Impact Of Multiple Chronic Conditions Research Articles

A longitudinal qualitative study on physician experience in managing multimorbidity across the COVID-19 pandemic in Odisha, India

While many studies have documented adverse impact of multiple chronic conditions or multimorbidity on COVID-19 outcomes in patients, there is scarcity of report on how physicians managed these patients. We investigated the experiences and challenges of clinicians in managing patients with multimorbidity throughout the COVID-19 pandemic in Odisha state, India. To understand the factors influencing illness management and the adaptive responses of physicians alongside the evolving pandemic, we followed a longitudinal qualitative study design. Twenty-three physicians comprising general practitioners, specialists, and intensivists, were telephonically interviewed in-depth. Saldana’s longitudinal qualitative data analysis method was employed for data analysis. COVID-19 pandemic initially diverted the attention of health systems, resulting in reduced care. With time, the physicians overcame fear, anxiety, and feelings of vulnerability to COVID-19 and started prioritising patients with multimorbidity for treatment and vaccination. All physicians recommended teleconsultation and digital health records to benefit chronic illness care during future public health crises. The findings underscore the transformative potential of physician resilience and adaptation during the COVID-19 pandemic, emphasizing the importance of prioritizing patients with multimorbidity, incorporating teleconsultation, and implementing digital health records in healthcare systems to enhance chronic illness care and preparedness for future public health crises.

Characterizing the impact of multiple chronic conditions on return to participation in chronic stroke survivors

ABSTRACT Background Each year, 795,000 Americans experience a stroke. As stroke mortality declines, more individuals are in the chronic phase of recovery (>6 months post-stroke). Over 80% of stroke survivors have multiple, chronic health conditions (MCC). While the relationship between MCC and mortality and function during acute recovery has been explored, less is known about how MCC burden affects participation in chronic stroke survivors. Objective This study investigated whether MCC burden is related to participation in those with chronic stroke. Methods Two hundred and sixty-six participants with chronic (≥6 months) stroke were included in this cross-sectional and retrospective analysis. Participants had a mean age of 62.2 ± 12.8 years, and time since stroke (TSS) of 36.0 ± 44.6 months (114F/152 M). Participants completed the 6-minute Walk Test (6MWT), Activities-Specific Balance Confidence Scale (ABC), Modified Cumulative Illness Rating Scale (MCIR) to quantify the presence and severity of chronic illness across 14 body systems, and the Stroke Impact Scale – Participation subscale (SIS-P). Participation (SIS-P) was the dependent variable. Independent variables were entered into a sequential regression model in three blocks: demographic variables, physical capacity (6MWT distance) and balance self-efficacy (ABC), and MCC burden (MCIR). Results After adjusting for age, sex, and time since stroke, physical capacity and balance self-efficacy explained 31.4% (p < 0.001), and the MCC burden explained 2.0% (p = 0.004). Higher participation was related to lower MCC burden. Conclusions MCC burden is a significant contributor to variance in participation in chronic stroke survivors, above and beyond demographics, physical capacity, and self-efficacy, and therefore should be considered when creating rehabilitation programs to improve participation.

The Importance of Studying Health Behavior in Older Adults

Behavior change is an inherent aspect of routine geriatric care. However, most research and clinical programs emphasis how to initiate behavior change with less emphasis placed on skills and strategies to maintain behaviors over time, including after an intervention has concluded. This presentation will provide an introduction to the symposium, including a review of prior work and our rationale for studying the critical yet overlooked construct of maintenance in older adults. Several key considerations in our work include the impact of multiple chronic conditions, declines in cognitive and functional capacity over time, changes in environmental context and/or social support, and sustainability of community and population-level programs and services.

Trends in Risk of Limitations in Instrumental Activities of Daily Living Over Age in Older Persons With and Without Multiple Chronic Conditions.

BackgroundTo investigate trends over age by comorbidity status for the risk of limitations in individual activities of daily living for community-living older persons.MethodsA longitudinal population-based study was conducted in 9,319 community-living Dutch persons aged 60 years and older. Self-reported multiple chronic conditions (MCC) and nine instrumental activities of daily livings (IADLs) were assessed in 15 studies of the Dutch National Care for the Elderly Program (TOPICS-MDS). Risks of limitations in IADLs, odds ratios (per 5 years), and rate ratios (per 5 years) were calculated with mixed logistic and negative binomial regression models with age as the underlying timescale, stratified by number of MCC (no, 1–2, ≥ 3 MCC), and corrected for confounders.ResultsAt inclusion, the number of IADL limitations was highest for the “≥3 MCC” group (2.00 interquartile range [1.00–4.00]) and equal for “no MCC” or “1–2 MCC” (1.00 interquartile range [0.00–2.00]). Trends of individual IADLs depicted a higher risk in IADL limitation with increasing age over 2 years of follow-up, except for handling finances for the “no MCC” group. The longitudinal age effect on IADL limitations varied subject to MCC, being strongest for the “no MCC” group for most IADLs; grooming and telephone use were almost unaltered by age and MCC.ConclusionWe observed a decline in IADL functioning with increasing age over 2 years of follow-up in persons with and without MCC. The impact of MCC on IADL decline varied per IADL activity.

Magnitude and impact of multiple chronic conditions with advancing age in older adults hospitalized with acute myocardial infarction

BackgroundTo examine age-specific differences in the frequency and impact of cardiac and non-cardiac conditions among patients aged 65 years and older hospitalized with acute myocardial infarction (AMI). MethodsStudy population consisted of 3863 adults hospitalized with AMI at 11 medical centers in central Massachusetts on a biennial basis between 2001 and 2011. The presence of 11 chronic conditions (five cardiac and six non-cardiac) was based on the review of hospital medical records. ResultsParticipants' median age was 79 years, 49% were men, and had an average of three chronic conditions (average of cardiac conditions: 2.6 and average of non-cardiac conditions: 1.0). Approximately one in every two patients presented with two or more cardiac related conditions whereas one in every three patients presented with two or more non-cardiac related conditions. The most prevalent chronic conditions in our study population were hypertension, diabetes, heart failure, chronic kidney disease, and peripheral vascular disease. Patients across all age groups with a greater number of previously diagnosed cardiac or non-cardiac conditions were at higher risk for developing important clinical complications or dying during hospitalization as compared to those with 0–1 condition. ConclusionsThe prevalence of multimorbidity among older adults hospitalized with AMI is high and associated with worse outcomes that should be considered in the management of this vulnerable population.

Impact of Multiple Chronic Conditions on Activity Limitations Among Older Mexican-American Care Recipients.

IntroductionOlder Mexican Americans are living longer with multiple chronic conditions (MCCs). This has placed greater demands on caregivers to assist with basic activities of daily living (ADL) or instrumental activities of daily living (IADL). To understand the needs of older Mexican-American care recipients, we examined the impact of MCC on ADL and IADL limitations.MethodsWe analyzed data from 485 Mexican American care-receiving/caregiving dyads. Selected MCCs in the analysis were diabetes, hypertension, stroke, heart disease, arthritis, emphysema/chronic obstructive pulmonary disease, cognitive impairment, depression, and cancer. Care recipients were dichotomized as having 3 or more conditions or as having 2 or fewer conditions. Three comorbidity clusters were established on the basis of the most prevalent health conditions among participants with comorbid arthritis and hypertension. These clusters included arthritis and hypertension plus: diabetes (cluster 1), cognitive impairment (cluster 2), and heart disease (cluster 3).ResultsCare recipients with 3 or more chronic conditions (n = 314) had higher odds of having mobility limitations (OR = 1.98; 95% CI, 1.34–2.94), self-care limitations (OR = 2.53; 95% CI, 1.70–3.81), >3 ADL limitations (OR = 2.00; 95% CI, 1.28–3.17), and >3 IADL limitations (OR = 1.88; 95% CI, 1.26–2.81). All clusters had increased odds of ADL and severe ADL limitations. Of care recipients in cluster 2, those with arthritis, hypertension, and cognitive impairment had significantly higher odds of mobility limitations (OR = 2.33; 95% CI, 1.05–5.24) than those with just arthritis and hypertension.ConclusionMCCs were associated with more ADL and IADL limitations among care recipients, especially for those with hypertension and arthritis plus diabetes, cognitive impairment, or heart disease. These findings can assist in developing programs to meet the needs of older Mexican-American care recipients.

Impact of Multiple Chronic Conditions in Patients Hospitalized with Stroke and Transient Ischemic Attack

The prevalence and clinical impact of chronic conditions (CCs) have increasingly been recognized as an important public health concern. We evaluated the prevalence of coexisting CCs and their association with 30-day mortality and readmission in hospitalized patients with stroke and transient ischemic attack (TIA). In a retrospective study of patients aged ≥18 years hospitalized for first-ever stroke and TIA, we assessed the prevalence of coexisting CCs and their predictive value for subsequent 30-day mortality and readmission. Study cohort comprised 6771 patients, hospitalized for stroke (n = 4068) and TIA (n = 2703), 51.4% men, with mean age of 68.2 years (standard deviation: ±15.6), mean number of CCs of 2.9 (±1.7), 30-day mortality rate of 8.6% (entire cohort), and 30-day readmission rate of 9.7% (in 2498 patients limited to Olmsted and surrounding counties). In multivariable models, significant predictors of (1) 30-day mortality were coexisting heart failure (HF) (odds ratio [OR]: 1.45, 95% confidence interval [CI]: 1.09-1.92), cardiac arrhythmia (OR: 1.74, 95% CI: 1.40-2.17), coronary artery disease (CAD) (OR: 1.64, 95% CI: 1.29-2.08), cancer (OR: 1.67, 95% CI: 1.31-2.14), and diabetes (HR: 1.28, 95% CI: 1.01-1.62); and (2) 30-day readmission (n = 2498) were CAD (OR: 1.50, 95% CI: 1.09-2.07), cancer (OR: 1.46, 95% CI: 1.01-2.10), and arthritis (OR: 1.62, 95% CI: 1.09-2.40). In patients hospitalized with stroke and TIA, CCs are highly prevalent and influence 30-day mortality and readmission. Optimal therapeutic and lifestyle interventions for CAD, HF, cardiac arrhythmia, cancer, diabetes, and arthritis may improve early clinical outcome.

How multiple chronic conditions increase the risk of ACSC hospitalizations

Introduction : The high financial burden of avoidable hospitalizations has led to an increase of the study of hospitalizations for ambulatory care sensitive conditions (ACSC). Although patients’ social and demographic characteristics are frequently identified in the literature as factors that increase the risk of an avoidable hospitalization, there is little information on the impact of multiple chronic conditions on these hospitalizations. Our study looks for the relationship between multiple chronic conditions and ACSC hospitalizations. Theory/Methods : Data consists of all hospitalizations in the portuguese health system between 2008 and 2012. Avoidable hospitalizations were identified according to the Canadian Institute for Healthcare Information and chronic conditions were identified according to criteria set by the Agency for Healthcare Research and Quality. A retrospective study analyzing all patients hospitalized for an ACSC and all patients hospitalized for non-ACSC was made, using different multiple logistic regression models to identify the impact of chronic conditions in the risk of admission. Results : We found that the population with ACSC hospitalizations when compared to the population with non-ACSC hospitalizations has in average more chronic conditions (3.93 to 1.98, p=0.008) and chronic conditions in more body systems (2.50 to 1.49, p=0.00419). We observed that the probability of an ACSC hospitalization increases 1.35 times (p Conclusion : The number of chronic conditions and the type of body systems affected increases the risk of admission for ACSC. Further investigation needs to follow in order to develop risk models that help both identify these patients in higher risk of an avoidable hospitalization and promote a more assertive use of ACSC as measure of access to care.

Standardizing disease-specific quality of life measures across multiple chronic conditions: development and initial evaluation of the QOL Disease Impact Scale (QDIS®).

BackgroundTo document the development and evaluation of the Quality of life Disease Impact Scale (QDIS®), a measure that standardizes item content and scoring across chronic conditions and provides a summary, norm-based QOL impact score for each disease.MethodsA bank of 49 disease impact items was constructed from previously-used descriptions of health impact to represent ten frequently-measured quality of life (QOL) content areas and operational definitions successfully utilized in generic QOL surveys. In contrast to health in general, all items were administered with attribution to a specific disease (osteoarthritis, rheumatoid arthritis, angina, myocardial infarction, congestive heart failure, chronic kidney disease (CKD), diabetes, asthma, or COPD). Responses from 5418 adults were analyzed as five disease groups: arthritis, cardiovascular, CKD, diabetes, and respiratory. Unidimensionality, item parameter and scale-level invariance, reliability, validity and responsiveness to change during 9-month follow-up were evaluated by disease group and for all groups combined using multi-group confirmatory factor analysis (MGCFA), item response theory (IRT) and analysis of variance methods. QDIS was normed in an independent chronically ill US population sample (N = 4120).ResultsMGCFA confirmed a 1-factor model, justifying a summary score estimated using equal parameters for each item across disease groups. In support of standardized IRT-based scoring, correlations were very high between disease-specific and standardized IRT item slopes (r = 0.88–0.96), thresholds (r = 0.93–0.99) and person-level scores (r ≥ 0.99). Internal consistency, test-retest and person-level IRT reliability were consistently satisfactory across groups. In support of interpreting QDIS as a disease-specific measure, in comparison with generic measures, QDIS consistently discriminated markedly better across disease severity levels, correlated higher with other disease-specific measures in cross-sectional tests, and was more responsive in comparisons of groups with better, same or worse evaluations of disease-specific outcomes at the 9-month follow-up.ConclusionsStandardization of content and scoring across diseases was shown to be justified psychometrically and enabled the first summary measure of disease-specific QOL impact normed in the chronically ill population. This disease-specific approach substantially improves discriminant validity and responsiveness over generic measures and provides a basis for better understanding the relative QOL impact of multiple chronic conditions in research and clinical practice.Electronic supplementary materialThe online version of this article (doi:10.1186/s12955-016-0483-x) contains supplementary material, which is available to authorized users.

Patterns of multimorbidity in an older population of persons with an intellectual disability: Results from the intellectual disability supplement to the Irish longitudinal study on aging (IDS-TILDA)

Multimorbidity (2 or more chronic conditions) is being widely studied in older populations and this study explores both the relevance of emerging conceptualizations and the extent to which multimorbidity is a feature of aging in persons with an intellectual disability. Data was generated from wave one of the intellectual disability supplement to the Irish longitudinal study on aging (IDS-TILDA) which included 753 persons with an ID aged 40 years and over. Information on the presence of 12 chronic conditions was collected using a standardized protocol administered in face to face interviews with persons with ID and/or their caregivers. Prevalence of multimorbidity was established and patterns were examined using logistic regression models. The patterns of multimorbidity for people with ID that emerged were then compared with those reported for other older adults. Multimorbidity was established for 71% of the IDS-TILDA sample with women at highest risk and rates of multimorbidity was high (63%) even among those aged 40-49 years. Eye disease and mental health problems were most often associated with a second condition and the most prevalent multimorbidity pattern was mental health/neurological disease. Further investigation, attention to mental health issues and the development of treatment guidelines that recognize chronic condition disease load are critical to mitigating the negative impact of multiple chronic conditions and preventing additional disability in adults with ID as they age.

Health-related quality of life associated with chronic conditions in eight countries: Results from the International Quality of Life Assessment (IQOLA) Project

Few studies and no international comparisons have examined the impact of multiple chronic conditions on populations using a comprehensive health-related quality of life (HRQL) questionnaire. The impact of common chronic conditions on HRQL among the general populations of eight countries was assessed. Cross-sectional mail and interview surveys were conducted. Sample representatives of the adult general population of eight countries (Denmark, France, Germany, Italy, Japan, The Netherlands, Norway and the United States) were evaluated. Sample sizes ranged from 2031 to 4084. Self-reported prevalence of chronic conditions (including allergies, arthritis, congestive heart failure, chronic lung disease, hypertension, diabetes, and ischemic heart disease), sociodemographic data and the SF-36 Health Survey were obtained. The SF-36 scale and summary scores were estimated for individuals with and without selected chronic conditions and compared across countries using multivariate linear regression analyses. Adjustments were made for age, gender, marital status, education and the mode of SF-36 administration. More than half (55.1%) of the pooled sample reported at least one chronic condition, and 30.2% had more than one. Hypertension, allergies and arthritis were the most frequently reported conditions. The effect of ischemic heart disease on many of the physical health scales was noteworthy, as was the impact of diabetes on general health, or arthritis on bodily pain scale scores. Arthritis, chronic lung disease and congestive heart failure were the conditions with a higher impact on SF-36 physical summary score, whereas for hypertension and allergies, HRQL impact was low (comparing with a typical person without chronic conditions, deviation scores were around -4 points for the first group and -1 for the second). Differences between chronic conditions in terms of their impact on SF-36 mental summary score were low (deviation scores ranged between -1 and -2). Arthritis has the highest HRQL impact in the general population of the countries studied due to the combination of a high deviation score on physical scales and a high frequency. Impact of chronic conditions on HRQL was similar roughly across countries, despite important variation in prevalence. The use of HRQL measures such as the SF-36 should be useful to better characterize the global burden of disease.

Prevalence and impact of multiple childhood chronic illnesses

Objective: To determine the prevalence and impact of multiple chronic conditions on children's health status and utilization of health services. Design: Analysis of the 1988 National Health Interview Survey on Child Health. Setting: Nationally representative sample of the U.S. civilian, noninstitutionalized population. Participants: A total of 17,710 children less than 18 years of age selected in a stratified cluster sampling of U.S. households. Intervention: None. Results: We estimated that fewer than 5% of children have multiple (two or more) chronic conditions and that less than 1% of children had three or more such conditions. However, despite this low overall prevalence, some notable features of multiple chronic conditions stand out. Many of the most prevalent condition-pairs were allergy related, and the rates of co-occurrence of these disorders were generally higher than would be predicted on the basis of prevalence rates for the individual conditions. Children with multiple chronic conditions had more mental and physical health problems and used substantially more health services than other children. For example, the prevalence of developmental delay, learning disabilities, and emotional and behavioral problems increased sharply with the number of chronic conditions reported. Notable deterioration in such health status measures as days in bed, school absences, and activity limitation was also observed with increasing numbers of chronic conditions. Similarly, utilization of hospital and physician services increased in tandem with increasing numbers of chronic conditions. Conclusions: Children who have multiple conditions of a chronic nature, even if few in number, have increased morbidity across a variety of measures. (J P EDIATR 1994;124:40-8)