Multimorbidity In Older Adults Research Articles

Association between multimorbidity and cognitive decline in the elderly population of the Eastern Province, Saudi Arabia.

Cognitive decline affects the quality of life, and dementia affects independence in daily life activities. Multimorbidity in older adults is associated with a higher risk of cognitive impairment. This research aims to study the relationship between cognitive decline and multimorbidity in the elderly population in the Eastern Province, Saudi Arabia. This cross-sectional research was conducted from July to October 2022 among adults over 60 years. All patients with two or more comorbidities were contacted for a face-to-face interview and cognitive testing to estimate cognitive function by trained family physicians using St. Louis University Mental State Examination. ANOVA and Chi-square test were used to test for statistical significance. Binary logistic regression was used to show the odds of having cognitive impairment and multimorbidity. All tests were performed at 5% level of significance. The study involved 343 individuals; majority (74.1%) aged 60-75 years and were males (67.9%). Hypertension, diabetes, and chronic pain were reported by 56%, 48%, and 44% participants, respectively. Thirty percent participants had 3 or more comorbidities. About 36% had mild neurocognitive disorder and 31.2% had dementia. The results showed that age, gender (female), diabetes, stroke, chronic pain, and multimorbidity were significantly associated with cognitive impairment. In our study, hypertension, coronary artery diseases, depression, and anxiety were not significantly associated with risk of cognitive decline. Our study found that multimorbidity is significantly associated with cognitive decline. Controlling comorbidities and preventing risk factors in midlife could help in delaying the progression of the disease.

Abstract P304: Sex Differences for the Progression of Cardiovascular Multimorbidity in Older Adults in the United States

Introduction: Understanding the progression of cardiovascular multimorbidity and recognizing differences are needed to develop effective strategies to improve health outcomes. There is a knowledge gap in the potential unequal burden and progression of cardiovascular multimorbidity. Our objective is to investigate sex differences in the progression of cardiovascular multimorbidity among older adults in the US and estimate relative life expectancies among patients with severe multimorbidity. Hypothesis: We hypothesized that life expectancy among older adults with severe cardiovascular multimorbidity is inversely related to the number of comorbid conditions and progresses more acutely in males. Methods: Repeated cross-sectional cohort study of inpatient, outpatient, and carrier claims for a 5% nationwide Medicare sample. We included Medicare beneficiaries aged 65 or older enrolled in Medicare Fee-For-Service program from 2010 to 2020 and living in the continental US. Multistate life table models were employed to estimate cardiovascular disease (CVD) progression and total life expectancies from ages 65 to 85 years. Progression probabilities and life expectancies were adjusted for age, non-cardiovascular comorbidities, and Medicaid dual eligibility. A microsimulation approach was utilized to derive life tables, and bootstrapping was used to estimate variability. The primary outcome was the development and progression of cardiovascular multimorbidity, defined by the number of major cardiovascular conditions (atrial fibrillation, acute myocardial infarction, heart failure, stroke, and chronic ischemic heart disease). Comorbidities were assessed using validated algorithms based on diagnostic codes billed over a 1-year lookback period, and beneficiaries were followed forward from their index date. Results: Of 2,189,633 beneficiaries, the median age was 69, median follow-up was 5 years, and 55.9% were female. For male beneficiaries, odds of developing cardiovascular comorbidities were significantly higher than for females, with odds ratios ranging from 1.20 (95% CI 1.19-1.21) for one CVD to 1.97 (95% CI 1.88-2.06) for 1 or more of the 4 CVD comorbidities. Men with 1 CVD at baseline had significant odds of developing 2 (OR: 1.10, 95% CI 1.09-1.11) and four CVDs (OR: 1.29, 95% CI 1.24-1.34), as well as a significant mortality risk (OR: 1.19, 95% CI 1.18-1.21). However, for men with 4 CVDs, the odds of progressing to 5 were not significant (OR: 1.00, 95% CI 0.97-1.04). Across levels of baseline multimorbidity, male beneficiaries had significantly elevated mortality risks compared to females, with the highest risk for those with no baseline CVD (OR: 1.50, 95% CI 1.48-1.52). Conclusions: These findings suggest persistent sex differences in cardiovascular multimorbidity progression, identifying a potentially important target for the improvement of health outcomes.

Determinants of multimorbidity in older adults in Iran: a cross-sectional study using latent class analysis on the Bushehr Elderly Health (BEH) program

Background and objectivesMultimorbidity, defined as the presence of two or more long-term health conditions in an individual, is one of the most significant challenges facing health systems worldwide. This study aimed to identify determinants of classes of multimorbidity among older adults in Iran.Research Design and methodsIn a cross-sectional sample of older adults (aged ≥ 60 years) from the second stage of the Bushehr Elderly Health (BEH) program in southern Iran, latent class analysis (LCA) was used to identify patterns of multimorbidity. Multinomial logistic regression was conducted to investigate factors associated with each multimorbidity class, including age, gender, education, household income, physical activity, smoking status, and polypharmacy.ResultsIn 2,426 study participants (mean age 69 years, 52% female), the overall prevalence of multimorbidity was 80.2%. Among those with multimorbidity, 3 latent classes were identified. These comprised: class 1, individuals with a low burden of multisystem disease (56.9%); class 2, individuals with predominantly cardiovascular-metabolic disorders (25.8%) and class 3, individuals with predominantly cognitive and metabolic disorders (17.1%). Compared with men, women were more likely to belong to class 2 (odds ratio [OR] 1.96, 95% confidence interval [CI] 1.52–2.54) and class 3 (OR 4.52, 95% CI 3.22–6.35). Polypharmacy was associated with membership class 2 (OR 3.52, 95% CI: 2.65–4.68) and class 3 (OR 1.84, 95% CI 1.28–2.63). Smoking was associated with membership in class 3 (OR 1.44, 95% CI 1.01–2.08). Individuals with higher education levels (59%) and higher levels of physical activity (39%) were less likely to belong to class 3 (OR 0.41; 95% CI: 0.28–0.62) and to class 2 (OR 0.61; 95% CI: 0.38–0.97), respectively. Those at older age were less likely to belong to class 2 (OR 0.95).Discussion and implicationsA large proportion of older adults in Iran have multimorbidity. Female sex, polypharmacy, sedentary lifestyle, and poor education levels were associated with cardiovascular-metabolic multimorbidity and cognitive and metabolic multimorbidity. A greater understanding of the determinants of multimorbidity may lead to strategies to prevent its development.

Association of Depression With the Progression of Multimorbidity in Older Adults: A Population-Based Cohort Study

The relationship between depression and the risk of multimorbidity progression has rarely been studied in older adults. This study was aimed to determine whether depression is associated with progression in the severity and complexity of multimorbidity, considering the influence of depression's severity and subtype. As a part of the Korean Longitudinal Study on Cognitive Aging and Dementia, this population-based cohort study followed a random sample of community-dwelling Koreans aged 60 and older for 8 years at 2-year intervals starting in 2010. Participants included those who completed mood and multimorbidity assessments and did not exhibit complex multimorbidity at the study's outset. Depression was assessed using the Geriatric Depression Scale, while multimorbidity was evaluated using the Cumulative Illness Rating Scale. The study quantified multimorbidity complexity by counting affected body systems and measured multimorbidity severity by averaging scores across 14 body systems. The 2,486 participants (age = 69.1 ± 6.5 years, 57.6% women) were followed for 5.9 ± 2.4 years. Linear mixed models revealed that participants with depression had a faster increase in multimorbidity complexity score (β = .065, SE = 0.019, p = 0.001) than those without depression, but a comparable increase in multimorbidity severity score (β = .001, SE = .009, p = 0.870) to those without depression. Cox proportional hazard models revealed that depression was associated with the risk of developing highly complex multimorbidity affecting five or more body systems, particularly in severe or anhedonic depression. Depression was associated with the worsening of multimorbidity in Korean older adults, particularly when severe or anhedonic. Early screening and management of depression may help to reduce the burden of multimorbidity in older adults.

Association of changes in waist circumference, waist-to-height ratio and weight-adjusted-waist index with multimorbidity among older Chinese adults: results from the Chinese longitudinal healthy longevity survey (CLHLS)

BackgroundThe association of changes in waist circumference (WC), waist-to-height ratio (WHtR) and weight-adjusted-waist index (WWI) with subsequent risk of multimorbidity remains unclear among older Chinese adults. Therefore, we aimed to assess this association by utilizing data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS).MethodsOur study was based on the 2011/2012 wave of the CLHLS whose follow-up surveys were conducted in 2014 and 2017/2018. A total of 2900 participants aged 65 and above at baseline were enrolled. WC, WHtR, and WWI were calculated from measured height, weight, and waist circumference. Multimorbidity refers to the coexistence of two or more of 18 chronic diseases. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (95%CIs) to evaluate the effect of three-year changes in WC, WHtR, and WWI on the risk of multimorbidity.ResultsDuring a mean follow-up time of 4.2 (2.0) years, 906 multimorbidity cases were identified. Compared to participants in the persistently low WC group, those in the WC gain group and the persistently high WC group had a higher multimorbidity risk with adjusted HRs (95%CI) of 1.23 (1.01–1.50) and 1.34(1.14–1.58), respectively. Participants in the WHtR gain group and the persistently high WHtR group also had higher risks of multimorbidity with HRs (95%CI) of 1.35 (1.08–1.67) and 1.27 (1.05–1.53), respectively, relative to the persistently low WHtR group. Compared to the persistently low WWI group, those in the WWI loss group had a lower risk of multimorbidity with HRs (95%CI) of 0.80 (0.66–0.98). For every standard deviation increase in WC, WHtR, and WWI over three years, the risk of multimorbidity was higher by 12% (95%CI: 1.05–1.19), 13% (95%CI: 1.06–1.20), and 12% (95%CI: 1.05–1.20), respectively.ConclusionsAssociations of changes in WC, WHtR and WWI with multimorbidity are significant among older Chinese adults. The findings highlight the importance of evaluating changes in WC, WHtR, and WWI in screening and prevention of multimorbidity in older adults.

Longitudinal clustering of health behaviours and their association with multimorbidity in older adults in England: A latent class analysis.

Health-risk behaviours such as smoking, unhealthy nutrition, alcohol consumption, and physical inactivity (termed SNAP behaviours) are leading risk factors for multimorbidity and tend to cluster (i.e. occur in specific combinations within distinct subpopulations). However, little is known about how these clusters change with age in older adults, and whether and how cluster membership is associated with multimorbidity. Repeated measures latent class analysis using data from Waves 4-8 of the English Longitudinal Study of Ageing (ELSA; n = 4759) identified clusters of respondents with common patterns of SNAP behaviours over time. Disease status (from Wave 9) was used to assess disorders of eight body systems, multimorbidity, and complex multimorbidity. Multinomial and binomial logistic regressions were used to examine how clusters were associated with socio-demographic characteristics and disease status. Seven clusters were identified: Low-risk (13.4%), Low-risk yet inactive (16.8%), Low-risk yet heavy drinkers (11.4%), Abstainer yet inactive (20.0%), Poor diet and inactive (12.9%), Inactive, heavy drinkers (14.5%), and High-risk smokers (10.9%). There was little evidence that these clusters changed with age. People in the clusters characterised by physical inactivity (in combination with other risky behaviours) had lower levels of education and wealth. People in the heavy drinking clusters were predominantly male. Compared to other clusters, people in the Low-risk and Low-risk yet heavy drinkers had a lower prevalence of all health conditions studied. In contrast, the Abstainer but inactive cluster comprised mostly women and had the highest prevalence of multimorbidity, complex multimorbidity, and endocrine disorders. High-risk smokers were most likely to have respiratory disorders. Health-risk behaviours tend to be stable as people age and so ought to be addressed early. We identified seven clusters of older adults with distinct patterns of behaviour, socio-demographic characteristics and multimorbidity prevalence. Intervention developers could use this information to identify high-risk subpopulations and tailor interventions to their behaviour patterns and socio-demographic profiles.

Multimorbidade em idosos e seus fatores associados em 2010 e 2021

Abstract The present study aimed to compare the factors associated with multimorbidity in older adults aged 60 to 69 years, in 2010 and 2021. This is a comparative cross-sectional study, comprised of other two cross-sectional studies. Both data collections were individually conducted by trained interviewers through household surveys in the municipality of Coxilha-RS, Brazil. Bivariate inferential analysis was conducted using Fisher's exact test and chi-square test, while multivariate analysis employed Poisson regression with robust variance with a significance level of p 0.05. It was observed that the prevalence of multimorbidity significantly decreased, decreasing from 66.5% in 2010 to 41.6% in 2021. Dependency for basic and instrumental activities of daily living was associated with higher prevalence of multimorbidity in the year 2010. However, in 2021, being dependent on instrumental activities, being unable to read/write, and being unemployed showed higher prevalence for multimorbidity. In conclusion, it is evident that the health conditions of older adults differed significantly over the years, highlighting the necessity for a reevaluation of healthcare practices to become more effective

Multimorbidity in older adults and its associated factors in 2010 and 2021

Resumo O presente estudo teve como objetivo comparar os fatores associados à multimorbidade em idosos de 60 a 69 anos, em 2010 e 2021. Trata-se de um estudo transversal comparativo, composto por dois estudos transversais. Ambas as coletas de dados foram realizadas de forma individual por entrevistadores treinados e deu-se por inquérito domiciliar, no município de Coxilha-RS, Brasil. Utilizou-se para análise inferencial bivariada, exato de Fisher e qui-quadrado, e multivariada o teste de regressão de Poisson com variância robusta com nível de significância de p 0,05. Detectou-se que a prevalência de multimorbidade teve uma diminuição significativa, passando de 66,5% em 2010, para 41,6% em 2021. Ser dependente para atividades básicas e instrumentais da vida diária associou-se a maior prevalência para a multimorbidade no ano de 2010, contudo no ano de 2021 o ser dependente para atividades instrumentais, não saber ler/escrever e não trabalhar apresentou maior prevalência para a multimorbidade. Por fim, concluise que as condições de saúde dos idosos diferiram significativamente apontando que os cuidados de saúde também precisam ser reavaliados para tornarem-se mais efetivos

Diet Quality and Multimorbidity in Older Adults: A Prospective Cohort Study.

The role of diet quality in the accumulation of multiple chronic conditions is mostly unknown. This study examined diet quality in association with the number of chronic conditions and the rate of multimorbidity development among community-dwelling older adults. We used data from 2784 adults aged ≥65 years from the Seniors-ENRICA 2 cohort. Diet quality was assessed at baseline (2015-17) with the Alternate Healthy Eating Index-2010 (AHEI-2010) and the Mediterranean Diet Adherence Screener (MEDAS). Information on medical diagnoses was obtained from electronic clinical records up to 2021. Higher adherence to the AHEI-2010 was associated with a lower number of total chronic conditions (β [95% CI] quartile 4 vs 1: -0.57 [-0.86 to 0.27], p trend < .001] and cardiometabolic conditions (-0.30 [-0.44 to -0.17], p trend < .001) at baseline, while higher adherence to the MEDAS was associated with a lower number of total chronic conditions (-0.30 [-0.58 to -0.02], p trend = .01) and neuropsychiatric and neurodegenerative conditions (-0.09 [-0.17 to -0.01], p trend = .01). After a median follow-up of 5.2 years (range: 0.1-6.1 years) higher adherence to the AHEI-2010 was associated with a lower increase in chronic conditions (β [95% confidence interval] quartile 4 vs 1: -0.16 [-0.30 to -0.01], p trend = .04) and with lower rate of chronic disease accumulation. Higher diet quality, as measured by the AHEI-2010, was associated with a lower number of chronic health conditions and a lower rate of multimorbidity development over time.

Longitudinal clustering of risk behaviours and their association with multimorbidity in older adults

Abstract Smoking, unhealthy nutrition, alcohol consumption, and physical inactivity (SNAP risk behaviours) are leading risk factors for multimorbidity and tend to cluster within specific subpopulations. Little is known about how these clusters change with age in older adults and their association with multimorbidity. Repeated measures latent class analysis using data from Waves 4-8 of the English Longitudinal Study of Ageing (n = 4759) identified clusters of respondents with common patterns of SNAP behaviours over time. Disease status (from Wave 9) was used to assess eight body system disorders, multimorbidity, and complex multimorbidity. Logistic regressions examined how clusters were associated with socio-demographic characteristics and disease status. Seven clusters were identified: Low-risk (13.4%), Low-risk yet inactive (16.8%), Low-risk yet heavy drinkers (11·4%), Abstainer yet inactive (20%), Poor diet and inactive (12.9%), Inactive, heavy drinkers (14.5%), and High-risk smokers (10·9%). There was little evidence these clusters changed with age. Clusters characterised by physical inactivity (in combination with other risky behaviours) were associated with lower levels of education and wealth. The heavy drinking clusters were predominantly male. Compared to other clusters, Low-risk and Low-risk yet heavy drinkers had a lower prevalence of all diseases studied. In contrast, the Abstainer but inactive cluster comprised mostly women and had the highest prevalence of multimorbidity, complex multimorbidity, and endocrine disorders. High-risk smokers were most likely to have respiratory disorders. Health-risk behaviours tend to be stable as people age and ought to be addressed early. By identifying seven clusters of older adults with distinct behaviour patterns, socio-demographic characteristics, and disease prevalence, our study provides valuable information for identifying high-risk subpopulations and tailoring interventions to their behaviour patterns and socio-demographic profiles. Key messages • We identified seven clusters of older adults with distinct behaviour patterns, socio-demographic characteristics and disease prevalence. • Health-risk behaviours tend to be stable as people age and ought to be addressed early.

My Wellbeing Journal: Development of a communication and goal-setting tool to improve care for older adults with chronic conditions and multimorbidity.

Chronic conditions and multimorbidity, the presence of two or more chronic conditions, are increasingly common in older adults. Effective management of chronic conditions and multimorbidity in older adults requires a collaborative and person-centred approach that considers the individual's goals, preferences and priorities. However, ensuring high-quality personalised care for older adults with multimorbidity can be challenging due to the complexity of their care needs, limited time and a lack of patient preparation to discuss their personal goals and preferences with their healthcare team. To codesign a communication and goal-setting tool, My Wellbeing Journal, to support personalised care planning for older adults with chronic conditions and multimorbidity. We drew on an experience-based codesign approach to develop My Wellbeing Journal. This article reports on the final end-user feedback, which was collected via an online survey with older adults and their carers. Older adults with chronic conditions, multimorbidity and informal carers living in Australia. Personalised care planning was considered in the context of primary care. A total of 88 participants completed the online survey. The survey focused on participants' feedback on the tool in terms of effectiveness, efficiency, satisfaction and errors encountered. This feedback resulted in modifications to My Wellbeing Journal, which can be used during clinical encounters to facilitate communication, goal setting and progress tracking. Clinicians and carers can use the tool to guide discussions with older adults about their care planning and help them set realistic goals that are meaningful to them. The findings of this study could be used to inform the development of recommendations for healthcare providers to implement person-centred, goal-oriented care for older adults with chronic conditions and multimorbidity. Older adults living with chronic conditions and multimorbidity and their carers have contributed to the development of a tool that has the potential to significantly enhance the experience of personalised care planning. Their direct involvement as collaborators has ensured that the tool is optimised to meet the standards of effectiveness and usability.

Literature Review of Frailty and Multi-morbidity in Older Adults: Exploring the Complex Relationship

In older adults, frailty and multi-morbidity are common conditions that lead to the increase vulnerability, healthcare outcomes and poor physical and mental health outcomes. This literature review contributes to the study of the complex and dynamic relationship of multi-morbidity and frailty. It also emphasizes various other factors that contribute to the frailty irrespective of presence of multi-morbidities. On dissecting existing literature, it is observed that high physical activity levels and functional independence play pivotal role on older adults in development of frailty. The presence of multiple morbidities and co-morbidity are indicators for development of risk of frailty. The targeted rehabilitation and treatment plan can help older adults to achieve good health outcomes in frail multi-morbid older adults. The frailty scoreis recognized tool for assessment of chronic stress and frailty known as Rockwood score system. The score system presents insightsinto frailty and multiple morbidity of older adults. Keywords: Frailty, older adults, multi-morbidity, functionality, Rockwood Frailty Score, comorbidity.

Technologies for frailty, comorbidity, and multimorbidity in older adults: a systematic review of research designs

BackgroundFrailty, neurodegeneration and geriatric syndromes cause a significant impact at the clinical, social, and economic level, mainly in the context of the aging world. Recently, Information and Communication Technologies (ICTs), virtual reality tools, and machine learning models have been increasingly applied to the care of older patients to improve diagnosis, prognosis, and interventions. However, so far, the methodological limitations of studies in this field have prevented to generalize data to real-word. This review systematically overviews the research designs used by studies applying technologies for the assessment and treatment of aging-related syndromes in older people.MethodsFollowing the PRISMA guidelines, records from PubMed, EMBASE, and Web of Science were systematically screened to select original articles in which interventional or observational designs were used to study technologies’ applications in samples of frail, comorbid, or multimorbid patients.ResultsThirty-four articles met the inclusion criteria. Most of the studies used diagnostic accuracy designs to test assessment procedures or retrospective cohort designs to build predictive models. A minority were randomized or non-randomized interventional studies. Quality evaluation revealed a high risk of bias for observational studies, while a low risk of bias for interventional studies.ConclusionsThe majority of the reviewed articles use an observational design mainly to study diagnostic procedures and suffer from a high risk of bias. The scarce presence of methodologically robust interventional studies may suggest that the field is in its infancy. Methodological considerations will be presented on how to standardize procedures and research quality in this field.

Prospective Association Between Plasma Concentrations of Fatty Acids and Other Lipids, and Multimorbidity in Older Adults.

Biological mechanisms that lead to multimorbidity are mostly unknown, and metabolomic profiles are promising to explain different pathways in the aging process. The aim of this study was to assess the prospective association between plasma fatty acids and other lipids, and multimorbidity in older adults. Data were obtained from the Spanish Seniors-ENRICA 2 cohort, comprising noninstitutionalized adults ≥65 years old. Blood samples were obtained at baseline and after a 2-year follow-up period for a total of 1 488 subjects. Morbidity was also collected at baseline and end of the follow-up from electronic health records. Multimorbidity was defined as a quantitative score, after weighting morbidities (from a list of 60 mutually exclusive chronic conditions) by their regression coefficients on physical functioning. Generalized estimating equation models were employed to assess the longitudinal association between fatty acids and other lipids, and multimorbidity, and stratified analyses by diet quality, measured with the Alternative Healthy Eating Index-2010, were also conducted. Among study participants, higher concentrations of omega-6 fatty acids [coef. per 1-SD increase (95% CI) = -0.76 (-1.23, -0.30)], phosphoglycerides [-1.26 (-1.77, -0.74)], total cholines [-1.48 (-1.99, -0.96)], phosphatidylcholines [-1.23 (-1.74, -0.71)], and sphingomyelins [-1.65 (-2.12, -1.18)], were associated with lower multimorbidity scores. The strongest associations were observed for those with a higher diet quality. Higher plasma concentrations of omega-6 fatty acids, phosphoglycerides, total cholines, phosphatidylcholines, and sphingomyelins were prospectively associated with lower multimorbidity in older adults, although diet quality could modulate the associations found. These lipids may serve as risk markers for multimorbidity.

Research trends in the mental health and multimorbidity of older people from 2002 to 2022: A bibliometric analysis via CiteSpace.

Using bibliometric analysis, the objective of this study was to identify research hotspots and trends on multimorbidity and mental health in older adults. This could help guide future research on this topic. We searched the Web of Science Core Collection for eligible studies. Type of publications were not restricted and the timeframe was set between 2002 and 2022. Knowledge maps were created using CiteSpace to visualize publications, nations, journals, institutions, authors, cited references, and keywords. Microsoft Excel displayed pertinent tables. A total of 216 studies were collected for analysis. The annual publication over the past 20 years demonstrated an upward trend. The main contributors in publications were in North America, Europe, Asia, and Oceania, of which aging was a primary issue. However, collaboration between countries, institutions, and authors were relatively sparce. Cluster analysis and co-citation analysis of references and keywords revealed that the research field could be subdivided into four themes: social psychology as the fundamental disciplinary base, Prevalence of mental disorders and multimorbidity in older adults, pertinent health conditions, and effective interventions. Research trends at present lies in health status, risk factors of prognoses, and effective interventions for prevention and management. The results revealed a reciprocal risk relationship between mental health and multimorbidity. Mental disorders such as depression and anxiety in older adults with multimorbidity garnered considerable interest in the defined population, and further exploration is still promising. Substantial studies on evidence-based prevention and treatment strategies are warranted for improved prognoses.

Instruments Measuring Self-Care and Self-Management of Chronic Conditions by Community-Dwelling Older Adults: A Scoping Review.

Given the high prevalence of chronic conditions and multimorbidity in older adults, there is a need to better conceptualize and measure self-care and self-management to promote a person-centered approach. This scoping review aimed to identify and map instruments measuring self-care and self-management of chronic conditions by older adults. We searched six electronic databases, charted data from the studies and tools and reported the results in accordance with the PRISMA-ScR guidelines. A total of 107 articles (103 studies) containing 40 tools were included in the review. There was substantial variation in the tools in terms of their aims and scope, structure, theoretical foundations, how they were developed, and the settings in which they have been used. The quantity of tools demonstrates the importance of assessing self-care and self-management. Consideration of the purpose, scope, and theoretical foundation should guide decisions about tools suitable for use in research and clinical practice.

Managing medical and psychiatric multimorbidity in older patients.

Aging increases susceptibility both to psychiatric and medical disorders through a variety of processes ranging from biochemical to pharmacologic to societal. Interactions between aging-related brain changes, emotional and psychological symptoms, and social factors contribute to multimorbidity - the presence of two or more chronic conditions in an individual - which requires a more patient-centered, holistic approach than used in traditional single-disease treatment guidelines. Optimal treatment of older adults with psychiatric and medical multimorbidity necessitates an appreciation and understanding of the links between biological, psychological, and social factors - including trauma and racism - that underlie physical and psychiatric multimorbidity in older adults, all of which are the topic of this review.

PATTERNS OF MULTIMORBIDITY IN AGING, RADIATION-EXPOSED NON-HUMAN PRIMATES

Abstract Resilience to stressors is a major component of biological aging and may mediate the onset of multimorbidity in older adults. The Wake Forest Non-Human Primate Radiation Survivor Cohort (RSC) provides a novel opportunity to study aging and resilience in 250 rhesus macaques (Macaca mulatta) with single-dose radiation exposures 0–15 years prior and 50 controls with semi-annual clinical, imaging, and biomarker measurements taken over their lifespan. Multimorbidity is extremely common among irradiated animals. Only 38% of animals have none of 20 common chronic diseases, falling to 16% of animals over age 8 and 11% over age 10 (middle-aged animals). 70% of animals have 5 or more diagnoses in this oldest cohort. The presence of any one disease increases the likelihood of having a second, co-morbid condition. Nevertheless, some animals continue disease-free until late in life, highlighting substantial variability in resilience. To identify patterns of multimorbidity, survival curves for each diagnosis were generated for age and time since radiation and k-median clustered resulting in four groupings of aging-associated morbidities. Bone, brain, and gastrointestinal disorders arise 3.5 years after radiation on average, followed by skin, heart, and cataracts. At 4.65 years, animals are at increased risk of being underweight and overweight and developing diabetes, hypertension, and hepatic dysfunction. Tumor, lung, and kidney disorders arise approximately 6 years after exposure. In all cases, these age-related disorders occur significantly earlier in irradiated animals than controls. These findings highlight the clustering of multimorbidities in aging, radiation-challenged primates and the potential of the RSC in studying resilience.

Patterns and Determinants of Multimorbidity in Older Adults: Study in Health-Ecological Perspective.

(1) Background: Multimorbidity has become one of the key issues in the public health sector. This study aims to explore the patterns and health-ecological factors of multimorbidity in China to propose policy recommendations for the management of chronic diseases in the elderly. (2) Methods: A multi-stage random sampling method was used to conduct a questionnaire survey on 3637 older adults aged 60 and older in Shanxi, China. Association rule mining analysis (ARM) and network analysis were applied to analyze the patterns of multimorbidity. The health-ecological model was adopted to explore the potential associated factors of multimorbidity in a multidimensional perspective. A hierarchical multiple logistic model was employed to investigate the association strengths reflected by adjusted odds ratios and 95% confidence. (3) Results: Multimorbidity occurred in 20.95% of the respondents. The graph of network analysis showed that there were 6 combinations of chronic diseases with strong association strengths and 14 with moderate association strengths. The results of the ARM were similar to the network analysis; six dyadic chronic disease combinations and six triadic ones were obtained. Hierarchical multiple logistic regression indicated that innate personal traits (age, history of genetics, and body mass index), behavioral lifestyle (physical activity levels and medication adherence), interpersonal network (marital status), and socioeconomic status (educational level) were the common predictors of multimorbidity for older adults, among which, having no family history was found to be a relative determinant as a protective factor for multimorbidity after controlling the other covariates. (4) Conclusions: multimorbidity was prevalent in older adults and most disease combinations are associated with hypertension, followed by diabetes. This shows that diabetes and hypertension have a high prevalence among older adults and have a wide range of associations with other chronic diseases. Exploring the patterns and associated factors of multimorbidity will help the country prevent complications and avoid the unnecessary use of the health service, adopting an integrated approach to managing multimorbidity rather than an individual disease-specific approach and implementing different strategies according to the location of residence.

Sedentary behavior is associated with disability and multimorbidity in older adults during the COVID-19 pandemic: a cross-sectional survey

Objective: We described sedentary behavior during the COVID-19 pandemic in Brazilian older adults and explored whether highly sedentary behavior was associated with multimorbidity, physical activity levels, adoption of physical distancing, perceived social isolation, disability, and depressive symptoms. Methods: We surveyed 184 older adults and gathered information on sedentary behavior, multimorbidity, physical activity, adoption of social distancing, perceived social isolation, disability, and depressive symptoms. Then, we investigated the association between highly sedentary behavior and these factors. Results: 26% of participants reported high levels of sedentary behavior, spending 5 hours per day in sitting (median). Highly sedentary behavior during COVID-19 pandemic was associated with multimorbidity (OR: 2.78, 95% CI 1.12-6.89) and disability (OR: 1.08, 95% CI 1.02-1.16). Conclusion: The prevalence of highly sedentary behavior in older adults during the pandemic was 26%. High sedentary behavior was associated with disability and multimorbidity in them. These findings can be used to guide the academia, the public sector, and health professionals to develop integrated initiatives to monitor and to decrease sedentary behavior especially in older adults with disability and multimorbidity during and beyond the COVID-19 pandemic.