Presence Of Multimorbidity Research Articles

Abstract 49: Impact of Multimorbidity on Adherence to Follow-Up Recommendations for Long-Term Breast Cancer Survivors

Abstract Purpose: To study the impact of comorbidities, multimorbidity, second primary cancers and socioeconomic determinants on adherence to follow-up recommendations for long-term breast cancer survivors (LTBCS), defined as women who survive 5 years or more after a primary breast cancer. Methods: We identified women diagnosed with breast cancer between 2000-2006 and followed-up between 2012-2016, including those with at least one contact with health services (n=2,078). Follow-up recommendations for LTBCS in Spain include 1 annual visit plus 1 image test. A woman was considered adherent with >50% of years with annual image test and visit throughout follow-up period. Multivariate logistic regression models were adjusted to determine the relationship between adherence and comorbidities and multimorbidity (2 or more chronic diseases) and other clinical and sociodemographic variables. A hierarchical cluster analysis was used to define specific multimorbidity clusters. A sensitivity analysis was conducted with mammogram as specific image test. Statistical significance was considered at 5% level. Results: Adherence to recommendations was 79.5% and 63.3% when considering mammograms only. We observed a higher adherence among LTBCS with multimorbidity, in those <70 years old, and with 5 to 9 years of survivorship. In the multivariate models, age under 40 years (OR=4.2; 95%CI: 2.3-7.6), a survivorship time between 5-9 years (OR=1.4; 95%CI: 1.1-1.8) and the metabolic and degenerative (OR=2.2 CI95%: 1.4-3.5) and thyroid disorders clusters (OR=2 IC95% 1.1-3.6) were associated with adherence. Similar results were observed in adjusted analyses by mammogram. In both analyses all multimorbidity clusters presented more adherence than LTBCS without chronic comorbidities. LTBCS with higher deprivation were found more adherent than LTBCS less deprived. Our results suggest a higher adherence among women experiencing second primary cancers, but the results were not statistically significant (OR=1.22; 95%CI: 0.8-2.0). Conclusion: There are differences in adherence according to age, survivorship time, and presence of multimorbidity. These results suggest a moderate adherence to the current follow-up recommendations for certain groups, making it necessary to adapt clinical practice guidelines considering the comorbidities and characteristics of the patients. Citation Format: Laia Domingo, David Abbad, Mercè Comas, Paula Santiá, Anna Jansana, Xavier Castells, Maria Sala. Impact of Multimorbidity on Adherence to Follow-Up Recommendations for Long-Term Breast Cancer Survivors [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 49.

Depression and anxiety in people with cognitive impairment and dementia during the COVID-19 pandemic: Analysis of the English Longitudinal Study of Ageing.

Some studies have identified declines in mental health during the Coronavirus Disease 2019 (COVID-19) pandemic in different age groups, including older people. As anxiety and depression are common neuropsychiatric symptoms among people with cognitive impairment, the mental health experiences of older people during the pandemic should take cognitive function into consideration, along with assessments made prior to the pandemic. This study addresses evidence gaps to test whether changes in depression and anxiety among older people through the COVID-19 pandemic were associated with cognitive impairment. It also investigates whether associations varied according to key sources of sociodemographic inequality. Using data from the English Longitudinal Study of Ageing (ELSA) collected from 2018/2019 to November/December 2020, we estimated changes in depression and anxiety for people aged 50+ in England across 3 cognitive function groups: no impairment, mild cognitive impairment, and dementia. Conditional growth curve models were estimated for continuous measures over 3 time points (N = 5,286), with mixed-effects logistic regression used for binary measures. All models adjusted for demographics (age, gender, ethnicity, and cohabiting partnership), socioeconomics (education, wealth, and employment status), geography (urban/rural and English region), and health (self-rated and the presence of multimorbidity). We found that depression (measured with CES-D score) worsened from 2018/2019 to November/December 2020 for people with mild cognitive impairment (1.39 (95% CI: 1.29 to 1.49) to 2.16 (2.02 to 2.30)) or no impairment (1.17 (95%CI: 1.12 to 1.22) to 2.03 (1.96 to 2.10)). Anxiety, using a single-item rating of 0 to 10 also worsened among those with mild cognitive impairment (2.48 (2.30 to 2.66) to 3.14 (2.95 to 3.33)) or no impairment (2.20 (2.11 to 2.28) to 2.85 (2.77 to 2.95)). No statistically significant increases were found for those with dementia. Using a clinical cutoff for likely depression (CES-D ≥4), we found statistically significant increases in the probability of depression between 2018/2019 and November/December 2020 for those with no impairment (0.110 (0.099 to 0.120) to 0.206 (0.191 to 0.222)) and mild impairment (0.139 (0.120 to 0.159) to 0.234 (0.204 to 0.263)). We also found that differences according to cognitive function that existed before the pandemic were no longer present by June/July 2020, and there were no statistically significant differences in depression or anxiety among cognitive groups in November/December 2020. Wealth and education appeared to be stronger drivers for depression and anxiety, respectively, than cognitive impairment. For example, those with no impairment in the richest two-thirds scored 1.76 (1.69 to 1.82) for depression in June/July, compared to 2.01 (1.91 to 2.12) for those with no impairment in the poorest third and 2.03 (1.87 to 2.19) for those with impairment in the poorest third. Results may be limited by the small number of people with dementia and are generalizable only to people living in the community, not to those in institutional care settings. Our findings suggest a convergence in mental health across cognitive function groups during the pandemic. This suggests mental health services will need to meet an increased demand from older adults, especially those not living with cognitive impairment. Further, with little significant change among those with dementia, their existing need for support will remain; policymakers and care practitioners should ensure this group continues to have equitable access to mental health support.

Multimorbity in brazilian elderly and the relationship with the use of health services

The presence of multimorbidity is considered a public health problem, responsible for a great pressure on health services. The present study aimed to assess the prevalence of multimorbidity and its association to the use of health services by Brazilian elderly people. Method: A cross-sectional, quantitative study with population-based survey data (PNS-2013). The sample consisted of 11,177 Brazilians aged 60 years or older. Multimorbidity was considered as a dependent variable and the use of health services as independent. The results were analyzed by the chi-square test. The sample consisted mostly of individuals aged among 60 and 69 years (55.8%), men (59.2%), white (47.5%), married (43.0%), who studied up to primary education (37.6%) and with an income of less than 1 minimum wage (45.5%). The prevalence of multimorbidity was 46.9%. Elderly people with multimorbidity used health services significantly more, having attended 4 or more medical appointments (p<0.001), required hospitalization (p<0.001) and needed emergency care at home (p<0.001). Brazilian elderly people have a high prevalence of multimorbidity and this condition significantly affects the demand for health services, whether primary and secondary, such as medical consultations and emergency and tertiary care, such as hospitalization.

Multimorbidity, healthcare utilization, and quality of life for older patients undergoing surgery: A prospective study.

Multimorbidity (≥2 chronic illnesses) is a worldwide healthcare challenge. Patients with multimorbidity have a reduced quality of life and higher mortality than healthy patients and use healthcare resources more intensively. This study investigated the prevalence of multimorbidity; examined the effects of multimorbidity on healthcare utilization; healthcare costs of multimorbidity; and compared the associations between the health-related quality of life (HRQoL) of older patients undergoing surgery and multimorbidity, the Charlson Comorbidity Index (CCI), the Simple Frailty Questionnaire (FRAIL), and the American Society of Anesthesiologists (ASA) physical status classifications. This prospective cohort study enrolled 360 patients aged > 65 years scheduled for surgery at a university hospital. Data were collected on their demographics, preoperative medical profiles, healthcare costs, and healthcare utilization (the quantification or description of the use of services, such as the number of preoperative visits, multiple-department consultations, surgery waiting time, and hospital length of stay). Preoperative-assessment data were collected via the CCI, FRAIL questionnaire, and ASA classification. HRQoL was derived using the EQ-5D-5L questionnaire. The 360 patients had a mean age of 73.9 ± 6.6 years, and 37.8% were men. Multimorbidity was found in 285 (79%) patients. The presence of multimorbidity had a significant effect on healthcare utilization (≥2 preoperative visits and consultations with ≥2 departments). However, there was no significant difference in healthcare costs between patients with and without multimorbidity. At the 3-month postoperative, patients without multimorbidity had significantly higher scores for HRQoL compared to those with multimorbidity (HRQoL = 1.00 vs 0.96; P < .007). While, patients with ASA Class > 2 had a significantly lower median HRQoL than patients with ASA Class ≤2 at postoperative day 5 (HRQoL = 0.76; P = .018), 1-month (HRQoL = 0.90; P = .001), and 3-months (HRQoL = 0.96; P < .001) postoperatively. Multimorbidity was associated with a significant increase in the healthcare utilization of the number of preoperative visits and a greater need for multiple-department consultations. In addition, multimorbidity resulted in a reduced HRQoL during hospital admission and 3-months postoperatively. In particular, the ASA classification > 2 apparently reduced postoperative HRQoL at day 5, 1-month, and 3-months lower than the ASA classification ≤2.

Presence of Multi-Morbidities and Colorectal Cancer Screening Utilization among Breast Cancer Survivors.

Our study aimed to examine the association between the presence of chronic diseases with guideline-concordant colorectal cancer (CRC) screening utilization among breast cancer survivors. We analyzed data among women with a history of breast cancer from the 2016, 2018, and 2020 Behavioral Risk Factor Surveillance System. Receipt of guideline-concordant CRC screening was the outcome of interest. Diabetes, coronary heart disease/myocardial infarction, stroke, chronic obstructive pulmonary disease, emphysema/chronic bronchitis, arthritis, depressive disorder, or kidney diseases were included in chronic disease conditions. Among 1324 survivors, those with multi-morbidities (3+ chronic diseases; 88.3%) had higher CRC screening use compared to those with one (84.4%) or two (85.4%) diseases (p-value < 0.05). In multivariable analysis, survivors with multi-morbidities were two times more likely to have CRC screening compared to those with only one disease (OR, 2.10; 95% CI, 1.11-3.98). Among survivors with multi-morbidities, Black women (OR, 14.07; 95% CI, 5.61-35.27), and those with frequent poor physical health (OR, 3.32; 95% CI, 1.57-7.00) were positively associated with CRC screening use. Conversely, survivors with frequent poor mental health were 67% less likely to receive CRC screening (OR, 0.33; 95% CI, 0.14-0.74). Among breast cancer survivors, multi-morbidities were positively associated with CRC screening.

Temporal Trend of Multimorbidity of Noncommunicable Diseases among Brazilian Adults, 2006–2021

We aimed to identify the temporal trend of multimorbidity of noncommunicable disease (NCDs) among Brazilian adults (n = 784,479) over a 16-year period of time. This is a time series of cross-sectional studies based on data from the Surveillance System of Risk and Protective Factors for Chronic Diseases by Telephone Survey (Vigitel) from 2006 to 2021. The presence of multimorbidity was assessed from the co-occurrence of (1) obesity and diabetes; (2) obesity and hypertension; and (3) obesity and diabetes and/or hypertension. Linear regression models (Prais–Winsten) were used to identify significant trends for the complete period (2006–2021) and the most recent quinquennium (2017–2021). Multimorbidity of obesity and diabetes and/or hypertension increased in the complete period (5.5% to 9.6%; 0.22 pp/year) and the most recent period (8.3% to 9.6%; 0.40 pp/year) studied. The highest increase occurred especially among men, older adults, and those with fewer years of education. Additionally, there was a high prevalence and an intense increase in multimorbidity among adults with poor self-rated health. These results reinforce the need for expanding and strengthening public health actions focused on individuals with multimorbidity especially with obesity.

Multimorbidity in patients with low back pain in Danish chiropractic practice: a cohort study

BackgroundPeople with multimorbidity, defined as the co-existence of two or more chronic conditions in an individual, often suffer from pain and functional limitations caused by musculoskeletal disorders and the chronic conditions. In chiropractic practice, two thirds of patients are treated for low back pain (LBP). It is unknown to what extent LBP is accompanied with chronic conditions in chiropractic practice. The objective was to determine the prevalence of multimorbidity among patients with LBP in chiropractric practice and to investigate if multimorbidity affects pain intensity, self-rated health, physical and mental health. Finally, to explore if individuals with multimorbidity have a different recovery for the LBP.MethodsPatients presenting with a new episode of LBP were recruited from 10 chiropractic clinics in 2016–2018. Patient-reported data concerning socio-demographics, self-rated health, pain intensity, history of LBP, mental health and chronic conditions were collected at baseline. The prevalence of multimorbidity was determined. To evaluate differences in recovery from the LBP, we estimated changes in the Roland Morris Disability Questionnaire (RMDQ) score and use of pain medication at baseline, 2 weeks, 3 months and 12 months. The analyses were adjusted using regression models.Results2083 patients were included at baseline and 71%, 68% and 64% responded to follow-up questionnaires at 2 weeks, 3 and 12 months. 1024 (49%) participants reported to have at least one chronic condition and 421 (20%) had multimorbidity (≥ 2 chronic conditions). The presence of multimorbidity was associated with increased odds of poor self-rated health (OR 2.13), physical fitness (OR 1.79), poor muscular strength (OR 1.52), poor endurance (OR 1.51), and poor balance (OR 1.33). Patients with high LBP intensity combined with multimorbidity showed a poorer recovery than patients without chronic diseases (mean difference in RMDQ score 3.53 at 12 months follow-up). More patients with multimorbidity used pain medication for LBP at 12 months follow-up compared to those without chronic disease (OR 2.36).ConclusionsChiropractors should be aware that patients with LBP may suffer from multimorbidity with poor general health. Patients with multimorbidity also have poorer recovery from LBP than people without chronic disease and clinical follow-up may be indicated.

Food insecurity and its association with health and well-being in middle-aged and older adults in India

AimFood insecurity is a global public health concern; however, there is limited knowledge about its health impacts in India. We examined the associations of food insecurity with socioeconomic conditions, chronic...

Handgrip strength in older adults from Antioquia-Colombia and comparison of cutoff points for dynapenia

Handgrip strength is a predictor of functional impairment and presence of morbimortality in older adults. However, appropriate reference values and cutoff points are required for its optimal use. This study describes handgrip characteristics in the older adult population of Antioquia-Colombia and compares the dynapenia handgrip cutoffs proposed for Colombians with international criteria. A cross-sectional study including 1592 older adults was done. Dynapenia prevalence by handgrip was analyzed using the following cutoffs: European Consensus of Sarcopenia (2018), Asian Working Group for Sarcopenia (2019), Chilean (2018), and Colombian (2019). Handgrip strength significantly decreased with aging, showing a positive and strong association with functional and health parameters. The highest prevalence of dynapenia was found with the Asian Consensus cutoffs (26.1%) and the lowest with the Colombian cutoffs (0.8%). Low agreement was found between the Colombian cutoffs with the European Consensus (kappa = 0.059; p < 0.001), the Asian Consensus (kappa = 0.039; p < 0.001) and the Chilean proposal (kappa = 0.053; p < 0.001). Dynapenia using the Chilean, European, and Asian cutoffs was associated with physical inactivity, presence of multimorbidity, slow gait speed, nutritional risk, and low calf circumference. Meanwhile, the Colombian cutoffs was only associated with slow gait speed and low calf circumference. The handgrip cutoffs proposed for Colombians seems to underestimate the dynapenia prevalence in older people from Antioquia. Furthermore, these cutoff points did not show associations with relevant functional and health parameters. The handgrip cutoffs proposed for Colombians should be used with caution.

Health-Seeking Behavior and its Determinants for Different Noncommunicable Diseases in Elderly.

Steady improvement in quality of life has led to increased survival time of elderly, especially of those with noncommunicable diseases. A study about their health-seeking behavior (HSB) and its determinants is essential for provision of comprehensive care and facilitate policy development. A cross-sectional study was conducted among 350 elderly participants over 60 years of age in an urbanized village of Delhi. Data was collected using a semi-structured questionnaire, and detailed general and systemic examination was done. Tests of significance were applied to assess the HSB with various demographic, clinico-social, and economic variables. A total of 87.4% of the study population was suffering from at least one noncommunicable disease (NCD). Majority of the study subjects' NCDs (72.66%) were diagnosed while getting treatment for a symptom of the disease. Also, 52.94% of the participants had inappropriate HSB. HSB was significantly associated with gender, age, duration of illness, and importantly with modifiable variables like the level of literacy, distance of preferred health facility, and presence of multimorbidity. HSB was found to be inappropriate in over half of the participants. Policymaking should focus on modifiable variables like education, distance of health facility, and multimorbidity, especially for commonly ignored diseases like osteoarthritis and diabetes.

Factors associated with health-related quality of life among home-dwelling older adults aged 75 or older in Switzerland: a cross-sectional study

BackgroundHRQoL is an indicator of individuals’ perception of their overall health, including social and environmental aspects. As a multidimensional concept, HRQoL can be influenced by a multitude of factors. Studies of HRQoL and factors associated with it among home-dwelling older adults have often been limited to inpatient settings or to a sub-population with a chronic disease. Studying HRQoL and its correlating factors among this population, by providing an ecological lens on factors beyond the individual level, can provide a better understanding of the construct and the role of the environment on how they perceive their HRQoL. Thus, we aimed to assess the HRQoL and investigate the correlates of HRQOL among home-dwelling older adults, guided by the levels of the ecological model.MethodsThis is a cross-sectional population survey conducted in 2019 in Canton Basel-Landschaft, in northwestern Switzerland, and includes a sample of 8786 home-dwelling older adults aged 75 and above. We assessed HRQoL by using the EQ-index and the EQ-VAS. The influence of independent variables at the macro, meso and micro level on HRQoL was tested using Tobit multiple linear regression modelling.ResultsWe found that having a better socio-economic status as denoted by higher income, having supplementary insurance and a higher level of education were all associated with a better HRQoL among home-dwelling older adults. Furthermore, being engaged in social activities was also related to an improved HRQoL. On the other hand, older age, female gender, presence of multimorbidity and polypharmacy as well as social isolation and loneliness were found to all have a negative impact on HRQoL.ConclusionsUnderstanding factors related to HRQoL by using an ecological lens can help identify factors beyond the individual level that impact the HRQoL of home-dwelling older adults. Our study emphasises the importance of social determinants of health and potential disparities that exists, encouraging policymakers to focus on policies to reduce socio-economic disparities using a life-course approach, which consequently could also impact HRQoL in later stages of life.

Association between risk, duration and cause of hospitalisations in people with rheumatoid arthritis and multimorbidity in the UK Biobank and Scottish Early Rheumatoid Arthritis (SERA) cohorts: Longitudinal observational study

ObjectivesTo investigate association between presence of multimorbidity in people with established and early rheumatoid arthritis (RA) and risk, duration and cause of hospitalisations. DesignLongitudinal observational study. SettingUK Biobank, population-based cohort recruited between 2006 and 2010, and the Scottish Early Rheumatoid Arthritis (SERA), inception cohort recruited between 2011 and 2015. Both linked to mortality and hospitalisation data. Participants4757 UK Biobank participants self-reporting established RA; 825 SERA participants with early RA meeting the 2010 ACR/EULAR classification criteria. Participants stratified by number of long-term conditions (LTCs) in addition to RA (RA only, RA + 1 LTC and RA + ≥ 2 LTCs) and matched to five non-RA controls. Main outcome measuresNumber and duration of hospitalisations and their causes. Incidence rate ratios (IRR) and 95% confidence intervals (CI) calculated using negative binomial regression models. ResultsParticipants with RA + ≥ 2 LTCs experienced higher hospitalisation rates compared to those with RA alone (UK Biobank: IRR 2.10, 95% CI 1.91 to 2.30; SERA: IRR 1.74, 95% CI 1.23 to 2.48). Total duration of hospitalisation in RA + ≥ 2 LTCs was also higher (UK Biobank: IRR 2.48, 95% CI 2.17 to 2.84; SERA: IRR 1.90, 95% CI 1.07 to 3.38) than with RA alone. Rate and total duration of hospitalisations was higher in UK Biobank RA participants than non-RA controls with equivalent number of LTCs. Hospitalisations for respiratory infection were higher in early RA than established RA and were the commonest cause of hospital admission in early RA. ConclusionsParticipants with established or early RA with multimorbidity experienced a higher rate and duration of hospitalisations than those with RA alone and with non-RA matched controls.

Long-Term Maintenance of Cardiorespiratory Fitness Gains After Cardiac Rehabilitation Reduces Mortality Risk in Patients With Multimorbidity.

The objective of this study was to characterize the impact of multimorbidity and cardiorespiratory fitness (CRF) on mortality in patients completing cardiac rehabilitation (CR). This cohort study included data from patients with a history of cardiovascular disease (CVD) completing a 12-wk CR program between January 1996 and March 2016, with follow-up through March 2017. Patients were stratified by the presence of multimorbidity, which was defined as having a diagnosis of ≥2 noncommunicable diseases (NCDs). Cox regression analyses were used to evaluate the effects of multimorbidity and CRF on mortality in patients completing CR. Symptom-limited exercise tests were completed at baseline, immediately following CR (12 wk), with a subgroup completing another test at 1-yr follow-up. Peak metabolic equivalents (METs) were determined from treadmill speed and grade. Of the 8320 patients (61 ± 10 yr, 82% male) included in the analyses, 5713 (69%) patients only had CVD diagnosis, 2232 (27%) had CVD+1 NCD, and 375 (4%) had CVD+≥2 NCDs. Peak METs at baseline (7.8 ± 2.0, 6.9 ± 2.0, 6.1 ± 1.9 METs), change in peak METs immediately following CR (0.98 ± 0.98, 0.83 ± 0.95, 0.76 ± 0.95 METs), and change in peak METs 1 yr after CR (0.98 ± 1.27, 0.75 ± 1.17, 0.36 ± 1.24 METs) were different ( P < .001) among the subgroups. Peak METs at 12 wk and the presence of coexisting conditions were each predictors ( P < .001) of mortality. Improvements in CRF by ≥0.5 METS from baseline to 1-yr follow-up among patients with or without multimorbidity were associated with lower mortality rates. Increasing CRF by ≥0.5 METs improves survival regardless of multimorbidity status.

Growing old with antiretroviral therapy or elderly people in antiretroviral therapy: two different profiles of comorbidity?

BackgroundIn persons living with HIV (PLWH), the burden of non-communicable chronic diseases increased over time, because of aging associated with chronic inflammation, systemic immune activation, and long-term exposure to the combination antiretroviral therapy (ART).MethodsTo explore the association of chronological age, age at first ART, and exposure to ART with non-communicable chronic diseases, we performed a cross-sectional analysis to evaluate the prevalence of comorbidities in patients enrolled in the SCOLTA Project, stratified by groups of chronological age (50–59 and 60–69 years) and by years of antiretroviral treatment (ART, ≤ 3 or > 3 years).ResultsIn 1394 subjects (23.8% women), mean age at enrollment was 57.4 (SD 6.5) years, and at first ART 45.3 (SD 10.7). Men were older than women both at enrollment (57.6 vs 56.8, p = 0.06) and at first ART (45.8 vs 43.6, p = 0.0009). ART duration was longer in women (13.1 vs 11.7 years, p = 0.01). The age- and sex-adjusted rate ratios (aRRs, and 95% confidence interval, CI) showed that longer ART exposure was associated with dyslipidemia (aRR 1.35, 95% CI 1.20–1.52), hypertension (aRR 1.52, 95% CI 1.22–1.89), liver disease (aRR 1.78, 95% CI 1.32–2.41), osteopenia/osteoporosis (aRR 2.88, 95% CI 1.65–5.03) and multimorbidity (aRR 1.36, 95% CI 1.21–1.54). These findings were confirmed in strata of age, adjusting for sex.ConclusionsOur data suggest that longer ART exposure was associated with increased risk of dyslipidemia, hypertension, and osteopenia/osteoporosis, hence the presence of multimorbidity, possibly due to the exposition to more toxic antiretrovirals. We observed different comorbidities, according to ART exposure and age.

Multimorbidity, healthcare use and catastrophic health expenditure by households in India: a cross-section analysis of self-reported morbidity from national sample survey data 2017–18

BackgroundThe purpose of this research is to generate new evidence on the economic consequences of multimorbidity on households in terms of out-of-pocket (OOP) expenditures and their implications for catastrophic OOP expenditure.MethodsWe analyzed Social Consumption Health data from National Sample Survey Organization (NSSO) 75th round conducted in the year 2017–2018 in India. The sample included 1,13,823 households (64,552 rural and 49,271 urban) through a multistage stratified random sampling process. Prevalence of multimorbidity and related OOP expenditure were estimated. Using Coarsened Exact Matching (CEM) we estimated the mean OOP expenditure for individuals reporting multimorbidity and single morbidity for each episode of outpatient visits and hospital admission. We also estimated implications in terms of catastrophic OOP expenditure for households.ResultsResults suggest that outpatient OOP expenditure is invariably lower in the presence of multimorbidity as compared with single conditions of the selected Non-Communicable Diseases(NCDs) (overall, INR 720 [USD 11.3] for multimorbidity vs. INR 880 [USD 14.8] for single). In the case of hospitalization, the OOP expenditures were mostly higher for the same NCD conditions in the presence of multimorbidity as compared with single conditions, except for cancers and cardiovascular diseases. For cancers and cardiovascular, OOP expenditures in the presence of multimorbidity were lower by 39% and 14% respectively). Furthermore, around 46.7% (46.674—46.676) households reported incurring catastrophic spending (10% threshold) because of any NCD in the standalone disease scenario which rose to 63.3% (63.359–63.361) under the multimorbidity scenario. The catastrophic implications of cancer among individual diseases was the highest.ConclusionsMultimorbidity leads to high and catastrophic OOP payments by households and treatment of high expenditure diseases like cancers and cardiovascular are under-financed by households in the presence of competing multimorbidity conditions. Multimorbidity should be considered as an integrated treatment strategy under the existing financial risk protection measures (Ayushman Bharat) to reduce the burden of household OOP expenditure at the country level.

Impact of multimorbidity on long-term outcomes in older adults with non-ST elevation acute coronary syndrome in the North East of England: a multi-centre cohort study of patients undergoing invasive care

ObjectivesOlder adults have a higher degree of multimorbidity, which may adversely affect longer term outcomes from non-ST elevation acute coronary syndrome (NSTE-ACS). We investigated the impact of multimorbidity on cardiovascular...

Correlates of Adherence of Multimodal Non-pharmacological Interventions in Older Adults With Mild Cognitive Impairment: A Cross-Sectional Study.

BackgroundNon-pharmacological interventions are promising for delaying cognitive decline in older adults with mild cognitive impairment (MCI). Although some studies have demonstrated adherence rates and factors influencing participation in single modality non-pharmacological interventions, little is known about the level and correlates of adherence to multimodal non-pharmacological interventions (MNPIs) in older adults with MCI.ObjectiveThis study aimed to explore the adherence level and the correlates of adherence to MNPIs in older adults with MCI.MethodsA cross-sectional design was employed. Community-dwelling older adults aged 60 years and over were recruited from senior community centers and healthcare centers in Huzhou from March 2019 to December 2020. Data were collected by a general information questionnaire and the adherence scale of cognitive dysfunction management (AS-CDM) in older adults with MCI. Hierarchical regression analyses were applied to explore the correlates of adherence to MNPIs.ResultsA total of 216 completed questionnaires were finally analyzed. Of these, 68.52% were female, and 45.4% of the participants had no less than 6 years of education. The overall mean score for adherence was 117.58 (SD = 10.51) out of 160, equivalent to 73.49 in the hundred-mark system, indicating a medium-level adherence to MNPIs in older adults with MCI. Of the five dimensions of adherence (AS-CDM), self-efficacy scored the highest, and the lowest was perceived barriers. The univariate analysis showed that the factors associated with the adherence to MNPIs were: regular physical exercise, meat-vegetable balance, absence of multimorbidity, high level of education, living alone, and living in urban (p < 0.05). In the hierarchical regression analysis, the final model explained 18.8% of variance in overall adherence (p < 0.01), which high school (Beta = 0.161, p < 0.05), college and above more (Beta = 0.171, p < 0.05), meat-vegetarian balance (Beta = 0.228, p < 0.05), regular physical exercise (Beta = 0.234, p < 0.05), and presence of multimorbidity (Beta = −0.128, p < 0.05) significantly contributed to adherence. In addition, nearly 80% of older adults with MCI preferred MNPIs.ConclusionEarly assessment and management of adherence to MNPIs were essential in older adults with MCI. Furthermore, the findings shed light on several critical areas of intervention to improve adherence to MNPIs in older adults with MCI.Clinical Trial Registrationhttp://www.chictr.org.cn/showproj.aspx?proj=35363, ChiCTR1900020950 (Registered on January 23, 2019).

Psychological distress, multimorbidity and health services among older adults in rural South Australia

ObjectivePsychological distress may relate to higher health services use. However, data on psychological distress and health services use among rural older adults are limited. This study investigates psychological distress in older adults (aged ≥60) and evaluates the relationship between psychological distress, multimorbidity and health services utilization. DesignA cross-sectional design was adopted using data on older adults (≥60) (n = 5920) from the South Australia's 2013–2017 population health survey. The Modified Monash Model MM2–7 was used to designate rural areas. The dataset provides information on reported physical health conditions, psychological distress, and patterns of health services use. The Kessler Psychological Distress Scale (K10) was used to compute scores for reported mental health disorders in this population. ResultsThe mean (SD) age of the study participants was 72.1 (8.1) years. Women constituted 58.8% of the sample. The mean (SD) score for psychological distress was 12.5 (3.6). One-fourth (33.7%) report one-chronic condition, 20.4% reported 2 chronic conditions and 13% had more than 3 chronic conditions. High psychological distress was associated with female gender (χ2 = 14.4, p < 0.001), <80 years (χ2 = 11.7, p = 0.019), lower education (χ2 = 10.9, p = 0.027). Similarly, multimorbidity was associated with female gender (χ2 = 51.1, p < 001), increasing age (χ2 = 173.6, p < 0.001) and lower education (χ2 = 28.8 p < 0.001). Psychological distress and multimorbidity were independently associated with health service use. High psychological distress was associated with general practitioner (GP) visit (odds ratio 3.6 (95% CI 2.6–5.1), p < 0.001), emergency department (ED) visit (odds ratio 2.5 (95% CI 1.2–5.0), p < 0.001) and hospital admission (odds ratio 2.3 (95% CI 1.3–4.3), p < 0.001). Multimorbidity was associated with general practitioner (GP) visit (odds ratio 6.8 (95% CI 5.6–8.3), p < 0.001), emergency department (ED) visit (odds ratio 2.5 (95% CI 1.4–4.3), p < 0.001) and hospital admission (odds ratio 3.1 (95% CI 1.9–5.1), p < 0.001). Model included age, gender, education, number of chronic condition and psychological distress. Conclusion/implicationPsychological distress and multimorbidity were independently associated with health services use. Thus, psychological distress, particularly in the presence of multimorbidity, presents an opportunity for intervention by clinicians that may reduce the demand on rural health services.

Clinical characteristics and risk factors for mortality in patients with COVID-19: A retrospective nationwide study in Malaysia

BackgroundAge and multiple comorbidities have been reported to influence the case fatality rate of COVID-19 worldwide, so also in Malaysia; however, to date, no scientific study among the local population has been published to confirm this. This study aimed to determine the overall demographics and clinical characteristics of COVID-19 non-survivors in Malaysia, stratified by age (< 65 vs. ≥ 65 years old). The mortality was also compared between two half-year periods: March–August 2020 and September 2020–March 2021.MethodDaily reports containing demographics and medical history of COVID-19 non-survivors from March 2020 to March 2021 were obtained from the Malaysian Ministry of Health website. All information was extracted retrospectively and analysed using descriptive and inferential statistics with SPSS.ResultsOf 1192 COVID-19 non-survivors, the overall mean (SD) age was 64.8 (15.7) years, with 64.7% male. Death was seen mostly among 50- to 64-year-olds (33.1%) and 65- to 74-year-olds (24.8%). The presence of underlying hypertension (61.8%) and diabetes mellitus (48.2%) were the most common comorbid diseases encountered in the COVID-19 non-survivors. Underlying hypertension, stroke, heart disease and dyslipidaemia were significantly higher among COVID-19 non-survivors who were ≥ 65 years old compared to those < 65 (p < 0.05). Mortality was a lot higher in September 2020–March 2021 compared to March 2020–August 2020 (91.3% vs. 8.3%).ConclusionOlder age, male gender and the presence of multimorbidity (hypertension, diabetes mellitus, stroke and heart disease) are risk factors that contribute to mortality due to COVID-19 in Malaysia, especially among those ≥ 65 years old.

Sedentary behavior and association with multimorbidity and patterns of multimorbidity in elderly Brazilians: data from the Brazilian National Health Survey, 2019

Sedentary behavior emerges as an important determinant of health in elderly persons, but its relationship to multimorbidity and its patterns in the Brazilian population have received little attention in epidemiological studies. Such associations can assist the elaboration of public policies aimed at modification of this behavior. This study thus aimed to assess the association between sedentary behavior and multimorbidity and its patterns in elderly Brazilians. This was a cross-sectional study of 43,554 elderly Brazilians in the Brazilian National Health Survey, 2019. Self-reported SB was categorized as < 3; 3-6; and > 6 hours a day. The presence of multimorbidity and its patterns were analyzed by self-report of two or more chronic diseases, where the three established patterns considered the diseases with similar clinical characteristics: (1) cardiopulmonary; (2) vascular-metabolic; and (3) mental-musculoskeletal. The associations were measured by binary logistic regression. Elderly persons that spent 3-6 hours/day in sedentary behavior had lower odds (OR = 1.39; 95%CI: 1.29; 1.50) of presenting multimorbidity, vascular-metabolic pattern (OR = 1.39; 95%CI: 1.29; 1.50), and mental-musculoskeletal pattern (OR = 1.11; 95%CI: 1.00; 1.24). Sedentary behavior > 6 hours/day was associated with higher odds of multimorbidity (OR = 1.58; 95%CI: 1.43; 1.74) and the cardiopulmonary (OR = 1.73; 95%CI: 1.33; 2.27), vascular-metabolic (OR = 1.49; 95%CI: 1.35; 1.64), and mental-musculoskeletal (OR = 1.15; 95%CI: 1.01; 1.31) patterns when compared to elders with 3 hours/day of sedentary behavior. This showed that extensive time in sedentary behavior is a relevant risk factor for multimorbidity and its patterns in the elderly.