Comorbidities In Older People Research Articles

Prevalence and patterns of comorbidities in older people with type 2 diabetes in Australian primary care settings.

The aim of this study was to identify the prevalence and patterns of comorbidity in community-dwelling older people with type 2 diabetes mellitus (T2DM) attending general practice settings in Australia. This study involveda cross-sectional analysis using the Bettering the Evaluation and Care of Health (BEACH) sub-study data. In a series of sub-studies, a representative sample of general practitioners was asked to record all diagnosed chronic conditions for patients at 40 consecutive encounters using structured paper-based recording forms. The dataset was analysed with descriptive analyses, and exploratory factor analyses were applied to examine comorbidity patterns. Of the 14,042 patients aged 65 years or older, 2688 had a diagnosis of T2DM (19%). Of the 2688 patients with T2DM, hypertension was present in 67% (95% CI: 64.6-70.0), followed by arthritis 52% (95% CI: 48.8-54.8), hyperlipidaemia 45% (95% CI: 41.8-47.9), ischemic heart disease, 23% (95% CI: 20.7-24.9), depression 16% (95% CI: 48.8-54.8), atrial fibrillation 10% (95% CI: 8.9-11.6), congestive heart failure 7% (95% CI: 6.0-8.1), stroke/cerebrovascular accident 7% (95% CI: 5.4-8.2) and peripheral vascular disease 5% (95% CI: 4.4-6.2). We identified two comorbidity patterns among older people with T2DM. The first were psychological and musculoskeletal conditions and the second were cardiovascular conditions and chronic renal failure. The prevalence of cardiovascular and non-cardiovascular comorbidities in community-dwelling older people with T2DM was high. Adequate primary care strategies should be in place to support the long-term care for this population.

The assessment of musculoskeletal disorders, quality of life, and comorbidities in older people in Bangladesh.

Musculoskeletal disorders are debilitating conditions that significantly impact the state of health, especially in older people. The study, which employed a cross-sectional design and practical sampling, included 206 participants among them 124 (62.2%) were men and 82 (39.8%) were women, from all over Bangladesh with musculoskeletal issues of varying severity and impact. The mean age of the participants was 64.9 (SD 4.3). The study was carried out between January and June of 2022. The majority of participants experienced musculoskeletal pain. Back pain was the most commonly complained of symptom among the participants (74.9%). It was also common to have limited mobility as a result of arthritic change, which eventually affected daily activities like taking care of oneself. To improve the health of the older adult population, more studies must be conducted to identify the many factors that contribute to musculoskeletal issues. The development of effective prevention and rehabilitation programs must then be based on this knowledge.

Association between sarcopenia-related traits and cardiovascular diseases: a bi-directional Mendelian randomization study.

The two geriatric diseases, sarcopenia and cardiovascular disease (CVD), often coexist, yet the causal relationship is unclear. However, few studies focus on the effect of muscle mass on CVD. This comprehensive study is dedicated to unearthing the potential connection between sarcopenia-related traits and CVD at the genetic level. A two-sample bi-directional Mendelian randomization (MR) study was conducted. In the first stage, we performed MR analysis regarding coronary heart disease (CHD), stroke, and myocardial infarction (MI) as exposure factors to reveal their effect on appendicular lean mass (ALM) and hand grip strength. In the second stage, we reverse the position of exposures and outcomes. The inverse variance weighted (IVW) method was used as the primary approach to reveal the potential causation between the exposure and outcome. The results of the IVW method revealed a negative causal effect of ALM on CHD (OR = 0.848, 95% CI = 0.804 to 0.894, p = 8.200E-10), stroke (OR = 0.931, 95% CI = 0.890 to 0.975, p = 2.220E-03), and MI (OR = 0.810, 95% CI = 0.694 to 0.901, p = 1.266E-13). Additionally, the left-hand grip strength is a significant protective factor for CHD (OR = 0.737, 95% CI = 0.601 to 0.904, p = 3.353E-03) and MI (OR = 0.631, 95% CI = 0.515 to 0.765, p = 2.575E-06), but is not causally linked to the stroke (OR = 0.971, 95% CI =0.829 to 1.139, p = 0.720). Meanwhile, the same conclusion about the effect of right-hand grip strength on CHD (OR = 0.681, 95% CI = 0.558 to 0.832, p = 1.702E-05), MI (OR = 0.634, 95% CI = 0.518 to 0.776, p = 9.069E-06), and stroke (OR = 1.041, 95% CI = 0.896 to 1.209, p = 0.604) was obtained. However, no significant causal effect of CVD (CHD, stroke, MI) on sarcopenia-related traits (ALM, handgrip strength) was found. There is a unidirectional causal relationship between sarcopenia and CVD. The loss of muscle mass and strength has a significant causal role in promoting the occurrence and development of CVD, providing a reference for the prevention and treatment of comorbidities in older people.

Association between postural tremor and risk of disability in community-dwelling older people.

The prevalence of postural tremor increases with age and the tremor has been found to be associated with aging-related physiological decline. However, whether postural tremor in older adults is associated with adverse outcomes such as disability is unclear. This study investigated the association between postural tremor and the risk of disability in activities of daily living (ADL) among community-dwelling older people. Data were derived from a population-based study of Chinese adults aged ≥55 years. Postural tremor was assessed at baseline using a two-step method (i.e., tremor screening followed by examination of positive cases). ADL disability was determined using an 8-item questionnaire, which covered the mobility and self-care domains of ADL. Participants free of ADL disability at baseline were followed for up to 4 years. The prospective analyses included 5868 participants. Participants with postural tremor were at greater risk of incident ADL disability, particularly disability in the mobility domain of ADL. After multivariate adjustment, postural tremor was not significantly associated with incident ADL disability (multivariate-adjusted relative risk [RR]=1.05, 95% confidence interval [CI]=0.77-1.43), and was marginally associated with incident disability in the mobility domain of ADL (multivariate-adjusted RR=1.36, 95% CI=0.98-1.88). The risk of mobility-related ADL disability was significantly increased among men, but not women, with postural tremor (multivariate-adjusted RR=1.84, 95% CI=1.11-3.05). Older age and an increased number of chronic comorbidities mainly explained the higher risk of ADL disability in older people with postural tremor. Postural tremor in older adults is associated with greater incidence of ADL disability, particularly mobility-related ADL disability. The association is largely due to older age and a higher prevalence of chronic comorbidities in older people with postural tremor. Postural tremor is not a strong independent predictor of ADL disability in older people.

185 CURRENT CHALLENGES IN MANAGING MULTIMORBID OLDER PATIENTS WITH ATRIAL FIBRILLATION – A PAN-EUROPEAN PERSPECTIVE

Abstract Background Atrial Fibrillation (AF) is the most common cardiac arrhythmia and associated with a substantial burden to patients and health systems globally and its prevalence is increasing as the population ages. Methods An online survey was distributed as part of a Horizon 2020 project (EHRA-PATHS) with the aim of evaluating how AF multimorbidity is currently addressed by clinicians, to characterize the treatment structure and to assess current interdisciplinary management of multimorbid AF. The survey included 21 questions and free-text option for comments on detection, assessment and management of AF-related comorbidities. Results A total of 451 responses were received with 339 responses eligible for inclusion with the highest response rate from United Kingdom, Spain and Ireland (n=149, 44%). From all responses, 221 were male (66%), 300 (91.5%) were physicians and 196 (57.8%) were working in academic university teaching hospitals. Half of the respondents managed between 20 to 50 patients per month with multimorbid AF. The survey revealed varying rates of specialist services and referral to these services such as diabetes and heart failure across Europe. Academic university teaching hospitals offered greater numbers of specialist services compared to non-teaching hospitals (e.g. anticoagulation clinic 92 (47%) vs 50 (35%), p<0.03). 67% (n=227) of respondents reported that approximately 40% of patients with multimorbid AF need onwards referral to other specialist clinicians. Barriers to referring to specialist services for AF comorbidities were identified and included lack of integrated care model (n=174, 51%), organisational or institutional issues (n=145, 43%) and issues with patient adherence (n=126, 37%). Respondents identified areas where patient outcomes could be improved: better access to patient lifestyle modifications; improved organisation flexibility to enable innovation; greater access to evidence-based guidelines; and better interdisciplinary collaboration. Conclusion The survey demonstrated the need for systematic, integrated management of AF-related comorbidities in older people and the results will inform the next stage of the EHRA-PATHS project.

The comorbidity network in older adults with atrial fibrillation: a Danish nationwide cohort study

Abstract Introduction Individuals affected by atrial fibrillation (AF) often present with multiple comorbidities that challenge their clinical management and worsen the prognosis. Characterizing the network structure of comorbid chronic conditions in AF patients may provide insights to better tailor medical and care management. Purpose To examine and compare the network structure of comorbidities in older people with and without AF. Methods Cross-sectional data derived from the Danish National Patient Register (period 2012–2017) were examined. Patients 60+ years old by 1. January 2017 with AF were selected and matched by age and sex to non-AF controls. Chronic conditions coded according to the International Classification of Diseases, 10th revision were retrieved and grouped into 60 clinically relevant disease categories for old age. Network analysis was applied to construct the disease networks and the centrality index of expected influence was measured to estimate the disease interconnectedness in each network. The difference in network structure and disease centrality between AF and non-AF patients was formally assessed through network comparison tests. Results A total of 96,117 AF patients (72 years old; 45% women) were identified and matched with 96,117 non-AF controls. The most prevalent chronic conditions in AF were hypertension (55.1%), large bowel diseases (36.4%) and ischemic heart disease (36.0%). A significant difference of global network structure was observed between AF and non-AF patients (p<0.001) (Figure1). Chronic obstructive pulmonary disease, depression, inflammatory arthropathy, chronic kidney disease and peripheral neuropathy had a higher connectivity with other diseases in the AF vs. non-AF patients (p<0.001). By contrast, hypertension, heart failure and stroke were more interconnected in the non-AF patients (p<0.001). Among AF patients, network differences were further observed between age categories (60–79 vs 80+ years) in male and female subgroups. Conclusions Older AF patients exhibited a complex network structure of chronic conditions that differed from age- and sex- matched non-AF patients. The network-based identification of highly co-morbid diseases in AF can improve our understanding of AF-related chronic conditions and potentially enhance prioritization and a personalized care for older patients with AF. Funding Acknowledgement Type of funding sources: Public grant(s) – EU funding. Main funding source(s): European Union's Horizon 2020 research and innovation programme

Dietary diversity associated with risk of cardiovascular diseases among community-dwelling older people: A national health examination survey from Thailand.

BackgroundCardiovascular diseases (CVD) are the common comorbidities in older people. Healthy diet is an essential strategy to alleviate the risk of developing CVD. Dietary diversity (DD) is an indicator of diet quality. Currently, limited research exists regarding DD and CVD in older people in developing countries, such as Thailand, despite rapid growth of older population. Therefore, this study aims to determine associations of DD with the risk of CVD and the cardiometabolic risk factors among Thai older people.MethodsThis cross-sectional study used the sub-sample of the fifth Thai National Health Examination Survey conducted from 2013 to 2015. A total of 6,956 older people aged 60 years and older and no pre-existing CVD were included.Dietary diversity score (DDS) was assessed the consumption of eight food groups using food frequency questionnaires. Each food group was scored from 0 to 4. The DDS was calculated as the sum of the scores (0–32). The risk of CVD was calculated by using a Thai cardiovascular (CV) risk score. The cardiometabolic risk factors included hypertension, diabetes mellitus (DM), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglyceride (TG) levels. Data were adjusted for a complex survey design and analysed using linear and logistic regression models.ResultsIn the adjusted model, DDS had a significant negative association with log-Thai CV risk score, with adjusted β (95% CI) values of −0.01 (−0.01, −0.01). Regarding the cardiometabolic risk factors, DDS had a significant negative association with hypertension, DM and log-TG levels, with adjusted OR (95% CI) values of 0.97 (95% CI 0.97, 0.98) for hypertension, 0.94 (0.93, 0.95) for DM, and adjusted β (95% CI) values of −0.002 (−0.004, −0.001) for log-TG level. DDS was positively associated with TC and LDL-C, with adjusted β (95% CI) values of 0.59 (0.38, 0.80) for TC and 0.59 (0.38, 0.79) for LDL-C levels, while DDS was not associated with HDL-C level.ConclusionHigher DD was associated with a lower risk of CVD among Thai older people. The nutritional policies or interventions should encourage a diverse food intake for the prevention of CVD in this population.

Aging with HIV: Increased Risk of HIV Comorbidities in Older Adults.

With improved access to antiretroviral treatment (ART), adults with HIV live longer to reach older age. The number of older adults living with HIV is increasing steadily, giving rise to a new population of interest in HIV research and for invigorated considerations in health service delivery and policy. We analysed the profile of comorbidities in older people (50 years and older) living with HIV in South Africa. We conducted a secondary analysis of all individuals over 15 years who tested HIV positive in the Fifth South African National HIV Prevalence, Incidence, Behaviour and Communication Survey, 2017. We conducted multivariate logistic regression to determine the factors associated with having HIV comorbidity using Stata 15.0 software. We entered 3755 people living with HIV into the analysis, of whom 18.3% (n = 688) were 50 years or older. Older adults had four times greater odds (OR = 4.7 (3.1–7.0)) of having an HIV comorbidity compared to younger adults. Being female (OR = 1.6 (1.1–2.4)) and living in an urban area (OR = 2.6 (1.8–3.7)) increased the odds of HIV comorbidity. Older adults with HIV require comprehensive health care to deal with multimorbidity, to maximise the benefits gained by advances in HIV therapies.

Mediterranean diet, walking outdoors and polypharmacy in older patients with type II diabetes.

Polypharmacy and its adverse health effects is an emerging public health issue, with increasing prevalence among patients with multiple chronic conditions, such as older adults with diabetes. A healthy lifestyle has been shown to improve both diabetes and polypharmacy incidence. We conducted a cross-sectional study to investigate the association of a healthy lifestyle with polypharmacy and comorbidities in older people with diabetes. All out-patients from January 2013 to June 2015 with type II diabetes aged 65 years or more from a Lazio Region reference centre for diabetes were included in the study. Socio-demographic, clinical and lifestyle data were collected from medical records and through face-to-face standardized questionnaires. The comorbidity-polypharmacy score (CPS) was used to characterize the overall patients' frailty, by assessing concurrently the presence of comorbidities and polypharmacy. The cumulative logit model was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Adjusted ORs for age, sex, body mass index, physical activity and cognitive status, showed that CPS score was inversely related to weekly consumption of cruciferous vegetables (OR: 0.56, 95% CI: 0.35-0.90; P-trend = 0.015), leafy green vegetables (OR: 0.54, 95% CI: 0.33-0.87; P-trend = 0.013) and daily intake of fruits (OR: 0.63, 95% CI: 0.41-0.97; P-trend = 0.036). Walking outdoors was found inversely related to CPS score (age- and sex-adjusted OR: 0.60, 95% CI: 0.42-0.86). Our findings suggest that eating some dietary factors present in the Mediterranean diet and walking outdoors regularly is associated with a lower intensity of medicines need to treat comorbidities among older people with diabetes.

Ayurvedic management of COVID-19/SARS-CoV-2 along with chronic diabetes mellitus: A case study

Introduction: SARS-CoV-2, a global pandemic that caused significant morbidity and mortality worldwide, even in the second wave. Multiple factors influence the disease burden including the vicious circulating virus characteristics, complications, limitations of the existing medicine, aggravation of the disease, and comorbidities in older people. In the present scenario, effective traditional treatment modalities should be scientifically applied to reduce massive disasters. Objectives: Here is the necessity to develop an appropriate treatment protocol from the field of Ayurvedic medicine. Diagnosis: It is a case study of a confirmed case of COVID-19/SARS-CoV-2 with uncontrolled diabetic history. Significant Clinical Findings: Presented intermittent fever, cough, headache, and dyspnea, along with symptoms associated with diabetes mellitus. Interventions: The case was successfully managed with Ama pachana (~carminative), Agnideepana (digestive), Jwara hara Oushdha, and simultaneously Prameha (~diabetes mellitus). Outcomes: The entire treatment course competed with a minimum number of hospitals stay compared with the national average. Ayurvedic management has a significant positive impact on the mental and physical quality of life. Both physical and mental scores got improved by more than 50% in this case. Marked radiological improvement noted, in this case, is associated with excellent quality of life after treatment. Conclusion: Ayurvedic management can be used in multiple levels preventive, curative, and restorative aspects.

Effect of telmisartan on blood glucose levels in euglycemic albino rats

Introduction: Diabetes is considered primary risk factor for heart disease and comorbidities in older people and in children. Due to escalating epidemic, diabetes is concerned high profile public health problem. Materials and Methods: Swiss albino rats weighing around 150-200gms of either sex were randomly selected from the central animal facility. Animals were randomly divided into 2 groups, six animals in each group. A group of 3 rats were kept in individual cages. The control was given 0.5 ml 1% Gum acacia, test group was given Telmisartan at the dose of 7.2mg/kg/day. All the drugs were given orally and for the period of 5 days. All rats were fasted overnight before the 5th day. On the 5th day glucose (0.6gm/kg body weight) was given orally using oral feeding tube and oral glucose tolerance test (OGTT) was performed. Blood was collected by tail snipping method and capillary blood glucose was assessed at 0, 60, and 150 minutes using a glucometer. Results: Fall in capillary blood glucose level was seen in Telmisartan group at all-time intervals when compared to control group. Conclusion:Telmisartan when given orally for 5 days showed fall in blood glucose level in swiss albino rats. Keywords: Adipokines, Capillary blood glucose, Diabetes, Euglycemic

Hypertension and Comorbidities in Rural and Urban Chinese Older People: An Epidemiological Subanalysis From the SAGE Study.

There is a lack of studies comparing hypertension and comorbidities in rural and urban older people in China. This study aimed to investigate the prevalence of hypertension and comorbidities in older people and to describe differences between patients from rural and urban areas in China. A cross-sectional study on global AGEing and adult health (SAGE) was conducted from 2007 to 2010 across 8 provinces in China. The current study included a nationally representative subsample of 7,403 respondents aged 60 years and above. Hypertension was either self-reported diagnosed hypertension or 1 elevated measured blood pressure measurement (≥140/90 mm Hg). Comorbidities were self-reported and included angina, arthritis, asthma, stroke, diabetes, depression, and chronic lung disease. The prevalence of hypertension was 66.1%. Hypertension associated with 1 comorbidity was recorded in 35.9% of all participants. A large majority (73.6%) of participants with hypertension reported "good" or "very good" general health status. The prevalence of hypertension and the number of comorbidities increased with age. The prevalence rates of multiple comorbidities were higher for urban participants than their rural counterparts (27.8 vs. 42.4% for 1 morbidity; 7.7 vs. 16.4% for 2 comorbidities; 1.4 vs. 4.7% for 3 comorbidities; 0.4 vs. 1.2% for ≥4 comorbidities) after adjustment for sociodemographic factors. However, urban participants reported better general health status, irrespective of the number of comorbidities. Our study implies that health promotion policies targeting older people should be developed. Rural areas should be a priority, and investment in the quality of health care in rural areas is urgently needed.

Multimorbidity in older people with intellectual disability.

There is paucity of research from Australia about comorbidity in older people with intellectual disability (PwID). This paper examines the burden of chronic diseases and associated sociodemographic correlates in a cohort of PwID aged 60+. A cross-sectional survey was used with community-dwelling older PwID in urban/rural regions of two Australian states. Recruitment was undertaken via a multi-prong approach and each subject (N=391; 236 urban/155 rural) personally interviewed. Findings show older PwID experience considerable multimorbidity (X=3.8; 53.5% had 2-6 conditions). Conditions included arthritis (40%), diabetes (26%), cardiovascular diseases (23.6%), asthma (16.1%), carcinomas (10.0%) and mental health disorders (34.5%). There was significant multimorbidity in older PwID, with evolution of life trajectories of select conditions associated with socioeconomic disadvantage and heath facility access barriers. Greater scrutiny of progressive health debilitation leading into older age and increased engagement by healthcare systems is required earlier in the lives of PwID.

71DEMENTIA INPATIENT STUDY ON THE RECOGNITION AND EVALUATION OF SIGNS SIGNALLING EMOTIONAL DISTRESS - THE DISTRESSED STUDY

Dementia is a common comorbidity in older people admitted to general hospital. People with dementia have a high prevalence of psychological symptoms, pain and delirium, which if left untreated can cause distress and predispose the person to worse outcomes. Identifying individual symptoms or the causes of distress can be difficult because people with more severe dementia often struggle to communicate. Systems are in place to help healthcare professionals recognise and treat individual symptoms, but they require the user to be able to apply and use them appropriately. This thesis describes the development and feasibility testing of a novel screening tool, which aims to improve distress recognition for dementia patients in a hospital setting. Initially, to understand areas of unmet need, a retrospective review of 116 case notes of people with dementia admitted to hospital was undertaken. The results suggested a discrepancy between observed and expected psychological symptoms, delirium, and pain, and that existing systems used to identify and manage them were underutilised. It was hypothesised that encouraging healthcare professionals to identify distress, rather than specific symptoms, may be a simple and sensitive method for improving the recognition of psychological symptoms, pain and delirium downstream. However, how hospital healthcare professionals identify distress in dementia patients was previously undescribed. Existing methods were explored using thematic analysis of 25 semi-structured interviews with healthcare professionals who regularly care for people with dementia. The participants interviewed all believed they could innately identify distress. However, common facilitators and barriers to this process were identified including: how the patient presents, familiarity with the patient, using the person’s usual community carer as a source of information, staff training, ward culture, and competing ward priorities. Following a series of design phases, the themes generated were combined with existing theories on implementing healthcare interventions to develop a novel distress screening tool, for use by healthcare professionals to assess dementia patients in a hospital setting. The Distress Recognition Tool (DRT), was deliberately simple and designed to complement existing hospital physical observation systems. As part of the assessment, community carers for the person with dementia are also asked to contribute to the process when visiting the ward. The DRT was further refined using feedback from focus groups comprising healthcare professionals and community carers of people with dementia. To test the use, usefulness and potential mechanistic impacts of the DRT, the tool was feasibility tested during the routine care of 32 consented patients with dementia admitted to a large teaching hospital. All staff on participating wards received DRT training and consequently the tool was used on average 0.9 times per participant day. Carers contributed to the assessment process on average 0.4 times per patient day. The feedback from healthcare professionals and community carers was positive but highlighted that more complex aspects of the DRT need refinement.

The subversive challenges of multimorbidity.

Epidemiology often reveals important insights by applying simple definitions and measurements to large numbers of people so that they can be studied in groups. A common approach is to define multimorbidity as having two or more conditions. A landmark study that used this approach showed multimorbidity increased with age, with an onset 10–15 years earlier in socioeconomically deprived areas.1 In this Scottish population, although prevalence rose with age, the demographic shape of the population determined that most people with multimorbidity were <65 years of age. Such observations are useful but in clinical practice a definition based on two or more conditions can be of little consequence. The commonest comorbidity in older people is hypertension, so that only one other condition is required to meet the definition of multimorbidity. This case definition offers little new challenge to clinicians or to services. On the other hand, the commonest comorbidity in deprived areas is a mental health problem,1 whose combination with another condition is likely to complicate the care that patients need and receive. More demanding case definitions — such as five or more conditions, the combination of a physical and psychological health problem, or three or more chronic conditions from three or more body systems — have smaller prevalences but steeper social gradients, and present a significantly greater clinical challenge.2,3 Even so, many patients with multiple conditions are not ‘complex’, whereas some patients with single conditions are very ‘complex’. Such distinctions draw on a wider body of knowledge concerning not only the individual but also their circumstances. For example, in the Care Plus Study, involving a randomised controlled trial of increased consultation time with a GP for patients ‘with complex problems’ in very deprived areas, it was impossible to agree on an operational definition of ‘complexity’.4 …

Exercise and comorbidity: the i3-S strategy for developing comorbidity-related adaptations to exercise therapy

Purpose: Exercise therapy is effective in a wide range of chronic diseases. Comorbid disease necessitates adaptations to exercise therapy. Guidance on how to develop such adaptations is currently not available. We present an innovative strategy for the development of comorbidity-related adaptations to exercise therapy in an index disease. Method: We previously developed comorbidity-related adaptations to exercise therapy in osteoarthritis. We now broaden this approach into a general strategy for the development of comorbidity-related adaptations to exercise therapy in an index disease. Results: The i3-S strategy consists of four steps. The first three steps involve creating an inventory of comorbid disease, an inventory of contraindications and restrictions on exercise therapy, and an inventory of potential adaptations to exercise therapy. In the fourth step, this information is synthesized into guidance on comorbidity-related adaptations to exercise therapy in the index disease. The adaptations concern physiological, behavioural and environmental factors. Conclusion: In view of the general effectiveness of exercise therapy and the high prevalence of comorbidity in older people, there is a great need for comorbidity-related adaptations to exercise therapy. We recommend to use and evaluate the i3-S strategy in future research.Implications for RehabilitationExercise therapy is effective in a wide range of chronic diseases.Comorbid disease necessitates adaptations to exercise therapy. Guidance on how to develop such adaptations is currently not available.We present an innovative strategy for the development of comorbidity-related adaptations to exercise therapy in an index disease.Researchers and clinicians can use this strategy to develop guidance on the adaptation of exercise therapy to comorbidity.

Multi-compartment compliance aids (MCAs): Application to the geriatric community

The high prevalence of co-morbidities in older people gives rise to an increasing number of prescribed medicine increasing the complexity of medicine management. Multi-compartment compliance aids and dispensing systems have the potential to organize the daily life of an older person. Various features of currently available compliance aids (such as multi-compartment design or an automated reminder function) have proved successful in assisting older patients to take their medication. This in turn enables them to manage their own often-complex drug regimens. Further investigations and collaborations between healthcare professionals, patients and carers are required for validated and effective use of compliance aids.

Do depressive symptoms on hospital admission impact early functional outcome in elderly patients with hip fracture?

Depression is the most common mood disorder in elderly people and one of the most prevalent comorbidities in older people with hip fracture. While several authors have confirmed that depressive symptoms assessed at a later stage after hip fracture impact functional outcome and mortality, the role of depressive symptoms identified at an earlier stage after hip fracture remains understudied. The aim of the present study was to determine if depressive symptoms assessed on hospital admission impact early functional outcome after hip fracture surgery. We studied 112 patients who underwent surgery for hip fracture during a 6-month period. Depressive symptoms were assessed using the 30-item Geriatric Depression Scale on admission to the acute setting. Multidimensional assessment included sociodemographic characteristics, general health status, cognitive status, functional status prior to injury, and perioperative variables. The primary outcome measure was motor Functional Independence Measure at discharge. Adjusted multivariate regression analysis revealed that the presence of moderate to severe depressive symptoms (Geriatric Depression Scale ≥ 20), older age, and female gender were independently related to motor Functional Independence Measure at discharge. Increasing levels of depressive symptoms in elderly hip fracture patients influence short-term functional outcome. We strongly support the introduction of routine assessment of this baseline comorbidity, especially in female patients. Failure to identify such patients is a missed opportunity for possible improvement of early functional outcome after hip fracture in elderly.

Peptic Ulcer Disease in Older People

ABSTRACTPeptic ulcer disease is a common disorder that affects millions of people worldwide. Peptic ulcer disease has a major impact on quality of life and on the utilisation of the health system when complications occur. Understanding the causative roles of Helicobacter pylori and non‐steroidal anti‐inflammatory drugs has led to changes in management of the disease. Comorbidities in older people add further complexity to treatment. This article summarises the clinical aspects of peptic ulcer disease and outlines principles which enable effective treatment.

Prediction, Progression, and Outcomes of Chronic Kidney Disease in Older Adults

Chronic kidney disease is a large and growing problem among aging populations. Although progression of chronic kidney disease to end-stage renal disease (ESRD) is a costly and important clinical event with substantial morbidity, it appears less frequently in aging people compared with cardiovascular mortality. The measurement of kidney function and management of kidney disease in older individuals remain challenging, partly because the pathophysiologic mechanisms underlying age-related decline in kidney function, the interactions between age and other risk factors in renal progression, and the associations of chronic kidney disease with other comorbidities in older people are understudied and poorly understood. The Association of Specialty Professors, the American Society of Nephrology, the American Geriatrics Society, the National Institute on Aging, and the National Institute of Diabetes and Digestive and Kidney Diseases held a workshop, summarized in this article, to review what is known about chronic kidney disease, identify research gaps and resources available to address them, and identify priority areas for future research. Answers to emerging research questions will support the integration of geriatrics and nephrology and thus improve care for older patients at risk for chronic kidney disease.