Management Of Multimorbidity Research Articles

Multimorbidity and Person-Centred care in a socioeconomically deprived community: a qualitative study.

Multimorbidity (>2 long-term conditions) has poorer outcomes in areas of high socioeconomic deprivation (SED). High-quality Person-Centred Care (PCC) is important in multimorbidity but socially vulnerable populations have not informed current PCC models. To explore how wider community factors influence management of multimorbidity in the context of high SED, how high-quality PCC is defined by patients, and whether this influences healthcare management. Ethnographically informed case study in community experiencing high SED in Scotland. Participant observation (hours = 142) within 4 community groups who also took part in 2 participatory workshops. 25 in-depth interviews with people with multimorbidity, recruited from local General Practices; emerging findings discussed with interviewees in one focus group. Field notes/transcripts analysed using inductive thematic analysis. Key aspects of PCC were "patient as person", "therapeutic relationship", "co-ordination" and "power-sharing"; power sharing was particularly enabling but rarely happened (barriers often unseen by practitioners). Shared community experiences of "being known", "stigma" and "none of the systems working" influenced how people approached health services, and healthcare decisions. High quality PCC may have been particularly effective in this setting because of its influence on ameliorating wider shared negative community experiences. In a high SED setting PCC is important and can enhance engagement. Wider community factors have a critical influence on engagement with healthcare in areas of high SED and PCC may be particularly important in this context because of its influence ameliorating these. Policy makers should prioritise and resource PCC.

Risk of Developing Multimorbidity among Previously Healthy Immigrants and Long-term Ontario Residents

Background Multimorbidity is an important health issue associated with a greater risk of adverse health outcomes, more frequent hospitalizations, greater healthcare needs, and premature death. This study examined patterns of and the risk of developing multimorbidity between immigrants and long-term residents of Ontario. Methods We used a 1:1 matched retrospective observational open cohort design from 1995 to 2016, using routinely collected population-based administrative data at ICES. Multimorbidity was defined as two or more and three or more co-occurring chronic conditions. Chronic disease frequencies of dyads and triads were examined. Stratified multivariate Cox Proportional Hazard models examined the risk of developing multimorbidity and further by world regions of origin for immigrants compared to long-term residents. Results Hypertension and diabetes, in combination with chronic obstructive pulmonary disease, were the leading multimorbidity dyad and triad groups. After controlling for age, sex, and neighborhood income quintiles, immigrants from the Caribbean and South Asia had a greater risk of developing 2+ multimorbidity, compared to long-term residents. Refugees from North Africa and the Middle East (HR = 1.22 [95% CI: 1.03-1.42]) as well as refugees (HR = 1.78 [95% CI: 1.59 – 1.98]) and family immigrants from South Asia (HR: 1.08 [95% CI: 1.02-1.14]), had a higher risk of 3+ multimorbidity compared to long-term residents of Ontario. Conclusion These findings highlight the importance of routine population-based data collection on immigration status and world regions of origin to inform public health research. Investments in preventive health services and management of multimorbidity are needed for specific population groups.

Priorities for multimorbidity management and research in cancer: a Delphi study of Australian cancer survivors, clinicians, and researchers.

Multimorbidity is common in people with cancer and associated with increased complexity of care, symptoms, mortality, and costs. This study aimed to identify priorities for care and research for cancer survivors with multimorbidity. A Delphi consensus process was conducted. Elements of care and research were based on Australia's National Strategic Framework for Chronic Conditions, a literature review, and expert input. In Round 1, health professionals, cancer survivors, and researchers rated the importance of 18 principles, 9 enablers, and 4 objectives. In Round 2, new elements were rated and all elements were ranked. In Round 1, all elements reached consensus for care delivery; three principles and one enabler did not reach consensus for research and were eliminated. One principle and two enablers were added, reaching consensus. In the final list, 19 principles, 10 enablers, and 4 objectives were included under care delivery; 14 principles, 9 enablers, and 4 objectives were included under research. For care delivery, principles of 'survivorship' and 'self-management' were ranked highest, and 'peer support' and 'technology' were the most important enablers. For research, 'survivorship' and 'coordinated care' were the highest-ranked principles, with 'peer support' and 'education' the most important enablers. Most elements apply to the general population and cancer survivors; however, additional elements relevant to survivorship need consideration when managing multimorbidity in cancer survivors. Chronic disease frameworks should be more inclusive of issues prioritised by people with, managing, or researching cancer through interdisciplinary approaches including acute and primary care.

Systematic screening for multimorbidities in patients with inflammatory rheumatic diseases enhanced preventive medication use and reduced hospitalisations: an exposed-non-exposed study

RationalStudies are needed to determine if multimorbidity screening and management reduce the rate of multimorbidity accumulation in patients with chronic inflammatory rheumatic diseases (IRD).ObjectivesThis study evaluates the impact of systematic...

A study on multimorbidity patterns, Inpatient care utilization, and associated factors in inpatients with Multimorbidity in township health centers of Guangxi

BackgroundThe epidemiology of multimorbidity, inpatient care utilization, and associated factors among inpatients in rural primary health care facilities in China remains unclear, hindering effective prevention and management of multimorbidity in rural populations. ObjectivesThis study aims to investigate the patterns of multimorbidity, inpatient care utilization, and related factors among hospitalized patients in township health centers (rural primary healthcare facilities) in Guangxi, China. MethodsA multistage stratified and cluster random sampling method was employed to select 10 township health centers (rural primary healthcare facilities) in Nanning, Wuzhou, Liuzhou, Yulin, and Guigang of Guangxi Autonomous Region of China. De-identified inpatient medical records from January 1, 2021, to June 30, 2023, were retrieved from inpatient and chronic disease management systems. Statistical analyses, including the Kruskal-Wallis H test, Mann-Whitney U test, and multinomial logistic regression, were used to explore the demographic characteristics, multimorbidity prevalence, comorbidity number, multimorbidity patterns, hospitalization frequency, and associated factors among inpatients with multimorbidity. ResultsA total of 9,330 patients with multimorbidity were included, with an average age of 68.1 ±11.8 years, and 52.6 % were female. The overall prevalence of multimorbidity was 31.24 %. The most prevalent comorbidity number was 2 (53.22 %), followed by 3 (28.76 %), 4 (12.92 %), and ≥5(5.1 %). Hypertension was the most prevalent co-existing chronic condition, and the most common multimorbidity patterns included combinations of hypertension, chronic cervical and lumbar spondylosis, chronic gastrointestinal diseases, stroke, diabetes mellitus, hyperlipidemia, and chronic pulmonary diseases. The median number of hospitalization frequency for the top 10 multimorbidity patterns ranged from 1 to 4.5, with significant differences in hospitalization frequency across multimorbidity groups. Age, BMI, gender, smoking, alcohol consumption, ethnicity, marital status, and medical insurance were significantly associated with number of co-existing chronic conditions, while age, gender, smoking, alcohol consumption, ethnicity, marital status, education level, medical insurance, and number of co-existing chronic conditions were significantly associated with hospitalization frequency. ConclusionsThe prevalence of multimorbidity among inpatients in township health centers(rural primary healthcare facilities) in Guangxi is high. Hypertension was the most prevalent co-existing condition, with frequent combinations involving chronic cervical and lumbar spondylosis, gastrointestinal diseases, stroke, diabetes, hyperlipidemia, and chronic pulmonary diseases. Multiple factors influence both number of co-exsiting chronic conditions and hospitalization frequency, emphasizing the need for comprehensive, multifaceted strategies to manage the challenges of multimorbidity in rural primary healthcare facilities.

The association between lower urinary tract symptoms secondary to benign prostatic hyperplasia and multimorbidity among Chinese middle-aged and elderly males: evidence based on propensity score matching.

With the aging population, patients with lower urinary tract symptoms/benign prostatic hyperplasia (LUTS/BPH) often face multiple chronic conditions (multimorbidity), significantly impacting their quality of life. This study aims to determine the relationship between LUTS/BPH, multimorbidity, and various chronic diseases in middle-aged and elderly Chinese populations. This cross-sectional study utilizes data from the China Health and Retirement Longitudinal Study (CHARLS), involving 6,645 residents aged 45 and above. Data on 14 chronic diseases were collected, with multimorbidity defined based on the presence of 2-5 chronic conditions. The number of chronic conditions was further categorized into five groups. Propensity score matching (PSM) was used to control for 11 confounding factors. Linear regression was employed to analyze the relationship between LUTS/BPH and the number of chronic conditions in middle-aged and elderly Chinese men before and after PSM. Both univariate and multivariate logistic regression analyses were used to explore the association between LUTS/BPH and multimorbidity as well as each chronic disease. The prevalence of multimorbidity was significantly higher among middle-aged and elderly individuals with LUTS/BPH compared to those without. Before PSM, LUTS/BPH was positively correlated with the number of chronic diseases (β=0.175, P<0.001), and the risk of multimorbidity significantly increased, showing a dose-response relationship. The risk of having at least two chronic diseases in patients with LUTS/BPH was 2.39 times higher than in those without LUTS/BPH [odds ratio (OR) =2.39, 95% confidence interval (CI): 2.04-2.80], and the risk of having five chronic diseases was 3.97 times higher (OR =3.97, 95% CI: 3.14-4.99). After PSM, 819 pairs were successfully matched. The positive correlation between LUTS/BPH and multimorbidity still existed, with the risks of having at least two and five chronic diseases being 2.37 times (OR =2.37, 95% CI: 1.94-2.90) and 3.69 times (OR =3.69, 95% CI: 2.62-5.29) higher, respectively. Among them, the risk of emotional/nervous/psychiatric problems was the highest in LUTS/BPH patients (OR =6.58, 95% CI: 2.22-28.13), while the risk of arthritis/rheumatism was the lowest (OR =1.60, 95% CI: 1.30-1.98). In the Chinese population, LUTS/BPH is closely associated with multimorbidity and each of the 14 chronic diseases examined, with a dose-response relationship based on the number of chronic diseases defined within multimorbidity. It is imperative to incorporate LUTS/BPH into multimorbidity research and management. We recommend that clinicians and policymakers consider the increased risk of multimorbidity and various chronic diseases among male LUTS/BPH patients.

Research status and recommendation on chronic diseases multimorbidity in the elderly in China

As Chinas population ages, the management of multimorbidity in the elderly has become a significant public health issue. Understanding the current state of research on chronic disease multimorbidity among elderly Chinese is now an urgent priority. This review addresses the growing problem of multimorbidity in elderly Chinese, focusing on prevalence, disease patterns, risk factors, and demographic characteristics. Current research highlights the significant impact of lifestyle habits and socioeconomic factors on multimorbidity. It also explores the negative effects on health-related quality of life (HRQoL), longevity, depression, and catastrophic health expenditure (CHE). This study provides valuable insights for public health governance and the development of targeted interventions for managing chronic disease multimorbidity in elderly Chinese. However, existing studies lack unified standards and definitions in disease classification and multimorbidity, and differences in study design and statistical methods may also affect the generalizability of the results. Therefore, future research should pay more attention to the important area of multimorbidity in the elderly and should focus on prevention and comprehensive management policies.

Evolution of the roles of family physicians through collaboration with rehabilitation therapists in rural community hospitals: a grounded theory approach

BackgroundThe role of rural family physicians continues to evolve to accommodate the comprehensive care needs of aging societies. For older individuals in rural areas, rehabilitation is vital to ensure that they can continue to perform activities of daily living. In this population, a smooth discharge following periods of hospitalization is essential and requires management of multimorbidity, and rehabilitation therapists may require support from family physicians to achieve optimal outcomes. Therefore, this study aimed to investigate changes in the roles of rural family physicians in patient rehabilitation.MethodsAn ethnographic analysis was conducted with rural family physicians and rehabilitation therapists at a rural Japanese hospital. A constructivist grounded theory approach was applied as a qualitative research method. Data were collected from the participants via field notes and semi-structured interviews.ResultsUsing a grounded theory approach, the following three themes were developed regarding the establishment of effective interprofessional collaboration between family physicians and therapists in the rehabilitation of older patients in rural communities: 1) establishment of mutual understanding and the perception of psychological safety; 2) improvement of relationships between healthcare professionals and their patients; and 3) creation of new roles in rural family medicine to meet evolving needs.ConclusionEnsuring continual dialogue between family medicine and rehabilitation departments helped to establish understanding, enhance knowledge, and heighten mutual respect among healthcare workers, making the work more enjoyable. Continuous collaboration between departments also improved relationships between professionals and their patients, establishing trust in collaborative treatment paradigms and supporting patient-centered approaches to family medicine. Within this framework, understanding the capabilities of family physicians can lead to the establishment of new roles for them in rural hospitals. Family medicine plays a vital role in geriatric care in community hospitals, especially in rural primary care settings. The role of family medicine in hospitals should be investigated in other settings to improve geriatric care and promote mutual learning and improvement among healthcare professionals.

A need to integrate pharmacological management for multimorbidity into dementia guidelines in Australia.

Pharmacological management is a vital aspect of dementia care. Suboptimal medication prescribing and adverse drug reactions are major causes for ongoing concerns for the quality of care. This review aims to investigate the existence and comprehensiveness of Australian guidelines dedicated to supporting dementia care in the context of pharmacological management. Guideline registries and databases (EMBASE and CINAHL) were searched to identify Australian guidelines addressing pharmacological management in dementia care and to uncover barriers and considerations associated with guideline implementation. Seven Australian guidelines were identified. Barriers to effective implementation were identified at individual, provider, and system levels. None of the identified guidelines provided comprehensive guidance on management of multimorbidity and polypharmacy. Although Australian guidelines are available to guide pharmacological management in dementia, several barriers impede their effective implementation. There is an urgent need for updated guidelines that address the management of multimorbidity and polypharmacy in people living with dementia.

Can the use of a structured management approach using ABCDEF mnemonic to manage multi-morbdiity in HFpEF improve clinical outcomes?

Abstract Introduction Patients with heart failure with preserved ejection fraction (HFpEF) also have other co-morbidities which independently influence clinical outcomes as well as response to treatment. ESC guidelines recommend management of multimorbidity to improve clinical outcomes. The aim of this feasibility study was to test the use of a structured approach by HF specialist nurse using the prompt of an ABCDEF mnemonic to guide management of multimorbidity in HFpEF clinics and compare this with standard care (without prompt by a mnemonic). Methods This was a retrospective analysis of a prospective cohort study of 75 patients with recent decompensated HFpEF within 30 days, who were reviewed in a clinic by a HF specialist nurse. (38 patients in the "mnemonic" cohort and 37 patients in the standard care cohort). ABCDEF mnemonic was used to prompt the HF specialist nurse to address co-morbidities in the "mnemonic cohort" (A-Anaemia/Atrial fibrillation/sleep Apnoea, B- Blood pressure control, Body Mass Index, C- Chronic Kidney Disease and Chronic Obstructive Pulmonary disease, D- Diabetes control, E- Exercise rehab, F- Frailty assessment and need for advance care planning) whereas the HF nurse who assessed patients in standard care cohort followed standard national and international HFpEF guidelines for multimorbidity management (without the aid/prompt of a mnemonic). We also compared all-cause readmissions at 30 days and 3 months between the 2 cohorts. Statistical analysis was performed using Chi-squared test or Student’s T test as appropriate. Results The mean age was comparable between the 2 cohorts (mnemonic cohort -77.5±13.6, standard care 76.9±10.2 p=0.8) as was the proportion of female patients (mnemonic cohort 54% vs. standard care 46%; p=0.45). There was also no significant difference in terms of co-morbidities (mnemonic cohort 3.7±1.2 vs. std. care 3.6±1.1; p=0.7), frailty (mnemonic cohort 4.3±1.3; std. care 4.5±1.1; p=0.42), NTproBNP (Mnemonic cohort 1590 ng/L (368-11657(; std. care 1926 ng/L IQR- 389-10593; p=0.51). Investigations or interventions were performed to address co-morbidities in lower proportion of HFpEF patients in the standard care cohort (43%) compared to mnemonic cohort (100%; p&amp;lt;0.001). 30-day all-cause re-admissions showed a trend towards being lower in the mnemonic cohort (30 readmissions mnemonic 10% vs. std. care 22%; p=0.1); 3 month (mnemonic cohort 16%, std. care 35% p=0.05). Conclusions Use of a structured mnemonic approach to manage multimorbidity appears to be an easy tool to apply in HFpEF clinics, reflected by the high adherence rate and shows a trend towards lower 3-month all-cause readmissions. The results will need to be validated in a a larger randomised controlled trial with longer follow-up.

Prevention and Management of Multimorbidity in Southeast Asia: A Narrative Review

ABSTRACTMultimorbidity, the coexistence of two or more chronic conditions, presents a growing global challenge, particularly in low‐ and middle‐income countries such as Southeast Asia. This trend necessitates the development of sustainable integrated care models to prevent and manage multimorbidity effectively. However, progress in this area has been hampered, especially in underdeveloped regions, by various barriers, including the epidemiology of multimorbidity, how to get different specialists and doctors to work together most availably and manage the multiple medication issues and how to develop cost‐effective approaches to reduce the health burden of multimorbidity. Preventive measures in Southeast Asia, which could tackle multiple components which commonly comprise multimorbidity, include enhancing health literacy and health promotion through school‐ and community‐based educational activities, primary healthcare and related policies on employing taxes on tobacco, alcohol and sugary beverages. The social determinants of health‐encompassing poverty and low education may also influence research on multimorbidity. Moreover, stakeholder engagements involving national governments, World Health Organization (WHO) and Association of Southeast Asian Nations (ASEAN) are crucial. Management strategies focus on integrated care models, including patient‐centred primary healthcare, digital healthcare technologies, and medication management to control polypharmacy. Although research on multimorbidity in Southeast Asia is increasing, translating findings into practical measures was limited. Future efforts should prioritize evidence‐based approaches to prevent and manage multimorbidity effectively, addressing challenges like health system focusing on single chronic disease treatment independently, resource limitations, healthcare provider shortages and individual adherence issues. These ways promise to enhance the quality of life and health outcomes in this region.

A Multi-State Model Study of the Disability-Free Life Expectancy Among Older Adults with Chronic Multimorbidity Based on CHARLS - China, 2011-2020.

Chronic disease multimorbidity is prevalent among older Chinese people, seriously affecting their well-being and quality of life. This study estimated the impact of multimorbidity on the risk of health state transitions and health expectancy among older adults in China. It used population-representative, long-term longitudinal data and multi-state Markov modeling along with microsimulation methods. The study results suggest that the Chinese government should strengthen the prevention and management of multimorbidity and accelerate the transition from chronic disease management to multimorbidity management.

Mapping multimorbidity progression among 190 diseases

BackgroundCurrent clustering of multimorbidity based on the frequency of common disease combinations is inadequate. We estimated the causal relationships among prevalent diseases and mapped out the clusters of multimorbidity progression among them.MethodsIn this cohort study, we examined the progression of multimorbidity among 190 diseases among over 500,000 UK Biobank participants over 12.7 years of follow-up. Using a machine learning method for causal inference, we analyzed patterns of how diseases influenced and were influenced by others in females and males. We used clustering analysis and visualization algorithms to identify multimorbidity progress constellations.ResultsWe show the top influential and influenced diseases largely overlap between sexes in chronic diseases, with sex-specific ones tending to be acute diseases. Patterns of diseases that influence and are influenced by other diseases also emerged (clustering significance Pau > 0.87), with the top influential diseases affecting many clusters and the top influenced diseases concentrating on a few, suggesting that complex mechanisms are at play for the diseases that increase the development of other diseases while share underlying causes exist among the diseases whose development are increased by others. Bi-directional multimorbidity progress presents substantial clustering tendencies both within and across International Classification Disease chapters, compared to uni-directional ones, which can inform future studies for developing cross-specialty strategies for multimorbidity. Finally, we identify 10 multimorbidity progress constellations for females and 9 for males (clustering stability, adjusted Rand index >0.75), showing interesting differences between sexes.ConclusionOur findings could inform the future development of targeted interventions and provide an essential foundation for future studies seeking to improve the prevention and management of multimorbidity.

Social media use and mental health among older adults with multimorbidity: the role of self-care efficacy.

To describe the prevalence and trends in the use of social media over time and explore whether social media use is related to better self-care efficacy and thus related to better mental health among United States older adults with multimorbidity. Respondents aged 65 years+ and having 2 or more chronic conditions from the 2017-2020 Health Information National Trends Survey were analyzed (N = 3341) using weighted descriptive and logistic regression analyses. Overall, 48% (n = 1674) of older adults with multimorbidity used social media and there was a linear trend in use over time, increasing from 41.1% in 2017 to 46.5% in 2018, and then further up to 51.7% in 2019, and 54.0% in 2020. Users were often younger, married/partnered, and non-Hispanic White with high education and income. Social media use was associated with better self-care efficacy that was further related to better mental health, indicating a significant mediation effect of self-care efficacy in the relationship between social media use and mental health. Although older adults with multimorbidity are a fast-growing population using social media for health, significant demographic disparities exist. While social media use is promising in improving self-care efficacy and thus mental health, relying on social media for the management of multimorbidity might be potentially harmful to those who are not only affected by multimorbidity but also socially disadvantaged (eg, non-White with lower education). Great effort is needed to address the demographic disparity and ensure health equity when using social media for patient care.

Enhancing clinical service design for multimorbidity management: A comprehensive approach to joined-up care for diabetes, chronic kidney disease, and heart failure.

Multimorbidity is becoming the norm rather than the exception, especially among the ageing population and people with lower socio-economic status. In addition to the rising healthcare cost, multimorbidity poses considerable difficulty in the delivery of adequate holistic care for affected patients. This review presents a discussion of the current barriers to delivering holistic care to people with multimorbidity and proposes a model of clinical care for people living with cardiovascular-kidney-metabolic (CKM) syndrome as an exemplar of a multimorbidity cluster. Single organ/disease services may not be able to provide optimum care to people with multimorbidity due to the potential complex interactions between multiple disease symptoms and management. In addition, people with multimorbidity may be required to attend multiple appointments in different healthcare centres. This may negatively impact access to services due to time and financial burden. Other barriers include co-ordinating communication between healthcare professionals and reduced continuity of care. Optimising CKM health requires patient-centred care led by an interdisciplinary care team who ideally should possess CKM competencies utilising a shared care protocol to coordinate evidence-based care and use of telehealth to empower patients. Stakeholders and policymakers need to adapt new policy models to establish and enhance CKM care models by allocating funds and implementing frameworks for educational reforms. A CKM service has the potential to increase the uptake of cardiac and renal protective medications as well as optimising metabolic care, increase capacity in both primary and secondary care, improve quality of life and clinical outcomes, reduce patient inconvenience, and importantly allow rapid translation of advances in cardiorenal metabolic diseases into clinical practice.

The burden of secrecy in the management of multimorbidity in older people living with HIV aged 70 and over

ABSTRACT The secrecy surrounding HIV continues to be a major concern for older people living with HIV (OPWH) despite their long-term experience of HIV and the presence of other chronic diseases. Our study aims to highlight how the secrecy surrounding HIV can affect the management of the other conditions. The results of this socio-anthropological sub-study of the ANRS EP66 SEPTAVIH study, which assesses frailty in OPWH, are based on in-depth interviews conducted with 20 OPWH with multimorbidities aged 70 years and over and 9 caregivers. Based on a cross-sectional thematic analysis, this study shows that HIV infection differs from other chronic diseases due to the secrecy and stigma associated with HIV. These specific issues associated with HIV complicate the lives of OPWH, depriving them of support from loved ones and forcing them to exclude their general practitioner from their care system. This then causes OPWH with multiple chronic diseases to become socially vulnerable and isolated. Interventions that support the sharing of information on HIV among OPWH and also among caregivers need to be identified as a matter of urgency in order to improve the lives and management of OPWH with multimorbidities. Trial Registration: ClinicalTrials.gov identifier: NCT03958786.

The Experiences and Perceptions of Older Adults with Multimorbidity Toward E-Health Care: A Qualitative Evidence Synthesis.

Background: Given the growing population of older adults globally, e-Health plays an indispensable role in the chronic disease management of multimorbidity. However, qualitative evidence that synthesizes the experiences of older adults with multimorbidity using e-Health service is currently lacking. The objective was to explore the experiences and perceptions of e-Health care in community-based settings among the older adults with multimorbidity. Methods: Seven electronic databases including PubMed, The Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, Embase, Web of Science, China National Knowledge Infrastructure, and Chinese BioMedical Literature were searched, and the search was limited to studies from inception to September 1, 2023. Screening, data extraction, and quality appraisal were conducted independently by two reviewers. Thomas and Harden's thematic synthesis methodology was applied to synthesize the original themes. The methodological quality of included studies was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research, and the confidence of synthesized themes was evaluated by the Confidence in the Evidence from Reviews of Qualitative Research approaches. Results: Ten studies with moderate methodological quality met eligibility criteria and were included finally. Studies were conducted in four countries with 235 participants who were living with multiple chronic conditions. Among the 10 included studies, 37 credible findings were extracted and interpreted into 3 synthesized themes and 12 subthemes: (1) advantages and benefits perceived during e-Health service, (2) multidimensional challenges and negative experience posed by e-Health service, and (3) preferences, suggestions, and expectations for future e-Health improvement. The confidence in the majority of the three final synthesized themes was rated between "low" and "moderate" scales. Conclusions: The findings of this study provide new insights into implementing tailored e-Health care for older adults with multimorbidity. Further research should emphasize on realizing the potential value of e-Health service based on users' needs and perspectives to promote age-friendliness in geriatric practice.

Multicentric Assessment of a Multimorbidity-Adjusted Disability Score to Stratify Depression-Related Risks Using Temporal Disease Maps: Instrument Validation Study.

Comprehensive management of multimorbidity can significantly benefit from advanced health risk assessment tools that facilitate value-based interventions, allowing for the assessment and prediction of disease progression. Our study proposes a novel methodology, the Multimorbidity-Adjusted Disability Score (MADS), which integrates disease trajectory methodologies with advanced techniques for assessing interdependencies among concurrent diseases. This approach is designed to better assess the clinical burden of clusters of interrelated diseases and enhance our ability to anticipate disease progression, thereby potentially informing targeted preventive care interventions. This study aims to evaluate the effectiveness of the MADS in stratifying patients into clinically relevant risk groups based on their multimorbidity profiles, which accurately reflect their clinical complexity and the probabilities of developing new associated disease conditions. In a retrospective multicentric cohort study, we developed the MADS by analyzing disease trajectories and applying Bayesian statistics to determine disease-disease probabilities combined with well-established disability weights. We used major depressive disorder (MDD) as a primary case study for this evaluation. We stratified patients into different risk levels corresponding todifferentpercentiles of MADS distribution. We statistically assessed the association of MADS risk strata with mortality, health care resource use, and disease progression across 1 million individuals from Spain, the United Kingdom, and Finland. The results revealed significantly different distributions of the assessed outcomes across the MADS risk tiers, including mortality rates; primary care visits; specialized care outpatient consultations; visits in mental health specialized centers; emergency room visits; hospitalizations; pharmacological and nonpharmacological expenditures; and dispensation of antipsychotics, anxiolytics, sedatives, and antidepressants (P<.001 in all cases). Moreover, the results of the pairwise comparisons between adjacent risk tiers illustrate a substantial and gradual pattern of increased mortality rate, heightened health care use, increased health care expenditures, and a raised pharmacological burden as individuals progress from lower MADS risk tiers to higher-risk tiers. The analysis also revealed an augmented risk of multimorbidity progression within the high-risk groups, aligned with a higher incidence of new onsets of MDD-related diseases. The MADS seems to be a promising approach for predicting health risks associated with multimorbidity. It might complement current risk assessment state-of-the-art tools by providing valuable insights for tailored epidemiological impact analyses of clusters of interrelated diseases and by accurately assessing multimorbidity progression risks. This study paves the way for innovative digital developments to support advanced health risk assessment strategies.Further validation is required to generalize its use beyond the initial case study of MDD.

Age-specific Multimorbidity Patterns and Burden on All-Cause Mortality and Public Direct Medical Expenditure: A Retrospective Cohort Study

ObjectiveTo evaluate age-specific multimorbidity patterns and morbidity burden on mortality and healthcare expenditure across age groups.Patients and MethodsRetrospective observational study between January 1, 2009 to December 31, 2017 using electronic health records in Hong Kong: Individuals were stratified by age (< 50, 50–64, 65–79, ≥ 80), and sub-classified by number of morbidities (0, 1, 2, 3, ≥ 4) out of 21 common chronic conditions. Clustering analyses were conducted to identify specific patterns of multimorbidity. Association between the number as well as combinations of morbidities and all-cause mortality and public expenditure was examined.Results4,562,832 individuals with a median follow-up of 7 years were included. Mental disorders were the top morbidities among young individuals, while cardiovascular diseases were prevalent in the elderly. An increased number of morbidities was associated with a greater relative risk for mortality and medical expenditure, and this relationship was stronger among younger patients. Compared to individuals in the same age group without morbidity, the hazard ratios (HR; 95% CI) of all-cause mortality in patients aged < 50 and ≥ 80 with two comorbidities 3.81 (3.60–4.03) and 1.38 (1.36–1.40), respectively, which increased to 14.22 (9.87–20.47) and 2.20 (2.13–2.26), respectively, as the number of morbidities increased to ≥ 4. The stroke-hypertension cluster was shown to be associated with the highest HR of mortality 2.48 (2.43–2.53) among all identified clusters arising from the clustering analysis.ConclusionGiven the stronger association between multimorbidity and all-cause mortality and greater opportunity costs in younger populations, prevention and management of early-onset multimorbidity are warranted. (248 words)

Telehealth access and experiences of older adults with HIV during the COVID-19 pandemic: Lessons for the future.

Telehealth services are proposed to improve access and retention to care for people with HIV (PWH). Yet the rapid uptake of telehealth services during the COVID-19 pandemic created equity concerns, especially for already vulnerable populations. Older PWH may face a combination of barriers to telehealth but also stand to benefit given social isolation and the need for multimorbidity management. Few studies have focused on this population, and we aimed to assess the telehealth capability and experiences of older PWH at an urban HIV clinic. We did this in two ways: (1) we contacted PWH aged ≥65 via telephone about telehealth capabilities and (2) we conducted focus groups with older PWH who transitioned from in-person to virtual classes affiliated with the clinic. Among 179 PWH aged ≥65, 80 answered the telehealth questions. Among those who answered, 91% were male with a mean age of 69 (SD 3.0), and 55% were White. One-third did not have internet access or an email address. A total of 65% had at least one telehealth-capable device but 12.5% of respondents with a device did not know how to use it. Thirteen older PWH participated in focus groups with a mean age of 64 (SD 6.9) and 44% female. Themes were grouped into benefits (social/emotional connection and convenience) and challenges (technological barriers and missed in-person experience). Participants preferred in-person classes but felt telehealth was a good alternative for mitigating isolation. Telehealth gave those with mobility and transportation issues improved access to supportive services. As the COVID-19 public health emergency ends, hybrid options should be considered to improve access for older PWH and address social isolation. Ensuring equitable access to devices and digital literacy training will be critical to ensure services can be utilized.