Multimorbid Group Research Articles

Impact of age and gender differences in the prevalence and patterns of multimorbidity in the Thai Cohort Study.

The study aims to identify the common patterns of multimorbidity and their distribution by age and gender. This cross-sectional study collected self-reported data from 42 785 Thai Cohort Study members through mailed questionnaires. Employing prevalence-based analysis, it identified common multimorbidity (coexistence of two or more chronic conditions) patterns, analysing the three most common patterns stratified by age and sex. P for trend (p-trend) was used to test the linear trend for associations between age and prevalence of these chronic conditions in the multimorbidity patterns. Chronic conditions with the highest prevalence were related to metabolic syndromes: obesity (28.5%), hyperlipidaemia (13.2%) and hypertension (7.2%). A positive linear age-multimorbidity association was observed (p-trend = 0.0111). The 60+ participants averaged 1.20 diseases, with 33.7% multimorbidity prevalence. Hyperlipidaemia + obesity was most prevalent in the under-40 multimorbid group (38.7%). Men exhibited a higher prevalence of multimorbidity and associated patterns involving hypertension, hyperlipidaemia and obesity than women. Metabolic syndrome components were the prominent factors driving multimorbidity. Significant age and gender differences were also revealed in multimorbidity prevalence. People aged 60+ faced high risk of multimorbidity, while younger individuals tended towards the multimorbidity pattern of obesity and hyperlipidaemia. Men were more susceptible to multimorbidity patterns associated with metabolic syndromes. Future studies for metabolic-related multimorbidity should consider these differences, addressing age and gender issues.

Oral anticoagulant therapy and risk of admission to long-term care in patients with atrial fibrillation: a nationwide cohort study

Abstract Background The impact of oral anticoagulants (OACs) on outcomes in patients with atrial fibrillation (AF) has been a focus of extensive research in the past decades, but there is a complete paucity of information about their effect on the need of long-term care (LTC) in this aging and multimorbid patient group. Purpose To assess the hypothesis that OAC therapy is associated with lower need of LTC in patients with AF. Methods The registry-based FinACAF cohort study covers all patients with incident AF from all levels of care in Finland from 2007 to 2018, as well as all their OAC purchases, LTC admissions, and information on previous home care acuity. Incidence rate ratios (IRRs) for admission to any type of LTC were estimated with Poisson regression using Lexis-type data structure based on three time scales: follow-up time from AF diagnosis, calendar year, and age. OAC use was treated as a time-varying variable from first OAC purchase onwards. Results We identified 188 752 patients (49.0% female; mean age 71.4 years; mean follow-up 3.6 years) with incident AF without prior LTC, of whom 143 534 (76.0%) initiated OAC therapy and 11 775 (6.2%) were admitted to LTC. OAC therapy was associated with a lower rate of LTC admission (adjusted IRR with 95% CI: 0.79 (0.76-0.82)). The association was most evident among patients over 70 years (Kaplan-Meier curve of survival without LTC in Figure). Warfarin and direct oral anticoagulants (DOACs) were both associated with lower need of LTC. Furthermore, when compared to warfarin, DOACs were associated with a lower LTC admission rate (adjusted IRR with 95% CI: 0.69 (0.61-0.79)). No significant disparities were observed between different DOACs. High age and previous need of home care, as well as dementia, psychiatric disorders, and ischemic stroke were the strongest factors associated with the need of LTC. Conclusions In this nationwide cohort of patients with incident AF, OAC therapy, particularly with DOACs, was associated with a substantially lower risk of admission to LTC.Survival without LTC. Age over 70 years.

Multimorbidity transitions and the associated healthcare cost among the Finnish adult population during a two-year follow-up.

Ageing of the population increases the prevalence and coexistence of many chronic diseases; a condition called multimorbidity. In Finland, information on the significance of multimorbidity and its relation to the sustainability of healthcare is scarce. To assess the prevalence of multimorbidity, the transitions between patient groups with and without multiple diseases and the associated healthcare cost in Finland in 2017-2019. A register-based cohort study covering all adults (n = 3,326,467) who used Finnish primary or specialised healthcare services in 2017. At baseline, patients were classified as 'non-multimorbid', 'multimorbid' or 'multimorbid at risk' based on the recordings of a diagnosis of interest. The costs were calculated using the care-related patient grouping and national standard rates. Transition plots were drawn to observe the transition of patients and costs between groups during the two-year follow-up. At baseline, 62% of patients were non-multimorbid, 23% multimorbid and 15% multimorbid at risk. In two years, the proportion of multimorbid patients increased, especially those at risk. Within the multimorbid at-risk group, total healthcare costs were greatest (€5,027 million), accounting for 62% of the total healthcare cost of the overall patient cohort in 2019. Musculoskeletal diseases, cardiometabolic diseases and tumours were the most common and expensive chronic diseases contributing to the onset of multimorbidity. Multimorbidity is causing a heavy burden on Finnish healthcare. The estimates of its effect on healthcare usage and costs should be used to guide healthcare planning.

Cluster analysis for the overall health status of elderly, multimorbid patients with diabetes.

To evaluate the overall health status and health-related abilities and problems of elderly patients with diabetes and multimorbidity compared with those with diabetes only. Additionally, we aimed to identify different subgroups of elderly, multimorbid patients with diabetes. This cross-sectional study included 538 elderly patients with diabetes. The participants completed a series of questionnaires on self-rated health (SRH), diabetes self-management, self-efficacy, health literacy, depression, and diabetes distress. Differences in health-related abilities and problems were compared between elderly patients with diabetes and multimorbidity and those with diabetes only, with adjustments for covariates using propensity score matching. A cluster analysis was also performed to identify the overall health status subgroups of elderly, multimorbid patients with diabetes. Additionally, we conducted a multinomial logistic regression analysis to examine the predictors of health-related abilities and problem-cluster group membership. Elderly patients with diabetes and multimorbidity experienced more health-related abilities and problems than those with diabetes only, particularly within the domains of depression (p < 0.001), and diabetes distress. The level of health literacy (p < 0.001) and self-management (p = 0.013) in elderly, multimorbid patients with diabetes was also significantly higher than that in elderly patients with diabetes only. Cluster analysis of elderly, multimorbid patients with diabetes revealed three distinct overall health status clusters. Multinomial logistic regression analysis indicated that age (OR = 1.090, p = 0.043), sex (OR = 0.503, p = 0.024), living situation (OR = 2.769, p = 0.011), BMI (OR = 0.838, p = 0.034), regular exercise (OR = 2.912, p = 0.041 in poor vs. good; OR = 3.510, p < 0.001 in intermediate vs. good), and cerebral infarction (OR = 26.280, p < 0.001) independently and significantly predicted cluster membership. Compared with elderly patients with diabetes only, those with diabetes and multimorbidity experienced more health-related abilities and problems within the domains of depression, and diabetes distress. Additionally, the level of health literacy and self-management in elderly, multimorbid patients with diabetes was significantly higher than that in those with diabetes only. Among the multimorbid diabetes group, old age, male sex, living without a partner, slightly lower BMIs, not exercising regularly, and experiencing cerebral infarctions were all positively correlated with worse overall health status.

Mental, Neurological, and Somatic Comorbidities and Their Treatment in Persons With Intellectual Disability.

Persons with intellectual disability (ID) often suffer from significant comorbidities. As data have been lacking until now, the present report is the first one containing outpatient data on the prevalence of ID in Germany, its comorbidities, and outpatient (drug) treatment. This study is based on the nationwide outpatient billing data and drug prescription data of all SHI-insured adults (SHI, statutory health insurance) (age 18-109) who were seen at least once in an outpatient medical practice in 2018. Patients with at least two F70-F79 diagnoses in two quarters were included in the study group (SG) (n = 324 428). A random sample of patients without ID served as the control/comparison group (CG) (n = 648 856). The odds ratios (SG vs. CG) for comorbidities, prescriptions of selected classes of drugs, and involvement of medical specialties were each analyzed by multivariate logistic regression. The prevalence of ID was 0.55%. ID was found to be associated with a variety of comorbidities. The highest odds ratios [OR] were for infantile cerebral palsy (OR: 121.71; 95% confidence interval: [111.67; 132.67]), autism spectrum disorders (OR: 83.85 [75.54; 93.08]), and developmental disabilities (OR: 61.34 [58.86; 63.94]). The most frequently prescribed drug categories (as classified by the anatomic-therapeutic-chemical (ATC) convention) were psychoactive drugs (antipsychotic, anxiolytic, and hypnotic drugs and sedatives) and antiepileptic drugs (OR: 10.40 [10.27; 10.53] and 9.90 [9.75; 10.05], respectively). Both general practitioners (OR: 2.64 [2.59; 2.69]) and medical specialists were consulted by the SG more frequently than by the CG; the type of specialist most commonly consulted was in the neuropsychiatric field, i.e., a neurologist or psychiatrist (OR: 6.85 [6.77; 6.92]). A diagnosis of ID frequently appears in outpatient billing data. Future analyses should be devoted to the specific care of people with intellectual disability, who constitute an especially multimorbid and vulnerable patient group.

Predictivity of the comorbidity indices for geriatric syndromes

BackgroundThe aging population and increasing chronic diseases make a tremendous burden on the health care system. The study evaluated the relationship between comorbidity indices and common geriatric syndromes.MethodsA total of 366 patients who were hospitalized in a university geriatric inpatient service were included in the study. Sociodemographic characteristics, laboratory findings, and comprehensive geriatric assessment(CGA) parameters were recorded. Malnutrition, urinary incontinence, frailty, polypharmacy, falls, orthostatic hypotension, depression, and cognitive performance were evaluated. Comorbidities were ranked using the Charlson Comorbidity Index(CCI), Elixhauser Comorbidity Index(ECM), Geriatric Index of Comorbidity(GIC), and Medicine Comorbidity Index(MCI). Because, the CCI is a valid and reliable tool used in different clinical settings and diseases, patients with CCI score higher than four was accepted as multimorbid. Additionally, the relationship between geriatric syndromes and comorbidity indices was assessed with regression analysis.ResultsPatients’ mean age was 76.2 ± 7.25 years(67.8% female). The age and sex of multimorbid patients according to the CCI were not different compared to others. The multimorbid group had a higher rate of dementia and polypharmacy among geriatric syndromes. All four indices were associated with frailty and polypharmacy(p < 0.05). CCI and ECM scores were related to dementia, polypharmacy, and frailty. Moreover, CCI was also associated with separately slow walking speed and low muscle strength. On the other hand, unlike CCI, ECM was associated with malnutrition.ConclusionsIn the study comparing the four comorbidity indices, it is revealed that none of the indices is sufficient to use alone in geriatric practice. New indices should be developed considering the complexity of the geriatric cases and the limitations of the existing indices.

Pooled analysis on image-guided moderately hypofractionated thoracic irradiation in inoperable node-positive/recurrent patients with non-small cell lung cancer with poor prognostic factors and severely limited pulmonary function and reserve.

The objective of this study was to investigate the feasibility and efficacy of image-guided moderately hypofractionated thoracic radiotherapy (hypo-IGRT) in patients with non-small cell lung cancer (NSCLC) with poor performance status and severely limited pulmonary function and reserve. Consecutive inoperable patients who had node-positive, stage IIB-IIIC (TNM, 8th edition) or recurrent NSCLC, had an Eastern Cooperative Oncology Group performance status ≥1, and had a forced expiratory volume in 1 second (FEV1 ) ≤1.0 L, had a single-breath diffusing capacity of the lung for carbon monoxide (DLCO-SB) ≤40% and/or on long-term oxygen therapy were analyzed. All patients received hypofractionated IGRT to a total dose of 42.0 to 49.0 Gy/13 to 16 fractions (2.8-3.5 Gy/fraction) (equivalent dose in 2-Gy fractions/biologically effective dose [α/β = 10] = 45.5-55.1 Gy/54.6-66.2 Gy) alone. Patients were monitored closely for nonhematological toxicity, which was classified per National Cancer Institute Common Terminology Criteria for Adverse Events version 5.0. Between 2014 and 2021, 47 consecutive patients with a median age of 72 years (range, 52.2-88 years) were treated. At baseline, the median FEV1 , vital capacity, and DLCO-SB were 1.17 L (range, 0.69-2.84 L), 2.34 L (range, 1.23-3.74 L), and 35% predicted (range, 13.3%-69.0%), respectively. The mean and median planning target volumes were 410.8 cc (SD, 267.1 cc) and 315.4 cc (range, 83.4-1174.1 cc). With a median follow-up of 28.9 months (range, 0.5-90.6 months) after RT, the median progression-free survival (PFS)/overall survival (OS) and 6- and 12-month PFS/OS rates were 10.4 months (95% CI, 7-13.8 months)/18.3 months (95% CI, 9.2-27.4 months), 70%/89.4%, and 38.8%/66%, respectively. Treatment was well tolerated with only 1 case each of grade 3 pneumonitis and esophagitis. No toxicity greater than grade 3 was observed. Patients with inoperable node-positive NSCLC, a poor performance status, and severely limited lung function can be safely and effectively treated with individualized moderately hypofractionated IGRT. The achieved survival rates for this highly multimorbid group of patients were encouraging.

Association of Social Determinants, Multimorbidity, and Functional Status with Mortality after Pneumonia

Social support, multimorbidity, and functional status are important determinants of health in older adults, but their prognostic implications remain unclear after an acute illness. We conducted a prospective cohort study of 201 patients 65 years or older who were hospitalized for pneumonia at a university hospital in Korea in 2019-2020. K-means cluster analysis was performed using social deprivation score (range: 0-5), activities of daily living (range: 0-7), instrumental activities of daily living (range: 0-7), physical limitation score (range: 0-7), and Gagne comorbidity index (range: 0-24) (higher scores indicate higher risk). Four groups were identified: 1) Group A: physically limited and non-disabled group with limited social support; 2) Group B: multimorbid but functional group with social support; 3) Group C: multimorbid and disabled group with social support; 4) Group D: multimorbid and disabled group with limited social support. For Groups A through D, the Kaplan-Meir estimates for 6-month mortality were 10.0%, 18.0%, 34.2%, and 43.6%, respectively, and the 6-month mean survival times were 166.4 days (95% CI: 156.1-176.6), 156.9 days (95% CI: 140.8-173.1), 145.2 days (95% CI: 126.6-163.8), and 125.9 days (95% CI: 107.7-144.1), respectively. After adjusting for sex, age, and pneumonia severity score, the hazard ratios for Groups B through D versus Group A were 2.07 (95% CI: 0.70-6.13), 3.14 (95% CI: 1.17-8.42), and 4.38 (95% CI: 1.73-11.04), respectively. Our results suggest that multimorbidity and disabilities were implicated in higher risk of 6-month mortality after pneumonia, and social support may mitigate this risk among those with multimorbidity and disability.

Association of Social Determinants, Multimorbidity, and Functional Status with Mortality after Pneumonia

Diet-related chronic diseases, such as hypertension and obesity, are prevalent in Native American (NA) communities where poor food environments are prominent and healthy food access is limited. The Chickasaw Healthy Eating Environments Research Study (CHEERS) is an NIH-funded study aimed to improve Body Mass Index and blood pressure control among NA adults with uncontrolled hypertension. This multi-level randomized trial, guided by a community-based participatory research orientation, was co-created by tribal and university partners and is implemented within the Chickasaw Nation of Oklahoma. We created hypertension-specific food boxes that contained DASH diet foods, coupons for purchasing vegetables and fruits, educational materials, and heart-healthy recipes for supporting healthy eating. Food boxes were packed and shipped monthly to intervention participants with a 30-day supply of: one fruit serving/day, one vegetable serving/day, one serving of unsalted nuts or seeds/day, one serving of beans or lentils/day, and two servings of fatty fish/week. We will present our participatory approach in co-developing the CHEERS study methods, findings with a focus on older adults, and lessons learned. CHEERS is the first innovative food box intervention to be conducted in NA communities. Food box interventions show promise in improving dietary intake and reducing hypertension and obesity in rural and poor food environments.

Changes in Functional Status Among Clusters of Older Adults After Hospitalization for Pneumonia

Little is known about how social determinants, comorbidity, and disability status are associated with functional recovery after an acute illness. A prospective cohort study was conducted between 2019-2020 at a university hospital in Korea, to investigate functional recovery after hospitalization for pneumonia in older adults with different degrees of social deprivation, disabilities, and comorbidities. K-means cluster analysis was used to identify groups of patients based on social deprivation score, activities of daily living, instrumental activities of daily living, physical limitation score, and Gagne comorbidity index. Four groups were identified: Group A: non-disabled group with limited social support (n=61 [30.3%]); Group B: multimorbid but non-disabled group with social support (n=45 [22.4%]); Group C: multimorbid and disabled group with social support (n=38 [18.9%]); Group D: multimorbid and disabled group with limited social support (n=57 [28.4%]). Functional status, defined as ability to perform 21 activities and physical tasks independently, was measured via telephone interviews at 1, 3, and 6 months after discharge. Group-based trajectory model identified four functional status trajectories: excellent (n=29 [14.4%]), good (n=51 [25.4%]), fair (n=58 [28.9%]) and poor (n=63 [31.3%]). The most common functional trajectory by four groups was good trajectory (59%) in Group A, excellent trajectory (48.9%) in Group B, fair (50%) and poor trajectory (50%) in Group C, and poor trajectory (77.2%) in Group D. Our results suggest that most patients without disability recover functional status after pneumonia, despite multimorbidity or limited social support. Social support seems to be more important for those with multimorbidity and disability.

Frailty and multimorbidity as mortality risk indicators in older men

Abstract Background Multimorbidity and frailty are frequent in ageing populations – also among cardiovascular patients – but their independent relationships to prognosis are poorly recognized. Purpose To compare effects of frailty and multimorbidity to mortality risk in old age and also relate them to cardiovascular risk in midlife. Methods Caucasian men with similar socioeconomic status (born 1919–1934, original n=3490) of an ongoing longitudinal cohort study have been followed-up since midlife in the 1960s (mean age 42 years), whereupon their combined cardiovascular risk (using Keys' risk index) was determined. In the year 2000, multimorbidity (at least 2 of the following: coronary artery disease, stroke, peripheral artery disease, heart failure, chronic pulmonary disease, diabetes, cancer, musculoskeletal disease) and phenotypic frailty status were determined in 1259 men (67% of survivors, mean age 74 years). Eighteen-year mortality was established from national registers and Cox regression (hazard ratio [HR] with 95% confidence interval [CI]) was used to find independent predictors. Various frailty/multimorbidity combinations were also related to cardiovascular risk index in midlife. In the present analyses we excluded men with phenotypic prefrailty (n=641) and the final analytic sample consisted of 618 men. Results Of the men 385 had neither multimorbidity nor frailty, 98 and 60 men had multimorbidity or frailty only, respectively, and 75 men had frailty + multimorbidity. Eighteen-year cumulative mortality in various groups is shown in the Figure (log-rank P value between groups &amp;lt;0.001). In age-adjusted Cox analyses (not frail-not multimorbid group as reference), frailty alone was significantly associated with similar mortality risk (HR 1.74, 95% CI 1.25–2.43) as multimorbidity alone (HR 1.65, 95% CI 1.27–2.16). Combination of frailty+multimorbidity was a strong prognostic sign (HR 3.15, 95% CI 2.37–4.21). As compared to not frail-not multimorbid group, combined cardiovascular risk index in healthy midlife was higher in men with multimorbidity (P=0.002), frailty (P=0.04), and frailty + multimorbidity (P=0.001) in old age. Conclusions Frailty phenotype without multimorbidity in older men indicated similar mortality risk as multimorbidity and was also associated with higher cardiovascular risk in midlife. Recognition of frailty would thus help assessment of prognosis in addition to multimorbidity. We also suggest that development of frailty should be included as an important outcome in prevention trials of cardiovascular diseases. Total mortality during follow-up Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): Helsinki University Hospital

Specific Motor and Cognitive Performances Predict Falls during Ward-Based Geriatric Rehabilitation in Patients with Dementia.

The aim of this study was to identify in-hospital fall risk factors specific for multimorbid hospitalized geriatric patients with dementia (PwD) during hospitalization. Geriatric inpatients during ward-based rehabilitation (n = 102; 79.4% females; 82.82 (6.19) years of age; 20.26 (5.53) days of stay) were included in a comprehensive fall risk assessment combining established clinical measures, comprehensive cognitive testing including detailed cognitive sub-performances, and various instrumented motor capacity measures as well as prospective fall registration. A combination of unpaired t-tests, Mann–Whitney-U tests, and Chi-square tests between patients with (“in-hospital fallers”) and without an in-hospital fall (“in-hospital non-fallers”), univariate and multivariate regression analysis were used to explore the best set of independent correlates and to evaluate their predictive power. In-hospital fallers (n = 19; 18.63%) showed significantly lower verbal fluency and higher postural sway (p < 0.01 to 0.05). While established clinical measures failed in discriminative as well as predictive validity, specific cognitive sub-performances (verbal fluency, constructional praxis, p = 0.01 to 0.05) as well as specific instrumented balance parameters (sway area, sway path, and medio-lateral displacement, p < 0.01 to 0.03) significantly discriminated between fallers and non-fallers. Medio-lateral displacement and visuospatial ability were identified in multivariate regression as predictors of in-hospital falls and an index combining both variables yielded an accuracy of 85.1% for fall prediction. Results suggest that specific cognitive sub-performances and instrumented balance parameters show good discriminative validity and were specifically sensitive to predict falls during hospitalization in a multimorbid patient group with dementia and an overall high risk of falling. A sensitive clinical fall risk assessment strategy developed for this specific target group should include an index of selected balance parameters and specific variables of cognitive sub-performances.

1105 - The burden of muscle invasive bladder cancer 12 months before death: How do we improve the care of this multimorbid group of patients?

1105 - The burden of muscle invasive bladder cancer 12 months before death: How do we improve the care of this multimorbid group of patients?

Risk of comorbidities in patients diagnosed with chronic urticaria: A nationwide registry-study

BackgroundThe autoimmune profile of Chronic Urticaria (CU) patients is an increasing topic of interest. Associated diseases suggest shared pathogenic pathways, and they may provide important knowledge on specific targets for future treatment models. In this study we examined the prevalence and risk of comorbidities in CU. MethodsThe Danish National Patient Registry was used to identify all CU patients from 1994 to 2015. Five of 5 specialized dermatological units in Denmark were covered. Analyses were conducted as a nested case control study and a matched cohort study. CSU patients were matched 1:10 on age and sex to an otherwise random group of people from the background population. ResultsA total of 12,185 CU patients were identified, with an overweight of female cases (69% versus 32%). There was an overrepresentation of mast cell mediated diseases including mastocytosis and anaphylaxis, as well as atopic diseases including type 1 allergies and atopic dermatitis. The prevalence of rheumatoid arthritis, systemic lupus erythematosus, thyroiditis and vitiligo was also increased, as was the prevalence of depression. CU patients who did not have any of the co-morbidities at the time of their CU diagnosis had an increased risk of developing both mast cell mediated diseases, atopic diseases, and autoimmune diseases excluding thyroiditis and diabetes. ConclusionThe autoimmune profile of the comorbidities of CU was demonstrated with an evident risk of developing rheumatoid arthritis. CU patients were also at increased risk of either having or achieving depression. Mast cell related diseases seemed to be overrepresented, although registry data within this disease category are questionable and similar to symptoms of CU to the untrained eye. Thus, CU patients constitute a multimorbid group of patients, which must be recognized among treating physicians.

A multicomponent exercise intervention to improve physical functioning, cognition and psychosocial well-being in elderly nursing home residents: a study protocol of a randomized controlled trial in the PROCARE (prevention and occupational health in long-term care) project

BackgroundOlder adults, who are living in nursing homes that provide a high level of long-term nursing care, are characterized by multimorbidity and a high prevalence of dependency in activities of daily living. Results of recent studies indicate positive effects of structured exercise programs during long-term care for physical functioning, cognition, and psychosocial well-being. However, for frail elderly the evidence remains inconsistent. There are no evidence-based guidelines for exercises for nursing home residents that consider their individual deficits and capacities. Therefore, high-quality studies are required to examine the efficacy of exercise interventions for this multimorbid target group. The purpose of this study is to determine the feasibility and efficacy of a multicomponent exercise intervention for nursing home residents that aims to improve physical and cognitive functioning as well as quality of life.MethodsA two-arm single-blinded multicenter randomized controlled trial will be conducted, including 48 nursing homes in eight regions of Germany with an estimated sample size of 1120 individuals. Participants will be randomly assigned to either a training or a waiting time control group. For a period of 16 weeks the training group will meet twice a week for group-based sessions (45–60 min each), which will contain exercises to improve physical functioning (strength, endurance, balance, flexibility) and cognitive-motor skills (dual-task). The intervention is organized as a progressive challenge which is successively adapted to the residents’ capacities. Physical functioning, cognitive performance, and quality of life will be assessed in both study groups at baseline (pre-test), after 16-weeks (post-treatment), and after 32-weeks (retention test, intervention group only).DiscussionThis study will provide information about the efficacy of a multicomponent exercise program in nursing homes (performance, recruitment). Results from this trial will contribute to the evidence of multicomponent exercises, which specifically focus on cognitive-motor approaches in the maintenance of mental and physical functioning. In addition, it will help to encourage older adults to actively engage in social life. Furthermore, the findings will lead to recommendations for health promotion interventions for frail nursing home residents.Trial registrationThe trial was prospectively registered at DRKS.de with the registration number DRKS00014957 on October 9, 2018.

P5352The main characteristics and multimorbidity in patients with history of stroke, myocardial infarction and their combination (hospital registry data)

Abstract Aim To assess characteristics and patterns of cardiovascular (CV) and non-cardiovascular (non-CV) multimorbidity in patients with history of stroke (STR) without myocardial infarction (STRH), history of myocardial infarction (MI) without stroke (MIH), and their combination (STRH+MIH) on a basis of the hospital registry. Methods The hospital registry included 8954 patients with arterial hypertension (AH), ischemic heart disease, chronic heart failure (CHF), atrial fibrillation (AF) and their combinations hospitalized to the National Medical Research Center for Preventive Medicine (Moscow, Russia) from 01.04.13 to 31.03.17. 2020 (22.6%) patients had a MIH, 857 (9.6%) – a STRH and 318 (3.6%) had a combination of them. Results The age of patients with MIH was significantly less than in STRH and in the combined group (66.8±11.3 vs 70.8±10.9 and 71.6±9.9 years, p&lt;0.05). 70% of patients in STRH+MIH group had primary MI earlier than STR (on the average 3.8 years). The age of primary MI and STR was 61.3±11.4 and 65.8±11.7 years respectively (p&lt;0.001). 27% of all STRH and 14% of MIH cases were presented in MIH+STRH group. Men prevailed in MIH and MIH+STRH (70% and 64.5%) groups, women – in STRH (59%). In MIH group compared with STRH and STRH+ MIH groups was lower frequency of AH (90.2% vs 97.2%; 96.5%) and AF (21.2% vs 41.5%; 41.5%). CHF patients prevailed in STRH+MIH and MIH groups (70.4%; 57.1% vs 40.7%), p&lt;0.0001. The most number of CV diseases (CVDs) was in STRH+MIH group (3.09±0.8) and less in MIH (2.9±1.0) and STRH (1.96±0.9) groups. In STRH+MIH patients compared with STRH and MIH groups were also more often identified: diabetes (35.2%; 22.3%; 24.7%, p&lt;0.0001), digestive diseases (80.2% vs 73.4%; 75.6%, p&lt;0.0001 and p=0.025), kidney diseases (56.6% vs 44,7%; 29%, p&lt;0.0001 and p=0.0003), respiratory diseases (37.4% vs 23.9%; 31.9%, p=0.005; p=0,001), anemia (12.9% vs 7.9% and 6.9%, p=0.0002 and p=0.009). The number of obese patients did not differ significantly in all groups (33.0%; 30.7%; 28.1%, p&gt;0.05). The average number of comorbid non-CV diseases (non-CVDs) was: 1.96±0.5 in MIH group; 2.03±0.3 in patients with STRH and 2.55±0.3 in STRH+MIH group (p&lt;0.05, adjusted to age and sex). The total number of CVDs and non-CVDs was maximal (5,6) in STRH+MIH group, less in MIH (4.65) and STRH (3,99) groups. Conclusions Patients with history of stroke and myocardial infarction had maximal number both of CVDs and non-CVDs compared with groups of only myocardial infarction or stroke history, i.e. they had the higher CV risk and the most unfavorable profile in hospital registry. So, the multidisciplinary approach for the treatment and prevention in this multimorbid group is most indicated. 70% of patients in combined group had primary MI earlier than primary stroke (on the average 3.8 years). This fact confirmed the suggestion that MI is the earlier part of cardiovascular continuum than stroke.

Cognitive profiles and associated structural brain networks in a multimorbid sample of marginalized adults.

IntroductionCognition is impaired in homeless and vulnerably housed persons. Within this heterogeneous and multimorbid group, distinct profiles of cognitive dysfunction are evident. However, little is known about the underlying neurobiological substrates. Imaging structural covariance networks provides a novel investigative strategy to characterizing relationships between brain structure and function within these different cognitive subgroups.MethodParticipants were 208 homeless and vulnerably housed persons. Cluster analysis was used to group individuals on the basis of similarities in cognitive functioning in the areas of attention, memory, and executive functioning. The principles of graph theory were applied to construct two brain networks for each cognitive group, using measures of cortical thickness and gyrification. Global and regional network properties were compared across networks for each of the three cognitive clusters.ResultsThree cognitive groups were defined by: higher cognitive functioning across domains (Cluster 1); lower cognitive functioning with a decision-making strength (Cluster 3); and an intermediate group with a relative executive functioning weakness (Cluster 2). Between-group differences were observed for cortical thickness, but not gyrification networks. The lower functioning cognitive group exhibited higher segregation and reduced integration, higher centrality in select nodes, and less spatially compact modules compared with the two other groups.ConclusionsThe cortical thickness network differences of Cluster 3 suggest that major disruptions in structural connectivity underlie cognitive dysfunction in a subgroup of people who have a high multimorbid illness burden and who are vulnerably housed or homeless. The origins, and possible plasticity of these structure-function relationships identified with network analysis warrant further study.

Energy and protein intake in 330 geriatric orthopaedic patients: Are the current nutrition guidelines applicable?

Elderly orthopaedic patients are potentially at a high nutritional risk. The reasons for this are numerous as i.e. reduced appetite, sensation of satiety after eating small amounts of food, multi-medication or immobility. This is in contrast to the increased energy and protein recommendations for geriatric orthopaedic patients. Oral intake during hospitalization of more than 1000 geriatric orthopaedic patients aged over 80, with or without fracture, was recorded, calculated and then compared to energy and protein requirements by clinical dietitians according to international guidelines. 330 patients were included in the sample of which 76.7% were female (n=253) and 23.3% male (n=77). The mean age was 87.4 (+/-4.7) years. Most patients (204=61.8%) had lived at home prior to hospital admission. 72 patients (21.8%) lived in a retirement home, 54 (16.4%) lived in a nursing home. 98.5% of the included patients were unable to cover their energy needs and 99% were unable to achieve their protein needs. Only five patients (1.5%) were able to achieve their energy needs and one single patient (0.3%) achieved his recommended protein intake. Orthogeriatric patients are at high risk of malnutrition. Very few of these patients were able to cover their estimated energy and protein needs through dietary intake. This suggests that there is a high need of dietetic interventions in this multimorbid elderly patient group. The aim of the nutritional therapy and its interventions should be its continuity, especially after hospital discharge so that long-term optimization of the nutritional status can occur. Future research should further investigate if current recommendations are applicable and the best way to achieve a better nutritional status in this population risk group.

Percutaneous Posterior Transarticular Atlantoaxial Fixation for the Treatment of Odontoid Fractures in the Elderly: A Prospective Study.

A prospective study of 20 multimorbid patients older than 65 years undergoing minimally invasive surgical treatment for odontoid fracture. To analyze the results of percutaneous transarticular atlantoaxial screw fixation as a new minimally invasive treatment modality in this high risk group of patients. Odontoid fractures are a common injury pattern in the elderly. These fractures typically present significant challenges as geriatric patients often have multiple comorbidities that may adversely affect fracture management. Despite numerous publications on this subject, with a trend toward primary operative stabilization, the appropriate treatment for this frequent and potentially life threatening injury remains controversial. Between January 2013 and December 2015, 20 consecutive patients underwent posterior percutaneous transarticular atlantoaxial screw fixation for odontoid fracture type II. The two main inclusion criteria were age 65 years or older and ASA score of III or IV. The screws were inserted percutaneously with the help of two fluoroscopy devices. Clinical and radiological examinations were regularly performed for a minimum of 18 months postoperatively. The mean age was 81 years, all of them with multiple comorbidities. Reduction of the fracture and screw insertion was possible in all cases. The mean operative time was 51.75 minutes and mean blood loss was 41.7 mL. Three patients died in the first 3 months after surgery. Healing of the fracture occurred in 15 patients (88.2%). Revision surgery was not necessary in any of the patients. Mean visual analogue scale (VAS) at the final follow-up was 2.4, and mean patient satisfaction score was 7.1. Percutaneous transarticular atlantoaxial fixation in elderly patients offers a good minimally invasive operative treatment in this multimorbid group of patients. This new technique with short operative time is well tolerated by the geriatric patients leading to a healing rate up to 88%. 4.

Multimorbidity patterns and associations with functional limitations among an aging population in prison

ObjectivesCo-occurring chronic diseases are associated with functional limitations, particularly for the aging population ≥50 years old. Aging offenders (individual who are imprisoned) tend to have greater prevalence of chronic, mental health, and substance use disorders compared to non-imprisoned populations. Our primary aim was to determine patterns of co-occurring conditions associated with functional limitations among aging offenders. Materials and methodsWe included all male offenders from one correctional system who were ≥50 years old (n = 2270) and extracted diagnoses for chronic diseases, mental health, substance use disorders, and functional limitations from an electronic health record. We performed a principal factor analysis (PFA) to identify patterns and chi-square to determine if the multimorbid population (≥3 diagnoses) differed from peer groups in regard to functional limitations. ResultsThree patterns (chronic diseases, geriatric conditions, and mental health/substance use) emerged from PFA. Functional limitations were associated with the chronic disease pattern (p = .03) where the multimorbid group compared to non-multimorbid peers had 1.5 odds, 95% CI [1.0, 2.1], for having a physical impairment. The geriatric (p = .10) and mental health/substance use disorders (p = .07) patterns were not associated with having a functional limitation compared to the population without multiple diagnoses. Controlling for multimorbidity, functional limitations, and overlapping patterns, increasing age was the only significant factor (p = .02) associated with having a physical impairment. ConclusionThe chronic disease pattern was consistent with investigations that included non-imprisoned populations. However, the geriatric pattern was not significant, which was unexpected.