Prevalence Of Multiple Chronic Conditions Research Articles

Estimated prevalence of multiple chronic conditions throughout adulthood using data from the All of Us Research Program.

Estimation of multiple chronic condition (MCC) prevalence throughout adulthood provides a critical reflection of MCC burden. We analyzed electronic health record codes for 58 conditions to estimate MCC prevalence for All of Us ( AoU ) Research Program adult participants (N=242,828). Approximately 76% of AoU participants were diagnosed with MCCs, with over 40% having 6 or more conditions and prevalence increasing with age; the most frequently occurring MCC combinations varied by age category (i.e., mental health conditions in early adulthood and physical health conditions in middle adulthood through advanced old age). We report notable prevalence of MCC throughout adulthood and variability in MCC condition combinations by age category in AoU participants. These findings highlight the need for targeted, innovative care modalities and population health initiatives to address MCC burden throughout adulthood.

Self-management in Older Adults with Multiple Chronic Conditions (MCCs): A Qualitative Content Analysis

Background: The growing population of older adults and the prevalence of multiple chronic conditions (MCCs) among them present significant challenges in care and treatment. Self-management is an effective approach to managing the consequences of MCCs. Objectives: This study aimed to explore the psychosocial and biological factors related to self-management among older adults with MCCs. Methods: This qualitative study employed a content analysis approach from June to April 2023 in hospitals and universities in Tehran. The sample consisted of 26 participants, including older adults with MCCs, family caregivers, and specialists. Data were collected through semi-structured interviews. Purposeful sampling was used, and continued until data saturation was achieved. The rigor of the study was evaluated using the Lincoln and Guba criteria, and analysis was conducted simultaneously with data collection using the Elo and Kyngäs methods. Results: The final analysis identified several factors affecting self-management. A total of 697 semantic units and 336 codes were categorized into 13 subcategories and 4 main categories. These categories included: Individual factors (biological factors, cognitive factors, coexisting diseases, mental health, economic status, health-oriented behaviors), interpersonal factors (interaction with the medical care team, family relationships), factors related to the health system (facilities of medical centers, staff empowerment, health policymaking), and extra-organizational factors (cultural factors, social factors). Conclusions: The findings of this study highlight the factors related to self-management in older adults with MCCs, which can be utilized in the design of self-management programs.

Prevalence and determinants of multiple chronic conditions (MCC) among young adults in Indian households: an analysis of NFHS-5

BackgroundMultiple chronic conditions (MCC) are defined as the presence of two or more chronic conditions, that significantly impact health status, functional capacity, quality of life, and overall healthcare management. Despite the significant evidence on chronic disease burden, the co-existence of MCC within a household in low- and middle-income countries (LMICs) is less studied. This study therefore estimates the prevalence of MCC and its determinants among adults in the Indian households.MethodsData used in this study were drawn from the fifth round of the National Family Health Survey (NFHS) conducted in 2019–21. Data sets of men (15–54 years) and women (15–49 years) were used for the study. The total sample size of adults for this analysis was N = 239,848. The outcome variable of this study was multiple chronic conditions (MCC) in adults which included a total of nine chronic conditions (hypertension, diabetes, chronic respiratory diseases, chronic kidney disorders, cancer, thyroid disorders, obesity, and heart diseases, consuming alcohol, chewing tobacco, and smoking) documented in NFHS-5. Descriptive statistics and binary logistic regression analysis were used to quantify the results.ResultsA prevalence of 5.5% of MCC in adults emerged from our study. Logistic regression analysis identified that younger age, males (AOR 0.36 (0.33–0.39)), urban areas (AOR 1.11 (1.02–1.17)) as the place of residence, and participants representing SC (AOR 0.89 (0.81–0.97)), and ST (AOR 1.30 (1.17–1.45)), had a higher risk of MCC irrespective of level of education, type of occupation, marital status, or wealth index, and states from any category of social progress.ConclusionA 5% prevalence of MCC specifically obesity, substance use, and hypertension calls for integrated efforts aiming at behavior change, and regulatory efforts to prevent further increase of MCC among young adults in India.

The Rising Prevalence of Multiple Chronic Conditions Among US Adults With Hypertension.

The Rising Prevalence of Multiple Chronic Conditions Among US Adults With Hypertension.

Trends in the Prevalence of Multiple Chronic Conditions Among US Adults With Hypertension From 1999-2000 Through 2017-2020.

The prevalence of many chronic conditions has increased among US adults. Many adults with hypertension have other chronic conditions. We estimated changes in the age-adjusted prevalence of multiple (≥3) chronic conditions, not including hypertension, using data from the National Health and Nutrition Examination Survey, from 1999-2000 to 2017-2020, among US adults with (n = 24,851) and without (n = 24,337 hypertension. Hypertension included systolic blood pressure (BP) ≥130 mm Hg, diastolic BP ≥80 mm Hg, or antihypertensive medication use. We studied 14 chronic conditions: arthritis, asthma, cancer, coronary heart disease, chronic kidney disease, depression, diabetes, dyslipidemia, hepatitis B, hepatitis C, heart failure, lung disease, obesity, and stroke. From 1999-2000 to 2017-2020, the age-adjusted mean number of chronic conditions increased more among US adults with vs. without hypertension (2.2 to 2.8 vs. 1.7 to 2.0; P-interaction <0.001). Also, the age-adjusted prevalence of multiple chronic conditions increased from 39.0% to 52.0% among US adults with hypertension and from 26.0% to 30.0% among US adults without hypertension (P-interaction = 0.022). In 2017-2020, after age, gender, and race/ethnicity adjustment, US adults with hypertension were 1.94 (95% confidence interval: 1.72-2.18) times as likely to have multiple chronic conditions compared to those without hypertension. In 2017-2020, dyslipidemia, obesity, and arthritis were the most common 3 co-occurring chronic conditions among US adults with and without hypertension (age-adjusted prevalence 16.5% and 3.1%, respectively). In 2017-2020, more than half of US adults with hypertension had ≥3 additional chronic conditions, a substantial increase from 20 years ago.

Mirtazapine for gastrointestinal and neuropsychological symptoms in older adults with irritable bowel syndrome

Irritable bowel syndrome (IBS) is a common and potentially modifiable contributor to excess disability, morbidity, and poor quality of life. Clinical trials of medications for IBS have largely been in younger adults. Yet, a growing number of adults aged 65 and older are living with IBS. No data exist to guide clinicians in the safe and effective use of medications (e.g., anticholinergics, anti-spasmodics, and tricyclic antidepressants (TCA)) for IBS in the geriatric population. These medications—especially anticholinergics and TCAs—carry a high risk of adverse effects (ADE) in older adults because of age-associated decline in drug metabolism and the high prevalence of multiple chronic conditions. Five or more medications (polypharmacy) are frequently used to treat common psychiatric and medical comorbidities of IBS: anxiety, depression, insomnia, migraine headache, diarrhea, nausea, poor appetite, pruritus/skin atopy, and fibromyalgia. These neurological and psychiatric comorbidities reflect shared pathogenic mechanisms and bidirectional crosstalk of high inflammation, alteration of gut microbiota, and dysregulation of multiple gastrointestinal and central nervous system-active neurotransmitters (e.g., serotonin, neuropeptides). Currently, these IBS-associated conditions are treated with multiple medications—which increase the risk of adverse drug–drug interactions. One way to reduce the number of medications used for IBS-associated conditions is the use of one medication that treats many or all of these conditions—Mirtazapine. In this perspective article, we present evidence from basic science, case series, observational and epidemiological studies, clinical studies, and clinical trials supporting mirtazapine, a noradrenergic and specific serotonergic receptor antagonist—with 5-hydroxytryptamine-2 and 3 antagonism, as a potential pharmacotherapeutic intervention for the myriad symptoms and conditions associated with IBS. Specifically, we found evidence of mirtazapine’s role in treating diarrhea, insomnia, migraine headache, nausea, and poor appetite. We propose a large randomized controlled trial to study mirtazapine as a potential one-stop treatment for multiple IBS symptoms, with the potential to reduce polypharmacy and ADEs, especially in the geriatric population.

SOCIAL ENGAGEMENT IN OLDER PEOPLE LIVING WITH HIV

Abstract More than 50% of people with HIV (PWH) are at least 50 years old. PWH experience a high prevalence of multiple chronic conditions and fragile social structures. Although social engagement may be protective against detrimental physical, cognitive, and mental health outcomes, there is limited evidence on older PWH’s social engagement and associated factors in engaging with family, friends, and community. This study sought to examine social engagement in a population of older PWH, using the 13-item Frequency of Leisure Activities Scale from the Research on Older Adults with HIV (ROAH 2.0) study at the Weill Cornell Campus in New York City. We conducted factor and regression analyses to characterize social engagement activities and examine their relationships with AIDS diagnosis, social vulnerability index (SVI), financial strain, loneliness, HIV-related stigma, and depressive symptoms, controlling for demographic factors. PWH (n=349, age range=50-84) were less engaged in social (Mean=1.31; SD=0.71) and cultural-physical (e.g. attending cultural events) (Mean=1.55; SD=0.78) than media-based activities (Mean=3.09; SD=0.72), with Omega reliability estimated at 0.716, 0.651, and 0.620 respectively. Having AIDS, experiencing increased HIV-related stigma, loneliness, and depressive symptoms were associated with low social activity engagement (F(6, 316) = 9.87, p &amp;lt; .001). High SVI score and financial strain were negatively associated with engagement in cultural-physical activities (F(5, 317) = 2.61, p &amp;lt; .001). Increased depressive symptoms were negatively associated with engagement in media-based activities (F(4, 318) = 5.88, p &amp;lt; .001). The findings provide foundations for future research to improve our understanding of social engagement in older PWH.

Assessing the Utility of a Machine-Learning Model to Assist With the Assignment of the American Society of Anesthesiology Physical Status Classification in Pediatric Patients

BACKGROUND: The American Society of Anesthesiologists Physical Status Classification System (ASA-PS) is used to classify patients’ health before delivering an anesthetic. Assigning an ASA-PS Classification score to pediatric patients can be challenging due to the vast array of chronic conditions present in the pediatric population. The specific aims of this study were to (1) suggest an ASA-PS score for pediatric patients undergoing elective surgical procedures using machine-learning (ML) methods; and (2) assess the impact of presenting the suggested ASA-PS score to clinicians when making their final ASA-PS assignment. The intent was not to create a new ASA-PS score but to use ML methods to generate a suggested score, along with information on how the score was generated (ie, historical information on patient comorbidities) to assist clinicians when assigning their final ASA-PS score. METHODS: A retrospective analysis of 146,784 pediatric surgical encounters from January 1, 2016, to December 31, 2019, using eXtreme Gradient Boosting (XGBoost) methods to predict ASA-PS scores using patients’ age, weight, and chronic conditions. SHapley Additive exPlanations (SHAP) were used to assess patient characteristics that contributed most to the predicted ASA-PS scores. The predicted ASA-PS model was presented to a prospective cohort study of 28,677 surgical encounters from December 1, 2021, to October 31, 2022. The predicted ASA-PS score was presented to the anesthesiology provider for review before entering the final ASA-PS score. The study focused on summarizing the available information for the anesthesiologist by using ML methods. The goal was to explore the potential for ML to provide assistance to anesthesiologists by highlighting potential areas of discordance between the variables that generated a given ML prediction and the physician’s mental model of the patient’s medical comorbidities. RESULTS: For the retrospective analysis, the distribution of predicted ASA-PS scores was 22.7% ASA-PS I, 48.5% II, 23.6% III, 5.1% IV, and 0.04% V. The distribution of clinician-assigned ASA-PS scores was 24.3% for ASA-PS I, 44.5% for ASA-PS II, 24.9% for ASA III, 6.1% for ASA-PS IV, and 0.2% for ASA-V. In the prospective analysis, the final ASA-PS score matched the initial ASA-PS 90.7% of the time and 9.3% were revised after viewing the predicted ASA-PS score. When the initial ASA-PS score and the ML ASA-PS score were discrepant, 19.5% of the cases have a final ASA-PS score which is different from the initial clinician ASA-PS score. The prevalence of multiple chronic conditions increased with ASA-PS score: 34.9% ASA-PS I, 73.2% II, 92.3% III, and 94.4% IV. CONCLUSIONS: ML derivation of predicted pediatric ASA-PS scores was successful, with a strong agreement between predicted and clinician-entered ASA-PS scores. Presentation of predicted ASA-PS scores was associated with revision in final scoring for 1-in-10 pediatric patients.

Abstract C076: Experiences of oncologists caring for Hispanic older adults with colorectal cancer and multiple chronic conditions

Abstract Background: In Puerto Rico, colorectal cancer (CRC) is the leading cause of cancer deaths. Patients with CRC often present with multiple chronic conditions (MCC), making it difficult for oncologists to coordinate their care. This qualitative study explores oncologists' perspectives of care among patients with CRC and MCC in Puerto Rico. Methods: Semi-structured interviews (n=9) were conducted with oncologists providing care for Hispanic older adults with CRC in Puerto Rico. Thematic analysis was employed to identify key themes and subthemes. Results: We identified several key themes related to social determinants of health, diagnosis pathways, treatment decisions, survivorship, end-of-life care, and care coordination. Oncologists reported a high prevalence of MCC, including comorbidities such as diabetes, high blood pressure, cholesterol problems, and hypothyroidism. Limited social support was identified as a care coordination challenge, as many patients undergo treatments without adequate support networks. Access to healthcare providers was a noted concern, due to a provider shortage and the absence of specialized cancer care. The health insurance system has been identified as having several issues, particularly concerning the requirement of pre-authorization for different procedures and treatments. These challenges can be especially problematic for older adults, who often lack a strong support system and may experience difficulties comprehending the process. Transportation issues and a lack of nearby services were noted as barriers for patients requiring specialized care. Diagnosis pathways varied, with some patients having undergone routine screenings when CRC was identified, while others presented with suspected CRC symptoms. Oncologists noted that the cancer stage was the most important factor when making treatment decisions, in addition to the diagnosis of MCC and the patient's ability to tolerate treatment. Other factors influencing treatment decisions included the patient's age, physical condition, and appointments attendance. For patients in advanced stages, end-of-life planning and palliative care were crucial for ensuring a dignified and comfortable transition, with discussions around hospice care and managing pain and symptom relief being essential components. Care coordination and communication were identified as challenging to manage when multiple providers and procedures were needed, often requiring patients to schedule appointments with different specialists themselves. Inter-provider communication and collaboration relied on various methods; however, phone calls or notes sent through the patient were the primary methods. Conclusions: Oncologists caring for Hispanic older adults with CRC and MCC face multiple, complex challenges influenced by social determinants of health and the presence of comorbidities. Tailored approaches to address disparities, culturally sensitive care, and improved coordination among healthcare providers are needed to enhance the quality of care in this patient population. Citation Format: Maira A. Castaneda-Avila, Daniela Latoni, Meagan J. Sabatino, Karen J. Ortiz-Ortiz, Kate Lapane. Experiences of oncologists caring for Hispanic older adults with colorectal cancer and multiple chronic conditions [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr C076.

Patterns of multiple chronic conditions in pregnancy: Population-based study using latent class analysis.

Adults with multiple chronic conditions (MCC) are a heterogeneous population with elevated risk of future adverse health outcomes. Yet, despite the increasing prevalence of MCC globally, data about MCC in pregnancy are scarce. To estimate the population prevalence of MCC in pregnancy and determine whether certain types of chronic conditions cluster together among pregnant women with MCC. We conducted a population-based cohort study in Ontario, Canada, of all 15-55-year-old women with a recognised pregnancy, from 2007 to 2020. MCC was assessed from a list of 22 conditions, identified using validated algorithms. We estimated the prevalence of MCC. Next, we used latent class analysis to identify classes of co-occurring chronic conditions in women with MCC, with model selection based on parsimony, clinical interpretability and statistical fit. Among 2,014,508 pregnancies, 324,735 had MCC (161.2 per 1000, 95% confidence interval [CI] 160.6, 161.8). Latent class analysis resulted in a five-class solution. In four classes, mood and anxiety disorders were prominent and clustered with one additional condition, as follows: Class 1 (22.4% of women with MCC), osteoarthritis; Class 2 (23.7%), obesity; Class 3 (15.8%), substance use disorders; and Class 4 (22.1%), asthma. In Class 5 (16.1%), four physical conditions clustered together: obesity, asthma, chronic hypertension and diabetes mellitus. MCC is common in pregnancy, with sub-types dominated by co-occurring mental and physical health conditions. These data show the importance of preconception and perinatal interventions, particularly integrated care strategies, to optimise treatment and stabilisation of chronic conditions in women with MCC.

The prevalence of multiple chronic conditions and medical burden in asthma patients.

The prevalence of multiple chronic conditions (MCC), defined as several coexisting chronic conditions, has increased with the aging of society. MCC is associated with poor outcomes, but most comorbid diseases in asthma patients have been evaluated as asthma-associated diseases. We investigated the morbidity of coexisting chronic diseases in asthma patients and their medical burdens. We analyzed data from the National Health Insurance Service-National Sample Cohort for 2002-2013. We defined MCC with asthma as a group of one or more chronic diseases in addition to asthma. We analyzed 20 chronic conditions, including asthma. Age was categorized into groups 1-5 (< 10, 10-29, 30-44, 45-64, and ≥ 65 years, respectively). The frequency of medical system use and associated costs were analyzed to determine the asthma-related medical burden in patients with MCC. The prevalence of asthma was 13.01%, and the prevalence of MCC in asthmatic patients was 36.55%. The prevalence of MCC with asthma was higher in females than males and increased with age. The significant comorbidities were hypertension, dyslipidemia, arthritis, and diabetes. Dyslipidemia, arthritis, depression, and osteoporosis were more common in females than males. Hypertension, diabetes, COPD, coronary artery disease, cancer, and hepatitis were more prevalent in males than females. According to age, the most prevalent chronic condition in groups 1 and 2 was depression, dyslipidemia in group 3, and hypertension in groups 4 and 5. Older age, low income, and severe disability were independent risk factors for MCC in patients with asthma. The frequency of asthma-related medical system use and asthma-associated costs increased with increasing numbers of coexisting chronic diseases. Comorbid chronic diseases in asthma patients differed according to age and sex. The asthma-related-medical burdens were highest in patients with five or more chronic conditions and groups 1 and 5.

An analysis of socioeconomic factors on multiple chronic conditions and its economic burden: evidence from the National Health Service Survey in Yunnan Province, China.

The economic burden of multiple chronic conditions (MCCs) and its socio-economic influencing factors have widely raised public concerns. However, there are few large population-based studies on these problems in China. Our study aims at determining the economic burden of MCCs and associated factors specific to multimorbidity among middle-aged and older individuals. As our study population, we extracted all 11,304 participants over 35 years old from the 2018 National Health Service Survey (NHSS) in Yunnan. Economic burden and socio-demographic characteristics were analyzed with descriptive statistics. Chi-square test and generalized estimating equations (GEE) regression models were used to identify influencing factors. The prevalence of chronic diseases was 35.93% in 11,304 participants and the prevalence of MCCs increased with age, was 10.12%. Residents who lived in rural areas were more likely to report MCCs than those who lived in urban areas (adjusted OR = 1.347, 97.5% CI: 1.116-1.626). Ethnic minority groups were less likely to report MCCs than those of Han (OR = 0.752, 97.5% CI: 0.601-0.942). Overweight or obese people were more likely to report MCCs than people with normal weight (OR = 1.317, 97.5% CI: 1.099-1.579). The per capita expenses of 2 weeks' illness, per capita hospitalization expenses, annual household income, annual household expenses, and annual household medical expenses of MCCs were ¥292.90 (±1427.80), ¥4804.22 (±11851.63), ¥51064.77 (±52158.76), ¥41933.50 (±39940.02) and ¥11724.94 (±11642.74), respectively. The per capita expenses of 2 weeks' illness, per capita hospitalization expenses, annual household income, annual household cost, and annual household medical expenses of hypertensive co-diabetic patients were more compared to those with other three comorbidity modes. The prevalence of MCCs was relatively high among middle-aged and older individuals in Yunnan, China, which bought a heavy economic burden. This encourages policy makers and health providers to pay more attention to the behavioral/lifestyle factors, that contribute to multimorbidity to a great extent. Furthermore, health promotion and education in terms of MCCs need to be prioritized in Yunnan.

Effect of Information Intervention on Prescribing Practice for Neuropathic Pain in Older Patients: A Nationwide Register-Based Study.

Management of prescription medicines is challenging for older patients due to frail health and the prevalence of multiple chronic conditions. A salient policy challenge of prescribing practices is that all physicians are not well informed about the national clinical guidelines. A feasible policy intervention to mitigate the harms caused by Potentially Inappropriate Medications is to influence the frequency of prescribing and other prescribing attributes of the drugs by providing accurate and up-to-date information about the national clinical guidelines. The objective of this study was to examine the effect of a nationwide information intervention on physicians' prescribing practices and patients' healthcare utilization. We used a quasi-experimental research design based on difference-in-differences variation and nationwide register data on prescribers and purchasers of pregabalin, nortriptyline, and amitriptyline combinations in Finland between January 2018 and May 2019. The study included 68,914 patients and 11,432 physicians. We found that the information letter sent to all prescribers of pregabalin, nortriptyline, or amitriptyline combinations to patients aged 75 years or older decreased the probability of prescribing of these medications. The estimated effect of -3.3 percentage points (95% confidence interval [-0.041, -0.024]) corresponds to a 29% reduction compared to the baseline mean of the outcome. The filled quantity, measured in Defined Daily Doses, of pregabalin, nortriptyline, and amitriptyline combinations per month was reduced by 11.7% [-14.5% to -8.9%] among patients aged 75 years or older. No effect on patients' healthcare utilization was observed. Findings of the study suggest that personal information intervention was an effective policy tool for nudging physicians to reduce prescribing of potentially inappropriate medicines, whereas the reduction in prescribing was not accompanied by improvements or adverse effects in patients' health.

Obesity, multiple chronic conditions, and the relationship with physical function: Data from the national health and aging trends survey

BackgroundThe population of older adults living with multiple chronic conditions (MCC) continues to grow. MCC is independently associated with functional limitation and obesity. The aim of our study was to evaluate the association between obesity and MCC, and secondarily, the combined presence of obesity and functional limitations with MCC. MethodsWe analyzed cross-sectional survey data from the National Health and Aging Trends Survey (NHATS) 2011 baseline data, a nationally representative Medicare beneficiary cohort of adults in the United States. We evaluated the coexistent prevalence of obesity and MCC overall, and by standard body mass index (BMI) categories. We then evaluated the prevalence of functional limitations (mobility, self-care, and household activities) and Fried-defined frailty status in persons with a BMI ≥ 30 kg/m2. Logistic regression was used to measure the association between MCC and BMI, and functional limitations and MCC among those with obesity. ResultsIn the 6,600 participants, the prevalence of concurrent obesity and MCC was 30.4%. Of those with obesity, the prevalence of MCC was 84.0%, and were more likely to have MCC (adjusted OR: 2.17, 95% CI 1.86, 2.54) compared to a normal BMI. Obesity and functional limitations or frailty were more likely have MCC than individuals with obesity alone. ConclusionsWe found that individuals with obesity is strongly associated with MCC and that functional limitations and frailty status have a greater association with having MCC than individuals with obesity without MCC. Future longitudinal analyses are needed to ascertain this relationship.

PSUN113 Evaluating The Efficacy Of Anti-Obesity Medications In a Multidisciplinary Weight Management Clinic At a VA Medical Center

Abstract Objective Anti-obesity medications have been shown to be effective in multiple randomized clinical trials, but there is limited data on the efficacy of these medications in the veteran population. This study was aimed to evaluate the effectiveness of anti-obesity medications in a multidisciplinary weight management clinic at our VA medical center. Methods This was a retrospective, descriptive study of 98 patients seen in a multidisciplinary weight management clinic at our VA medical center between January 1, 2019 and October 31, 2021. General requirements to be seen in the clinic were a BMI &amp;gt;30 or BMI &amp;gt;27 with comorbid conditions. Patients seen at least twice in the clinic were included in the study. Patients who received anti-obesity medications (phentermine-topiramate, naltrexone-bupropion, or GLP-1 receptor agonist (liraglutide or semaglutide)) had weights recorded at medication start date and at 2-4 months, 4-8 months, 8-10 months, and 10-14 months intervals. Baseline BMI, HbA1c, LDL-C and triglycerides were recorded at the medication start and followed up at similar intervals. Results There were 98 participants (56% males) within this study, with mean age of 54.9 years, mean baseline weight of 127.3 kg, and BMI of 43.5. Of all 98 patients seen in the clinic (regardless of being on anti-obesity medicine), 85 experienced some weight loss with 39 losing at least 5% of their body weight. The average weight loss from first to last visit was 4.1%. There were 72 patients who received anti-obesity medications for at least 3 consecutive months, including 12 patients who were subsequently trialed on a second class of anti-obesity medication. There were 35 trials of Qsymia, 43 trials of GLP-1 receptor agonists, and 6 trials of naltrexone-bupropion. For those patients receiving medications, average weight loss at 2-4 months was 3.7% (N=73), 4-8 months was 4.9% (N=58), 8-10 months was 6.0% (N=32), and 10-14 months was 5.5% (N=29). The percentage of patients able to lose at least 5.0% of their weight was 30.1% at 2-4 months, 43.1% at 4-8 months, 68.8% at 8-10 months, and 51.7% at 10-14 months. There was a decrease noted in HbA1c and LDL-C at all time periods, while there was no change in triglycerides. Conclusion Our data shows the effectiveness of anti-obesity medications in a veteran population seen in a multidisciplinary weight management clinic, though to a lesser extent as compared to clinical trials. Given the higher prevalence of multiple chronic conditions seen in veterans when compared to the general population, these patients have additional challenges when trying to achieve their weight loss goals. Further study must be performed to determine the long-term effectiveness and tolerability of these medications in this population. The differential effects among the anti-obesity medications should also be investigated further. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

Comparing the association between multiple chronic conditions, multimorbidity, frailty, and survival among older patients with cancer

IntroductionThe high prevalence of multiple chronic conditions (MCC), multimorbidity, and frailty may affect treatment and outcomes for older adults with cancer. The goal of this study was to use three conceptually distinct measures of morbidity to examine the association between these measures and mortality. Materials and MethodsUsing Medicare claims data linked with the 2012–2016 Ohio Cancer Incidence Surveillance System we identified older adults with incident primary cancer sites of breast, colorectal, lung, or prostate (n = 29,140). We used claims data to identify their Elixhauser comorbidities, Multimorbidity-Weighted Index (MWI), and Claims Frailty Index (CFI) as measures of MCC, multimorbidity, and frailty, respectively. We used Cox proportional hazard models to examine the association between these measures and survival time since diagnosis. ResultsLung cancer patients had the highest levels of MCC, multimorbidity, and frailty. There was a positive association between all three measures and a greater hazard of death after adjusting for age, sex (colorectal and lung only), and stage. Breast cancer patients with 5+ comorbidities had an adjusted hazard ratio (aHR) of 1.63 (95% confidence interval [CI]: 1.38, 1.93), and those with mild frailty had an aHR of 3.38 (95% CI; 2.12, 5.41). The C statistics for breast cancer were 0.79, 0.78, and 0.79 for the MCC, MWI, and CFI respectively. Similarly, lung cancer patients who were moderately or severely frail had an aHR of 1.82 (95% CI: 1.53, 2.18) while prostate cancer patients had an aHR of 3.39 (95% CI: 2.12, 5.41) and colorectal cancer patients had an aHR of 4.51 (95% CI: 3.23, 6.29). Model performance was nearly identical across the MCC, multimorbidity, and frailty models within cancer type. The models performed best for prostate and breast cancer, and notably worse for lung cancer. The frailty models showed the greatest separation in unadjusted survival curves. DiscussionThe MCC, multimorbidity, and frailty indices performed similarly well in predicting mortality among a large cohort of older cancer patients. However, there were notable differences by cancer type. This work highlights that although model performance is similar, frailty may serve as a clearer indicator in risk stratification of geriatric oncology patients than simple MCCs or multimorbidity.

Emerging approaches to multiple chronic condition assessment.

Older adults experience a higher prevalence of multiple chronic conditions (MCCs). Establishing the presence and pattern of MCCs in individuals or populations is important for healthcare delivery, research, and policy. This report describes four emerging approaches and discusses their potential applications for enhancing assessment, treatment, and policy for the aging population. The National Institutes of Health convened a 2-day panel workshop of experts in 2018. Four emerging models were identified by the panel, including classification and regression tree (CART), qualifying comorbidity sets (QCS), the multimorbidity index (MMI), and the application of omics to network medicine. Future research into models of multiple chronic condition assessment may improve understanding of the epidemiology, diagnosis, and treatment of older persons.

Limitations of the new ISO standard for health and wellness apps

Limitations of the new ISO standard for health and wellness apps

Predictors of poor knowledge, attitude, and practice among primary care physicians toward end-of-life care

BackgroundThe prevalence of multiple chronic conditions in elderly people rises recently. Establishing comprehensive end-of-life (EOL) care to improve their quality of life and avoid any unnecessary suffering is mandatory. Being the first point of contact with the health care system, primary care physicians' knowledge, attitude, and practice (KAP) toward EOL care is evidently considered.ObjectivesTo assess KAP among primary care physicians and the predictors of poor KAP regarding EOL care.AimTo improve the EOL services among primary care physicians.Patients and methodsA cross-sectional study was conducted on randomly selected 300 primary care physicians from the 1st of May to the end of November 2019. The selected participants were interviewed through a semistructured self-administered questionnaire composed of four parts inquiring about their sociodemographic data, KAP level toward EOL care.ResultsThe majority of the studied participants had poor knowledge (94.7%) and practice (96.3%) about EOL care. Only 37.7% of them had a negative attitude. Being female (P = 0.03) and general practitioner (P = 0.02) were the most affecting factors of poor knowledge. General practitioner was the most influencing factor on poor attitude (P = 0.04). There was a positive correlation between knowledge score and attitude score (P < 0.001), and the same with knowledge score and practice score (P < 0.001).ConclusionAlthough more than half of the physicians had positive attitude as regards EOL care, their knowledge and practice levels were poor. Being a female and general practitioner expressed more poor knowledge. Being a general practitioner showed poor attitude, while working in rural areas was the main affecting factor on poor practice.RecommendationEOL care should be integrated in both undergraduate and postgraduate studies.

Patients with Multiple Illnesses

Approximately one-third of all individuals have multiple chronic conditions (MCCs) worldwide. Certain disorders tend to cluster together often, with correlations, such as depression and stroke, Alzheimer’s illness and infectious diseases such as HIV/AIDS and tuberculosis coupled and diabetes and cardiovascular diseases. The prevalence of MCC is highly variable according to the definition used and the number of conditions included in the study. In the United States, it was reported to be 23.1%. While other studies report MCC as high as 80% among elder population. The patient hardship encompasses a decline in standards of living, costly expenditures, adherence to multiple medications, incapacity to work, symptoms management, and a significant financial load on caregivers. This significant load from MCCs is expected to rise further. At the current time, the presence of more than one disease causes the patients to take multiple drugs, further prescribing may be indicated for the side effects of the used drugs. Furthermore, new conditions can be misdiagnosed and mistaken as side effects of the drugs the patients is taking. Strategies for treatments include establishing agreement on MCC taxonomy, putting more emphasis on MCC research, focusing on primary prevention to reduce morbidity, and shifting healthcare institutions and policies to a multiple-condition paradigm.