Self-reported Chronic Medical Conditions Research Articles

Accessibility of medications by chronically ill older patients: a cross-sectional assessment of universal health coverage in Nigeria

BackgroundUniversal health coverage (UHC) is defined by WHO as ensuring that all people and communities receive the quality services they need, and are protected from health threats without financial hardship. Without considering the health and social care needs of the increasing numbers of older people, UHC will be impossible to achieve. One of the six assessment questions asked in UHC is “can you get medicine and other products that you need?” Hypertension, diabetes, and arthritis are common chronic illnesses among older populations, requiring constant accessibility of medication to prevent complications. We aimed to assess UHC among older patients in Nigeria.MethodsUsing a cross-sectional study design, we did a 1-day enrolment (on Dec 16, 2016) of older people in community projects in three communities (Ukpo, Uburu, and Afikpo) across Nigeria. Using a systematic random sampling technique, people who were aged 55 years or older and had at least one reported common chronic medical condition (hypertension, arthritis, and/or diabetes) were selected. An in-depth interview using a guided structured questionnaire was conducted. Participants’ demographics were recorded along with self-reported chronic medical conditions. Key questions on accessibility of medication and UHC were “Can you always afford the medicine that you need for your chronic medical condition?” and “Are you under the National Health Insurance scheme that aids health access?” Data was analysed using SPSS version 20, comparing demographic characteristics of respondents.FindingsRespondents were 521 older people aged 55–91 years. 365 (70%) were female, 302 (58%) had a minimum of primary education, 240 (46%) reported farming as their occupation, and 81 (16%) reported business as their occupation. 279 (54%) reported at least two of the three common chronic illnesses associated with ageing: 234 (45%) reported hypertension, 229 (44%) arthritis, and 57 (11%) had diabetes. Only 22% (114/521) responded yes to the question “Can you always afford the medicine that you need for your chronic medical condition?”—19% (44/234) of hypertensive patients, 24% (55/229) of arthritic patients, and 7% (4/57) of diabetic patients. The remaining 78% had missed medications owing to unaffordability. Those who stated “business” as occupation were most likely to afford medications compared with others (odds ratio 0·20, 95% CI 0·13–0·31, p<0·0001). On the other hand, most (82% [427/521]) responded “no” to the question “Are you under the National Health Insurance scheme that aids health access?”InterpretationChronically ill older people in Nigeria cannot always afford medications or health access and thus are short of UHC. An innovative strategy to improve UHC among the older population is recommended.FundingMission to Elderlies Project.

COGNITIVE DECLINE AFTER ELECTIVE AND NONELECTIVE HOSPITALIZATION IN COMMUNITY-DWELLING OLDER ADULTS

Accelerated cognitive decline after hospitalization of older adults is widely recognized, but there is little data as to whether elective hospital admissions are associated with the same negative cognitive outcomes as nonelective (emergent or urgent) admissions. We tested the hypothesis that elective hospitalizations are associated with less acceleration in cognitive decline as compared to nonelective hospitalizations in older adults. Data came from 930 older adults (74.5% female, mean age = 80.8 years) enrolled in the Rush Memory and Aging Project for which annual cognitive assessments (battery of 19 cognitive tests) were linked to over a decade of Medicare claims records. The MedPAR file codes all hospital admissions as elective, emergency, or urgent. We fit a series of mixed effects regression models with global cognitive function as the outcome with time-varying separate indicators for having elective or nonelective hospitalizations, and their interactions with time. Of the 930 participants, 613 were hospitalized at least once over an average of 4.8 (SD=2.6) years of follow-up; 260 (28.0%) had at least one elective hospital admission, and 553 (59.5%) had at least one nonelective hospital admission. Two hundred participants (21.5%) had both an elective and nonelective hospitalization. In separate models adjusted for age at baseline, sex, education, and self-reported chronic medical conditions, the rate of cognitive decline accelerated (as compared to rate of change with no hospitalization) after elective hospitalizations (estimate = -0.025, p<0.001) and the acceleration was almost twice as fast after nonelective hospitalizations (estimate = -0.043, P<0.001). When both types of hospitalizations were put in the same model, nonelective hospitalizations were related to faster cognitive decline (estimate= -0.042, p<0.001) but the association for elective hospitalizations was markedly attenuated and not significant (estimate= -0.002, p=0.81). Inferences were essentially unchanged after adding terms for mean length of stay, surgeries, ICU stays, and Charlson comorbidity index, a measure of seriousness of illness. These data indicate that elective hospitalizations are not significantly related to acceleration in cognitive decline in older persons after accounting for nonelective hospitalizations.

Health-related quality of life in Brazil: normative data for the SF-36 in a general population sample in the south of the country

The objective of this study was to provide normative SF-36 scores in a general population sample in Brazil and to describe differences in mean scores according to socio-demographic characteristics. The SF-36 questionnaire was distributed to a randomly selected sample of the general population of Porto Alegre in the State of Rio Grande do Sul. The response rate was 68% and 755 subjects were included (38% male, 62% female). Lower health status was revealed among females in the 30 to 44 year age bracket, from the lower income class, with less education and self-reported chronic medical conditions. The results and percentiles of scores of the SF-36 are reported as normative data for the general population. The SF-36 was an acceptable and practical instrument for measuring health-related quality of life in a sample of Brazilians. The results of this study can be useful for researchers using the SF-36 questionnaire in other groups to compare the scores with normative data. The SF-36 may prove a valuable tool for discovering vulnerable groups in epidemiological studies due to the ability to discriminate between different population subgroups.

Pathological gambling: relationship to obesity, self-reported chronic medical conditions, poor lifestyle choices, and impaired quality of life

BackgroundPathological gambling (PG) is an important public health problem that is prevalent, costly to society, and associated with substance misuse, depression, domestic violence, crime, and suicide. Despite these challenges, little is known about the physical health and medical correlates of PG. The goal of this project was to assess self-reported chronic medical conditions, medication usage, lifestyle choices, health care utilization, quality of life variables, and body mass index (BMI) in persons with and without PG. MethodsSubjects with PG and community controls were systematically assessed for their medical health, lifestyle choices, medication usage, and health care utilization. We administered the Medical Outcome Study Short-Form 36 Health Survey to assess perceived health and quality of life. BMI was calculated for all subjects. Obesity was defined as having a BMI≥30kg/m2. ResultsWe compared 95 subjects with DSM-IV PG (South Oaks Gambling Screen [SOGS] score≥5) and 91 control subjects without PG (SOGS≤2) selected through random digit dialing from the general community. PG subjects and controls were similar in age and gender. Persons with PG had more medical and mental health conditions than controls, and were more likely to avoid regular exercise, smoke≥1 pack/day, drink≥5 servings of caffeine daily, and watch television≥20hours/week. They had more emergency department visits for physical and mental health conditions, were more likely to have been psychiatrically hospitalized in the past year, and were more likely to take psychotropic medication. They were less likely to have had regular dental visits and were more likely to put off medical care due to financial problems. Severity of gambling was positively correlated with number of medical conditions. Persons with PG had poorer self-reported health perceptions on all but one SF-36 subscale. Importantly, persons with PG had a higher BMI than controls and were more likely to be obese. ConclusionsPG is associated with obesity, chronic medical conditions, poor lifestyle choices, worse quality of life, and the use of costly forms of medical care. Pathological gamblers are less likely to receive regular dental care and are more likely to be unable to pay for medical care. The implications of the findings are discussed.

Chronic medical conditions, health status, and health care practices at 25 years in 5-year survivors of Wilms tumor: A report from the Childhood Cancer Survivor Study.

9514 Background: High proportions of children with Wilms Tumor (WT), cured by surgery, chemotherapy, ± irradiation (RT), risk late effects of therapy. Methods: Self-reported chronic medical conditions (CMCs), health status, and health care practices were analyzed in this retrospective cohort including 1,256 5-yr survivors of WT diagnosed 1970-1986 and a sibling comparison group (n=4023). The risk of specific CMCs was analyzed by treatment. Results: The cumulative incidence at 25 yrs of any CMC was 51% and severe/disabling CMC was 11%. Compared to the siblings, WT survivors were twice as likely to report a CMC (hazard ratio [HR]2.0, 95% confidence interval (CI), 1.8-2.4) and almost five- times more likely to have a severe/disabling CMC (HR4.7, 95%CI, 3.6-6.1). The HR of specific CMCs were: congestive heart failure (CHF) 23.6 (95% CI, 10.8- 51.5), renal failure 50.7 (95% CI, 14.5-177.4), and hypertension (HTN) 8.2 (95% CI, 6.4-10.5). RT to the heart increased the likelihood of reporting CHF without doxorubicin (HR6.6, 95% CI, 1.6-28.3), with ≤ 250 mg/m2 (HR13.0, 95% CI, 1.9-89.7), and with > 250 mg/m2 (HR18.3, 95% CI, 3.8-88.2). Doxorubicin without RT did not increase the likelihood of CHF. RT to the contralateral kidney did not increase the likelihood of reporting renal failure or HTN. The prevalence ratio (PR) of adverse health status was significantly different from the sibling group for general overall health (PR 1.7, p=0.001), functional impairment (PR 3.3, p<0.001) and activity limitations (PR 1.9, p<0.001), but not for mental health status (PR 1.2, p=0.09). WT survivors and the siblings showed no differences in self or professional screening for cancer. WT survivors <30 yrs old reported more general medical exams (PR 1.1, p<0.001). Female WT survivors <30 yrs were more likely to report having had a mammogram (PR 1.6, p=0.008). Of female WT survivors who received chest RT, only 13% <30 yrs and 57% ≥30 yrs reported having had a mammogram. Conclusions: Survivors of WT have an excess risk of chronic medical conditions and adverse health status. The health care practices of WT survivors were similar to their siblings, providing opportunity for intervention. No significant financial relationships to disclose.

Prevalence of chronic medical conditions among jail and prison inmates in the USA compared with the general population

Background:Despite growing inmate populations in the USA, inmates are excluded from most national health surveys and little is known about whether the prevalence of chronic disease differs between inmates and...

Does number of lifetime traumas explain the relationship between PTSD and chronic medical conditions? Answers from the National Comorbidity Survey-Replication (NCS-R)

The present study sought to extend prior research by using data from the National Comorbidity Survey-Replication (NCS-R) to examine the relationship between number of lifetime traumas, posttraumatic stress disorder (PTSD) and 15 self-reported chronic medical conditions. The goal was to determine whether the commonly found relationship between PTSD symptomatology and physical health were better explained by the number of lifetime traumas experienced. The NCS-R is a representative US household survey that assessed lifetime experience of a variety of traumas, lifetime diagnosis of PTSD and 15 chronic medical conditions (e.g. pain conditions, cardiovascular disorders, etc.). Two major findings emerged: (1) there was a graded relationship between trauma exposure, PTSD, and the majority of chronic medical conditions where individuals with PTSD had the highest likelihood of chronic medical condition and non-traumatized individuals had the lowest risk and; (2) with the exception of headaches, the relationship between PTSD and chronic medical conditions was explained by the number of lifetime traumas experienced when analyses were subset to traumatized individuals. The present study supports prior research suggesting that multiple traumas have a cumulative effect on physical health. The impact of trauma on health may be independent of PTSD symptomatology.

Association of Mood, Anxiety, and Substance Use Disorders With Occupational Status and Disability in a Community Sample

Association of Mood, Anxiety, and Substance Use Disorders With Occupational Status and Disability in a Community Sample

Is the number of prescribing physicians an independent risk factor for adverse drug events in an elderly outpatient population?

Background: Studies indicate that adverse drug events (ADEs) are common and costly. It appears that the elderly are at greater risk of ADEs because they use more medications, have less specific presentations, and have more chronic conditions than younger populations. Objective: The goal of this study was to determine if the number of physicians prescribing medications to an elderly patient was associated with that patient's likelihood of reporting an ADE. Methods: This cohort study was a secondary analysis of data collected from a previous survey of Medicare managed care enrollees aged ≥65 years at the time of enrollment. A telephone survey of residents in the Philadelphia, Pennsylvania, area was conducted. Data included self-reported information on the number of prescribing physicians, chronic conditions, medications, ADEs, and general health status. Results: A total of 405 patients (mean [SD] age, 74 [5.1 ] years) were included in the study. Enrollees had a mean (SD) of 2.9 (1.3) prescribing physicians, and 98 (24%) patients reported having experienced an ADE in the previous 6 months. The mean (SD) number of self-reported chronic medical conditions and number of prescription medications was 4.7 (2.4) and 4.0 (2.8), respectively. In a multivariable logistic regression model, each additional provider prescribing medications increased the odds of reporting an ADE by 29% (odds ratio [OR], 1.3; 95% CI, 1.0–1.6). The number of chronic health conditions was also associated with ADEs. Having 4 or 5 self-reported chronic conditions doubled a person's odds of experiencing an ADE (OR, 2.1; 95% CI, 1.0–4.1) and having ≥6 conditions tripled the likelihood of experiencing an ADE (OR, 3.4; 95% CI, 1.6–6.9). The number of prescription medications or taking a potentially contraindicated medication was not significantly associated with self-reported ADEs. Conclusions: In this study population, the number of prescribing physicians was an independent risk factor for patients self-reporting an ADE. More research is needed to confirm and explain this finding. One possibility is poor communication between multiple providers. Physicians should work to ensure more effective coordination of care between providers and communicate information about all medications prescribed to their patients with their colleagues.

Cognitive and functional decline in adults aged 75 and older.

To simultaneously examine the influence of functional disability on the development of cognitive impairment and the influence of cognitive status on the development of functional disability over time and compare findings across ethnic groups. A population-based longitudinal study. Galveston County, Texas. Three hundred sixty-five community-dwelling Hispanic Americans, African Americans, and non-Hispanic whites, aged 75 and older. Baseline measures included demographics, self-reported chronic medical conditions, functional disability, and cognitive status. Longitudinal measures included functional decline and cognitive decline. Substantial functional decline was associated with each additional error on the mental status measure; substantial cognitive decline was associated with each additional antecedent disability. These findings were evident across all three ethnic groups, even when taking into account the effects of demographic factors and chronic health conditions, although the specific chronic health conditions that influenced cognitive and functional decline were found to vary across the three ethnic groups. Our findings suggest that, rather than simply being correlated markers of increasing frailty, cognitive and functional decline appear to influence the development of one another. Clinicians need to be aware of these associations, which may affect the direction of preventive care and rehabilitation in the oldest old. Appropriate intervention may result in the prevention or delay of functional disability and cognitive decline. Awareness of the specific chronic health conditions that increase the risk for cognitive or functional decline in various ethnic groups, and the effect of comorbid disease, may also help efforts to prevent decline in older adults.

Validation of case-mix measures derived from self-reports of diagnoses and health

Self-reported chronic diseases and health status are associated with resource use. However, few data exist regarding their ability to predict mortality or hospitalizations. We sought to determine whether self-reported chronic medical conditions and the SF-36 could be used individually or in combination to assess co-morbidity in the outpatient setting. The study was designed as a prospective cohort study. Patients were enrolled in the primary care clinics at seven Veterans Affairs (VA) medical centers participating in the Ambulatory Care Quality Improvement Project (ACQUIP). 10,947 patients, ⩾ 50 years of age, enrolled in general internal medicine clinics who returned both a baseline health inventory checklist and the baseline SF-36 who were followed for a mean of 722.5 (±84.3) days. The primary outcome was all-cause mortality, with a secondary outcome of hospitalization within the VA system. Using a Cox proportional hazards model in a development set of 5,469 patients, a co-morbidity index [Seattle Index of Co-morbidity (SIC)] was constructed using information about age, smoking status and seven of 25 self-reported medical conditions that were associated with increased mortality. In the validation set of 5,478 patients, the SIC was predictive of both mortality and hospitalizations within the VA system. A separate model was constructed in which only age and the PCS and MCS scores of the SF-36 were entered to predict mortality. The SF-36 component scores and the SIC had comparable discriminatory ability (AUC for discrimination of death within 2 y 0.71 for both models). When combined, the SIC and SF-36 together had improved discrimination for mortality (AUC = 0.74, p-value for difference in AUC < 0.005). A new outpatient co-morbidity score developed using self-identified chronic medical conditions on a baseline health inventory checklist was predictive of 2-y mortality and hospitalization within the VA system in general internal medicine patients.

Physician visits, emergency room utilization, and overnight hospitalization in the old-old in Israel: the cross-sectional and longitudinal aging study (CALAS).

The objective of this paper is to assess the risk factors for physician contact in the month before the interview (PM) and emergency room utilization (ERU) and overnight hospitalization (OH) in the year before the interview, through the use of the behavioral model as a conceptual framework. A random stratified sample of subjects age 75 to 94 was selected from the National Population Register (a complete listing of the Israeli population maintained by the Ministry of the Interior). The study sample consisted of Jews living in Israel on January 1, 1989, stratified by age (four 5-year age groups: 75-79, 80-84, 85-89, and 90-94), sex, and place of birth (Europe/America, Asia/Africa, and Israel). Community-dwelling old-old Jewish Israelis. 1,487 people living in the community at the time of the baseline interview. The dependent variables were PM in the month before the interview and ERU and OH in the previous year. The independent variables were: predisposing variables (age, sex, place of birth, and education); enabling variables (income and the social network variables of marital status, living arrangements, and number of in-person contacts per week with any child); and need variables (number of self-reported chronic medical conditions, subjective health, depressive symptoms, number of difficulties with activities of daily living and instrumental activities of daily living, measures of physical robustness, and engaging in regular physical sportive activities). The predisposing and enabling factors were only minimally associated with utilization rates in the old old in Israel, with the exception of lower rates of ERU by those who were living alone. Age was not significantly associated with healthcare utilization in the old-old population studied. Healthcare utilization was found to be associated primarily with health and functional status. In a system of free and equal access to healthcare services, the demand for health services by a population with high levels of chronic disease and disability is driven primarily by health needs, rather than by extraneous factors such as income and education. The study indicates that equity in the provision of health services is attainable. Policy makers should provide for actual need, remove artificial barriers, and prepare accurate estimates of future needs.