Types Of Chronic Illnesses Research Articles

Patient outcomes following buprenorphine treatment for opioid use disorder: A retrospective analysis of the influence of patient- and prescriber-level characteristics in Massachusetts, USA.

Opioid use disorder (OUD) is treatable with buprenorphine/naloxone (buprenorphine), but many patients discontinue treatment prematurely. The aim of this study was to assess the influence of patient- and prescriber-level characteristics relative to several patient outcomes following the initiation of buprenorphine treatment for OUD. This was a retrospective observational investigation. We used the Public Health Data Warehouse from the Massachusetts Department of Public Health to construct a sample of patients who initiated buprenorphine treatment between 2015 and 2019. We attributed each patient to a prescriber based on information from prescription claims. We used multilevel models to assess the influence of patient- and prescriber-level characteristics on each outcome. Massachusetts, USA. The study cohort comprised 37 955 unique patients and 2146 prescribers. Among patients, 64.6% were male, 52.6% were under the age of 35 and 82.2% were White, non-Hispanic. For insurance coverage, 72.1% had Medicaid. The outcome measures were poor medication continuity, treatment discontinuation and opioid overdose, all assessed within a 12-month follow-up period that began with a focal prescription for buprenorphine. Each patient had a single follow-up period. Poor medication continuity was defined as medication gaps totaling more than 7days during the initial 180 days of buprenorphine treatment and treatment discontinuation was defined as having a medication gap for 2 consecutive months within the 12-month follow-up period. The patient-level rates for poor medication continuity, treatment discontinuation and opioid overdose were 59.7% [95% confidence interval (CI) = 59.2-60.2], 57.4% (95% CI = 56.9-57.9) and 10.3% (95% CI = 10.0-10.6), respectively, with 1.1% (95% CI = 1.0-1.2) experiencing a fatal opioid overdose. At the patient level, after adjustment for covariates, adverse outcomes were associated with race/ethnicity as both Black, non-Hispanic and Hispanic patients had worse outcomes than did White, non-Hispanic patients (Black, non-Hispanic -- poor continuity: 1.50, 95% CI = 1.34-1.68; discontinuation: 1.44, 95% CI = 1.30-1.60; Hispanic -- poor continuity: 1.21, 95% CI = 1.12-1.31; discontinuation: 1.38, 95% CI = 1.28-1.48). Patients with insurance coverage through Medicaid also had worse outcomes than those with commercial insurance (poor continuity: 1.18, 95% CI = 1.11-1.26; discontinuation: 1.09, 95% CI = 1.03-1.16; overdose: 1.98, 95% CI = 1.75-2.23). Pre-treatment mental health conditions and other types of chronic illness were also associated with worse outcomes (History of mental health conditions -- poor continuity: 1.11, 95% CI = 1.06-1.17; discontinuation: 1.05, CI = 1.01-1.10; overdose: 1.47, 95% CI = 1.36-1.60; Chronic health conditions -- poor continuity: 1.15, 95% CI = 1.05-1.27; discontinuation: 1.15, 95% CI = 1.05-1.26; overdose: 1.83, 95% CI = 1.60-2.10; History of substance use disorder other than for opioids -- poor continuity: 1.54, 95% CI = 1.46-1.62; discontinuation: 1.54, 95% CI = 1.47-1.62; overdose: 1.93, 95% CI = 1.80-2.07). At the prescriber level, after adjustments for covariates, adverse outcomes were associated with clinical training, as primary care physicians had higher rates of adverse outcomes than psychiatrists (poor continuity: 1.12, 95% CI = 1.02-1.23; discontinuation: 1.04, 95% CI = 1.01-1.09). A larger prescriber panel size, based on number of patients being prescribed buprenorphine, was also associated with higher rates of adverse outcomes (poor continuity: 1.36, 95% CI = 1.27-1.46; discontinuation: 1.21, 95% CI = 1.14-1.28; overdose: 1.10, 95% CI = 1.01-1.19). Between 9% and 15% of the variation among patients for the outcomes was accounted for at the prescriber level. Patient- and prescriber-level characteristics appear to be associated with patient outcomes following buprenorphine treatment for opioid use disorder. In particular, patients' race/ethnicity and insurance coverage appear to be associated with substantial disparities in outcomes, and prescriber characteristics appear to be most closely associated with medication continuity during early treatment.

The explorations of the awareness, contemplation, self-Efficacy, and readiness of advance care planning, and its predictors in Taiwanese patients while receiving hemodialysis treatment

BackgroundEnd-stage renal disease (ESRD) is a major chronic illness worldwide, and Taiwan reports one of the highest incidence rates of ESRD with 529 cases per million population (pmp). A number of patients with ESRD patients might require lifelong hemodialysis (HD) or peritoneal dialyses (PD). Due to the progression of dialysis, patients are likely to experience other chronic comorbidities, anxiety and depression, frequent hospitalizations, and higher rates of mortality compared to patients with other types of chronic illnesses. As a result, dialysis patients are prone to experience advance care planning (ACP) needs, such as whether they withdraw from receiving dialysis while approaching their end-of-life (EOL). Yet, existing studies have shown that dialysis patients seldom receive timely consultation regarding ACP and there are limited studies examining ACP amongst Taiwan HD patients.PurposeThe purpose of this study was to examine ACP awareness, contemplation, self-efficacy and readiness; and factors influencing ACP readiness.DesignThis cross-sectional descriptive study with convenience sampling was conducted in the out-patient HD unit at a regional teaching hospital in southern Taiwan. A total of 143 ESRD patients undergoing HD treatments were recruited. A 55-item ACP engagement survey containing the subscales of awareness, contemplation, self-efficacy, and readiness was employed. The data were analyzed with t-tests, one-way ANOVAs, Pearson’s correlations and multiple regressions.ResultsThe results of our investigation revealed that approximately half of the participants (n = 67, 46.9%) were not informed of ACP. Although they reported considering their EOL, medical decisions and desired care, they demonstrated significantly low self-efficacy in discussing ACP (t= -5.272, p < 0.001). HD duration influenced all four ACP subscales; religious beliefs significantly influenced ACP-self-efficacy and readiness; and marital status, education, and primary decision-maker status significantly influenced ACP-readiness. The predictors of ACP-readiness were high self-efficacy and being the primary decision-maker (Adjusted R2 61%).ConclusionMost of the HD patients in this study had low ACP-awareness, contemplation, self-efficacy, and readiness, and most had not completed any ACP-related advance directives (AD). Healthcare professionals should proactively provide HD patients with ACP-related information and answer patients’ and medical decision-makers’ questions in a timely manner, thereby improving the quality of EOL care.

Education Regarding and Adherence to Recommended Nutrition Guidelines among Dental Students.

The Dietary Guidelines for Americans (DGA) were developed to reduce or prevent many types of chronic illness, including cancer, heart disease and diabetes. Healthcare provider recommendations may be influenced by understanding of and adherence to the DGA, which may be incorporated into provider training, medical and dental clinical curricula—although few studies have evaluated adherence to the DGA among dental students. This approved retrospective study of voluntary student responses from a first-year dental school nutrition course included a short dietary and exercise survey administered as part of the DGA learning module. A total of N = 299 students completed the voluntary nutrition survey, yielding a response rate of 91.4%. Daily fruit and vegetable intake, dairy and whole grain servings among UNLV-SDM students were significantly lower than the DGA recommendations but higher than U.S. averages for 18–30-year-olds—although neither group met DGA recommendations. This study represents one of the first to evaluate the dietary intake of U.S. dental students for comparison with the DGA for positive health behaviors. These data demonstrate a lack of adherence to the DGA among highly educated dental students and the need for the curricular inclusion of diet and nutrition into the dental school curriculum.

Fatigue management for adults living with HIV: A randomized controlled pilot study.

Fatigue is a prevalent symptom for adults living with HIV infection. The purpose of this randomized clinical trial was to pilot test a behavioral-educational intervention to reduce fatigue. The intervention included education about daytime behaviors as well as nighttime sleep behaviors. Participants were HIV-positive, between 45 and 75 years old, unemployed, and experiencing fatigue. They were randomized to intervention (n = 25) or control (n = 26) after obtaining baseline measures, administered the intervention or attention control, and followed with monthly assessments for 3 months. Primary outcome measures included the Fatigue Severity Scale (FSS) and fatigue symptom burden using the four-dimension structure of the Memorial Symptom Assessment Scale that includes occurrence, frequency, severity, and distress of a symptom. Other measures included the International Physical Activity Questionnaire, step counts with a Fitbit Flex, Hospital Anxiety and Depression Scale, Pittsburgh Sleep Quality Index, and Sleep Behavior Rating Scale. Compared with attention controls, the intervention group had significantly (p < .05) lower FSS scores and fatigue symptom burden over time, particularly in the frequency dimension. Secondary outcomes for reducing daytime naps and improving sleep quality were also significant (p < .05). This intervention, focused on both daytime and nighttime behaviors, demonstrated promising effects for reducing fatigue among adults living with HIV. Results provide useful direction for larger clinical trials to reduce fatigue in adults living with other types of chronic illness.

Commonalities and Differences in Psychological Adjustment to Chronic Illnesses Among Older Adults: a Comparative Study Based on the Stress and Coping Paradigm.

This study aimed to validate the role of the stress and coping paradigm in the context of psychological adjustment to chronic illnesses among older adults by using the structural equation modeling technique, as well as investigating the differences in structural weights between older adults with arthritis and older adults with hypertension. A cross-sectional study was conducted with 325 older adults with chronic illnesses (149 hypertension, 176 arthritis), aged 60-88years, who completed questions on perceived social support, psychological resources, threat appraisal, self-efficacy, coping strategy, depressive symptoms, and anxiety. The results revealed that older adults with arthritis experienced significantly higher anxiety (t= 2.91, p< 0.01) than those with hypertension, whereas no significant difference in their depressive symptoms was observed (t= 1.61, p> 0.05). Social support, psychological resources, threat appraisal, and self-efficacy had a significant direct relationship with psychological distress (β= - 0.15, β= - 0.38, β=0.19, β= - 0.23, respectively). Multi-group analyses showed significant differences in structural weights between older adults with hypertension and those with arthritis (Δχ2= 41.336, Δdf= 18, p < 0.01). The stress and coping paradigm appears to be applicable for adjustment to chronic illnesses by allowing direct paths from social support, psychological resources, threat appraisal, and self-efficacy to psychological distress. The differences in structural weights may offer an intervening angle for clinical practitioners to design targeted interventions for older adults with different types of chronic illnesses.

Psychosocial implications of disorders of sex development treatment for parents

Historically, studies of caregivers of children with disorders of sex development (DSD) have been limited. Recent data reveal that parents of young children with DSD report increased stress, anxiety, depression, and decreased quality of life in ways that are similar to parents of children with other types of chronic illnesses. Also similar to other chronic illnesses of childhood, parents of children with DSD exhibit overprotective parenting and perceive their child as being vulnerable. These emotions and behaviors exhibited by parents are concerning as they may limit an affected child's emotional and social development over time. Perhaps, more unique to the situation of DSD is the perceived, or real, child-focused stigma experienced by parents of children with DSD. Interventions to improve parents' psychosocial adaptation to their child's medical condition, including coaching in how to discuss their child's condition in a manner that makes them feel safe and supported, are needed to optimize outcomes for families.

HEALTH PROMOTERS’ CONTRIBUTION REGARDING HEALTH PROMOTION FOR FAMILIES WITH ADOLESCENTS WITHIN THE HIV AND AIDS CONTEXT

Health care workers are faced with increased workloads because of clients who are suffering from different types of chronic illnesses, including HIV and AIDS. This article explored and described the role of health promoters regarding health promotion programmes for families with adolescents that have been orphaned by the HIV and AIDS endemic. A descriptive, qualitative phenomenological study was employed. The population involved health promoters in the Hammanskraal region in rural South Africa. The participants were purposively selected for focus group interviews. Data were qualitatively analysed. Various health promoters’ contributions were identified regarding home visits, patient care, social care and health education. The contributions of health promoters were visible and efficient in the communities. It was recommended that the community, the governmental and non-governmental organisations should train and support health promoters to assist in service delivery for local communities.

ISQUA16-2364ASSESSING THE PILLARS OF LIFE QUALITY FOR LONG-TERM CARE CLIENTS IN RESIDENTIAL AND COMMUNITY CONTEXTS

The goal of this research was to validate a scale for assessing 9 life quality indicators for long-term care clients with and without dementia, across ages and genders and with all types of chronic illness or disability in both residential and community care contexts. The basic elements of the assessment cover social capacity, self-efficacy, relationships, mood state and feelings of security. The Long-Term Care quality of life (LTC-Qol) scale fills a gap in reliable quality of life assessments in such contexts. The scale was developed and refined …

Multi-morbidity, disability and adaptation strategies among community-dwelling adults aged 75 years and older

BackgroundThe impact of multi-morbidity and disability on the use of adaptation strategies in older adults has not been well researched. ObjectiveThis study investigated categories of adaptation strategies that community-dwelling older adults use to complete their daily activities, identified factors that are associated with the use of behavioral adaptations, and examined the relationship among multi-morbidity, disability and adaptation strategies in this population. MethodsA mixed methods research design was used. 105 community-dwelling older adults with ages ranging from 75 to 94 years completed a questionnaire and semi-structured interview on types of chronic illnesses (multi-morbidity), amount of difficulty in completing daily activities (degree of disability), and types of behavioral efforts made to complete daily activities that are challenging (adaptation strategies). The model of selective optimization with compensation (SOC) was used to categorize these strategies. ResultsThe findings revealed that older adults use a wide range of adaptations with compensation and selection the most (40.4%) and least (16.5%) frequently reported respectively. Degree of disability was uniquely associated with the frequency of using SOC strategies while controlling for other factors. Furthermore, degree of disability was a mediator for multi-morbidity in predicting frequency of using SOC strategies. ConclusionsThe findings support that older adults using behavioral adaptations to cope with functional decline is prevalent. Knowing the types of adaptation that older adults employed and the indirect relationship between multi-morbidity and frequency of using SOC strategies, with degree of disability as the mediator will be helpful in planning interventions and prevention programs for educating older adults.

Wish to Die and Physical Illness in Older Adults

The wish to die is the first step into the suicidal process. While depression is a major risk factor for the wish to die in old age, it seems that chronic physical illness could also be an important associated factor. Therefore, it would be interesting to look at the relations between 15 specific illnesses and the wish to die in old age. A representative probabilistic sample of community-dwelling older adults aged over 65 (M = 73.9) took part in a large survey on the prevalence of mental disorders, that also gathered information on chronic illness. RESULTS indicated that 5.2% of the 2,811 respondents believed that they would be better dead, and that nine types of chronic illnesses were found significantly more often in elderly persons with the wish to die compared to those without. A logistic regression, including these nine diseases, revealed that, when gender was controlled for, three types of chronic illnesses were significantly associated with increased odds of wish to die: arthritis/rheumatism (OR = 1.72), respiratory problems (OR = 1.85), and urinary/prostate disorders (OR = 1.76). Although many chronic illnesses were found significantly more often in persons with a wish to die, painful diseases causing functional limitations (arthritis) and illnesses that affect basic physiological needs (breathing, eliminating) were particularly important associated factors. New research should look at the possible mediating effects of helplessness, hopelessness, perceived burdensomeness, and reduced quality of life on the relation between chronic illness and the wish to die. Language: en

Family income and child health in China

We examine the effect of family income on child health using data from the China Health and Nutrition Survey. We find a significant child health/family income gradient for the overall sample of Chinese children. Our preferred specification shows that the income gradient increases with child age until the age of 12. We find that parental health consciousness, household sanitation conditions and nutrition intake are the channels through which family income affects child health. After controlling for these transmission channels, the gradient strengthens with child age until the age of 17. We find that children from poorer families in China are not only more likely to experience several types of chronic illnesses, but also less likely to address effectively some health conditions. The income gradient is found to be very heterogeneous, with greater effect on children with poorer health, girls and children in rural China.

Can the Fatigue Severity Scale 7-item version be used across different patient populations as a generic fatigue measure - a comparative study using a Rasch model approach

BackgroundFatigue is a disabling symptom associated with reduced quality of life in various populations living with chronic illnesses. The transfer of knowledge about fatigue from one group to another is crucial in both research and healthcare. Outcomes should be validly and reliably comparable between groups and should not be unduly influenced by diagnostic variations. The present study evaluates whether the Fatigue Severity Scale 7-item version (FSS-7) demonstrates similar item hierarchy across people with multiple sclerosis, stroke or HIV/AIDS to ensure valid comparisons between groups, and provide further evidence of internal scale validity.MethodsA secondary comparative analysis was performed using data from three different studies of three different chronic illnesses: multiple sclerosis, stroke and HIV/AIDS. Each of these studies had previously concluded that the FSS-7 has better psychometric properties than the original FSS for measuring fatigue interference. Data from 224 people with multiple sclerosis, 104 people with stroke and 316 people with HIV/AIDS were examined. Item response theory and a Rasch model were chosen to analyze the similarity of the FSS-7 item hierarchy across the three diagnostic groupsResultsCross-sample differences were found for items #3, #5, #6 and #9 for two of the three samples, which raise questions about item validity across groups. However, disease-specific and disease-generic Rasch measures were similar across samples, indicating that individual fatigue interference measures in these three chronic illnesses might still be reliably comparable using the FSS-7.ConclusionsSome items performed differently between the three samples but did not bias person measures, thereby indicating that fatigue interference in these illnesses might still be reliably compared using FSS-7 scores. However, caution is warranted when comparing fatigue raw sum scores directly across diagnostic groups using the FSS-7. Further studies of the scale are needed in other types of chronic illnesses.

Concerned about their learning: mathematics students with chronic illness and their teachers at school

Chronic illness often goes hand-in-hand with absence from school, and students miss out on learning opportunities at school for extended or accumulative periods of time. Many young people seek to continue their school studies nonetheless. The need to consider viable ways to support them academically arose in the context of a project called Link ‘n Learn funded by an Australian Research Council Linkage grant (2008–2010). This paper reports on one aspect of the project – an in-depth qualitative case study of 22 participants: senior secondary students with diverse types of chronic illness who were continuing their studies during absence from school and their mathematics teachers. The study found that the students’ concerns centred on academic issues – their perceived need for support from and interaction with their teachers. The teachers' concerns focused on medical issues – their students having to manage illness. Facilitators of these students' ability to continue studying included their ambition, perseverance with independent learning, initiative in seeking help, and quick recovery from medical treatment cycles. Teacher-related facilitators included the teachers' willingness to interact using communication media, confidence in initiating contact, and ability to modify their students' learning programme. Other facilitators included a responsive school technology department, technology tutoring from students, and the involvement of family members or tutors. Outcomes for students and teachers of their interactions with each other during lengthy periods of absence, and implications for schools, are discussed.

The After Discharge Care Management of Low Income Frail Elderly (AD-LIFE) Randomized Trial: Theoretical Framework and Study Design

Interdisciplinary care management is advocated for optimal care of patients with many types of chronic illnesses; however, few models exist that have been tested using randomized trials. The purpose of this report is to describe the theoretical basis for the After Discharge Management of Low Income Frail Elderly (AD-LIFE) trial, which is an ongoing 2-group randomized trial (total n = 530) to test a chronic illness management and transitional care intervention. The intervention is based on Wagner's chronic illness care model and involves comprehensive posthospitalization nurse-led interdisciplinary care management for low income frail elders with chronic illnesses, employs evidence-based protocols that were developed using the Assessing Care of Vulnerable Elders (ACOVE) guidelines, emphasizes patient activation, and integrates with community-based long-term care and other community agencies. The primary aim of the AD-LIFE trial is to test a chronic illness management intervention in vulnerable patients who are eligible for Medicare and Medicaid. This model, with its standardized, evidence-based medical and psychosocial intervention protocols, will be easily transportable to other sites interested in optimizing outcomes for chronically ill older adults. If the results of the AD-LIFE trial demonstrate the superiority of the intervention, then this data will be important for health care policy makers.

Temporomandibular disorder patients’ journey through care

Temporomandibular disorders (TMDs) are a common group of chronic disorders (illnesses) that health care providers can find difficult to diagnose and explain. Similar difficulties in the diagnosis of other chronic conditions have been shown to have a negative impact on health. An understanding of TMD patients' experiences and journey through care could indicate time points and strategies to help patients. To develop a robust empirically derived map of TMD sufferers' journey through care. A qualitative study using semi-structured interviews was undertaken using a purposive sample of patients with TMDs. Analysis followed the principles of the constant comparative method where data collection and thematic analysis occurred concurrently and continued until data saturation (n = 29). The experiences of patients could be grouped into three key stages: genesis of problem, seeking help in primary care and secondary care intervention. A wide variety of negative effects were described throughout these stages. An empirically derived map of the patients' reported journey through care emerged. The experiences of patients with TMDs mirror experiences of other types of chronic illness. Mapping the journey through care for TMDs highlights the potential for interaction between the stages of the journey and the individual's illness. It may be possible to target interventions at specific stages on the map to help minimize the psychosocial effects of TMDs.

The AD-LIFE Trial

Interdisciplinary care management that fully integrates medical and social care is advocated for optimal care of patients with many types of chronic illnesses, yet the effectiveness of this care model has been insufficiently tested using randomized controlled trials. This article presents the results of a pilot care management program and a description of a larger randomized controlled trial modeled after the pilot program (the After Discharge Care Management of Low-Income Frail Elderly [AD-LIFE] trial). It compares an integrated medical and social care management model (intervention group) with a purely social model (control group) involving low-income elderly patients with chronic conditions and functional impairment at high risk for rehospitalization or nursing home placement. A case study of a patient participant in the AD-LIFE study is presented. The case illustrates the positive effects of the intervention on biopsychosocial outcomes.

Effectiveness and cost-effectiveness of a minimal psychological intervention to reduce non-severe depression in chronically ill elderly patients: the design of a randomised controlled trial [ISRCTN92331982

BackgroundDepression is a prevalent disorder in chronically ill elderly persons. It may decrease quality of life, and increase functional disability, medical costs, and healthcare utilisation. Because patients may slip into a downward spiral, early recognition and treatment of depression is important. Depression can be treated with antidepressants or psychological interventions; the latter can also be applied by trained paraprofessionals.In this paper, we describe the design of the DELTA study (Depression in Elderly with Long-Term Afflictions). The first objective of the DELTA study is to evaluate the effectiveness and cost-effectiveness of a minimal psychological intervention (MPI) to reduce depression in chronically ill elderly patients. The second objective is to evaluate whether a potential effect of the MPI may differ between types of chronic illnesses. The tailor-made intervention is administered by nurses, who are trained in the principles of cognitive behavioural therapy and self-management.Methods/DesignDELTA is a two-armed randomised controlled trial, comparing MPI to usual care. A total number of 180 patients with diabetes mellitus type II (DM) and 180 patients with chronic obstructive pulmonary disease (COPD), who in addition suffer from non-severe depression, will be included in the study. In our study, non-severe depression is defined as having minor depression, mild major depression or moderate major depression. The primary outcome measure is depression using the Beck Depression Inventory. Secondary outcome measures include quality of life, daily functioning, self-efficacy, autonomy, and participation. In the economic evaluation, cost-effectiveness and cost-utility ratios will be calculated. Furthermore, a process evaluation will be carried out.Analyses will include both univariate and multivariate techniques and according to the intention to treat principle. The economic evaluation will be done from a societal perspective and data of the process evaluation will be analysed using descriptive techniques.DiscussionA total number of 361 patients has been included in the study. All interventions have been administered and follow-up data will be complete in September 2006.Preliminary results from the process evaluation indicate that patients' satisfaction with the intervention is high. If this intervention proves to be effective, implementation of the DELTA intervention is considered and anticipated.

Global childhood chronic illness.

Chronic illness of children has become a global concern. Although the etiology and types of chronic illness may differ from developing countries to developed countries, some aspects are universal. This article examines childhood chronic disease prevalence worldwide and describes strategies for detection, prevention, and intervention.

Factors associated with the use of publicly funded services by Hong Kong Chinese older adults

This article analyzes cross-sectional data collected from a representative community sample of 2003 Chinese elderly people aged 60 or above in Hong Kong. We examined whether the use of publicly funded health services by older adults is equitable under the framework of Andersen model. A number of predisposing, enabling, and need factors were assessed as predictors of utilization in four categories of services including hospital admission, emergency room, general outpatient clinics, and specialist outpatient clinics. It was found that utilization of these four health services was consistently correlated with need factors. Specifically, self-rated health status and particular types of chronic illness were consistently and significantly related to utilization for all four of services in Hong Kong. On the other hand, age and family support were related to hospital admission whereas functional impairment was associated with the use of emergency room and general outpatient clinics. Findings suggest that publicly funded health services in Hong Kong are used equitably by elderly people.

Survey of major chronic iIlnesses and hospital admissions via the emergency department in a randomized older population in Randwick, Australia.

To find out if patients with chronic illnesses living in the community are at risk of unplanned hospital admissions through emergency departments; what types of chronic illnesses may be putative risk factors; and if an increase in the number of chronic illnesses may be associated with increased risk. The survey included the completion of a standardized questionnaire for medical illnesses in a random sample of older people dwelling in the community and analysis of admission records to our hospital. The principal diagnoses for admissions were recorded. The risk factors for admissions were analysed. Five hundred and twenty-six (239 men and 287 women) people aged 55 years and over were interviewed. Musculoskeletal disorders, hypertension, gastrointestinal disorders and ischaemic heart disease were the most frequently reported of the chronic illnesses surveyed. A total number of 70 people from the survey group with a total of 115 admissions through emergency departments were recorded. Using logistic regression model, hypertension, ischaemic heart disease and age were found to be risk factors for emergency admissions amongst this group of community-dwelling residents. The ratios were 2.03 (95% confidence interval (CI): 1.2-3.44), 2.02 (95% CI: 1.16-3.49) and 1.05 (95% CI: 1.02-1.09), respectively. Furthermore, multiple (three or more) chronic illnesses were found to be a strong predictor of hospital admission via emergency department (chi-square = 16.647, DF = 1, P-value < 0.001). We conclude that there was significant association between multiple chronic diseases and emergency admissions for older people. Of these, hypertension and ischaemic heart disease were found to be significant predictors. Age per se was found to be of borderline significance.