear regression analyses were used to examine the cross-sectional and longitudinal associations of lifestyle-related factors and physical health with depression risk and life satisfaction in older adults. In this study, sleep duration and multimorbidity was found to be significantly related to baseline and follow-up depressive symptoms in older adults. Compared to non-drinkers, current drinkers reported more severe depressive symptoms. More depressive symptoms were associated with worse impairment in physical function or Activities of Daily Living (IADLs). Among older adults remaining no depressive symptoms at baseline and follow-up, current drinkers tended to have lower life satisfaction than non-drinker. Shorter sleep duration showed a longitudinal correlation with lower life satisfaction. In the subgroups of emerging depression, past drinkers tended to have lower life satisfaction than non-drinkers, and baseline multimorbidity significantly predicted lower subsequent life satisfaction. In conclusion, our findings identified drinking and shorter sleep duration as the lifestyle-related detrimental factors of late-life depression and life satisfaction in Chinese community-dwelling older adults. Other physical-health-related risk factors of depression included worse impairment in physical function or IADLs, and multimorbidity. Our findings have implications for future psychosocial interventions targeted at alleviating depressive symptoms and promoting life satisfaction of the older adults based on their long-term mental and physical health conditions.

AGING-RELATED HUMAN MONOCYTE TRANSCRIPTOMIC PATHWAYS PREDICT WORSENING MULTIMORBIDITY

Abstract In a cross-sectional analysis, we identified aging-associated monocyte transcriptional modules associated with the multimorbidity in the Multi-Ethnic Study of Atherosclerosis (MESA) study. Here we examine whether these modules predict worsening multimorbidity over time. Transcriptomic profiles were determined in circulating monocytes from 1,264 MESA participants aged 55-94 (51% female, 53% minority). The multimorbidity index was defined as the number of prevalent diseases: cardiovascular disease, type-2 diabetes, hypertension, cancer, dementia, chronic kidney disease, chronic obstructive pulmonary disease, and hip fracture. The mean index at baseline was 1.0 (33%, 45%, and 22% with 0, 1, and 2-6 diseases respectively). At baseline, the index was associated with 5 co-expressed transcriptional modules (FDR&amp;lt; 0.05). During a 6-year follow-up, 449 individuals developed new morbidities. In Cox proportional hazards regression models, 4 (p&amp;lt; 0.05) of these 5 modules including those enriched for downregulation of apoptosis (RH=1.11 per SD increment, p=0.03) and upregulation of complement subcomponent C1q (RH=1.14, p=0.005) predicted incident morbid diseases after adjusting for age, sex, race/ethnicity, study site, and the baseline multimorbidity index. Persons having above the median expression of both modules developed an average of 0.63 new diseases, while those with both below the median developed an average of 0.40 new diseases. These two modules predicted increasing morbidities independently of one another and IL6 levels (p&amp;lt; 0.05). In conclusion, transcriptomic analysis of human immune cells provided evidence that decreased apoptosis and increased immune response predict the onset of a variety of age-related diseases. Whether targeting these pathways will change morbidity risk remains to be demonstrated.

Implementing pharmacists' medication safety recommendations is associated with reduced health care resource utilization and mortality in high-risk older Americans

BackgroundA medication safety review (MSR) is a novel, pharmacist-driven, technology-supported intervention that prioritizes adverse drug event risk mitigation. Previous research has shown that Medicare Part D beneficiaries who received MSRs in an enhanced medication therapy management (EMTM) model realized improvements in total Medicare spending, hospitalizations, emergency department (ED) visits, and mortality compared to control. However, it is unknown whether beneficiaries implemented pharmacists’ MSR recommendations. ObjectiveThe objective of the study was to evaluate whether MSR recommendation implementation is associated with improvements in these same outcomes for Part D beneficiaries enrolled in EMTM compared to a control group. MethodsThis retrospective, pre-post, cohort study evaluated outcomes for beneficiaries who were targeted for MSR services in 2018 and 2019. The “validated implementation MSR (viMSR)” cohort included those who received their first-ever MSR in 2018, received another MSR in 2019, and validated implementation of ≥1 recommendation in their 2018 MSR. The “failed to engage” (FTE) cohort included beneficiaries who were targeted for MSR services in both 2018 and 2019 but did not engage in an MSR at any point through the end of 2019. For both cohorts, we calculated the 2018-to-2019 change for each outcome and then determined whether year-over-year changes differed significantly between cohorts. For mortality, we relaxed the requirement for continuous enrollment in 2019, permitting us to compare the proportion of beneficiaries that died in each group in 2019. Analyses were adjusted for baseline multimorbidity. ResultsOf 4384 beneficiaries who completed MSRs, 602 (13.7%) implemented ≥1 recommendation. The viMSR cohort (N = 602) outperformed the FTE cohort (N = 7052) in total Medicare costs ($2162/y lower; P = 0.020), Part A Medicare costs ($1855/y; P = 0.024), hospitalizations (9.1 fewer admissions/100 beneficiaries/y, P = 0.020), ED visits (10.8 fewer visits/100 beneficiaries/y, P = 0.014), and mortality (3.8% fewer died in 2019; P < 0.001). ConclusionImplementing pharmacists’ recommendations in MSRs was associated with improved health care resource utilization and mortality for MSR-eligible beneficiaries.

Multimorbidity and associations with clinical outcomes in a middle-aged population in Iran: a longitudinal cohort study.

BackgroundAs the populations of lower-income and middle-income countries age, multimorbidity is increasing, but there is little information on its long-term consequences. We aimed to show associations between multimorbidity and outcomes of mortality and hospitalisation in Iran, a middle-income country undergoing rapid economic transition.MethodsWe conducted a secondary analysis of longitudinal data collected in the Golestan Cohort Study. Data on demographics, morbidities and lifestyle factors were collected at baseline, and information on hospitalisations or deaths was captured annually. Logistic regression was used to analyse the association between baseline multimorbidity and 10-year mortality, Cox-proportional hazard models to measure lifetime risk of mortality and zero-inflation models to investigate the association between hospitalisation and multimorbidity. Multimorbidity was classified as ≥2 conditions or number of conditions. Demographic, lifestyle and socioeconomic variables were included as covariables.ResultsThe study recruited 50 045 participants aged 40–75 years between 2004 and 2008, 47 883 were available for analysis, 416 (57.3%) were female and 12 736 (27.94%) were multimorbid. The odds of dying at 10 years for multimorbidity defined as ≥2 conditions was 1.99 (95% CI 1.86 to 2.12, p<0.001), and it increased with increasing number of conditions (OR of 3.57; 95% CI 3.12 to 4.08, p<0.001 for ≥4 conditions). The survival analysis showed the hazard of death for those with ≥4 conditions was 3.06 (95% CI 2.74 to 3.43, p<0.001). The number of hospital admissions increased with number of conditions (OR of not being hospitalised of 0.36; 95% CI 0.31 to 0.52, p<0.001, for ≥4 conditions).ConclusionThe long-terms effects of multimorbidity on mortality and hospitalisation are similar in this population to those seen in high-income countries.

8-Year Changes in Frailty in Adults: Links to Cognitive and Physical Function and Mortality

Deficit accumulation frailty indices are being evaluated as clinical markers of biological aging. In this context, it is to be expected that changes over time in such indices should be predictive of downstream changes in cognition, physical function, and mortality. We derived a frailty index (FI) based on deficit accumulation in 38 functional, behavioral, and clinical characteristics and examined associations between 8-year changes in FI and subsequent standardized measures of cognitive and physical function and mortality collected over years 8-18. We drew data from the Look AHEAD clinical trial of a multidomain intensive lifestyle intervention (ILI) in 3841 adults, aged 45-76 years at baseline with overweight/obesity and type 2 diabetes mellitus. Greater FI increases tended to occur among individuals who were older, non-Hispanic White, heavier, and who had greater baseline multimorbidity. Greater increases in FI were associated with subsequently worse levels of composite cognitive function and 400m walk speed (all p<0.001). Additionally, compared with the lowest tertile of FI change, hazard ratios [95% confidence intervals] for 10-year mortality for the middle and highest tertiles of FI change were 1.28 [1.03.1.58] and 1.56 [1.24,1.96], respectively. While assignment to ILI was associated with smaller 8-year increases in FI, this did not translate overall to better cognitive functioning compared to the Diabetes Support and Education control condition across years 8-18. Increase in FI over 8 years predicts subsequent reduced function and greater mortality. However, whether interventions generally targeting FI reduce risks for downstream outcomes remains to be seen.

Changes in clinical indices of multimorbidity and frailty predict subsequent cognitive decline: Findings from the Look AHEAD and Look AHEAD MIND studies

AbstractBackgroundTwo common features of aging are increases in the number of chronic diseases and in the number of deficits in functional, behavioral, and clinical characteristics. Accordingly, indices of multimorbidity and deficit accumulation (i.e. frailty indices) have been promoted as clinical markers of biological aging. As such, it is to be expected that changes over time in these indices should be predictive of downstream changes in important functions, such as cognition.MethodWe examined associations that 8‐year changes in 1) a multimorbidity index comprised of 9 chronic diseases (e.g. CHD, cancer, depression) and 2) a frailty index (FI) based on deficit accumulation in 38 functional, behavioral, and clinical characteristics had with subsequent standardized measures of cognitive function over 10 years. We drew data from the Look AHEAD clinical trial of a multidomain intensive lifestyle intervention (ILI) in 3841 adults, aged 45‐76 years at baseline, who were at risk for accelerated biological aging due to overweight/obesity and type 2 diabetes mellitus, and who underwent cognitive assessment. The domains of memory, attention, and executive function were assessed with validated instruments and combined to form a composite cognitive measure.Result1501 (39%) of the cohort had increases of one and 867 (23%) had increases of &gt;2 chronic diseases. Older individuals, males, and non‐Hispanic Whites tended to be over‐represented among those with the greatest increase in multimorbidities. The 33%ile of the distribution of FI changes was ‐0.005 and the 67%ile was 0.048. Greater FI increases tended to occur among individuals who were older, non‐Hispanic White, heavier, and who had greater baseline multimorbidity. Changes in multimorbidity and FI were moderately correlated (r=0.25; p&lt;0.001). As seen in the attached table, greater increases in both multimorbidity and FI were associated with subsequently worse levels of executive function, attention, and composite cognitive function (p&lt;0.001). While assignment to ILI was associated with smaller increases in both indices of aging, this did not translate overall to better cognitive functioning.ConclusionAccelerated aging, as captured by these geroscience‐informed indices, predicts subsequent poorer cognitive function. However, whether interventions generally targeting multimorbidity and FI reduce risks for cognitive impairment remains to be seen.

Effects of a group experiential therapy program on the psychological health of military veterans: a preliminary investigation

ABSTRACT This study examined the clinical effects of a brief group experiential therapy treatment centered on psychodrama in a sample of military veterans. The sample (N = 72) comprised male (n = 54) and female (n = 18) United States military veterans (M age = 44.19, SD age = 12.51) who completed the six-day treatment. Self-reported military-related posttraumatic stress (M-PTSD), anxiety, depression, and quality of life were assessed at baseline (T0), end of treatment (T1), three-month follow-up (T2), and six-month follow-up (T3). Prior combat exposure was also measured at T0, and acceptability and user satisfaction ratings were reported at T1. Within-subjects changes on all outcomes from T0 to T1, T2, and T3 were medium to large in effect size. After controlling for relevant demographic characteristics, prior combat exposure, and baseline multimorbidity, the results revealed significant improvements in clinical symptoms and quality of life from T0 to T1, T2, and T3. A majority of the participants who met criteria for M-PTSD, anxiety, or depression caseness at T0 attained recovery status at T1, T2, and T3. Acceptability and satisfaction ratings were high. The findings offer preliminary evidence supporting the efficacy of the group experiential treatment in sustaining reduced psychological symptoms and improving the quality of life of military veterans.

How does chronic multimorbidity affect daily routines? An experience sampling study of community-dwelling adults in Hong Kong.

Limited by conventional data collection methods, it is unclear how community-dwelling multimorbid people's daily routines are affected by their co-occurring illnesses. This study investigated the differences in everyday life schedules between multimorbid and nonmultimorbid people. Three hundred community-dwelling adults, representative of the Hong Kong Chinese population, provided real-time self-reports of daily routines over a 7-day study period. Stratified by baseline multimorbidity status, we implemented generalized linear mixed models (binomial) for each of the four outcomes: meal, chores, conversation, and work/school, with time intervals as independent variable and potential confounders adjusted. The odds of engaging in these activities were compared between multimorbid and nonmultimorbid participants by time intervals. Significant differences were identified. Unlike nonmultimorbid participants, late evening (22:00-24:00) was estimated to be the most frequently observed meal time among multimorbid participants (adjusted odds ratio [AOR] = 8.21, 95% confidence interval [CI] = 2.59-26.01 vs. 14:00-16:00), who also did chores significantly earlier in the morning (AOR = 1.97, 95% CI = 1.09-3.58 in 8:00-10:00 vs. 14:00-16:00). Conversations were significantly less likely among multimorbid participants throughout the day. Last, multimorbid participants seemed to have less typical working/schooling hours. Further studies are warranted to investigate how these disruptions may lead to lower levels of quality of life and poorer mental health.

Multimorbidity of cardiometabolic diseases: prevalence and risk for mortality from one million Chinese adults in a longitudinal cohort study

ObjectivesThe evolution of multimorbidity describes the continuum from a healthy status to the development of a single disease and further progression to multimorbidity with additional diseases. We investigated the evolution...

Multimorbidity is associated with more subsequent depressive symptoms in three months: a prospective study of community-dwelling adults in Hong Kong.

Multimorbid adults are more likely to have depression. However, existing data are mostly cross-sectional or retrospective with poor control of baseline depressive symptoms and a focus on long-term effects. This prospective study examined the short-term independent predictive association of multimorbidity with depressive symptoms. We collected baseline and three-month follow-up data from a population-based sample of 300 community-dwellers (aged 18-77) in Hong Kong. Multiple regression was used to examine the predictive association of baseline multimorbidity (two or more physical chronic conditions), relative to having one or zero conditions, with depressive symptoms in three months measured by the Center for Epidemiological Studies-Depression (CES-D, out of 60) scale. Multivariable adjustments were made for socio-demographics, baseline CES-D scores, and baseline self-perceived physical health status. A sub-analysis was conducted to compare multimorbid participants with monomorbid (one condition) ones. In our sample, 48 participants (16%) had multimorbidity. Adjusted analysis showed that on average, multimorbid participants had 2.71 (95% CI, 0.36-5.06, Cohen's d = 0.128) more points in the CES-D scale at three-month follow-up than non-multimorbid participants (zero or one condition) did, which was independent of baseline CES-D scores, self-perceived physical health status, and socio-demographics. Compared with monomorbid participants, multimorbidity was associated with a similar difference of 2.92 (95% CI, 0.81-5.66, Cohen's d = 0.220) points. Incremental R-square changes associated with the inclusion of multimorbidity were significant (P < 0.05). In conclusion, the effect of multimorbidity on depressive symptoms may take a shorter period to manifest than previously assumed. The mental health of adults with multimorbidity warrants more attention.

Multimorbidity, inflammation, and disability: a longitudinal mediational analysis.

Background:Using longitudinal data from the Survey of Mid-Life Development in the United States, this study examined the role of systemic inflammation in mediating the link between multimorbidity and increases in and onset of functional limitations over a 17–19 year follow-up period.Methods:Participants completed questionnaire assessments of chronic conditions and functional limitations. Interleukin-6, C-reactive protein, and fibrinogen were assayed in serum. Structural equation models were used to predict increases in and onset of functional limitations associated with baseline multimorbidity status; mediation by inflammation was also determined.Results:Multimorbidity (versus 0–1 conditions) predicted more functional limitations and greater odds of onset of limitations over time. Significant indirect effects showed that inflammation partially mediated the link between multimorbidity and changes in, but not onset of, limitations.Discussion:These results show that inflammation, a nonspecific marker of multiple disease conditions, explains in part the degree to which multimorbidity is disabling.

Comorbid psychopathology and everyday functioning in a brief intervention study to reduce khat use among Somalis living in Kenya: description of baseline multimorbidity, its effects of intervention and its moderation effects on substance use.

Migration and khat use were found to correlate with high rates of psychopathology. In this paper we aimed for assessing baseline multimorbidity and its interactions with a Brief Intervention. In the RCT, 330 male Somali khat users were assigned to treatment conditions (khat use is a predominantly male habit). The ASSIST-linked BI for khat users was administered. Using the TLFB Calendar, the PHQ-9, a Somali short version of the PDS and parts from the CIDI, khat use and comorbidity was assessed. With a regression analysis we tested for the influence of comorbidity and with mixed effect models group differences over time in sleep duration, khat use-time and everyday functioning. We found high rates of baseline multimorbidity: 51% (N = 168) for depression, 22% (N = 74) for PTSD and 23% (N = 73) for khat-psychotic symptoms. Depression and khat-psychotic symptoms, but not PTSD symptoms decreased without group differences. Khat use-time decreased and functional time increased with significant time × group interactions (p ≤ 0.046). Depression and PTSD did not influence therapy success but in participants without comorbid psychopathology, more khat use reduction after the intervention was found (p = 0.024). Somali khat users in Kenya are highly burdened by multimorbidity of depression, PTSD and khat-psychotic symptoms. The main effects for time and differences in healthy vs. mentally ill khat users indicate potential of unspecific support and the specific need for mental health care in combination with substance abuse treatment. The increase of everyday functioning promises more options for alternative activities, preventing excessive use and addiction.

Beyond Return to Work: The Effect of Multimorbidity on Work Functioning Trajectories After Sick Leave due to Common Mental Disorders

Objectives Patients with common mental disorders (CMDs) often suffer from comorbidities, which may limit their functioning at work. We assessed the longitudinal impact of multimorbidity, defined as two or more co-occurring chronic health conditions, on work functioning over time among workers who had returned to work after sick leave due to CMDs. Methods Prospective cohort study of 156 workers followed for 1 year after return to work from sick leave due to CMDs. A multimorbidity score was computed by counting severity-weighted chronic health conditions measured at baseline. Work functioning was measured at baseline and at 3, 6 and 12 months follow-up with the Work Role Functioning Questionnaire. Work functioning trajectories, i.e. the course of work functioning after return to work over time, were identified through latent class growth analysis. Results A total of 44 % of workers had multimorbidity. Four work functioning trajectories were identified: one (12 % of the workers) showed increasing work functioning scores during follow-up, whereas the other trajectories showed low, medium and high scores (23, 41 and 25 %, respectively) that remained stable across time points. Although multimorbidity did not predict membership in any trajectory, within the increasing score trajectory levels of work functioning were lower among those with high baseline multimorbidity score (p < 0.001). Conclusions Over time, multimorbidity negatively impacts work functioning after return to work from sick leave due to CMDs.