Global and regional prevalence of multimorbidity in the adult population in community settings: a systematic review and meta-analysis

Adverse childhood experiences with physical, depressive, and cognitive multimorbidity among Chinese adults and the mediating role of loneliness

Little is known about the associations between adverse childhood experiences (ACES) and physical, depressive, and cognitive (PDC) disorders and their multimorbidity. Moreover, no study has assessed whether loneliness mediates any such associations. Using a nationally population-based study in China, we aimed to investigate the associations between ACES and PDC disorders and their multimorbidity among 11,124 middle-aged and older adults. Eight categories of outcomes including no disorders, physical disorder, depressive symptoms, cognitive disorder, and their four combinations were assessed. Twelve ACES indicators were measured using a validated questionnaire. Multivariate logistic regression and stratification analyses were performed to explore the association between ACES and PDC disorders and their multimorbidity, as well as potential modifiers. Mediate analyses were applied to examine the potential pathways via loneliness. Of the 11,124 individuals (45.8 % women, mean [SD] age: 60.1 [8.9] years), 79.3 % had at least one ACE. Compared with individuals without ACES, those who had four or more ACES had elevated risks of PDC disorders and their multimorbidity. The estimated odds ratios (OR) were 2.95 (95 % CI: 2.46-3.54) for physical-depressive multimorbidity, 1.59 (1.28-1.98) for physical-cognitive multimorbidity, 2.58 (2.01-3.31) for depressive-cognitive multimorbidity, and 2.91 (2.15-3.96) for PDC multimorbidity, respectively. There is an exposure-response relationship between cumulative ACES with different outcomes. These associations were mediated by loneliness, with a mediation proportion varying from 8.7 % to 32.5 %. However, no significant modification was observed by sex, age, educational level, and childhood economic status. Our findings provided important insights for reducing childhood adversity to prevent chronic multimorbidity.

Association between cardiovascular comorbidities and psychological anxiety & depression in the elderly

BACKGROUND

Limited research examining the relationship between cardiovascular comorbidities and psychological anxiety & depression in the elderly, and the conclusions are inconsistent. This study aimed to investigate the intricate relationships between them among the pariticipants aged 60 years and above.

METHODS

Utilizing multivariate logistic regression and stratified analysis to analyze the association between cardiovascular comorbidities and psychological anxiety & depression. Trend analysis was performed to evaluate the risk of developing depression and anxiety as the number of diseases increased. Interaction analysis was utilized to explore potential factors underlying the comorbidity of cardiovascular diseases and depression.

RESULTS

Among 11,960 elder participants (mean age 82 years, 46.5 % male), the prevalences of psychological anxiety, depression, and ≥2 types of cardiovascular diseases are 11.7 %, 25.8 %, and 24.7 %, respectively. Compared to subjects without cardiovascular diseases, those with 2, 3, and 4 types of cardiovascular diseases respectively have increased risk of depression, with corresponding ORs (95 % CI) being 1.23 (1.08-1.40), 1.50 (1.24-1.81), and 1.91 (1.42-2.56), respectively. Trend analysis shows that for each additional cardiovascular comorbidity, the risk of depression increases by 15 % (OR 1.15, 95%CI 1.10-1.20). The interaction effect showed that social activities were both additive and multiplicative factors affecting cardiovascular comorbidity and depression. The association between the risk of anxiety and the complexity of cardiovascular comorbidities is not strong (P > 0.05).

CONCLUSION

As the complexity of cardiovascular comorbidity increases, the risk of depression skyrockets among older adults, social activities may serve as a remedy.

Perceptions of Hospital Care Quality According to People Living With Multiple Long-Term Conditions: A Scoping Review

BACKGROUND

Delivering high-quality hospital care for people with multiple long-term conditions (MLTC), defined as the co-existence of two or more chronic health conditions, is important. However, evidence on care quality from the perspective of people living with MLTC has not been synthesised. The aim of this scoping review was to identify studies investigating how people living with MLTC perceive hospital care quality and to summarise key concepts and gaps in the evidence base.

METHODS

Systematic searches of five databases to identify all eligible studies published up until March 2024 were undertaken and supplemented by citation tracking. Peer-reviewed articles featuring people with MLTC's perceptions of the quality of 'usual' care in hospitals were eligible for inclusion. All records were screened independently by two reviewers.

RESULTS

Of the 3178 titles and abstracts screened, 17 papers were eligible for inclusion (9 qualitative, 7 quantitative and 1 mixed-methods). Studies highlighted an unmet desire for holistic interdisciplinary care (n = 4), prioritisation of inpatients' acute conditions over long-term conditions (n = 2), barriers to patient engagement (n = 3) and insufficient discharge planning (n = 3).

CONCLUSION

Existing studies that have investigated how people living with MLTC perceive the quality of their hospital care are diverse. However, all included studies point to ways in which hospital care for people with MLTC could be improved. The review highlights a need for studies including people of a wider range of ages, mixed-methods studies and studies that focus on under-researched elements of care quality, such as safety and preventative care.

PATIENT OR PUBLIC CONTRIBUTION

There have been regular opportunities for engagement with the ADMISSION research collaborative's Patient Advisory Group (PAG), a group of patients and carers with lived experience of multiple long-term conditions, who meet every 4 months. At these meetings, hospital care quality (and patients' perception thereof) has been a recurring theme, which encouraged the conceptualisation of this review. The PAG had no further direct involvement in the conduct of this review.

Multimorbidity and analgesic-related harms: a systematic review

BACKGROUND

Multimorbidity is the presence of two or more long-term medical conditions. Chronic pain affects more than half of people with multimorbidity, and optimal treatment strategies are unknown. We aimed to quantify the risk of adverse outcomes from the following analgesics: opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), and gabapentinoids in adults with multimorbidity.

METHOD

The review was registered on PROSPERO (CRD42023462592). We searched Medline, CINAHL, Web of Science, Embase, and CENTRAL for studies reporting analgesic-related harms in people with multimorbidity or the impact of multimorbidity on harms in adults exposed to analgesics. Two researchers independently screened titles/abstracts, completed full-text reviews, extracted data, and assessed risk of bias using the Newcastle-Ottawa scale. Studies were synthesised narratively, grouping by analgesic class and direction of effect.

RESULTS

We screened 6690 records and 344 full texts, with 27 studies included (n=2 671 958 patients). Studies were heterogenous, with variable quality (high risk of bias, n=11). Most studies on opioids reported adverse outcomes (12/16). Opioid use compared with non-use was associated with increased mortality in adults with multimorbidity. Multimorbidity was associated with opioid overdose and death among adults prescribed opioids for pain. Half of studies of NSAIDs reported adverse outcomes (6/11) including gastrointestinal bleeding. Only one study assessed gabapentinoids which found an association with delirium and pneumonia, but not mortality in people with multimorbidity.

CONCLUSIONS

There is evidence of harms associated with opioids in adults with multimorbidity, including overdose and increased mortality. There is a lack of evidence on gabapentinoids. Further research is required to understand optimal analgesic management in people with multimorbidity.

SYSTEMATIC REVIEW PROTOCOL

PROSPERO (CRD42023462592).

Substance use and psychiatric comorbidities among medical inpatients: associations with length of stay, health-related quality of life, and functioning, with consideration for gender

Little is known about the impact of substance use and psychiatric comorbidities on the management and outcomes of medical inpatients. This study explores the influence of psychiatric comorbidities, and substance use (tobacco, alcohol, and cannabis) on the length of hospital stay (LOS), Health-Related Quality of Life (HRQoL), and functioning in 800 medical inpatients at a high-complexity academic hospital. Multivariate analyses demonstrated that psychiatric comorbidities were associated with reduced HRQoL (β = -0.050, p-value = 0.017), and impaired functioning (β = 3.4, p-value <0.001). High-risk tobacco, alcohol, and cannabis use, according to the ASSIST were independently associated with impaired functioning. High-risk alcohol use was furthermore associated with longer stays (RR = 1.5, p-value <0.001). Female gender was associated with poorer HRQoL and functioning outcomes but with shorter LOS. These findings underscore the necessity of integrated mental health care within medical settings and emphasize the importance of a comprehensive approach considering psychiatric comorbidities, substance use, and gender perspective.

Defining phenotypes of disease severity for long-term cardiovascular, renal, metabolic, and mental health conditions in primary care electronic health records: A mixed-methods study using the nominal group technique

OBJECTIVE

Inclusion of severity measures for long-term conditions (LTC) could improve prediction models for multiple long-term conditions (MLTC) but some severity measures have limited availability in electronic health records (EHR). We aimed to develop consensus on feasible severity phenotypes for nine cardio-renal-metabolic and mental health conditions.

METHODS

This was a mixed-methods study using novel methodology. From existing literature, we identified potential severity phenotypes and explored feasibility of their use in EHR through analysis of data from 31 randomly selected general practices in the Clinical Practice Research Datalink (CPRD) Aurum database, a large UK-based primary care EHR database. We recruited clinical academic experts to participate in a survey and nominal group technique workshop. Participants used a Likert scale to rate clinical importance and feasibility for each severity phenotype independently (informed by the exploratory analysis). For the optimal severity phenotype (highest combined score) for each condition, adjusted hazard ratios (aHR) of five-year mortality were calculated using Cox regression on the full CPRD database.

RESULTS

Fifteen existing severity indexes for nine conditions informed the survey. Eighteen clinical academics participated in the survey, twelve also participated in the workshops. Combined mean scores for clinical importance and feasibility were highest for estimated glomerular filtration rate (eGFR) for chronic kidney disease (CKD) (9.42/10) and for microvascular complications of diabetes (9.08/10). Mortality was higher for each reduction in eGFR stage; Stage 3b aHR 1.42, 95 %CI 1.41-1.44 versus Stage 3a CKD and for each additional microvascular complication of diabetes; one complication aHR 1.44, 95 %CI 1.32-1.57 versus none. Some phenotypes (e.g., aneurysm diameter) were not well recorded within the database and could not feasibly be applied.

CONCLUSION

We developed a methodology for identifying severity phenotypes in EHRs. Severity phenotypes were identified for diabetes (type 1 and 2), ischaemic heart disease, CKD and peripheral vascular disease. Data quality in EHR should be improved for under-recorded severity measures.

Multimorbidity and fluid biomarkers of Alzheimer's disease: a systematic review

PURPOSE

This systematic review aimed to summarize the evidence on the association between multimorbidity and fluid biomarkers of Alzheimer's disease (AD).

METHODS

We systematically searched PubMed, Web of Science, and Embase for studies investigating the association between multimorbidity-defined as the co-occurrence of multiple chronic conditions in the same individual-and levels of cerebrospinal fluid (CSF) or blood biomarkers of AD, focusing on the most established AD biomarkers (amyloid-beta, phosphorylated-tau, total-tau, neurofilament light chain, and glial fibrillary acidic protein). Studies were selected following PRISMA guidelines.

RESULTS

Out of 3,104 records, we identified 10 cross-sectional studies. Four studies assessed CSF biomarkers in dementia-free participants with mean age between 61.8 and 66.6 years, yielding mixed findings with no consistent association between multimorbidity and CSF biomarkers. Six studies focused on blood biomarkers in participants with mean age ranging from 66.5 to 76.4 years, five of which included individuals with dementia. Most of these studies reported an association between multimorbidity and elevated blood biomarker levels.

CONCLUSIONS

This review suggests a significant association between multimorbidity and AD blood biomarkers in older populations, while the results on CSF are mixed and inconsistent. Further research is needed, particularly longitudinal studies assessing both CSF and blood biomarkers within the same populations.

Association between depression and multimorbidity in Chinese middle-aged and older adults: a prospective cohort study

BACKGROUND

The association between depression and multimorbidity and different multimorbidity patterns in Chinese middle-aged and older people remains unclear.

METHODS

This prospective cohort study used the 2011-2020 China Health and Retirement Longitudinal Study (CHARLS), which included 7185 middle-aged and older adults aged 45 years and older as the study sample. Study analyses were conducted using the adjusted Cox proportional hazard model, restricted cubic spline (RCS), latent class analysis (LCA), subgroup analysis, and mediation analysis.

RESULTS

Patients with depression at baseline exhibited a 47.5 % elevated risk of developing multimorbidity in comparison to the general population (HR:1.475, 95 % CI: (1.372, 1.585)). For each one-unit increase in the depression score, the risk of developing multimorbidity increases by 3.8 % (HR:1.038, 95 % CI: (1.032, 1.044)). There was an overall non-linear trend in the RCS curves (P < 0.001, P for nonlinear <0.001). Meanwhile, we found a significantly reduced risk of complex disease patterns (OR: 2.744, 95%CI: (1.990, 3.783)) and respiratory disease patterns (OR: 2.296, 95%CI: (1.508, 3.495)) in depressed participants compared to healthy participants. The mediation rate of activities of daily living (ADL) between depression and multimorbidity was 8.838 %.

CONCLUSION

Chinese middle-aged and older adults with depression were more prone to multimorbidity than healthy person, and more likely to suffer from the respiratory disease pattern and the complex disease pattern. We should adopt diversified prevention and treatment measures tailored to different patterns of multimorbidity and varying degrees of chronic diseases, including weight management, physical exercise, and attention to functional health.

Longitudinal effects of diet quality on healthy aging - Focus on cardiometabolic health: findings from the Canadian longitudinal study on aging (CLSA)

BACKGROUND

Hypertension, a major concern for older adults, contributes to morbidity and mortality by increasing the risk of cardiovascular disease, stroke, kidney dysfunction, and cognitive decline. A healthy diet plays a vital role in limiting chronic disease progression in aging populations.

AIM

This study investigated the association between diet quality and healthy aging, focusing on blood pressure measurements (BPMs), using the Canadian Longitudinal Study on Aging (CLSA).

METHODS

Participants aged 45-85 years at baseline were followed for up to nine years. Mediterranean diet score (MDS) was determined based on the validated short diet questionnaire (SDQ). BP and mean arterial pressure (MAP) were measured at baseline (2010), follow-up 1 (2015), and follow-up 2 (2018). Linear regression models (LRMs), linear mixed-effects models (LMMs), and latent change score models (LCSMs) examined the associations and longitudinal effect between MDS and BPMs, adjusted for potential confounders. Individuals who participated in all three waves (n = 25,377) were included.

RESULTS

Fully adjusted LRMs showed significant (p < 0.001) inverse associations between MDS and all BPMs across all time points, e.g., 1 unit increase in the MDS (min0-max50) was associated with a 0.058 mmHg decrease of diastolic BP (DBP) (β=-0.058), 0.052 mmHg systolic BP (SBP) (β=-0.052), and 0.056 mmHg MAP (β=-0.056). LCSMs indicated that a 1-unit higher baseline MDS was significantly associated with 0.090 mmHg reductions in DBP at follow-up 2 (β=-0.090,p < 0.001), 0.078 mmHg for SBP (β=-0.078,p = 0.002) and 0.076 mmHg for MAP (β=-0.076,p = 0.003). Changes in MDS during follow-ups showed no consistent significant associations with BPMs at follow-up 1 or 2.

DISCUSSION AND CONCLUSION

Higher MDS was associated with lower BPMs over time. This study highlights the role of diet quality in healthy aging and mitigating cardiometabolic risk in older adults.

Beliefs About Medication as a Mediator in the Relationship Between eHealth Literacy and Medication Adherence Among Older Adults With Multimorbidity: A Cross-Sectional Survey

BACKGROUND

Medication nonadherence has long been a problem for older adults with multimorbidity. As more and more eHealth apps are being used to improve medication adherence, eHealth literacy (eHL) provides an opportunity for patients to benefit. Therefore, there is a need to identify the relationship between eHL and medication adherence.

OBJECTIVE

To explore the relationship between eHL and medication adherence, and to clarify the role that beliefs about medication play in the relationship.

METHODS

A cross-sectional survey was conducted in a community in Xuzhou, China, using a convenience sampling method. Information on eHL, beliefs about medication, and medication adherence were collected through questionnaires. Spearman correlation analysis and structural equation modeling were used to measure the relationship between eHL and adherence to medication, and the mediation effect of beliefs about medications.

RESULTS

A total of 297 adults with multimorbidity were included in this study. The results showed that medication adherence was positively correlated with necessity beliefs (r = 0.321, P < .001) and negatively correlated with concerns (r = -0.644, P < .001). In addition to directly and favorably predicting medication adherence, eHL also had an impact on adherence through the mediating effects of necessity beliefs (β = 0.045, 95% CI: 0.011-0.086) and concerns about medication (β = 0.213, 95% CI: 0.165-0.273).

CONCLUSION

Our findings highlighted the importance of improving eHL, fostering positive recognition of polypharmacy, and alleviating concerns about medicine-taking to improve medication adherence among older adults with multimorbidity.

Cluster and survival analysis of UK biobank data reveals associations between physical multimorbidity clusters and subsequent depression

BACKGROUND

Multimorbidity, the co-occurrence of two or more conditions within an individual, is a growing challenge for health and care delivery as well as for research. Combinations of physical and mental health conditions are highlighted as particularly important. Here, we investigated associations between physical multimorbidity and subsequent depression.

METHODS

We performed a clustering analysis upon physical morbidity data for UK Biobank participants aged 37-73. Of 502,353 participants, 142,005 had linked general practice data with at least one baseline physical condition. Following stratification by sex (77,785 women; 64,220 men), we used four clustering methods and selected the best-performing based on clustering metrics. We used Fisher's Exact test to determine significant over-/under-representation of conditions within each cluster. Amongst people with no prior depression, we used survival analysis to estimate associations between cluster-membership and time to subsequent depression diagnosis.

RESULTS

Our results show that the k-modes models perform best, and the over-/under-represented conditions in the resultant clusters reflect known associations. For example, clusters containing an overrepresentation of cardiometabolic conditions are amongst the largest (15.5% of whole cohort, 19.7% of women, 24.2% of men). Cluster associations with depression vary from hazard ratio 1.29 (95% confidence interval 0.85-1.98) to 2.67 (2.24-3.17), but almost all clusters show a higher association with depression than those without physical conditions.

CONCLUSIONS

We show that certain groups of physical multimorbidity may be associated with a higher risk of subsequent depression. However, our findings invite further investigation into other factors, such as social considerations, which may link physical multimorbidity with depression.

The Impact of Multidisciplinary Transitional Care Interventions for Complex Care Needs: A Systematic Review and Meta-Analysis

BACKGROUND AND OBJECTIVES

Multidisciplinary transitional care interventions (MTCIs) ensure care coordination and continuity after hospital discharge while addressing (older) patients' complex care needs related to their physical, nutritional, cognitive, and/or psychological status. This study aimed to identify, critically appraise, and synthesize the current body of evidence investigating the effectiveness of such interventions.

RESEARCH DESIGN AND METHODS

Medline, Embase, CINAHL, and CENTRAL were searched for randomized controlled trials assessing MTCIs' impact on readmissions, mortality, and health-related outcomes from inception to July 2024. Risk of bias was evaluated with the Risk of Bias-2 tool. Subgroup analyses assessed whether different intervention types affected outcomes differently. The certainty of the evidence was assessed with the Grading of Recommendations Assessment, Development, and Evaluation approach and the credibility of subgroup analyses with the Instrument to evaluate the Credibility of Effect Modification Analyses.

RESULTS

Forty-nine trials involving 25,566 patients were included. There was low certainty that MTCIs reduced readmissions (relative risk [RR] = 0.88; 95% confidence intervals [95% CI] = 0.80 to 0.96) and high certainty for reduced mortality (RR = 0.92; 95% CI = 0.84 to 1.01). There was low to moderate certainty that MTCIs improved physical quality of life (standardized mean difference [SMD] = 0.54; 95% CI = -0.06 to 1.15), mental quality of life (SMD = 0.44; 95% CI = -0.08 to 0.96), patient satisfaction (SMD = 0.49; 95% CI = -0.14 to 1.12), and physical performance (SMD = 0.49; 95% CI = -0.11 to 1.10). Subgroup analysis revealed a larger and statistically significant effect on physical performance in more complex interventions (SMD = 0.83; 95% CI = 0.02 to 1.65).

DISCUSSION AND IMPLICATIONS

These findings suggest that MTCIs can reduce readmissions and mortality while improving quality of life and physical performance. Further investigations should focus on tailoring MTCIs to specific contexts to maximize their impact.

Prevalence, patterns, and determinants of multimorbidity in South Africa: Insights from a nationally representative survey

BACKGROUND

Multimorbidity in Sub-Saharan Africa is under researched and includes distinct disease combinations to those seen in high income countries. The aim of this study was to determine the prevalence and distribution of multimorbidity in South Africa, as well as the associated individual, area-level and contextual factors.

METHODOLOGY

Multilevel logistic regression analyses were conducted on nationally representative 2016 South Africa Demographic Health Survey Data. The sample included 5,592 individuals (level 1) living in 691 neighbourhoods (level 2).

PRINCIPAL FINDINGS

Multimorbidity was present in 45.3% of the study population, ranging from 35.6% in Limpopo to 52.1% in Eastern Cape. Hypertension was the most prevalent condition (46.4%) followed by diabetes (22.6%). Individuals aged 65-95 had 11.57 times higher odds (95% CI 8.50-15.74) of multimorbidity compared to those aged 15-24. Women had nearly twice the odds of men (OR 1.95, 95% CI 1.68-1.27). Formerly married individuals had 1.63 times higher odds (95% CI 1.32-2.02) than never married. Compared to Black Africans, White individuals had 44% lower odds (OR 0.56, 95% CI 0.39-0.82) and those of mixed ethnicity had 31% lower odds (OR 0.69, 95% CI 0.51-0.92). Obesity increased the odds by 38% (OR 1.38, 95% CI 1.17-1.64) and occupational smoke exposure by 26% (OR 1.26, 95% CI 1.07-1.49). There was variation in multimorbidity at the neighbourhood level, with 2.9% of the variation attributable to contextual factors in the empty model. The median odds ratio was 1.35, indicating substantially higher odds of multimorbidity if an individual moved to a higher risk neighbourhood.

CONCLUSIONS

This study found a high burden of multimorbidity in South Africa patterned by demographic, socioeconomic, lifestyle and contextual factors. The results highlight the need for multilevel strategies to reduce multimorbidity and its inequities by addressing individual risk factors as well as neighbourhood-level determinants of health.

The relationship between multiple chronic diseases and sleep quality among the older people ≥ 60 years in China

BACKGROUND

High-quality sleep is essential for both physical well-being and mental health, particularly in promoting the health and longevity of older adults. However, limited evidence exists regarding the relationship between chronic diseases and sleep quality in this population.

METHODS

The study investigated 35 common chronic diseases among 1186 older individuals aged 60 and above from six rural communities in northwest China. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Multiple logistic regression and interaction analyses were employed to explore the relationship between multiple chronic diseases and sleep quality.

RESULTS

Compared with the first quartile (≤ 1) of the number of chronic diseases, the second (2), third (3-4), and fourth (≥ 5) quartile ORs were 1.771 (95% CI: 1.191-2.631, p = 0.005), 2.434 (95% CI: 1.660-3.567, p < 0.001), and 3.180 (95% CI: 2.039-4.959, p < 0.001), respectively. For the duration of chronic diseases, compared with the first quartile (≤ 4.32 years) of duration of chronic diseases, the second (4.33-7.49 years), third (7.50-11.32 years) and fourth (≥ 11.33 years) quartile ORs were 1.350 (95% CI: 0.931-1.957, p = 0.113), 1.381 (95% CI: 0.953-2.000, p = 0.088), and 1.629 (95% CI: 1.122-2.365, p = 0.010), respectively. Older adults with multimorbidity and a longer duration of chronic diseases (≥ 7.5 years) had poorer sleep quality than those without multimorbidity and shorter duration of chronic diseases.

CONCLUSION

The higher number and longer duration of chronic diseases are associated with poorer sleep quality among older adults, with a stronger correlation observed in females compared to males.

The spatial analysis of multimorbidity in Thai Cohort Study

BACKGROUND

This study used Thai Cohort Study (TCS) data to investigate the spatial and sociodemographic determinants of multimorbidity (two or more chronic conditions coexistence on one person) prevalence in Thailand in 2013.

METHODS

Crude and age-adjusted prevalence were calculated for each province. Hotspot analysis was conducted to identify regions with statistically significant hotspots and cold spots, including areas without significant clustering. Then, ordinal logistic regression was used to identify sociodemographic background variables that predict hotpots.

RESULTS

The highest age-adjusted provincial level prevalence of multimorbidity was in Sing Buri (18.26%). Sak Lek District in Phichit Province also had the highest age-adjusted district level prevalence of multimorbidity at 37.13%. The cold spots region in crude and age-adjusted prevalence of multimorbidity were clustered in Southern Thailand. Forty-eight districts were identified as hotspots in both crude and age-adjusted multimorbidity prevalence, 19 of which are in Bangkok (the capital). Population density (person/km2, odd ratio, provincial level: OR:1.00, 95% CI: 1.00-1.01; district level: OR: 1.01, 95% CI: 1.00-1.01), Aging index (provincial level: OR:1.03, 95% CI: 1.01-1.04; district level: OR: 1.01, 95% CI: 1.00-1.01), and average educational years (provincial level: OR:1.92, 95% CI: 1.07-3.48; district level: OR: 1.27, 95% CI: 1.02-2.26) were greater in hot spots areas.

CONCLUSION

This study shows that the prevalence of multimorbidity in Thailand is positively correlated with the degree of development of the region. Spatial cluster analysis provides new evidence for policymakers to design tailored interventions to target multimorbidity and allocate health resources to areas of unmet need.

Individual and joint associations of depression and physical multimorbidity with all-cause mortality: a prospective cohort study

The study aimed to investigate the separate, interactive, and combined effects of depression and physical multimorbidity on all-cause mortality using data from the National Health and Nutrition Examination Survey (NHANES) 2005-2016. Depression was assessed using the Patient Health Questionnaire-9 (PHQ-9), and multimorbidity was defined as the presence of ≥ 2 chronic conditions. Cox proportional hazards models were used to assess these associations. During a median follow-up of 8.3 years (interquartile range, 5.4-11.4), 3,005 deaths occurred. After adjusting for potential confounders and multimorbidity, each one-point increase in depression score was associated with a 3% higher risk of mortality (hazard ratio [HR]: 1.03, 95% confidence interval [CI]: 1.02-1.04). Compared to those without depressive symptoms, mild and moderate to severe symptoms were linked to a 27% (HR: 1.27, 95% CI: 1.11-1.47) and 37% (HR: 1.37, 95% CI: 1.17-1.61) higher mortality risk, respectively. However, among women, only moderate to severe depression was significantly associated with increased mortality (HR: 1.50, 95% CI: 1.19-1.89). After adjusting for potential confounders and depression, multimorbidity was associated with a 64% higher mortality risk (HR: 1.64, 95% CI: 1.46-1.86). No significant interaction between depression and multimorbidity was found. Joint analysis showed that among participants without multimorbidity, moderate to severe depressive symptoms increased mortality risk (HR: 1.54, 95% CI: 1.09-2.17). In those with multimorbidity, risk increased with depression severity, peaking at HR: 2.22 (95% CI: 1.85-2.65). These findings highlight depression and multimorbidity as independent mortality risk factors, with their combined presence further amplifying this risk.

Uncovering bridging diseases in complex multimorbidity pathways: A network science approach

Multimorbidity, the co-occurrence of multiple chronic diseases, represents a significant challenge in healthcare, necessitating advanced analytical methods for a better understanding. Although numerous studies focus on characterizing chronicity profiles across different population groups, there is still a need to identify specific diseases that play a crucial role in shaping multimorbidity patterns. This study applies network science to analyze multimorbidity structures and identify bridging diseases that facilitate the development of complex multimorbidity patterns, using data from a representative sample of 2,200 individuals aged 50 and older residing in southern Spain. Our findings reveal significant gender-based differences in multimorbidity patterns, with women experiencing a higher burden of chronic diseases, resulting in more complex and tightly linked disease networks. The analysis highlights the relevance of specific conditions, such as liver dysfunction in men and depression in women, as key contributors to the formation of complex multimorbidity structures. These findings emphasize the importance of sex/gender-specific healthcare strategies aimed at controlling and preventing diseases that may act as catalysts for multisystem multimorbidity, which have a profound impact on both mortality rates and healthcare utilization.

Urban health inequities and healthy longevity: traditional and emerging risk factors across the cities and policy implications

Urbanization is reshaping global health, with over 55% of the world's population residing in urban areas, a figure projected to reach 68% by 2050. This demographic shift presents significant challenges and opportunities for public health, as urban environments exacerbate health disparities rooted in social determinants of health, such as economic stability, education, neighborhood conditions, and access to healthcare. Rapid urban growth, particularly in low- and middle-income countries, has led to the emergence of inequitable living conditions, environmental hazards, and limited access to essential health services, contributing to the early onset of multimorbidity and rising non-communicable disease burdens. Urbanization-driven factors such as obesogenic environments, sedentary lifestyles, air pollution, and inadequate sleep exacerbate cardiovascular and metabolic risks, while social exclusion, overcrowding, and inadequate mental health services heighten vulnerabilities. Emerging risks, including urban heat islands, noise pollution, and exposure to endocrine-disrupting chemicals, further compound urban health inequities. Effective mitigation requires multi-sectoral policies that prioritize health-promoting infrastructure, reduce environmental pollutants, foster equitable healthcare access, and address systemic barriers affecting marginalized groups. This review explores the intersections between urbanization and health inequities, emphasizing the importance of addressing traditional and emerging risk factors across the lifespan. Policy implications include promoting green infrastructure, enhancing urban mobility, expanding mental health care, and leveraging participatory governance to foster resilient and inclusive cities. By adopting an integrated approach that prioritizes social equity and sustainability, cities can mitigate health disparities and create healthier, more inclusive urban environments that support the well-being of all residents.

Health and well-being of older adults in rural and urban Rwanda: epidemiological findings from a population based cross-sectional study

Background

Ageing often leads to multimorbidity, frailty, and disability; these interconnected conditions significantly impact quality of life (QoL) and strain healthcare systems through increased dependency and care needs. Despite their importance for health system planning, they remain understudied in Rwanda's older population. Here we describe the epidemiology of these outcomes in Rwanda's ageing population.

Methods

We conducted a cross-sectional, population-based study among Rwandan adults aged ≥40 years across urban and rural districts, whereby we used validated tools to assess multimorbidity (≥2 chronic conditions), frailty (Fried Frailty Score), disability (World Health Organization Disability Assessment Schedule (WHODAS) 2.0), and QoL (European Health Interview Survey - World Health Organization Quality of Life (EUROHIS-QoL)). We used multivariable analyses to examine associations between the outcomes and demographic and socioeconomic factors.

Results

Among 4369 adults, multimorbidity prevalence was 55.2% (95% confidence interval (CI) = 53.7, 56.6), with frailty affecting 14.5% (95% CI = 13.5, 15.6) of this population. Disability prevalence was relatively low, with a median score of 10.4% (interquartile range = 2.1-25.0), while the mean QoL score was 48.2% (standard deviation = 15.6). We observed impairment in activities of daily living (ADL) in 16.0% (95% CI = 14.9, 17.1) of the sample. Health outcomes worsened with age, particularly among those aged ≥70 years, and among females compared to males. Multivariable analyses showed that higher socioeconomic status and urban residence were significantly associated with lower frailty, disability, and ADL impairment, though urban residents had higher multimorbidity rates and poorer QoL. Higher educational status was associated with reduced disability and improved QoL.

Conclusions

Our findings show a substantial burden of multimorbidity and frailty among older adults in Rwanda, with significant gender, socioeconomic, and urban-rural disparities. Integrated care models that address both the physical and social determinants of health, with a focus on reducing gender, socioeconomic, and geographical disparities, are needed to improve the well-being of older adults in Rwanda.

Impact of Potentially Inappropriate Medication on Disability and Mortality in Older Adults: Nationwide Population-Based Study in Korea

BACKGROUND

Potentially inappropriate medications (PIMs) increase the risk of adverse health outcomes in older adults. However, the long-term effects of PIMs, particularly considering frailty and polypharmacy, remain unclear.

METHODS

We analyzed data from the National Health Insurance Service and the National Screening Program for Transitional Ages (NSPTA) in Korea, including individuals aged 66 who participated between 2015 and 2016. Participants were categorized into PIM and No PIM groups based on prescriptions, with frailty index calculated from NSPTA results. Outcomes were tracked over 6.77 years. The primary outcome was disability; secondary outcomes included all-cause mortality and a composite endpoint of death or disability. The association between PIM and adverse outcomes was evaluated using Cox proportional hazard models.

RESULTS

A total of 564 036 individuals were included. During follow-up, 10 735 (1.9%) developed disabilities, and 17 887 (3.1%) died. The PIM group (64.4%) showed higher risks of disability (2.3% vs 1.2%) and mortality (3.6% vs 2.4%) compared with the No PIM group (p < .001). The composite outcome was also more frequent in the PIM group (5.3%) compared with the No PIM group (3.2%; p < .001). PIM use was associated with increased risks of disability (HR 1.22 [95% CI, 1.16, 1.28]), mortality (HR 1.15 [95% CI 1.11, 1.19]), and the composite outcome (HR 1.16 [95% CI, 1.13, 1.20]), even after adjusting for frailty and polypharmacy. Furthermore, as the number of PIMs increased (0, 1-2, 3-4, ≥5), the risks of disability, mortality, and the composite outcome also significantly increased (all p < .001).

CONCLUSION

PIM use in older adults raises the risk of disability and mortality, even after adjusting to frailty and polypharmacy, and the impact grows with the number of PIMs prescribed.

Cost-effectiveness of multidisciplinary transitional care interventions: A systematic review and meta-analysis

BACKGROUND

Multidisciplinary transitional care interventions promote care coordination after hospital discharge and address (older) patients' complex care needs related to their physical, nutritional, and/or psychosocial status.

OBJECTIVE

This review aimed to identify, critically appraise, and synthesize evidence on the cost-effectiveness of multidisciplinary transitional care interventions compared to usual care.

DESIGN

Systematic review and meta-analysis.

SETTING(S)

Hospitals and primary care.

PARTICIPANTS

Adult patients admitted to a hospital, regardless of their condition, and discharged home.

METHODS

Medline, Embase, CINAHL, and CENTRAL were searched for randomized controlled trials assessing multidisciplinary transitional care interventions' cost-effectiveness compared to usual care and reporting quality of life or quality-adjusted life years (QALY) from inception to July 2024. Findings were stratified by economic perspective and follow-up duration. Evidence certainty was assessed using Grading of Recommendations Assessment, Development, and Evaluation. The primary outcome was the incremental net monetary benefit (expressed as mean difference). Cost-effectiveness acceptability curves depicted probabilities of cost-effectiveness at various willingness-to-pay thresholds.

RESULTS

Thirteen trials, containing 4114 patients, were included. From a healthcare perspective over 12 months, there was "low" certainty that multidisciplinary transitional care interventions reduced healthcare costs (MD, €-3452; 95 % CI, -8816 to 1912) while there was no difference in QALYs (MD, 0.00; 95 % CI, -0.03 to 0.04) compared to usual care. The probability of cost-effectiveness over 12 months was 90 % at a willingness-to-pay of €0/QALY, decreasing slightly to 84 % at higher willingness-to-pay thresholds ("moderate" certainty). Over six months, cost-effectiveness probabilities ranged from 43 % at €0/QALY to 87 % at €100,000/QALY, exceeding 80 % at a willingness to pay of €50,000/QALY ("low" to "moderate" certainty). From a societal perspective, the probabilities of cost-effectiveness were lower, primarily due to a limited number of studies with conflicting results.

CONCLUSIONS

Multidisciplinary transitional care interventions demonstrate potential for cost-effectiveness. However, the "low" evidence certainty of most comparisons underscores the need for further research to explore the cost-effectiveness of different types of multidisciplinary transitional care interventions across patient populations and country income levels to identify the most cost-effective strategies.

REGISTRATION

The review protocol was registered on PROSPERO, CRD42023421423.

In Pursuit of a Person-Centered Approach to Care Delivery: A Qualitative Descriptive Study of the Patient Experience of a Long-Term Conditions Clinic in General Practice

Innovative ways of working are emerging in health care to meet the complex needs of people living with multiple long-term conditions. While these initiatives are often measured for their health and economic outcomes, few studies prioritize the patient experience. This qualitative descriptive study is one of a few studies exploring the patient experience of attending a dedicated long-term conditions annual review clinic in a primary care setting in England. The service model aims to provide a person-centered, holistic approach to the management and support of people living with multiple long-term conditions. The study presents findings from in-depth interviews with 12 participants. Data analyzed through framework analysis revealed four themes relating to the patient experience: the clinic as a place, continuity, staying healthy, and partnership opportunities. Results highlight the challenges to providing personalized care. We found that attendance at the clinic prompted self-care behaviors, however, patients wanted a more holistic, integrated, and consistent service that provided continuity of therapeutic relationships that involved them in decision-making and care planning. We conclude that the experience of patients in this study suggests this service model can enable patients to manage their health and improve well-being, however, while a person-centered philosophy may underpin service models, our research shows that ensuring this philosophy is born out in service delivery and recognized by patients is problematic. Therefore, service providers need to recognize the values and perspectives of patients, aligning these with the design and delivery of services.

In vitro and in vivo evaluation of in situ forming polyester implants for the extended release of carvedilol

Polyester based in situ forming implants (ISFIs) are injectable long-acting drug delivery systems that offer a wide range of unique advantages. As a result of these advantages, two relatively high molecular weight, ester terminated grades of poly (D,L-lactide-co-glycolide) (PLGA) and poly(D,L-lactide) (PLA) were evaluated for their ability (i) to form ISFIs loaded with carvedilol, and (ii) to control its release both in vitro and in vivo. At a polymeric concentration of 40% w/w, implant solutions were syringeable, injectable, and able to encapsulate carvedilol to a high degree (encapsulated drug% > 97%). When visualized using scanning electron microscopy (SEM), implants were found to have a dense thin surface atop porous sublayers. As for their in vitro evaluation, PLGA and PLA implants were able to maintain drug release over the course of 49 and 84 days, respectively. On the other hand, in vivo drug release from both implants was almost identical and lasted for only 42 days. This may be due to the overriding effect of the similar host environment at the injection site that diminished the effect of polymeric physiochemistry on phase inversion and drug release. Lastly, while the polymer-free drug/NMP solution completely released its drug content within the initial half hour in vitro, the formulation extended drug release in vivo. This could be due to a yet to be investigated interaction between carvedilol and NMP under in vivo conditions. These results cement the significance of formulating carvedilol loaded ISFIs for the management of chronic conditions.

The association between multimorbidity patterns and physical frailty among middle-aged and older community-dwelling adults: the mediating role of depressive symptoms

Background

This study aimed to investigate the association between multimorbidity and frailty, and the potential mediating role of depressive symptoms in Chinese middle-aged and older community-dwelling adults.

Methods

We selected a total of 5,232 adults with two or more chronic diseases from the China Health and Retirement Longitudinal Study (CHARLS) database. Clusters of participants with similar multimorbidity patterns were identified through fuzzy c-means cluster analyses. The cross-sectional association between multimorbidity and frailty was measured through logistic regression analyses. Mediation analysis was applied to examine direct and indirect associations within the counterfactual framework.

Results

At baseline, we identified five multimorbidity patterns. Two of these patterns significantly increased the risk of frailty compared to a non-specific pattern. Depression mediated 35.20% of the effect of multimorbidity on frailty (p = 0.042). Notably, in adults aged 60 years and older, this mediation accounted for 69.84% of the total effect, surpassing the direct impact of multimorbidity on frailty. Among individuals with economic support (0.020, 95% CI: 0.002-0.040), high school education (0.062, 95% CI: 0.007-0.120), and no alcohol consumption (0.024, 95% CI: 0.003-0.050), depression entirely mediated the impact of comorbidities.

Conclusion

This study reveals strong links between specific multimorbidity patterns and physical frailty, with depression significantly mediating these effects, particularly in certain populations. Findings emphasize tailored mental health interventions' necessity in specific groups.

Exploring the Skills Prioritised in the Assessment of Students Pursuing Adult Nursing, Post-COVID: A Qualitative Analysis

AIM

To explore comments made by registered nurse practice assessors during the clinical assessment of students pursuing adult nursing.

BACKGROUND

Student nurses are entering a workforce that has changed professional and educational nursing practice systems due to the COVID-19 pandemic. Limited placement learning during lockdowns reduced opportunities for students to practise clinical skills in person. However, the current state of practice assessment for students pursuing adult nursing, particularly post-COVID, has yet to be explored.

DESIGN

Qualitative content analysis.

METHODS

Data were collected from the online assessment documentation of second-year BSc students pursuing adult nursing. A qualitative content analysis was performed to analyse comments made by qualified adult nurses who are positioned as clinical practice assessors for students pursuing adult nursing. COREQ reporting guidelines were followed.

RESULTS

Two main themes were identified: (1) task-focussed competencies and (2) relational aspects of care. Task-focussed competencies included 'technically complex physical health skills' with an emphasis on specialist clinical interventions and procedures. Relational aspects of care included values-based attributes such as compassion and empathy. However, relational aspects of care were noted less frequently. Comments related to communication skills and values-based care were less diverse than those relating to technical tasks and the language used was perfunctory.

CONCLUSION

Adult nursing assessments emphasise technical, task-focused competencies, with less attention given to relational skills like compassion and communication. To address this gap, nursing education must better integrate relational and technical competencies, enhancing patient care and supporting nurses' mental health and wellbeing for a more holistic post-pandemic nursing practice.

IMPLICATIONS FOR PRACTICE

Results suggest an increased focus on the development of relational skills is needed for students pursuing adult nursing.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Advanced Care Plan Among Older Chinese in Residential Aged Care: A Retrospective Review

INTRODUCTION

Worldwide in the population of older people, ethnic diversity is prevalent and therefore warrants culturally sensitive advanced care planning. This study aimed to explore advanced care planning documentation related to the cultural needs of residents of Chinese ethnicity in Australian aged care facilities.

METHODS

A retrospective review of advanced care plan documentation was undertaken among 31 older Chinese residents with life-limiting illnesses across two residential aged care facilities in New South Wales, Australia. Data were analyzed using descriptive statistics.

RESULTS

90% of residents had advanced care planning documentation. The presence of the resident and their representative and medical care directives were well documented. Specific details on the provision of palliative care that considers the person's cultural needs and preferences were limited.

DISCUSSION

Findings suggest the need for further research that explores an optimal way of embedding culture-specific information and the development of a culturally sensitive advanced care plan for people of Chinese ethnicity.

Prevalence of potentially inappropriate prescribing in community-dwelling older adults: an application of STOPP/START version 3 to The Irish Longitudinal Study on Ageing (TILDA)

PURPOSE

Potentially inappropriate prescribing includes prescribing potentially inappropriate medicines (PIMs), where risk of medication-related harm may outweigh the clinical benefit(s), and potential prescribing omissions (PPOs), whereby clinically indicated medications are unprescribed without good reason. This study aimed to assess prevalence of PIMs and PPOs (subset of STOPP/START version 3) in older community-dwelling adults and any association with healthcare utilisation and functional decline over time.

METHODS

Retrospective cohort study of a nationally representative longitudinal study of ageing in Ireland (n = 3619) (2016-2018). Logistic regressions examined association of patient characteristics with PIMs/PPOs and between prevalent PIMs/PPOs and functional decline. Negative binomial regressions examined association between PIM/PPO with healthcare utilisation over time.

RESULTS

Participants' mean age was 74.2 years (SD 6.99), 53.9% were female and were prescribed a mean of 4.02 (SD 3.16) medications. A total of 1123 (31.0%) participants experienced STOPP PIMs and 1309 (36.2%) START PPOs. STOPP PIMs were associated with increased hospital admissions (adjusted incident rate ratio (aIRR) 1.38, 95% confidence interval (CI) 1.08, 1.75), and functional decline (adjusted odds ratio (aOR) 1.46, 95% CI 1.11, 1.91) at follow-up. Age ≥ 75 years (aOR 1.32, 95% CI 1.10, 1.57) and three or more chronic conditions (aOR 5.19, 95% CI 3.69, 7.31) were significantly associated with START PPOs.

CONCLUSION

Approximately one-third of study participants experienced STOPP PIMs, associated with an increased risk of hospital admissions and functional decline. START PPOs also occurred in over one-third, associated with increasing age and degree of multimorbidity. Balancing the risk: benefit of medications for older people with multimorbidity remains challenging.

Dissecting cross-population polygenic heterogeneity across respiratory and cardiometabolic diseases

Biological mechanisms underlying multimorbidity remain elusive. To dissect the polygenic heterogeneity of multimorbidity in twelve complex traits across populations, we leveraged biobank resources of genome-wide association studies (GWAS) for 232,987 East Asian individuals (the 1st and 2nd cohorts of BioBank Japan) and 751,051 European individuals (UK Biobank and FinnGen). Cross-trait analyses of respiratory and cardiometabolic diseases, rheumatoid arthritis, and smoking identified negative genetic correlations between respiratory and cardiometabolic diseases in East Asian individuals, opposite from the positive associations in European individuals. Associating genome-wide polygenic risk scores (PRS) with 325 blood metabolome and 2917 proteome biomarkers supported the negative cross-trait genetic correlations in East Asian individuals. Bayesian pathway PRS analysis revealed a negative association between asthma and dyslipidemia in a gene set of peroxisome proliferator-activated receptors. The pathway suggested heterogeneity of cell type specificity in the enrichment analysis of the lung single-cell RNA-sequencing dataset. Our study highlights the heterogeneous pleiotropy of immunometabolic dysfunction in multimorbidity.

Multimorbidity patterns of mental disorders and physical diseases of adults in northeast China: a cross-sectional network analysis

AIMS

Multimorbidity, especially physical-mental multimorbidity, is an emerging global health challenge. However, the characteristics and patterns of physical-mental multimorbidity based on the diagnosis of mental disorders in Chinese adults remain unclear.

METHODS

A cross-sectional study was conducted from November 2004 to April 2005 among 13,358 adults (ages 18-65years) residing in Liaoning Province, China, to evaluate the occurrence of physical-mental multimorbidity. Mental disorders were assessed using the Composite International Diagnostic Interview (version 1.0) with reference to the Diagnostic and Statistical Manual of Mental Disorders (3rd Edition Revised), while physical diseases were self-reported. Physical-mental multimorbidity was assessed based on a list of 16 physical and mental morbidities with prevalence ≥1% and was defined as the presence of one mental disorder and one physical disease. The chi-square test was used to calculate differences in the prevalence and comorbidity of different diseases between the sexes. A matrix heat map was generated of the absolute number of comorbidities for each disease. To identify complex associations and potential disease clustering patterns, a network analysis was performed, constructing a network to explore the relationships within and between various mental disorders and physical diseases.

RESULTS

Physical-mental multimorbidity was confirmed in 3.7% (498) of the participants, with a higher prevalence among women (4.2%, 282) than men (3.3%, 216). The top three diseases with the highest comorbidity rate and average number of comorbidities were dysphoric mood (86.3%; 2.86), social anxiety disorder (77.8%; 2.78) and major depressive disorder (77.1%; 2.53). A physical-mental multimorbidity network was visually divided into mental and physical domains. Additionally, four distinct multimorbidity patterns were identified: 'Affective-addiction', 'Anxiety', 'Cardiometabolic' and 'Gastro-musculoskeletal-respiratory', with the digestive-respiratory-musculoskeletal pattern being the most common among the total sample. The affective-addiction pattern was more prevalent in men and rural populations. The cardiometabolic pattern was more common in urban populations.

CONCLUSIONS

The physical-mental multimorbidity network structure and the four patterns identified in this study align with previous research, though we observed notable differences in the proportion of these patterns. These variations highlight the importance of tailored interventions that address specific multimorbidity patterns while maintaining broader applicability to diverse populations.

Health and social care staff's experiences working with adults with complex needs - a focus group study

BACKGROUND

Multimorbidity is increasing globally, affecting over one-third of the population. Adults with complex needs often experience physical, mental, and cognitive disorders, leading to increased healthcare utilization, reduced quality of life, and social challenges. The frequent co-occurrence of psychiatric conditions, substance abuse, addiction, and homelessness highlights the complexity of these needs. Collaboration between healthcare and social services is essential for delivering integrated care but is often hindered by legislative constraints and difficulties in coordinating care. Although integrated care has been shown to improve outcomes, persistent challenges affect staff in their daily work with adults with complex needs. Therefore, the aim was to describe health and social care staff's experiences working with adults with complex needs, with a focus on what promotes or hinders collaboration and the individual's participation.

METHODS

This study employed a descriptive qualitative design. Data were collected through four focus group interviews with 17 health and social care staff members and analyzed using qualitative content analysis.

RESULTS

Data analysis resulted in three generic categories: (i) collaboration between authorities is complex, (ii) challenges working according to the person's needs, and (iii) participation under difficult conditions.

CONCLUSIONS

This study highlights both challenges and facilitators in working with adults with complex needs. Collaboration was hindered by legislative, financial, and organizational disparities but facilitated by interprofessional forums and collaborative meetings. Establishing trusting relationships free from bureaucratic constraints was important for providing person-centered care. However, fostering meaningful participation remains challenging because of the individual's limited capacity to engage and the complexities that staff face in balancing respect for autonomy with acting in the person's best interest. Further research incorporating perspectives from adults with complex needs, their relatives, and management could enhance the understanding of how collaboration, participation, and organizational barriers impact the provision of integrated healthcare and social services.

Prevalence of Self-Reported Adverse Effects to Cannabis by Older Canadians: A Cross-Sectional Analysis

BACKGROUND AND OBJECTIVE

Despite the increasing use of cannabis by older Canadians, little is known about cannabis safety in this population, particularly in non-clinical settings. The purpose of this study was to describe the self-reported adverse effects experienced by community-dwelling older Canadians who use cannabis.

METHODS

Canadians aged 50 years and older completed an online survey regarding their knowledge, perceptions, and experiences with cannabis. Respondents who reported current cannabis use were asked to report any adverse effects experienced in the past year related to their cannabis use. Adverse effects were categorized, and multivariate logistic regressions were performed to assess predictors of adverse effects.

RESULTS

A total of 1615 older adults completed the survey, of whom 503 reported current use of cannabis and were included in this analysis. Adverse effects were reported by 308 participants (61.2%) and included dry mouth (36.2%), feeling high (25.9%), and adverse effects impacting balance (22.1%) and mental alertness (20.3%). Compared with participants aged 50-60 years, those aged 70 years and older had lower odds of reporting any adverse effects (odds ratio (OR) 0.524, 95% confidence interval (CI) 0.303-0.906) or adverse effects impacting mental alertness (OR 0.318, 95% CI 0.172-0.588). Female participants had higher odds of reporting any adverse effect (OR 1.989, 95% CI 1.332-2971) or adverse effects impacting balance (OR 1.930, 95% CI 1.198-3.109).

CONCLUSIONS

Adverse effects to cannabis are common amongst community-dwelling older adults. Increased education and guidance regarding adverse effects of cannabis, including the composition and dose of cannabis products, may help increase safe use by this population.

Health Coaching Enhanced Older Adults' Self-Efficacy in Managing Their Chronic Diseases: A Randomized Controlled Trial

Although health coaching is a well-known self-management intervention for individuals with chronic diseases, the research on its effect on older adults is limited. A total of 414 older Hong Kong adults were randomly assigned to the intervention group, which received 12-week health coaching sessions, and the control group without intervention. Participants in the intervention group completed assessments at three time points (baseline, postintervention, and three-month follow-up), and those in the control group completed baseline and three-month follow-up assessments. Generalized estimating equations first revealed a significant improvement in self-efficacy and blood pressures among the intervention group participants, and such improvements were maintained at follow-up. In addition, the self-efficacy of the intervention group significantly increased while that of the control group significantly decreased from baseline to follow-up. Thus, the overall results demonstrate the effectiveness of the health coaching intervention in improving the self-efficacy of older adults in managing their chronic diseases and health risks.

Unveiling the Potential of Large Language Models in Transforming Chronic Disease Management: Mixed Methods Systematic Review

BACKGROUND

Chronic diseases are a major global health burden, accounting for nearly three-quarters of the deaths worldwide. Large language models (LLMs) are advanced artificial intelligence systems with transformative potential to optimize chronic disease management; however, robust evidence is lacking.

OBJECTIVE

This review aims to synthesize evidence on the feasibility, opportunities, and challenges of LLMs across the disease management spectrum, from prevention to screening, diagnosis, treatment, and long-term care.

METHODS

Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines, 11 databases (Cochrane Central Register of Controlled Trials, CINAHL, Embase, IEEE Xplore, MEDLINE via Ovid, ProQuest Health & Medicine Collection, ScienceDirect, Scopus, Web of Science Core Collection, China National Knowledge Internet, and SinoMed) were searched on April 17, 2024. Intervention and simulation studies that examined LLMs in the management of chronic diseases were included. The methodological quality of the included studies was evaluated using a rating rubric designed for simulation-based research and the risk of bias in nonrandomized studies of interventions tool for quasi-experimental studies. Narrative analysis with descriptive figures was used to synthesize the study findings. Random-effects meta-analyses were conducted to assess the pooled effect estimates of the feasibility of LLMs in chronic disease management.

RESULTS

A total of 20 studies examined general-purpose (n=17) and retrieval-augmented generation-enhanced LLMs (n=3) for the management of chronic diseases, including cancer, cardiovascular diseases, and metabolic disorders. LLMs demonstrated feasibility across the chronic disease management spectrum by generating relevant, comprehensible, and accurate health recommendations (pooled accurate rate 71%, 95% CI 0.59-0.83; I2=88.32%) with retrieval-augmented generation-enhanced LLMs having higher accuracy rates compared to general-purpose LLMs (odds ratio 2.89, 95% CI 1.83-4.58; I2=54.45%). LLMs facilitated equitable information access; increased patient awareness regarding ailments, preventive measures, and treatment options; and promoted self-management behaviors in lifestyle modification and symptom coping. Additionally, LLMs facilitate compassionate emotional support, social connections, and health care resources to improve the health outcomes of chronic diseases. However, LLMs face challenges in addressing privacy, language, and cultural issues; undertaking advanced tasks, including diagnosis, medication, and comorbidity management; and generating personalized regimens with real-time adjustments and multiple modalities.

CONCLUSIONS

LLMs have demonstrated the potential to transform chronic disease management at the individual, social, and health care levels; however, their direct application in clinical settings is still in its infancy. A multifaceted approach that incorporates robust data security, domain-specific model fine-tuning, multimodal data integration, and wearables is crucial for the evolution of LLMs into invaluable adjuncts for health care professionals to transform chronic disease management.

TRIAL REGISTRATION

PROSPERO CRD42024545412; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024545412.

Effects of multidisciplinary teamwork in non-hospital settings on healthcare and patients with chronic conditions: a systematic review and meta-analysis

BACKGROUND

There is evidence that multidisciplinary teams can improve health outcomes for patients with chronic conditions, enhance the quality and coordination of care, and promote teamwork among staff in hospital settings. However, their effectiveness in non-hospital settings remains unclear. Therefore, we conducted a systematic review and meta-analysis to assess the effects of multidisciplinary teams on patients with chronic conditions, health professionals, and healthcare in non-hospital settings.

METHODS

We searched PubMed, Web of Science, Embase, EconLit, OpenGrey, China National Knowledge Infrastructure (CNKI), and WanFang for randomised controlled trials published before March 2025. Narrative syntheses were used to synthesise the characteristics of multidisciplinary teams, interventions, and effects. Data were statistically pooled using both random-effects and fixed-effects meta-analyses to synthesize the outcomes. The methodological quality of the included studies was assessed using Cochrane's risk of bias tool.

RESULTS

Thirty-nine studies were analyzed, with a total of 8186 participants. Nurses, general practitioners, and specialists were the most common members of the multidisciplinary teams. Staffing models, shared care and role expansion or task shifting are the most common multidisciplinary teamwork interventions. Narrative syntheses revealed improvements in self-management, self-efficiency, satisfaction, health behaviours, and knowledge. A meta-analysis found a significant reduction in hospitalisation days for patients with chronic obstructive pulmonary disease (MD=-0.66, 95% CI -1.05 to -0.26, I2 = 0%) and significant improvement in quality of life for patients with chronic heart failure (MD=-4.63, 95% CI: -8.67 to -0.60, I2 = 0%). There is no consistent evidence of other indicators of this effect.

CONCLUSIONS

Multidisciplinary teamwork can improve patient-reported outcomes for patients with chronic conditions in non-hospital settings, but the effects on clinical outcomes, health utilisation, and costs are not evident.

TRIAL REGISTRATION

The study protocol was registered with PROSPERO on January 21, 2019, with the registration number CRD42019121109.

Clinical factors associated with multimorbidity, polypharmacy and medication regimen complexity among adults with hypertension: a multicentre cross-sectional study

OBJECTIVES

Factors associated with multimorbidity, polypharmacy and Medication Regimen Complexity Index (MRCI) may vary across countries. However, such data are lacking in the present study setting. This study aimed to identify factors associated with multimorbidity, polypharmacy and MRCI among adults living with hypertension in public hospitals of South Gondar Zone.

DESIGN

Multicentred cross-sectional design SETTING: Public hospitals of Comprehensive Specialised and Primary Hospitals, Ethiopia.

PARTICIPANTS

Adults living with hypertension who had follow-up visits at outpatient clinics and were selected by systematic random sampling from 1 December 2021 to 28 February 2022.

PRIMARY AND SECONDARY OUTCOME MEASURES

Medication regimen complexity was assessed using a 65-item medication regimen complexity tool. Sociodemographic data were collected through an interview, while polypharmacy and clinical characteristics were documented using a checklist. Data were entered into SPSS V.26 and analysed using STATA V.17. A binary logistic regression model was used to determine the AOR of factors associated with multimorbidity and polypharmacy. For factors influencing MRCI, an ordinal logistic regression was used.

RESULTS

We found participants from Nefas Mewucha Hospital (AOR = 0.3, 95% CI 0.15 to 0.59) and Mekane Eyesus Hospital (AOR = 0.17, 95% CI 0.07 to 0.38), compared with Debre Tabor Comprehensive Specialised Hospital, polypharmacy (AOR = 5.52, 95% CI 1.49 to 20.39), medium (AOR = 19.76, 95% CI 5.86 to 66.56) and high MRCI (AOR = 120.32, 95% CI 33.12 to 437.07) were associated with multimorbidity. Multimorbidity (AOR = 25.4, 95% CI 7.48 to 86.23), controlled blood pressure (AOR = 0.43, 95% CI 0.19 to 0.92) and duration of hypertension therapy 5 years or more (AOR = 2.12, 95% CI 1.08 to 4.16) were associated with polypharmacy. Whereas controlled BP (AOR = 0.48, 95% CI 0.32 to 0.72) and multimorbidity (AOR = 14.55, 95% CI 9.00 to 23.52) were significantly associated with high MRCI. The prevalence of multimorbidity, high MRCI and polypharmacy was found in 46.1%, 35.22% and 12.29% of participants, respectively.

CONCLUSION

A considerable proportion of participants with hypertension experienced multimorbidity, polypharmacy and high medication complexity. Polypharmacy, primary hospital setting and high MRCI were independent variables associated with multimorbidity. On the other hand, multimorbidity and controlled BP were associated with polypharmacy and MRCI. Hypertension care should consider multimorbidity, polypharmacy and medication complexity.

Unmet healthcare needs of people with multimorbidity-can community pharmacists close the gap?

OBJECTIVES

Identify factors associated with unmet healthcare needs in patients with multimorbidity and determine the support community pharmacists can offer to meet these needs.

METHODS

People with multimorbidity were recruited from community pharmacies where research assistants approached all patients and asked them questions to determine their eligibility: having two or more chronic conditions, being at least 18 years old, and speaking either Arabic or English. Those who met the criteria were invited to participate in the study. Consenting participants completed a survey designed based on international guidelines, utilizing validated tools to measure healthcare needs, quality of life, treatment burden, and medication self-efficacy. Generalized linear models were used to identify predictors of unmet needs.

KEY FINDINGS

Two hundred and twenty-four participants completed the survey (response rate = 81%). Participants indicated significant healthcare needs particularly in areas such as communication and relationships (M = 4.4 ± 0.9) and medication information (M = 3.8 ± 0.7). Higher education and medication self-efficacy were associated with lower needs for counselling (B = -0.966; P < .001 and B = -113; P < .001, respectively) and communication (B = -0.547; P < .008 and B = -0.088; P = .003, respectively).

CONCLUSIONS

This study demonstrated community pharmacists' potential to address multimorbidity. To optimize their role, primary healthcare delivery needs to be reorganized to empower pharmacists to support patients with complex healthcare needs.

Determinants of Multimorbidity in a Low-Resource Setting: A Population-Based Cross-Sectional Study in Bangladesh

Multimorbidity is a complex and highly prevalent health condition characterised by the coexistence of two or more chronic diseases within an individual. It is a growing public health issue worldwide, predominantly in low-resource countries like Bangladesh. Therefore, this study aimed to determine the prevalence and associated factors of multimorbidity among the adult population in Bangladesh. A cross-sectional study was carried out among 504 respondents who were 18 years or older. The generalised linear mixed model was used to identify the risk factors. Among the respondents, 65.3% (95% confidence interval [CI]: 61.0 to 69.3) had multimorbidity. The most common chronic conditions were allergic disorder (34%, 95% CI: 30 to 39), gastritis (31%, 95% CI: 27 to 35), low back pain (28.4%, 95% CI: 24.6 to 32.5), oral diseases (27%, 95% CI: 23 to 29) and arthritis (21%, 95% CI: 18 to 25). Middle-aged adults (adjusted odds ratio [AOR] = 7.97; 95% CI: 3.35 to 18.92) and older adults (AOR = 8.44; 95% CI: 1.90 to 36.64) had significantly higher odds of multimorbidity than young adults. Employed respondents had an 86% (AOR = 0.14; 95% CI: 0.07 to 0.36) lower odds of multimorbidity than non-working individuals. Higher sleeping duration (6 to 8 h: AOR = 0.44; 95% CI: 0.25 to 0.80; 8 to 10 h: AOR = 0.26; 95% CI: 0.11 to 0.60), regular vegetable consumption (AOR = 0.42; 95% CI: 0.22 to 0.80) and adequate water intake (AOR = 0.48; 95% CI: 0.29 to 0.79) were protective factors against multimorbidity, whereas obesity increased the odds (AOR = 3.32; 95% CI: 1.06 to 10.43). These findings emphasise the need to promote healthy lifestyle habits, such as maintaining a balanced diet, staying hydrated and engaging in regular physical exercise, to reduce the burden of multimorbidity in low-resource settings.

Prevalence and regional disparities of undiagnosed diabetes mellitus in Bangladesh: Results from the Bangladesh Demographic and Health Survey data

BACKGROUND

While undiagnosed diabetes mellitus (DM) presents a substantial global concern, there is a dearth of research examining its prevalence and characteristics specifically within the regional context of Bangladesh. The study focused on assessing the prevalence of undiagnosed diabetes mellitus in Bangladesh and examining regional disparities.

METHODS

The study analyzed data from the Bangladesh Demographic and Health Survey conducted between 2017 and 2018. The analysis focused on 11,911 participants aged 18 and above. Prevalence rates of both diagnosed and undiagnosed DM were calculated across various demographic and regional factors. To understand the impact of socio-demographic and regional variables on diagnosed and undiagnosed DM, the study employed multinomial regression analysis.

RESULTS

The study encompassed 11,911 participants with an average age of 39, of whom 57% were females. Among them, 333 individuals (2.8%) were diagnosed with diabetes mellitus (DM), while 667 participants (5.6%) had undiagnosed DM. The prevalence of both diagnosed and undiagnosed DM was notably higher in elderly, hypertensive, overweight or obese, and rural residents. Regression analysis indicated that individuals aged 70 and above faced 2.14 times more likely of diagnosed diabetes compared to those aged 30-39 (RRR = 2.20; 95% CI = 1.35-3.58). Regarding residential regions, individuals from the city exhibited significantly higher prevalence rates for both diagnosed DM (RRR: 1.83; 95% CI = 1.31-2.57) and undiagnosed DM (RRR: 1.52; 95% CI = 1.18-1.95) compared to those from the rural of Bangladesh.

CONCLUSION

The high prevalence of undiagnosed DM in city areas suggests potential shortcomings in routine diabetes screening practices. Prioritizing screening, particularly for high-risk groups like older adults, individuals with elevated BMI, hypertension, and urban residents from the central region of the country, is crucial. These groups have elevated diabetes risk and face higher complications without timely detection and treatment. To address this issue, collaborative efforts among the Bangladeshi government, healthcare providers, and community organizations are imperative.

Risk prediction models for mortality in patients with multimorbidity: a systematic review and meta-analysis

Background

Multimorbidity is a major aging and public health problem that has a significant burden on a global scale. The number of risk prediction models for mortality in patients with multimorbidity is increasing; however, the quality and applicability of these prediction models in clinical practice and future research remain uncertain.

Objective

To systematically review published studies on risk prediction models for mortality in patients with multimorbidity.

Methods

The Wanfang, China National Knowledge Infrastructure, China Science and Technology Journal (VIP), PubMed, SinoMed, Cochrane Library, Web of Science, Embase, and Cumulative Index to Nursing and Allied Health Literature databases were searched from inception until May 30, 2024. Two independent reviewers performed study selection, data extraction, and quality assessment. The Prediction Model Risk of Bias Assessment Tool (PROBAST) checklist was utilized to assess the risk of bias and applicability.

Results

Overall, 18 studies with 21 prediction models were included in this review. Logistic regression was used for model development in 12 studies, Cox regression in four, a parametric Weibull regression in one, and machine learning in one study. The incidence of mortality in patients with multimorbidity ranged from 7.6-50.0%. The most frequently used predictors were age and body mass index. The reported area under the receiver operating characteristic curve (AUC) and C-index values ranged from 0.700-0.907. Three studies were rated as having a low risk of bias, 11 as high, and four as unclear, primarily owing to poor reporting of the analysis domain. The pooled AUC value of the seven validated models was 0.81, with a 95% confidence interval ranging from 0.77-0.86, signifying a fair level of discrimination.

Conclusion

The included studies revealed a degree of discriminatory ability in predicting mortality in patients with multimorbidity; however, they all demonstrated significant risks of bias based on the PROBAST checklist assessment. Future researchers should prioritize the development of new models that incorporate rigorous study designs and multicenter external validation, which may improve the precision of risk predictions and help the development of global strategies for this significant public health problem.

Registration

The study protocol was registered in PROSPERO (registration number: CRD42024543170).

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/recorddashboard, PROSPERO CRD42024543170.

Exploring physical activity experiences of community-dwelling oldest-old adults with chronic multimorbidity: A qualitative study

AIM

To explore the physical activity experiences of community-dwelling oldest-old adults with chronic multimorbidity.

DESIGN

Descriptive qualitative study.

METHOD

Data collection was conducted through semi-structured interviews with 19 community-dwelling oldest-old adults with chronic multimorbidity. The study was conducted between December 2022 and May 2023. ATLAS.ti software was used for data analysis.

RESULTS

Three main themes with their respective sub-themes and units of meaning were developed from the data analysis: (1) motivational factors for engaging in physical activity; (2) fear of getting hurt during physical activity and (3) confidence in being physically active.

CONCLUSION

Motivation, kinesiophobia and confidence are three core elements that influence the experience of physical activity in oldest-old adults with chronic multimorbidity. Interventions tailored to meet the needs of the oldest-old adults are important for promotion and development of active ageing.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Nurses and other healthcare professionals should design, implement and evaluate interventions that aim to increase oldest-old adults' motivation and confidence, while decreasing their fear to engage in physical activity.

IMPACT

This study provides insights into the way community-dwelling oldest-old adults with chronic multimorbidity experience physical activity in their daily lives. Our findings suggest that motivation, kinesiophobia and confidence are key factors for oldest-old adults to engage in physical activity. These findings could contribute to the design and implementation of interventions that specifically aim at raising the physical activity levels of community-dwelling oldest-old adults with chronic multimorbidity.

REPORTING METHOD

The study findings are reported according to the COREQ guidelines.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Translating and Validating the Japanese Version of the Tolerance for Ambiguity Scale

Background

Ambiguity is inherent in medicine, and tolerance for ambiguity (TFA) has recently been of substantial interest. Effective medical education for TFA requires a validated inventory; one validated measure in wide use is the seven-item TFA scale. In Japan, however, a tool for measuring TFA in undergraduate medical education has not been available. Here, we aimed to develop and validate the Japanese version of the TFA scale (J-TFA scale).

Methods

We translated the original English scale into Japanese following an international guideline. We then conducted a validation survey by distributing an online anonymous self-administered questionnaire to medical students at three medical schools in Japan. We assessed the structural validity and internal reliability of consistency of the scale.

Results

A total of 399 participants were included in our analysis. We used a split-half validation approach, with exploratory factor analysis (EFA) on the first half and confirmatory factor analysis (CFA) on the second. EFA indicated a two-factor structure. CFA showed that the two-factor structure suggested by EFA had acceptable model fitness indices. Cronbach's alpha was 0.72, exceeding the satisfactory internal reliability consistency criteria.

Conclusions

The J-TFA scale was developed and its psychometric properties were confirmed. This instrument may be useful for future educational interventions and research on TFA.

Real-world evidence: state-of-the-art and future perspectives

Recent developments in digital infrastructure, advanced analytical approaches, and regulatory settings have facilitated the broadened use of real-world evidence (RWE) in population health management and evaluation of novel health technologies. RWE has uniquely contributed to improving human health by addressing unmet clinical needs, from assessing the external validity of clinical trial data to discovery of new disease phenotypes. In this perspective, we present exemplars across various health areas that have been impacted by real-world data and RWE, and we provide insights into further opportunities afforded by RWE. By deploying robust methodologies and transparently reporting caveats and limitations, real-world data accessed via secure data environments can support proactive healthcare management and accelerate access to novel interventions in England.

Advance Care Planning: A Retrospective Audit in a National Referral Center for Interstitial Lung Diseases

BACKGROUND

Idiopathic and progressive pulmonary fibrosis (IPF/PPF) of known cause are relatively rare lung diseases with a limited survival time after diagnosis. Conscious attention for palliative care is recommended. Optimal care requires collaboration to define goals and preferences for future medical treatment and care with the patient and their families, to inform (or enable) Advance Care Planning (ACP).

OBJECTIVE

To get insight into the frequency of key elements of ACP described after dialogues with patients with IPF/PPF.

METHODS

A retrospective audit included charts of patients with IPF/PPF who died between December 2017 and December 2020. A data extraction model was developed based on a guideline for patient federation and wider literature and finally consisted of fourteen key elements. Subsequently content analysis was performed.

RESULTS

The medical charts of 60 patients showed that an element of ACP was recorded in 57(95%) of cases. No medical chart contained all fourteen key elements of ACP. Most frequently recorded ACP elements were: knowledge of illness, goals of treatment and care and fears and concerns.

CONCLUSION

The lack of structural implementation of ACP in the care for patients with interstitial lung disease, results in only some elements of ACP being dialogued by health care professionals (HCP). These notes recorded are often superficial and reflect the view of the HCP. Implementation of ACP conversations and structured documentation is needed to gain better insight into the wishes and preferences of the patient.

Experiences with hospital-to-home transitions: perspectives from patients, family members and healthcare professionals. A systematic review and meta-synthesis of qualitative studies

PURPOSE

Multiple studies have explored the needs and experiences of patients, family members, and healthcare professionals regarding hospital-to-home transitions. Our study aimed to identify, critically appraise, and summarize these studies in a qualitative meta-synthesis.

MATERIALS AND METHODS

Medline, CINAHL and Embase were systematically searched to identify eligible articles from inception to June 2024. Qualitative studies were included and critically appraised using the Critical Appraisal Skills Program. Insufficient-quality papers were excluded. We performed a meta-synthesis following (1) open coding by two independent researchers and (2) discussing codes during reflexivity meetings.

RESULTS

Ninety-eight studies were appraised, of which 53 were included. We reached thematic saturation, four themes were constructed: (1) care coordination and continuity, (2) communication, (3) patient and family involvement, and (4) individualized support and information exchange. For patients and families, tailored information and support are prerequisites for a seamless transition and an optimal recovery trajectory after hospital discharge. It is imperative that healthcare professionals communicate effectively within and across care settings to ensure multidisciplinary collaboration and care continuity.

CONCLUSIONS

This study identifies essential elements of optimal transitional care. These findings could be supportive to researchers and healthcare professionals when (re)designing transitional care interventions to ensure care continuity after hospital discharge.

The Impact of Digital Tool Use on Older Caregivers' Burden, Depression and Quality of Life: A Systematic Review and Meta-Analysis

BACKGROUND

Assumption of an informal caregiving role is often circumstantial and unexpected. Older informal caregivers (OICGs), those aged 60 years and above, exhibit impaired coping and considerably poorer psychological and physical health outcomes due to the demanding nature of the caregiving role. Digital caregiving tools were found to be effective in enhancing caregivers' mental health.

AIMS

To synthesize randomized controlled trials related to digital caregiving tools and aids available for OICGs and to study their impact on OICG's key outcomes, including burden, depression, and quality of life (QoL).

METHODS

Literature from 7 electronic databases from January 1, 2006 to April 1, 2024 was reviewed: Medline, PsycINFO, Embase, Cochrane, Scopus, CINAHL, and Web of Science. The protocol for this review is registered in PROSPERO (CRD42023493282).

RESULTS

Eight randomized controlled trials were included for analysis. None of the included trials purposefully recruited or catered to OICGs. There was low quality evidence suggesting that the use of digital tools may slightly reduce caregiver burden (SMD -0.42, CI [-0.66, -0.18]) and depression (MD -2.5, 4.19 lower to 0.82 lower). For QoL, moderate quality evidence suggests that digital tool use will likely result in a slight improvement in QoL (SMD 0.21, CI [-0.18, 0.6]). Within the retrieved literature, complex digital interventions were associated with higher dropout rates in OICGs. There is also a trend of OICGs caring for dependents with neurodegenerative diseases.

LINKING EVIDENCE TO ACTION

This systematic review highlighted the increased uptake and benefits of digital tool use by the OICG population. Nursing research on technology-enabled caregiving innovations should include an in-depth consideration of their target audience's demography, offering simplified, age-friendly features as necessary.

Comorbidities and Severe COVID-19 Outcomes: A Retrospective Analysis of Hospitalized Patients in Three Counties in Romania

The COVID-19 pandemic represents a major global health crisis, with clinical manifestations ranging from asymptomatic infection to fatal outcomes. While all individuals are susceptible, specific populations, particularly those with pre-existing medical conditions, face a heightened risk of severe disease. This study aimed to assess the prevalence of severe COVID-19 among hospitalized patients with comorbidities in the Central Region of Romania, and to analyze the association between these conditions and mortality. We conducted a retrospective cohort study using data from the Corona Forms platform (2020-2022), encompassing hospitalized cases across three Romanian counties. A total of 1458 patients with confirmed SARS-CoV-2 infection and documented comorbidities were included. Demographic characteristics, comorbid conditions, and hospitalization outcomes were analyzed. The overall mortality rate among comorbid patients was 89.3%. Renal, neurologic, hepatic disease, cardiovascular conditions, obesity, type 2 diabetes mellitus, and cerebrovascular accidents are significant risk factors for death outcomes in the SARS-CoV-2-infected study population. The strength of their association varies, with odds ratios ranging from 25.32 to 1. The findings underscore the critical impact of comorbidities on COVID-19 severity and mortality among the Central Romanian population, emphasizing the necessity of targeted clinical interventions and public health strategies to protect high-risk populations.

Analysis of chronic disease comorbidity patterns in middle-aged and elderly smokers in China: The China Health and Retirement Longitudinal Study

BACKGROUND

China has the largest tobacco consumer population in the world, and with the increasing severity of aging, the health issues caused by smoking continue to draw attention. This study aims to explore the current state of chronic disease comorbidity under different smoking patterns, providing a foundation for the formulation of public health policies.

METHODS

A total of 10771 participants older than 45 were included from CHARLS collected in 2020 after screening. The research variables were extracted and processed using Stata 18.0 software, followed by data filtering and organization in Excel. Through chi-square tests and multinomial logistic regression analysis, the study explored the influencing factors of comorbidity patterns under different smoking statuses.

RESULTS

The results indicate that within the framework of multiple chronic conditions, 2,254 individuals (20.9%) were relatively healthy, while 79.1% had one or more chronic conditions: 3,656 in the simple chronic disease group (33.9%), 3,998 in the minor complex chronic disease group (37.1%), and 863 in the major complex chronic disease group (8.0%). The severity of comorbidity patterns was significantly associated with age, alcohol consumption, hospitalization in the past year, outpatient visits in the past month, insufficient sleep, and poor cognitive function across different smoking statuses. Additionally, living in urban areas and having depression were linked to higher comorbidity severity among non-smokers. Among smokers, being female and having low life satisfaction were independent risk factors for comorbidity patterns. In the group of former smokers, intense physical activity was associated with an increased risk of severe comorbidity patterns.

CONCLUSION

In response, it is recommended to strengthen public health strategies and interventions related to chronic disease comorbidity among smokers.