High Prevalence Of Multimorbidity Research Articles

Multimorbidity, polypharmacy, and COVID-19 infection within the UK Biobank cohort.

It is now well recognised that the risk of severe COVID-19 increases with some long-term conditions (LTCs). However, prior research primarily focuses on individual LTCs and there is a lack of data on the influence of multimorbidity (≥2 LTCs) on the risk of COVID-19. Given the high prevalence of multimorbidity, more detailed understanding of the associations with multimorbidity and COVID-19 would improve risk stratification and help protect those most vulnerable to severe COVID-19. Here we examine the relationships between multimorbidity, polypharmacy (a proxy of multimorbidity), and COVID-19; and how these differ by sociodemographic, lifestyle, and physiological prognostic factors. We studied data from UK Biobank (428,199 participants; aged 37-73; recruited 2006-2010) on self-reported LTCs, medications, sociodemographic, lifestyle, and physiological measures which were linked to COVID-19 test data. Poisson regression models examined risk of COVID-19 by multimorbidity/polypharmacy and effect modification by COVID-19 prognostic factors (age/sex/ethnicity/socioeconomic status/smoking/physical activity/BMI/systolic blood pressure/renal function). 4,498 (1.05%) participants were tested; 1,324 (0.31%) tested positive for COVID-19. Compared with no LTCs, relative risk (RR) of COVID-19 in those with 1 LTC was no higher (RR 1.12 (CI 0.96-1.30)), whereas those with ≥2 LTCs had 48% higher risk; RR 1.48 (1.28-1.71). Compared with no cardiometabolic LTCs, having 1 and ≥2 cardiometabolic LTCs had a higher risk of COVID-19; RR 1.28 (1.12-1.46) and 1.77 (1.46-2.15), respectively. Polypharmacy was associated with a dose response higher risk of COVID-19. All prognostic factors were associated with a higher risk of COVID-19 infection in multimorbidity; being non-white, most socioeconomically deprived, BMI ≥40 kg/m2, and reduced renal function were associated with the highest risk of COVID-19 infection: RR 2.81 (2.09-3.78); 2.79 (2.00-3.90); 2.66 (1.88-3.76); 2.13 (1.46-3.12), respectively. No multiplicative interaction between multimorbidity and prognostic factors was identified. Important limitations include the low proportion of UK Biobank participants with COVID-19 test data (1.05%) and UK Biobank participants being more affluent, healthier and less ethnically diverse than the general population. Increasing multimorbidity, especially cardiometabolic multimorbidity, and polypharmacy are associated with a higher risk of developing COVID-19. Those with multimorbidity and additional factors, such as non-white ethnicity, are at heightened risk of COVID-19.

The comorbidity conditions and polypharmacy in elderly patients with mental illness in a middle income country: a cross-sectional study⋆

BackgroundMental disorders increase the risk factor for developing physical comorbidity conditions, such as cardiometabolic diseases. There is a high prevalence of multimorbidity and polypharmacy in the elderly population which hampers clinical response. Studies have shown that this positive correlation between the aging process and enhancement of physical comorbidities is especially high among older adults who live in low or middle income countries. ObjectiveTo investigate the association between physical disease comorbidities and polypharmacy in older adults with a clinical diagnosis of Alzheimer’s disease (AD), mild cognitive impairment (MCI) or major depressive disorder (MDD), living in a middle income country. MethodsCross-sectional study of community-dwelling elderly individuals who are cognitively healthy and those with AD, MCI, or MDD. The severity scale of the Charlson Comorbidity Index (CCI) was calculated to classify the severity of comorbidity condition. Logistic regression model (unadjusted and adjusted for age) were used to calculate odds ratios (OR) and 95 % confidence intervals (CI) for cardiometabolic comorbidity (hypertension, diabetes, dyslipidemia and overweight), and polypharmacy. ResultsAlthough there was not an increased risk of hypertension, diabetes, and obesity among the groups, elderly people with mental disorders presented higher odds for polypharmacy condition. Polypharmacy was significantly higher for all groups in comparison with cognitively healthy participants: AD (OR 22.00, 95 % CI 6.11–79.11), MDD (OR 14.73, 95 % CI 3.69–58.75) and MCI (OR 10.31, 95 % CI 2.44–43.59). Elderly patients with AD presented more severe comorbidities and higher risks for dyslipidemia. ConclusionElderly patients with depression, dementia and mild cognitive impairment have considerably higher odds for polypharmacy. People with dementia also have greater comorbidity severity than those who are cognitively healthy. In middle income countries, there is an urgent need to focus on promoting age-appropriate health approaches for the elderly with mental illness to prevent the development of aggravated cardiometabolic conditions and polypharmacy.

The burden of chronic disease, multimorbidity, and polypharmacy in adults with Down syndrome.

Data on clinical characteristics of adults with Down syndrome (DS) are limited and the clinical phenotype of these persons is poorly described. This study aimed to describe the occurrence of chronic diseases and pattern of medication use in a population of adults with DS. Participants were 421 community dwelling adults with DS, aged 18 years or older. Individuals were assessed through a standardized clinical protocol. Multimorbidity was defined as the occurrence of two or more chronic conditions and polypharmacy as the concomitant use of five or more medications. The mean age of study participants was 38.3 ± 12.8 years and 214 (51%) were women. Three hundred and seventy-four participants (88.8%) presented with multimorbidity. The most prevalent condition was visual impairment (72.9%), followed by thyroid disease (50.1%) and hearing impairment (26.8%). Chronic diseases were more prevalent among participants aged >40 years. The mean number of medications used was 2.09 and polypharmacy was observed in 10.5% of the study sample. Psychotropic medications were used by a mean of 0.7 individuals of the total sample. The high prevalence of multimorbidity and the common use of multiple medications contributes to a high level of clinical complexity, which appears to be similar to the degree of complexity of the older non-trisomic population. A comprehensive and holistic approach, commonly adopted in geriatric medicine, may provide the most appropriate care to persons with DS as they grow into adulthood.

Texture-Modified Diet for Improving the Management of Oropharyngeal Dysphagia in Nursing Home Residents: An Expert Review

ObjectivesThis paper provides evidence-based and, when appropriate, expert reviewed recommendations for long-stay residents who are prescribed texture-modified diets (TMDs), with the consideration that these residents are at high risk of worsening oropharyngeal dysphagia (OD), malnutrition, dehydration, aspiration pneumonia, and OD-associated mortality, poorer quality of life and high costs.DesignNestlé Health Science funded an initial virtual meeting attended by all authors, in which the unmet needs and subsequent recommendations for OD management were discussed. The opinions, results, and recommendations detailed in this paper are those of the authors, and are independent of funding sources.SettingOD is common in nursing home (NH) residents, and is defined as the inability to initiate and perform safe swallowing. The long-stay NH resident population has specific characteristics marked by a shorter life expectancy relative to community-dwelling older adults, high prevalence of multimorbidity with a high rate of complications, dementia, frailty, disability, and often polypharmacy. As a result, OD is associated with malnutrition, dehydration, aspiration pneumonia, functional decline, and death. Complications of OD can potentially be prevented with the use of TMDs.ResultsThis report presents expert opinion and evidence-informed recommendations for best practice on the nutritional management of OD. It aims to highlight the practice gaps between the evidence-based management of OD and real-world patterns, including inadequate dietary provision and insufficient staff training. In addition, the unmet need for OD screening and improvements in therapeutic diets are explored and discussed.ConclusionThere is currently limited empirical evidence to guide practice in OD management. Given the complex and heterogeneous population of long-stay NH residents, some ‘best practice’ approaches and interventions require extensive efficacy testing before further changes in policy can be implemented.

PDB63 MULTIMORBIDTY AND FIVE-YEAR TREND IN DIABETES CARE MANAGEMENT (DCM) AMONG ADULTS WITH DIABETES

A high prevalence of multimorbidity (co-occurrence of more than one chronic condition, excluding diabetes) is reported in adults with diabetes. Multimorbidity can negatively affect DCM due to competing demands and prioritization of clinical management. The objective of this study is to examine the associations of multimorbidity to DCM and assess changes in DCM over a five-year period. We used a pooled cross-sectional design with two independent cross-sections (2011 and 2015) of the Medical Expenditure Panel Survey, representative of the noninstitutionalized population in the US. Adults (age > 18 years) with professional diagnosed diabetes and who completed Diabetes Care Survey (DCS) (N= 4,291; N 2011 = 2,116; N 2015 = 2,175) were included. DCS is a self-administered paper-based survey that queried DCM practices in the last 12 months (HbA1c test, blood cholesterol test, feet checked for soreness and irritation, dilated-pupil eye-examination, and flu vaccination). Unadjusted, adjusted, and stratified logistic regressions were used to achieve the study objectives. Adjusted analyses controlled for biological, socio-economic, healthcare access, health status, and behavioral characteristics. All analyses accounted for the complex survey design. 85.1% reported multimorbidity; adults with multimorbidity had poor physical, mental health, had higher rates of chronic pain, obesity, and physical inactivity. Adjusted analyses indicated that adults with multimorbidity were more likely to participate in all DCM recommendations except foot examination (example: HbA1c AOR = 1.68, 95% CI: 1.26, 2.24; Cholesterol level AOR = 1.71, 95% CI: 1.21, 2.41) compared to those without multimorbidity. Trend analysis showed no statistically significant differences in the DCM patterns for those with multimorbidity. Eight in 10 adults with diabetes reported multimorbidity. Those with multimorbidity were more likely to receive recommended DCM services, which can be explained by “the surveillance hypothesis” (i.e. more likely to access health services).

Prevalence of the age-related diseases in older patients with acquired thrombotic thrombocytopenic purpura

BackgroundThe prevalence of older patients with acquired thrombotic thrombocytopenic purpura (TTP) is increasing. There is scarce information on the prevalence of multimorbidity, polypharmacy and age-related diseases in aging TTP patients. This study aimed to evaluate the prevalence of multimorbidity and polypharmacy in a population of acquired TTP patients aged 65 years or more compared with a group of age-matched controls. MethodsAcquired TTP patients enrolled in the Milan TTP registry from December 1st 1999 to March 31th 2018 and aged 65 years or more at the date of last follow-up were evaluated. Controls were Italian healthy individuals recruited from 2006 to March 31th 2018 among friends and non-consanguineous relatives of patients tested for thrombophilia screening at the Angelo Bianchi Bonomi Hemophilia and Thrombosis Center of Milan. Results36 TTP patients and 127 age-matched controls were included. Compared with controls, TTP patients had a higher prevalence of multimorbidity and polypharmacy. They also showed a higher prevalence of autoimmune diseases, osteoporosis and arterial hypertension and were more chronically treated with corticosteroids and antiplatelets for primary cardiovascular prevention. All these results were confirmed after adjusting for sex. Compared with the general elderly population, TTP patients showed a higher prevalence of ischemic heart disease and stroke. ConclusionsOur findings suggest that a careful comprehensive geriatric assessment of acquired TTP patients is necessary. It is important to look for other autoimmune diseases and such age-related comorbidities as osteoporosis, arterial hypertension, ischemic heart disease and cerebrovascular disease.

Effect Modification of Multimorbidity on the Association Between Regularity of General Practitioner Contacts and Potentially Avoidable Hospitalisations.

Scheduled regular contact with the general practitioner (GP) may lower the risk of potentially avoidable hospitalisations (PAHs). Despite the high prevalence of multimorbidity, little is known about its effect on the relationship between regularity of GP contact and PAHs. To investigate potential effect modification of multimorbidity on the relationship between regularity of GP contact and probability of PAHs. A retrospective, cross-sectional study. 229,964 individuals aged 45years and older from the 45 and Up Study in New South Wales, Australia, from 2009 to 2015. The main exposure was regularity of GP contact (capturing dispersion of GP contacts); the outcomes were PAHs evaluated by unplanned hospitalisations, chronic ambulatory care sensitive condition (ACSC) hospitalisations and unplanned chronic ACSC hospitalisations. Multivariable logistic regression models and population attributable fractions (PAF) were conducted to identify effect modification of multimorbidity, assessed by Rx-Risk comorbidity score. Compared with the lowest quintile of regularity, the highest quintile had significantly lower predicted probability of unplanned admission (- 79.9 per 1000 people at risk, 95% confidence interval (CI) - 85.6; - 74.2), chronic ACSC (- 6.07 per 1000 people at risk, 95%CI - 8.07; - 4.08) and unplanned chronic ACSC hospitalisation (- 4.68 per 1000 people at risk, 95%CI - 6.11; - 3.26). Effect modification of multimorbidity was observed. Specifically, the PAF among people with no multimorbidity indicated that 31.7% (95%CI 28.7-34.4%) of unplanned, 36.4% (95%CI 25.1-45.9%) of chronic ACSC and 48.9% (95%CI 32.9-61.1%) of unplanned chronic ACSC hospitalisation would be reduced by a shift to the highest quintile of regularity. However, among people with 10+ morbidities, the proportional reduction was only 5.2% (95%CI 3.8-6.5%), 9.0% (95%CI 0.5-16.8%) and 17.8% (95%CI 5.4-28.5%), respectively. Weakening of the association between regularity and PAHs with increasing levels of multimorbidity suggests a need to improve primary care support to prevent PAHs for patients with multimorbidity.

The impact on health-related quality of life of mixed mental and physical multimorbidity in adults aged 60 years and older: secondary analysis of primary care data.

Given the number of patients with mental conditions who receive treatment within the primary care (PC) context, and the high prevalence of multimorbidity (especially in older people), there is a need to study mental-physical multimorbidity (MPM) in this population and context. This study sought to identify the impact on health-related quality of life (QoL) of MPM in adults aged 60 years and older. Secondary analysis of data derived from 251 primary health individuals. Data were collected via a sociodemographic and clinical questionnaire. Health-related QoL was assessed using the SF-12 instrument. Multiple linear regressions were performed for physical and mental health in MPM patients and in patients with physical-only multimorbidity. Mean age of participants was 70.6 years; 57.8% were female. Quality of life was lower in MPM patients than in those with physical-only multimorbidity. Regarding MPM patients, female sex, 75 years and over, and low income were associated with worse physical health. Female sex was also associated with worse mental health. This study contributes to the global knowledge of MPM in older people, illuminates health-related QoL differences among MPM and physical-only multimorbidity patients, and highlights the importance of non-modifiable characteristics associated with deterioration of health-related QoL. Team collaboration between primary care physicians, psychiatrists (and other mental health providers), and social workers may be necessary to assess psychiatric and physical symptoms and provide for the care needs of older people with MPM.

Multimorbidity by Patient and Tumor Factors and Time-to-Surgery Among Colorectal Cancer Patients in Spain: A Population-Based Study.

BackgroundCancer treatment and outcomes can be influenced by tumor characteristics, patient overall health status, and comorbidities. While previous studies have analyzed the influence of comorbidity on cancer outcomes, limited information is available regarding factors associated with the increased prevalence of comorbidities and multimorbidity among patients with colorectal cancer in Spain.Patients and MethodsThis cross-sectional study obtained data from all colorectal cancer cases diagnosed in two Spanish provinces in 2011 from two population-based cancer registries and electronic health records. We calculated the prevalence of comorbidities according to patient and tumor factors, identified factors associated with an increased prevalence of comorbidity and multimorbidity, analyzed the association between comorbidities and time-to-surgery, and developed an interactive web application (https://comcor.netlify.com/).ResultsThe most common comorbidities were diabetes (23.6%), chronic obstructive pulmonary disease (17.2%), and congestive heart failure (14.5%). Among all comorbidities, 52% of patients were diagnosed at more advanced stages (stage III/IV). Patients with advanced age, restricted performance status or who were disabled, obese, and smokers had a higher prevalence of multimorbidity. Patients with multimorbidity had a longer time-to-surgery than those without comorbidity (17 days, 95% confidence interval: 3–29 days).ConclusionWe identified a consistent pattern of factors associated with a higher prevalence of comorbidities and multimorbidity at diagnosis and an increased time-to-surgery among patients with colorectal cancer with multimorbidity in Spain. This pattern may provide insights for further etiological and preventive research and help to identify patients at a higher risk for poorer cancer outcomes and suboptimal treatment.

Multimorbidity Development in Working People.

Multimorbidity is defined as the coexistence of multiple chronic conditions in one person. It affects the way people lead their lives and might be a heavy burden, especially for those with limited material resources. This study explores the prevalence of multimorbidity in the working population and discusses the distribution of multimorbidity in specific sub-groups. We conducted a longitudinal analysis of nationally representative data in South Korea (Korea Health Panel, 2010–2015). Generalized estimation models were applied to examine the individual effect of socioeconomic status (SES) and job-related variables. We found that about five percent of workers who initially had no or one chronic condition developed multimorbidity during within five years. About 20% of working women had multimorbidity at age 55, about 10 years earlier than working men. A higher prevalence appeared in working women with school-age children, non-standard employment, no autonomy at work, or unskilled occupation. SES was significantly associated with a higher prevalence of multimorbidity in both gender after controlling for the effect of age and other covariates. Multimorbidity is a major health concern in the working population and prevention and control should be promoted in the workplace.

RURALITY, ALCOHOL, AND OPIOID USE AS PRECURSOR TO ELDER ABUSE

Pain, alcohol, and opioid risk management is an increasingly important issue in the care of the older adult population. Older adults are at higher risk for pain and the negative outcomes associated with opioid and alcohol use due to higher prevalence of multimorbidity, polypharmacy, and the age-associated changes in metabolism and elimination. Evidence-based approaches for pain and substance use management exist and are effective for older adults, but underutilized and have limited availability in rural areas. Therein, undermanagement of pain and substance use becomes a risk factor for elder abuse. Improved dissemination and implementation in practice, as well as training for health professionals and the community is needed to better realize and prevent negative health outcomes from pain, alcohol, and opioid use. Community education and training tools for health professionals will be discussed, with suggestions for community initiatives to address pain, alcohol, and opioid risk management to prevent elder abuse.

Acculturation is associated with older Turkish immigrants\u2019 self-management abilities

BackgroundThe few previous studies investigating acculturation and self-management have suggested that increased participation in (or adaptation to) the host culture is associated with better health and disease management. However, research on the relationship between acculturation strategies (attachment to the Dutch and Turkish cultures) and broader self-management abilities among older Turkish immigrants in the Netherlands is lacking. This study aimed to investigate this relationship in this population.MethodsTurkish immigrants aged > 65 years and residing in Rotterdam, the Netherlands (n = 2350), were identified using the municipal register. In total, 680 respondents completed the questionnaire (32% response rate).ResultsThe average age of the respondents was 72.90 (standard deviation, 5.02; range, 66–95) years and 47.6% of respondents were women. The majority (80.3%) of respondents reported having low educational levels. Women, single individuals, less-educated respondents, and those with multimorbidity experienced lower levels of attachment to the Dutch culture and reported poorer self-management abilities. Slightly stronger relationships were found between self-management and attachment to the Dutch culture than attachment to the Turkish culture. Multimorbidity negatively affected the self-management abilities of older Turkish people living in the Netherlands.ConclusionsThe study findings indicate that especially attachment to the Dutch culture matters for the self-management abilities of older Turkish immigrants in the Netherlands. Given the high prevalence of multimorbidity in this population, investment in their self-management abilities is expected to be beneficial. Special attention is needed for women, single individuals, less-educated people, and those with multimorbidity. Interventions aiming to better integrate these groups into Dutch society are also expected to be beneficial for their self-management abilities.

Multimorbity in elderly municipal of northeast Brazil: prevalence and associated factors

To estimate the prevalence and the factors associated with the presence of multimorbidity in the elderly population of the municipality of Ibicuí - BA. This study was carried out with 310 elderly individuals, aged > 60 years old, of both sexes, living in the municipality of Ibicuí - BA. Sociodemographic information and personal information, living conditions, life habits, body mass, stature and presence of multimorbidity were collected. The descriptive analysis was used and multimorbidity prevalence ratios were estimated according to variables of interest. As a measure of statistical significance, the qui-quadrado de Pearson test was used, adopting p≤0.05. The multivariate analysis hierarchized by Poisson regression was employed after bivariate analysis to select the independent variables (p<0.20). The general prevalence of multimorbidity was 80.3%. The hierarchical multi-varied analysis showed the variables of gender and monthly income (p<1.5) were significantly related to the problem. The results reveal also a high prevalence of multimorbidity in the studied population. Mainly women and the poorest suffer from it. It is necessary to redirect the planning of health actions in the municipality, with changes in the health care policy of the elderly, and especially in the social support networks that support these individuals, considering that in this locality the presence of multimorbidity was related to socio-economic grounds.

Heart Failure Guidelines are Evidence-Based, but are They Patient-Centered?

Introduction To apply evidence-based medicine (EBM) to individual patients and implement shared decision-making, it is necessary for clinical practice guidelines (CPGs) to incorporate performance metrics for diagnostic studies and therapeutic interventions, as well as relevant patient contexts. This is especially important in heart failure (HF), which is a highly heterogeneous population with a high prevalence of multimorbidity, and impairments in other domains (e.g. function and cognition) that can significantly impact the value of diagnostic studies and therapeutic interventions. We sought to determine the extent to which performance metrics and patient context are incorporated into major HF CPGs. Methods We reviewed the main and supplementary documents of 2013 American College of Cardiology Foundation/American Heart Association (ACCF/AHA) CPG, 2017 ACCF/AHA/HFSA update, and 2016 European Society of Cardiology (ESC) CPG. We assessed the following domains from each recommendation: performance metrics including sensitivity/specificity, positive/negative predictive value, number needed to treat, absolute benefit/harm, and time horizon to benefit; and patient context, including comorbidity, socio-personal milieu, personal preferences, and life expectancy. Results We examined 169 recommendations from the 2013 ACCF/AHA CPG and 2017 update, and 187 recommendations from the 2016 ESC CPG. Performance metrics for diagnostic studies were rarely included; metrics for therapeutic interventions were included to a varying degree depending on the CPG (Figure). Sensitivity/specificity, time horizon to benefit, and absolute benefits were mentioned in 7%, 13%, and 30% of all recommendations, respectively. Patient context was included in over 60% of ACCF/AHA/HFSA CPG recommendations but only included in 25% of the ESC CPG recommendations (Figure). Conclusion The majority of recommendations from HF CPGs lack granular information on diagnostic and therapeutic performance metrics. Contextual patient factors are also inconsistently included. These findings indicate that while HF CPGs may be evidence-based, they are not yet patient-centered. Given their importance to effectively implement EBM and shared decision-making among the complex and heterogeneous HF population, future CPGs should explicitly incorporate these aspects.

Patterns of multimorbidity in internal medicine patients in Swiss university hospitals: a multicentre cohort study.

Despite the high prevalence of multimorbidity, we lack detailed descriptive data on the most prevalent combinations of chronic comorbidities in Switzerland. We aimed to describe and quantify the most prevalent combinations of comorbidities in internal medicine multimorbid inpatients. We conducted a multicentre retrospective cohort study including all consecutive adults (n = 42,739) discharged from the general internal medicine department of three Swiss tertiary teaching hospitals in 2010&ndash;2011. We used the Chronic Condition Indicator and the Clinical Classification Software to classify International Classification of Diseases diagnosis codes into chronic or acute diseases, into body system categories and into categories of chronic comorbidities. We defined multimorbidity as &ge;2 chronic diseases. We described the most prevalent combinations of comorbidities and their prevalence. Seventy-nine percent (n = 33,871) of the patients were multimorbid, with a median of four chronic diseases. Chronic heart disease, chronic kidney disease, solid malignancy and substance-related disorders were the most prevalent comorbidities, with a prevalence of more than 10% for each. All these comorbidities were frequently found in combination with chronic obstructive pulmonary disease and bronchiectasis, pulmonary heart disease, and peripheral and visceral atherosclerosis. Chronic heart disease was identified in 80% of the most prevalent combinations. Half of the combinations occurred more often than it would have been expected if they were independent. The vast majority of patients fulfilled the criteria for multimorbidity. Chronic heart disease, chronic kidney disease, solid malignancy and substance-related disorders were each present in at least one tenth of the patients. This in-depth description of the most frequent comorbidities and of their frequent associations in a multicentre population may advise healthcare providers to improve preventive care and develop appropriate guidelines for multimorbid patients. &nbsp.

Efficacy of a blended low-intensity internet-delivered psychological programme in patients with multimorbidity in primary care: study protocol for\xa0a randomized controlled trial

BackgroundThe World Health Organization (WHO) has included comorbidity between depression and a chronic disease among the 10 leading global health priorities. Although there is a high prevalence of multimorbidity, health care systems are mainly designed for the management of individual diseases. Given the difficulty in delivering face-to-face psychological treatments, alternative models of treatment delivery have been proposed, emphasizing the role of technologies such as the Internet. The aim of this study is to assess the efficacy in Primary Care (PC) of a blended low-intensity psychological intervention applied using information and communication technologies (ICTs) for the treatment of multimorbidity in PC (depression and type 2 diabetes/low back pain) by means of a randomized controlled trial (RCT). Our main hypothesis is that improved usual care combined with psychological therapy applied using ICTs will be more efficacious for improvement in the symptomatology of multimorbidity, compared to a group with only improved treatment as usual six months after the end of treatment.MethodsA protocol has been designed combining a face-to-face intervention with a supporting online programme that will be tested by an RCT conducted in three different regions (Andalusia, Aragon and the Balearic Islands). The RCT will evaluate three hundred participants diagnosed with depression and type 2 diabetes/low back pain. Four highly experienced research groups specializing in clinical psychology are involved in this trial, and there will be ample possibilities for translation and transfer to usual clinical practice.DiscussionThis clinical trial will lead to improvement in financial sustainability, maximizing the use of resources and responding to principles of efficiency and effectiveness. Furthermore, based on the evaluation of the feasibility of implementing this intervention in primary care facilities, we expect to be able to suggest the intervention for incorporation into public policy. In conclusion, positive results of this study could have a significant impact on one of the most important health-related problems, multimorbidity.Trial registrationClinicalTrials.gov, NCT03426709. Registered retrospectively on 08 February 2018.

Challenges of Ageing in Portugal: Data from the EpiDoC Cohort.

Portuguese adults have a long lifespan, but it is unclear whether they live a healthy life in their final years. We aimedto determine the prevalence of multimorbidity and characterize lifestyle and other health outcomes among older Portuguese adults. We performed a cross-sectional evaluation of 2393 adults, aged 65 and older, during the second wave offollow-up of the EpiDoC cohort, a population-based study involving long-term follow-up of a representative sample of the Portuguesepopulation. Subjects completed a structured questionnaire during a telephone interview. Socioeconomic, demographic, lifestylebehaviours, chronic diseases, and health resources consumption were assessed. Cluster analysis was done to identify dietary patterns.Descriptive and analytic analysis was performed to estimate multimorbidity prevalence and its associated factors. Multimorbidity prevalence among older adults was 78.3%, increased with age strata (72.8% for 65 - 69 years to 83.4% for ≥80 years), and was highest in Azores (84.9%) and Alentejo (83.6%). The most common chronic diseases were hypertension (57.3%),rheumatic disease (51.9%), hypercholesterolemia (49.4%), and diabetes (22.7%). Depression symptoms were frequent (11.8%) andhighest in the oldest strata. The mean health-related quality of life (EQ-5D-3L) score was 0.59 ± 0.38. Hospitalization in the previous12 months was reported by 25.8% of individuals. Overall, 66.6% of older adults were physically inactive. 'Fruit and vegetables dietarypattern' was followed by 85.4% of individuals; however, regional inequalities were found (69% in Azores). Obesity prevalence was22.3% overall and was highest among Azoreans (33%). The high prevalence of multimorbidity, combined with unhealthy lifestyle behaviours, suggests that the elderly populationconstitutes a vulnerable group warranting dedicated intervention.

Measuring the association between marginalization and multimorbidity in Ontario, Canada: A cross-sectional study.

There is growing evidence to suggest that multimorbidity is not only a consequence of aging but also other environmental risk factors such as socio-economic status and social marginalization. In this study, the prevalence of multimorbidity was examined (defined as the simultaneous occurrence of two or more chronic morbidities) by age, gender and the Ontario Marginalization index (material deprivation, residential instability, dependency and ethnic concentration). With a cross-sectional design, 2015 data on 18 morbidities from 12,516,587 residents of the province of Ontario, Canada, were analysed. About 82.1% of the population had one or no chronic conditions, 10.3% were multimorbid with two chronic conditions and 7.6% had three or more chronic conditions. The results showed that the prevalence of multimorbidity is noticeably higher in the most deprived areas compared to least deprived for all age groups. Our findings challenge the notion that multimorbidity is primarily driven by aging. Of the 18% of the total population which were multimorbid, 43% of them were under the age of 65. We noted a substantial excess of multimorbidity in younger and middle-aged adults who were most deprived. In some cases, those in the most deprived areas were showing increased cases of multimorbidity nearly 10 years sooner than those who were least deprived. This study shows that environmental factors such as material deprivation and residential instability are correlated with higher prevalence of multimorbidity.

High prevalence of multimorbidity in overweight and obese women with Polycystic Ovary Syndrome (PCOS)

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Mapping the global research landscape and knowledge gaps on multimorbidity: a bibliometric study

BackgroundTo summarize global research trends and activities on multimorbidity; then to assess the knowledge gaps and to identify implications for knowledge exchange between high income countries (HICs) and low– and middle– income countries (LMICs).MethodsA comprehensive search was conducted to identify research publications on multimorbidity in the Web of ScienceTM, as well as diabetes, depression, hypertension, and Chronic Obstructive Pulmonary Disease (COPD). The time frame for the search was from 1900 to June, 2016. Information (such as publication date, subject category, author, country of origin, title, abstract, and keywords) were extracted and the full texts were obtained for the co–citation analysis. Data were linked with the life expectancy at birth (years) and Gross National Income (GNI). Co–citation and hierarchal clustering analysis was used to map the trends and research networks with CiteSpace II (JAVA freeware, copyright Chaomei Chen, http://cluster.cis.drexel.edu/~cchen/citespace/).FindingsWe identified 2864 relevant publications as at June 2016, with the first paper on this topic indexed in 1974 from Germany, but 80% were published after 2010. Further analysis yielded two knowledge gaps: (1) compared with single conditions (diabetes, hypertension, depression, and COPD), there is a mismatch between the high prevalence of multimorbidity and its research outputs (ratio of articles on multimorbidity vs other four single conditions is 1:13–150); (2) although a total of 76 countries have contributed to this research area, only 5% of research originated from LMICs where 73% of non–communicable disease (NCD) related deaths had occurred. Additional analysis showed the median year of first publication occurred 15 years later in the LMICs compared with HICs (2010 vs 1995); and longer life expectancy was associated with exponentially higher publication outputs (Pearson correlation coefficient r = 0.95) at the global level. The life expectancy at the median year (1994) of first publication was 66.1, with the gap between LMICs and HICs 7.9 (68.4 vs 76.3).ConclusionsThis study confirms substantial knowledge gaps in the research agenda on multimorbidity, with input urgently needed to move us forward worldwide, especially for and in LMICs. There is the possibility that LMICs can learn from and collaborate with HICs in this area.