What is the impact of multimorbidity on the risk of hospitalisation in older adults? A systematic review study protocol

The Impact of Multimorbidity on Labor Force Participation Among the Middle-Aged and Older Working Population in the United States

OBJECTIVES

Multimorbidity, known as multiple chronic conditions (MCC), is the coexistence of two or more chronic health conditions (CHC). The near-retirement-age population with MCC is more likely to experience discontinued labor force participation (LFP). Our objective was to evaluate the impact of MCC on LFP among adults aged 50-64 and to explore heterogeneous effects between self-employed and non-self-employed workers.

METHODS

We constructed our sample using the Health and Retirement Study (HRS) from 1996 to 2018. We adopted an individual fixed-effect (F.E.) model and propensity score matching (PSM) to measure the impact of MCC on the probability of being employed and changes in annual work hours.

RESULTS

50.5% of respondents have MCC. Individuals with MCC exhibit a predicted probability of being employed that is 9.3 percentage points (p < .01, 95% confidence interval [95% CI]: -0.109, -0.078) lower than those without MCC. Compared with non-CHC, MCC significantly reduced annual working hours by 6.1% (p < .01, 95% CI: -0.091, -0.036) in the F.E. model and by 4.9% (p < .01, 95% CI: -0.064, -0.033) in PSM estimation. The effect is more pronounced for the self-employed with MCC, who have 13.0% (p < .05, 95% CI: -0.233, -0.026) fewer annual work hours than non-CHC based on the FE model and 13.4% (p < .01, 95% CI: -0.197, -0.070) in PSM estimation.

DISCUSSION

MCC significantly reduces LFP compared with non-MCC. MCC has a heterogeneous impact across occupational types. It is important to support the near-retirement-age working population with multimorbidity through effective clinical interventions and workplace wellness policies to help manage health conditions and remain active in the labor market.

Aging With Grace: The Quest for Integrated, Compassionate Care for Older Adults

Introduction

This Practice Update discusses the potential for implementation of the 4M model for care of older adults in Israel, to complement the medical-centric model that exists today. The older adult population in Israel is increasing. However, efficient and sufficient care that takes patient's wishes into consideration is lacking.

Purpose

Care of older adults, particularly palliative patients, is complex and requires multidisciplinary efforts. There are numerous challenges to caring for older adults. These include fragmentation of care, unclear boundaries between palliative and geriatric care, and the preservation of patient autonomy, indicating a need to adopt new care frameworks.

Conclusion

The authors suggest implementing the 4M model as a new care framework in addition to the current medical-centric model. This framework considers important care aspects during discussions of care: what matters to the patient, medication, mentation, and mobility. Implementation of this model can promote better-integrated care, thus improving the quality of life for older adults.

Impact of type, intensity, frequency, duration and volume of physical activity on dementia and mild cognitive impairment in older adults: protocol for a systematic review and meta-analysis

INTRODUCTION

Worldwide, the prevalence of degenerative diseases such as dementia and mild cognitive impairment (MCI) is increasing with population ageing and increasing life expectancy. Both conditions share modifiable risk factors. Physical inactivity is one of these modifiable risk factors, and research points to the protective effect of physical activity on the incidence of dementia and MCI. However, this association tends to change according to type, intensity, frequency, duration and volume of physical activity. Furthermore, it remains unclear which of these characteristics offers the greatest protective effect. Therefore, this study aims to evaluate the impacts of different types, intensities, frequencies, duration and volume of physical activity on dementia and cognitive decline in older adults.

METHODS AND ANALYSIS

The search will be carried out from October 2023, using the following databases: PubMed, Embase, Scopus, CINAHL and Web of Science. Cohort studies with a follow-up time of 1 year or longer that have investigated the incidence of dementia and/or MCI in older adults exposed to physical activity will be included. There will be no limitations on the date of publication of the studies. Studies published in English, Spanish or Portuguese will be analysed. Two researchers will independently screen the articles and extract the data. Any discrepancies will be resolved by a third reviewer. Association measures will be quantified, including OR, HR, relative risk and incidence ratio, with a 95% CI. If the data allow, a meta-analysis will be performed. To assess the methodological quality of the selected studies, the Grading of Recommendations, Assessment, Development and Evaluations instrument, and the Downs and Black instrument to assess the risk of bias, will be used.

ETHICS AND DISSEMINATION

Ethical approval is not required. The results will be submitted for publication in a peer-reviewed journal.

PROSPERO REGISTRATION NUMBER

CRD42023400411.

Association between multimorbidity and hospitalization in older adults: systematic review and meta-analysis

Background

Multimorbidity is defined as the presence of multiple chronic conditions in the same individual. Multimorbidity is more prevalent in older adults and can lead to several adverse health outcomes.

Methods

We systematically reviewed evidence from observational studies to verify the association between multimorbidity and hospitalization in older adults. Furthermore, we also aimed to identify whether it changes according to gender, advanced age, institutionalization, and wealth of the country of residence. We searched the PubMed, Embase and Scopus databases from December 2020 to April 2021. The analysed outcomes were as follows: hospitalization, length of stay and hospital readmission.

Results

Of the 6,948 studies identified in the databases, 33 were included in this review. From the meta-analysis results, it was found that multimorbidity, regardless of the country’s wealth, was linked to hospitalization in older adults (OR = 2.52, CI 95% = 1.87–3.38). Both definitions of multimorbidity, ≥2 (OR = 2.35, 95% CI = 1.34–4.12) and ≥3 morbidities (OR = 2.52, 95% CI = 1.87–3.38), were associated with hospitalization. Regardless of gender, multimorbidity was associated with hospitalization (OR = 1.98, 95% CI = 1.67–2.34) and with readmission (OR = 1.07, 95% CI = 1.04–1.09). However, it was not possible to verify the association between multimorbidity and length of stay.

Conclusions

Multimorbidity was linked to a higher hospitalization risk, and this risk was not affected by the country’s wealth and patient’s gender. Multimorbidity was also linked to a higher hospital readmission rate in older adults. PROSPERO Registration (Registration number: CRD42021229328).