Multimorbidity and long-term disability and physical functioning decline in middle-aged and older Americans: an observational study

The impact of perceived social support on chronic disease self-management among older inpatients in China: The chain-mediating roles of psychological resilience and health empowerment

BACKGROUND

Chronic disease self-management is a critical concern in public health, in which perceived social support plays an important role. However, the underlying pathways and mechanisms linking perceived social support to chronic disease self-management remained unclear. This study investigated whether psychological resilience and health empowerment mediated the relationship between perceived social support and the effectiveness of chronic disease self-management.

METHODS

A total of 368 older inpatients with chronic non-communicable diseases were recruited from three grade-A tertiary hospitals in Changsha City, China, using a convenience sampling method between January and June 2023. Data were collected using the General Information Questionnaire, the Chronic Disease Self-Management Scale, the Perceived Social Support Scale, the Connor-Davidson Resilience Scale, and the Health Empowerment Scale. Descriptive demographic analysis and Pearson correlation analysis were conducted using SPSS 26.0, and model 6 in the macro program Process 4.1 was employed to test the chain mediation effect.

RESULTS

Most older inpatients were aged 60-69 years (52.2%), followed by those aged 70-79 years (30.7%). Regression analysis revealed that perceived social support, psychological resilience, and health empowerment collectively explained 45.7% of the variance in chronic disease self-management. Mediation analysis demonstrated that perceived social support not only had a direct positive impact on chronic disease self-management (effect = 0.141, 95% CI: LL = 0.041, UL = 0.241), but also indirectly affected chronic disease self-management through three significant mediating pathways: the independent mediating effect of psychological resilience (effect = 0.102, 95% CI: LL = 0.061, UL = 0.155), the independent mediating effect of health empowerment (effect = 0.042, 95% CI: LL = 0.010, UL = 0.080), and the chain mediating effect between psychological resilience and health empowerment (effect = 0.024, 95% CI: LL = 0.006, UL = 0.047).

CONCLUSION

Perceived social support influenced chronic disease self-management directly and indirectly through psychological resilience and health empowerment. These findings offered practical guidance for developing more effective intervention strategies aimed at improving chronic disease self-management among older inpatients.

Analysis of drug patterns and drug-drug-interactions: associations with physical performance in middle-aged military personnel undergoing rehabilitation- a retrospective cohort study

BACKGROUND

Comprehensive medication regimens increase the risk of potential drug-drug interactions, adversely affecting health outcomes regardless of age. This risk is particularly pertinent in the context of medical vocational rehabilitation for middle-aged patients, who aim at facilitating rapid reintegration into employment. Identifying and addressing unfavourable drug regimens may substantially contribute to the effectiveness of interdisciplinary therapeutic interventions.

METHODS

The retrospective cohort study was conducted among middle-aged soldiers diagnosed with post-traumatic stress disorder and at least one physical impairment and long-term medication intake. Patient records were analysed to investigate the nature of the medication such as the number of drugs and distribution according to the anatomical therapeutic code classification and drug-drug interactions in relation to bicycle ergometry performance.

RESULTS

A substantial majority (73.2%) of all patients enrolled were prescribed an average of 3.0 (± 2.0) long-term medications per person. All patients received treatments containing ATC N drugs, which exert antidepressant properties. On average, each patient encountered the possible risk of 1.7 (± 1.3) drug interactions. Patients administered at least two ATC N drugs exhibited reduced maximum performance compared to controls. Conversely, patients receiving at least two drugs, wherein only one drug classified as ATC N, did not demonstrate significant performance differences from the control group. Notably, treatments incorporating selective monoamine reuptake inhibitors significantly reduced maximum performance relative to controls. The risk for potential drug-drug interactions, particularly those leading to QT interval prolongation, accounted for 47.5% of interactions involving ATC N drugs. Patients exclusively exposed to potential QT-prolonging interactions exhibited significantly reduced maximum performance compared to controls as well as patients who experienced different potential interactions.

CONCLUSION

Potential drug-drug interactions and disadvantageous drug combinations were prevalent among middle-aged adults with psychiatric disorders and may hinder a positive prognosis for physical fitness. The findings of this study underscore the importance of personalized medication management and continuous monitoring to mitigate negative impacts. Clinicians should diligently review patients' medication records and adjust therapies accordingly to prevent adverse drug reactions. Proactive strategies, such as regular medication reviews and drug-drug interaction screening tools, may be essential for optimizing therapeutic efficacy and maintaining physical performance.

Reduced functional independence and multimorbidity increases the risk of severe infection among older patients with Omicron: a multicenter retrospective cohort study

BACKGROUND

Multimorbidity and physical function in older adults have been identified as associated with coronavirus disease 2019 (COVID-19) outcomes. This study aimed to investigate whether multimorbidity affects the association of impaired functional independence (FI) with critical COVID-19 among older inpatients during the peak of Omicron infection in China.

METHODS

This is a multicentre, retrospective cohort study in northeastern China. Patients aged ≥ 60 years, who were diagnosed with COVID-19 at the time of admission or during hospitalisation. The Barthel index was used to assess FI. Patients were classified into independent, mildly dependent, moderately dependent, and severely dependent groups. Disease severity was classified as critical, severe, and non-severe and combined into severe or critical and non-severe. Binary logistic regression analysis was used to investigate any correlation between FI and disease severity. Patients were further stratified by presence or absence of multimorbidity.

FINDINGS

In this study, of 1598 patients, 530 (33.17%) developed severe or critical infections during the entire hospital stay. Patients with severe dependency had 7.39 times (95% CI: [4.60, 12.15]) higher risk of serious or critical infections than those without dependency. An interaction was noted between reduced FI and multimorbidity (p for interaction < 0.001). Compared to non-multimorbid patients (OR = 3.71, 95% CI: [1.58, 9.16]), multimorbid patients (OR = 10.04, 95% CI: [5.63, 18.57]) had a more pronounced risk of severe or critical infection.

CONCLUSIONS

Our results provide further scientific evidence on the association between FI, multimorbidity, and disease severity in older COVID-19 patients, contributing to future health decision-making for COVID-19 and other infectious diseases.

Latent profile and determinants of self-management behaviors among older adult patients with chronic diseases: a cross-sectional study

Objective

To explore latent profiles of self-management behaviors in older adult patients with chronic diseases and identify the factors that influence different profiles, guiding targeted interventions.

Methods

This study used convenience sampling to recruit 536 older adult patients with chronic diseases from three tertiary hospitals in Anhui Province between October 2023 and May 2024. Data were collected using a general information questionnaire, the age-adjusted Charlson Comorbidity Index (aCCI), the Chronic Disease Self-Management Behavior Scale, the Chronic Disease Management Self-Efficacy Scale, the Psychological Status Scale, the Digital Health Literacy Scale, and the Social Support Scale. Latent profile analysis was conducted using Mplus 8.3, and univariate and multivariate logistic regression analyses were performed using SPSS 26.0.

Results

Three profiles of self-management behaviors emerged: "Low Self-Management" (50.2%), "High Exercise and Cognitive Management" (8.6%), and "Moderate Management with Enhanced Communication" (41.2%). Multivariate logistic regression revealed that residence, aCCI, number of digital devices used, perceived usefulness of digital health information, digital health literacy, social support, chronic disease management self-efficacy, and psychological status were significant factors affecting self-management profiles (all p < 0.05).

Conclusion

Self-management behaviors in older adult patients with chronic diseases were generally low, with substantial heterogeneity across profiles. Healthcare providers should tailor interventions based on the characteristics of each group to enhance self-management in digital health contexts.

Challenges and improvement strategies in the hospitalization of chronic multimorbid patients

BACKGROUND

Addressing the growing challenge of hospitalizing chronic multimorbid patients, this study examines the strain these conditions impose on healthcare systems at a local level, focusing on a pilot program. Chronic diseases and complex patients require comprehensive management strategies to reduce healthcare burdens and improve patient outcomes. If proven effective, this pilot model has the potential to be replicated in other healthcare settings to enhance the management of chronic multimorbid patients.

AIM

To evaluate the effectiveness of the high complexity unit (HCU) in managing chronic multimorbid patients through a multidisciplinary care model and to compare it with standard hospital care.

METHODS

The study employed a descriptive longitudinal approach, analyzing data from the Basic Minimum Data Set (BMDS) to compare hospitalization variables among the HCU, the Internal Medicine Service, and other services at Antequera Hospital throughout 2022. The HCU, designed for patients with complex chronic conditions, integrates a patient-centered model emphasizing multidisciplinary care and continuity post-discharge.

RESULTS

The study employed a descriptive longitudinal approach, analyzing data from the BMDS to compare hospitalization variables among the HCU, the Internal Medicine Service, and other services at Antequera Hospital throughout 2022. The HCU, designed for patients with complex chronic conditions, integrates a patient-centered model emphasizing multidisciplinary care and continuity post-discharge.

CONCLUSION

This study demonstrates the effectiveness of the HCU in managing patients with complex chronic diseases through a multidisciplinary approach. The coordinated care provided by the HCU results in improved patient outcomes, reduced unnecessary hospitalizations, and better management of patient complexity. The superiority of the HCU compared to standard care is evident in key outcomes such as fewer readmissions and higher patient satisfaction, reinforcing its value as a model of care to be replicated.

The Functional Profile, Depressive Symptomatology, and Quality of Life of Older People in the Central Alentejo Region: A Cross-Sectional Study

Background: Europe's aging population presents challenges such as a shrinking labor force, pressure on health services, and increased demand for long-term care. This study assesses the functional profile, depressive symptoms, and quality of life of older adults in the Central Alentejo region of Portugal. Methods: A cross-sectional, descriptive study was conducted with a convenience sample of 868 older adults in Portuguese long-term care facilities across the Évora district. A structured questionnaire collected sociodemographic data, elderly nursing core set patient information, a health questionnaire with nine responses, and WHO Quality of Life Assessment (short version) scores. Results: Nearly half of the participants needed assistance with care. Women (OR = 1.46) and those with cognitive impairment (OR = 10.83) had higher impaired functionality, while education (OR = 0.52) and being overweight (OR = 0.52) were inversely related to functional dependence. Quality of life scores ranged from 56.4 (physical) to 66.6 (environmental). Moderate depressive symptoms were found in 17.1% of participants, with 9% having moderately severe to severe symptoms. Higher dependence doubled the likelihood of depressive symptoms (OR = 2.18). Discussion and Conclusions: High rates of depression and functional dependence correlate with a low perception of quality of life, highlighting the need for research to promote and protect the health of older adults.

Recommendations and quality of multimorbidity guidelines: A systematic review

BACKGROUND

As the population is aging, multimorbidity has become an increasingly important global health challenge. Clinical practice guidelines are essential references to guide daily practice for health care providers. This systematic review aims to assess whether existing multimorbidity guidelines adhered to the principles outlined in a previously developed framework for multimorbidity management recommendations, Ariadne, and evaluate their methodological and reporting quality.

METHODS

We systematically searched six literature databases and nine guideline platforms from their inception until September 30, 2024. We included guidelines and guideline-like documents on multimorbidity and polypharmacy. Language was limited to English and Chinese. We extracted data related to basic information and guideline development methodology, and categorized guideline recommendations based on the Ariadne framework. We used the Appraisal of Guidelines, Research and Evaluation II (AGREE II) instrument and Reporting Items for practice Guidelines in HealThcare (RIGHT) checklist to evaluate the methodological and reporting quality of the guidelines, respectively.

RESULT

Our systematic review identified 20 eligible guidelines, of which 10 focused on multimorbidity, eight on polypharmacy, and two covered both topics. The mean overall AGREE II score was 27.9 % and the mean compliance rate to the RIGHT reporting checklist 35.1 %. Individualized management was the most frequently addressed of the five steps of the Ariadne framework (n=18 guidelines, 90.0 %), followed by interaction assessment (n=17, 85.0 %).

CONCLUSION

The methodological and reporting quality of multimorbidity guidelines were suboptimal. The recommendations of these guidelines covered primarily the management process of multimorbid patients. Future guidelines should pay more attention to the scientific quality of the development methodology and the feasibility of implementing the guidelines in practice.

FUNDING

Research Unit of Evidence-Based Evaluation and Guidelines (2021RU017), Chinese Academy of Medical Sciences, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China.

The prevalence of disability in older adults with multimorbidity: a meta-analysis

BACKGROUND

Disability is typically correlated with lower quality of life and decreased capacity for self-care. It has been demonstrated that multimorbidity is closely linked to a variety of unfavorable events, such as disability. Researchers are still figuring out how and to what extent co-morbidities impact disability, though. In order to fill up this gap, this study examines the prevalence and contributing variables of disability in older patients who have multimorbidity.

METHODS

We conducted a systematic search of Pubmed, Cochrane Library, Web of Science, Embase, and CINAL databases for articles from their inception until September 2023. We selected co-morbid older adults aged > 60 years and used the ADL scale or any scale that assesses disability as an assessment tool. We excluded literature that did not meet the criteria, and literature that could not be included in the data we needed. We extracted data from the included literature and calculated synthetic prevalence rates, ORs, and 95% confidence intervals.

RESULTS

A total of 32 papers (71,135 older adults) were included in the study. The prevalence of disability among older patients with multimorbidity was around 34.9% (95% CI = 25.8-43.9%). Subgroup analysis showed higher rates of disability among comorbidities who were older, female, unmarried, and long-term users of health services. And the incidence of disability increased each year. Meanwhile, the regions of the United States, China, and Spain showed higher rates of disability.

CONCLUSIONS

Disability rates in older patients with multimorbidity are higher, thus it's critical to focus on risk factors while fully accounting for regional variances.

Physical activity dynamically moderates the impact of multimorbidity on the trajectory of healthy aging over sixteen years

BACKGROUND

Research examining the healthy aging trajectory of retired older adults with multimorbidity is limited, leaving uncertainties regarding the optimal physical activity (PA) intensity and frequency necessary to sustain healthy aging during retirement.

METHODS

Our study investigated the moderating effects of PA on the healthy aging trajectories of retired older adults living with multimorbidity in the United States (US). We utilized data from 1,238 retired individuals aged 50 to 102 who contributed 11,142 observations over 16 years from the Health and Retirement Study (HRS). We employed mixed effects modeling to assess the impact of various classes of multimorbidity on this group and examine how different PA, PA intensities, and PA frequencies influence the disability, physical, and cognitive functioning domains of healthy aging.

RESULTS

The results reveal that while outcomes differed significantly, retired older adults in the US attained healthy aging at baseline. However, their ability to maintain healthy aging declined over time, with multimorbidity, especially musculoskeletal and neurological conditions, accelerating this decline. Fortunately, PA, especially light to moderate intensities, is associated with improving healthy aging and moderating the impact of multimorbidity on the disability and cognitive functioning domains of healthy aging. However, the specific moderating effects of PA depend on its frequency, intensity, and chronic conditions.

CONCLUSIONS

The significant variability in healthy aging attainment among retired older adults underlies the need to consider these differences when addressing healthy aging issues in the US. Accounting for these variations would aid in evaluating the potential impact of future interventions and contribute to achieving health equity. Fortunately, our dynamic findings facilitate this objective by identifying specific frequencies and intensities of PA tailored to different aspects of multimorbidity and healthy aging. This highlights PA, especially light-to-moderate intensity, as an essential, cost-effective, and amenable strategy for alleviating the impact of multimorbidity on healthy aging.

The association between HIV infection, disability and lifestyle activity among middle-aged and older adults: an analytical cross-sectional study in Ivory Coast (the VIRAGE study)

INTRODUCTION

People living with HIV (PLWH) live longer and face new health challenges resulting from the confluence of chronic HIV infection and the natural effect of aging and comorbidities. However, there is a dearth of information on the long-term impact of HIV infection on the health and wellbeing of PLWH in sub-Saharan Africa. This research aimed to fill this gap by reporting on physical, functional and social outcomes among PLWH treated at a referral center in Abidjan, Ivory Coast, and comparing them with those of a control group.

METHODS

Body composition, functional capacity, sarcopenia, limitations in daily activities and social participation were assessed among 300 PLWH (aged ≥ 30 years) and 200 uninfected adults of similar age and sex. The associations between these outcomes and participants' socioeconomic characteristics, HIV history and physical activity level were assessed using generalized additive models adjusted for age and sex.

RESULTS

The median age was 51 years, and the median antiretroviral therapy duration was 15 years. Compared to controls, PLWH reported higher levels of physical activity (p < 0.0001). They had a lower muscle index (adjusted p < 0.0001) and grip strength (adjusted p < 0.0001) but achieved similar performance on the 6-min walk test (6MWT, p = 0.2). Among PLWH, physical activity level was positively associated with better performance in the 6MWT (p = 0.006) and greater hand grip strength (p = 0.04). The difference in physical performance according to the level of physical activity appeared mainly after the age of 60. PLWH reported similar rates of activity limitations (p = 0.8), lower depression levels and greater scores for social functioning (p = 0.02).

CONCLUSION

In this study, PLWH achieved high levels of physical activity, which may explain why they maintained good physical performance and social functioning despite having a higher risk of sarcopenia. These results have important implications for resource-limited health systems and show avenues for chronic care models.

TRIAL REGISTRATION

This study was registered on the ClinicalTrials.gov website (NCT05199831, first registration the 20/01/2022).

Multiple Long-Term Conditions and Disability are Independently Associated with Higher Risk of Fall Among Community Adults: a Cross-Sectional Study

Background

Previous studies have suggested an association between falls and the presence of Multiple Long-Term Conditions (MLTC) or disabilities. However, there is limited understanding of how these factors independently or collectively contribute to the risk of falls and fear of falling among community-dwelling adults.

Objective

This study examined the independent association between MLTC and the presence of disability with the risk of falls among community adults.

Methods

A cross-sectional study included 324 adults (age ≥ 50). Demographic and clinical data included age, sex, body mass index (BMI), MLTC (≥ two chronic diseases) risk of fall (ie, history of fall in the previous 12-months, number of falls, and recurrent falls). The Barthel Index and Falls Efficacy Scale-International (FES-I) were used to assess disability and fear of fall, respectively.

Results

MLTC (Odds Ratio (OR) 2.50, 95% Confidence Interval (CI) [1.26, 4.95], p=0.009), and disability (OR 1.71, 95% CI [1.04, 2.79], p = 0.034) were independently associated with history of falls. MLTC (Incidence Rate Ratio (IRR) 2.87, 95% CI [1.93, 4.29], p < 0.001) and disability (IRR 1.86 95% CI [1.46, 2.36], p < 0.001) were independently associated with an increased number of falls. MLTC (OR 4.50, 95% CI [1.78, 11.36], p = 0.001) and disability (OR 2.82, 95% CI [1.58, 5.05], p < 0.001) were independently associated with recurrent falls. MLTC (B = 6.45, p < 0.001) and disability (B = 3.05, p = 0.025) were independently associated with increased fear of falling.

Conclusion

This study indicated that both MLTC and disability are independently associated with falls, number of falls and fear of falling in this population.

Effects of the COVID-19 associated United Kingdom lockdown on physical activity in older adults at high risk of cardiovascular disease: a mixed methods perspective from the MedEx-UK multicenter trial

Introduction

Physical inactivity and sedentary behaviour are linked to increased risk of cardiovascular disease, infections and dementia, as well as placing a significant economic burden on healthcare systems. The implementation of COVID-19 pandemic lockdown measures aimed at reducing virus transmission posed challenges to the opportunity to be physically active. This study investigates how the first UK COVID-19 lockdown affected objectively measured physical activity in older adults at higher risk of cardiovascular disease.

Methods

We studied 48 individuals aged 55-74 years (81.3% female) with self-reported PA levels < 90 min/week and a QRISK2 score ≥ 10 (indicative of a ≥ 10% risk of a major cardiovascular event in the next 10 years) without mild cognitive impairment or dementia. Physical activity data was collected using objective wrist-based activity monitors and analysed across three time periods, usual activity (pre-pandemic), the precautionary phase when the UK began advising on limiting social contact and finally during the first UK lockdown period was collected (27 January 2020 and 07 June 2020). Data was analysed using linear mixed effects model was used to investigate PA levels over the measured 12-week period. Effects of BMI, age, deprivation score and baseline PA levels on PA across the three measurement periods were also examined. Focus-group and individual interviews were conducted, and data were thematically analysed.

Results

Average daily step count (-34% lower, p < 0.001) and active energy expenditure (-26% lower, p < 0.001) were significantly lower during the precautionary period compared with the usual activity period. Physical activity remained low during the UK lockdown period. Participants with a lower BMI engaged in significantly more (+45% higher daily steps p < 0.001) physical activity and those over 70 years old were more physically active than those under 70 years across the 12-week period (+23% higher daily steps p < 0.007). The risk of COVID-19 infection and restrictions because of lockdown measures meant some individuals had to find alternative methods to staying physical active. Participants described a lack of access to facilities and concerns over health related to COVID-19 as barriers to engaging in physical activity during lockdown. For some, this resulted in a shift towards less structured activities such as gardening or going for a walk.

Discussion

The data presented shows that lockdown measures during the COVID-19 pandemic significantly reduced physical activity among older individuals at risk of cardiovascular disease, particularly those with a higher body mass index. To support this population group in staying active during future lockdowns, a multifaceted strategy is needed, emphasizing psychosocial benefits and home-based physical activity. The MedEx-UK study was pre-registered with ClinicalTrials.gov (NCT03673722).

Assessing the modifiable and non-modifiable risk factors associated with multimorbidity in reproductive aged women in India

BACKGROUND

Reproductive span is the foundation of every woman's health in later life. India is currently facing a growing burden of multiple morbidities among the women in their reproductive age group which may further increase over the coming decades. The purpose of the present study aimed to identify different modifiable and non-modifiable risk factors affecting multimorbidity among the women in reproductive age group in Indian context.

METHODS

Secondary data were obtained from the Demography and Health Survey (DHS), conducted in India during 2019-2021. A total of 671,967 women aged 15-49 years were selected for this present study. Descriptive, association studies and multinominal logistic regression analyses were performed to accomplish the objectives.

RESULTS

Currently, 6.3% of total study participant's reproductive age group women suffered from multimorbidity in India. Never consuming protein, fruits, vegetables and milk increase the chances of developing multimorbidity. Consumption of fried foods, aerated drinks and addiction towards tobacco and alcohol also has a greater influence on the prevalence of multimorbidity. The prevalence of multimorbidity is sharply increased with increasing age and Body Mass Index (BMI). Regionally, the prevalence of multimorbidity was found more among the women hailed from eastern and north-eastern India.

CONCLUSION

To reduce the risk of developing multimorbidity, targeted interventions are needed in the form of educating every woman concerning the importance of having minimum health-related knowledge, maintaining healthy lifestyle, weight management and having proper and balanced diet.

Associations between vision impairment and multimorbidity among older Chinese adults: results from the China health and retirement longitudinal study

BACKGROUND

Although several studies have reported the relationship between vision impairment (VI) and multimorbidity in high-income countries, this relationship has not been reported in low- and middle-income countries. This study aimed to explore the relationship between VI with multimorbidity and chronic conditions among the elderly Chinese population.

METHODS

The cross-sectional analysis was applied to data from the China Health and Retirement Longitudinal Study (CHARLS) in 2018. A total of 8,108 participants ≥ 60 years old were included, and 15 chronic conditions were used in this study. Logistic regression analysis was used to analyze the relationship between VI with multimorbidity and chronic conditions.

RESULTS

The prevalence of 15 chronic conditions and multimorbidity was higher among the elderly with VI than those without VI. After adjusting for demographic and socioeconomic confounders, 10 chronic conditions were associated with VI (all P < 0.05). Furthermore, positive association was observed between VI and one (odds ratio [OR]: 1.52; 95% confidence intervals [95%CI]: 1.16-2.00; P = 0.002), two (OR: 2.09; 95%CI: 1.61-2.71; P < 0.001), three (OR: 2.87; 95%CI: 2.22-3.72; P < 0.001), four (OR: 3.60; 95%CI: 2.77-4.69; P < 0.001), and five or more (OR: 5.53; 95%CI: 4.32-7.09; P < 0.001) chronic conditions, and the association increased as the number of chronic conditions (P for trend < 0.001). Sensitivity analysis stratified by gender, education, smoking status, and annual per capita household expenditure still found VI to be positively associated with multimorbidity.

CONCLUSIONS

For patients older than 60 years, VI was independently associated with multimorbidity and various chronic conditions. This result has important implications for healthcare resource plans and clinical practice, for example, increased diabetes and kidney function screening for patients with VI.

A prospective cohort study of the impact of chronic disease on fall injuries in middle-aged and older adults

This cohort study investigated the impact of chronic diseases on fall risk in middle-aged and older individuals, offering insights for fall prevention strategies. Analysing data from 4,670 participants aged 40+ years, we used a Cox proportional risk model to assess chronic disease types, numbers, and interactions with other factors on fall injury risk across age groups. Results showed that middle-aged adults with respiratory diseases had a 26% increased fall risk (hazard ratio [HR] = 1.26, 95% confidence interval [CI]: 1.05-1.48), and a linear dose-response relationship was observed between chronic disease number and fall risk (p < 0.001). The study also examined interaction effects of chronic diseases with gender, disability, and fall injury history. Female middle-aged and older adults with chronic diseases had a 67% higher fall risk than their male counterparts without chronic diseases (HR = 1.67, 95% CI: 1.36-1.88). In conclusion, chronically ill middle-aged and older adults have a higher fall risk, with high-risk groups including women, those with chronic diseases, and individuals with fall injury history. Fall prevention efforts should target middle-aged adults as well.