Presence Of Multiple Chronic Diseases Research Articles

Oxidative stress and antioxidant status mong the elderly in Jakarta

Background: Indonesia is experiencing a demographic shift, with the elderly population comprising 9.92% (26.82 million) of the total population, 8.21% of whom reside in Jakarta. Oxidative stress is a key contributor to the development of degenerative diseases associated with aging, while antioxidant defenses can mitigate its effects. Objective: This study aimed to assess oxidative stress levels, measured by malondialdehyde (MDA), and antioxidant status, including catalase, reduced glutathione (GSH), and vitamin C, in the elderly population of Jakarta. Methods: A cross-sectional study was conducted with 91 elderly participants from three sub-districts in Jakarta. Erythrocyte lysate samples were analyzed to measure MDA, catalase, and GSH levels, while plasma was used to measure vitamin C. All parameters were quantified using a spectrophotometer. MDA levels and antioxidant status were categorized based on age, blood pressure, and the number of chronic diseases, with statistical analysis performed using the Kruskal-Wallis test. Results: The median MDA level was 2.68 (1.61–5.64) nmol/mL, with the highest levels observed in participants aged 60–64 and those with three chronic diseases. The mean catalase level was 2.41 ± 0.39 U/mL, the median GSH level was 6.16 (2.02–128.07) µmol/mL, and the mean vitamin C level was 10.87 ± 4.9 µg/mL. No significant differences in antioxidant status were observed based on age, blood pressure, or the number of chronic diseases. Conclusion: Oxidative stress is prevalent in the elderly and is particularly influenced by the presence of multiple chronic diseases. However, antioxidant status does not significantly vary with age, blood pressure, or disease burden in this population.

The factors related to depressive symptoms in urban older adults in South Korea: a study based on the Seoul Aging Survey

PurposeThis study aims to comprehensively examine the determinants of depression among urban older adults in Seoul, utilizing the social-ecological model to address multifaceted influences.MethodsA comprehensive analysis was conducted using data from the 2022 Seoul Aging Survey, which surveyed 2,914 individuals aged 65 and above. A multiple logistic regression analysis was performed to identify factors contributing to depressive symptoms, including socio-demographic characteristics, health behaviors and status, research accessibility, social support, and environmental influences.ResultsThis study revealed that poor subjective health (OR = 1.47) and the presence of multiple chronic diseases (OR = 1.59) significantly increased the risk of depressive symptoms among urban older adults. From a social support standpoint, living alone was associated with a higher risk of depression (OR = 1.66), low food security (OR = 2.56), and low digital competency (OR = 2.70) were all significant predictors of depressive symptoms. Additionally, a lack of engagement with cultural facilities (OR = 2.15) was identified as a critical environmental factor contributing to depression.ConclusionsThe findings underscore the need for comprehensive policy and practical interventions aimed at preventing chronic disease, enhancing social support networks, improving digital literacy, ensuring food security, and expanding access to healthcare and cultural facilities. Such measures are crucial in mitigating depression among urban older adults, thereby enhancing their overall well-being and quality of life.

Effects of multimorbidity and polypharmacy on blood pressure target attainment in patients with hypertension

Background Hypertension prevalence increases with age, as well as polypharmacy and multimorbidity (P&M), which are the use of multiple medications and the presence of multiple chronic diseases, respectively. Whether P&M affects attaining blood pressure (BP) goals is not clear. Methods Hypertensive patients in the general internal medicine outpatient clinic were evaluated retrospectively. Data regarding age, gender, comorbidities, medications, office BP (OBP), home BP (HBP), and ambulatory BP (ABP) were obtained. Having two or more diseases was classified as multimorbidity, whereas using five or more drugs was classified as polypharmacy. OBP

Dietary patterns and multiple chronic diseases in older adults

BackgroundThe prevalence rate of multiple chronic diseases among the elderly is relatively high, posing a risk to their health and also imposing a financial burden on them. Optimal dietary patterns have positive effects on multiple chronic diseases. This study aimed to identify dietary patterns associated with multiple chronic diseases in older adults.MethodsDietary intake was assessed through two non-consecutive 24-hour dietary recalls. The presence of multiple chronic diseases was assessed based on the existence of dyslipidemia, hypertension, chronic kidney disease, sleep disorders, diabetes, moderate or severe depressive symptoms, and cognitive impairment, with two or more of these conditions being considered. Latent class analysis was used to identify types of multiple chronic diseases, and two-step cluster analysis was used to determine individual dietary patterns. Logistic regression analysis with robust standard errors was conducted to determine the associations between dietary patterns and types of multiple chronic diseases.ResultsThree dietary patterns and three types of multiple chronic diseases were identified. Individuals following a diet rich in legumes, meat, vegetables and fruits (HLMVF dietary pattern) were 59% less likely to have the cardiometabolic cognitive impairment comorbidity (CCC) than those following a diet rich in milk and eggs but with low grain intake (HME-LG) (OR = 0.41, 95% CI: 0.27–0.64, P < 0.001) and 66% less likely to have the especially sleep disorders comorbidity (ESC) than those following a diet rich in grains but lacking milk and eggs (HG-LME) (OR = 0.34, 95% CI: 0.14–0.87, P < 0.05).DiscussionThe HLMVF dietary pattern may serve as a healthy dietary pattern to reduce the incidence of multiple chronic diseases and should be promoted among the older adult population.

Prioritized health outcomes of acutely hospitalized older patients.

Background: The population is ageing, leading to an increase in older patients visiting the Emergency Department (ED) and acute hospitalizations. Ageing is often accompanied by the presence of multiple chronic diseases, known as multimorbidity. This presence of multimorbidity challenges the application of treatment guidelines, that are generally focused on treating a single disease. Consequently, choosing the most fitting treatment option for the patient with multimorbidity often entails making a trade-off. A trade-off is a situational decision in which prioritization leads to a decrease of benefits for an outcome in return for gains in another. Insight in the health priorities of patients can aid in making this trade-off. Little is known about older patients’ health priorities while being hospitalized, especially for acute hospitalizations. Therefore, we aimed to explore the health priorities of acutely hospitalized older patients.&#x0D; Method: In this study we performed a post-hoc analysis of prospectively collected data by the Acutelines Bio- and Databank. Older hospitalized patients (aged ≥ 70 years) were included between September 2020 and October 2022 at the University Medical Centre Groningen, the Netherlands. Demographic, medical and survey data were collected. The primary outcome was the prioritized health outcome of the patient, assessed using the Outcome Prioritization Tool (OPT). Health outcomes of the OPT were life extension, maintain independence, reducing pain and reducing other complaints. Data were analyzed descriptively, whereafter two separate multivariate logistic regression analyses were performed to assess which factors are associated with prioritized health outcomes. For analysis, reducing pain and reducing other complaints were taken together and life extension was used as reference category.&#x0D; Preliminary Results: Three-hundred-ninety-nine older patients (mean age 76.7 ± 5.3) were included, with a median Charlson comorbidity score of five. Patients mainly experienced problems with their mobility (75%), somatic complaints (73%) and problems with activities in daily living (69%). Their self-rated health (0-100), based on two weeks before hospitalization, was scored with a mean of 55.5 ± 21.9. The main prioritized health outcome by patients was maintaining independence (42%), whereafter reducing pain (22%), life extension (20%) and reducing other complaints (16%) were ranked. When patients prioritized maintaining independence highest, life extension was most often the lowest priority. If patients did not prioritize maintaining independence highest, it was often prioritized as the second most important health outcome. The education level of the patient and the presence of cognitive impairment were associated more with maintaining independence compared to life extension. Experiencing fear and a lower self-rated health were associated more with reducing complaints compared to life extension. &#x0D; &#x0D; Conclusion: Our study showed that, despite being hospitalized for an acute problem, most patients prioritized maintaining independence. This is an interesting finding, as treatment guidelines focus on life extension and treating complaints. Our findings in acutely hospitalized older patients, emphasizes the importance of goal elicitation by healthcare professionals and alignment of a treatment plan to the patients’ goal. An increased awareness of this importance amongst healthcare professionals can lead to providing more optimally integrated care.

Effect of patient education and healthcare campaigns on medication adherence in co-morbid patients

Co-morbidities are characterized by the presence of multiple chronic diseases within a single individual. They pose an escalating healthcare challenge and managing this growing burden, particularly with non-communicable diseases, has become a major concern. However, a significant impediment to effective management lies in medication nonadherence. The importance of medication adherence has long been a focus of healthcare literature, yet many comorbid patients tend to underestimate its significance, leading to health deterioration. Research studies indicate alarmingly low adherence rates in comorbid patients. To address this issue, patient education and healthcare campaigns have become essential tools in enhancing adherence. The research, which commenced on October 19, 2023, was initiated after an exhaustive review of existing academic literature. Multiple databases, such as PubMed, Web of Science, and Cochrane, were employed for this comprehensive literature review, utilizing a wide array of medical terminology combinations. The study aims to shed light on potential strategies and educational approaches to enhance medication adherence in comorbid patients. Findings from this research have the potential to influence healthcare policy, the design of tailored interventions, and overall healthcare delivery improvements for co-morbid patients, ultimately leading to enhanced health outcomes, reduced costs, and an improved quality of life.

SARS-CoV2 Infection and Comorbidity in Inmates: A Study of Central Italy.

The presence of multiple chronic diseases is associated with an increase in mortality when related to COVID-19 infection. (i) to evaluate the association between the severity of the COVID-19 disease, defined as symptomatic hospitalized in prison or symptomatic hospitalized out of prison, and the presence of one or more comorbidities in two prisons in central Italy: L'Aquila and Sulmona; (ii) to describe the profiles of inmates using multiple correspondence analysis (MCA). A database was created including age, gender and clinical variables. The database containing anonymized data was password-protected. The Kruskal-Wallis test was used to evaluate a possible association between diseases and the severity of COVID-19 stratified by age groups. We used MCA to describe a possible characteristic profile of inmates. Our results show that in the 25-50-year-old age group (COVID-19-negative) in the L'Aquila prison, 19/62 (30.65%) were without comorbidity, 17/62 (27.42%) had 1-2 comorbidities and only 3.23% had >2 diseases. It is interesting to note that in the elderly group, the frequency of 1-2 or >2 pathologies was higher than in the younger group, and only 3/51 (5.88%) inmates did not have comorbidities and were COVID-19 negative (p = 0.008). The MCA identified the following profiles: the prison of L'Aquila showed a group of women over 60 with diabetes, cardiovascular and orthopedic problems, and hospitalized for COVID-19; the Sulmona prison presented a group of males over 60 with diabetes, cardiovascular, respiratory, urological, gastrointestinal and orthopedic problems, and hospitalized or symptomatic due to COVID-19. our study has demonstrated and confirmed that advanced age and the presence of concomitant pathologies have played a significant role in the severity of the disease: symptomatic hospitalized in the prison; symptomatic hospitalized out of the prison.

Racial Differences in the Effect of Alzheimer’s Disease on Adherence to Medication Therapy for Chronic Diseases

Multiple dementia (the presence of one or more types of dementia in a single individual) and multi-morbidity (the presence of multiple chronic diseases in an individual) present a major challenge to the U.S. healthcare system. The reduction in cognitive function associated with neurocognitive disorders such as Alzheimer’s Disease (AD) and Related Dementias (ADRD) reduce the ability of the affected individual to take care of him/herself. This can manifest as reduced adherence to medication regimens designed to manage other chronic conditions, in reduced ability to engage in healthy behavior such as exercise, or in other ways. The result is an increase in the probability of otherwise avoidable adverse health outcomes and related healthcare costs. In this study, we showcase two high impact chronic conditions common in the elderly: hypertension and type 2 diabetes mellitus (T2D). Using a 5% sample of the total Medicare population we identify groups of individuals with AD/ADRD and i) hypertension, ii) T2D or iii) both. Each group is then propensity-score-matched to similar individuals with hypertension, T2D or both but without a diagnosis of AD/ADRD. The primary explanatory variable of interest is the medication possession ratio (MPR) calculated at 1-year intervals for prescribed diabetes and/or hypertension medications. MPRs were compared between the two groups using t-tests and standardized differences each year after baseline and until death/censoring. A Cox proportional hazard model was then used to estimate differences in survival between these two groups and across race/ethnicity-related strata. Reduced adherence with time and notable race/ethnicity-related differences were identified.

The impact of multimorbidity patterns on health-related quality of life in the general population: results of the Belgian Health Interview Survey

BackgroundChronic diseases and multimorbidity are a major cause of disease burden—for patients, caregivers, and society. Little is known however about potential interaction effects between specific disease combinations. Besides an additive effect, the presence of multiple conditions could also act synergistically or antagonistically regarding the impact on patients’ health-related quality of life (HRQoL). The aim was to estimate the impact of coexisting chronic diseases on HRQoL of the adult general Belgian population.MethodsThe Belgian Health Interview Survey 2018 provided data on self-reported chronic conditions and HRQoL (EQ-5D-5L) for a nationally representative sample. Linear mixed models were used to analyze two-way and three-way interactions of disease combinations on HRQoL.ResultsMultimorbidity had a prevalence of 46.7% (≥ 2 conditions) and 29.7% (≥ 3 conditions). HRQoL decreased considerably with the presence of multiple chronic diseases. 14 out of 41 dyad combinations and 5 out of 13 triad combinations showed significant interactions, with a dominant presence of negative/synergistic effects. Positive/antagonistic effects were found in more subjective chronic diseases such as depression and chronic fatigue. Conditions appearing the most frequently in significant disease pair interactions were dorsopathies, respiratory diseases, and arthropathies.ConclusionsDiverse multimorbidity patterns, both dyads and triads, were synergistically or antagonistically associated with lower HRQoL. Tackling the burden of multimorbidity is needed, especially because most disease combinations affect each other synergistically, resulting in a greater reduction in HRQoL. Further knowledge about those multimorbidity patterns with a greater impact on HRQoL is needed to better understand disease burden beyond mortality and morbidity data.

Assessment of Medication Related Problems in Geriatrics Unit of Nigerian Tertiary Hospital

Medication related problems are prevalent especially in the geriatric populationandcancause considerable patient morbidity and in some cases death as well as increased health expenditure. The elderly population is at increased risk for medication related problems as a result of age – related physiological changes and the presence of multiple chronic diseases. Aim: This study aimed to assess medication related problems (MRP) in University of Port Harcourt Teaching Hospital, with the objective to identify and categorize the MRP according to types as well as identify the most frequent MRP encountered and interventions made by the pharmacists. Method: The study was a retrospective study carried out among 200 geriatric patientsrandomly sampled, over 18months period (January 2018 to June 2019). Data extracted include patients’ demographic information, prescribed medication and number, medical condition, and pharmacist’s intervention (where available) using data collection form. Information collected were categorized and analyzed statistically. Result: showed that female geriatric patients (64.4%) were more than male (35.5%). Most (43%) of the studied population were in the range of 60yrs – 70yrs. Out of the 200 patients assessed, 157 (78.4%) had medication related problems. Drug- drug interaction was the most frequently (64.4%) occurred MRP, as most (62.5%) of the studied group had 6 -10 medications in one prescription, and 12.5% had more than 10 medications in one prescription. Following drug interaction was incorrect drug administration (18.5%). Of the population studied, 56.5% of the patients were using their medication inappropriately. The major contributing factors responsible for these MRPs were comorbidities, poly-pharmacy, and medication non- adherence. Conclusion: The study identified categories of medication related problem in the geriatric Unit of the hospital and the need for pharmacists’ interventions.

Angiotensin Converting Enzyme (ACE) Inhibitor-Induced Cough Resulting in Prescribing Cascade

Objective: Prescribing cascade usually results from the misdiagnosis of a drug-related adverse event or condition. Although the prevalence of prescribing cascade remains unknown, it likely increases the risks associated with polypharmacy (e.g., adverse drug events). Furthermore, consequences of prescribing cascade are more likely to be detrimental for the elderly population due to the presence of multiple chronic diseases and the complexity of the derived medication regimen. This case aims to shed light on a particular prescribing cascade due to angiotensinconverting enzyme (ACE) inhibitor-induced cough. Case: A 101-year-old male with a past medical hypertension, osteoarthritis, gastroesophageal reflux disease, atrial fibrillation, hyperlipidemia, muscle weakness, and mild intermittent asthma was experiencing worsening of cough. To manage his hypertension, the patient was previously prescribed lisinopril and amlodipine. To control the cough, the patient was then prescribed benzonatate (Tessalon Perles®) and budesonideformoterol (Symbicort®). Lisinopril-induced cough was postulated; after the discontinuation of lisinopril and the initiation of losartan, the cough resolved. However, the use of the benzonatate and budesonide-formoterol was not re-evaluated. Conclusion: This case is an example of prescribing cascade resulting from a misdiagnosis of an ACE inhibitor-induced cough. Misdiagnosis may result in inappropriate prescribing of medications that increase the risks resulting from polypharmacy, such as adverse drug events. Pharmacists are uniquely positioned to intercept and avoid such prescribing cascade.

A Framework to Understand the Progression of Cardiovascular Disease for Type 2 Diabetes Mellitus Patients Using a Network Approach.

The prevalence of chronic disease comorbidity has increased worldwide. Comorbidity—i.e., the presence of multiple chronic diseases—is associated with adverse health outcomes in terms of mobility and quality of life as well as financial burden. Understanding the progression of comorbidities can provide valuable insights towards the prevention and better management of chronic diseases. Administrative data can be used in this regard as they contain semantic information on patients’ health conditions. Most studies in this field are focused on understanding the progression of one chronic disease rather than multiple diseases. This study aims to understand the progression of two chronic diseases in the Australian health context. It specifically focuses on the comorbidity progression of cardiovascular disease (CVD) in patients with type 2 diabetes mellitus (T2DM), as the prevalence of these chronic diseases in Australians is high. A research framework is proposed to understand and represent the progression of CVD in patients with T2DM using graph theory and social network analysis techniques. Two study cohorts (i.e., patients with both T2DM and CVD and patients with only T2DM) were selected from an administrative dataset obtained from an Australian health insurance company. Two baseline disease networks were constructed from these two selected cohorts. A final disease network from two baseline disease networks was then generated by weight adjustments in a normalized way. The prevalence of renal failure, fluid and electrolyte disorders, hypertension and obesity was significantly higher in patients with both CVD and T2DM than patients with only T2DM. This showed that these chronic diseases occurred frequently during the progression of CVD in patients with T2DM. The proposed network-based model may potentially help the healthcare provider to understand high-risk diseases and the progression patterns between the recurrence of T2DM and CVD. Also, the framework could be useful for stakeholders including governments and private health insurers to adopt appropriate preventive health management programs for patients at a high risk of developing multiple chronic diseases.

Multimorbidity in Portugal: Results from The First National Health Examination Survey

The simultaneous presence of multiple chronic diseases in the same individual is recognized as an important public health problem. Patients with multimorbidity have greater healthcare needs, which represents a higher burden on health services. Although there is no consensual definition of this concept, multimorbidity is usually defined as the presence of two or more chronic diseases in the same patient. The existence of evidence regarding multimorbidity will lead to more efficient management and treatment of these patients. In order to estimate the prevalence of multimorbidity and to identify the associated factors, a cross-sectional epidemiological study was developed based on data from the INSEF, a population-based survey conducted on a representative probability sample of the Portuguese population (n = 4911). The prevalence of multimorbidity was estimated for the total population and separately for men and women, stratified by age group, region, education and income. The magnitudes of the associations were measured by the adjusted prevalence ratios calculated by the Poisson regression model. Prevalence of multimorbidity was 38.3% (95% CI: 35.4% to 41.3%), with higher frequency in women, older people, Lisbon and Tagus Valley; Northern Portugal; Algarve and Alentejo regions and in those with lower academic qualifications. No association was found between multimorbidity and income. Multimorbidity affects more than one third of the Portuguese population. Epidemiological data about multimorbidity in Portugal allows the identification of population groups with higher multimorbidity prevalence. Our results, which highlight the greater risk of multimorbidity among older and less instructed people, are in line with the literature. These results show the relevance of multimorbidity patients and are especially important in the way how healthcare is organized and provided.

The relationship between multiple chronic diseases and depressive symptoms among middle-aged and elderly populations: results of a 2009 korean community health survey of 156,747 participants

BackgroundThe purpose of this study was to investigate the relationship between multiple chronic diseases and depressive symptoms in middle-aged and elderly populations.MethodsThis study was performed using the 2009 Korean Community Health Survey, which targeted adults over the age of 40 (N = 156,747 participants, 88,749 aged 40–59 years and 67,998 aged ≥60 years). The Korean version of the Center for Epidemiologic Studies Depression Scale (CES-D-K) was used as the measurement tool for depressive symptoms (CES-D-K score over 16). Multiple chronic diseases were defined as the concurrent presence of two or more chronic diseases.ResultsThe prevalence and risk ratios (RRs) of experiencing depressive symptoms increased in the presence of multiple chronic diseases and with the number of comorbidities. The RRs of experiencing depressive symptoms according to the presence of multiple chronic diseases were higher in the middle-aged population (adjusted RR, 1.939, 95% confidence limits (CL), 1.82-2.06) than in the elderly population (adjusted RR, 1.620, 95% CL, 1.55-1.69). In particular, middle-aged women who suffer from 4 or more chronic diseases have the highest RR (adjusted RR, 4.985, 95% CL, 4.13-6.03) for depressive symptoms.ConclusionsMultiple chronic diseases are closely associated with depressive symptoms in middle-aged and elderly populations. Given the mutual relationship between multiple chronic diseases and depressive symptoms, attention to and the assessment of depressive symptoms are needed in people with multiple chronic diseases.

Potentially Inappropriate Medications in the Elderly in Korean Long-Term Care Facilities.

BackgroundElderly residents of long-term care facilities are more vulnerable to being prescribed inappropriate medications because of the high incidence of co-medication in this population resulting from the presence of multiple chronic diseases and also age-related changes in pharmacokinetics and pharmacodynamics.ObjectiveWe evaluated the frequency of potentially inappropriate medications and factors influencing their frequency.MethodsA retrospective cross-sectional study was conducted in 20 long-term care facilities located in the northwest regions of South Korea for 824 patients aged 65 years and older who were assessed between January and February of 2012. Potentially inappropriate medications were identified using the 2012 American Geriatric Society’s Beers Criteria. We assessed the relationship between the frequency of potentially inappropriate medications prescribed and patient age, sex, co-medications, comorbidity, activities of daily living, length of stay, grade of long-term care insurance for seniors, and the bed size and business type of the long-term care facility.ResultsOf the 529 participants who satisfied our inclusion criteria, 308 (58.2 %) had received at least one inappropriate medication according to the 2012 Beers Criteria. The most frequently prescribed classes of inappropriate medications were central nervous system drugs (58.7 %), anti-cholinergics (21.2 %), and cardiovascular medications (10.8 %). The most commonly used drugs were quetiapine (28.4 %), chlorpheniramine (15.8 %), risperidone (6.5 %), and zolpidem (5.8 %). Inappropriate medication use was associated with the number of co-medications and long-term care insurance grade 3, which means less dependence and a requirement of low-level care.ConclusionsCentral nervous system drugs (58.7 %) were the most prescribed class of inappropriate medications. Quetiapine was the drug most often given inappropriately (28.4 %). There was a relationship between inappropriate medication use and the number of co-medications. The frequency of inappropriate medication prescriptions was higher among patients whose long-term care insurance for seniors was grade 3, which means less dependence and a requirement of low-level care.

Impact of medical and psychiatric multi-morbidity on mortality in diabetes: emerging evidence.

BackgroundMulti-morbidity, or the presence of multiple chronic diseases, is a major problem in clinical care and is associated with worse outcomes. Additionally, the presence of mental health conditions, such as depression, anxiety, etc., has further negative impact on clinical outcomes. However, most health systems are generally configured for management of individual diseases instead of multi-morbidity. The study examined the prevalence and differential impact of medical and psychiatric multi-morbidity on risk of death in adults with diabetes.MethodsA national cohort of 625,903 veterans with type 2 diabetes was created by linking multiple patient and administrative files from 2002 through 2006. The main outcome was time to death. Primary independent variables were numbers of medical and psychiatric comorbidities over the study period. Covariates included age, gender, race/ethnicity, marital status, area of residence, service connection, and geographic region. Cox regression was used to model the association between time to death and multi-morbidity adjusting for relevant covariates.ResultsHypertension (78%) and depression (13%) were the most prevalent medical and psychiatric comorbidities, respectively; 23% had 3+ medical comorbidities, 3% had 2+ psychiatric comorbidities and 22% died. Among medical comorbidities, mortality risk was highest in those with congestive heart failure (hazard ratio, HR = 1.92; 95% CI 1.89-1.95), Lung disease (HR = 1.42; 95% CI 1.40-1.44) and cerebrovascular disease (HR = 1.39; 95% CI 1.37-1.40). Among psychiatric comorbidities, mortality risk was highest in those with substance abuse (HR = 1.50; 95% CI 1.46-1.54), psychoses (HR = 1.16; 95% CI 1.14-1.19) and depression (HR = 1.05; 95% CI 1.03-1.07). There was an interaction between medical and psychiatric comorbidity (p = 0.003) so stratified analyses were performed. HRs for effect of 3+ medical comorbidity (2.63, 2.66, 2.15) remained high across levels of psychiatric comorbidities (0, 1, 2+), respectively. HRs for effect of 2+ psychiatric comorbidity (1.69, 1.63, 1.42, 1.38) declined across levels of medical comorbidity (0, 1, 2, 3+), respectively.ConclusionsMedical and psychiatric multi-morbidity are significant predictors of mortality among older adults (veterans) with type 2 diabetes with a graded response as multimorbidity increases.

Abstract P12: Medication Therapy Management Services - A Requirement for Medicare Part D Plans: Are Your Patients Eligible?

Background: Medication Therapy Management (MTM) is a mandated component of Medicare Part D whereby a pharmacist-patient encounter identifies, resolves and prevents medication-related problems. MTM programs have been shown to improve drug therapy goal attainment while reducing overall costs in cardiac patients; however, MTM has been greatly underutilized. The purpose of this study is to identify the proportion of patients eligible for MTM from those enrolled in the NCDR's outpatient PINNACLE Registry. Methods: MTM eligibility is based on the presence of multiple chronic diseases and medications plus the likelihood of exceeding an annual drug cost threshold ($4000 in 2009 and $3000 in 2010). Patients from PINNACLE (5/1/08 to 9/30/10) with 3 or more of the following diseases were identified: HTN, HF, dyslipidemia, DM, CAD. Patient demographics, cardiac diseases, and cardiac drug classes prescribed (individual drugs not available) were captured. To estimate individual patient drug costs to determine MTM eligibility, a weighted average cost was calculated using nationally representative drug utilization data and average wholesale prices (AWP). Sensitivity analyses for determining MTM eligibility were performed by varying drug costs using AWP for the highest cost and clinician-defined most frequently prescribed drugs in each class. Results: Of the 160,593 Medicare patients enrolled in PINNACLE, 93,089 (58%) were identified with ≥ 3 cardiac diseases. The cohort’s mean age was 74.4 ± 9.2 yrs, 54.4% were male and 86.5% were white. Patients were prescribed a mean of 3.5 cardiac drugs. The table displays drug costs and MTM eligibility results. Conclusions: A substantial number of patients met MTM eligibility requirements with this conservative approach using only cardiac drug costs, although variability existed based on cost method. These data serve to raise cardiologists' awareness of their patients' potential eligibility to receive the benefits of MTM services. Cost Methodology Median Annual Cost (IQR) 2009 MTM Eligibility [N (%)] 2010 MTM Eligibility [N (%)] Weighed average cost $1329 (915,2609) 6,202 (6.7% ) 19,903 (21.4%) Frequently prescribed cost $366 (193,1361) 1084 (1.2% ) 7326 (7.9%) High cost $3,958 (2406,5358) 46,477 (49.9% ) 59,619 (64%) 2009 and 2010 MTM eligibility based on likelihood of exceeding drug cost threshold of $4000 and $3000, respectively. IQR - interquartile range; MTM - medication therapy management.

Co-occurrence of diabetes, myocardial infarction, stroke, and cancer: quantifying age patterns in the Dutch population using health survey data

BackgroundThe high prevalence of chronic diseases in Western countries implies that the presence of multiple chronic diseases within one person is common. Especially at older ages, when the likelihood of having a chronic disease increases, the co-occurrence of distinct diseases will be encountered more frequently. The aim of this study was to estimate the age-specific prevalence of multimorbidity in the general population. In particular, we investigate to what extent specific pairs of diseases cluster within people and how this deviates from what is to be expected under the assumption of the independent occurrence of diseases (i.e., sheer coincidence).MethodsWe used data from a Dutch health survey to estimate the prevalence of pairs of chronic diseases specified by age. Diseases we focused on were diabetes, myocardial infarction, stroke, and cancer. Multinomial P-splines were fitted to the data to model the relation between age and disease status (single versus two diseases). To assess to what extent co-occurrence cannot be explained by independent occurrence, we estimated observed/expected co-occurrence ratios using predictions of the fitted regression models.ResultsPrevalence increased with age for all disease pairs. For all disease pairs, prevalence at most ages was much higher than is to be expected on the basis of coincidence. Observed/expected ratios of disease combinations decreased with age.ConclusionCommon chronic diseases co-occur in one individual more frequently than is due to chance. In monitoring the occurrence of diseases among the population at large, such multimorbidity is insufficiently taken into account.

Síndrome metabólico y envejecimiento

In recent years, the current “obesity epidemic” and its correlate, metabolic syndrome, have been related not only to cardiovascular disease but also to the presence of multiple chronic diseases and even to the development of disability. Therefore, it has been hypothesized that this situation of risk and that of frailty, which has aroused such interest in geriatrics, could share common physiopathologic mechanisms. These mechanisms are reviewed in the present article.

Risk for Increased Utilization and Adverse Health Outcomes among Men Served by the Veterans Health Administration

Using data from a nationally representative survey, we evaluated the prevalence of multiple risk factors known to predict increased health care utilization and adverse health outcomes, comparing U.S. men who rely solely on the Veterans Affairs Health Administration (VA) for health care to men in the general population. Adjusting for age and race, men who only use the VA were significantly more likely to have multiple socioeconomic and lifestyle risk factors including current smoking. Their self-reported health status was more often fair or poor and they were more likely to report the presence of multiple chronic diseases ranging from arthritis to previous heart attack to poor mental health. Although the finding that VA-only users are at elevated health risk was anticipated, our study now provides nationally representative estimates of the magnitude of these differences and reinforces the importance of accounting for them when making VA to non-VA comparisons.